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Wang X, Wang B, Cheng M, Yu L, Liu W, Nie X, Wang M, Zhou M, Chen W. Lipid peroxidation mediates the association between iron overload and liver injury: cross-sectional and longitudinal analyses in general Chinese urban adults. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:60343-60353. [PMID: 37022540 DOI: 10.1007/s11356-023-26702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/24/2023] [Indexed: 05/10/2023]
Abstract
Iron overload has been associated with acute/chronic organ failure, but whether iron overload induces liver injury remains unclear. The objectives of this study were to assess the relationship between urinary iron and serum alanine aminotransferase (ALT, a biomarker for liver injury), and investigate the potential mediating roles of lipid peroxidation and oxidative DNA damage in such association. Levels of urinary iron, serum ALT, and urinary biomarkers of lipid peroxidation (8-iso-prostaglandin-F2α [8-iso-PGF2α]) and oxidative DNA damage (8-hydroxy-deoxyguano-sine [8-OHdG]) were measured among 5386 observations of 4220 participants from the Wuhan-Zhuhai cohort. The relationships of urinary iron with serum ALT and risk of hyperALT were evaluated by linear mixed model and logistic regression model, respectively. The mediating roles of 8-iso-PGF2α and 8-OHdG were assessed by mediation analyses. This cross-sectional analysis found that urinary iron was positively associated with ALT (β = 0.032; 95% CI: 0.020, 0.044) and hyperALT prevalence (OR = 1.127; 95% CI: 1.065, 1.192). After 3 years of follow-up, participants with persistent high iron levels had increased risk of developing hyperALT (RR = 3.800; 95% CI: 1.464, 9.972) when compared with those with persistent low iron levels. In addition, each 1% increase in urinary iron was associated with a 0.146% (95% CI: 0.128%, 0.164%) increase and a 0.192% (95% CI: 0.154%, 0.229%) increase in 8-iso-PGF2α and 8-OHdG, respectively. Urinary 8-iso-PGF2α (β = 0.056; 95% CI: 0.039, 0.074) was positively associated with ALT, while the association between 8-OHdG and ALT was insignificant. Furthermore, increased 8-iso-PGF2α significantly mediated 22.48% of the urinary iron-associated ALT increment. Our study demonstrated that iron overload was significantly associated with liver injury, which was partly mediated by lipid peroxidation. Controlling iron intake and regulating lipid peroxidation may help in preventing liver injury.
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Affiliation(s)
- Xing Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Bin Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Man Cheng
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Linling Yu
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Wei Liu
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xiuquan Nie
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Mengyi Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Min Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Ma C, Iwai-Shimada M, Nakayama SF, Isobe T, Kobayashi Y, Tatsuta N, Taniguchi Y, Sekiyama M, Michikawa T, Yamazaki S, Kamijima M. Association of prenatal exposure to cadmium with neurodevelopment in children at 2 years of age: The Japan Environment and Children's Study. ENVIRONMENT INTERNATIONAL 2021; 156:106762. [PMID: 34256298 DOI: 10.1016/j.envint.2021.106762] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Prenatal cadmium exposure has been associated with adverse neurodevelopmental outcomes. However, previous findings are contradictory, and little is known about the potential modifiers of the cadmium-related neurodevelopmental risk. We investigated the associations between prenatal cadmium exposure and neurodevelopment in 2-year-old children and examined the influence of mother/child characteristics. METHODS We recruited 3545 mother-child pairs from the Japan Environment and Children's Study. We collected maternal blood during mid/late pregnancy and cord blood at delivery, and measured cadmium concentrations using inductively coupled plasma mass spectrometry. Neurodevelopment was assessed using the Kyoto Scale of Psychological Development (KSPD), which includes cognitive-adaptive (C-A), language-social (L-S), postural-motor (P-M) and developmental quotient (DQ) domains. Associations between cadmium and KSPD scores were tested using multivariable models after controlling for confounders. RESULTS Median levels (interquartile ranges) of cadmium in maternal and cord blood were 0.70 (0.52-0.95) and 0.04 (0.03-0.06) μg/L, respectively. Maternal blood cadmium concentrations were inversely associated with P-M scores in boys (β = -1.4, 95% confidence interval (CI): -2.7, -0.038), DQ in children of mothers who smoked during pregnancy (β = -2.9, 95% CI: -5.7, -0.12), P-M (β = -5.4, 95% CI: -10, -0.67), C-A (β = -6.1, 95% CI: -11, -1.8), L-S (β = -9.0, 95% CI: -13, -4.8) and DQ scores (β = -6.4, 95% CI: -9.6, -3.1) in children born to mothers with gestational diabetes. Cord blood cadmium concentrations were negatively associated with L-S scores (β = -6.0., 95% CI: -11, -0.91) in children born to mothers with gestational diabetes. CONCLUSIONS Prenatal cadmium exposure was negatively associated with neurodevelopment in boys, in children whose mothers smoked, and in children born to mothers with gestational diabetes. Further studies in other populations are needed to confirm our findings.
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Affiliation(s)
- Chaochen Ma
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Miyuki Iwai-Shimada
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Shoji F Nakayama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Tomohiko Isobe
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Yayoi Kobayashi
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Nozomi Tatsuta
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan
| | - Yu Taniguchi
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Makiko Sekiyama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Takehiro Michikawa
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan; Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo 143-8540, Japan
| | - Shin Yamazaki
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Michihiro Kamijima
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
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Ali T, Khan A, Alam SI, Ahmad S, Ikram M, Park JS, Lee HJ, Kim MO. Cadmium, an Environmental Contaminant, Exacerbates Alzheimer's Pathology in the Aged Mice's Brain. Front Aging Neurosci 2021; 13:650930. [PMID: 34248598 PMCID: PMC8263901 DOI: 10.3389/fnagi.2021.650930] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023] Open
Abstract
Cadmium (Cd) is an environmental contaminant, which is a potential risk factor in the progression of aging-associated neurodegenerative diseases. Herein, we have assessed the effects of chronic administration of Cd on cellular oxidative stress and its associated Alzheimer's disease (AD) pathologies in animal models. Two groups of mice were used, one group administered with saline and the other with Cd (1 mg/kg/day; intraperitoneally) for 3 months. After behavioral studies, molecular/biochemical (Immunoblotting, ELISAs, ROS, LPO, and GSH assays) and morphological analyses were performed. We observed an exacerbation of memory and synaptic deficits in chronic Cd-injected mice. Subacute and chronic Cd escalated reactive oxygen species (ROS), suppressed the master antioxidant enzymes, e.g., nuclear factor-erythroid 2-related factor 2 and heme oxygenase-1, and evoked the stress kinase phospho-c-Jun N-terminal kinase 1 signaling pathways, which may escalate AD pathologies possibly associated with amyloidogenic processes. These findings suggest the regulation of oxidative stress/ROS and its associated amyloid beta pathologies for targeting the Cd-exacerbated AD pathogenesis. In addition, these preclinical animal studies represent a paradigm for epidemiological studies of the human population exposed to chronic and subacute administration of Cd, suggesting avoiding environmental contaminants.
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Affiliation(s)
- Tahir Ali
- Division of Applied Life Science (BK 21 Four), College of Natural Science, Gyeongsang National University, Jinju, South Korea
- Calgary Prion Research Unit, Department of Comparative Biology & Experimental Medicine, Faculty of Veterinary Medicine, Hotchkiss Brain Institute Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amjad Khan
- Division of Applied Life Science (BK 21 Four), College of Natural Science, Gyeongsang National University, Jinju, South Korea
| | - Sayed Ibrar Alam
- Division of Applied Life Science (BK 21 Four), College of Natural Science, Gyeongsang National University, Jinju, South Korea
| | - Sareer Ahmad
- Division of Applied Life Science (BK 21 Four), College of Natural Science, Gyeongsang National University, Jinju, South Korea
| | - Muhammad Ikram
- Division of Applied Life Science (BK 21 Four), College of Natural Science, Gyeongsang National University, Jinju, South Korea
| | - Jun Sung Park
- Division of Applied Life Science (BK 21 Four), College of Natural Science, Gyeongsang National University, Jinju, South Korea
| | - Hyeon Jin Lee
- Division of Applied Life Science (BK 21 Four), College of Natural Science, Gyeongsang National University, Jinju, South Korea
| | - Myeong Ok Kim
- Division of Applied Life Science (BK 21 Four), College of Natural Science, Gyeongsang National University, Jinju, South Korea
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Zhang X, Meng Z, Li X, Liu M, Ren X, Zhu M, He Q, Zhang Q, Song K, Jia Q, Zhang C, Wang X, Liu X. The association between total bilirubin and serum triglyceride in both sexes in Chinese. Lipids Health Dis 2018; 17:217. [PMID: 30208888 PMCID: PMC6136171 DOI: 10.1186/s12944-018-0857-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/28/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Dyslipidemia can cause some chronic diseases. Bilirubin is reported to have anti-inflammatory and anti-oxidant properties. We aimed to explore the relationship between triglyceride and total bilirubin (TB) in a large Chinese cohort. METHODS A total of 80,298 healthy Chinese (48,971 male, 31,327 female) enrolled in this cross-sectional study. Clinical data were collected from participants. Database was divided according to sex and age. The relationship between triglyceride and TB was analyzed by quartiles of TB. Levels of triglyceride were compared in different TB subgroups by one-way analysis of variance and independent sample's t-test. Crude and adjusted odds ratios of triglyceride for TB with 95% confidence intervals were analyzed by binary logistic regression models. RESULTS Overall, men showed higher levels of TB and triglyceride than women. In people older than 60 years, women had higher triglyceride levels than men. Linear logistic regression analyses showed a negative relationship between triglyceride and TB in both genders. Men showed significantly higher overall incidence of high triglyceride than women. Men less than 60 years old showed a higher incidence of high triglyceride. For women older than 60 years, the incidence of high triglyceride was higher. However, high TB showed no protective effects on both genders from high TG in the binary logistic regression models. TB showed a detrimental effect on high TG in model 2 which included TB as a covariate. But that effect disappeared after other confounding factors were included. CONCLUSIONS Our findings showed no association between TB and triglyceride in Chinese.
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Affiliation(s)
- Xuemei Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, P.R, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, P.R, China.
| | - Xue Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, P.R, China
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R, China
| | - Xiaojun Ren
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R, China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R, China
| | - Qing Zhang
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R, China
| | - Kun Song
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R, China
| | - Qiyu Jia
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R, China
| | - Chunmei Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, P.R, China
| | - Xiaoran Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, P.R, China
| | - Xiangxiang Liu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, P.R, China
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Gustin K, Tofail F, Vahter M, Kippler M. Cadmium exposure and cognitive abilities and behavior at 10 years of age: A prospective cohort study. ENVIRONMENT INTERNATIONAL 2018; 113:259-268. [PMID: 29459184 DOI: 10.1016/j.envint.2018.02.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND We have previously reported inverse associations of prenatal and childhood cadmium exposure with cognition in 5-year-old Bangladeshi children. OBJECTIVES To assess if cadmium exposure affected cognition and behavior in the Bangladeshi children at 10 years. METHODS Cadmium exposure was assessed by urinary concentrations at 10 (n = 1498) and 5 years of age (n = 1453), and of the mothers in early pregnancy (n = 1299), measured by ICP-MS. Cognitive abilities were assessed with Wechsler Intelligence Scale for Children (4th edition) and behavior with the parent-rated Strengths and Difficulties Questionnaire. RESULTS In multivariable-adjusted models, urinary cadmium at 10 years was inversely associated with Full scale IQ and most of the sub-scales. Associations were mainly observed in boys, in whom the difference in Full scale IQ was 7.0 scores (95% CI: -11, -2.7), corresponding to 0.21 SD, when comparing those in the highest (range: 0.30-2.6 μg/L) and lowest tertile of urinary cadmium (0.036-0.18 μg/L). Urinary cadmium at 5 years was inversely, but not significantly, associated with IQ. Children in the highest exposure tertile at 10 years also had poorer Prosocial behavior scores. The association appeared strongest in girls, in whom the corresponding OR for Prosocial scores in relation to cadmium exposure at 10 years and prenatally was 0.58 (95% CI: 0.34, 0.99) and 0.48 (95% CI: 0.25, 0.93), respectively. CONCLUSION Childhood cadmium exposure was associated with lower intelligence in boys, and there were indications of altered behavior in girls for both prenatal and childhood exposures. Findings are of concern as similar exposure levels are common world-wide.
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Affiliation(s)
- Klara Gustin
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
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Masullo LF, Magalhães RA, Lemes RPG, de Almeida Filho TP, de Castro MF, Maia Filho PA, Cunha TOV, Quidute ARP, Fontenele EGP, Sun G, Martins MRA. Levothyroxine Replacement Improves Oxidative Status in Primary Hypothyroidism. Front Endocrinol (Lausanne) 2018; 9:655. [PMID: 30467493 PMCID: PMC6235903 DOI: 10.3389/fendo.2018.00655] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: Although hypothyroidism has been linked to oxidative stress, data regarding the relationship between thyroid hormone levels and oxidative stress is still inconsistent. This study was designed to evaluate the effect of levothyroxine replacement on oxidative stress in women with primary hypothyroidism. Design: A total of 25 female patients with primary hypothyroidism were included. Oxidative stress markers were measured before and after levothyroxine replacement treatment in all patients. Methods: Oxidative stress was evaluated through the measurement of oxidants (thiobarbituric acid reactive substances [TBARS] and nitrite/nitrate levels), and antioxidants (superoxide dismutase and catalase activity). Results: Antioxidant catalase activity (63.77 ± 23.8 vs. 50.12 ±12.75 atv/min; p = 0.03) was significantly increased and the levels of TBARS (3.02 ± 0.86 vs. 3.55 ± 0.87 μM; p = 0.03) were significantly decreased in the state of euthyroidism after levothyroxine replacement compared to the hypothyroidism before levothyroxine treatment. No significant change in neither nitrite/nitrate concentration (p = 0.18) nor in superoxide dismutase activity (p = 0.93) after L-T4 adjustment was found. Conclusions: Our data demonstrate that levothyroxine replacement improved oxidative status in patients with primary hypothyroidism, indexed by the significantly decreased levels of malonaldehyde (MDA) and increased catalase (CAT) activity.
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Affiliation(s)
- Laís Farias Masullo
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
| | - Rejane Araújo Magalhães
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
- Division of Endocrinology and Diabetes, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Brazil
| | - Romélia Pinheiro Gonçalves Lemes
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
| | - Tarcísio Paulo de Almeida Filho
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
| | - Marilena Facundo de Castro
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
| | - Pedro Aurio Maia Filho
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
| | | | - Ana Rosa Pinto Quidute
- Division of Endocrinology and Diabetes, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Brazil
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Brazil
- Drug Research and Development Center-NPDM/Fortaleza, Fortaleza, Brazil
| | - Eveline Gadelha Pereira Fontenele
- Division of Endocrinology and Diabetes, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Brazil
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Guang Sun
- Discipline of Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Manoel Ricardo Alves Martins
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
- Division of Endocrinology and Diabetes, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Brazil
- Drug Research and Development Center-NPDM/Fortaleza, Fortaleza, Brazil
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- *Correspondence: Manoel Ricardo Alves Martins
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