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Oikonomou G, Bothou A, Eirini O, Daglas M, Iliadou M, Antoniou E, Palaska E. Breastfeeding and its Association with Breast Cancer: a Systematic Review of the Literature. MAEDICA 2024; 19:106-115. [PMID: 38736915 PMCID: PMC11079727 DOI: 10.26574/maedica.2021.19.1.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Objective:Breast cancer is a global public health issue. The disease can be diagnosed in both older and younger women, with the latter facing several dilemmas. Breastfeeding is of general concern to the scientific community as well as its connection with the prevention of breast cancer is being sought. The purpose of this review is to search for studies investigating the relationship between breast cancer and breastfeeding. Material and methods: The articles included in the present paper were searched in PubMed and Scopus databases according to PRISMA guidelines for systematic reviews. This systematic review sought primary studies investigating the relationship between breastfeeding and breast cancer and that were published in English between 2017-2022. Results:Seventeen articles that investigated the relationship of breast cancer with lactation duration, women's age, family history and lifestyle were included in the present review. Conclusion:It was found that, in most studies, breastfeeding could be evaluated as a protective factor of the disease. From all studied articles, the need for the design of additional studies investigating the relationship between breastfeeding and breast cancer emerges.
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Affiliation(s)
| | - Anastasia Bothou
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Orovou Eirini
- Department of Midwifery, University of Western Macedonia, Ptolemaida, Greece
| | - Maria Daglas
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | | | - Ermioni Palaska
- Department of Midwifery, University of West Attica, Egaleo, Greece
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Yun WJ, Xue H, Yang N, Xiao LJ, Sun HZ, Zheng HC. Oncogenic roles of GPR176 in breast cancer: a potential marker of aggressiveness and a potential target of gene therapy. Clin Transl Oncol 2023; 25:3042-3056. [PMID: 37079213 PMCID: PMC10462518 DOI: 10.1007/s12094-023-03174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/26/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Belonging to the G-protein coupled receptor 1 family, G protein-coupled receptor 176 (GPR176) is associated with the Gz/Gx G-protein subclass and is capable of decreasing cAMP production. METHODS GPR176 expression was detected by qRT-PCR, bioinformatics analysis, Western blot and immunohistochemistry, and compared with clinicopathological characteristics of breast cancer. GPR176-related genes and pathways were subjected to bioinformatic analysis. We also explored the effects of GPR176 on the phenotypes of breast cancer cells. RESULTS Lower expression of GPR176 mRNA was seen in breast cancer than in normal tissues, but the opposite pattern was found for its protein (p < 0.05). GPR176 mRNA was associated with female sex, low T staging, non-Her-2+ subtypes, non-mutant p53 status in breast cancer (p < 0.05). GPR176 methylation was negatively correlated with its mRNA level and T staging in breast cancer, and was higher in breast cancer than normal tissues (p < 0.05). GPR176 protein expression was positively correlated with older age, small tumor size, and non-luminal-B subtype of breast cancers (p < 0.05). The differential genes of GPR176 were involved in receptor-ligand interaction, RNA maturation, and so forth (p < 0.05). GPR176-related genes were categorized into cell mobility, membrane structure, and so on (p < 0.05). GPR176 knockdown weakened the proliferation, glucose catabolism, anti-apoptosis, anti-pyroptosis, migration, invasion, and epithelial-mesenchymal transition of breast cancer cells. CONCLUSION These results indicate that GPR176 might be involved in the tumorigenesis and subsequent progression of breast cancer by deteriorating aggressive phenotypes. It might be utilized as a potential biomarker to indicate the aggressive behaviors and poor prognosis of breast cancer and a potential target of genetic therapy.
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Affiliation(s)
- Wen-Jing Yun
- Department of Oncology and Central Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, China
| | - Hang Xue
- Department of Oncology and Central Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, China
| | - Ning Yang
- Department of Oncology and Central Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, China
| | - Li-Jun Xiao
- Department of Immunology, Basic Medical College of Chengde Medical University, Chengde, 067000, China
| | - Hong-Zhi Sun
- Cancer Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, China
| | - Hua-Chuan Zheng
- Department of Oncology and Central Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, China.
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Oma D, Teklemariam M, Seifu D, Desalegn Z, Anberbir E, Abebe T, Mequannent S, Tebeje S, Labisso WL. Immunohistochemistry versus PCR Technology for Molecular Subtyping of Breast Cancer: Multicentered Expereinces from Addis Ababa, Ethiopia. J Cancer Prev 2023; 28:64-74. [PMID: 37434799 PMCID: PMC10331035 DOI: 10.15430/jcp.2023.28.2.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 07/13/2023] Open
Abstract
The application of immunohistochemistry (IHC) for molecular characterization of breast cancer (BC) is of paramount importance; however, it is not universally standardized, subject to observer variability and quantifying is a challenge. An alternative molecular technology, such as endpoint reverse transcription (RT)-PCR gene expression analysis, may improve observer variability and diagnostic accuracy. This study was intended to compare IHC with the RT-PCR based technique and assess the potential of RT-PCR for molecular subtyping of BC. In this comparative cross-sectional study, 54 BC tissues were collected from three public hospitals in Addis Ababa and shipped to Gynaecology department at Martin-Luther University (Germany) for laboratory analysis. Only 41 samples were qualified for IHC and RT-PCR investigation of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 protein expression analysis. Kappa statistics was used to assess the concordance between the two techniques. The overall percent agreement between RT-PCR and IHC was 68.3% for ER (positive percent agreement [PPA] 71.1%; negative percent agreement [NPA] 33.3%), 39.0% for PR (PPA 14.3%; NPA 92.3%), and 82.9% for HER2 (PPA 62.5%; NPA 87.9%). Cohen's κ-values of 0.018 (< 0.20), 0.045 (< 0.200), and 0.481 (0.41-0.60) were generated for ER, PR, and HER2, respectively. Concordance for molecular subtypes was only 56.1% (23/41) and 0.20 kappa value. IHC and endpoint RT-PCR techniques have shown to be discordant for 43% samples. Molecular subtyping using endpoint RT-PCR was fairly concordant with IHC. Thus, endpoint RT-PCR may give an objective result, and can be applied for BC subtyping.
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Affiliation(s)
- Dessiet Oma
- Department of Medical Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria Teklemariam
- Department of Medical Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Seifu
- Department of Biochemistry, University of Global Health Equity, Kigali, Rwanda
| | - Zelalem Desalegn
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Endale Anberbir
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Mequannent
- Department of Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Tebeje
- Department of Medical Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wajana Lako Labisso
- Department of Pathology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mwangi KW, Kamita MK, Waweru JW, Sayed S, Figueroa JD, Ambs S, Cios KJ, Blanck G, Makokha FW. Adaptive immune receptor features related to breast cancer tissue in Kenyan patients: high immunoglobulin gene expression and high levels of gamma-delta T-cells. Breast Cancer Res Treat 2023; 199:207-214. [PMID: 36882607 PMCID: PMC10687744 DOI: 10.1007/s10549-023-06897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Characterization of the breast cancer (BC) immune response may provide information for a point of intervention, such as application of immunotherapeutic treatments. In this study, we sought to recover and characterize the adaptive immune receptor (IR) recombination reads from genomics files representing Kenyan patients, to better understand the immune response specifically related to those patients. METHODS We used a previously applied algorithm and software to obtain productive IR recombination reads from cancer and adjacent normal tissue samples representing 22 Kenyan BC patients. RESULTS From both the RNAseq and exome files, there were significantly more T-cell receptor (TCR) recombination reads recovered from tumor samples compared to marginal tissue samples. Also, the immunoglobulin (IG) genes were expressed at a much higher level than the TCR genes (p-value = 0.0183) in the tumor samples. And, the tumor IG CDR3s consistently represented more positively charged amino acid R-groups, in comparison to the marginal tissue, IG CDR3s. CONCLUSION For Kenyan patients, a high level of IG expression, representing specific CDR3 chemistries, was associated with BC. These results lay the foundation for studies that could support specific immunotherapeutic interventions for Kenyan BC patients.
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Affiliation(s)
- Kennedy W Mwangi
- Directorate of Research & Innovation, Mount Kenya University, Thika, Kenya
| | - Moses K Kamita
- Directorate of Research & Innovation, Mount Kenya University, Thika, Kenya
| | | | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Jonine D Figueroa
- Usher Institute and the Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Stefan Ambs
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Konrad J Cios
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Bd. MDC7, Tampa, FL, 33612, USA
| | - George Blanck
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Bd. MDC7, Tampa, FL, 33612, USA.
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA.
| | - Francis W Makokha
- Directorate of Research & Innovation, Mount Kenya University, Thika, Kenya
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Sayed S, Koka H, Abubakar M, Gardner K, Salgado R, Moloo Z, Caban-Ureña AB, Rosen D, Castro P, Saleh M, Shaikh AJ, Shah J, Figueroa J, Makokha F, Ha HK, Wang Z, Magangane P, Naidoo R, Ngundo V, Yang XR, Govender D. Tumour Infiltrating Lymphocytes (TILs) and immune composition in breast cancer patients from Kenya: Spatial distributions and associations with risk factors and tumour characteristics. Breast Cancer Res Treat 2023; 199:401-413. [PMID: 37010652 DOI: 10.1007/s10549-023-06921-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The immune landscape of breast cancer (BC) in patients from Sub Saharan Africa is understudied. Our aims were to describe the distribution of Tumour Infiltrating Lymphocytes (TILs) within the intratumoural stroma (sTILs) and the leading/invasive edge stroma (LE-TILs), and to evaluate TILs across BC subtypes with established risk factors and clinical characteristics in Kenyan women. METHODS Visual quantification of sTILs and LE-TILs were performed on Haematoxylin and eosin -stained pathologically confirmed BC cases based on the International TIL working group guidelines. Tissue Microarrays were constructed and stained with immunohistochemistry (IHC) for CD3, CD4, CD8, CD68, CD20, and FOXP3. Linear and logistic regression models were used to assess associations between risk factors and tumour features with IHC markers and total TILs, after adjusting for other covariates. RESULTS A total of 226 invasive BC cases were included. Overall, LE-TIL (mean = 27.9, SD = 24.5) proportions were significantly higher than sTIL (mean = 13.5, SD = 15.8). Both sTILs and LE- TILs were predominantly composed of CD3, CD8, and CD68. We found higher TILs to be associated with high KI67/high grade and aggressive tumour subtypes, although these associations varied by TIL locations. Older age at menarche (≥ 15 vs. < 15 years) was associated with higher CD3 (OR: 2.06, 95%CI:1.26-3.37), but only for the intra-tumour stroma. CONCLUSION The TIL enrichment in more aggressive BCs is similar to previously published data in other populations. The distinct associations of sTIL/LE-TIL measures with most examined factors highlight the importance of spatial TIL evaluations in future studies.
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Affiliation(s)
- Shahin Sayed
- Department of Pathology, Aga Khan University, East Africa, P.O Box30270- 00100, Nairobi, Kenya.
- Division of Anatomical Pathology, University of Cape Town, Cape Town, South Africa.
| | - Hela Koka
- Integrative Tumour Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mustapha Abubakar
- Integrative Tumour Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kevin Gardner
- Department of Pathology and Cell Biology, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Roberto Salgado
- Department of Pathology/Division of Research, Peter MacCallum Cancer, Melbourne, VIC, 3000, Australia
- Department of Pathology, GZA-ZNA Hospitals, Wilrijk, Antwerp, Belgium
- Department of Pathology, ZAS Hospitals, Antwerp, Belgium
| | - Zahir Moloo
- Department of Pathology, Aga Khan University, East Africa, P.O Box30270- 00100, Nairobi, Kenya
| | - Ambar Beatriz Caban-Ureña
- Department of Pathology and Cell Biology, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Daniel Rosen
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - Patricia Castro
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - Mansoor Saleh
- Department of Pathology, Aga Khan University, East Africa, P.O Box30270- 00100, Nairobi, Kenya
| | - Asim Jamal Shaikh
- Department of Pathology, Aga Khan University, East Africa, P.O Box30270- 00100, Nairobi, Kenya
- Comprehensive Cancer Care and Research, Sultan Qaboos Comprehensive Cancer Care and Research Institute, Muscat, Oman
| | - Jasmit Shah
- Department of Pathology, Aga Khan University, East Africa, P.O Box30270- 00100, Nairobi, Kenya
| | - Jonine Figueroa
- The Usher Institute and CRUK Edinburgh Cancer Centre, The University of Edinburgh, Edinburgh, Scotland
| | - Francis Makokha
- Department of Human Health Research Programme, Mount Kenya University, Thika, Kenya
| | - Hien Khanh Ha
- Department of Biochemistry, University of Alberta, Edmonton, Canada
| | - Zhong Wang
- Department of Pathology and Cell Biology, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Pumza Magangane
- Department of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Richard Naidoo
- Division of Anatomical Pathology, University of Cape Town, Cape Town, South Africa
| | - Veronica Ngundo
- Department of Pathology, Aga Khan University, East Africa, P.O Box30270- 00100, Nairobi, Kenya
| | - Xiaohong Rose Yang
- Integrative Tumour Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dhirendra Govender
- Division of Anatomical Pathology, University of Cape Town, Cape Town, South Africa
- PathCare, Cape Town, South Africa
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Cosar R, Sut N, Ozen A, Tastekin E, Topaloglu S, Cicin I, Nurlu D, Ozler T, Demir S, Yıldız G, Şenödeyici E, Uzal MC. Breast Cancer Subtypes and Prognosis: Answers to Subgroup Classification Questions, Identifying the Worst Subgroup in Our Single-Center Series. BREAST CANCER: TARGETS AND THERAPY 2022; 14:259-280. [PMID: 36105268 PMCID: PMC9467695 DOI: 10.2147/bctt.s380754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Rusen Cosar
- Department of Radiation Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
- Correspondence: Rusen Cosar, Trakya University, Faculty of Medicine, Department of Radiation Oncology, Edirne, Turkey, Tel +902842361074, Email
| | - Necdet Sut
- Department of Biostatistics and Medical Informatics Trakya University Medical Faculty, Edirne, Turkey
| | - Alaattin Ozen
- Department of Radiation Oncology, Eskisehir University Faculty of Medicine, Eskisehir, Turkey
| | - Ebru Tastekin
- Department of Pathology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Sernaz Topaloglu
- Department of Medical Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Irfan Cicin
- Department of Medical Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Dilek Nurlu
- Department of Radiation Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Talar Ozler
- Department of Radiation Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Seda Demir
- Department of Radiation Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Gokay Yıldız
- Department of Radiation Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
| | | | - Mustafa Cem Uzal
- Department of Radiation Oncology, Istanbul Arel University Faculty of Medicine, Istanbul, Turkey
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Rweyemamu LP, Akan G, Adolf IC, Magorosa EP, Mosha IJ, Dharsee N, Namkinga LA, Lyantagaye SL, Nateri AS, Atalar F. The distribution of reproductive risk factors disclosed the heterogeneity of receptor-defined breast cancer subtypes among Tanzanian women. BMC Womens Health 2021; 21:423. [PMID: 34930226 PMCID: PMC8686374 DOI: 10.1186/s12905-021-01536-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background Recent epidemiological studies suggest that reproductive factors are associated with breast cancer (BC) molecular subtypes. However, these associations have not been thoroughly studied in the African populations. The present study aimed to investigate the prevalence of BC molecular subtypes and assess their association with reproductive factors in Tanzanian BC patients. Methods This hospital-based case-only cross-sectional study consisted of 263 histologically confirmed BC patients in Tanzania. Clinico-pathological data, socio-demographic characteristics, anthropometric measurements, and reproductive risk factors were examined using the Chi-square test and one-way ANOVA. The association among reproductive factors and BC molecular subtypes was analyzed using multinomial logistic regression. The heterogeneity of the associations was assessed using the Wald test. Results We found evident subtype heterogeneity for reproductive factors. We observed that post-menopausal status was more prevalent in luminal-A subtype, while compared to luminal-A subtype, luminal-B and HER-2 enriched subtypes were less likely to be found in post-menopausal women (OR: 0.21, 95%CI 0.10–0.41, p = 0.001; OR: 0.39, 95%CI 0.17–0.89, p = 0.026, respectively). Also, the luminal-B subtype was more likely to be diagnosed in patients aged ≤ 40 years than the luminal-A subtype (OR: 2.80, 95%CI 1.46–5.32, p = 0.002). Women who had their first full-term pregnancy at < 30 years were more likely to be of luminal-B (OR: 2.71, 95%CI 1.18–4.17, p = 0.018), and triple-negative (OR: 2.28, 95%CI 1.02–4.07, p = 0.044) subtypes relative to luminal-A subtype. Furthermore, we observed that breastfeeding might have reduced odds of developing luminal-A, luminal-B and triple-negative subtypes. Women who never breastfed were more likely to be diagnosed with luminal-B and triple-negative subtypes when compared to luminal-A subtype (OR: 0.46, 95%CI 0.22–0.95, p = 0.035; OR: 0.41, 95%CI 0.20–0.85, p = 0.017, respectively). . Conclusion Our results are the first data reporting reproductive factors heterogeneity among BC molecular subtypes in Tanzania. Our findings suggest that breast-feeding may reduce the likelihood of developing luminal-A, luminal-B, and triple-negative subtypes. Meanwhile, the first full-term pregnancy after 30 years of age could increase the chance of developing luminal-A subtype, a highly prevalent subtype in Tanzania. More interventions to promote modifiable risk factors across multiple levels may most successfully reduce BC incidence in Africa. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01536-6.
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Affiliation(s)
- Linus P Rweyemamu
- Department of Molecular Biology and Biotechnology, University of Dar es Salaam, P.O Box 35179, Dar es Salaam, Tanzania.,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P.O Box 608, Mbeya, Tanzania
| | - Gokce Akan
- MUHAS Genetic Laboratory, Department of Biochemistry, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Ismael C Adolf
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P.O Box 608, Mbeya, Tanzania
| | - Erick P Magorosa
- Department of Anatomical Pathology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Innocent J Mosha
- Department of Anatomical Pathology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Nazima Dharsee
- Academic, Research and Consultancy Unit, Ocean Road Cancer Institute, P.O Box 3592, Dar es Salaam, Tanzania
| | - Lucy A Namkinga
- Department of Molecular Biology and Biotechnology, University of Dar es Salaam, P.O Box 35179, Dar es Salaam, Tanzania
| | - Sylvester L Lyantagaye
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P.O Box 608, Mbeya, Tanzania
| | - Abdolrahman S Nateri
- Cancer Genetics and Stem Cell Group, Division of Cancer and Stem Cells, School of Medicine, BioDiscovery Institute, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Fatmahan Atalar
- MUHAS Genetic Laboratory, Department of Biochemistry, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania. .,Department of Rare Diseases, Child Health Institute, Istanbul University, Istanbul, 34093, Turkey.
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