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Xiong J, Xue WX. The role of vitamin D in the link between physical frailty and cognitive function: A mediation analysis in community-dwelling Chinese older adults. Front Nutr 2022; 9:922673. [PMID: 35958260 PMCID: PMC9359101 DOI: 10.3389/fnut.2022.922673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Physical frailty and cognitive aging have important influences on poor clinical outcomes in older adults. Many studies have investigated the association between frailty and cognitive function, but whether vitamin D mediates the association between frailty and cognitive function is unclear. We explored the mediating role of vitamin D on the cross-sectional association between physical frailty and cognitive function using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Methods We analyzed data from 1944 subjects aged 60 years and older from the 2011 CLHLS cohort. Frailty status was identified by the Osteoporotic Fracture Study (SOF) index. The Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. Linear regression models were used to examine the association between frailty, vitamin D, and cognition, adjusted for a range of covariates. Mediation analyses tested the indirect effects of vitamin D on physical frailty and cognitive function. Result Physical frailty was negatively associated with vitamin D levels and scores on the MMSE, and vitamin D levels were positively associated with scores on the MMSE. Linear regression analysis showed that physical frailty and serum vitamin D concentration were significant predictors of cognitive function. Importantly, mediation analysis showed that serum vitamin D concentration significantly mediated the relationship between physical frailty and cognitive function. Conclusion The association between physical frailty and cognitive function appears to be mediated by vitamin D. Future studies should explore whether serum vitamin D concentrations may mediate the association between physical frailty and cognitive decline and whether this mediating role is moderated by other factors.
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Affiliation(s)
- Jian Xiong
- Department of Rehabilitation, Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
| | - Wen-Xiong Xue
- Department of Rehabilitation, Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
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Rivera-Paredez B, Hidalgo-Bravo A, León-Reyes G, Antuna-Puente B, Flores YN, Salmerón J, Velázquez-Cruz R. Association of GC Variants with Bone Mineral Density and Serum VDBP Concentrations in Mexican Population. Genes (Basel) 2021; 12:genes12081176. [PMID: 34440350 PMCID: PMC8391993 DOI: 10.3390/genes12081176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Vitamin D-binding protein (VDBP) is encoded by the GC gene and is an active participant in the control of bone metabolism. However, the effect of its major variants on VDBP concentration and bone mineral density (BMD) remains unclear. Our aim was to analyze the effect of major GC variants on serum VDBP concentration and BMD. We recruited individuals from the Health Workers Cohort Study, which includes employees of the Mexican Institute of Social Security (IMSS). A total of 1853 adults were included. The single nucleotide polymorphisms (SNPs) rs7041 and rs4588 were genotyped to identify the three best characterized haplotypes of GC. Serum VBDP, 25(OH)D and BMD were also measured. Among women, the G allele of rs7041 was associated with higher VDBP and BMD compared to homozygous TT. The A allele of rs4588 was associated with lower VDBP and BMD compared to CC homozygous. In men, GC variants were only associated with VDBP levels. We did not observe an association between free/bioavailable 25(OH)D and BMD in men and women. Our results support an association of VDBP in bone health. The G and C alleles, from rs7041 and rs4588, respectively, are associated with high concentrations of VDBP and BMD in this sample of Mexican postmenopausal women.
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Affiliation(s)
- Berenice Rivera-Paredez
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico 04510, Mexico; (B.R.-P.); (J.S.)
| | - Alberto Hidalgo-Bravo
- Department of Genetics, National Institute of Rehabilitation (INR), Mexico 014389, Mexico;
| | - Guadalupe León-Reyes
- Genomics of Bone Metabolism Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico 14610, Mexico;
| | - Bárbara Antuna-Puente
- Laboratory of Genomics of Cardiovascular Diseases, National Institute of Genomic Medicine (INMEGEN), Mexico 14610, Mexico;
| | - Yvonne N. Flores
- Epidemiological and Health Services Research Unit, Morelos Delegation, Mexican Institute of Social Security, Cuernavaca, Morelos 62000, Mexico;
- University of California, Los Angeles (UCLA), Department of Health Policy and Management and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, CA 90095, USA
- UCLA Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA
| | - Jorge Salmerón
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico 04510, Mexico; (B.R.-P.); (J.S.)
| | - Rafael Velázquez-Cruz
- Genomics of Bone Metabolism Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico 14610, Mexico;
- Correspondence: ; Tel.: +52-(55)-5350-1900; Fax: +52-(55)-5350-1999
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Abstract
Frailty is a condition marked by greater susceptibility to adverse outcomes, including disability and mortality, which affects up to 50% of those 80 years of age and older. Concurrently, serum vitamin D insufficiency and deficiency, for which as many as 70% of older adults may be at risk, potentially play an important role in frailty onset and progression. Large population driven studies have uncovered associations between low serum vitamin D levels and higher incidence of frailty. However, attempts to apply vitamin D therapeutically to treat and/or prevent frailty have not yielded consistent support for benefits. Given the complexity and inconsistency arising from human studies involving vitamin D, our research group has recently published on animal models of vitamin D insufficiency. Combining our model with the emerging development of animal frailty assessment, we identified that higher than standard levels of vitamin D supplementation may delay frailty in mice. In this viewpoint article, we will discuss current knowledge regarding the importance of vitamin D in frailty progression, the emerging significance of animal models in addressing these relationships, and the future for pre-clinical and clinical research.
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Capitanio D, Barbacini P, Arosio B, Guerini FR, Torretta E, Trecate F, Cesari M, Mari D, Clerici M, Gelfi C. Can Serum Nitrosoproteome Predict Longevity of Aged Women? Int J Mol Sci 2020; 21:ijms21239009. [PMID: 33260845 PMCID: PMC7731247 DOI: 10.3390/ijms21239009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023] Open
Abstract
Aging is characterized by increase in reactive oxygen (ROS) and nitrogen (RNS) species, key factors of cardiac failure and disuse-induced muscle atrophy. This study focused on serum nitroproteome as a trait of longevity by adopting two complementary gel-based techniques: two-dimensional differential in gel electrophoresis (2-D DIGE) and Nitro-DIGE coupled with mass spectrometry of albumin-depleted serum of aged (A, n = 15) and centenarian (C, n = 15) versus young females (Y, n = 15). Results indicate spots differently expressed in A and C compared to Y and spots changed in A vs. C. Nitro-DIGE revealed nitrosated protein spots in A and C compared to Y and spots changed in A vs. C only (p-value < 0.01). Nitro-proteoforms of alpha-1-antitripsin (SERPINA1), alpha-1-antichimotripsin (SERPINA3), ceruloplasmin (CP), 13 proteoforms of haptoglobin (HP), and inactive glycosyltransferase 25 family member 3 (CERCAM) increased in A vs. Y and C. Conversely, nitrosation levels decreased in C vs. Y and A, for immunoglobulin light chain 1 (IGLC1), serotransferrin (TF), transthyretin (TTR), and vitamin D-binding protein (VDBP). Immunoblottings of alcohol dehydrogenase 5/S-nitrosoglutathione reductase (ADH5/GSNOR) and thioredoxin reductase 1 (TRXR1) indicated lower levels of ADH5 in A vs. Y and C, whereas TRXR1 decreased in A and C in comparison to Y. In conclusion, the study identified putative markers in C of healthy aging and high levels of ADH5/GSNOR that can sustain the denitrosylase activity, promoting longevity.
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Affiliation(s)
- Daniele Capitanio
- Department of Biomedical Sciences for Health, University of Milan, 20090 Segrate (MI), Italy; (D.C.); (P.B.)
| | - Pietro Barbacini
- Department of Biomedical Sciences for Health, University of Milan, 20090 Segrate (MI), Italy; (D.C.); (P.B.)
| | - Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
| | - Franca Rosa Guerini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (F.R.G.); (F.T.); (M.C.)
| | | | - Fabio Trecate
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (F.R.G.); (F.T.); (M.C.)
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
| | - Daniela Mari
- Laboratorio Sperimentale di Ricerche di Neuroendocrinologia Geriatrica ed Oncologica, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy;
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (F.R.G.); (F.T.); (M.C.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Cecilia Gelfi
- Department of Biomedical Sciences for Health, University of Milan, 20090 Segrate (MI), Italy; (D.C.); (P.B.)
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy;
- Correspondence: ; Tel.: +39-02-5033-0475
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Low Vitamin D Levels and Frailty Status in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12082286. [PMID: 32751730 PMCID: PMC7469050 DOI: 10.3390/nu12082286] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/16/2022] Open
Abstract
Serum vitamin D deficiency is widespread among older adults and is a potential modifiable risk factor for frailty. Moreover, frailty has been suggested as an intermediate step in the association between low levels of vitamin D and mortality. Hence, we conducted a systematic review of the literature and meta-analysis to test the possible association of low concentrations of serum 25-hydroxyvitamin D (25(OH)D), a marker of vitamin D status, with frailty in later life. We reviewed cross-sectional or longitudinal studies evaluating populations of older adults and identifying frailty by a currently validated scale. Meta-analyses were restricted to cross-sectional data from studies using Fried’s phenotype to identify frailty. Twenty-six studies were considered in the qualitative synthesis, and thirteen studies were included in the meta-analyses. Quantitative analyses showed significant differences in the comparisons of frail (standardized mean difference (SMD)—1.31, 95% confidence interval (CI) (−2.47, −0.15), p = 0.0271) and pre-frail (SMD—0.79, 95% CI (−1.58, −0.003), p = 0.0491) subjects vs. non-frail subjects. Sensitivity analyses reduced heterogeneity, resulting in a smaller but still highly significant between-groups difference. Results obtained indicate that lower 25(OH)D levels are significantly associated with increasing frailty severity. Future challenges include interventional studies testing the possible benefits of vitamin D supplementation in older adults to prevent/palliate frailty and its associated outcomes.
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A Comparison Study of Vitamin D Deficiency among Older Adults in China and the United States. Sci Rep 2019; 9:19713. [PMID: 31873182 PMCID: PMC6928152 DOI: 10.1038/s41598-019-56297-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/09/2019] [Indexed: 12/26/2022] Open
Abstract
Vitamin D deficiency is a common health concern worldwide. We aim to compare the prevalence of vitamin D deficiency among older adults (65+) in China and the United States (US). We used data from the 2011 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS) in China (n = 2180), and 2011–2014 National Health and Nutrition Examination Survey (NHANES) in the US (n = 2283). Serum 25-hydroxyvitamin D [25(OH)D] was measured and a level of under 30/50 nmol/L was defined as vitamin D severe deficiency/deficiency. Risk factors of vitamin D deficiency were examined by multivariate regression models. We found that the mean 25(OH)D concentration was lower in China than in the US (45.1 vs. 83.5 nmol/L), with Chinese elderly lower than American elderly for every age group. 70.3% in China and 17.4% in the US were considered as vitamin D deficiency (30.6% and 3.4% were considered as severe deficiency). Older age, females, ethnic minorities, higher household income, self-rated “very bad” health, and never drinkers, were statistically significant in predicting lower serum 25(OH)D levels in China. In the US, males, ethnic minorities, lower income, self-rated “very bad” health, physically inactive, overweight, and obese were related to lower serum 25(OH)D levels. Our findings suggest that different interventional strategies are needed to improve vitamin D deficiency and its associated negative health outcomes in China and the US.
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Stakisaitis D, Lesauskaitė V, Girdauskaitė M, Janulionis E, Ulys A, Benetis R. Investigation of Vitamin D-Binding Protein Polymorphism Impact on Coronary Artery Disease and Relationship with Longevity: Own Data and a Review. Int J Endocrinol 2016; 2016:8347379. [PMID: 27143969 PMCID: PMC4837253 DOI: 10.1155/2016/8347379] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022] Open
Abstract
The aim of the study was to assess the effect of vitamin D-binding protein (DBP) polymorphism on coronary artery disease (CAD). DBP phenotypes were identified in the groups: control (n = 306), men suffering from CAD (n = 154), and long-lived individuals (n = 108). Isoelectric focusing of DBP phenotypes in serum was performed on polyacrylamide gel. Distribution of DBP phenotypes in the study groups was found to be in Hardy-Weinberg equilibrium. Gc1s-1s phenotype and Gc1s allele frequency in CAD groups were significantly higher than in control, and Gc1s allele frequency was found significantly more often in CAD compared with long-lived group (p < 0.05). The Gc2 allele frequency in control was higher as compared with Gc2 frequency in CAD group (p < 0.05). The Gc2-2 phenotype was more frequent in long-lived survivors than in the CAD group (p < 0.05). It was found that the Gc1s allele significantly increased the risk of CAD with the odds ratio (OR) equal to 1.45 (p < 0.02) and showed Gc2 to be related with a decreased risk of CAD (OR = 0.69; p < 0.03). Authors review the role of DBP in resistance to atherosclerosis and cancer as the main longevity determinants.
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Affiliation(s)
- Donatas Stakisaitis
- Laboratory of Cancerogenesis and Cancer Epidemiology, Scientific Research Center, National Cancer Institute, Santariskiu 1, LT-08660 Vilnius, Lithuania
- Department of Biolaw, Mykolas Romeris University, Ateities 21, LT-08303 Vilnius, Lithuania
- *Donatas Stakisaitis:
| | - Vita Lesauskaitė
- Department of Geriatrics, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus 9, LT-44307 Kaunas, Lithuania
| | - Milda Girdauskaitė
- Laboratory of Cancerogenesis and Cancer Epidemiology, Scientific Research Center, National Cancer Institute, Santariskiu 1, LT-08660 Vilnius, Lithuania
| | - Ernestas Janulionis
- Radiation and Medical Oncology Clinics, National Cancer Institute, Santariskiu 1, LT-08660 Vilnius, Lithuania
| | - Albertas Ulys
- Oncosurgery Clinics, National Cancer Institute, Santariskiu 1, LT-08660 Vilnius, Lithuania
| | - Rimantas Benetis
- Institute of Cardiology of the Medical Academy, Lithuanian University of Health Sciences, Sukileliu 17, LT-50161 Kaunas, Lithuania
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Krams T, Cesari M, Guyonnet S, Abellan Van Kan G, Cantet C, Vellas B, Rolland Y. Is the 25-Hydroxy-Vitamin D Serum Concentration a Good Marker of Frailty? J Nutr Health Aging 2016; 20:1034-1039. [PMID: 27925143 DOI: 10.1007/s12603-016-0714-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The phenotype proposed by Fried and colleagues is a widely used operational definition of frailty defining such state of extreme vulnerability of older persons. Low serum 25-hydroxy-vitamin D (25(OH)D) has been suggested as biomarker of frailty in literature. STUDY DESIGN Cross-sectional. OBJECTIVES To explore the association of 25(OH)D concentrations with the frailty phenotype and its criteria. METHODS 321 subjects referred by their general practitioner to a geriatric frailty clinic were assessed between January 1, 2013 and September 23, 2013. Adjusted logistic regression models were performed between serum concentrations of 25(OH)D and the frailty phenotype (global score as well as its specific criteria). Receivers operating curves were established in order to explore the existence of a possible threshold of vitamin D levels highly predictive of frailty. RESULTS Two hundred forty-one (75%) participants had 25(OH)D levels lower than 22 ng/ml. No significant association was reported between 25(OH)D levels and frailty. Among the five criteria of frailty, 25(OH)D was only associated with sedentariness (odds ratio 0.97 [95% confidence interval 0.95-0.99]). CONCLUSION In our sample, no association was found between 25(OH)D levels and phenotype of frailty or the different frailty criterion except for sedentariness.
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Affiliation(s)
- T Krams
- Krams Thomas, 170 Avenue de Casselardit, 31059 Toulouse, France, Tel : +33561776673, Email :
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Behrens JR, Rasche L, Gieß RM, Pfuhl C, Wakonig K, Freitag E, Deuschle K, Bellmann-Strobl J, Paul F, Ruprecht K, Dörr J. Low 25-hydroxyvitamin D, but not the bioavailable fraction of 25-hydroxyvitamin D, is a risk factor for multiple sclerosis. Eur J Neurol 2015. [PMID: 26220765 DOI: 10.1111/ene.12788] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Low 25-hydroxyvitamin D [25(OH)D] levels correlate with higher disease activity in patients with multiple sclerosis (MS). However, it is not clear whether low 25(OH)D levels directly contribute to increased disease activity or merely represent a consequence of reduced endogenous vitamin D synthesis in more disabled MS patients. Furthermore, recent data suggest that bioavailable vitamin D, which also integrates the levels of vitamin D binding proteins and albumin, could be a biologically more relevant parameter than 25(OH)D. METHODS Measured de-seasonalized 25(OH)D3 and vitamin D binding protein and calculated bioavailable and free vitamin D were compared in the baseline serum samples of 76 patients with clinically isolated syndrome enrolled in a longitudinal observational study and in 76 age- and sex-matched healthy controls (HC). RESULTS 25(OH)D3 levels were lower in patients with clinically isolated syndrome (P = 0.002) than in HC, and more patients (8/76, 10.5%) than HC (1/76, 1.3%) had 25(OH)D3 levels <25 nmol/l (P = 0.03). In contrast, levels of 25(OH)D2, vitamin D binding protein and calculated levels of free and bioavailable vitamin D did not differ between the two groups. CONCLUSIONS Lower 25(OH)D3 levels already in the earliest phase of disease and in clinically hardly affected patients suggest that low 25(OH)D3 levels are rather a risk factor for than a consequence of MS. Nevertheless, because bioavailable vitamin D levels did not differ between the two groups, the mechanism underlying the association of 25(OH)D3 and MS does not appear to be related to reduced bioavailability of vitamin D.
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Affiliation(s)
- Janina R Behrens
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ludwig Rasche
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rene M Gieß
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Catherina Pfuhl
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Wakonig
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Erik Freitag
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katrin Deuschle
- Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Ruprecht
- Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Dörr
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
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