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Yasmeen N, Selvaraj H, Lakhawat SS, Datta M, Sharma PK, Jain A, Khanna R, Srinivasan J, Kumar V. Possibility of averting cytokine storm in SARS-COV 2 patients using specialized pro-resolving lipid mediators. Biochem Pharmacol 2023; 209:115437. [PMID: 36731803 PMCID: PMC9884647 DOI: 10.1016/j.bcp.2023.115437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
Fatal "cytokine storms (CS)" observed in critically ill COVID-19 patients are consequences of dysregulated host immune system and over-exuberant inflammatory response. Acute respiratory distress syndrome (ARDS), multi-system organ failure, and eventual death are distinctive symptoms, attributed to higher morbidity and mortality rates among these patients. Consequent efforts to save critical COVID-19 patients via the usage of several novel therapeutic options are put in force. Strategically, drugs being used in such patients are dexamethasone, remdesivir, hydroxychloroquine, etc. along with the approved vaccines. Moreover, it is certain that activation of the resolution process is important for the prevention of chronic diseases. Until recently Inflammation resolution was considered a passive process, rather it's an active biochemical process that can be achieved by the use of specialized pro-resolving mediators (SPMs). These endogenous mediators are an array of atypical lipid metabolites that include Resolvins, lipoxins, maresins, protectins, considered as immunoresolvents, but their role in COVID-19 is ambiguous. Recent evidence from studies such as the randomized clinical trial, in which omega 3 fatty acid was used as supplement to resolve inflammation in COVID-19, suggests that direct supplementation of SPMs or the use of synthetic SPM mimetics (which are still being explored) could enhance the process of resolution by regulating the aberrant inflammatory process and can be useful in pain relief and tissue remodeling. Here we discussed the biosynthesis of SPMs, & their mechanistic pathways contributing to inflammation resolution along with sequence of events leading to CS in COVID-19, with a focus on therapeutic potential of SPMs.
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Affiliation(s)
- Nusrath Yasmeen
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, Rajasthan, India
| | - Harikrishnan Selvaraj
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, Rajasthan, India
| | - Sudarshan S Lakhawat
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, Rajasthan, India
| | - Manali Datta
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, Rajasthan, India
| | - Pushpender K Sharma
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, Rajasthan, India
| | - Ajay Jain
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, Rajasthan, India
| | - Rakhi Khanna
- Rajasthan State Regional Forensic Science Laboratory, Kota, Rajasthan, India
| | | | - Vikram Kumar
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, Rajasthan, India.
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Nursyifa Fadiyah N, Megawati G, Erlangga Luftimas D. Potential of Omega 3 Supplementation for Coronavirus Disease 2019 (COVID-19): A Scoping Review. Int J Gen Med 2022; 15:3915-3922. [PMID: 35431568 PMCID: PMC9012318 DOI: 10.2147/ijgm.s357460] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/31/2022] [Indexed: 12/27/2022] Open
Abstract
COVID-19 can cause fever, cough, headache, and shortness of breath but patients with comorbidities can experience worsening and death. An action is needed to treat this condition in COVID-19 patients. Omega 3 fatty acids may be one possibility associated with COVID-19 prevention, management, and treatment. Therefore, this review aimed to identify the existing studies on potency of omega 3 fatty acid supplementation on COVID-19. We searched studies from PubMed, Google Scholar, Springer Link, and Emerald Insight databases published on January 31, 2020, to September 1, 2021. The studies selected were the full-text, non-review ones which focused on the omega 3 fatty acid intervention in COVID-19 with COVID-19 patients and people affected by COVID-19 as their subjects and clinical manifestations or the results of supporting examinations as their outcomes. No quality assessment was performed in this review. Of the 211, there were 4 studies selected for this review. They showed that severe COVID-19 patients have low levels of omega 3 in their blood. Omega 3 was considered to reduce the risk of positive for SARS-CoV-infection and the duration of symptoms, overcome the renal and respiratory dysfunction, and increase survival rate in COVID-19 patients. Omega 3 fatty acid supplementations were thought to have a potential effect in preventing and treating COVID-19. This can be a reference for further research about omega 3 fatty acid supplementation and COVID-19.
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Affiliation(s)
| | - Ginna Megawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Correspondence: Ginna Megawati, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, Tel +62 81312349351, Email
| | - Dimas Erlangga Luftimas
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Nutrition Working Group (NWG), SKIP-NAKES Study Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Theken KN, Tang SY, Sengupta S, FitzGerald GA. The roles of lipids in SARS-CoV-2 viral replication and the host immune response. J Lipid Res 2021; 62:100129. [PMID: 34599996 PMCID: PMC8480132 DOI: 10.1016/j.jlr.2021.100129] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
The significant morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 infection has underscored the need for novel antiviral strategies. Lipids play essential roles in the viral life cycle. The lipid composition of cell membranes can influence viral entry by mediating fusion or affecting receptor conformation. Upon infection, viruses can reprogram cellular metabolism to remodel lipid membranes and fuel the production of new virions. Furthermore, several classes of lipid mediators, including eicosanoids and sphingolipids, can regulate the host immune response to viral infection. Here, we summarize the existing literature on the mechanisms through which these lipid mediators may regulate viral burden in COVID-19. Furthermore, we define the gaps in knowledge and identify the core areas in which lipids offer therapeutic promise for severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Katherine N Theken
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Oral Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Soon Yew Tang
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shaon Sengupta
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Garret A FitzGerald
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Ambrosy AP, Malik UI, Thomas RC, Parikh RV, Tan TC, Goh CH, Selby VN, Solomon MD, Avula HR, Fitzpatrick JK, Skarbinski J, Philip S, Granowitz C, Bhatt DL, Go AS. Rationale and design of the pragmatic randomized trial of icosapent ethyl for high cardiovascular risk adults (MITIGATE). Am Heart J 2021; 235:54-64. [PMID: 33516752 PMCID: PMC7843090 DOI: 10.1016/j.ahj.2021.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The MITIGATE study aims to evaluate the real-world clinical effectiveness of pre-treatment with icosapent ethyl (IPE), compared with usual care, on laboratory-confirmed viral upper respiratory infection (URI)-related morbidity and mortality in adults with established atherosclerotic cardiovascular disease (ASCVD). BACKGROUND IPE is a highly purified and stable omega-3 fatty acid prescription medication that is approved for cardiovascular risk reduction in high-risk adults on statin therapy with elevated triglycerides. Preclinical data and clinical observations suggest that IPE may have pleiotropic effects including antiviral and anti-inflammatory properties that may prevent or reduce the downstream sequelae and cardiopulmonary consequences of viral URIs. METHODS MITIGATE is a virtual, electronic health record-based, open-label, randomized, pragmatic clinical trial enrolling ∼16,500 participants within Kaiser Permanente Northern California - a fully integrated and learning health care delivery system with 21 hospitals and >255 ambulatory clinics serving ∼4.5 million members. Adults ≥50 years with established ASCVD and no prior history of coronavirus disease 2019 (COVID-19) will be prospectively identified and pre-randomized in a 1:10 allocation ratio (∼ 1,500 IPE: ∼15,000 usual care) stratified by age and previous respiratory health status to the intervention (IPE 2 grams by mouth twice daily with meals) vs the control group (usual care) for a minimum follow-up duration of 6 months. The co-primary endpoints are moderate-to-severe laboratory-confirmed viral URI and worst clinical status due to a viral URI at any point in time. CONCLUSION The MITIGATE study will inform clinical practice by providing evidence on the real-world clinical effectiveness of pretreatment with IPE to prevent and/or reduce the sequelae of laboratory-confirmed viral URIs in a high-risk cohort of patients with established ASCVD.
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Affiliation(s)
- Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA.
| | - Umar I Malik
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Rachel C Thomas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Choon H Goh
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Van N Selby
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Matthew D Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Harshith R Avula
- Department of Cardiology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA
| | - Jesse K Fitzpatrick
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Infectious Disease, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; Departments of Medicine (Nephrology), Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Medicine (Nephrology), Stanford University, Palo Alto, CA
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Berber E, Sumbria D, Rouse BT. Could targeting immunometabolism be a way to control the burden of COVID-19 infection? Microbes Infect 2021; 23:104780. [PMID: 33482357 PMCID: PMC7816601 DOI: 10.1016/j.micinf.2021.104780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
This review portrays the metabolic consequences of Covid-19 infection at different stages of the clinical syndrome. It also describes how events can change when patients with metabolic problems are infected and the effects that diet and nutrition might play to influence the outcome of infection. We also discuss the types of maneuvers that could be used to reshape metabolic events and question if this approach could be a practical therapy used alone or in combination with other approaches to reduce the burden of Covid-19 infection.
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Affiliation(s)
- Engin Berber
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA; Department of Virology, Faculty of Veterinary Medicine, Erciyes University, Kayseri, TR, Turkey
| | - Deepak Sumbria
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Barry T Rouse
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA.
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Suh W, Urits I, Viswanath O, Kaye AD, Patel H, Hall W, Eskander JP. Three Cases of COVID-19 Pneumonia That Responded to Icosapent Ethyl Supportive Treatment. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e928422. [PMID: 33311431 PMCID: PMC7751801 DOI: 10.12659/ajcr.928422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/17/2020] [Accepted: 10/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Icosapent ethyl, a form of eicosapentaenoic acid with anti-inflammatory activity, has been approved as an adjunctive treatment with statins in patients with hypertriglyceridemia. Icosapent ethyl is currently undergoing clinical trials to determine its anti-inflammatory effects in patients with coronavirus disease 2019 (COVID-19). This report describes 3 intensive care unit (ICU) patients with moderate to severe COVID-19 pneumonia treated with icosapent ethyl as part of their supportive care who had favorable outcomes. CASE REPORT Case 1 was a 75-year-old man with a past medical history of hyperlipidemia, hypertension, type 2 diabetes mellitus, obesity, and benign prostatic hyperplasia. Case 2 was a 23-year old man with a past medical history of type 2 diabetes mellitus and obesity. Case 3 was a 24-year old man with a history of autism. All cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were confirmed from a nasopharyngeal swab using the Becton Dickinson nasopharyngeal reverse-transcription polymerase chain reaction. All patients in these cases were treated with a course of 2 g of icosapent ethyl twice a day by nasogastric tube. CONCLUSIONS This report of 3 cases describes the use of icosapent ethyl as a component of supportive treatments in ICU patients with moderate to severe COVID-19 pneumonia. However, as of yet there are no evidence-based treatments for SARS-CoV-2 infection from controlled clinical trials. The outcomes of ongoing clinical trials are awaited to determine whether icosapent ethyl has anti-inflammatory effects in patients with SARS-CoV-2 infection and which patients might benefit from the use of this adjunctive treatment.
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Affiliation(s)
- Winston Suh
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, U.S.A
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, U.S.A
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, U.S.A
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, U.S.A
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, U.S.A
- Valley Anesthesiology and Pain Consultants–Envision Physician Services, Phoenix, AZ, U.S.A
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, U.S.A
| | - Haresh Patel
- Department of Critical Care Medicine, Maryview Medical Center, Portsmouth, VA, U.S.A
| | - Wade Hall
- Old Dominion University, Norfolk, VA, U.S.A
| | - Jonathan P. Eskander
- Department of Anesthesiology and Pain Medicine, Portsmouth Anesthesia Associates, Portsmouth, VA, U.S.A
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Berger AA, Sherburne R, Urits I, Patel H, Eskander J. Icosapent Ethyl (Vascepa®) for the Treatment of Acute, Severe Pancreatitis. Cureus 2020; 12:e11551. [PMID: 33365220 PMCID: PMC7748593 DOI: 10.7759/cureus.11551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute pancreatitis is the most common gastrointestinal pathology that warrants hospital admission, with an estimated incidence of 13-45/100,000 annually in the US. The overall mortality is low but is significantly increased in 15-25% of patients that develop severe disease, likely secondary to an increase in inflammation and an exaggerated response, sometimes referred to as a cytokine storm. Management is largely supportive, and no specific cure exists to hasten recovery. Icosapent Ethyl (IPE, Vascepa®) is an omega-3 fatty acid derivative that is indicated for the treatment of hypertriglyceridemia and has been shown to improve mortality from cardiovascular causes, likely through an anti-inflammatory mechanism. We report here a case of very severe, abrupt acute alcoholic pancreatitis in a 31-year-old male, requiring intensive care unit admission, ventilation, and support with multiple vasoactive medications. Shortly after the initiation of IPE, the patient started to improve and ultimately made a complete recovery. His initially greatly elevated inflammatory markers downtrended quickly under IPE treatment and he followed with a remarkable clinical recovery. Several previous studies, such as the Patients With Persistent High Triglyceride Levels (≥ 200 mg/dL and < 500 mg/dL) Despite Statin Therapy (ANCHOR; NCT01047501) and the Multi-Center, PlAcebo-Controlled, Randomized, Double-BlINd, 12-week study with an open-label Extension (MARINE; NCT01047683), provided evidence of the anti-inflammatory activity of IPE. In our case, we provide the first evidence to support its use as a direct anti-inflammatory in severe disease. With the absence of direct therapy and the significant mortality from severe acute pancreatitis, IPE can be a breakthrough therapy. Its treatment is not limited to pancreatitis only, and it may also be beneficial in other cases of severe inflammation. Though anecdotal, this case provides evidence to support further study of IPE in states of exaggerated inflammation.
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Affiliation(s)
- Amnon A Berger
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Robert Sherburne
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Haresh Patel
- Critical Care Medicine, Maryview Medical Center, Portsmouth, USA
| | - Jonathan Eskander
- Anesthesiology and Pain Medicine, Portsmouth Anesthesia Associates, Portsmouth, USA
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Bhatt DL, Hull MA, Song M, Van Hulle C, Carlsson C, Chapman MJ, Toth PP. Beyond cardiovascular medicine: potential future uses of icosapent ethyl. Eur Heart J Suppl 2020; 22:J54-J64. [PMID: 33061868 PMCID: PMC7537800 DOI: 10.1093/eurheartj/suaa119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The REDUCE-IT trial demonstrated that icosapent ethyl, an ethyl ester of eicosapentaenoic acid (EPA), reduced cardiovascular events in an at-risk population by a substantial degree. While the cardiovascular protective properties of this compound are now proven, several other potential uses are being actively explored in clinical studies. These areas of investigation include cancer, inflammatory bowel disease, infections, Alzheimer’s disease, dementia, and depression. The next decade promises to deepen our understanding of the beneficial effects that EPA may offer beyond cardiovascular risk reduction.
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Affiliation(s)
- Deepak L Bhatt
- Brigham and Women's Hospital, Heart & Vascular Center and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Mark A Hull
- Division of Gastrointestinal and Surgical Sciences, Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, LS9 7TF, UK
| | - Mingyang Song
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA.,Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Boston, MA 02114, USA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 50 Fruit Street, Boston, MA 02114, USA
| | - Carol Van Hulle
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Cindy Carlsson
- William S. Middleton Memorial Veterans Hospital, Madison VA Geriatric Research, Education and Clinical Center (GRECC), 2500 Overlook Terrace, Madison, WI 53705, USA.,Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center (ADRC), 600 Highland Ave, J5/1 Mezzanine, Madison, WI 53792, USA.,Wisconsin Alzheimer's Institute (WAI), 610 Walnut St Suite 957, Madison, WI 53726, USA
| | - M John Chapman
- Sorbonne University, 21, Rue de l'Ecole de Medicine, 75006 Paris, France.,Endocrinology-Metabolism Division, Pitie-Salpetriere University Hospital, 47-83, Boulevard de lopital, 75651 Paris Cedex, France
| | - Peter P Toth
- CGH Medical Center, 101 East Miller Road, Sterling, IL 61081, USA.,Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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