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Lopes ALF, Araújo AKDS, Chaves LDS, Pacheco G, Oliveira APD, Silva KCD, Oliveira ACPD, Aquino CCD, Gois MB, Nicolau LAD, Medeiros JVR. Protective effect of alpha-ketoglutarate against water-immersion restraint stress-induced gastric mucosal damage in mice. Eur J Pharmacol 2023; 960:176118. [PMID: 37871764 DOI: 10.1016/j.ejphar.2023.176118] [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: 06/27/2023] [Revised: 09/22/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
Gastric lesions have several aetiologies, among which stress is the most prominent. Therefore, identification of new therapies to prevent stress is of considerable importance. Alpha-ketoglutarate (α-kg) several beneficial effects and has shown promise in combating oxidative stress, inflammation, and premature aging. Thus, this study aimed to evaluate the protective effect of α-kg in a gastric damage model by water-immersion restraint stress (WIRS). Pretreatment with α-kg decreased stress-related histopathological scores of tissue oedema, cell loss, and inflammatory infiltration. The α-kg restored the percentage of type III collagen fibres. Mucin levels were preserved as well as the structure and area of the myenteric plexus ganglia were preserved after pretreatment with α-kg. Myeloperoxidase (MPO) levels and the expression of pro-inflammatory cytokines (TNF-α and IL-1β) were also reduced following α-kg pretreatment. Decreased levels of glutathione (GSH) in the stress group were restored by α-kg. The omeprazole group was used as standard drug e also demonstrated improve on some parameters after the exposition to WIRS as inflammatory indexes, GSH and mucin. Through this, was possible to observe that α-kg can protect the gastric mucosa exposed to WIRS, preserve tissue architecture, reduce direct damage to the mucosa and inflammatory factors, stimulate the production of type III collagen and mucin, preserve the myenteric plexus ganglia, and maintain antioxidant potential. Due to, we indicate that α-kg has protective activity of the gastric mucosa, demonstrating its ability to prevent damage associated with gastric lesions caused by stress.
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Affiliation(s)
- André Luis Fernandes Lopes
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
| | - Andreza Ketly da Silva Araújo
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
| | - Letícia de Sousa Chaves
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
| | - Gabriella Pacheco
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
| | - Ana Patrícia de Oliveira
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
| | - Katriane Carvalho da Silva
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
| | - Antonio Carlos Pereira de Oliveira
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
| | | | - Marcelo Biondaro Gois
- Post-Graduation Program in Biosciences and Health, Federal University of Rondonópolis, Rondonópolis, Brazil.
| | - Lucas Antonio Duarte Nicolau
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
| | - Jand Venes Rolim Medeiros
- Laboratory of Inflammation and Translational Gastroenterology (LIGAT), Post-graduation Program in Biotechnology (PPGBIOTEC), Parnaíba Delta Federal University, Av. São Sebastião, 2819, Parnaíba, PI, CEP 64202-020, Brazil.
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Genistein: Therapeutic and Preventive Effects, Mechanisms, and Clinical Application in Digestive Tract Tumor. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5957378. [PMID: 35815271 PMCID: PMC9259214 DOI: 10.1155/2022/5957378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/28/2022] [Indexed: 12/30/2022]
Abstract
Genistein is one of the numerous recognized isoflavones that may be found in a variety of soybeans and soy products, including tofu and tofu products. The chemical name for genistein is 4', 5, 7-trihydroxyisoflavone, and it is found in plants. In recent years, the scientific world has become more interested in genistein because of its possible therapeutic effects on many forms of cancer. It has been widely investigated for its anticancer properties. The discovery of genistein's mechanism of action indicates its potential for apoptosis induction and cell cycle arrest in gastrointestinal cancer, especially gastric and colorectal cancer. Genistein's pharmacological activities as determined by the experimental studies presented in this review lend support to its use in the treatment of gastrointestinal cancer; however, additional research is needed in the future to determine its efficacy, safety, and the potential for using nanotechnology to increase bioavailability and therapeutic efficacy.
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Siriviriyakul P, Werawatganon D, Phetnoo N, Somanawat K, Chatsuwan T, Klaikeaw N, Chayanupatkul M. Genistein attenuated gastric inflammation and apoptosis in Helicobacter pylori-induced gastropathy in rats. BMC Gastroenterol 2020; 20:410. [PMID: 33297977 PMCID: PMC7724785 DOI: 10.1186/s12876-020-01555-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Helicobacter pylori (H. pylori) infection is a major cause of chronic gastritis, peptic ulcer diseases and cancer. Genistein (4′,5,7-trihydroxyisoflavone), a tyrosine-specific-protein kinase inhibitor, has been shown to exert an anti-inflammatory property. The aim of this study was to examine the treatment effects of genistein and its mechanisms in rats with H. pylori infection.
Methods Eighteen male Sprague-Dawley rats were divided into three groups (6 rats per group): (1) control group (Con); (2) H. pylori infected group (HP): the rats were inoculated with H. pylori (108− 1010 CFU/mL; 1 mL/rat.) for 3 consecutive days; and (3) HP + genistein group (HP + Gen): the rats were inoculated with H. pylori as above. Then, they were gavaged with genistein (16 mg/kg BW) for 14 days. Gastric tissue was used for the determination of nuclear factor (NF)-κB expression by immunohistochemistry (IHC), degree of apoptosis by the terminal deoxynucleotidyl transferasemediated dUTP nick-end labeling (TUNEL) reaction, and histopathology. Serum samples were used to measure the levels of tumor necrosis factor-alpha (TNF-α) and cytokine-induced neutrophil chemoattractant-1 (CINC-1). Results Rats in the HP group had significantly higher levels of pro-inflammatory mediators, NF-κB expression and apoptotic cells when compared with the Con group, and these markers significantly decreased in HP + Gen group when compared with the HP group. The histopathology of HP group showed moderate gastric inflammation and many HP colonization. Gastric pathology in HP + Gen group demonstrated the attenuation of inflammatory cell infiltration and H. pylori colonization. Conclusion Genistein exerted its gastroprotective effects through the reduction of pro-inflammatory mediators, nuclear receptor NF-κB expression and gastric mucosal apoptosis in rats with H. pylori-induced gastropathy.
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Affiliation(s)
- Prasong Siriviriyakul
- Department of Physiology, Faculty of Medicine, Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Duangporn Werawatganon
- Department of Physiology, Faculty of Medicine, Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Nisarat Phetnoo
- Department of Physiology, Faculty of Medicine, Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kanjana Somanawat
- Department of Physiology, Faculty of Medicine, Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Naruemon Klaikeaw
- Department of Pathology, Faculty of Medicine, Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Maneerat Chayanupatkul
- Department of Physiology, Faculty of Medicine, Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand
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Serafim C, Araruna ME, Júnior EA, Diniz M, Hiruma-Lima C, Batista L. A Review of the Role of Flavonoids in Peptic Ulcer (2010-2020). Molecules 2020; 25:molecules25225431. [PMID: 33233494 PMCID: PMC7699562 DOI: 10.3390/molecules25225431] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Peptic ulcers are characterized by erosions on the mucosa of the gastrointestinal tract that may reach the muscle layer. Their etiology is multifactorial and occurs when the balance between offensive and protective factors of the mucosa is disturbed. Peptic ulcers represent a global health problem, affecting millions of people worldwide and showing high rates of recurrence. Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most important predisposing factors for the development of peptic ulcers. Therefore, new approaches to complementary treatments are needed to prevent the development of ulcers and their recurrence. Natural products such as medicinal plants and their isolated compounds have been widely used in experimental models of peptic ulcers. Flavonoids are among the molecules of greatest interest in biological assays due to their anti-inflammatory and antioxidant properties. The present study is a literature review of flavonoids that have been reported to show peptic ulcer activity in experimental models. Studies published from January 2010 to January 2020 were selected from reference databases. This review refers to a collection of flavonoids with antiulcer activity in vivo and in vitro models.
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Affiliation(s)
- Catarina Serafim
- Postgraduate Program in Natural Products and Bioactive Synthetic, Health Sciences Center, Federal University of Paraiba, João Pessoa 58051900, Paraiba, Brazil; (C.S.); (M.E.A.); (E.A.J.)
| | - Maria Elaine Araruna
- Postgraduate Program in Natural Products and Bioactive Synthetic, Health Sciences Center, Federal University of Paraiba, João Pessoa 58051900, Paraiba, Brazil; (C.S.); (M.E.A.); (E.A.J.)
| | - Edvaldo Alves Júnior
- Postgraduate Program in Natural Products and Bioactive Synthetic, Health Sciences Center, Federal University of Paraiba, João Pessoa 58051900, Paraiba, Brazil; (C.S.); (M.E.A.); (E.A.J.)
| | - Margareth Diniz
- Department of Pharmacy, Health Sciences Center, Federal University of Paraíba, João Pessoa 58051900, Paraiba, Brazil;
| | - Clélia Hiruma-Lima
- Department of Structural and Functional Biology (Physiology), Institute of Biosciences, São Paulo State University, Botucatu 18618970, São Paulo, Brazil;
| | - Leônia Batista
- Department of Pharmacy, Health Sciences Center, Federal University of Paraíba, João Pessoa 58051900, Paraiba, Brazil;
- Correspondence: ; Tel.: +55-83-32167003; Fax: +55-83-32167502
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Duran Y, Karaboğa İ, Polat FR, Polat E, Erboğa ZF, Ovalı MA, Öztopuz RÖ, Çelikkol A, Yılmaz A. Royal jelly attenuates gastric mucosal injury in a rat ethanol-induced gastric injury model. Mol Biol Rep 2020; 47:8867-8879. [PMID: 33135128 DOI: 10.1007/s11033-020-05939-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
The aim of the study was to investigate traditionally used Royal Jelly (RJ) for treating an ethanol-induced gastric ulcer model in rats. A total of 32 Wistar albino male rats were divided into 4 groups of 8: group I = Control, group II = Ethanol, group III = RJ + Ethanol, and group IV = Lansoprazole + Ethanol. In groups II, III, and IV, animals were administered 1 ml of absolute ethanol orally after a 24-h fast to induce ulcer formation. The histopathological changes in the gastric mucosa were determined using hematoxylin-eosin (H&E) staining. Immunohistochemically, inducible nitric oxide (iNOS) and nuclear factor kappa beta (Nf-κβ) markings were evaluated in gastric tissue. Cell death in the gastric mucosa was determined by the TUNEL method. Oxidative status markers, superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), and myeloperoxidase (MPO) levels were determined spectrophotometrically. Expression of the interleukin - 1 beta (IL-1β) and tumor necrosis factor-α (TNF-α) genes in gastric tissues was determined by real-time PCR; and TNF-α, IL-10, and IL-1β levels were determined. RJ was found to inhibit iNOS and Nf-κβ activity in the gastric mucosa and prevent epithelial cell apoptosis. In particular, pro-inflammatory cytokines TNF-α and IL-1β levels were significantly decreased in the RJ + Ethanol group compared to the Ethanol group. In addition, a decrease in the MPO level indicated that RJ prevented tissue damage, especially by preventing inflammatory cell infiltration. The study demonstrated a possible gastroprotective effect of RJ in a rat ethanol-induced gastric ulcer model.
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Affiliation(s)
- Yasin Duran
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of General Surgery, Tekirdağ, Turkey
| | - İhsan Karaboğa
- Tekirdağ Namık Kemal University, School of Health, Department of Emergency and Disaster Management, Tekirdağ, Turkey.
| | - Fatin Rüştü Polat
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of General Surgery, Tekirdağ, Turkey
| | - Elif Polat
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Histology and Embryology, Tekirdağ, Turkey
| | - Zeynep Fidanol Erboğa
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Histology and Embryology, Tekirdağ, Turkey
| | - Mehmet Akif Ovalı
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Physiology, Çanakkale, Turkey
| | - Rahime Özlem Öztopuz
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Biophysics, Çanakkale, Turkey
| | - Aliye Çelikkol
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Biochemistry, Tekirdağ, Turkey
| | - Ahsen Yılmaz
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Biochemistry, Tekirdağ, Turkey
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Eraslan E, Tanyeli A, Güler MC, Kurt N, Yetim Z. Agomelatine prevents indomethacin-induced gastric ulcer in rats. Pharmacol Rep 2020; 72:984-991. [PMID: 32048252 DOI: 10.1007/s43440-019-00049-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/26/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastric ulcer is a very common gastrointestinal disease that may be dangerous and even may lead to death. The current study was conducted to detect the prophylactic effects of agomelatine on indomethacin-induced gastric ulcer. METHODS In this study, a total of 5 groups were created as the sham, ulcer, omeprazole, agomelatine 1 mg/kg and agomelatine 5 mg/kg groups. The effects of agomelatine on indomethacin-induced gastric injury were investigated. Total antioxidant and oxidant levels; the oxidant parameters like oxidative stress index and the inflammation markers such as tumor necrosis factor-α, interleukin-1β, interleukin-6 and interleukin-10 levels in stomach tissue were determined by ELISA. In addition, the gastric mucosal injury occurred in stomach wall was examined with histopathological methods. RESULTS While the levels of the inflammatory markers, total oxidant status and oxidative stress index increased at an obvious level especially in the indomethacin group, the total antioxidant status levels decreased. It was observed that these parameters were improved at a significant level in agomelatine 1 mg/kg and agomelatine 5 mg/kg groups when compared to ulcer group; and the results were similar to omeprazole group. It was also observed that our histopathological findings were consistent with all our other results. CONCLUSIONS The results of this study showed that agomelatine usage in indomethacin-induced gastric ulcer model provides beneficial results.
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Affiliation(s)
- Ersen Eraslan
- Department of Physiology, Faculty of Medicine, Yozgat Bozok University, Yozgat, 66200, Turkey.
| | - Ayhan Tanyeli
- Department of Physiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Mustafa Can Güler
- Department of Physiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Nezahat Kurt
- Department of Biochemistry, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Zeliha Yetim
- Department of Histology and Embryology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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A comparative study on the possible protective effect of esomeprazole, spirulina, wheatgrass on indomethacin-induced gastric ulcer in male albino rats. Mol Biol Rep 2019; 46:4843-4860. [PMID: 31297714 DOI: 10.1007/s11033-019-04933-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/20/2019] [Indexed: 12/16/2022]
Abstract
Gastric ulcer is a common problem affecting the gastrointestinal tract. Spirulina and wheatgrass are natural substances that have anti-inflammatory and antioxidant effects. The aim of the Work was to elucidate the possible protective role of spirulina and wheatgrass versus standard treatment esomeprazole on indomethacin-induced gastric ulcer in adult male albino rats. Eighty adult male albino rats were divided into eight groups: group I (the control group), group II that received indomethacin (100 mg/kg orally), group III that received esomeprazole (20 mg/kg orally), group IV that received spirulina (1000 mg/kg orally), group V that received wheatgrass (1000 mg/kg orally), group VI that received indomethacin (100 mg/kg) + esomeprazole (20 mg/kg), group VII that received indomethacin (100 mg/kg) + spirulina (1000 mg/kg) and group VIII that received indomethacin (100 mg/kg) + wheatgrass (1000 mg/kg). Six hours after indomethacin treatment, all rats were anesthetized and their stomachs obtained for measures of gastric acidity, pepsin activity, mucin content, gastrin, ulcer index, total antioxidant capacity (TAC), tumor necrosis factor -α (TNF-α), interleukin-8 (IL8), proapoptotic protein (Bax). Histological (using H&E stain, PAS reaction) and immunohistochemical (using anti Ki67 immunostain) techniques were performed. Western immunoblot analysis for heat shock protein 70 (HSP70) was also done. Moreover, a morphometric study was done for area% of positive immunoreactive cells for Ki67 and optical density and area% of PAS reaction. All performed measurements were followed by statistical analysis. Indomethacin induced loss of normal architecture of gastric mucosa with sloughing of surface epithelium and inflammatory cellular infiltration. It also led to a significant increase in gastric acidity, inflammatory mediators (TNF-α, IL-8), pro-apoptotic protein Bax and a significant decrease in TAC levels and HSP-70 expression. There was also a significant decrease in area% of Ki67 immunoreactivity and area% and optical density of PAS reaction as compared with the control group and other pre-treated rats. These disturbed parameters were associated with increased ulcer index. In pre-treatment groups, the structure of the mucosa was similar to control with marked improvement in the biochemical assay. In conclusion, Spirulina and wheatgrass can partly protect the gastric mucosa against indomethacin-induced damage to a degree similar to that of the classical treatment esomeprazole.
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Hegab II, Abd-Ellatif RN, Sadek MT. The gastroprotective effect of N-acetylcysteine and genistein in indomethacin-induced gastric injury in rats. Can J Physiol Pharmacol 2018; 96:1161-1170. [PMID: 30011378 DOI: 10.1139/cjpp-2017-0730] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The protective effect of N-acetylcysteine (NAC) and genistein (GEN) on an experimental model of indomethacin (IND)-induced gastric injury was investigated. A total of 50 male rats were divided into 5 groups: (1) control, (2) IND, (3) NAC pretreated, (4) GEN pretreated, and (5) NAC+GEN pretreated. Rats in groups 3-5 were orally administered NAC (500 mg/kg), GEN (10 mg/kg), or both, respectively, once daily for 7 days before the induction of gastric injury by IND (50 mg/kg). The stomach was removed for biochemical analysis and histopathological examination. Pretreatment with NAC, GEN, or both significantly improved ulcer indices and increased nitric oxide level and superoxide dismutase activity. They also significantly decreased malondialdehyde, tumour necrosis factor α levels, and myeloperoxidase activity, and downregulated matrix metalloproteinase 9 (MMP-9) gene expression compared to the IND group. NAC alone ameliorated IND-induced apoptosis, whereas GEN only significantly increased prostaglandin E2 level. Further, coadministration of both resulted in a significantly better gastroprotective effect versus solo administration. Coadministration of NAC and GEN has an additive gastroprotective effect in IND-induced gastric injury, which may be through interaction of their potential cytoprotective, antioxidant, anti-inflammatory, and antiapoptotic mechanisms together with regulation of MMP-9 expression.
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Affiliation(s)
- Islam Ibrahim Hegab
- a Physiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Mona Tayssir Sadek
- c Histology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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