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Steblaj B, Kutter APN, Stirn M, Daminet S, Major A, Zini E. Endotoxic kidney injury in Beagle dogs assessed by serum creatinine and symmetric dimethylarginine, and urinary neutrophil gelatinase-associated lipocalin and clusterin. Res Vet Sci 2023; 162:104966. [PMID: 37516042 DOI: 10.1016/j.rvsc.2023.104966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/12/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Sepsis of Gram negative bacterial origin results in lipopolysaccharide-induced endotoxemia. This often leads to acute kidney injury (AKI) and its recognition remains a challenge and delays treatment. As renal damage occurs before a rise in serum creatinine is detected, new early biomarkers of kidney injury need to be explored. The aim of this study was to determine changes in serum parameters of renal function and urine biomarkers of renal injury. This was a descriptive study. Endotoxemia was induced intravenously in six anaesthetized Beagles (T1). To achieve normotension, dogs received fluids (T2), followed by a continuous infusion of noradrenaline and dexmedetomidine or 0.9% NaCl (T3). Ten minutes later, the dogs received fluids (T4) and noradrenaline and dexmedetomidine or 0.9% NaCl in a crossover manner (T5). At each timepoint, blood and urine were collected for serum creatinine, urea, symmetric dimethylarginine, urine protein/creatinine (UPC) ratio, urine neutrophil-gelatinase-associated lipocalin (U-NGAL), U-NGAL/creatinine ratio, urine clusterin (U-clusterin) and U-clusterin/creatinine ratio. Data were analyzed using a mixed-effect model taking into account time and stage of veterinary AKI (VAKI). Three of six dogs had a VAKI stage ≥1; one with anuria and elevated creatinine. Serum creatinine (P < 0.001), U-NGAL/creatinine ratio (P = 0.01) and U-clusterin/creatinine ratio increased over time (P < 0.01). The UPC ratio (mean (range) 0.68 (0.35-2.3) versus 0.39 (0.15-0.71) P < 0.01) and U-NGAL (3164 pg/mL (100-147,555) versus 100 (100-14,524), P = 0.01) were higher in VAKI stage ≥1 versus stage 0, respectively. Endotoxemia induced VAKI stage ≥1 in half of the dogs. Repeated measurement of selected parameters could detect AKI early.
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Affiliation(s)
- B Steblaj
- Section of Anesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zürich, Switzerland.
| | - A P N Kutter
- Section of Anesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zürich, Switzerland
| | - M Stirn
- Clinical laboratory, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zürich, Switzerland
| | - S Daminet
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - A Major
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zürich, Switzerland
| | - E Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zürich, Switzerland; Department of Animal Medicine, Production and Health, University of Padova, Agripolis, Viale dell'Università, 35020 Legnaro, Italy
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Wijewickrama ES, Mohamed F, Gawarammana IB, Endre ZH, Buckley NA, Isbister GK. Serum and urinary biomarkers for early detection of acute kidney injury following Hypnale spp. envenoming. PLoS Negl Trop Dis 2021; 15:e0010011. [PMID: 34871314 PMCID: PMC8675918 DOI: 10.1371/journal.pntd.0010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/16/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Hump-nosed pit viper (HNV; Hypnale spp.) bites account for most venomous snakebites in Sri Lanka. Acute kidney injury (AKI) is the most serious systemic manifestation (1–10%) following HNV envenoming. We aimed to identify the value of functional and injury biomarkers in predicting the development of AKI early following HNV bites. Methods We conducted a prospective cohort study of patients with confirmed HNV envenoming presenting to two large tertiary care hospitals in Sri Lanka. Demographics, bite details, clinical effects, complications and treatment data were collected prospectively. Blood and urine samples were collected from patients for coagulation and renal biomarker assays on admission, at 0-4h, 4-8h, 8-16h and 16-24h post-bite and daily until discharge. Follow-up samples were obtained 1 and 3 months post-discharge. Creatinine (sCr) and Cystatin C (sCysC) were measured in serum and kidney injury molecule-1 (uKIM-1), clusterin (uClu), albumin (uAlb), β2-microglobulin (uβ2M), cystatin C (uCysC), neutrophil gelatinase associated lipocalin (uNGAL), osteopontin (uOPN) and trefoil factor-3 (uTFF-3) were measured in urine. Definite HNV bites were based on serum venom specific enzyme immunoassay. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to stage AKI. Two patients had chronic kidney disease at 3 month follow-up, both with pre-existing abnormal sCr, and one developed AKI following HNV envenoming. Results There were 52 patients with confirmed HNV envenoming; median age 48y (Interquartile range [IQR]:40-59y) and 29 (56%) were male. Median time to admission was 1.87h (IQR:1–2.75h). Twelve patients (23%) developed AKI (AKI stage 1 = 7, AKI stage 2 = 1, AKI stage 3 = 4). Levels of five novel biomarkers, the functional marker serum Cystatin C and the damage markers urinary NGAL, cystatin C, β2-microglobulin and clusterin, were elevated in patients who developed moderate/severe acute kidney injury. sCysC performed the best at 0–4 h post-bite in predicting moderate to severe AKI (AUC-ROC 0.95;95%CI:0.85–1.0) and no biomarker performed better than sCr at later time points. Conclusions sCysC appears to be a better marker than sCr for early prediction of moderate to severe AKI following HNV envenoming. Snakebite is a major public health problem associated with considerable morbidity and mortality worldwide. Acute kidney injury is one of the major systemic complications of snakebites. Its pathophysiology is poorly understood and the diagnosis is often delayed due to lack of sensitive biomarkers. We aimed to investigate the value of selected biomarkers in the early diagnosis of acute kidney injury following hump-nosed pit viper (Hypnale spp.) envenoming. In a group of 52 patients with confirmed hump-nosed pit viper envenoming acute kidney injury was found to be common and was associated with severe disease in some. Levels of five novel biomarkers, the functional marker serum Cystatin C and the damage markers urinary NGAL, cystatin C, β2-microglobulin and clusterin, were elevated in patients who developed moderate/ severe acute kidney injury. Serum Cystatin C performed better than serum creatinine in early prediction of moderate/severe acute kidney injury. Serum Cystatin C appears to be a promising novel biomarker in diagnosing acute kidney injury in the setting of hump-nosed pit viper envenoming.
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Affiliation(s)
- Eranga Sanjeewa Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- * E-mail:
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- The University of Sydney, Faculty of Medicine and Health, Biomedical informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Sydney, NSW, Australia
- Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Indika B. Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Zoltan H. Endre
- Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Nicholas A. Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- The University of Sydney, Faculty of Medicine and Health, Biomedical informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Sydney, NSW, Australia
| | - Geoffrey K. Isbister
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
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Abdul K, De Silva PMC, Ekanayake E, Thakshila W, Gunarathna S, Gunasekara T, Jayasinghe S, Asanthi H, Chandana E, Chaminda G, Siribaddana S, Jayasundara N. Occupational Paraquat and Glyphosate Exposure May Decline Renal Functions among Rural Farming Communities in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3278. [PMID: 33810013 PMCID: PMC8005187 DOI: 10.3390/ijerph18063278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 01/21/2023]
Abstract
Extensive use of herbicides is common among rural agricultural workers in Sri Lanka. Recent studies have postulated their role in the development of chronic kidney disease of unknown etiology (CKDu). Paraquat and glyphosate are leading herbicides used by sugarcane farmers (SF), hence occupational exposure is inevitable. This study examined the expression of urinary paraquat, glyphosate and biomarkers among residential SF in CKDu emerging regions, Warunagama (WA) and Rahathangama (RH), in the Uva Province with non-endemic Matara (MA) in the Southern Province of Sri Lanka. Urinary glyphosate, Paraquat, kidney injury molecule -1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and β2-microglobulin (B2M) were determined using enzyme-linked immunosorbent assays (ELISA). Urinary creatinine, microalbumin, serum creatinine (SCr), serum cystatin C, estimated glomerular filtration rate (eGFR), and albumin creatinine ratio (ACR) were also assessed. Generally, herbicide residues and kidney injury biomarkers were higher in SF compared to the non-endemic MA. Creatinine-adjusted urinary glyphosate and paraquat levels were significantly higher in WA compared to MA. ACR in RH (median 14.9; IQR 5.4-393.1 mg/g) and WA (23.7; 11.5-64.6) was significantly higher than MA (4.3; 2.2-6.7). This study reports 39 individuals with impaired kidney function among SF in Sri Lanka for the first time. Urinary NGAL levels were significantly higher in both WA (median 2.14; IQR 1.28-6.15 ng/mg Cr) and RH (3.09; 1.15-9.09) compared to MA (1.28; 0.56-2.81). However, urinary KIM-1 levels in RH (3.2; 1.29-106.1 ng/g Cr) and WA (3.6; 1.94-115.1) were not significantly higher in MA (1.74; 0.76-116.9). Urinary NGAL (r = 0.493), eGFR (r = -0.147) and ACR (r = 0.171) significantly correlated with urinary glyphosate, but not with urinary paraquat levels. Urinary KIM-1 levels did not correlate with either urinary glyphosate or paraquat, while urinary B2M and serum cystatin C levels showed significant correlation with urinary glyphosate levels. The current study reports higher urinary herbicide levels among sugarcane farmers in WA and RH, and that is potentially linked to the subsequent decline in kidney function, as indicated by ACR, eGFR, and NGAL. We posit that these indicators may serve as markers to detect renal injury among herbicide-exposed SF in Rural Sri Lanka.
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Affiliation(s)
- K.S.M. Abdul
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China;
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - P. Mangala C.S. De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - E.M.D.V. Ekanayake
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58203, USA
| | - W.A.K.G. Thakshila
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - S.D. Gunarathna
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - T.D.K.S.C. Gunasekara
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - S.S. Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka;
| | - H.B. Asanthi
- Department of Limnology, Faculty of Fisheries and Marine Sciences and Technology, University of Ruhuna, Matara 81000, Sri Lanka;
| | - E.P.S. Chandana
- Department of Biosystems Technology, Faculty of Technology, University of Ruhuna, Matara 81000, Sri Lanka;
| | - G.G.T. Chaminda
- Department of Civil Engineering, Faculty of Engineering, University of Ruhuna, Hapugala 80000, Sri Lanka;
| | - S.H. Siribaddana
- Department of Medicine, Faculty of Medical & Allied Sciences, Rajarata University, Saliyapura 50008, Sri Lanka;
| | - Nishad Jayasundara
- The Nicholas School of the Environment, Duke University, Durham, NC 27708, USA;
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Abstract
The traditional chronic kidney disease (CKD) biomarkers (eGFR based on serum creatinine, sex and age and albuminuria) cannot predict a patient's individual risk for developing progressive CKD. For this reason, it is necessary to identify novel CKD biomarkers that will be able to predict which patients are prone to develop progressive disease and discriminate between disease processes in different parts of the nephron (glomeruli or tubules). A good biomarker should change before or simultaneously with lesion development and its changes should correlate strongly with lesion development. Also, there should be a close relationship between severity of injury and amount of detectable biomarker and its levels should decrease with diminishing injury. Among the large number of molecules under investigation, we have reviewed the most promising ones: NGAL and KIM-1, MCP-1, MMP-9, clusterin, MMP-9, TIMP-1, Procollagen I alpha 1 and suPAR. All these, have been studied as biomarkers for prediction of CKD progression in cohorts of patients with chronic kidney disease of different stages and various aetiologies (proteinuric and non-proteinuric, glomerulonephritides, diabetic, hypertensive and polycystic kidney disease). There is evidence that these molecules could be useful as biomarkers for progressive chronic kidney disease, however, the available data are not enough to draw final conclusions. Further studies with large cohorts and long follow-up are required to identify appropriate biomarkers, that will be able to accurately and reliably define the risk for progressive chronic kidney disease.
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Mueangkhiao P, Siviroj P, Sapbamrer R, Khacha-Ananda S, Lungkaphin A, Seesen M, Jaikwang P, Wunnapuk K. Biological variation in kidney injury and kidney function biomarkers among farmers in Lamphun province, Thailand. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:12386-12394. [PMID: 31989504 DOI: 10.1007/s11356-020-07661-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
Frequent and long-term exposure to pesticides can induce acute kidney injury and subsequent chronic kidney diseases. In this study, we aimed to investigate the correlation between kidney injury, kidney function biomarkers, and pesticide use in farmers from the Pasang district, Lamphun province, Thailand. A cross-sectional study was performed in 59 farmers occupationally exposed to various types of pesticides. The levels of urinary neutrophil gelatinase-associated lipocalin (uNGAL), serum creatinine (sCr), urinary microalbumin-to-creatinine ratio (ACR), serum cystatin C (sCys-C), estimated glomerular filtration rate (eGFR), and exposure intensity index (EII) were evaluated. Spearman's correlation and a linear regression analysis were carried out to investigate the association between age, pesticide use, EII, kidney injury markers, and kidney function biomarkers. The most common pesticide used in this study area was glyphosate, followed by paraquat and iprodione. Urinary NGAL levels showed a significant correlation with sCys-C levels, EII, and eGFR Cr-Cys. In addition, the sCr levels were associated with glyphosate use (B = 0.08) and EII (B = 0.01). In conclusion, occupation exposure to pesticides is likely to be linked to kidney injury and dysfunction. Pesticide mix status, pesticide application method, equipment repair status, and personal protective equipment (PPE) use are all involved in changes in kidney markers.
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Affiliation(s)
- Patthawee Mueangkhiao
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Supakit Khacha-Ananda
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anusorn Lungkaphin
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mathuramat Seesen
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pittaya Jaikwang
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Klintean Wunnapuk
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Singh A, Kamal R, Tiwari R, Gaur VK, Bihari V, Satyanarayana G, Patel DK, Azeez PA, Srivastava V, Ansari A, Kesavachandran CN. Association between PAHs biomarkers and kidney injury biomarkers among kitchen workers with microalbuminuria: A cross-sectional pilot study. Clin Chim Acta 2018; 487:349-356. [DOI: 10.1016/j.cca.2018.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 02/08/2023]
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Shadnia S, Ebadollahi-Natanzi A, Ahmadzadeh S, Karami-Mohajeri S, Pourshojaei Y, Rahimi HR. Delayed death following paraquat poisoning: three case reports and a literature review. Toxicol Res (Camb) 2018; 7:745-753. [PMID: 30310653 PMCID: PMC6116805 DOI: 10.1039/c8tx00120k] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/12/2018] [Indexed: 12/12/2022] Open
Abstract
Paraquat (PQ) poisoning is principally reported in developing countries. However, most fatalities occur elsewhere due to the induction of multi-organ failure. PQ poisoning can hardly be managed by clinical practice, and no specific antidote has come into existence yet. Here three cases, including 17-, 20-, and 23-year-old men, who were poisoned with PQ, have been reported. Furthermore, the literature regarding biological mechanisms, clinical manifestation, and treatment of PQ-induced toxicity was reviewed. Patients who, either intentionally or accidentally, ingested PQ earlier were initially found to be stable at the emergency department (ED). Therefore, they were discharged from the hospital under a follow-up. However, after several days, the patients were referred to the hospital for the second time and despite cardiovascular resuscitation (CPR) efforts, they suddenly expired. The delayed death following exposure to PQ was reported for inducing gradual progressive pulmonary fibrosis, metabolic acidosis, neurotoxicity, renal failure, and liver injury in poisoned patients. Therefore, PQ-intoxicated patients should be supervised for up to several weeks, and kept in the hospital for a longer period of time. Clinical manifestations and laboratory findings are beneficial markers that act as useful predictors of PQ poisoning.
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Affiliation(s)
- Shahin Shadnia
- Toxicology Research Center , Excellence Center of Clinical Toxicology , Department of Clinical Toxicology , Loghman Hakim Hospital , School of Medicine , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Alireza Ebadollahi-Natanzi
- Medicinal Plants Department , Imam Khomeini Higher Education Center , Agricultural Research , Education and Extension Organization (AREEO) , Karaj , Iran
| | - Saeid Ahmadzadeh
- Pharmaceutics Research Center , Institute of Neuropharmacology , Kerman University of Medical Sciences , Kerman , Iran . ;
| | - Somayyeh Karami-Mohajeri
- Department of Toxicology & Pharmacology , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
| | - Yaghoub Pourshojaei
- Department of Medicinal Chemistry , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
| | - Hamid Reza Rahimi
- Pharmaceutics Research Center , Institute of Neuropharmacology , Kerman University of Medical Sciences , Kerman , Iran . ;
- Department of Toxicology & Pharmacology , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
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Tong Y, Huang X, Lu M, Yu BY, Tian J. Prediction of Drug-Induced Nephrotoxicity with a Hydroxyl Radical and Caspase Light-Up Dual-Signal Nanoprobe. Anal Chem 2018; 90:3556-3562. [DOI: 10.1021/acs.analchem.7b05454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Yuling Tong
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of TCM Evaluation and Translational Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, P.R. China
| | - Xitong Huang
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of TCM Evaluation and Translational Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, P.R. China
| | - Mi Lu
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of TCM Evaluation and Translational Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, P.R. China
| | - Bo-Yang Yu
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of TCM Evaluation and Translational Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, P.R. China
| | - Jiangwei Tian
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of TCM Evaluation and Translational Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, P.R. China
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