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Yadav S, Deepika, Moar K, Kumar A, Khola N, Pant A, Kakde GS, Maurya PK. Reconsidering red blood cells as the diagnostic potential for neurodegenerative disorders. Biol Cell 2024; 116:e2400019. [PMID: 38822416 DOI: 10.1111/boc.202400019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Red blood cells (RBCs) are usually considered simple cells and transporters of gases to tissues. HYPOTHESIS However, recent research has suggested that RBCs may have diagnostic potential in major neurodegenerative disorders (NDDs). RESULTS This review summarizes the current knowledge on changes in RBC in Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and other NDDs. It discusses the deposition of neuronal proteins like amyloid-β, tau, and α-synuclein, polyamines, changes in the proteins of RBCs like band-3, membrane transporter proteins, heat shock proteins, oxidative stress biomarkers, and altered metabolic pathways in RBCs during neurodegeneration. It also highlights the comparison of RBC diagnostic markers to other in-market diagnoses and discusses the challenges in utilizing RBCs as diagnostic tools, such as the need for standardized protocols and further validation studies. SIGNIFICANCE STATEMENT The evidence suggests that RBCs have diagnostic potential in neurodegenerative disorders, and this study can pave the foundation for further research which may lead to the development of novel diagnostic approaches and treatments.
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Affiliation(s)
- Somu Yadav
- Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Deepika
- Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Akshay Kumar
- Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Nikhila Khola
- Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Ganseh S Kakde
- Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendergarh, India
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Lei T, Yang Z, Li H, Qin M, Gao H. Interactions between nanoparticles and pathological changes of vascular in Alzheimer's disease. Adv Drug Deliv Rev 2024; 207:115219. [PMID: 38401847 DOI: 10.1016/j.addr.2024.115219] [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: 10/30/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Emerging evidence suggests that vascular pathological changes play a pivotal role in the pathogenesis of Alzheimer's disease (AD). The dysfunction of the cerebral vasculature occurs in the early course of AD, characterized by alterations in vascular morphology, diminished cerebral blood flow (CBF), impairment of the neurovascular unit (NVU), vasculature inflammation, and cerebral amyloid angiopathy. Vascular dysfunction not only facilitates the influx of neurotoxic substances into the brain, triggering inflammation and immune responses but also hampers the efflux of toxic proteins such as Aβ from the brain, thereby contributing to neurodegenerative changes in AD. Furthermore, these vascular changes significantly impact drug delivery and distribution within the brain. Therefore, developing targeted delivery systems or therapeutic strategies based on vascular alterations may potentially represent a novel breakthrough in AD treatment. This review comprehensively examines various aspects of vascular alterations in AD and outlines the current interactions between nanoparticles and pathological changes of vascular.
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Affiliation(s)
- Ting Lei
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, West China School of Pharmacy, Mental Health Center and National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zixiao Yang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, West China School of Pharmacy, Mental Health Center and National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hanmei Li
- School of Food and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Meng Qin
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, West China School of Pharmacy, Mental Health Center and National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Huile Gao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, West China School of Pharmacy, Mental Health Center and National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, China.
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Wu J, Zhang X, Azhati G, Li T, Xu G, Liu F. Retinal microvascular attenuation in mental cognitive impairment and Alzheimer's disease by optical coherence tomography angiography. Acta Ophthalmol 2020; 98:e781-e787. [PMID: 32153141 DOI: 10.1111/aos.14381] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/25/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To explore regional variation of the macular microvasculature in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD), also to detect the association between retinal macular microvascular parameters and the progress of preclinical AD. METHODS Prospective study of healthy controls, patients with MCI and patients with AD by using Optical coherence tomography angiography (OCT-A). We quantified foveal avascular zone (FAZ) areas, densities of the superficial retinal capillary plexuses (SRCP) and deep retinal capillary plexuses (DRCP). The SRCP and DRCP were divided into inner (3 mm) and external (6 mm) annular rings, each containing four quadrants (SI, II, TI, NI, SE, IE, TE and NE). The data were analysed statistically by using SPSS 22 software. RESULTS Totally, 60 subjects including 21 HC (33 eyes), 21 patients with MCI (32 eyes) and 18 AD patients (28 eyes) were recruited. The microvascular densities of DRCP at all quadrants of the parafovea and perifovea were significantly lower in AD patients compared to HC group (p < 0.05). Compared to the HCs, MCI patients showed significant microvascular loss in most sectors of the parafovea and the SE sector of the DRCP (p < 0.05), but not in the parafovea (p = 0.829) or perifovea (p = 0.824) of the SRCP. No significant difference was found in microvascular density of SRCP among the groups, except at SI between the AD and HC groups (p = 0.048). CONCLUSION Our findings demonstrated the macular microvascular attenuation in MCI and AD patients. Both AD and MCI patients showed retinal microvascular density loss, which is more significant in the deep retinal capillary plexuses. Optical coherence tomography angiography (OCT-A) can be used to identify early microvascular abnormalities in AD and MCI. Quantified microvascular density in the DRCP might serve as potential biomarkers of early sign of AD then contribute to forestall the progression of preclinical AD.
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Affiliation(s)
- Jing Wu
- Department of Ophthalmology Shanghai Tenth People's Hospital Tongji University Shanghai China
- School of Medicine Tongji University Shanghai China
| | - Xiaojun Zhang
- Department of Neurology OSF St. Francis Medical Center University of Illinois College of Medicine Peoria Peoria Illinois USA
| | - Guliqiwaer Azhati
- Department of Ophthalmology Shanghai Tenth People's Hospital Tongji University Shanghai China
| | - Tingting Li
- Department of Ophthalmology Clinical Medical College of Shanghai Tenth People's Hospital of Nanjing Medical University Shanghai China
| | - Guoxing Xu
- Department of Ophthalmology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Fang Liu
- Department of Ophthalmology Shanghai Tenth People's Hospital Tongji University Shanghai China
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Venturelli L, Kohler AC, Stupar P, Villalba MI, Kalauzi A, Radotic K, Bertacchi M, Dinarelli S, Girasole M, Pešić M, Banković J, Vela ME, Yantorno O, Willaert R, Dietler G, Longo G, Kasas S. A perspective view on the nanomotion detection of living organisms and its features. J Mol Recognit 2020; 33:e2849. [PMID: 32227521 DOI: 10.1002/jmr.2849] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 12/23/2022]
Abstract
The insurgence of newly arising, rapidly developing health threats, such as drug-resistant bacteria and cancers, is one of the most urgent public-health issues of modern times. This menace calls for the development of sensitive and reliable diagnostic tools to monitor the response of single cells to chemical or pharmaceutical stimuli. Recently, it has been demonstrated that all living organisms oscillate at a nanometric scale and that these oscillations stop as soon as the organisms die. These nanometric scale oscillations can be detected by depositing living cells onto a micro-fabricated cantilever and by monitoring its displacements with an atomic force microscope-based electronics. Such devices, named nanomotion sensors, have been employed to determine the resistance profiles of life-threatening bacteria within minutes, to evaluate, among others, the effect of chemicals on yeast, neurons, and cancer cells. The data obtained so far demonstrate the advantages of nanomotion sensing devices in rapidly characterizing microorganism susceptibility to pharmaceutical agents. Here, we review the key aspects of this technique, presenting its major applications. and detailing its working protocols.
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Affiliation(s)
- Leonardo Venturelli
- Laboratoire de Physique de la Matière Vivante, Institut de Physique, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Anne-Céline Kohler
- Laboratoire de Physique de la Matière Vivante, Institut de Physique, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Petar Stupar
- Laboratoire de Physique de la Matière Vivante, Institut de Physique, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Maria I Villalba
- Centro de Investigación y Desarrollo en Fermentaciones Industriales (CINDEFI-CONICET-CCT La Plata), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Aleksandar Kalauzi
- Institute for Multidisciplinary Research, Department of Life Sciences, University of Belgrade, Belgrade, Serbia
| | - Ksenija Radotic
- Institute for Multidisciplinary Research, Department of Life Sciences, University of Belgrade, Belgrade, Serbia
| | | | - Simone Dinarelli
- Consiglio Nazionale delle Ricerche - Istituto di Struttura della Materia, CNR-ISM, Rome, Italy
| | - Marco Girasole
- Consiglio Nazionale delle Ricerche - Istituto di Struttura della Materia, CNR-ISM, Rome, Italy
| | - Milica Pešić
- Department of Neurobiology, Institute for Biological Research "Siniša Stanković" National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jasna Banković
- Department of Neurobiology, Institute for Biological Research "Siniša Stanković" National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Maria E Vela
- Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas (INIFTA-CONICET-CCT La Plata), Universidad Nacional de La Plata, La Plata, Argentina
| | - Osvaldo Yantorno
- Centro de Investigación y Desarrollo en Fermentaciones Industriales (CINDEFI-CONICET-CCT La Plata), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Ronnie Willaert
- ARG VUB-UGent NanoMicrobiology, IJRG VUB-EPFL BioNanotechnology & NanoMedicine, Structural Biology Brussels, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Giovanni Dietler
- Laboratoire de Physique de la Matière Vivante, Institut de Physique, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Giovanni Longo
- Consiglio Nazionale delle Ricerche - Istituto di Struttura della Materia, CNR-ISM, Rome, Italy
| | - Sandor Kasas
- Laboratoire de Physique de la Matière Vivante, Institut de Physique, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Centre Universitaire Romand de Médecine Légale, UFAM, Université de Lausanne, Lausanne, Switzerland
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Ruggeri FS, Marcott C, Dinarelli S, Longo G, Girasole M, Dietler G, Knowles TPJ. Identification of Oxidative Stress in Red Blood Cells with Nanoscale Chemical Resolution by Infrared Nanospectroscopy. Int J Mol Sci 2018; 19:E2582. [PMID: 30200270 PMCID: PMC6163177 DOI: 10.3390/ijms19092582] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/18/2022] Open
Abstract
During their lifespan, Red blood cells (RBC), due to their inability to self-replicate, undergo an ageing degradation phenomenon. This pathway, both in vitro and in vivo, consists of a series of chemical and morphological modifications, which include deviation from the biconcave cellular shape, oxidative stress, membrane peroxidation, lipid content decrease and uncoupling of the membrane-skeleton from the lipid bilayer. Here, we use the capabilities of atomic force microscopy based infrared nanospectroscopy (AFM-IR) to study and correlate, with nanoscale resolution, the morphological and chemical modifications that occur during the natural degradation of RBCs at the subcellular level. By using the tip of an AFM to detect the photothermal expansion of RBCs, it is possible to obtain nearly two orders of magnitude higher spatial resolution IR spectra, and absorbance images than can be obtained on diffraction-limited commercial Fourier-transform Infrared (FT-IR) microscopes. Using this approach, we demonstrate that we can identify localized sites of oxidative stress and membrane peroxidation on individual RBC, before the occurrence of neat morphological changes in the cellular shape.
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Affiliation(s)
| | - Curtis Marcott
- Department of Materials Science and Engineering, University of Delaware, Newark, DE 19716, USA.
- Light Light Solutions, Athens, GA 30608, USA.
| | - Simone Dinarelli
- Institute of Structural Matter, ISM-CNR, via del Fosso del Cavaliere 100, 00133 Rome, Italy.
| | - Giovanni Longo
- Institute of Structural Matter, ISM-CNR, via del Fosso del Cavaliere 100, 00133 Rome, Italy.
| | - Marco Girasole
- Institute of Structural Matter, ISM-CNR, via del Fosso del Cavaliere 100, 00133 Rome, Italy.
| | - Giovanni Dietler
- Laboratoire de Physique de la Matière Vivante, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland.
| | - Tuomas P J Knowles
- Department of Chemistry, Cambridge University, Cambridge CB21EW, UK.
- Cavendish Laboratory, Department of Physics, University of Cambridge, Cambridge CB3 0HE, UK.
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Carelli-Alinovi C, Dinarelli S, Sampaolese B, Misiti F, Girasole M. Morphological changes induced in erythrocyte by amyloid beta peptide and glucose depletion: A combined atomic force microscopy and biochemical study. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2018; 1861:236-244. [PMID: 30040926 DOI: 10.1016/j.bbamem.2018.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/21/2018] [Accepted: 07/19/2018] [Indexed: 12/28/2022]
Abstract
Circulating red blood cells (RBCs) undergo aging, a fundamental physiological phenomenon that regulates their turnover. We show that treatment with beta amyloid peptide 1-42 (Aβ) accelerates the occurrence of morphological and biochemical aging markers in human RBCs and influences the cell metabolism leading to intracellular ATP depletion. The morphological pattern has been monitored using Atomic Force Microscopy (AFM) imaging and measuring the RBCs' plasma membrane roughness employed as a morphological parameter capable to provide information on the structure and integrity of the membrane-skeleton. Results evidence that Aβ boosts the development of crenatures and proto-spicules simultaneously to acceleration in the weakening of the cell-cytoskeleton contacts and to the induction of peculiar nanoscale features on the cell membrane. Incubation in the presence of glucose can remove all but the latter Aβ-induced effects. Biochemical data demonstrate that contemporaneously to morphological and structural alterations, Aβ and glucose depletion trigger a complex signaling pathway involving caspase 3, protein kinase C (PKC) and nitric oxide derived metabolites. As a whole, the collected data revealed that, the damaging path induced by Aβ in RBC provide a sequence of morphological and functional intermediates following one another along RBC life span, including: (i) an acceleration in the development of shape alteration typically observed along the RBC's aging; (ii) the development of characteristic membrane features on the plasma membrane and (iii) triggering a complex signaling pathway involving caspase 3, PKC and nitric oxide derived metabolites.
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Affiliation(s)
- Cristiana Carelli-Alinovi
- Biochemistry and Clinical Biochemistry Institute, Catholic University, School of Medicine, L. go F. Vito n.1, 00168 Rome, Italy
| | - Simone Dinarelli
- Institute for the Structure of the Matter (ISM), National Research Council (CNR), via Fosso del Cavaliere 100, 00133 Rome, Italy
| | - Beatrice Sampaolese
- Institute of Chemistry of the Molecular Recognition (ICRM), National Research Council (CNR), L. go F. Vito n.1, 00168 Rome, Italy
| | - Francesco Misiti
- Human, Social and Health Department, University of Cassino and Lazio Meridionale, V. S. Angelo, Loc. Folcara, 03043 Cassino, FR, Italy.
| | - Marco Girasole
- Institute for the Structure of the Matter (ISM), National Research Council (CNR), via Fosso del Cavaliere 100, 00133 Rome, Italy
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Zou J, Chen Z, Liang C, Fu Y, Wei X, Lu J, Pan M, Guo Y, Liao X, Xie H, Wu D, Li M, Liang L, Wang P, Wang Q. Trefoil Factor 3, Cholinesterase and Homocysteine: Potential Predictors for Parkinson's Disease Dementia and Vascular Parkinsonism Dementia in Advanced Stage. Aging Dis 2018; 9:51-65. [PMID: 29392081 PMCID: PMC5772858 DOI: 10.14336/ad.2017.0416] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/16/2017] [Indexed: 01/23/2023] Open
Abstract
Trefoil factor 3 (TFF3), cholinesterase activity (ChE activity) and homocysteine (Hcy) play critical roles in modulating recognition, learning and memory in neurodegenerative diseases, such as Parkinson's disease dementia (PDD) and vascular parkinsonism with dementia (VPD). However, whether they can be used as reliable predictors to evaluate the severity and progression of PDD and VPD remains largely unknown. METHODS We performed a cross-sectional study that included 92 patients with PDD, 82 patients with VPD and 80 healthy controls. Serum levels of TFF3, ChE activity and Hcy were measured. Several scales were used to rate the severity of PDD and VPD. Receivers operating characteristic (ROC) curves were applied to map the diagnostic accuracy of PDD and VPD patients compared to healthy subjects. RESULTS Compared with healthy subjects, the serum levels of TFF3 and ChE activity were lower, while Hcy was higher in the PDD and VPD patients. These findings were especially prominent in male patients. The three biomarkers displayed differences between PDD and VPD sub-groups based on genders and UPDRS (III) scores' distribution. Interestingly, these increased serum Hcy levels were significantly and inversely correlated with decreased TFF3/ChE activity levels. There were significant correlations between TFF3/ChE activity/Hcy levels and PDD/VPD severities, including motor dysfunction, declining cognition and mood/gastrointestinal symptoms. Additionally, ROC curves for the combination of TFF3, ChE activity and Hcy showed potential diagnostic value in discriminating PDD and VPD patients from healthy controls. CONCLUSIONS Our findings suggest that serum TFF3, ChE activity and Hcy levels may underlie the pathophysiological mechanisms of PDD and VPD. As the race to find biomarkers or predictors for these diseases intensifies, a better understanding of the roles of TFF3, ChE activity and Hcy may yield insights into the pathogenesis of PDD and VPD.
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Affiliation(s)
| | | | - Caiqian Liang
- 2Department of Emergency, The Third Affiliated Hospital of Sun Yat-Sen University, China
| | - Yongmei Fu
- 2Department of Emergency, The Third Affiliated Hospital of Sun Yat-Sen University, China
| | | | - Jianjun Lu
- 3Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Mengqiu Pan
- 3Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Yue Guo
- 4Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Xinxue Liao
- 4Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Huifang Xie
- 5Department of Neurology, Zhujiang Hospital, Southern Medical University, China
| | - Duobin Wu
- 5Department of Neurology, Zhujiang Hospital, Southern Medical University, China
| | - Min Li
- 6School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Lihui Liang
- 7Department of Geriatric Medicine, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Penghua Wang
- 8Department of Microbiology & Immunology, School of Medicine, New York Medical College, NY 10595, USA
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Carelli-Alinovi C, Misiti F. Erythrocytes as Potential Link between Diabetes and Alzheimer's Disease. Front Aging Neurosci 2017; 9:276. [PMID: 28890694 PMCID: PMC5574872 DOI: 10.3389/fnagi.2017.00276] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/03/2017] [Indexed: 12/20/2022] Open
Abstract
Many studies support the existence of an association between type 2 diabetes (T2DM) and Alzheimer's disease (AD). In AD, in addition to brain, a number of peripheral tissues and cells are affected, including red blood cell (RBC) and because there are currently no reliable diagnostic biomarkers of AD in the blood, a gradually increasing attention has been given to the study of RBC's alterations. Recently it has been evidenced in diabetes, RBC alterations superimposable to the ones occurring in AD RBC. Furthermore, growing evidence suggests that oxidative stress plays a pivotal role in the development of RBC's alterations and vice versa. Once again this represents a further evidence of a shared pathway between AD and T2DM. The present review summarizes the two disorders, highlighting the role of RBC in the postulated common biochemical links, and suggests RBC as a possible target for clinical trials.
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Affiliation(s)
- Cristiana Carelli-Alinovi
- School of Medicine, Biochemistry and Clinical Biochemistry Institute, Università Cattolica del Sacro CuoreRome, Italy
| | - Francesco Misiti
- Human, Social and Health Department, University of Cassino and Lazio MeridionaleCassino, Italy
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