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Örsten S, Baysal İ, Çiftçi T, Ünal E, Yabanoğlu Çiftçi S, Doğrul AB, Akıncı D, Akyön Y, Akhan O. Evaluation of Potential Inflammatory Markers for Cystic Echinococcosis: P-selectin and Resistin. TURKIYE PARAZITOLOJII DERGISI 2022; 46:195-200. [PMID: 36094120 DOI: 10.4274/tpd.galenos.2022.55265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Cystic echinococcosis (CE) is one of the most common zoonotic diseases worldwide. Diagnosis of CE is predominantly based on imaging techniques and serological tests are used in cases of non-characteristic imaging findings as diagnostic reference. However, serological test results cannot be completely reliable as they are affected by multi-factors. P-selectin and resistin are inflammatory markers that are altered during the acute stages of infection. In this purpose, inflammatory markers as P-selectin and resistin have been investigated for a potential diagnostic reference for CE diagnosis. METHODS A total of 60 patients who were diagnosed with CE and twenty-five healthy individuals were included in this study. Blood samples were obtained from all participants. Obtained sera were evaluated using the P-selectin and resistin ELISA kits for protein levels. Additionally, the relative expression of SELP (P-selectin) and RETN (resistin) genes were determined using the comparative CT (ΔΔCT) method between groups as CE patients with active and inactive cysts, CE patients and healthy controls. RESULTS SELP (13.9-fold change, p<0.05) and RETN (8.1-fold change, p<0.05) were differentially expressed in CE patients compared in the control group. Whereas resistin protein levels were significantly higher in CE patients than the healthy controls (p<0.001), the difference in P-selectin protein levels was not significant (p>0.05). There was no difference between active and inactive CE patients in terms of P-selectin and resistin in gene and protein levels (p>0.05). CONCLUSION Although there was no difference between the active and inactive CE patients, the good differentiation between the healthy controls and the CE patients suggested that resistin is a potential inflammatory diagnostic reference.
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Affiliation(s)
- Serra Örsten
- Hacettepe University Vocational School of Health Services, Ankara, Turkey
| | - İpek Baysal
- Hacettepe University Vocational School of Health Services, Ankara, Turkey
| | - Türkmen Çiftçi
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Emre Ünal
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | | | - Ahmet Bülent Doğrul
- Hacettepe University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
| | - Devrim Akıncı
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Yakut Akyön
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Okan Akhan
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
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Hegazy S, Elsabaawy M, Eltabakh M, Hammad R, Bedair H. CD62P (P-selectin) expression as a platelet activation marker in patients with liver cirrhosis with and without cholestasis. Clin Exp Hepatol 2021; 7:231-240. [PMID: 34295992 PMCID: PMC8284161 DOI: 10.5114/ceh.2021.107566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
AIM OF THE STUDY P-selectin (CD62P) is a platelet activation marker that was claimed to mediate the accumulation of platelets induced by cholestasis. The nature of platelet dysfunction and hemostasis abnormalities in cholestatic liver disease needs to be more explored. The aim of this study was to assess platelet CD62P expression in cirrhotic patients with and without cholestasis, and to evaluate its relationship with a bleeding tendency. MATERIAL AND METHODS 150 patients were included in this case-control study. Participants were divided into 84 patients with liver cirrhosis (group I), 44 of whom had cholestasis (Group Ia) and 40 patients were without cholestasis (group Ib); 36 patients who were cholestatic without liver cirrhosis (group II); and 30 healthy subjects who formed the control group (group III). Platelet CD62P expression was assessed by a flow cytometer. RESULTS Platelets expressing CD62P were significantly increased in all patient groups compared to controls (p < 0.001). Platelets expressing CD62P were significantly increased in gastrointestinal (GIT) bleeders compared to non-bleeders in cirrhotic and cholestatic groups (p < 0.001 each). Among group I patients at cut-off > 12.4, up-regulation of platelet CD62P yielded 72% sensitivity and 44.1% specificity to discriminate bleeders from non-bleeders (p = 0.01), while among group II at cut-off > 12.9, it yielded 90% sensitivity and 80.8% specificity (p < 0.001). In cirrhotic patients, platelet CD62P expression was significantly increased in patients with an advanced Child-Pugh class (p < 0.001). Platelet expressing CD62P was shown as an independent risk factor for bleeding among cirrhotic cases with an odds ratio of 1.07 and CI 0.99-1.15. CONCLUSIONS Up-regulation of platelet CD62P expression can serve as a GIT bleeding predictor in liver cirrhosis.
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Ali RO, Moon MS, Townsend EC, Hill K, Zhang GY, Bradshaw A, Guan H, Hamilton D, Kleiner DE, Auh S, Koh C, Heller T. Exploring the Link Between Platelet Numbers and Vascular Homeostasis Across Early and Late Stages of Fibrosis in Hepatitis C. Dig Dis Sci 2020; 65:524-533. [PMID: 31407130 PMCID: PMC7988415 DOI: 10.1007/s10620-019-05760-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Thrombocytopenia is a hallmark of advanced liver disease. Platelets, growth factors (GFs), and vascular integrity are closely linked factors in disease pathogenesis, and their relationship, particularly in early disease stages, is not entirely understood. The aim was to compare circulating platelets, growth factors, and vascular injury markers (VIMs) in hepatitis C-infected (HCV) patients with early fibrosis and cirrhosis. METHODS Retrospective evaluation of serum GFs and VIMs by ELISA were evaluated from twenty-six HCV patients. Analytes from an earlier time-point were correlated with MELD at a later time-point. RESULTS Platelets and GFs decreased, and VIMs increased with fibrosis. Platelets correlated positively with PDGF-AA, PDGF-BB, TGFB1, EGF, and P-selectin, and negatively with ICAM-3 and VCAM-1. P-selectin showed no correlations with VIMs but positively correlated with PDGF-AA, PDGF-BB, TGFB1, and EGF. Soluble VCAM-1 and ICAM-3 were linked to increasing fibrosis, liver enzymes, and synthetic dysfunction. Higher VCAM-1 and ICAM-3 and lower P-selectin at an earlier time-point were linked to higher MELD score at a later time-point. CONCLUSION In chronic HCV, progressive decline in platelets and growth factors with fibrosis and their associations suggest that platelets are an important source of circulating GFs and influence GF decline with fibrosis. Enhanced markers of vascular injury in patients with early fibrosis suggest an earlier onset of endothelial dysfunction preceding cirrhosis. Associations of VIMs with platelets suggest a critical link between platelets and vascular homeostasis. Circulating markers of vascular injury may not only have prognostic importance but emphasize the role of vascular dysfunction in liver disease pathogenesis (NCT00001971).
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Affiliation(s)
- Rabab O Ali
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA.
| | - Mi Sun Moon
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Elizabeth C Townsend
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Kareen Hill
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Grace Y Zhang
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Alyson Bradshaw
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Hannah Guan
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Destanee Hamilton
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Christopher Koh
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Theo Heller
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA.
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Chimponda TN, Mushayi C, Osakunor DNM, Vengesai A, Enwono E, Amanfo S, Murray J, Tshuma C, Mutapi F, Mduluza T. Elevation of C-reactive protein, P-selectin and Resistin as potential inflammatory biomarkers of urogenital Schistosomiasis exposure in preschool children. BMC Infect Dis 2019; 19:1071. [PMID: 31856765 PMCID: PMC6924053 DOI: 10.1186/s12879-019-4690-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background Schistosomiasis is known to induce inflammatory immune responses. C-reactive protein (CRP), resistin and P-selectin are serological inflammatory markers that rise during the acute stages of infection. Here, we propose such inflammatory biomarkers have a potential for use in urogenital schistosomiasis diagnostic screening for exposure and infection in preschool-aged children. Methods As part of a larger study on urogenital schistosomiasis, 299 preschool children aged 1–5 years were included in this cross-sectional study. Parasitological diagnosis was conducted using urine filtration for Schistosoma haemtobium infection, and Kato Katz for S. mansoni infection. Serum levels of P-selectin, resistin, CRP, and antibodies against S. haematobium cercarial antigen preparation (CAP) and soluble worm antigen preparation (SWAP) were measured by ELISA. Results Of the 299 participants, 14% were egg positive for S. haematobium. Serology showed 46 and 9% of the participants to have been exposed to S. haematobium cercarial antigens and adult worm antigens, respectively. Levels of P-selectin were significantly higher in participants infected with S. haematobium (egg-positive) than in uninfected participants (p = 0.001). Levels of P-selectin were also higher in those exposed to cercarial antigen than in unexposed participants (p = 0.019). There was a positive correlation between P-selectin and infection intensity (r = 0.172; p = 0.002), as well as with IgM responses to CAP and SWAP (r = 0.183; p = 0.001); (r = 0.333; p < 0.0001) respectively. CRP significantly correlated with IgM responses to CAP (r = 0.133; p = 0.029) while resistin correlated with IgM responses to CAP and SWAP (r = 0.127; p = 0.016); (r = 0.197; p = 0.0004). CRP levels were higher in those exposed to cercarial and adult worm antigens than unexposed participants (p = 0.035); (p = 0.002) respectively, while resistin was higher in participants exposed to cercarial antigen than unexposed participants (p = 0.024). Conclusion In this preschool population, P-selectin is significantly associated with urogenital schistosome infection and intensity; hence a potential biomarker for infection diagnosis and disease monitoring. The inflammatory biomarkers (P-selectin, Resistin and CRP) were significantly higher in participants exposed to cercarial antigens than unexposed individuals indicating an underlying inflammatory environment.
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Affiliation(s)
- Theresa N Chimponda
- University of Zimbabwe, Biochemistry Department, P. O. Box MP 167, Mt Pleasant, Harare, Zimbabwe.
| | - Caroline Mushayi
- Mashonaland Central Provincial Health Office, Ministry of Health & Child Care, Harare, Zimbabwe
| | - Derick N M Osakunor
- Statistics Department, University of Zimbabwe, P. O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Arthur Vengesai
- University of Zimbabwe, Biochemistry Department, P. O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Eyoh Enwono
- Statistics Department, University of Zimbabwe, P. O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Seth Amanfo
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Building Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK.,Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Janice Murray
- Statistics Department, University of Zimbabwe, P. O. Box MP 167, Mt Pleasant, Harare, Zimbabwe.,Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Cremance Tshuma
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa at the University of Edinburgh, Edinburgh, UK
| | - Francisca Mutapi
- Statistics Department, University of Zimbabwe, P. O. Box MP 167, Mt Pleasant, Harare, Zimbabwe.,Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Takafira Mduluza
- University of Zimbabwe, Biochemistry Department, P. O. Box MP 167, Mt Pleasant, Harare, Zimbabwe.,Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Pengue C, Cesar G, Alvarez MG, Bertocchi G, Lococo B, Viotti R, Natale MA, Castro Eiro MD, Cambiazzo SS, Perroni N, Nuñez M, Albareda MC, Laucella SA. Impaired frequencies and function of platelets and tissue remodeling in chronic Chagas disease. PLoS One 2019; 14:e0218260. [PMID: 31199841 PMCID: PMC6570032 DOI: 10.1371/journal.pone.0218260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/29/2019] [Indexed: 01/30/2023] Open
Abstract
Chronic inflammation, as a consequence of the persistent infection with Trypanosoma cruzi, leads to continuous activation of the immune system in patients with chronic Chagas disease. We have previously shown that increased sera levels of soluble P-selectin are associated with the severity of the cardiomyopathy distinctive of chronic Chagas disease. In this study, we explored the expression of biomarkers of platelet and endothelial activation, tissue remodeling, and mediators of the coagulation cascade in patients at different clinical stages of chronic Chagas heart disease. The frequencies of activated platelets, measured by the expression of CD41a and CD62P were decreased in patients with chronic Chagas disease compared with those in uninfected subjects, with an inverse association with disease severity. Platelet activation in response to adenosine diphosphate was also decreased in T. cruzi-infected subjects. A major proportion of T. cruzi infected subjects showed increased serum levels of fibrinogen. Patients with severe cardiac dysfunction showed increased levels of endothelin-1 and normal values of procollagen I. In conclusion, chronic infection with T. cruzi induced hemostatic alterations, even in those patients who do not yet present cardiac symptoms.
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Affiliation(s)
- Claudia Pengue
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Gonzalo Cesar
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | | | - Graciela Bertocchi
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Bruno Lococo
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Rodolfo Viotti
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - María Ailén Natale
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | | | | | - Nancy Perroni
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Myriam Nuñez
- Departamento de Matemática y Física, Facultad Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - María Cecilia Albareda
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
- * E-mail: (SAL); (MCA)
| | - Susana A. Laucella
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
- * E-mail: (SAL); (MCA)
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Yu J, Wang F, Xu S, Gao M. CD62P and P10 as predictive markers for assessing the efficacy of hemodialysis in treating end-stage renal disease. J Clin Lab Anal 2019; 33:e22662. [PMID: 30320415 PMCID: PMC6818603 DOI: 10.1002/jcla.22662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND CD62P is a platelet α-granule membrane protein, and P10 is a platelet membrane glycoprotein thrombospondin. To better understand the effects of hemodialysis (HD), we have conducted this study to investigate CD62P and P10 in assessing the efficacy of HD in treating patients with end-stage renal disease (ESRD). METHODS The case group consisted of 111 patients suffering ESRD treated with regular HD and the control group enrolled 117 healthy subjects. Before and after HD treatment, a series of parameters were observed, based on which, CD62P and P10 levels were detected in the patients in two groups before and after HD therapy. The correlation analysis analyzed the correlations of CD62P and P10 markers with serum creatinine (Scr), blood urea nitrogen (BUN), and subjective score; and logistic regression analysis was performed to reveal factors affecting the efficacy of HD. RESULTS BUN, Scr, serum phosphorus, intact parathyroid hormone (iPTH), fibrinogen, and β2-microglobulin (β2-MG) decreased while hemoglobin, albumin, and activated partial thromboplastin time increased in the patients suffering ESRD; patients presented with improvements in subjective symptoms and an increase in dry weight. CD62P and P10 levels were lower in post-treatment patients. CD62P and P10 positively correlated with Scr, BUN and subjective score; post-treatment CD62P and P10 levels, BUN, hemoglobin, albumin, triglyceride, iPTH, β2-MG, and fibrinogen were correlated with the efficacy of HD. CONCLUSION CD62P and P10 might be correlated to the efficacy of HD in treating ESRD, in turn providing predictive markers for assessing the ability of HD in treating ESRD.
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Affiliation(s)
- Ji‐Rong Yu
- Department of NephrologyZhongda Hospital Southeast UniversityNanjingChina
| | - Feng‐Mei Wang
- Department of NephrologyZhongda Hospital Southeast UniversityNanjingChina
| | - Sheng‐Chun Xu
- Department of NephrologyZhongda Hospital Southeast UniversityNanjingChina
| | - Min Gao
- Department of NephrologyZhongda Hospital Southeast UniversityNanjingChina
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Attallah AM, El-Far M, Omran MM, Farid K, Attallah AA, Abd-Elaziz D, El-Bendary MS, El-Dosoky I, Ismail H. Levels of Schistosoma mansoni Circulating Antigen in Chronic Hepatitis C Patients with Different Stages of Liver Fibrosis. J Immunoassay Immunochem 2016; 37:316-30. [PMID: 26745203 DOI: 10.1080/15321819.2015.1135163] [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: 01/11/2023]
Abstract
The goal of this study was to determine the levels of S. mansoni antigen in different liver fibrosis stages with chronic hepatitis C (CHC) Egyptian patients. A total of 174 CHC patients showing HCV-NS4 antigen and HCV- RNA in their sera were included. S. mansoni antigen was detected in serum using Western blot and ELISA. The levels of interferon-γ (IFN- γ) were determined using ELISA. The 50 kDa S. mansoni antigen discriminated patients infected with S. mansoni from healthy individuals with 0.93 area under curve (AUC), 92% sensitivity, and 97% specificity. The level of S. mansoni antigen (μg/ml) was significantly (P < 0.0001) increased with the progression of liver fibrosis stages (26.9 ± 17.5 in F1, 42.1 ± 25.2 in F2, 49.8 ± 30.3 in F3 and 62.2 ± 26.3 μg/mL in F4 liver cirrhosis), 26.9 ± 17.59 in significant fibrosis (F2-F4); 51.2 ± 27.9 in advanced fibrosis (F3-F4). A significant correlation (r = 0.506; P < 0.0001) was shown between the levels of the S. mansoni antigen and the HCV-NS4 antigen. In conclusion, the presence of S. mansoni antigen in different liver fibrosis stages of CHC patients confirming that concomitant schistosome infection aggravates liver disease.
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Affiliation(s)
| | - Mohamed El-Far
- b Chemistry Department, Faculty of Science , Mansoura University , Mansoura , Egypt
| | - Mohamed M Omran
- c Chemistry Department, Faculty of Science , Helwan University , Cairo , Egypt
| | - Khaled Farid
- d Tropical Medicine Department, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Ahmed A Attallah
- a R & D Department, Biotechnology Research Center , New Damietta , Egypt
| | - Dalal Abd-Elaziz
- a R & D Department, Biotechnology Research Center , New Damietta , Egypt
| | | | - Ibrahim El-Dosoky
- e Pathology Department, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Hisham Ismail
- a R & D Department, Biotechnology Research Center , New Damietta , Egypt.,f Biochemistry Division, Chemistry Department, Faculty of Science , Minia University , Minia , Egypt
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