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Zi-chang N, Xiao-ling H, Qi J, Ting L, Ming-hui O, Hao-ping M. Ginseng Radix et Rhizoma enhanced the effect of metoprolol in chronic heart failure by inhibiting autophagy in male C57BL/6J mice. PLoS One 2024; 19:e0301875. [PMID: 39141645 PMCID: PMC11324128 DOI: 10.1371/journal.pone.0301875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Ginseng Radix et Rhizoma (GS) is frequently used as an adjuvant therapy for patients with heart failure (HF). Metoprolol is widely used in patients with HF. However, there is no report on the combined effects of GS and metoprolol in patients with HF. OBJECTIVE This study investigated the combined effects of GS and metoprolol in male C57BL/6J mice with HF and the underlying mechanisms. MATERIALS AND METHODS We utilized a mouse myocardial HF model to measure the serum levels of creatine kinase (CK) and creatine kinase-MB form (CK-MB) using an automated biochemical analyzer. Lactate dehydrogenase (LDH) and cardiac troponin (cTnT) levels were determined using enzyme-linked immunosorbent assays. Autophagy of myocardial cells was evaluated using transmission electron microscopy, and changes in signal pathway proteins related to autophagy were analyzed by Western blotting. RESULTS GS combined with metoprolol improved heart function, reduced heart damage, and decreased serum levels of CK, CK-MB, LDH, and cTnT. The combination of GS and metoprolol decreased autophagy in myocardial cells by reducing the levels of autophagy-related proteins (LC3, p62, Beclin1, and Atg5) and increasing the ratios of p-PI3K/PI3K, p-Akt/Akt, and p-mTOR/mTOR. CONCLUSION GS enhanced the anti-heart failure effect of metoprolol. Its mechanism of action might be related to the inhibition of autophagy mediated by the activation of the PI3K/Akt/mTOR pathway.
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Affiliation(s)
- Niu Zi-chang
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulea, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Han Xiao-ling
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulea, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Jin Qi
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulea, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Liu Ting
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulea, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Ouyang Ming-hui
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulea, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Mao Hao-ping
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulea, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
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Cheng PP, Wang XT, Liu Q, Hu YR, Dai ER, Zhang MH, Yang TS, Qu HY, Zhou H. Nrf2 mediated signaling axis in heart failure: Potential pharmacological receptor. Pharmacol Res 2024; 206:107268. [PMID: 38908614 DOI: 10.1016/j.phrs.2024.107268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Heart failure (HF) has emerged as the most pressing health concerns globally, and extant clinical therapies are accompanied by side effects and patients have a high burden of financial. The protein products of nuclear factor erythroid 2-related factor 2 (Nrf2) target genes have a variety of cardioprotective effects, including antioxidant, metabolic functions and anti-inflammatory. By evaluating established preclinical and clinical research in HF to date, we explored the potential of Nrf2 to exert unique cardioprotective functions as a novel therapeutic receptor for HF. In this review, we generalize the progression, structure, and function of Nrf2 research in the cardiovascular system. The mechanism of action of Nrf2 involved in HF as well as agonists of Nrf2 in natural compounds are summarized. Additionally, we discuss the challenges and implications for future clinical translation and application of pharmacology targeting Nrf2. It's critical to developing new drugs for HF.
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Affiliation(s)
- Pei-Pei Cheng
- Institute of Cardiovascular Disease of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Branch of National Clinical Research Center for Chinese Medicine Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xin-Ting Wang
- Institute of Cardiovascular Disease of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Branch of National Clinical Research Center for Chinese Medicine Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Qian Liu
- Institute of Cardiovascular Disease of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Branch of National Clinical Research Center for Chinese Medicine Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yi-Ran Hu
- Institute of Cardiovascular Disease of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Branch of National Clinical Research Center for Chinese Medicine Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - En-Rui Dai
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Ming-Hao Zhang
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Tian-Shu Yang
- Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai 200071, China
| | - Hui-Yan Qu
- Institute of Cardiovascular Disease of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Branch of National Clinical Research Center for Chinese Medicine Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Hua Zhou
- Institute of Cardiovascular Disease of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Branch of National Clinical Research Center for Chinese Medicine Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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Zhong G, Chen J, Li Y, Han Y, Wang M, Nie Q, Xu M, Zhu Q, Chang X, Wang L. Ginsenoside Rg3 attenuates myocardial ischemia/reperfusion-induced ferroptosis via the keap1/Nrf2/GPX4 signaling pathway. BMC Complement Med Ther 2024; 24:247. [PMID: 38926825 PMCID: PMC11209975 DOI: 10.1186/s12906-024-04492-4] [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: 01/12/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Ginsenoside Rg3 is a component of ginseng that protects against myocardial ischemia/reperfusion (MI/R) injury. Ferroptosis is a new form of cell death characterized by oxidative damage to phospholipids. The purpose of this study was to examine the role and of ginsenoside Rg3 in MI/R and the mechanism. METHODS A mouse model of left anterior descending (LAD) ligation-induced myocardial ischemia/reperfusion (MI/R) injury and oxygen-glucose deprivation/reperfusion (OGD/R) were used as in vitro and in vivo models, respectively. Echocardiographic analysis, 2,3,5-triphenyltetrazolium chloride (TTC) staining and hematoxylin-eosin (H&E) staining were used to assess the cardioprotective effects of ginsenoside Rg3. Western blotting, biochemical analysis, small interfering RNA analysis and molecular docking were performed to examine the underlying mechanism. RESULTS Ginsenoside Rg3 improved cardiac function and infarct size in mice with MI/R injury. Moreover, ginsenoside Rg3 increased the expression of the ferroptosis-related protein GPX4 and inhibited iron deposition in mice with MI/R injury. Ginsenoside Rg3 also activated the Nrf2 signaling pathway. Ginsenoside Rg3 attenuated myocardial ischemia/reperfusion-induced ferroptosis via the Nrf2 signaling pathway. Notably, ginsenoside Rg3 regulated the keap1/Nrf2 signaling pathway to attenuate OGD/R-induced ferroptosis in H9C2 cells. Taken together, ginsenoside Rg3 attenuated myocardial ischemia/reperfusion-induced ferroptosis via the keap1/Nrf2/GPX4 signaling pathway. CONCLUSIONS Our findings demonstrated that ginsenoside Rg3 ameliorate MI/R-induced ferroptosis via the keap1/Nrf2/GPX4 signaling pathway.
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Affiliation(s)
- GuoFu Zhong
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Junteng Chen
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Yangtao Li
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Yue Han
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Maosheng Wang
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Qinqi Nie
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Mujuan Xu
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Qinghua Zhu
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Xiao Chang
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China.
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China.
| | - Ling Wang
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, China.
- Department of intensive care unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China.
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Wang Y, An X, Wang F, Jiang Y. Ginsenoside RH4 inhibits Ang II-induced myocardial remodeling by interfering with NFIL3. Biomed Pharmacother 2024; 172:116253. [PMID: 38359490 DOI: 10.1016/j.biopha.2024.116253] [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: 11/06/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024] Open
Abstract
Ventricular remodeling refers to the structural and functional changes of the heart under various stimuli or disease influences and may also be accompanied by myocardial fibrosis, where an excessive amount of fibrous tissue appears in the myocardial tissue, affecting the heart's normal contraction and relaxation. Hypertension is posing the potential risk of causing myocardial injury and remodeling. The significance of the renin-angiotensin-aldosterone system (RAAS) in myocardial remodeling cannot be overlooked. Drug targeting of RAAS can effectively lower blood pressure and reduce left ventricular mass. Studies have shown that ginsenoside Rh4 can inhibit oxidative stress and inflammatory responses. In this study, a myocardial remodeling model was established using angiotensin (Ang) II, and the inhibitory effect of RH4 on myocardial hypertrophy and remodeling induced by Ang II was investigated using pathological staining and quantitative polymerase chain reaction (qPCR). Immunofluorescence and qPCR demonstrated that Rh4 causes myocardial hypertrophy and the generation of reactive oxygen species (ROS) in vitro. The Rh4 target was identified using transcriptomics. The findings indicated that RH4 could inhibit myocardial hypertrophy, inflammatory fibrosis, and oxidative stress induced by Ang II, suggesting potential cardiovascular protection effects. In vitro experiments have shown that Rh4 inhibits myocardial hypertrophy. Transcriptomics revealed that nuclear factor interleukin-3 (NFIL3) is a downstream regulator of Rh4. By constructing AAV9-NFIL3 and injecting it into mice, it was found that NFIL3 overexpression interfered with anti-Ang II-induced myocardial remodeling of Rh4. These results indicate that Rh4 demonstrates potential therapeutic effects on myocardial hypertrophy and fibrosis.
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Affiliation(s)
- Yitong Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiangbo An
- Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Feng Wang
- Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Yinong Jiang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Du L, Lu H, Wang Z, Liu C, Xiao Y, Guo Z, Li Y. Therapeutic Potential of Ginsenoside Rb1-PLGA Nanoparticles for Heart Failure Treatment via the ROS/PPARα/PGC1α Pathway. Molecules 2023; 28:8118. [PMID: 38138606 PMCID: PMC10745441 DOI: 10.3390/molecules28248118] [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: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Ginsenoside Rb1-PLGA nanoparticles (GRb1@PLGA@NPs) represent a novel nanotherapeutic system, yet their therapeutic efficacy and underlying mechanisms for treating heart failure (HF) remain unexplored. This study aims to investigate the potential mechanisms underlying the therapeutic effects of GRb1@PLGA@NPs in HF treatment; (2) Methods: The left anterior descending coronary artery ligation was employed to establish a HF model in Sprague-Dawley rats, along with an in vitro oxidative stress model using H9c2 myocardial cells. Following treatment with GRb1@PLGA@NPs, cardiac tissue pathological changes and cell proliferation were observed. Additionally, the serum levels of biomarkers such as NT-proBNP, TNF-α, and IL-1β were measured, along with the expression of the ROS/PPARα/PGC1α pathway; (3) Results: GRb1@PLGA@NPs effectively ameliorated the pathological status of cardiac tissues in HF rats, mitigated oxidative stress-induced myocardial cell damage, elevated SOD and MMP levels, and reduced LDH, MDA, ROS, NT-proBNP, TNF-α, and IL-1β levels. Furthermore, the expression of PPARα and PGC1α proteins was upregulated; (4) Conclusions: GRb1@PLGA@NPs may attenuate myocardial cell injury and treat HF through the ROS/PPARα/PGC1α pathway.
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Affiliation(s)
- Lixin Du
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China; (L.D.); (H.L.); (Y.X.)
| | - Huiling Lu
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China; (L.D.); (H.L.); (Y.X.)
| | - Ziyan Wang
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, China; (Z.W.); (C.L.); (Z.G.)
| | - Chengxin Liu
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, China; (Z.W.); (C.L.); (Z.G.)
| | - Yifei Xiao
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China; (L.D.); (H.L.); (Y.X.)
| | - Zhihua Guo
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, China; (Z.W.); (C.L.); (Z.G.)
| | - Ya Li
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China; (L.D.); (H.L.); (Y.X.)
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Du L, Lu H, Xiao Y, Guo Z, Li Y. Preparation, characterization and in vivo pharmacokinetic study of ginsenoside Rb1-PLGA nanoparticles. Sci Rep 2023; 13:18472. [PMID: 37891245 PMCID: PMC10611732 DOI: 10.1038/s41598-023-45858-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to construct a Ginsenoside Rb1-PLGA nano drug delivery system, optimize its preparation process, characterize and evaluate the resulting Ginsenoside Rb1-PLGA Nanoparticles (GRb1@PLGA@NPs). GRb1@PLGA@NPs were prepared using the emulsion solvent evaporation method. The optimal preparation process was determined using Plackett-Burman design combined with Box-Behnken experiments. Physical characterization and in vitro release studies were conducted. LC-MS/MS technique was employed to investigate the pharmacokinetic characteristics of GRb1 and GRb1@PLGA@NPs in rat plasma. The optimal preparation process yielded GRb1@PLGA@NPs with a particle size of 120.63 nm, polydispersity index (PDI) of 0.172, zeta potential of - 22.67 mV, encapsulation efficiency of 75%, and drug loading of 11%. In vitro release demonstrated sustained drug release. Compared to GRb1, GRb1@PLGA@NPs exhibited a shortened time to peak concentration by approximately 0.72-fold. The area under the plasma concentration-time curve significantly increased to 4.58-fold of GRb1. GRb1@PLGA@NPs formulated using the optimal process exhibited uniform distribution and stable quality, its relative oral bioavailability was significantly improved compared to free GRb1.
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Affiliation(s)
- Lixin Du
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Huiling Lu
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Yifei Xiao
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Zhihua Guo
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Ya Li
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha, 410208, China.
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Kundakci YE, Bilir A, Atay E, Vurmaz A, Firat F, Arikan ES. Protective Effects of Different Doses of Ginsenoside-Rb1 Experimental Cataract Model That in Chick Embryos. Curr Eye Res 2023; 48:817-825. [PMID: 37260421 DOI: 10.1080/02713683.2023.2221415] [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: 03/20/2023] [Revised: 05/04/2023] [Accepted: 05/31/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE There has been increased interest in phytochemical antioxidants to prevent protein damage and aggregate formation in cataract treatment. In this study, the protective effect of different doses of Rb1 (GRb1), one of the ginsenosides of Panax Ginseng, in the experimental cataract model formed in chick embryos was investigated. METHODS Five different experimental groups were formed with 100 SPF fertilized eggs: Control (0.9% NaCl to physiological saline), hydrocortisone hemisuccinate sodium (HC), low dose (HC + L-GRb1 (1 mg/kg)), medium dose (HC+). M-GRb1 (2.5 mg/kg)), and high dose (HC + H-GRb1 (5 mg/kg)). All solutions were given to air sack at 15 days of incubation. On the 17th day, the bulbous oculi of the chick embryos were dissected. Cataract formations of the lenses, glutathione (GSH), malondialdehyde (MDA), total antioxidant (TAS), total oxidant (TOS) levels, Caspase-3 H-score, and TUNEL index were determined. In addition, crystalline alpha A (CRYAA) gene expression was evaluated. RESULTS Cataracts were observed in the control, HC, HC + L-GRb1, HC + M-GRb1, and HC + H-GRb1 groups with a frequency of 0%, 100%, 75%, 56.25%, and 100%, respectively. There were statistically significant differences between the control and HC groups in terms of TAS, TOS, MDA, GSH, Caspase-3 H-score, and TUNEL index (p < .05). When the therapeutic effect of the GRb1 groups was evaluated, the HC group showed significant differences with the HC + L-GRb1 and HC + M-GRb1 groups in almost all parameters (p < .05), while there was no statistical difference with the HC + H-GRb1 group (p > .05). In addition, gene expression levels differed between the groups, although not statistically significant (p > .05). CONCLUSION 1 mg/kg and 2.5 mg/kg GRb1 applications show therapeutic properties on the HC-induced cataract model. This effect is more pronounced at 2.5 mg/kg.
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Affiliation(s)
- Yunus Emre Kundakci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Abdulkadir Bilir
- Department of Anatomy, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Emre Atay
- Department of Anatomy, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ayhan Vurmaz
- Department of Biochemistry, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Fatma Firat
- Department of Histology and Embryology, Medicine Faculty, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Evrim Suna Arikan
- Department of Medical Biology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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