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Sangalli L, Boggero IA. The impact of sleep components, quality and patterns on glymphatic system functioning in healthy adults: A systematic review. Sleep Med 2023; 101:322-349. [PMID: 36481512 DOI: 10.1016/j.sleep.2022.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/04/2022] [Accepted: 11/13/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The glymphatic system is thought to be responsible for waste clearance in the brain. As it is primarily active during sleep, different components of sleep, subjective sleep quality, and sleep patterns may contribute to glymphatic functioning. This systematic review aimed at exploring the effect of sleep components, sleep quality, and sleep patterns on outcomes associated with the glymphatic system in healthy adults. METHODS PubMed®, Scopus, and Web of Science were searched for studies published in English until December 2021. Articles subjectively or objectively investigating sleep components (total sleep time, time in bed, sleep efficiency, sleep onset latency, wake-up after sleep onset, sleep stage, awakenings), sleep quality, or sleep pattern in healthy individuals, on outcomes associated with glymphatic system (levels of amyloid-β, tau, α-synuclein; cerebrospinal fluid, perivascular spaces; apolipoprotein E) were selected. RESULTS Out of 8359 records screened, 51 studies were included. Overall, contradictory findings were observed according to different sleep assessment method. The most frequently assessed sleep parameters were total sleep time, sleep quality, and sleep efficiency. No association was found between sleep efficiency and amyloid-β, and between slow-wave activity and tau. Most of the studies did not find any correlation between total sleep time and amyloid-β nor tau level. Opposing results correlated sleep quality with amyloid-β and tau. CONCLUSIONS This review highlighted inconsistent results across the studies; as such, the specific association between the glymphatic system and sleep parameters in healthy adults remains poorly understood. Due to the heterogeneity of sleep assessment methods and the self-reported data representing the majority of the observations, future studies with universal study design and sleep methodology in healthy individuals are advocated.
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Affiliation(s)
- L Sangalli
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA; College of Dental Medicine - Illinois, Downers Grove, Illinois, USA.
| | - I A Boggero
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA; Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
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4
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Martino Adami PV, Orellana A, García P, Kleineidam L, Alarcón-Martín E, Montrreal L, Aguilera N, Espinosa A, Abdelnour C, Rosende-Roca M, Tartari JP, Vargas L, Mauleón A, Esteban-De Antonio E, López-Cuevas R, Dalmasso MC, Martin RC, Parveen K, Andrade Fuentes VM, Amin N, Ahmad S, Ikram MA, Lewczuk P, Kornhuber J, Peters O, Frölich L, Rüther E, Wiltfang J, Tarraga L, Boada M, Maier W, de Rojas I, Cano A, Sanabria A, Alegret M, Hernández I, Marquié M, Valero S, van Duijn CM, Wagner M, Jessen F, Schneider A, Sáez Goñi ME, Pérez AG, Ruiz A, Ramírez A. Matrix metalloproteinase 10 is linked to the risk of progression to dementia of the Alzheimer's type. Brain 2022; 145:2507-2517. [PMID: 35088840 DOI: 10.1093/brain/awac024] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 11/12/2022] Open
Abstract
Alzheimer's disease has a long asymptomatic phase that offers a substantial time window for intervention. Utilizing this window of opportunity will require early diagnostic and prognostic biomarkers to detect Alzheimer's disease pathology at pre-dementia stages, thus allowing identification of patients who will most probably progress to dementia of the Alzheimer's type and benefit from specific disease-modifying therapies. Consequently, we searched for CSF proteins associated with disease progression along with the clinical disease staging. We measured the levels of 184 proteins in CSF samples from 556 subjective cognitive decline and mild cognitive impairment patients from three independent memory clinic longitudinal studies (Spanish ACE, n = 410; German DCN, n = 93; German Mannheim, n = 53). We evaluated the association between protein levels and clinical stage, and the effect of protein levels on the progression from mild cognitive impairment to dementia of the Alzheimer's type. Mild cognitive impairment subjects with increased CSF level of matrix metalloproteinase 10 showed a higher probability of progressing to dementia of the Alzheimer's type and a faster cognitive decline. CSF matrix metalloproteinase 10 increased the prediction accuracy of CSF Aβ42, P-tau181, and T-tau for conversion to dementia of the Alzheimer's type. Including matrix metalloproteinase 10 to the [A/T/(N)] scheme improved considerably the prognostic value in mild cognitive impairment patients with abnormal Aβ42, but normal P-tau181 and T-tau, and in mild cognitive impairment patients with abnormal Aβ42, P-tau181, and T-tau. Matrix metalloproteinase 10 was correlated with age in subjects with normal Aβ42, P-tau181, and T-tau levels. Our findings support the use of CSF matrix metalloproteinase 10 as a prognostic marker for dementia of the Alzheimer's type and its inclusion to the [A/T/(N)] scheme to incorporate pathologic aspects beyond amyloid and tau. CSF level of matrix metalloproteinase 10 may reflect ageing and neuroinflammation.
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Affiliation(s)
- Pamela V Martino Adami
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Adelina Orellana
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Pablo García
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, 53127 Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Emilio Alarcón-Martín
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Laura Montrreal
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Nuria Aguilera
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Ana Espinosa
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Carla Abdelnour
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Maitee Rosende-Roca
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Juan Pablo Tartari
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Liliana Vargas
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Ana Mauleón
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Ester Esteban-De Antonio
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Rogelio López-Cuevas
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Maria Carolina Dalmasso
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Rafael Campos Martin
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Kayenat Parveen
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Victor M Andrade Fuentes
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Najaf Amin
- Nuffield Department of Population Health, University of Oxford, University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - Shahzad Ahmad
- Department of Epidemiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany.,Department of Neurodegeneration Diagnostics, Medical University of Białystok, 15-269 Białystok, Poland
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Oliver Peters
- Department of Biochemical Diagnostics, University Hospital of Białystok, 15-269 Białystok, Poland.,Department of Psychiatry, Charité University Medicine, Campus Benjamin Franklin, 12200 Berlin, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159 Mannheim, Germany
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen. von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen. von-Siebold-Str. 5, 37075 Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany.,iBiMED, Medical Sciences Department, University of Aveiro. Aradas 3810-193, Aveiro, Portugal
| | - Lluis Tarraga
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Merce Boada
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, 53127 Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Itziar de Rojas
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Amanda Cano
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Angela Sanabria
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain
| | - Montserrat Alegret
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Isabel Hernández
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Marta Marquié
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Sergi Valero
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | | | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, 53127 Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Anja Schneider
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, 53127 Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | | | | | - Agustín Ruiz
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, International University of Catalonia, 8029 Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Alfredo Ramírez
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, 53127 Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany.,Department of Psychiatry and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, 78229 San Antonio, Texas, USA.,Cluster of Excellence Cellular Stress Responses in Aging-associated Diseases (CECAD), University of Cologne. Joseph-Stelzmann-Straße 26, 50931 Cologne, Germany
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Mentis AFA, Dardiotis E, Chrousos GP. Apolipoprotein E4 and meningeal lymphatics in Alzheimer disease: a conceptual framework. Mol Psychiatry 2021; 26:1075-1097. [PMID: 32355332 PMCID: PMC7985019 DOI: 10.1038/s41380-020-0731-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
Abstract
The potential existence and roles of the meningeal lymphatic system in normal and pathological brain function have been a long-standing enigma. Recent evidence suggests that meningeal lymphatic vessels are present in both the mouse and human brain; in mice, they seem to play a role in clearing toxic amyloid-beta peptides, which have been connected with Alzheimer disease (AD). Here, we review the evidence linking the meningeal lymphatic system with human AD. Novel findings suggest that the recently described meningeal lymphatic vessels could be linked to, and possibly drain, the efferent paravascular glial lymphatic (glymphatic) system carrying cerebrospinal fluid, after solute and immune cell exchange with brain interstitial fluid. In so doing, the glymphatic system could contribute to the export of toxic solutes and immune cells from the brain (an exported fluid we wish to describe as glymph, similarly to lymph) to the meningeal lymphatic system; the latter, by being connected with downstream anatomic regions, carries the glymph to the conventional cervical lymphatic vessels and nodes. Thus, abnormal function in the meningeal lymphatic system could, in theory, lead to the accumulation, in the brain, of amyloid-beta, cellular debris, and inflammatory mediators, as well as immune cells, resulting in damage of the brain parenchyma and, in turn, cognitive and other neurologic dysfunctions. In addition, we provide novel insights into APOE4-the leading genetic risk factor for AD-and its relation to the meningeal lymphatic system. In this regard, we have reanalyzed previously published RNA-Seq data to show that induced pluripotent stem cells (iPSCs) carrying the APOE4 allele (either as APOE4 knock-in or stemming from APOE4 patients) express lower levels of (a) genes associated with lymphatic markers, and (b) genes for which well-characterized missense mutations have been linked to peripheral lymphedema. Taking into account this evidence, we propose a new conceptual framework, according to which APOE4 could play a novel role in the premature shrinkage of meningeal lymphatic vessels (meningeal lymphosclerosis), leading to abnormal meningeal lymphatic functions (meningeal lymphedema), and, in turn, reduction in the clearance of amyloid-beta and other macromolecules and inflammatory mediators, as well as immune cells, from the brain, exacerbation of AD manifestations, and progression of the disease. Altogether, these findings and their potential interpretations may herald novel diagnostic tools and therapeutic approaches in patients with AD.
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Affiliation(s)
- Alexios-Fotios A Mentis
- Public Health Laboratories, Hellenic Pasteur Institute, Vas. Sofias Avenue 127, 115 21, Athens, Greece.
- Department of Microbiology, University of Thessaly, Panepistimiou 3, Viopolis, 41 500, Larissa, Greece.
| | - Efthimios Dardiotis
- Department of Neurology, University of Thessaly, Panepistimiou 3, Viopolis, 41 500, Larissa, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Livadias 8, 115 27, Athens, Greece
- UNESCO Chair on Adolescent Health Care, Athens, Greece
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7
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Grammatikopoulou MG, Goulis DG, Gkiouras K, Theodoridis X, Gkouskou KK, Evangeliou A, Dardiotis E, Bogdanos DP. To Keto or Not to Keto? A Systematic Review of Randomized Controlled Trials Assessing the Effects of Ketogenic Therapy on Alzheimer Disease. Adv Nutr 2020; 11:1583-1602. [PMID: 32597927 PMCID: PMC7666893 DOI: 10.1093/advances/nmaa073] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/16/2020] [Accepted: 05/27/2020] [Indexed: 12/14/2022] Open
Abstract
Alzheimer disease (AD) is a global health concern with the majority of pharmacotherapy choices consisting of symptomatic treatment. Recently, ketogenic therapies have been tested in randomized controlled trials (RCTs), focusing on delaying disease progression and ameliorating cognitive function. The present systematic review aimed to aggregate the results of trials examining the effects of ketogenic therapy on patients with AD/mild cognitive impairment (MCI). A systematic search was conducted on PubMed, CENTRAL, clinicaltrials.gov, and gray literature for RCTs performed on adults, published in English until 1 April, 2019, assessing the effects of ketogenic therapy on MCI and/or AD compared against placebo, usual diet, or meals lacking ketogenic agents. Two researchers independently extracted data and assessed risk of bias with the Cochrane tool. A total of 10 RCTs were identified, fulfilling the inclusion criteria. Interventions were heterogeneous, acute or long term (45-180 d), including adherence to a ketogenic diet, intake of ready-to-consume drinks, medium-chain triglyceride (MCT) powder for drinks preparation, yoghurt enriched with MCTs, MCT capsules, and ketogenic formulas/meals. The use of ketoneurotherapeutics proved effective in improving general cognition using the Alzheimer's Disease Assessment Scale-Cognitive, in interventions of either duration. In addition, long-term ketogenic therapy improved episodic and secondary memory. Psychological health, executive ability, and attention were not improved. Increases in blood ketone concentrations were unanimous and correlated to the neurocognitive battery based on various tests. Cerebral ketone uptake and utilization were improved, as indicated by the global brain cerebral metabolic rate for ketones and [11C] acetoacetate. Ketone concentrations and cognitive performance differed between APOE ε4(+) and APOE ε4(-) participants, indicating a delayed response among the former and an improved response among the latter. Although research on the subject is still in the early stages and highly heterogeneous in terms of study design, interventions, and outcome measures, ketogenic therapy appears promising in improving both acute and long-term cognition among patients with AD/MCI. This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42019128311.
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Affiliation(s)
- Maria G Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Xenophon Theodoridis
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Athanasios Evangeliou
- 4th Department of Pediatrics, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Efthimis Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Division of Transplantation Immunology and Mucosal Biology, MRC Centre for Transplantation, King's College London Medical School, London, United Kingdom
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