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Cakmak A, Kale İ, Muhcu M. Investigation of maternal serum hepassocin concentrations in pregnant women with gestational diabetes mellitus: a prospective case-control study. Z Geburtshilfe Neonatol 2023; 227:441-447. [PMID: 37369220 DOI: 10.1055/a-2096-6339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVE We aimed to investigate the relationship between gestational diabetes mellitus (GDM) and maternal serum hepassocin concentrations. MATERIALS AND METHODS This cross-sectional study was conducted with 88 pregnant women who applied to the Ümraniye Training and Research Hospital Gynecology and Obstetrics Clinic between April 2022 and November 2022. The GDM group consisted of 44 pregnant women who had a 75-g OGTT between the 24th and 28th week of pregnancy and were diagnosed with GDM. The control group consisted of 44 healthy pregnant women who were matched with the GDM group in terms of age and body mass index (BMI) and had a normal 75-g OGTT result. Demographic characteristics, laboratory findings, and perinatal outcomes were noted. Two groups were compared in terms of maternal serum hepassocin concentrations. RESULTS Both groups were similar in terms of age, BMI, weight gain, gravida, parity, polycystic ovary syndrome history, history of diabetes mellitus in the family, and the gestational week at blood sampling for hepassocin (p>0.05 for each). The median maternal serum hepassocin concentration was found to be 18.21 ng/ml in the GDM group, while it was determined as 13.05 ng/ml in the non-GDM group (p=0.012). The GDM group was divided into two groups: the group that only dieted until birth and the group that used insulin until birth for blood glucose regulation. The median hepassocin concentration was found to be 17.99 ng/ml in the diet-only GDM group and 32.15 ng/ml in the insulin-using GDM group. ROC analysis was performed to determine the value of maternal serum hepassocin concentration in predicting GDM. AUC analysis of maternal serum hepassocin for estimation of GDM was 0.656 (p=0.012, 95% CI=0.53-0.77). The optimal threshold value for maternal serum hepassocin concentration was determined as 14.13 ng/ml with 61.4% sensitivity and 61.4% specificity. CONCLUSION Serum hepassocin concentration evaluated between 24 and 28 weeks of gestation was found to be higher in pregnant women with GDM than in the non-GDM group. The highest serum hepassocin concentration was found in the GDM group using insulin for blood glucose regulation. Hepassocin seems to be a promising molecule that can be used in GDM screening in pregnant women who do not want to have an OGTT in the future.
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Affiliation(s)
- Aysegul Cakmak
- Obstetrics and Gynecology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - İbrahim Kale
- Obstetrics and Gynecology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Murat Muhcu
- Obstetrics and Gynecology, Umraniye Training and Research Hospital, Istanbul, Turkey
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Wang CC, Lin CH, Chou HW, Wang CT, Liang YC, Wu HT, Ou HY. Compensatory Increase of Serum Hepassocin Protects Hyperthyroidism-Induced Hepatic Dysfunction. Biomedicines 2023; 11:1936. [PMID: 37509575 PMCID: PMC10377103 DOI: 10.3390/biomedicines11071936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Hepatic dysfunction is commonly observed in subjects with hyperthyroidism. Hepassocin is a hepatokine playing an important role in metabolic diseases and exhibiting a hepatic protective effect. Nevertheless, the relationship between hepassocin and hyperthyroidism was still unknown. In the present study, a total of 36 subjects with Graves' disease were enrolled, and we found that the alanine aminotransferase (ALT) levels were significantly decreased in parallel with the decrement in serum hepassocin concentrations at 6 months after standard treatment for hyperthyroidism. In addition, HepG2 cell line was used to investigate the role of hepassocin in hyperthyroidism-induced hepatic dysfunction. Treatment of hepassocin recombinant protein in HepG2 cells dose-dependently decreased triiodothyronine (T3)-induced ALT and aspartate aminotransferase (AST) elevation. Moreover, hepassocin significantly increased the expression of phosphoenolpyruvate carboxykinase (PEPCK) in a dose-dependent manner. Deletion of hepassocin in HepG2 cells reversed the effects of T3 on PEPCK expressions. Furthermore, we found that T3 increased the expression of hepassocin through a hepatocyte nuclear factor 1α-dependent pathway. Taken together, these results indicated a compensatory increase in serum hepassocin might have a protective role in hyperthyroidism-induced hepatic dysfunction.
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Affiliation(s)
- Chih-Chen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Ching-Han Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Hsuan-Wen Chou
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Chung-Teng Wang
- Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Yu-Cheng Liang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Hung-Tsung Wu
- Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Horng-Yih Ou
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
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Ketenci Gencer F, Yuksel S, Goksever Celik H. Do serum hepassocin levels change in women with polycystic ovary syndrome? Eur J Obstet Gynecol Reprod Biol 2021; 267:137-141. [PMID: 34768120 DOI: 10.1016/j.ejogrb.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/04/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Insulin resistance is common in polycystic ovary syndrome (PCOS), especially in obese patients. Hepassocin is a peptid marker which increases in obesity and insulin resistance. OBJECTIVE We aimed to investigate hepassocin levels in patients with PCOS in this study. METHODS This prospective case-control study was conducted with a total of 60 patients with PCOS and age-matched 30 healthy women with body mass index < 30. Patients with PCOS were classified as obese PCOS and non-obese PCOS according to their BMI. Hepassocin levels were measured by using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. A multivariate linear regression analysis was used to determine independent factors related to hepassocin levels. RESULTS Hepassocin levels of the obese-PCOS group were found significantly higher than non-obese PCOS and control group (6.95 ± 3.59, 2.69 ± 2.51, 2.66 ± 2.22, respectively, p < 0.001). There was no significant difference in hepassocin levels between control and non-obese PCOS group (p = 0.99). Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was independently associated with hepassocin concentrations after adjusting for age, low density lipoprotein C (LDL-C), high density lipoprotein C (HDL-C), triglyceride (TG), total testosterone, dehydroepiandrosterone sulfate (DHEA-S), and C reactive protein (CRP). CONCLUSION Obese patients with PCOS exhibited high serum levels of hepassocin. HOMA-IR index was found as the independent variable associated with high levels of hepassocin. Hepassocin can be used as a simple and easy way of detecting insulin resistance in obese patients with PCOS.
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Affiliation(s)
- Fatma Ketenci Gencer
- University of Health Sciences Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey.
| | - Semra Yuksel
- Basaksehir Cam and Sakura City Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Hale Goksever Celik
- University of Health Sciences, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Role of placental fibrinogen-like protein 1 in gestational diabetes. Transl Res 2020; 218:73-80. [PMID: 32006524 DOI: 10.1016/j.trsl.2020.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/30/2019] [Accepted: 01/06/2020] [Indexed: 02/08/2023]
Abstract
In view of the increasing prevalence of gestational diabetes mellitus (GDM) and the increased risks of delivering a macrosomic infant, developing preeclampsia, and suffering a perinatal death due to GDM, GDM has emerged as a growing public health problem. Although the placenta was suggested to play a crucial role in the pathology of GDM, the mechanisms that induce the development of GDM are still obscure. Fibrinogen-like protein (FGL)-1 is a hepatokine that plays an important role in hepatogenesis, as well as in nonalcoholic fatty liver disease and diabetes. Although FGL-1 is also expressed by the placenta, the pathophysiological role of FGL-1 in GDM is still unknown. In this study, FGL-1 levels were evaluated in 45 subjects with (n = 16) or without (n = 29) GDM. We found that FGL-1 was mainly expressed by placental trophoblasts, and FGL-1 expression was significantly higher in subjects with GDM. FGL-1 increased trophoblast proliferation through an extracellular signal-regulated kinase 1/2-dependent pathway. In addition, plasma concentrations of FGL-1 were higher in subjects with GDM, and the increased circulating FGL-1 might contribute to systemic insulin resistance. FGL-1 disrupted the gluconeogenic action of insulin in HepG2 cells, and decreased insulin-induced glucose uptake by L6 myotubes. Taken together, placental FGL-1 possibly plays a role in the impairment of insulin function in the development of GDM, and it might be a novel biomarker for diagnosing GDM.
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Impacts of Different Modes of Bariatric Surgery on Plasma Levels of Hepassocin in Patients with Diabetes Mellitus. REPORTS 2019. [DOI: 10.3390/reports2040024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Hepassocin is a liver-derived protein and its serum concentrations significantly increase in diabetes and fatty liver patients. Hepassocin is also a biomarker for diabetes and fatty liver; therefore, we aimed to investigate the impacts of different types of bariatric surgery on hepassocin plasma levels in obese patients with diabetes, and to determine if hepassocin could be a potential new marker for monitoring the effects of bariatric surgery and a treatment target. Methods: Overall, 12 patients undergoing gastric bypass (GB), 10 patients undergoing sleeve gastrectomy (SG) and 11 patients undergoing duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) were enrolled. Fasting hepassocin levels were measured at baseline, three, 12, and 24 months after surgery. Results: All the three groups significantly decreased their body mass index, waist-to-hip ratio, a body shape index (ABSI), triglycerides, fasting blood sugar, hemoglobin A1c, C-peptide levels and homeostasis model assessment of insulin resistance 24 months after surgery. There were no significant changes in hepassocin levels, even 24 months after the three surgeries. Hepassocin had a significant negative relationship with the ABSI (p< 0.001) 24 months after the SG. Conclusions: Neither GB, SG, nor DJB-SG altered plasma hepassocin levels in diabetic patients up to 24 months after surgery. The use of hepassocin in clinical settings requires more investigation.
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Wu WC, Lee WJ, Yeh C, Chen SC, Chen CY. WITHDRAWN: Do different bariatric surgery procedures impact hepassocin plasma levels in patients with type 2 diabetes mellitus? LIVER RESEARCH 2019. [DOI: 10.1016/j.livres.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Abdelmoemen G, Khodeir SA, Zaki AN, Kassab M, Abou-Saif S, Abd-Elsalam S. Overexpression of Hepassocin in Diabetic Patients with Nonalcoholic Fatty Liver Disease May Facilitate Increased Hepatic Lipid Accumulation. Endocr Metab Immune Disord Drug Targets 2019; 19:185-188. [PMID: 30009716 DOI: 10.2174/1871530318666180716100543] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/05/2018] [Accepted: 05/24/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS Insulin resistance is the real determinant of both Nonalcoholic fatty liver disease (NAFLD) and diabetes, and can facilitate the accumulation of triglycerides in the liver. Overexpression of hepassocin (HPS) increased the accumulation of hepatic fat and NAFLD activity scores (NAS) in mice. The aim of this study was to investigate the relationship between hepassocin and steatosis of the liver in diabetic patients with or without NAFLD in humans. METHODS The study enrolled 60 patients plus 20 healthy controls that were divided into 4 groups: Group I: included 20 patients who were diagnosed as diabetes mellitus type 2, Group II: included 20 patients who were diagnosed as nonalcoholic fatty liver disease (NAFLD), Group III: included 20 patients who were diagnosed as diabetes type 2 and NAFLD, and Group IV (control group): included 20 healthy person or controls who were matched in age and sex with patients group. All patients and controls were subjected to full history taking, thorough clinical examination, laboratory investigations including measurement of serum hepassocin in peripheral blood by ELISA technique. RESULTS There was a significant overexpression of serum hepassocin in patients with type 2 diabetes and NAFLD patients (Group 3) more than diabetic patients (Group 1) and even more than non-alcoholic fatty liver disease (Group 2). CONCLUSION This study provides evidence that increased HPS may facilitate increased hepatic lipid accumulation with NAFLD and type 2 diabetes.
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Affiliation(s)
- Ghada Abdelmoemen
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Egypt
| | | | - Ahmed Nabil Zaki
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Egypt
| | - Maha Kassab
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Egypt
| | - Sabry Abou-Saif
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Egypt
| | - Sherief Abd-Elsalam
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Egypt
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Ou HY, Wu HT, Lin CH, Du YF, Hu CY, Hung HC, Wu P, Li HY, Wang SH, Chang CJ. The Hepatic Protection Effects of Hepassocin in Hyperglycemic Crisis. J Clin Endocrinol Metab 2017; 102:2407-2415. [PMID: 28402540 DOI: 10.1210/jc.2016-3287] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 04/06/2017] [Indexed: 02/09/2023]
Abstract
CONTEXT High glucose generates reactive oxygen species (ROS) and contributes to glucotoxicity in hepatocytes, and hyperglycemia causes structural and functional damage to the liver. However, only a mild hepatic dysfunction was observed in subjects with hyperglycemic crisis, implying a factor exists to exert a hepatic protective effect. Hepassocin is a hepatokine that modulates the proliferation and metabolism of hepatocytes and also exerts protective activity in liver injury. However, its role in hyperglycemic crisis-induced hepatic dysfunction remains unknown. OBJECTIVE To investigate the possible hepatic protection effects of hepassocin in hyperglycemic crisis. DESIGN, SETTING, AND PATIENTS Plasma hepassocin concentrations and routine biochemistry were measured in 21 patients with hyperglycemic crisis before and after standard treatments. The effects of hepassocin on hepatic functions were evaluated in streptozotocin-induced hyperglycemic mice (STZ mice). HepG2 cells were used to clarify the possible mechanisms regulating hepassocin expression. RESULTS Plasma hepassocin concentrations decreased significantly in subjects with hyperglycemic crisis after standard treatment accompanied by improved hepatic functions. Correction of hyperglycemia in STZ mice also decreased the hepatic hepassocin expression. Injection of recombinant hepassocin improved hepatic functions and histologic changes and increased the expression of antioxidative stress proteins, including superoxide dismutase 1 (SOD1). In HepG2 cells, high glucose increased hepassocin expression through signal transducer and activator of transcription 3 and hepatocyte nuclear factor-related pathways. We also demonstrated that hepassocin increased SOD1 expression through an extracellular signal-regulated kinase 1/2 nuclear factor erythroid-2-related factor 2 pathway, decreasing ethyl acetate-induced ROS production and improving cell viability. CONCLUSIONS Increased hepassocin secretion in hyperglycemic crisis might offset the deleterious effects of hyperglycemia on hepatocytes.
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Affiliation(s)
- Horng-Yih Ou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Hung-Tsung Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ching-Han Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ye-Fong Du
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Che-Yuan Hu
- Department of Urology, National Cheng Kung University Hospital, Tainan 70403, Taiwan
| | - Hao-Chang Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Pansee Wu
- Institute for Science and Technology in Medicine, Keele University, Keele ST5 5BG, United Kingdom
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10048, Taiwan
| | - Shu-Huei Wang
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
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Wu HT, Ou HY, Hung HC, Su YC, Lu FH, Wu JS, Yang YC, Wu CL, Chang CJ. A novel hepatokine, HFREP1, plays a crucial role in the development of insulin resistance and type 2 diabetes. Diabetologia 2016; 59:1732-42. [PMID: 27221093 DOI: 10.1007/s00125-016-3991-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/27/2016] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes is highly correlated with nonalcoholic fatty liver disease (NAFLD). Hepatocyte-derived fibrinogen-related protein 1 (HFREP1) is a hepatokine that mediates NAFLD development; however, the role of HFREP1 in the development of insulin resistance and diabetes remains obscure. METHODS A total of 193 age- and sex-matched participants with normal glucose tolerance, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and newly diagnosed diabetes (NDD) were recruited for a cross-sectional study. Plasma HFREP1 levels were measured and multivariate linear regression analysis was used to evaluate the relationship between HFREP1, IFG, IGT and NDD. The causal relationship between HFREP1 and insulin resistance was then investigated in animal and cell models. Glucose and insulin tolerance tests, and euglycaemic-hyperinsulinaemic clamp, were used to evaluate insulin sensitivity in animals with Hfrep1 overexpression or knockdown in liver by lentiviral vectors. HepG2 cells were used to clarify the possible mechanism of HFREP1-induced insulin resistance. RESULTS Plasma HFREP1 concentrations were significantly increased in participants with IFG, IGT and NDD. HFREP1 concentrations were independently associated with fasting plasma glucose levels, insulin resistance, IFG, IGT and NDD. Injection of recombinant HFREP1 or Hfrep1 overexpression induced insulin resistance in mice, and HFREP1 disrupted insulin signalling to induce insulin resistance through an extracellular signal-regulated kinase (ERK)1/2-dependent pathway. Moreover, hepatic knockdown of HFREP1 improved insulin resistance in both mice fed a high-fat diet and ob/ob mice. CONCLUSIONS/INTERPRETATION These findings highlight the crucial role of HFREP1 in insulin resistance and diabetes, and provide a potential strategy and biomarker for developing therapeutic approaches to combat these diseases.
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Affiliation(s)
- Hung-Tsung Wu
- Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70403, Taiwan
| | - Horng-Yih Ou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Chang Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chu Su
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70403, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70403, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70403, Taiwan
| | - Chao-Liang Wu
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 70101, Taiwan.
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70403, Taiwan.
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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