1
|
Genua I, Miñambres I, Puig R, Sardà H, Fernández-Ananin S, Sánchez-Quesada JL, Pérez A. Weight loss benefits on HDL cholesterol persist even after weight regaining. Surg Endosc 2024; 38:3320-3328. [PMID: 38684527 DOI: 10.1007/s00464-024-10826-7] [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: 11/09/2023] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Obesity-related comorbidities may relapse in patients with weight regain after bariatric surgery. However, HDL cholesterol (HDLc) levels increase after surgery and seem to remain stable despite a gradual increase in BMI. The aim of this study is to analyze the effects of weight regain after bariatric surgery on HDL cholesterol. MATERIALS AND METHODS This is a retrospective, observational, cohort study in patients who underwent bariatric surgery in the Hospital de la Santa Creu i Sant Pau (Barcelona) between 2007 and 2015. Patients without at least 5 years of follow-up after surgery, under fibrate treatment, and those who required revisional surgery were excluded from the analysis. Data were collected at baseline, 3 and 6 months after surgery, and then annually until 5 years post-surgery. RESULTS One hundred fifty patients were analyzed. 93.3% of patients reached > 20% of total weight loss after surgery. At 5th year, 37% of patients had regained > 15% of nadir weight, 60% had regained > 10%, and 22% had regained < 5% of nadir weight. No differences were found in HDLc levels between the different groups of weight regain, nor in the % of change in HDLc levels between nadir weight and 5 years, or in the proportion of patients with normal HDLc concentrations either. CONCLUSION HDLc remains stable regardless of weight regain after bariatric surgery.
Collapse
Affiliation(s)
- Idoia Genua
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Inka Miñambres
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain.
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Rocío Puig
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain
| | - Helena Sardà
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sonia Fernández-Ananin
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
- Unit of Esophagogastric and Bariatric and Metabolic Surgery, Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Luis Sánchez-Quesada
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Cardiovascular Biochemistry Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Antonio Pérez
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain.
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| |
Collapse
|
2
|
Hafiane A. Adiponectin-mediated regulation of the adiponectin cascade in cardiovascular disease: Updates. Biochem Biophys Res Commun 2024; 694:149406. [PMID: 38134479 DOI: 10.1016/j.bbrc.2023.149406] [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: 08/08/2023] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
The endocrine function of white adipose tissue is characterized by the synthesis of one its main hormones: adiponectin. Although the biological role of adiponectin has not been fully defined, clinical and experimental observations have shown that low plasma concentrations of adiponectin participate in the prevalence of insulin resistance and cardiovascular diseases, mainly in obese patients. Adiponectin also exerts its effects on the heart and blood vessels, thereby influencing their physiology. Studying the effects of adiponectin presents some complexities, primarily due to potential cross-interactions and interference with other pathways, such as the AdipoR1/R2 pathways. Under optimal conditions, the activation of the adiponectin cascade may involve signals such as AMPK and PPARα. Interestingly, these pathways may trigger similar responses, such as fatty acid oxidation. Understanding the downstream effectors of these pathways is crucial to comprehend the extent to which adiponectin signaling impacts metabolism. In this review, the aim is to explore the current mechanisms that regulate the adiponectin pathways. Additionally, updates on the major downstream factors involved in adiponectin signaling are provided, specifically in relation to metabolic syndrome and atherosclerosis.
Collapse
Affiliation(s)
- Anouar Hafiane
- Research Institute, McGill University Health Center, Montreal, QC, Canada.
| |
Collapse
|
3
|
Denimal D, Monier S, Bouillet B, Vergès B, Duvillard L. High-Density Lipoprotein Alterations in Type 2 Diabetes and Obesity. Metabolites 2023; 13:metabo13020253. [PMID: 36837872 PMCID: PMC9967905 DOI: 10.3390/metabo13020253] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Alterations affecting high-density lipoproteins (HDLs) are one of the various abnormalities observed in dyslipidemia in type 2 diabetes mellitus (T2DM) and obesity. Kinetic studies have demonstrated that the catabolism of HDL particles is accelerated. Both the size and the lipidome and proteome of HDL particles are significantly modified, which likely contributes to some of the functional defects of HDLs. Studies on cholesterol efflux capacity have yielded heterogeneous results, ranging from a defect to an improvement. Several studies indicate that HDLs are less able to inhibit the nuclear factor kappa-B (NF-κB) proinflammatory pathway, and subsequently, the adhesion of monocytes on endothelium and their recruitment into the subendothelial space. In addition, the antioxidative function of HDL particles is diminished, thus facilitating the deleterious effects of oxidized low-density lipoproteins on vasculature. Lastly, the HDL-induced activation of endothelial nitric oxide synthase is less effective in T2DM and metabolic syndrome, contributing to several HDL functional defects, such as an impaired capacity to promote vasodilatation and endothelium repair, and difficulty counteracting the production of reactive oxygen species and inflammation.
Collapse
Affiliation(s)
- Damien Denimal
- INSERM, UMR1231, University of Burgundy, 21000 Dijon, France
- Department of Biochemistry, CHU Dijon Bourgogne, 21000 Dijon, France
- Correspondence:
| | - Serge Monier
- INSERM, UMR1231, University of Burgundy, 21000 Dijon, France
| | - Benjamin Bouillet
- INSERM, UMR1231, University of Burgundy, 21000 Dijon, France
- Department of Endocrinology and Diabetology, CHU Dijon Bourgogne, 21000 Dijon, France
| | - Bruno Vergès
- INSERM, UMR1231, University of Burgundy, 21000 Dijon, France
- Department of Endocrinology and Diabetology, CHU Dijon Bourgogne, 21000 Dijon, France
| | - Laurence Duvillard
- INSERM, UMR1231, University of Burgundy, 21000 Dijon, France
- Department of Biochemistry, CHU Dijon Bourgogne, 21000 Dijon, France
| |
Collapse
|
4
|
Alizadeh F, Mirzaie Bavil F, Keyhanmanesh R, Lotfi H, Ghiasi F. Association of pro-inflammatory cytokines, inflammatory proteins with atherosclerosis index in obese male subjects. Horm Mol Biol Clin Investig 2023:hmbci-2022-0022. [PMID: 36592952 DOI: 10.1515/hmbci-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/19/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Investigation the association of pro-inflammatory markers interleukin (IL)-1β and IL- 10 expression, serum levels of C-reactive protein (CRP), cyclooxygenase-2 (COX2), High-density lipoprotein (HDL), Apolipoprotein A1 (ApoA1), and ATP Binding Cassette Subfamily A Member 1 (ABCA1) inflammatory proteins with atherosclerosis index (homocysteine) in normal-weight and obese male subjects. METHODS 59 males including 30 obese (Body mass index (BMI) of ≥30 kg/m2) and 29 normal-weight (BMI of 18.5-24.9 kg/m2) were joined to this study. Plasma levels of IL-1β and IL-10 (pg/mL), CRP (pg/mL), COX-2 (ng/mL), APOA1 (mg/dL), ABCA1 (ng/mL), HDL, Cholesterol, and Triglyceride (TG) (mg/dL), and homocysteine (µmol/L) was measured. Association of these biomarkers with homocysteine was determined. RESULTS Obese subjects had higher serum levels of IL10, IL1β, CRP, COX-2, TG, and cholesterol concentrations (all p<0.05 except IL-10 and cholesterol) and low levels of HDL, APOA1, and ABCA1 (non-significant differences) in comparison to normal-weight group. Homocysteine levels were high in obese men with no significant differences between the two groups. In obese subjects, homocysteine had a significant inverse correlation with APOA1, ABCA1, and HDL, and a strong and moderate positive correlation was found with CRP and TG levels, respectively. CONCLUSIONS High level of homocysteine and its correlation with inflammation proteins and markers in obese subjects appear to be contributed with atherosclerosis development.
Collapse
Affiliation(s)
- Farhad Alizadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Mirzaie Bavil
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rana Keyhanmanesh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hajie Lotfi
- Cellular and Molecular Research Center, Research Institute for prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran.,Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fariba Ghiasi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
5
|
Mitu I, Dimitriu CD, Preda C, Mitu O, Costache II, Miftode RȘ, Ciocoiu M. The Importance of HDL-Cholesterol and Fat-Free Percentage as Protective Markers in Risk Factor Hierarchy for Patients with Metabolic Syndrome. Metabolites 2022; 12:metabo12121217. [PMID: 36557255 PMCID: PMC9784319 DOI: 10.3390/metabo12121217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
This research focused on establishing a hierarchy concerning the influence of various biological markers and body composition parameters on preventing, diagnosing and managing Metabolic Syndrome (MetS). Our cross-sectional cohort study included 104 subjects without any atherosclerotic antecedent pathology, organized in two groups (with and without MetS). All participants underwent clinical and anthropometric measurements, DEXA investigation and blood tests for all MetS criteria, together with adiponectin, leptin, insulin, uric acid and CRP. Based on mathematical logic, we calculated a normalized sensitivity score to compare the predictive power of biomarkers and parameters associated with MetS, upon the prevalence of MetS. Patients with MetS report higher levels of uric acid (p = 0.02), CRP (p = 0.012) and lower levels of adiponectin (p = 0.025) than patients without MetS. The top three biological markers with the highest predictive power of the prevalence of the disease are HDL, insulin, and adiponectin:leptin ratio, and the top three body composition parameters are trunk fat-free percentage, waist-height ratio and trunk fat percentage. Their high sensitivity scores differentiate them from all the other markers analysed in the study. Our findings report relevant scores for estimating the importance of cardiometabolic risks in the prevalence of MetS. The high rank of protective markers, HDL and trunk fat-free percentage, suggest that positive effects have a stronger association with the prevalence of MetS, than negative ones do. Therefore, this risk stratification study provides important support for prevention and management programs regarding MetS.
Collapse
Affiliation(s)
- Ivona Mitu
- Department of Morpho-Functional Sciences II, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Cristina-Daniela Dimitriu
- Department of Morpho-Functional Sciences II, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Cristina Preda
- Department of Endocrinology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Ovidiu Mitu
- 1st Medical Department, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Correspondence: (O.M.); (R.-Ș.M.); Tel.: +40-745279714 (O.M.)
| | - Irina-Iuliana Costache
- 1st Medical Department, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Radu-Ștefan Miftode
- 1st Medical Department, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Correspondence: (O.M.); (R.-Ș.M.); Tel.: +40-745279714 (O.M.)
| | - Manuela Ciocoiu
- Department of Morpho-Functional Sciences II, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| |
Collapse
|
6
|
Dietrich E, Jomard A, Osto E. Crosstalk between high-density lipoproteins and endothelial cells in health and disease: Insights into sex-dependent modulation. Front Cardiovasc Med 2022; 9:989428. [PMID: 36304545 PMCID: PMC9594152 DOI: 10.3389/fcvm.2022.989428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022] Open
Abstract
Atherosclerotic cardiovascular disease is the leading cause of death worldwide. Intense research in vascular biology has advanced our knowledge of molecular mechanisms of its onset and progression until complications; however, several aspects of the patho-physiology of atherosclerosis remain to be further elucidated. Endothelial cell homeostasis is fundamental to prevent atherosclerosis as the appearance of endothelial cell dysfunction is considered the first pro-atherosclerotic vascular modification. Physiologically, high density lipoproteins (HDLs) exert protective actions for vessels and in particular for ECs. Indeed, HDLs promote endothelial-dependent vasorelaxation, contribute to the regulation of vascular lipid metabolism, and have immune-modulatory, anti-inflammatory and anti-oxidative properties. Sex- and gender-dependent differences are increasingly recognized as important, although not fully elucidated, factors in cardiovascular health and disease patho-physiology. In this review, we highlight the importance of sex hormones and sex-specific gene expression in the regulation of HDL and EC cross-talk and their contribution to cardiovascular disease.
Collapse
Affiliation(s)
- Elisa Dietrich
- Institute for Clinical Chemistry, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Anne Jomard
- Institute for Clinical Chemistry, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Elena Osto
- Institute for Clinical Chemistry, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, Heart Center, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
7
|
The Role of Adiponectin in the Resolution of Male-Obesity-Associated Secondary Hypogonadism after Metabolic Surgery and Its Impact on Cardiovascular Risk. Biomedicines 2022; 10:biomedicines10082000. [PMID: 36009547 PMCID: PMC9405896 DOI: 10.3390/biomedicines10082000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
Male-obesity-associated secondary hypogonadism (MOSH) is a very prevalent entity that may resolve after marked weight loss. Adiponectin (APN) is an adipokine with anti-inflammatory properties that regulates metabolism. Low-circulating APN is associated with obesity, diabetes, and cardiovascular risk, along with circulating testosterone. We aimed to evaluate APN changes in men with MOSH (low circulating free testosterone (FT) with low or normal gonadotropins) and without it after metabolic surgery. We look for their possible association with cardiovascular risk measured by carotid intima-media thickness (cIMT). We included 60 men (20 submitted to lifestyle modification, 20 to sleeve gastrectomy, and 20 to gastric bypass) evaluated at baseline and 6 months after. The increase in APN at follow-up was reduction in patients with persistent MOSH (n = 10) vs. those without MOSH (n = 30) and MOSH resolution (n = 20), and the former did not achieve a decrease in cIMT. The increase in APN correlated positively with FT (r = 0.320, p = 0.013) and inversely with cIMT (r = −0.283, p = 0.028). FT inversely correlated with cIMT (r = −0.269, p = 0.038). In conclusion, men without MOSH or with MOSH resolution showed a high increase in APN after weight loss with beneficial effects on cIMT. Those without MOSH resolution failed to attain these effects.
Collapse
|
8
|
Zocchi M, Della Porta M, Lombardoni F, Scrimieri R, Zuccotti GV, Maier JA, Cazzola R. A Potential Interplay between HDLs and Adiponectin in Promoting Endothelial Dysfunction in Obesity. Biomedicines 2022; 10:biomedicines10061344. [PMID: 35740366 PMCID: PMC9220412 DOI: 10.3390/biomedicines10061344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 12/11/2022] Open
Abstract
Obesity is an epidemic public health problem that has progressively worsened in recent decades and is associated with low-grade chronic inflammation (LGCI) in metabolic tissues and an increased risk of several diseases. In particular, LGCI alters metabolism and increases cardiovascular risk by impairing endothelial function and altering the functions of adiponectin and high-density lipoproteins (HDLs). Adiponectin is an adipokine involved in regulating energy metabolism and body composition. Serum adiponectin levels are reduced in obese individuals and negatively correlate with chronic sub-clinical inflammatory markers. HDLs are a heterogeneous and complex class of lipoproteins that can be dysfunctional in obesity. Adiponectin and HDLs are strictly interdependent, and the maintenance of their interplay is essential for vascular function. Since such a complex network of interactions is still overlooked in clinical settings, this review aims to highlight the mechanisms involved in the impairment of the HDLs/adiponectin axis in obese patients to predict the risk of cardiovascular diseases and activate preventive countermeasures. Here, we provide a narrative review of the role of LGCI in altering HDLs, adiponectin and endothelial functions in obesity to encourage new studies about their synergic effects on cardiovascular health and disease.
Collapse
Affiliation(s)
- Monica Zocchi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (M.Z.); (M.D.P.); (F.L.); (R.S.); (G.V.Z.); (J.A.M.)
| | - Matteo Della Porta
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (M.Z.); (M.D.P.); (F.L.); (R.S.); (G.V.Z.); (J.A.M.)
| | - Federico Lombardoni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (M.Z.); (M.D.P.); (F.L.); (R.S.); (G.V.Z.); (J.A.M.)
| | - Roberta Scrimieri
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (M.Z.); (M.D.P.); (F.L.); (R.S.); (G.V.Z.); (J.A.M.)
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (M.Z.); (M.D.P.); (F.L.); (R.S.); (G.V.Z.); (J.A.M.)
- Department of Pediatrics, Ospedale dei Bambini, 20154 Milan, Italy
| | - Jeanette A. Maier
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (M.Z.); (M.D.P.); (F.L.); (R.S.); (G.V.Z.); (J.A.M.)
| | - Roberta Cazzola
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (M.Z.); (M.D.P.); (F.L.); (R.S.); (G.V.Z.); (J.A.M.)
- Correspondence:
| |
Collapse
|
9
|
Thakkar H, Vincent V, Shukla S, Sra M, Kanga U, Aggarwal S, Singh A. Correction to: Improvements in cholesterol efux capacity of HDL and adiponectin contribute to mitigation in cardiovascular disease risk after bariatric surgery in a cohort with morbid obesity. Diabetol Metab Syndr 2021; 13:67. [PMID: 34127065 PMCID: PMC8204477 DOI: 10.1186/s13098-021-00684-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
Collapse
Affiliation(s)
- Himani Thakkar
- Department of Biochemistry, All India Institute of Medical Sciences, Room No. 3044, New Delhi, 110029, India
| | - Vinnyfred Vincent
- Department of Biochemistry, All India Institute of Medical Sciences, Room No. 3044, New Delhi, 110029, India
| | - Sakshi Shukla
- Department of Biochemistry, All India Institute of Medical Sciences, Room No. 3044, New Delhi, 110029, India
| | - Manraj Sra
- All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kanga
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Archna Singh
- Department of Biochemistry, All India Institute of Medical Sciences, Room No. 3044, New Delhi, 110029, India.
| |
Collapse
|