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Moreno-Vedia J, Llop D, Rodríguez-Calvo R, Plana N, Amigó N, Rosales R, Esteban Y, Masana L, Ibarretxe D, Girona J. Lipidomics of triglyceride-rich lipoproteins derived from hyperlipidemic patients on inflammation. Eur J Clin Invest 2024; 54:e14132. [PMID: 38010694 DOI: 10.1111/eci.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIM Triglyceride-rich lipoproteins (TRLs) can have an important role in atherosclerosis development due to their size and ability to penetrate the endothelium. While high plasma triglyceride (TG) levels and chronic inflammation are relevant in metabolic diseases, it remains unclear whether TGs are atherogenic or which TRL-TG-derived metabolites are responsible for inflammation. Here, we aimed to study the lipidome modifications of TRL particles enriched in TG in patients with hyperlipidemia and their associations with a proinflammatory status both in vivo and in vitro. METHODS Using proton nuclear magnetic resonance (1 H-NMR), we analysed the plasma levels of glycoprotein acetyls and the TRL lipidomic profile of 307 patients with dyslipidemia. THP-1-derived macrophages were used as an in vitro model to explore the molecular inflammatory effects mediated by TRL. RESULTS In vivo, higher TRL-TG levels were associated with higher circulating levels of NMR-measured glycoproteins (Glyc-A, Glyc-B and Glyc-F; p < .001). Lipidomic analysis showed that TRL-TG enrichment led to decreased cholesterol and phospholipid content (p < .01), an increase in omega-9, and a decrease in saturated fatty acids (p < .001). THP-1 macrophages exposed to increasing TRL particle concentrations augmented the secretion of IL-1β and TNF-α, which varied based on particle composition. Particles with higher cholesterol and phospholipid contents exerted higher cytokine secretion. The activation of MAPK, Akt/NFκB, and caspase-1 was concurrent with this proinflammatory response. CONCLUSIONS High TRL-TG levels are associated with a higher systemic inflammatory status and increased particle concentrations. In vitro, higher particle numbers increase proinflammatory cytokine secretion, with cholesterol and phospholipid-rich TRL being more proinflammatory.
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Affiliation(s)
- Juan Moreno-Vedia
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
| | - Dídac Llop
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Ricardo Rodríguez-Calvo
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Núria Plana
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Núria Amigó
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Biosfer Teslab SL, Department of Basic Medical Sciences, Universitat Rovira i Virgili (URV), Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Roser Rosales
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Yaiza Esteban
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Lluís Masana
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Josefa Girona
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili. Institut Investigacio Sanitaria Pere Virgili (IISPV), Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
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2
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García-González A, Espinosa-Cabello JM, Cerrillo I, Montero-Romero E, Rivas-Melo JJ, Romero-Báez A, Jiménez-Andreu MD, Ruíz-Trillo CA, Rodríguez-Rodríguez A, Martínez-Ortega AJ, Del Carmen Roque-Cuellar M, García-Rey S, Jiménez-Sánchez A, Mangas-Cruz MÁ, Pereira-Cunill JL, Perona JS, García-Luna PP, Castellano JM. Bioavailability and systemic transport of oleanolic acid in humans, formulated as a functional olive oil. Food Funct 2023; 14:9681-9694. [PMID: 37812020 DOI: 10.1039/d3fo02725b] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Evidence of the pharmacological activity of oleanolic acid (OA) suggests its potential therapeutic application. However, its use in functional foods, dietary supplements, or nutraceuticals is hindered by limited human bioavailability studies. The BIO-OLTRAD trial is a double-blind, randomized controlled study with 22 participants that received a single dose of 30 mg OA formulated as a functional olive oil. The study revealed that the maximum serum concentration of OA ranged from 500 to 600 ng mL-1, with an AUC0-∞ value of 2862.50 ± 174.50 ng h mL-1. Furthermore, we discovered a physiological association of OA with serum albumin and triglyceride-rich lipoproteins (TRL). UV absorption spectra showed conformational changes in serum albumin due to the formation of an adduct with OA. Additionally, we demonstrated that TRL incorporate OA, reaching a maximum concentration of 140 ng mL-1 after 2-4 hours. We conjecture that both are efficient carriers to reach target tissues and to yield high bioavailability.
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Affiliation(s)
- Aída García-González
- University Pablo de Olavide, Department of Molecular Biology and Biochemical Engineering, 41013-Seville, Spain
| | | | - Isabel Cerrillo
- University Pablo de Olavide, Department of Molecular Biology and Biochemical Engineering, 41013-Seville, Spain
| | - Emilio Montero-Romero
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | | | - Andrea Romero-Báez
- Spanish Scientific Research Council, Instituto de la Grasa-CSIC, 41013-Seville, Spain.
| | - María Dolores Jiménez-Andreu
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - Carmen Amelia Ruíz-Trillo
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - Ana Rodríguez-Rodríguez
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - Antonio Jesús Martínez-Ortega
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - María Del Carmen Roque-Cuellar
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - Silvia García-Rey
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - Andrés Jiménez-Sánchez
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - Miguel Ángel Mangas-Cruz
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - José Luis Pereira-Cunill
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - Javier S Perona
- Spanish Scientific Research Council, Instituto de la Grasa-CSIC, 41013-Seville, Spain.
| | - Pedro Pablo García-Luna
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013-Seville, Spain.
| | - José María Castellano
- Spanish Scientific Research Council, Instituto de la Grasa-CSIC, 41013-Seville, Spain.
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3
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Espinosa JM, Quintero-Flórez A, Carrasquilla N, Montero E, Rodríguez-Rodríguez A, Castellano JM, Perona JS. Bioactive compounds in pomace olive oil modulate the inflammatory response elicited by postprandial triglyceride-rich lipoproteins in BV-2 cells. Food Funct 2023; 14:8987-8999. [PMID: 37740318 DOI: 10.1039/d3fo02460a] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Modulation of microglial response could be a target to reduce neuroinflammation associated with Alzheimer's disease. In this study, we propose that lipophilic bioactive molecules present in pomace olive oil (POO), transported in triglyceride-rich lipoproteins (TRLs), are able to modulate microglial high-oleic sunflower oil (HOSO, points) or pomace olive oil (POO, stripes). In order to prove this hypothesis, a randomized crossover postprandial trial was performed in 18 healthy young women. POO was assayed in opposition to high-oleic sunflower oil (HOSO), a common dietary oil which shares with POO an almost identical fatty acid composition but lacks certain biomolecules with recognized antioxidant and anti-inflammatory activities. TRLs were isolated from blood at the baseline and 2 and 4 hours postprandially and used to treat BV-2 cells to assess their ability to modulate the microglial function. We found that the intake of POO leads to the constitution of postprandial TRLs that are able to modulate the inflammatory response in microglia compared to HOSO. TRL-derived POO reduced the release of pro-inflammatory cytokines (tumor necrosis factor-α, and interleukins 1β and 6) and nitric oxide and downregulated genes codifying for these cytokines and inducible nitric oxide synthase (iNOS) in BV-2 cells. Moreover, the ingestion of POO by healthy women slightly improved glycemic control and TRL clearance throughout the postprandial phase compared to HOSO. In conclusion, we demonstrated that consuming POO results in postprandial TRLs containing lipophilic bioactive compounds capable of regulating the inflammatory response prompted by microglial activation.
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Affiliation(s)
- Juan Manuel Espinosa
- Instituto de la Grasa, Department of Food and Health, Spanish National Research Council (CSIC), Campus University Pablo de Olavide, 41013, Seville, Spain.
| | | | - Natalia Carrasquilla
- Instituto de la Grasa, Department of Food and Health, Spanish National Research Council (CSIC), Campus University Pablo de Olavide, 41013, Seville, Spain.
| | - Emilio Montero
- University Hospital Virgen del Rocío, Andalusian Regional Health Service, Seville, Spain
| | | | - José María Castellano
- Instituto de la Grasa, Department of Food and Health, Spanish National Research Council (CSIC), Campus University Pablo de Olavide, 41013, Seville, Spain.
| | - Javier S Perona
- Instituto de la Grasa, Department of Food and Health, Spanish National Research Council (CSIC), Campus University Pablo de Olavide, 41013, Seville, Spain.
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4
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Alagna F, Reed J, Calderini O, Thimmappa R, Cultrera NGM, Cattivelli A, Tagliazucchi D, Mousavi S, Mariotti R, Osbourn A, Baldoni L. OeBAS and CYP716C67 catalyze the biosynthesis of health-beneficial triterpenoids in olive (Olea europaea) fruits. THE NEW PHYTOLOGIST 2023; 238:2047-2063. [PMID: 36880371 PMCID: PMC10952584 DOI: 10.1111/nph.18863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/28/2023] [Indexed: 05/04/2023]
Abstract
The bioactive properties of olive (Olea europaea) fruits and olive oil are largely attributed to terpenoid compounds, including diverse triterpenoids such as oleanolic, maslinic and ursolic acids, erythrodiol, and uvaol. They have applications in the agri-food, cosmetics, and pharmaceutical industries. Some key steps involved in the biosynthesis of these compounds are still unknown. Genome mining, biochemical analysis, and trait association studies have been used to identify major gene candidates controlling triterpenoid content of olive fruits. Here, we identify and functionally characterize an oxidosqualene cyclase (OeBAS) required for the production of the major triterpene scaffold β-amyrin, the precursor of erythrodiol, oleanolic and maslinic acids, and a cytochrome P450 (CYP716C67) that mediates 2α oxidation of the oleanane- and ursane-type triterpene scaffolds to produce maslinic and corosolic acids, respectively. To confirm the enzymatic functions of the entire pathway, we have reconstituted the olive biosynthetic pathway for oleanane- and ursane-type triterpenoids in the heterologous host, Nicotiana benthamiana. Finally, we have identified genetic markers associated with oleanolic and maslinic acid fruit content on the chromosomes carrying the OeBAS and CYP716C67 genes. Our results shed light on the biosynthesis of olive triterpenoids and provide new gene targets for germplasm screening and breeding for high triterpenoid content.
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Affiliation(s)
- Fiammetta Alagna
- Department of Energy Technologies and Renewable SourcesNational Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Trisaia Research Centre75026RotondellaItaly
| | - James Reed
- Department of Biochemistry and MetabolismJohn Innes CentreNorwich Research ParkNorwichNR4 7UHUK
| | - Ornella Calderini
- Institute of Biosciences and BioresourcesNational Research Council (CNR)06128PerugiaItaly
| | - Ramesha Thimmappa
- Department of Biochemistry and MetabolismJohn Innes CentreNorwich Research ParkNorwichNR4 7UHUK
- Amity Institute of Genome EngineeringAmity University Uttar PradeshNoida201313India
| | - Nicolò G. M. Cultrera
- Institute of Biosciences and BioresourcesNational Research Council (CNR)06128PerugiaItaly
| | - Alice Cattivelli
- Department of Life SciencesUniversity of Modena and Reggio Emilia42100Reggio EmiliaItaly
| | - Davide Tagliazucchi
- Department of Life SciencesUniversity of Modena and Reggio Emilia42100Reggio EmiliaItaly
| | - Soraya Mousavi
- Institute of Biosciences and BioresourcesNational Research Council (CNR)06128PerugiaItaly
| | - Roberto Mariotti
- Institute of Biosciences and BioresourcesNational Research Council (CNR)06128PerugiaItaly
| | - Anne Osbourn
- Department of Biochemistry and MetabolismJohn Innes CentreNorwich Research ParkNorwichNR4 7UHUK
| | - Luciana Baldoni
- Institute of Biosciences and BioresourcesNational Research Council (CNR)06128PerugiaItaly
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5
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Krajewska M, Dopierała K, Prochaska K. The Biomimetic System of Oleanolic Acid and Oleic Acid at the Air-Water Interface-Interactions in Terms of Nanotechnology-Based Drug Delivery Systems. MEMBRANES 2022; 12:1215. [PMID: 36557123 PMCID: PMC9782233 DOI: 10.3390/membranes12121215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Oleanolic acid (OLA) and oleic acid (OA) are ubiquitous in the plant kingdom, exhibiting a therapeutic effect on human health, and are components of novel pharmaceutical formulations. Since OLA has limited solubility, the utilization of nanotechnology-based drug delivery systems enhancing bioavailability is highly advantageous. We report on the interfacial behavior of the OLA:OA system at various molar ratios, using the Langmuir technique to assess the dependence of the molar composition on miscibility and rheological properties affecting film stability. Specifically, we evaluate the interfacial properties (morphology, thermodynamics, miscibility, and viscoelasticity) of the OLA:OA binary system in various molar ratios, and indicate how the OLA:OA system exhibits the most favorable molecular interactions. We apply the Langmuir monolayer technique along with the complementary techniques of Brewster angle microscopy, dilatational interfacial rheology, and excess free energy calculations. Results demonstrate that the properties of mixed monolayers depend on OLA:OA molar ratio. Most of the systems (OLA:OA 2:1, 1:1, 1:5) are assumed to be immiscible at surface pressures >10 mN/m. Moreover, the OLA:OA 1:2 is immiscible over the entire surface pressure range. However, the existence of miscibility between molecules of OLA and OA in the 5:1 for every surface pressure tested suggests that OA molecules incorporate into the OLA lattice structure, improving the stability of the mixed film. The results are discussed in terms of providing physicochemical insights into the behavior of the OLA:OA systems at the interface, which is of high interest in pharmaceutical design.
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Affiliation(s)
- Martyna Krajewska
- Correspondence: (M.K.); (K.D.); Tel.: +48-61-665-33-42 (M.K.); +48-61-665-37-72 (K.D.)
| | - Katarzyna Dopierała
- Correspondence: (M.K.); (K.D.); Tel.: +48-61-665-33-42 (M.K.); +48-61-665-37-72 (K.D.)
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6
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Yang YH, Dai SY, Deng FH, Peng LH, Li C, Pei YH. Recent advances in medicinal chemistry of oleanolic acid derivatives. PHYTOCHEMISTRY 2022; 203:113397. [PMID: 36029846 DOI: 10.1016/j.phytochem.2022.113397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Oleanolic acid (OA), a ubiquitous pentacyclic oleanane-type triterpene isolated from edible and medicinal plants, exhibits a wide spectrum of pharmacological activities and tremendous therapeutic potential. However, the undesirable pharmacokinetic properties limit its application and development. Numerous researches on structural modifications of OA have been carried out to overcome this limitation and improve its pharmacokinetic and therapeutic properties. This review aims to compile and summarize the recent progresses in the medicinal chemistry of OA derivatives, especially on structure-activity relationship in the last few years (2010-2021). It gives insights into the rational design of bioactive derivatives from OA scaffold as promising therapeutic agents.
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Affiliation(s)
- Yi-Hui Yang
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Harbin, 150081, PR China
| | - Si-Yang Dai
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Harbin, 150081, PR China
| | - Fu-Hua Deng
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Harbin, 150081, PR China
| | - Li-Huan Peng
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Harbin, 150081, PR China
| | - Chang Li
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Harbin, 150081, PR China.
| | - Yue-Hu Pei
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Harbin, 150081, PR China.
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7
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Seidita A, Soresi M, Giannitrapani L, Di Stefano V, Citarrella R, Mirarchi L, Cusimano A, Augello G, Carroccio A, Iovanna JL, Cervello M. The clinical impact of an extra virgin olive oil enriched mediterranean diet on metabolic syndrome: Lights and shadows of a nutraceutical approach. Front Nutr 2022; 9:980429. [PMID: 35990331 PMCID: PMC9386289 DOI: 10.3389/fnut.2022.980429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 12/01/2022] Open
Abstract
For years it has been established that the only truly effective treatment of metabolic syndrome (MS) is lifestyle modification to prevent its cardiovascular (e.g., coronary artery disease and atherosclerosis), metabolic (e.g., diabetes mellitus), and hepatic (e.g., steatosis and non-alcoholic steatohepatitis) complications. The focal points of this approach are to increase physical activity and intake of a diet characterized by high quantities of fruits, vegetables, grains, fish, and low-fat dairy products, the so called mediterranean diet (MD); however, the added value of MD is the presence of extra virgin olive oil (EVOO), a healthy food with a high content of monounsaturated fatty acids, especially oleic acid, and variable concentrations (range 50–800 mg/kg) of phenols (oleuropein, ligstroside, and oleocanthal, and their derivatives, phenolic alcohols, such as hydroxytyrosol and tyrosol). Phenolic compounds not only determine EVOO’s main organoleptic qualities (oxidative stability, specific flavor, and taste features) but, theoretically, make it a source of antioxidant, anti-inflammatory, insulin-sensitizing, cardioprotective, antiatherogenic, neuroprotective, immunomodulatory, and anticancer activity. Although many studies have been carried out on EVOO’s clinical effects and attention toward this dietary approach (healthy and palatable food with strong nutraceutical activity) has become increasingly pressing, there are still many dark sides to be clarified, both in terms of actual clinical efficacy and biochemical and molecular activity. Thus, we reviewed the international literature, trying to show the state of the art about EVOO’s clinical properties to treat MS (along with correlated complications) and the future prospective of its nutraceutical use.
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Affiliation(s)
- Aurelio Seidita
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Maurizio Soresi
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Lydia Giannitrapani
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Institute for Biomedical Research and Innovation (IRIB), National Research Council, Palermo, Italy
| | - Vita Di Stefano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
| | - Roberto Citarrella
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Luigi Mirarchi
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonella Cusimano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council, Palermo, Italy
| | - Giuseppa Augello
- Institute for Biomedical Research and Innovation (IRIB), National Research Council, Palermo, Italy
| | - Antonio Carroccio
- Unit of Internal Medicine, "V. Cervello" Hospital, Ospedali Riuniti "Villa Sofia-Cervello", Palermo, Italy.,Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Juan Lucio Iovanna
- Cancer Research Center of Marseille, Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Melchiorre Cervello
- Institute for Biomedical Research and Innovation (IRIB), National Research Council, Palermo, Italy
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