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Mohebbi A, Motamedaria P, Naderi M, Hassanpour M, Salavatiha Z, Makouei M, Ataei-Pirkooh A. Understanding Creutzfeldt-Jakob disease in Iran: a systematic review of case reports. J Int Med Res 2024; 52:3000605241247706. [PMID: 38717041 PMCID: PMC11080748 DOI: 10.1177/03000605241247706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/31/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To systematically review the reported cases of Creutzfeldt-Jakob disease (CJD) in Iran. METHODS A comprehensive literature review of CJD cases in Iran was undertaken using the PubMed®, Scopus® and Google Scholar databases. In addition, the Iranian database MagIran was searched for Persian language reports. Case selection used the following criteria: (i) patients of Iranian origin; (ii) publication in peer-reviewed journals or reputable medical databases; (iii) a definitive diagnosis of CJD based on established diagnostic criteria. RESULTS Thirteen cases from twelve reports were included in this systematic review. The majority of the cases were female (11 of 13; 84.6%). The mean ± SD age of patients at hospital admission was 59.38 ± 7.44 years. The findings of the case review suggested that the prevalence of CJD in Iran is not fully established. CJD may be misdiagnosed alongside other clinical signs. The most prevalent early indications of the disease were psychiatric and neurological in nature. A considerable delay in diagnosis was observed in some cases and there was a shortage of brain autopsy records. CONCLUSION Efforts to improve diagnostic capabilities, promote awareness and establish monitoring systems are necessary for managing the challenges of providing an early diagnosis of CJD in Iran.
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Affiliation(s)
- Alireza Mohebbi
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parastoo Motamedaria
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Malihe Naderi
- Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Mina Hassanpour
- Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Salavatiha
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Makouei
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Angila Ataei-Pirkooh
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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2
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Crestini A, Santilli F, Martellucci S, Carbone E, Sorice M, Piscopo P, Mattei V. Prions and Neurodegenerative Diseases: A Focus on Alzheimer's Disease. J Alzheimers Dis 2021; 85:503-518. [PMID: 34864675 DOI: 10.3233/jad-215171] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Specific protein misfolding and aggregation are mechanisms underlying various neurodegenerative diseases such as prion disease and Alzheimer's disease (AD). The misfolded proteins are involved in prions, amyloid-β (Aβ), tau, and α-synuclein disorders; they share common structural, biological, and biochemical characteristics, as well as similar mechanisms of aggregation and self-propagation. Pathological features of AD include the appearance of plaques consisting of deposition of protein Aβ and neurofibrillary tangles formed by the hyperphosphorylated tau protein. Although it is not clear how protein aggregation leads to AD, we are learning that the cellular prion protein (PrPC) plays an important role in the pathogenesis of AD. Herein, we first examined the pathogenesis of prion and AD with a focus on the contribution of PrPC to the development of AD. We analyzed the mechanisms that lead to the formation of a high affinity bond between Aβ oligomers (AβOs) and PrPC. Also, we studied the role of PrPC as an AβO receptor that initiates an AβO-induced signal cascade involving mGluR5, Fyn, Pyk2, and eEF2K linking Aβ and tau pathologies, resulting in the death of neurons in the central nervous system. Finally, we have described how the PrPC-AβOs interaction can be used as a new potential therapeutic target for the treatment of PrPC-dependent AD.
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Affiliation(s)
- Alessio Crestini
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Francesca Santilli
- Biomedicine and Advanced Technologies Rieti Center, "Sabina Universitas", Rieti, Italy.,Department of Experimental Medicine, "Sapienza" University, Rome, Italy
| | - Stefano Martellucci
- Biomedicine and Advanced Technologies Rieti Center, "Sabina Universitas", Rieti, Italy
| | - Elena Carbone
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Maurizio Sorice
- Department of Experimental Medicine, "Sapienza" University, Rome, Italy
| | - Paola Piscopo
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Vincenzo Mattei
- Biomedicine and Advanced Technologies Rieti Center, "Sabina Universitas", Rieti, Italy.,Department of Experimental Medicine, "Sapienza" University, Rome, Italy
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3
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Mattei V, Martellucci S, Pulcini F, Santilli F, Sorice M, Delle Monache S. Regenerative Potential of DPSCs and Revascularization: Direct, Paracrine or Autocrine Effect? Stem Cell Rev Rep 2021; 17:1635-1646. [PMID: 33829353 PMCID: PMC8553678 DOI: 10.1007/s12015-021-10162-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
A new source of mesenchymal stem cells has recently been discovered, the so-called dental pulp derived stem cells (DPSCs) which therefore could represent potentially tools for regenerative medicine. DPSC originate from the neural crest and are physiologically involved in dentin homeostasis; moreover, they contribute to bone remodeling and differentiation into several tissues including cartilage, bone, adipose and nervous tissues. DPSCs have also been shown to influence the angiogenesis process, for example through the release of secretory factors or by differentiating into vascular and/or perivascular cells. Angiogenesis, that has a pivotal role in tissue regeneration and repair, is defined as the formation of new vessels from preexisting vessels and is mediated by mutual and reciprocal interactions between endothelial cells and perivascular cells. It is also known that co-cultures of perivascular and endothelial cells (ECs) can form a vascular network in vitro and also in vivo. Since DPSCs seem to have characteristics similar to pericytes, understanding the possible mechanism of interaction between DPSCs and ECs during neo-angiogenesis is dramatically important for the development of advanced clinical application in the field of regeneration.
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Affiliation(s)
- Vincenzo Mattei
- Biomedicine and Advanced Technologies Rieti Center, Sabina Universitas, 02100, Rieti, Italy
- Department of Experimental Medicine, "Sapienza" University, 00161, Rome, Italy
| | - Stefano Martellucci
- Biomedicine and Advanced Technologies Rieti Center, Sabina Universitas, 02100, Rieti, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Fanny Pulcini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Francesca Santilli
- Biomedicine and Advanced Technologies Rieti Center, Sabina Universitas, 02100, Rieti, Italy
- Department of Experimental Medicine, "Sapienza" University, 00161, Rome, Italy
| | - Maurizio Sorice
- Department of Experimental Medicine, "Sapienza" University, 00161, Rome, Italy
| | - Simona Delle Monache
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
- StemTeCh Group, Chieti, Italy.
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4
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Prion Protein in Stem Cells: A Lipid Raft Component Involved in the Cellular Differentiation Process. Int J Mol Sci 2020; 21:ijms21114168. [PMID: 32545192 PMCID: PMC7312503 DOI: 10.3390/ijms21114168] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
The prion protein (PrP) is an enigmatic molecule with a pleiotropic effect on different cell types; it is localized stably in lipid raft microdomains and it is able to recruit downstream signal transduction pathways by its interaction with various biochemical partners. Since its discovery, this lipid raft component has been involved in several functions, although most of the publications focused on the pathological role of the protein. Recent studies report a key role of cellular prion protein (PrPC) in physiological processes, including cellular differentiation. Indeed, the PrPC, whose expression is modulated according to the cell differentiation degree, appears to be part of the multimolecular signaling pathways of the neuronal differentiation process. In this review, we aim to summarize the main findings that report the link between PrPC and stem cells.
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5
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Martellucci S, Santacroce C, Santilli F, Piccoli L, Delle Monache S, Angelucci A, Misasi R, Sorice M, Mattei V. Cellular and Molecular Mechanisms Mediated by recPrP C Involved in the Neuronal Differentiation Process of Mesenchymal Stem Cells. Int J Mol Sci 2019; 20:E345. [PMID: 30654447 PMCID: PMC6358746 DOI: 10.3390/ijms20020345] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 12/21/2022] Open
Abstract
Human Dental Pulp Stem Cells (hDPSCs) represent a type of adult mesenchymal stem cells that have the ability to differentiate in vitro in several lineages such as odontoblasts, osteoblasts, chondrocytes, adipocytes and neurons. In the current work, we used hDPSCs as the experimental model to study the role of recombinant prion protein 23⁻231 (recPrPC) in the neuronal differentiation process, and in the signal pathway activation of ERK 1/2 and Akt. We demonstrated that recPrPC was able to activate an intracellular signal pathway mediated by extracellular-signal-regulated kinase 1 and 2 (ERK 1/2) and protein kinase B (Akt). Moreover, in order to understand whether endogenous prion protein (PrPC) was necessary to mediate the signaling induced by recPrPC, we silenced PrPC, demonstrating that the presence of endogenous PrPC was essential for ERK 1/2 and Akt phosphorylation. Since endogenous PrPC is a well-known lipid rafts component, we evaluated the role of these structures in the signal pathway induced by recPrPC. Our results suggest that lipid rafts integrity play a key role in recPrPC activity. In fact, lipid rafts inhibitors, such as fumonisin B1 and MβCD, significantly prevented ERK 1/2 and Akt phosphorylation induced by recPrPC. In addition, we investigated the capacity of recPrPC to induce hDPSCs neuronal differentiation process after long-term stimulation through the evaluation of typical neuronal markers expression such as B3-Tubulin, neurofilament-H (NFH) and growth associated protein 43 (GAP43). Accordingly, when we silenced endogenous PrPC, we observed the inhibition of neuronal differentiation induced by recPrPC. The combined data suggest that recPrPC plays a key role in the neuronal differentiation process and in the activation of specific intracellular signal pathways in hDPSCs.
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Affiliation(s)
- Stefano Martellucci
- Laboratory of Experimental Medicine and Environmental Pathology, Rieti University Hub "Sabina Universitas", 02100 Rieti, Italy.
- Department of Experimental Medicine, "Sapienza" University, 00161 Rome, Italy.
| | - Costantino Santacroce
- Laboratory of Experimental Medicine and Environmental Pathology, Rieti University Hub "Sabina Universitas", 02100 Rieti, Italy.
| | - Francesca Santilli
- Laboratory of Experimental Medicine and Environmental Pathology, Rieti University Hub "Sabina Universitas", 02100 Rieti, Italy.
- Department of Experimental Medicine, "Sapienza" University, 00161 Rome, Italy.
| | - Luca Piccoli
- Department of Science Dentistry and Maxillofacial, "Sapienza" University, 00161 Rome, Italy.
| | - Simona Delle Monache
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Adriano Angelucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Roberta Misasi
- Department of Experimental Medicine, "Sapienza" University, 00161 Rome, Italy.
| | - Maurizio Sorice
- Department of Experimental Medicine, "Sapienza" University, 00161 Rome, Italy.
| | - Vincenzo Mattei
- Laboratory of Experimental Medicine and Environmental Pathology, Rieti University Hub "Sabina Universitas", 02100 Rieti, Italy.
- Department of Experimental Medicine, "Sapienza" University, 00161 Rome, Italy.
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6
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Gugjoo MB, Amarpal. Mesenchymal stem cell research in sheep: Current status and future prospects. Small Rumin Res 2018. [DOI: 10.1016/j.smallrumres.2018.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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7
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Martellucci S, Manganelli V, Santacroce C, Santilli F, Piccoli L, Sorice M, Mattei V. Role of Prion protein-EGFR multimolecular complex during neuronal differentiation of human dental pulp-derived stem cells. Prion 2018; 12:117-126. [PMID: 29644924 DOI: 10.1080/19336896.2018.1463797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cellular prion protein (PrPC) is expressed in a wide variety of stem cells in which regulates their self-renewal as well as differentiation potential. In this study we investigated the presence of PrPC in human dental pulp-derived stem cells (hDPSCs) and its role in neuronal differentiation process. We show that hDPSCs expresses early PrPC at low concentration and its expression increases after two weeks of treatment with EGF/bFGF. Then, we analyzed the association of PrPC with gangliosides and EGF receptor (EGF-R) during neuronal differentiation process. PrPC associates constitutively with GM2 in control hDPSCs and with GD3 only after neuronal differentiation. Otherwise, EGF-R associates weakly in control hDPSCs and more markedly after neuronal differentiation. To analyze the functional role of PrPC in the signal pathway mediated by EGF/EGF-R, a siRNA PrP was applied to ablate PrPC and its function. The treatment with siRNA PrP significantly prevented Akt and ERK1/2 phosphorylation induced by EGF. Moreover, siRNA PrP treatment significantly prevented neuronal-specific antigens expression induced by EGF/bFGF, indicating that cellular prion protein is essential for EGF/bFGF-induced hDPSCs differentiation. These results suggest that PrPC interact with EGF-R within lipid rafts, playing a role in the multimolecular signaling complexes involved in hDPSCs neuronal differentiation.
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Affiliation(s)
- Stefano Martellucci
- a Laboratory of Experimental Medicine and Environmental Pathology - Rieti University Hub "Sabina Universitas" , Via Angelo Maria Ricci 35/A, Rieti , Italy.,b Department of Experimental Medicine - "Sapienza" University , Viale Regina Elena 324, Rome , Italy
| | - Valeria Manganelli
- b Department of Experimental Medicine - "Sapienza" University , Viale Regina Elena 324, Rome , Italy
| | - Costantino Santacroce
- a Laboratory of Experimental Medicine and Environmental Pathology - Rieti University Hub "Sabina Universitas" , Via Angelo Maria Ricci 35/A, Rieti , Italy
| | - Francesca Santilli
- a Laboratory of Experimental Medicine and Environmental Pathology - Rieti University Hub "Sabina Universitas" , Via Angelo Maria Ricci 35/A, Rieti , Italy
| | - Luca Piccoli
- c Department of Science Dentistry and Maxillofacial - "Sapienza" University , Viale Regina Elena 287/A, Rome , Italy
| | - Maurizio Sorice
- b Department of Experimental Medicine - "Sapienza" University , Viale Regina Elena 324, Rome , Italy
| | - Vincenzo Mattei
- a Laboratory of Experimental Medicine and Environmental Pathology - Rieti University Hub "Sabina Universitas" , Via Angelo Maria Ricci 35/A, Rieti , Italy.,b Department of Experimental Medicine - "Sapienza" University , Viale Regina Elena 324, Rome , Italy
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8
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Autologous neural progenitor cell transplantation into newborn mice modeling for E200K genetic prion disease delays disease progression. Neurobiol Aging 2018; 65:192-200. [DOI: 10.1016/j.neurobiolaging.2018.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/18/2017] [Accepted: 01/08/2018] [Indexed: 01/04/2023]
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9
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Vella LJ, Coleman B, Hill AF. Generation of Infectious Prions and Detection with the Prion-Infected Cell Assay. Methods Mol Biol 2017; 1658:105-118. [PMID: 28861786 DOI: 10.1007/978-1-4939-7244-9_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Cell lines propagating prions are an efficient and useful means for studying the cellular and molecular mechanisms implicated in prion disease. Utilization of cell-based models has led to the finding that PrPC and PrPSc are released from cells in association with extracellular vesicles known as exosomes. Exosomes have been shown to act as vehicles for infectivity, transferring infectivity between cell lines and providing a mechanism for prion spread between tissues. Here, we describe the methods for generating a prion-propagating cell line with prion-infected brain homogenate, cell lysate, conditioned media, and exosomes and also detection of protease-resistant PrP with the prion-infected cell assay.
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Affiliation(s)
- Laura J Vella
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Bradley Coleman
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, VIC, Australia
| | - Andrew F Hill
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, VIC, Australia. .,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, 3086, Australia.
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10
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Mediano DR, Sanz-Rubio D, Bolea R, Marín B, Vázquez FJ, Remacha AR, López-Pérez Ó, Fernández-Borges N, Castilla J, Zaragoza P, Badiola JJ, Rodellar C, Martín-Burriel I. Characterization of mesenchymal stem cells in sheep naturally infected with scrapie. J Gen Virol 2016; 96:3715-3726. [PMID: 26431976 DOI: 10.1099/jgv.0.000292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stem cells (MSCs) can be infected with prions and have been proposed as in vitro cell-based models for prion replication. In addition, autologous MSCs are of interest for cell therapy in neurodegenerative diseases. To the best of our knowledge, the effect of prion diseases on the characteristics of these cells has never been investigated. Here, we analysed the properties of MSCs obtained from bone marrow (BM-MSCs) and peripheral blood (PB-MSCs) of sheep naturally infected with scrapie — a large mammal model for the study of prion diseases. After three passages of expansion, MSCs derived from scrapie animals displayed similar adipogenic, chondrogenic and osteogenic differentiation ability as cells from healthy controls, although a subtle decrease in the proliferation potential was observed. Exceptionally, mesenchymal markers such as CD29 were significantly upregulated at the transcript level compared with controls. Scrapie MSCs were able to transdifferentiate into neuron-like cells, but displayed lower levels of neurogenic markers at basal conditions, which could limit this potential .The expression levels of cellular prion protein (PrPC) were highly variable between cultures, and no significant differences were observed between control and scrapie-derived MSCs. However, during neurogenic differentiation the expression of PrPC was upregulated in MSCs. This characteristic could be useful for developing in vitro models for prion replication. Despite the infectivity reported for MSCs obtained from scrapie-infected mice and Creutzfeldt–Jakob disease patients, protein misfolding cyclic amplification did not detect PrPSc in BM- or PB-MSCs from scrapie-infected sheep, which limits their use for in vivo diagnosis for scrapie.
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Affiliation(s)
- Diego R Mediano
- Laboratorio de Genética Bioquímica, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - David Sanz-Rubio
- Laboratorio de Genética Bioquímica, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Rosa Bolea
- Centro de Investigación en Encefalopatías y Enfermedades Transmisibles Emergentes, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Belén Marín
- Centro de Investigación en Encefalopatías y Enfermedades Transmisibles Emergentes, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Francisco J Vázquez
- Laboratorio de Genética Bioquímica, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Ana R Remacha
- Laboratorio de Genética Bioquímica, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Óscar López-Pérez
- Laboratorio de Genética Bioquímica, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.,Centro de Investigación en Encefalopatías y Enfermedades Transmisibles Emergentes, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Joaquín Castilla
- CIC bioGUNE, Parque Tecnológico de Bizkaia, Derio, Spain.,IKERBasque, Basque Foundation for Science, Bilbao, Spain
| | - Pilar Zaragoza
- Laboratorio de Genética Bioquímica, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Juan J Badiola
- Centro de Investigación en Encefalopatías y Enfermedades Transmisibles Emergentes, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Clementina Rodellar
- Laboratorio de Genética Bioquímica, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Inmaculada Martín-Burriel
- Centro de Investigación en Encefalopatías y Enfermedades Transmisibles Emergentes, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.,Laboratorio de Genética Bioquímica, Instituto de Investigación Agroalimentaria (IA2), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
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