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Tong Z, Kong L, Zhang Y, Hu T, Dai R, Wang Y, Ji J, Huang Z, Hu L. Brassisterol A, a new ergosterol from co-cultivation of fungi attenuates neuroinflammation via targeting NLRP3/caspase-1/GSDMD pathway. Bioorg Chem 2024; 142:106955. [PMID: 37924754 DOI: 10.1016/j.bioorg.2023.106955] [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: 09/05/2023] [Revised: 10/19/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023]
Abstract
Three new ergosterol derivatives brassisterol A-C (1-3) and two new epimeric bicycle-lactones brassictones A and B (4 and 5), were isolated from the co-cultivation of Alternaria brassicicola and Penicillium granulatum. The absolute configurations of these isolates were confirmed by extensive NMR spectra, TD-DFT ECD calculation, and the single crystal XRD data analysis. Amongst the metabolites, compound 1 exhibited potential anti-Parkinson's disease activity in both MPTP-induced zebrafish and MPP+-induced SH-SY5Y cells. Molecular mechanism studies in vitro showed that 1 attenuated the increase of α-synuclein, NLRP3, ASC, caspase-1, IL-1β, IL-18, and GSDMD expression in the MPP+ induced PD model. Molecular docking in silico simulations exhibited that 1 was well accommodated to one of the binding pockets of NLRP3 8ETR in an appropriate conformation via forming typical hydrogen bonds as well as possessing a high negative binding affinity (-8.97 kcal/mol). Thus, our work suggested that 1 protected dopaminergic cell from neuroinflammation via targeting NLRP3/caspase-1/GSDMD signaling pathway.
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Affiliation(s)
- Zhou Tong
- State Key Laboratory of Biocatalysis and Enzyme Engineering, National & Local Joint Engineering Research Centre of High-throughput Drug Screening Technology, School of Life Sciences, Hubei University, Wuhan 430062, China
| | - Luqi Kong
- State Key Laboratory of Biocatalysis and Enzyme Engineering, National & Local Joint Engineering Research Centre of High-throughput Drug Screening Technology, School of Life Sciences, Hubei University, Wuhan 430062, China
| | - Yuexing Zhang
- College of Chemistry and Chemical Engineering, Hubei University, Wuhan 430062, China
| | - Tianhui Hu
- State Key Laboratory of Biocatalysis and Enzyme Engineering, National & Local Joint Engineering Research Centre of High-throughput Drug Screening Technology, School of Life Sciences, Hubei University, Wuhan 430062, China
| | - Rongrong Dai
- State Key Laboratory of Biocatalysis and Enzyme Engineering, National & Local Joint Engineering Research Centre of High-throughput Drug Screening Technology, School of Life Sciences, Hubei University, Wuhan 430062, China
| | - Yilan Wang
- State Key Laboratory of Biocatalysis and Enzyme Engineering, National & Local Joint Engineering Research Centre of High-throughput Drug Screening Technology, School of Life Sciences, Hubei University, Wuhan 430062, China
| | - Juan Ji
- Jiangsu Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing 211166, China
| | - Zhiyong Huang
- Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China.
| | - Linzhen Hu
- State Key Laboratory of Biocatalysis and Enzyme Engineering, National & Local Joint Engineering Research Centre of High-throughput Drug Screening Technology, School of Life Sciences, Hubei University, Wuhan 430062, China; Jiangsu Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing 211166, China.
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2
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Yuan Z, Yu D, Gou T, Tang G, Guo C, Shi J. Research progress of NLRP3 inflammasome and its inhibitors with aging diseases. Eur J Pharmacol 2023; 957:175931. [PMID: 37495038 DOI: 10.1016/j.ejphar.2023.175931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
In recent years, a new target closely linked to a variety of diseases has appeared in the researchers' vision, which is the NLRP3 inflammasome. With the deepening of the study of NLRP3 inflammasome, it was found that it plays an extremely important role in a variety of physiological pathological processes, and NLRP3 inflammasome was also found to be associated with some age-related diseases. It is associated with the development of insulin resistance, Alzheimer's disease, Parkinson's, cardiovascular aging, hearing and vision loss. At present, the only clinical approach to the treatment of NLRP3 inflammasome-related diseases is to use anti-IL-1β antibodies, but NLRP3-specific inhibitors may be better than the IL-1β antibodies. This article reviews the relationship between NLRP3 inflammasome and aging diseases: summarizes some of the relevant experimental results reported in recent years, and introduces the biological signals or pathways closely related to the NLRP3 inflammasome in a variety of aging diseases, and also introduces some promising small molecule inhibitors of NLRP3 inflammasome for clinical treatment, such as: ZYIL1, DFV890 and OLT1177, they have excellent pharmacological effects and good pharmacokinetics.
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Affiliation(s)
- Zhuo Yuan
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Dongke Yu
- Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Tingting Gou
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Guoyuan Tang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Chun Guo
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
| | - Jianyou Shi
- Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
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Chen P, Zhao LJ, Huang L, He WQ, Tang YR, Liu Y, Ren JD. Nafamostat mesilate prevented caerulein-induced pancreatic injury by targeting HDAC6-mediated NLRP3 inflammasome activation. Inflamm Res 2023; 72:1919-1932. [PMID: 37725105 DOI: 10.1007/s00011-023-01794-0] [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: 06/08/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Nafamostat mesilate (NM), a synthetic broad-spectrum serine protease inhibitor, has been commonly used for treating acute pancreatitis (AP) and other inflammatory-associated diseases in some East Asia countries. Although the potent inhibitory activity against inflammation-related proteases (such as thrombin, trypsin, kallikrein, plasmin, coagulation factors, and complement factors) is generally believed to be responsible for the anti-inflammatory effects of NM, the precise target and molecular mechanism underlying its anti-inflammatory activity in AP treatment remain largely unknown. METHODS The protection of NM against pancreatic injury and inhibitory effect on the NOD-like receptor protein 3 (NLRP3) inflammasome activation were investigated in an experimental mouse model of AP. To decipher the molecular mechanism of NM, the effects of NM on nuclear factor kappa B (NF-κB) activity and NF-κB mediated NLRP3 inflammasome priming were examined in lipopolysaccharide (LPS)-primed THP-1 cells. Additionally, the potential of NM to block the activity of histone deacetylase 6 (HDAC6) and disrupt the association between HDAC6 and NLRP3 was also evaluated. RESULTS NM significantly suppressed NLRP3 inflammasome activation in the pancreas, leading to a reduction in pancreatic inflammation and prevention of pancreatic injury during AP. NM was found to interact with HDAC6 and effectively inhibit its function. This property allowed NM to influence HDAC6-dependent NF-κB transcriptional activity, thereby blocking NF-κB-driven transcriptional priming of the NLRP3 inflammasome. Furthermore, NM exhibited the potential to interfere the association between HDAC6 and NLRP3, impeding HDAC6-mediated intracellular transport of NLRP3 and ultimately preventing NLRP3 inflammasome activation. CONCLUSIONS Our current work has provided valuable insight into the molecular mechanism underlying the immunomodulatory effect of NM in the treatment of AP, highlighting its promising application in the prevention of NLRP3 inflammasome-associated inflammatory pathological damage.
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Affiliation(s)
- Peng Chen
- Department of Pharmacy, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Safety Evaluation Center, Sichuan Institute for Drug Control (Sichuan Testing Center of Medical Devices), Chengdu, 610097, China
| | - Li-Jun Zhao
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Ling Huang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Wen-Qi He
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Ying-Rui Tang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Yi Liu
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Jian-Dong Ren
- Department of Pharmacy, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China.
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Chen X, Li P, Huang R, Zhang J, Ouyang X, Tan D. Ulinastatin affects focal cerebral ischemia-reperfusion injury via SOCS1-mediated JAK2/STAT3 signalling pathway. Clin Exp Pharmacol Physiol 2023; 50:107-116. [PMID: 36222378 DOI: 10.1111/1440-1681.13731] [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: 01/18/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
Cerebral ischemia results in loss of cerebral blood flow, which contributes to neuronal damage, neurocognitive impairment, as well as learning and memory difficulties. Although reperfusion is necessary to restore the blood supply to the brain, it also leads to several detrimental effects on the brain. The purpose of this study was to assess the effects of ulinastatin (UTI) on preventing focal cerebral ischemia/reperfusion-induced injury (FCIRI). First, a rat model of FCIRI was established and treated with UTI. The effects of UTI on FCIRI in rats were evaluated using Morris water maze assay, triphenyl tetrazolium chloride staining, TUNEL, western blot assay, and enzyme-linked immunosorbent assay analysis. UTI was found to improve the learning memory ability, reduce infarction area, inhibit apoptosis and decrease inflammation in FCIRI rats. Messenger RNA microarray analysis of hippocampal tissues revealed that suppressor of cytokine signalling-1 (SOCS1) was the downstream target of UTI in FCIRI. SOCS1 depletion impaired the protective effect of UTI on FCIRI in rats. SOCS1 blocked the activation of the JAK2/STAT3 pathway. JAK2 inhibitor caused the JAK2/STAT3 pathway deficit, hence reversing the effect of sh-SOCS1 on FCIRI in rats. Taken together, our results demonstrate that UTI alleviated FCIRI in rats, which was, to some extent, related to SOCS1-mediated JAK2/STAT3 pathway.
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Affiliation(s)
- Xiaoxi Chen
- Department of Anesthesiology, Hengyang City Central Hospital, Hengyang, China
| | - Peng Li
- Department of Anesthesiology, Hengyang City Central Hospital, Hengyang, China
| | - Renming Huang
- Department of Anesthesiology, Hengyang City Central Hospital, Hengyang, China
| | - Juan Zhang
- Department of Anesthesiology, Hengyang City Central Hospital, Hengyang, China
| | - Xingzhi Ouyang
- Department of Anesthesiology, Hengyang City Central Hospital, Hengyang, China
| | - Dianxiang Tan
- Department of Anesthesiology, Hengyang City Central Hospital, Hengyang, China
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Zhang CY, Hu XC, Zhang GZ, Liu MQ, Chen HW, Kang XW. Role of Nrf2 and HO-1 in intervertebral disc degeneration. Connect Tissue Res 2022; 63:559-576. [PMID: 35736364 DOI: 10.1080/03008207.2022.2089565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intervertebral disc degeneration (IDD) is a common age-related disease with clinical manifestations of lumbar and leg pain and limited mobility. The pathogenesis of IDD is mainly mediated by the death of intervertebral disc (IVD) cells and the imbalance of extracellular matrix (ECM) synthesis and degradation. Oxidative stress and inflammatory reactions are the important factors causing this pathological change. Therefore, the regulation of reactive oxygen species and production of inflammatory factors may be an effective strategy to delay the progression of IDD. In recent years, nuclear factor erythroid 2-related factor 2 (Nrf2) and its downstream regulated protein heme oxygenase-1 (HO-1) have received special attention due to their antioxidant, anti-inflammatory and anti-apoptotic protective effects. Recent studies have elucidated the important role of these two proteins in the treatment of IDD disease. However, Nrf2 and HO-1 have not been systematically reported in IDD-related diseases. Therefore, this review describes the biological characteristics of Nrf2 and HO-1, the relationship between Nrf2- and HO-1-regulated oxidative stress and the inflammatory response and IDD, and the progress in research on some extracts targeting Nrf2 and HO-1 to improve IDD. Understanding the role and mechanism of Nrf2 and HO-1 in IDD may provide novel ideas for the clinical treatment and development of Nrf2- and HO-1-targeted drugs.
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Affiliation(s)
- Cang-Yu Zhang
- The second clinical medical college, Lanzhou University, Lanzhou, Gansu, PR China.,Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Xu-Chang Hu
- The second clinical medical college, Lanzhou University, Lanzhou, Gansu, PR China.,Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Guang-Zhi Zhang
- The second clinical medical college, Lanzhou University, Lanzhou, Gansu, PR China.,Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Ming-Qiang Liu
- The second clinical medical college, Lanzhou University, Lanzhou, Gansu, PR China.,Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Hai-Wei Chen
- The second clinical medical college, Lanzhou University, Lanzhou, Gansu, PR China.,Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Xue-Wen Kang
- The second clinical medical college, Lanzhou University, Lanzhou, Gansu, PR China.,Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
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Bai X, Yang M, Zhu T, Xu J, Wang W, He Y, Liu Y, Li X, He M, Meng T, Wang Z, Zhang H, Zhu L. Analysis of transcriptome characteristics of UTI therapy for cerebral injury after CA/ROSC based on RNA-seq technique. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:715-722. [PMID: 35949311 PMCID: PMC9320207 DOI: 10.22038/ijbms.2022.61990.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/12/2022] [Indexed: 11/06/2022]
Abstract
Objectives To study the effects and mechanisms of ulinastatin (UTI) on brain injury caused by cardiac arrest/return of spontaneous circulation (CA/ROSC). Materials and Methods In this study, modeling of CA/ROSC was set up in 56 Sprague Dawley (SD) rats, which were randomly divided into the model group, UTI (100000U/kg) treatment group, and control group. Each group then was divided into two subgroups: 24 hr and 72 hr. The survival rates between different groups was observed during two weeks. AimPlex multiplex immunoassays technology was performed to detect the expression of inflammatory cytokines in serum, such as IL-6 and TNF-α. RNA-sequencing (RNA-seq) transcriptome, Gene Ontology (GO), and Kyoto. Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were used to investigate the possible mechanism of UTI. Western blot and immunohistochemistry were performed to detect the expression of C-C motif chemokine ligand 2 (CCl2) and plasminogen (plg) protein expression. Results The survival rate of the UTI group was significantly higher than the model group during two weeks. And UTI can significantly reduce the content of IL-6 and TNF-α in serum. GO and KEGG pathway enrichment analysis revealed that differentially expressed genes mainly belonged to the IL-17 signaling pathway and neuroactive ligand-receptor interaction signaling pathway. Besides, UTI can down-regulate the expression of the CCl2 inflammatory gene and up-regulate the expression of plg in the brain tissue of CA/ROSC rats. Conclusion UTI has neuroprotective effects on brain injury after CA/ROSC. And the key mechanisms belong to the regulation of immune-inflammatory response as well as the signaling molecules and interaction.
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Affiliation(s)
- Xiaojie Bai
- Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China,These authors contributed equally to this work
| | - Mingya Yang
- Department of Hematology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China,These authors contributed equally to this work
| | - Tiantian Zhu
- Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Jun Xu
- Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Wei Wang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Yuanyuan He
- Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Yu Liu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Xingxing Li
- Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Miao He
- Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Tao Meng
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Zhenzhen Wang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Hong Zhang
- Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China,Corresponding authors: Hong Zhang. Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China. ; Lixin Zhu. Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China.
| | - Lixin Zhu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China,Corresponding authors: Hong Zhang. Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China. ; Lixin Zhu. Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China.
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Li J, Wang Y, Wu T, Li S, Sun YN, Liu ZH. Baicalein suppresses high glucose-induced inflammation and apoptosis in trophoblasts by targeting the miRNA-17-5p-Mfn1/2-NF-κB pathway. Placenta 2022; 121:126-136. [DOI: 10.1016/j.placenta.2022.02.013] [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: 08/16/2021] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 12/21/2022]
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Nguyen LTN, Nguyen HD, Kim YJ, Nguyen TT, Lai TT, Lee YK, Ma HI, Kim YE. Role of NLRP3 Inflammasome in Parkinson's Disease and Therapeutic Considerations. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2117-2133. [PMID: 35988226 PMCID: PMC9661339 DOI: 10.3233/jpd-223290] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 05/23/2023]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease, with two main pathological features: misfolded α-synuclein protein accumulation and neurodegeneration. Inflammation has recently been identified as a contributor to a cascade of events that may aggravate PD pathology. Inflammasomes, a group of intracellular protein complexes, play an important role in innate immune responses to various diseases, including infection. In PD research, accumulating evidence suggests that α-synuclein aggregations may activate inflammasomes, particularly the nucleotide-binding oligomerization domain-leucine-rich repeat-pyrin domain-containing 3 (NLRP3) type, which exacerbates inflammation in the central nervous system by secreting proinflammatory cytokines like interleukin (IL)-18 and IL-1β. Afterward, activated NLRP3 triggers local microglia and astrocytes to release additional IL-1β. In turn, the activated inflammatory process may contribute to additional α-synuclein aggregation and cell loss. This review summarizes current research evidence on how the NLRP3 inflammasome contributes to PD pathogenesis, as well as potential therapeutic strategies targeting the NLRP3 inflammasome in PD.
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Affiliation(s)
- Linh Thi Nhat Nguyen
- Department of Medical Sciences, Graduate School of Hallym University, Chuncheon, Gangwon, South Korea
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Gyeonggi, South Korea
| | - Huu Dat Nguyen
- Department of Medical Sciences, Graduate School of Hallym University, Chuncheon, Gangwon, South Korea
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Gyeonggi, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi, South Korea
| | - Tinh Thi Nguyen
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Gyeonggi, South Korea
| | - Thuy Thi Lai
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Gyeonggi, South Korea
| | - Yoon Kyoung Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Gyeonggi, South Korea
| | - Hyeo-il Ma
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Gyeonggi, South Korea
- Hallym Neurological Institute, Hallym University, Anyang, Gyeonggi, South Korea
| | - Young Eun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Gyeonggi, South Korea
- Hallym Neurological Institute, Hallym University, Anyang, Gyeonggi, South Korea
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