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Petitjean K, Verres Y, Bristeau S, Ribault C, Aninat C, Olivier C, Leroyer P, Ropert M, Loréal O, Herault O, Amalric L, Baran N, Fromenty B, Corlu A, Loyer P. Low concentrations of ethylene bisdithiocarbamate pesticides maneb and mancozeb impair manganese and zinc homeostasis to induce oxidative stress and caspase-dependent apoptosis in human hepatocytes. CHEMOSPHERE 2024; 346:140535. [PMID: 37923018 DOI: 10.1016/j.chemosphere.2023.140535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
The worldwide and intensive use of phytosanitary compounds results in environmental and food contamination by chemical residues. Human exposure to multiple pesticide residues is a major health issue. Considering that the liver is not only the main organ for metabolizing pesticides but also a major target of toxicities induced by xenobiotics, we studied the effects of a mixture of 7 pesticides (chlorpyrifos-ethyl, dimethoate, diazinon, iprodione, imazalil, maneb, mancozeb) often detected in food samples. Effects of the mixture was investigated using metabolically competent HepaRG cells and human hepatocytes in primary culture. We report the strong cytotoxicity of the pesticide mixture towards hepatocytes-like HepaRG cells and human hepatocytes upon acute and chronic exposures at low concentrations extrapolated from the Acceptable Daily Intake (ADI) of each compound. Unexpectedly, we demonstrated that the manganese (Mn)-containing dithiocarbamates (DTCs) maneb and mancozeb were solely responsible for the cytotoxicity induced by the mixture. The mechanism of cell death involved the induction of oxidative stress, which led to cell death by intrinsic apoptosis involving caspases 3 and 9. Importantly, this cytotoxic effect was found only in cells metabolizing these pesticides. Herein, we unveil a novel mechanism of toxicity of the Mn-containing DTCs maneb and mancozeb through their metabolization in hepatocytes generating the main metabolite ethylene thiourea (ETU) and the release of Mn leading to intracellular Mn overload and depletion in zinc (Zn). Alteration of the Mn and Zn homeostasis provokes the oxidative stress and the induction of apoptosis, which can be prevented by Zn supplementation. Our data demonstrate the hepatotoxicity of Mn-containing fungicides at very low doses and unveil their adverse effect in disrupting Mn and Zn homeostasis and triggering oxidative stress in human hepatocytes.
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Affiliation(s)
- Kilian Petitjean
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France
| | - Yann Verres
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France
| | - Sébastien Bristeau
- BRGM, Direction Eau, Environnement, Procédés et Analyses (DEPA), 3 Avenue Claude-Guillemin - BP 36009, 45060 Orléans Cedex 2, France
| | - Catherine Ribault
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France
| | - Caroline Aninat
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France
| | - Christophe Olivier
- Cancéropole Grand Ouest (CGO), NET "Niches and Epigenetics of Tumors" Network, 44000 Nantes, France; INSERM UMR 1232 CRCINA, 44000 Nantes-Angers, France; Faculty of Pharmaceutical and Biological Sciences, Nantes University, 44000 Nantes, France
| | - Patricia Leroyer
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France
| | - Martine Ropert
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France; AEM2 Platform, CHU Pontchaillou, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Olivier Loréal
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France
| | - Olivier Herault
- Cancéropole Grand Ouest (CGO), NET "Niches and Epigenetics of Tumors" Network, 44000 Nantes, France; Department of Biological Hematology, Tours University Hospital, 37000 Tours, France; CNRS ERL 7001 LNOx, EA 7501, Tours University, 37000 Tours, France; CNRS GDR3697 Micronit "Microenvironment of Tumor Niches", Tours, France
| | - Laurence Amalric
- BRGM, Direction Eau, Environnement, Procédés et Analyses (DEPA), 3 Avenue Claude-Guillemin - BP 36009, 45060 Orléans Cedex 2, France
| | - Nicole Baran
- BRGM, Direction Eau, Environnement, Procédés et Analyses (DEPA), 3 Avenue Claude-Guillemin - BP 36009, 45060 Orléans Cedex 2, France
| | - Bernard Fromenty
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France
| | - Anne Corlu
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France; Cancéropole Grand Ouest (CGO), NET "Niches and Epigenetics of Tumors" Network, 44000 Nantes, France.
| | - Pascal Loyer
- Inserm, INRAE, Univ Rennes, Institut NUMECAN (Nutrition Métabolismes et Cancer) UMR-A 1341, UMR-S 1317, F-35000 Rennes, France; Cancéropole Grand Ouest (CGO), NET "Niches and Epigenetics of Tumors" Network, 44000 Nantes, France.
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Garnier R. [Environmental and occupational risk factors for myelodysplastic syndrome]. Bull Cancer 2023; 110:1116-1128. [PMID: 37419729 DOI: 10.1016/j.bulcan.2023.02.024] [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: 11/18/2022] [Accepted: 02/03/2023] [Indexed: 07/09/2023]
Abstract
Chemotherapy and radiotherapy for a previous cancer can lead to subsequent myelodysplastic syndrome (MDS). However, these therapy-related cases are hypothesized to explain only 5 % of diagnosed MDS cases. Environmental or occupational exposure to chemicals or radiations has also been reported to be associated with higher risk of MDS. The present review analyses those studies evaluating the association of MDS with environmental or occupational risk factors. There is sufficient evidence that environmental or occupational exposure to ionizing radiation or benzene can cause MDS. Tobacco smoking is also a sufficiently documented riskfactor for MDS. A positive association has been reported between exposure to pesticides and MDS. However, there is only limited evidence that this association could be causal.
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Affiliation(s)
- Robert Garnier
- AP-HP, Hôpitaux universitaires Lariboisière-Fernand-Widal-Saint-Louis, Centre antipoison de Paris, FedTox, Paris, France.
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Shimomura Y, Sobue T, Zha L, Kitamura T, Iwasaki M, Inoue M, Yamaji T, Tsugane S, Sawada N. Association between meat, fish, and fatty acid intake and incidence of acute myeloid leukemia and myelodysplastic syndrome: the Japan Public Health Center-based Prospective Study. Environ Health Prev Med 2023; 28:19. [PMID: 36878605 PMCID: PMC10025862 DOI: 10.1265/ehpm.22-00233] [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: 09/30/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The association between meat, fish, or fatty acid intake and acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) has been investigated in a few studies, and the results were inconsistent. In addition, most studies are mainly based on the United States and European countries, in which the dietary patterns differ from that in Asia. Therefore, the risk of AML/MDS from meat, fish, or fatty acid intake in Asia requires further exploration. The aim of this study was to investigate the association between AML/MDS incidence and meat, fish, or fatty acid intake using the Japan Public Health Center-based prospective study. METHODS The present study included 93,366 participants who were eligible for analysis and followed up from the 5-year survey date until December 2012. We estimated the impact of their intake on AML/MDS incidence using a Cox proportional hazards model. RESULTS The study participants were followed up for 1,345,002 person-years. During the follow-up period, we identified 67 AML and 49 MDS cases. An increased intake of processed red meat was significantly associated with the incidence of AML/MDS, with a hazard ratio of 1.63 (95% confidence interval, 1.03-2.57) for the highest versus lowest tertile and a Ptrend of 0.04. Meanwhile, the intake of other foods and fatty acids was not associated with AML/MDS. CONCLUSION In this Japanese population, processed red meat was associated with an increased incidence of AML/MDS.
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Affiliation(s)
- Yoshimitsu Shimomura
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomotaka Sobue
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Ling Zha
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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DeStefano CB, Gibson SJ, Sperling AS, Richardson PG, Ghobrial I, Mo CC. The emerging importance and evolving understanding of clonal hematopoiesis in multiple myeloma. Semin Oncol 2022; 49:19-26. [DOI: 10.1053/j.seminoncol.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
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Low-Dose Pesticides Alter Primary Human Bone Marrow Mesenchymal Stem/Stromal Cells through ALDH2 Inhibition. Cancers (Basel) 2021; 13:cancers13225699. [PMID: 34830855 PMCID: PMC8616329 DOI: 10.3390/cancers13225699] [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: 09/20/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/25/2022] Open
Abstract
(1) Background: The impact of occupational exposure to high doses of pesticides on hematologic disorders is widely studied. Yet, lifelong exposure to low doses of pesticides, and more particularly their cocktail effect, although poorly known, could also participate to the development of such hematological diseases as myelodysplastic syndrome (MDS) in elderly patients. (2) Methods: In this study, a cocktail of seven pesticides frequently present in water and food (maneb, mancozeb, iprodione, imazalil, chlorpyrifos ethyl, diazinon and dimethoate), as determined by the European Food Safety Authority, were selected. Their in vitro effects at low-doses on primary BM-MSCs from healthy volunteers were examined. (3) Results: Exposure of normal BM-MSCs to pesticides for 21 days inhibited cell proliferation and promoted DNA damage and senescence. Concomitantly, these cells presented a decrease in aldehyde dehydrogenase 2 (ALDH2: mRNA, protein and enzymatic activity) and an increase in acetaldehyde levels. Pharmacological inhibition of ALDH2 with disulfiram recapitulated the alterations induced by exposure to low doses of pesticides. Moreover, BM-MSCs capacity to support primitive hematopoiesis was significantly altered. Similar biological abnormalities were found in primary BM-MSCs derived from MDS patients. (4) Conclusions: these results suggest that ALDH2 could participate in the pathophysiology of MDS in elderly people long exposed to low doses of pesticides.
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Paridar M, Zibara K, Ahmadi SE, Khosravi A, Soleymani M, Azizi E, Ghalesardi OK. Clinico-Hematological and cytogenetic spectrum of adult myelodysplastic syndrome: The first retrospective cross-sectional study in Iranian patients. Mol Cytogenet 2021; 14:24. [PMID: 33964952 PMCID: PMC8106119 DOI: 10.1186/s13039-021-00548-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Myelodysplastic syndrome (MDS), a heterogeneous group of hematopoietic malignancy, has been shown to present different cytogenetic abnormalities, risk factors, and clinico-hematological features in different populations and geographic areas. Herein, we determined the cytogenetic spectrum and clinico-hematological features of Iranian MDS patients for the first time.
Methods This prospective cross-sectional study was conducted on 103 patients with MDS in Ahvaz, southwest of Iran, from 2014 to 2018. Clinical presentations, complete blood counts (CBC), and bone marrow (BM) biopsy samples were assessed. Perls' staining was used to evaluate BM iron storage. The cytogenetic evaluation was performed using the conventional G banding method on the BM. Results Patients’ median age was 62.3 (ranged from 50–76), and the majority were male (72.8%). The most common clinical symptom at the time of admission was fatigue (n = 33) followed by pallor (n = 27). The most common subgroup was MDS-Multi Lineage Dysplasia (MDS-MLD) (n = 38, 36.8%), followed by MDS-Single Lineage Dysplasia (MDS-SLD) (n = 28, 18.4%). A normal karyotype was observed in 59 patients (57.3%), while 44 patients (42.7%) had cytogenetic abnormalities. Trisomy 8 (+ 8) was the most common cytogenetic abnormality (n = 14) followed by del 17p (n = 9) and monosomy 7 (− 7) (n = 7). Twelve patients (11.65%) were transformed to AML. Conclusion Our data betokened that among our MDS patients, Trisomy 8 is the predominant cytogenetic abnormality, and MDS-MLD and MDS-SLD are the most common of subtypes. Noteworthy, the male: female ratio was slightly higher in Iran than in previous reports from other parts of the world. Our study is the first report of the clinical, hematological, and cytogenetic spectrum of MDS patients in Iran
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Affiliation(s)
- Mostafa Paridar
- Deputy of Education, Ministry of Health and Medical Education, Tehran, Iran
| | - Kazem Zibara
- PRASE, Biology Department, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
| | - Seyed Esmaeil Ahmadi
- Department of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Khosravi
- Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Maral Soleymani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ebrahim Azizi
- Research Center for Thalassemia and Hemoglobinopathy, Health Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Omid Kiani Ghalesardi
- Department of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Yarosh R, Roesler MA, Murray T, Cioc A, Hirsch B, Nguyen P, Warlick E, Poynter JN. Risk factors for de novo and therapy-related myelodysplastic syndromes (MDS). Cancer Causes Control 2021; 32:241-250. [PMID: 33392905 PMCID: PMC7878335 DOI: 10.1007/s10552-020-01378-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Myelodysplastic syndromes (MDS) are classified as de novo and therapy-related (tMDS). We evaluated associations between MDS risk factors separately for de novo and tMDS. METHODS The study population included 346 de novo MDS cases, 37 tMDS cases and 682 population controls frequency matched by age and sex. Polytomous logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS After adjustment, former smoking status (OR = 1.45, 95% CI: 1.10-1.93), personal history of autoimmune disease (OR = 1.34, 95% CI: 0.99-1.82) and exposure to benzene (OR = 1.48, 95% CI: 1.00-2.19) were associated with de novo MDS. Risk estimates for the associations between smoking, autoimmune disease, and benzene exposure were similar in magnitude but non-significant in tMDS cases. Among individuals with a previous diagnosis of cancer, de novo MDS cases and controls were more likely to have had a previous solid tumor, while tMDS cases more commonly had a previous hematologic malignancy. CONCLUSIONS We observed similar associations between smoking, history of autoimmune disease and benzene exposure in de novo and tMDS although estimates for tMDS were imprecise due to small sample sizes. Future analyses with larger sample sizes will be required to confirm whether environmental factors influence risk of tMDS.
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Affiliation(s)
- Rina Yarosh
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Thomas Murray
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | | | - Betsy Hirsch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Phuong Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Erica Warlick
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Jenny N Poynter
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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Costa MB, Farias IR, da Silva Monte C, Filho LIPF, de Paula Borges D, de Oliveira RTG, Ribeiro-Junior HL, Magalhães SMM, Pinheiro RF. Chromosomal abnormalities and dysregulated DNA repair gene expression in farmers exposed to pesticides. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2021; 82:103564. [PMID: 33326828 DOI: 10.1016/j.etap.2020.103564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/24/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
Exposure to pesticides is considered a major factor underlying increased risk of hematological disorders in agricultural workers due to its carcinogenic potential. However, genotoxic impact of pesticides in DNA integrity of bone marrow stem cells (BMSC) of farmers exposed is not yet well known. We evaluated presence of chromosomal abnormalities (CA) and mRNA expression of DNA repair targets (ATM, BRCA1, BRCA2, RAD51, XRCC5, XRCC6, LIG4, CSA, CSB, XPA, XPC, XPG) in 90 bone marrow samples of farmers divided into three groups: commercial farming (CF), family farming (FF) and organic farming (OF). Our results showed that farmers in CF (72.7 %) and FF (27.3 %) groups had significantly higher values of CA when compared to OF group (0.0 %; p = 0.003). CF showed lower XPG (p = 0.008), CSA (p < 0.001), ATM (p = 0.036) and LIG4 (p = 0.004) mRNA expression than OF. FF presented lower XPG (p = 0.012) and LIG4 (p = 0.004) expression than OF. CF + FF individual with ≥12 years of exposure to pesticides showed decreased mRNA expression of XPC (p = 0.001), XPG (p = 0.010), CSB (p = 0.05), ATM (p = 0.030) and LIG4 (p = 0.044) than those who have been exposed for <12 years. CF + FF with CA showed a lower expression of BRCA2 when compared to CF + FF group without CA (p = 0.007). These results highlight that genotoxic exposure to pesticides negatively affects expression profile of important DNA repair genes in BMSC, favoring irreparable chromosomal lesions.
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Affiliation(s)
- Marilia Braga Costa
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil; Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Izabelle Rocha Farias
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil; Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Cristiane da Silva Monte
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil; Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Luiz Ivando Pires Ferreira Filho
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil; Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Daniela de Paula Borges
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil; Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Roberta Taiane Germano de Oliveira
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil; Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Howard Lopes Ribeiro-Junior
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil; Post-Graduate Program in Translational Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Silvia Maria Meira Magalhães
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil; Clinical Medicine Department, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - Ronald Feitosa Pinheiro
- Cancer Cytogenomic Laboratory, Federal University of Ceará, Fortaleza, Ceará, Brazil; Clinical Medicine Department, Federal University of Ceara, Fortaleza, Ceara, Brazil; Post-Graduate Program in Translational Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil.
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9
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Foucault A, Vallet N, Ravalet N, Picou F, Bene MC, Gyan E, Herault O. Occupational pesticide exposure increases risk of acute myeloid leukemia: a meta-analysis of case-control studies including 3,955 cases and 9,948 controls. Sci Rep 2021; 11:2007. [PMID: 33479366 PMCID: PMC7820275 DOI: 10.1038/s41598-021-81604-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/06/2021] [Indexed: 01/11/2023] Open
Abstract
The impact of pesticides on health is a major public health concern. A higher risk to develop chronic lymphoid malignancies has been demonstrated to be associated with occupational pesticide exposure (OPE). By contrast, little is known of the impact of OPE on the occurrence of myeloid malignancies especially acute myeloid leukemia (AML). The purpose of this meta-analysis is to summarize data on the association between OPE and AML. A relevant dataset of case-control studies was extracted. Among 6784 references extracted, 14 were selected, representing 3,955 AML patients and 9,948 control subjects diagnosed between 1976 and 2010. An adverse association was found between OPE and AML (OR = 1.51; 95%CI: 1.10-2.08), not affected by sensitivity analyses. Funnel plot asymmetry suggested a publication bias underestimating OR. Stratified analysis showed the association to be driven by studies with: (1) monocentric AML patients and hospital-based control population, (2) Newcastle-Ottawa scale > 6 and the group of studies identified as with the lowest risk, (3) exposure assessment through peer-to-peer interview, (4) diagnosis in North America and Asia and after 1995, (5) restriction to de novo AML. Moreover, the association between OPE and AML was significant with insecticides. These findings broaden the spectrum of pesticide toxicity to myeloid malignancies.
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Affiliation(s)
- Amelie Foucault
- Department of Biological Hematology, Tours University Hospital, Tours, France
- CNRS ERL7001 LNOX, EA 7501, Tours University, Tours, France
| | - Nicolas Vallet
- Department of Hematology and Cell Therapy, Tours University Hospital, Tours, France
| | - Noemie Ravalet
- Department of Biological Hematology, Tours University Hospital, Tours, France
- CNRS ERL7001 LNOX, EA 7501, Tours University, Tours, France
| | - Frederic Picou
- Department of Biological Hematology, Tours University Hospital, Tours, France
- CNRS ERL7001 LNOX, EA 7501, Tours University, Tours, France
| | - Marie C Bene
- Department of Biological Hematology, Nantes University Hospital, Nantes, France
| | - Emmanuel Gyan
- CNRS ERL7001 LNOX, EA 7501, Tours University, Tours, France
- Department of Hematology and Cell Therapy, Tours University Hospital, Tours, France
| | - Olivier Herault
- Department of Biological Hematology, Tours University Hospital, Tours, France.
- CNRS ERL7001 LNOX, EA 7501, Tours University, Tours, France.
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Rojas-Rueda D, Morales-Zamora E, Alsufyani WA, Herbst CH, AlBalawi SM, Alsukait R, Alomran M. Environmental Risk Factors and Health: An Umbrella Review of Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020704. [PMID: 33467516 PMCID: PMC7830944 DOI: 10.3390/ijerph18020704] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/31/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
Background: Environmental health is a growing area of knowledge, continually increasing and updating the body of evidence linking the environment to human health. Aim: This study summarizes the epidemiological evidence on environmental risk factors from meta-analyses through an umbrella review. Methods: An umbrella review was conducted on meta-analyses of cohort, case-control, case-crossover, and time-series studies that evaluated the associations between environmental risk factors and health outcomes defined as incidence, prevalence, and mortality. The specific search strategy was designed in PubMed using free text and Medical Subject Headings (MeSH) terms related to risk factors, environment, health outcomes, observational studies, and meta-analysis. The search was limited to English, Spanish, and French published articles and studies on humans. The search was conducted on September 20, 2020. Risk factors were defined as any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or death. The environment was defined as the external elements and conditions that surround, influence, and affect a human organism or population’s life and development. The environment definition included the physical environment such as nature, built environment, or pollution, but not the social environment. We excluded occupational exposures, microorganisms, water, sanitation and hygiene (WASH), behavioral risk factors, and no-natural disasters. Results: This umbrella review found 197 associations among 69 environmental exposures and 83 diseases and death causes reported in 103 publications. The environmental factors found in this review were air pollution, environmental tobacco smoke, heavy metals, chemicals, ambient temperature, noise, radiation, and urban residential surroundings. Among these, we identified 65 environmental exposures defined as risk factors and 4 environmental protective factors. In terms of study design, 57 included cohort and/or case-control studies, and 46 included time-series and/or case-crossover studies. In terms of the study population, 21 included children, and the rest included adult population and both sexes. In this review, the largest body of evidence was found in air pollution (91 associations among 14 air pollution definitions and 34 diseases and mortality diagnoses), followed by environmental tobacco smoke with 24 associations. Chemicals (including pesticides) were the third larger group of environmental exposures found among the meta-analyses included, with 19 associations. Conclusion: Environmental exposures are an important health determinant. This review provides an overview of an evolving research area and should be used as a complementary tool to understand the connections between the environment and human health. The evidence presented by this review should help to design public health interventions and the implementation of health in all policies approach aiming to improve populational health.
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Affiliation(s)
- David Rojas-Rueda
- Department of Environmental and Radiological Health Sciences, Colorado State University, Environmental Health Building, 1601 Campus Delivery, Fort Collins, CO 80523, USA
- Correspondence: ; Tel.: +1-(970)-491-7038; Fax: +1-(970)-491-2940
| | | | - Wael Abdullah Alsufyani
- Saudi Center for Disease Prevention and Control, 70 SCDC Building, Al Aarid, King Abdulaziz Rd, Riyadh 13354, Saudi Arabia; (W.A.A.); (S.M.A.); (M.A.)
| | - Christopher H. Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Diplomatic Quarter, Riyadh Country Office, Riyadh 94623, Saudi Arabia; (C.H.H.); (R.A.)
| | - Salem M. AlBalawi
- Saudi Center for Disease Prevention and Control, 70 SCDC Building, Al Aarid, King Abdulaziz Rd, Riyadh 13354, Saudi Arabia; (W.A.A.); (S.M.A.); (M.A.)
| | - Reem Alsukait
- Health, Nutrition and Population Global Practice, The World Bank, Diplomatic Quarter, Riyadh Country Office, Riyadh 94623, Saudi Arabia; (C.H.H.); (R.A.)
- Community Health Department, King Saud University, Riyadh 11433, Saudi Arabia
| | - Mashael Alomran
- Saudi Center for Disease Prevention and Control, 70 SCDC Building, Al Aarid, King Abdulaziz Rd, Riyadh 13354, Saudi Arabia; (W.A.A.); (S.M.A.); (M.A.)
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11
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Minervini A, Coccaro N, Anelli L, Zagaria A, Specchia G, Albano F. HMGA Proteins in Hematological Malignancies. Cancers (Basel) 2020; 12:E1456. [PMID: 32503270 PMCID: PMC7353061 DOI: 10.3390/cancers12061456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
The high mobility group AT-Hook (HMGA) proteins are a family of nonhistone chromatin remodeling proteins known as "architectural transcriptional factors". By binding the minor groove of AT-rich DNA sequences, they interact with the transcription apparatus, altering the chromatin modeling and regulating gene expression by either enhancing or suppressing the binding of the more usual transcriptional activators and repressors, although they do not themselves have any transcriptional activity. Their involvement in both benign and malignant neoplasias is well-known and supported by a large volume of studies. In this review, we focus on the role of the HMGA proteins in hematological malignancies, exploring the mechanisms through which they enhance neoplastic transformation and how this knowledge could be exploited to devise tailored therapeutic strategies.
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Affiliation(s)
| | | | | | | | | | - Francesco Albano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, 70124 Bari, Italy; (A.M.); (N.C.); (L.A.); (A.Z.); (G.S.)
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12
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Reagan M. CAUSES OF CANCER. Cancer 2019. [DOI: 10.1002/9781119645214.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Sweeney MR, Applebaum KM, Arem H, Braffett BH, Poynter JN, Robien K. Medical Conditions and Modifiable Risk Factors for Myelodysplastic Syndrome: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2019; 28:1502-1517. [DOI: 10.1158/1055-9965.epi-19-0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/13/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022] Open
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14
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Yang S, Gu Y, Wang G, Hu Q, Chen S, Wang Y, Zhao M. HMGA2 regulates acute myeloid leukemia progression and sensitivity to daunorubicin via Wnt/β-catenin signaling. Int J Mol Med 2019; 44:427-436. [PMID: 31173171 PMCID: PMC6605696 DOI: 10.3892/ijmm.2019.4229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/09/2019] [Indexed: 12/15/2022] Open
Abstract
Acute myeloid leukemia (AML) is a malignant disease with an increasing prevalence in adults and children. However, valuable molecular diagnostic research is rare. In the present study, plasmids silencing and overexpressing high‑mobility group AT‑hook 2 (HMGA2) were respectively transfected in HL60 and NB4 cells. The effects of HMGA2 on AML cell viability, apoptosis, migration and invasion were determined by preforming MTT, flow cytometry, wound scratch and Transwell assays, respectively. Genes associated with apoptosis and Wnt signaling were evaluated by reverse transcription‑quantitative (RT‑q)‑PCR and western blotting. AML cell sensitivity to daunorubicin (DNR) and the regulatory effects of the Wnt signaling pathway via HMGA2 following treatment with the agonist LiCl or antagonist XAV939 were detected by MTT, RT‑qPCR and western blot analysis. The results revealed that the expression of HMGA2 was elevated more so in HL60, KG1, U937, Kasumi‑1, THP‑1 and K562 cells than in NB4 cells. Silencing HMGA2 suppressed cell viability, migration and invasion, enhanced cell apoptosis and sensitivity to DNR, and almost restored the DNR inhibitory function that was promoted by LiCl treatment. In addition, low expression of HMGA2 attenuated X‑linked inhibitor of apoptosis and Bcl‑2 mRNA and protein levels, and upregulated the expression of Bax and cleaved‑caspase‑3. Furthermore, silencing HMGA2 not only decreased Wnt and non‑phospho‑β‑catenin expressions, but also partially reversed the increased expressions of these proteins induced by LiCl treatment. On the other hand, overexpression of HMGA2 exhibited the opposite results after transfection in NB4 cells. The results of the present study demonstrated that HMGA2 played important roles in driving AML progression and chemosensitivity in HL60 and NB4 cells, potentially by activating the Wnt/β‑catenin signaling pathway. Therefore, it was suggested that HMGA2 may be a promising molecular marker for AML diagnosis.
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Affiliation(s)
- Shuo Yang
- First Center Clinic College of Tianjin Medical University, Tianjin 300192, P.R. China
| | - Yueli Gu
- Department of Hematology, The First People's Hospital of Shangqiu, Shangqiu, Henan 476100, P.R. China
| | - Genjie Wang
- Department of Hematology, The First People's Hospital of Shangqiu, Shangqiu, Henan 476100, P.R. China
| | - Qingzhu Hu
- Department of Hematology, The First People's Hospital of Shangqiu, Shangqiu, Henan 476100, P.R. China
| | - Shuxia Chen
- Department of Hematology, The First People's Hospital of Shangqiu, Shangqiu, Henan 476100, P.R. China
| | - Yong Wang
- Department of Cardiology, The First People's Hospital of Shangqiu, Shangqiu, Henan 476100, P.R. China
| | - Mingfeng Zhao
- Department of Hematology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
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15
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Avgerinou C, Giannezi I, Theodoropoulou S, Lazaris V, Kolliopoulou G, Zikos P, Alamanos Y, Leotsinidis M, Symeonidis A. Occupational, dietary, and other risk factors for myelodysplastic syndromes in Western Greece. ACTA ACUST UNITED AC 2017; 22:419-429. [PMID: 28102107 DOI: 10.1080/10245332.2016.1277006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We have observed an increasing incidence of myelodysplastic syndromes (MDS) in the geographic area of Western Greece during the past two decades. The objective of this study was to investigate potential risk factors for the manifestation of MDS in this area of Greece. METHODS A hospital-based case-control study was conducted in the public hospitals of the region. Participants were interviewed based on a questionnaire regarding demographics, occupational exposures, smoking, alcohol consumption, dietary, and domestic factors. RESULTS A total of 228 individuals (126 cases, 102 controls) were recruited in this study. Univariate analysis showed that risk of MDS was associated with a family history of hematologic malignancy or solid tumor, exposure to pesticides, insecticides, herbicides, increased weekly intake of meat and eggs, and increased alcohol intake, whereas fruit intake had a protective effect. Analysis by pesticide ingredient showed a weak association of exposure to paraquat and glyphosate with the occurrence of MDS. Multivariate analysis showed that independent risk factors for the manifestation of MDS were family history of solid tumor (OR 2.47, 95% CI 1.32-4.65), meat intake for ≥5 days/week (OR 2.67, 95% CI 1.05-6.80) and exposure to pesticides (OR 3.25, 95% CI 1.73-6.11). CONCLUSIONS Exposure to pesticides is a major risk factor of MDS in Western Greece. Family history of solid tumor and increased meat intake also appear to play a role in the pathogenesis of MDS. Public health authorities should implement policies to advise and protect farmers from the harmful effects of agrochemicals. Emphasis should also be given to health promotion advice including healthy eating.
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Affiliation(s)
- Christina Avgerinou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.,b Laboratory of Public Health , Medical School, University of Patras , Greece
| | - Ioanna Giannezi
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Stela Theodoropoulou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Vasileios Lazaris
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Georgia Kolliopoulou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Panagiotis Zikos
- c Department of Hematology , 'St Andrew' General Hospital , Patras , Greece
| | - Yannis Alamanos
- b Laboratory of Public Health , Medical School, University of Patras , Greece
| | | | - Argiris Symeonidis
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
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16
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Poynter JN, Richardson M, Roesler M, Blair CK, Hirsch B, Nguyen P, Cioc A, Cerhan JR, Warlick E. Chemical exposures and risk of acute myeloid leukemia and myelodysplastic syndromes in a population-based study. Int J Cancer 2017; 140:23-33. [PMID: 27603749 PMCID: PMC5245124 DOI: 10.1002/ijc.30420] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/19/2016] [Indexed: 01/04/2023]
Abstract
Benzene exposure is one of the few well-established risk factors for myeloid malignancy. Exposure to other chemicals has been inconsistently associated with hematologic malignancies. We evaluated occupational and residential chemical exposures as risk factors for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) using population-based data. AML and MDS cases were identified by the Minnesota Cancer Surveillance System. Controls were identified through the Minnesota driver's license/identification card list. Chemical exposures were measured by self-report. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). We included 265 MDS cases, 420 AML cases and 1388 controls. We observed significant associations between both MDS and AML and benzene (OR = 1.77, 95% CI 1.19, 2.63 and OR = 2.10, 95% CI 1.35, 3.28, respectively) and vinyl chlorides (OR = 2.05, 95% CI 1.15, 3.63 and OR = 2.81, 95% CI 1.14, 6.92). Exposure to soot, creosote, inks, dyes and tanning solutions and coal dust were associated with AML (range ORs = 2.68-4.03), while no association was seen between these exposures and MDS (range ORs = 0.57-1.68). Pesticides and agricultural chemicals were not significantly associated with AML or MDS. Similar results were observed in analyses stratified by sex. In addition to providing risk estimates for benzene from a population-based sample, we also identified a number of other occupational and residential chemicals that were significantly associated with AML; however, all exposures were reported by only a small percentage of cases (≤10%). While chemical exposures play a clear role in the etiology of myeloid malignancy, these exposures do not account for the majority of cases.
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Affiliation(s)
- Jenny N. Poynter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Michaela Richardson
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Michelle Roesler
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Betsy Hirsch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Phuong Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - James R. Cerhan
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Erica Warlick
- Blood and Marrow Transplant Program, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
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Exposure to p, p'-DDE Induces Morphological Changes and Activation of the PKC α-p38-C/EBP β Pathway in Human Promyelocytic HL-60 Cells. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1375606. [PMID: 27833915 PMCID: PMC5090076 DOI: 10.1155/2016/1375606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 01/23/2023]
Abstract
Dichlorodiphenyldichloroethylene (p,p′-DDE), the most persistent metabolite of dichlorodiphenyltrichloroethane (DDT), is still present in the human population. Both are present in the bone marrow of patients with bone marrow disorders, but thus far there are no studies that assess the capability of p,p′-DDE to affect myeloid cells. The aim of this study was to determine the effect of p,p′-DDE on promyelocytic cell differentiation and intracellular pathways related to this event. p,p′-DDE induced morphological changes compatible with promyelocytic differentiation in a concentration-dependent manner. The p,p′-DDE effect on [Ca2+]i, C/EBPβ protein levels, PKCα and p38 activation, and the role of oxidative stress or PLA2 was assayed. Exposure to 1.9 μg/mL of p,p′-DDE increased [Ca2+]i, PKCα, p38, and C/EBPβ protein levels; the increase of nuclear C/EBPβ protein was dependent on p38. PKCα phosphorylation was dependent on PLA2 and p,p′-DDE-induced oxidative stress. p38 phosphorylation induced by p,p′-DDE was dependent on PLA2, PKC activation, and oxidative stress. These effects of p,p′-DDE at concentrations found in human bone marrow may induce alterations in immature myeloid cells and could affect their cellular homeostasis. In order to establish the risk from exposure to p,p′-DDE on the development of bone marrow disorders in humans, these effects deserve further study.
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18
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Liang Z, Wang X, Xie B, Zhu Y, Wu J, Li S, Meng S, Zheng X, Ji A, Xie L. Pesticide exposure and risk of bladder cancer: A meta-analysis. Oncotarget 2016; 7:66959-66969. [PMID: 27557494 PMCID: PMC5341850 DOI: 10.18632/oncotarget.11397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 08/08/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We conducted a meta-analysis to quantitatively evaluate the correlation between pesticide exposure and the risk of bladder cancer by summarizing the results of published case-control and cohort studies. METHODS A systematic literature search of articles update to February 2015 was conducted via Pubmed, Web of Science, Cochrane Library, and the Chinese National Knowledge Infrastructure (CNKI) databases, and the references of the retrieved articles. Fixed- or random-effect models were used to summarize the estimates of OR with 95% CIs for the highest versus the lowest exposure of pesticide. RESULTS The pooled OR estimates indicated that pesticide exposure was associated with an increased risk of bladder cancer (OR=1.649, 95% CI 1.223-2.223). In subgroup analysis, we detected pesticide exposure demonstrated as a significant risk factor on bladder cancer in America (OR=1.741, 95% CI 1.270-2.388). Similar results were discovered in both case-control group and cohort group (OR=2.075, 95% CI 1.183-3.638, OR=1.146, 95% CI 1.074-1.223, respectively). No evidence of publication bias was found by Begg's or Egger's test (P = 0.210, P = 0.358, respectively). CONCLUSION In conclusion, our meta-analysis indicated that pesticide exposure was associated with an increased risk of bladder cancer. Further researches should be conducted to confirm the findings in our study and better clarify the potential biological mechanisms.
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Affiliation(s)
- Zhen Liang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiao Wang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Bo Xie
- Department of Urology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yi Zhu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jian Wu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shiqi Li
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shuai Meng
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiangyi Zheng
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Alin Ji
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Liping Xie
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
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