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Martchenko A, Papaelias A, Bolz SS. Physiologic effects of the maqui berry ( Aristotelia chilensis): a focus on metabolic homeostasis. Food Funct 2024; 15:4724-4740. [PMID: 38618933 DOI: 10.1039/d3fo02524a] [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: 04/16/2024]
Abstract
The prevalence and socioeconomic impact of metabolic diseases is rapidly growing. The limited availability of effective and affordable treatments has fuelled interest in the therapeutic potential of natural compounds as they occur in selected food sources. These compounds might help to better manage the current problems of treatment availability, affordability, and adverse effects that, in combination, limit treatment duration and efficacy at present. Specifically, berries garnered interest given a strong epidemiological link between their consumption and improved metabolic functions, making the analysis of their phytochemical composition and the identification and characterization of biologically active ingredients an emerging area of research. In this regard, the present review focuses on the South American maqui berry Aristotelia chilensis, which has been extensively used by the indigenous Mapuche population for generations to treat a variety of disease conditions. An overview of the maqui plant composition precedes a review of pre-clinical and clinical studies that investigated the effects of maqui berries and their major components on metabolic homeostasis. The final part of the review highlights possible technologies to conserve maqui berry structural and functional integrity during passage through the small intestine, ultimately aiming to augment their systemic and luminal bioavailability and biological effects. The integration of the various aspects discussed herein can assist in the development of effective maqui-based therapies to benefit the growing population of metabolically compromised patients.
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Affiliation(s)
- Alexandre Martchenko
- Department of Physiology, University of Toronto, Toronto, Canada
- Toronto Centre for Microvascular Medicine at The Ted Rogers Centre for Heart Research Translational Biology and Engineering Program, University of Toronto, 661 University Avenue, 14th Floor, Toronto, M5G 1M1, Canada.
| | - Alexandra Papaelias
- Department of Physiology, University of Toronto, Toronto, Canada
- Toronto Centre for Microvascular Medicine at The Ted Rogers Centre for Heart Research Translational Biology and Engineering Program, University of Toronto, 661 University Avenue, 14th Floor, Toronto, M5G 1M1, Canada.
| | - Steffen-Sebastian Bolz
- Department of Physiology, University of Toronto, Toronto, Canada
- Toronto Centre for Microvascular Medicine at The Ted Rogers Centre for Heart Research Translational Biology and Engineering Program, University of Toronto, 661 University Avenue, 14th Floor, Toronto, M5G 1M1, Canada.
- Heart & Stroke/Richard Lewar Centre of Excellence for Cardiovascular Research, University of Toronto, Toronto, Canada
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Marozin S, Simon-Nobbe B, Huth A, Beyerer E, Weber L, Nüssler A, Lepperdinger G. Aggregation of human osteoblasts unlocks self-reliant differentiation and constitutes a microenvironment for 3D-co-cultivation with other bone marrow cells. Sci Rep 2024; 14:10345. [PMID: 38710795 DOI: 10.1038/s41598-024-60986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024] Open
Abstract
Skeletal bone function relies on both cells and cellular niches, which, when combined, provide guiding cues for the control of differentiation and remodeling processes. Here, we propose an in vitro 3D model based on human fetal osteoblasts, which eases the study of osteocyte commitment in vitro and thus provides a means to examine the influences of biomaterials, substances or cells on the regulation of these processes. Aggregates were formed from human fetal osteoblasts (hFOB1.19) and cultivated under proliferative, adipo- and osteoinductive conditions. When cultivated under osteoinductive conditions, the vitality of the aggregates was compromised, the expression levels of the mineralization-related gene DMP1 and the amount of calcification and matrix deposition were lower, and the growth of the spheroids stalled. However, within spheres under growth conditions without specific supplements, self-organization processes occur, which promote extracellular calcium deposition, and osteocyte-like cells develop. Long-term cultivated hFOB aggregates were free of necrotic areas. Moreover, hFOB aggregates cultivated under standard proliferative conditions supported the co-cultivation of human monocytes, microvascular endothelial cells and stromal cells. Overall, the model presented here comprises a self-organizing and easily accessible 3D osteoblast model for studying bone marrow formation and in vitro remodeling and thus provides a means to test druggable molecular pathways with the potential to promote life-long bone formation and remodeling.
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Affiliation(s)
- Sabrina Marozin
- Department of Biosciences and Medical Biology, University Salzburg, 5020, Salzburg, Austria.
| | - Birgit Simon-Nobbe
- Department of Biosciences and Medical Biology, University Salzburg, 5020, Salzburg, Austria
| | - Astrid Huth
- Department of Biosciences and Medical Biology, University Salzburg, 5020, Salzburg, Austria
| | - Evelyn Beyerer
- Department of Biosciences and Medical Biology, University Salzburg, 5020, Salzburg, Austria
| | - Laurenz Weber
- Department of Biosciences and Medical Biology, University Salzburg, 5020, Salzburg, Austria
| | - Andreas Nüssler
- Siegfried Weller Institut (SWI) | BG Klinik Tübingen, Tübingen, Germany
| | - Günter Lepperdinger
- Department of Biosciences and Medical Biology, University Salzburg, 5020, Salzburg, Austria
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Zhang S, Pan P, Xie H, Wei C, Wang Q, Yang B, Sun Y, Li Y, Luo Y, Song Y, Jiang Q, Huang Y. Resveratrol improves meat quality traits by activating the lncRNAs-KEAP1-NRF2 axis in pigs. Meat Sci 2024; 209:109411. [PMID: 38061306 DOI: 10.1016/j.meatsci.2023.109411] [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: 08/13/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
This research aims at uncovering the effects and investigating the molecular mechanisms of dietary resveratrol (RES) supplementation on antioxidant capacity and meat quality of pigs. In this study, 20 μM RES could activate the KEAP1-NRF2 antioxidant defense pathway in response to oxidative stress in porcine skeletal muscle satellite cells was firstly found. Then, twenty-four healthy crossbred castrated boars were allocated to 4 treatments that were fed with a basal diet (control) and a basal diet supplemented with 200 mg, 400 mg or 600 mg RES per Kilogram (kg) of feed for 41 days, respectively. 400 and 600 mg/kg RES-supplemented diet can effectively improve the meat quality traits and activities of antioxidizing enzymes via the KEAP1-NRF2 signaling pathway of pigs. The molecular dynamic simulation further revealed that RES could directly binding to KEAP1 to reduce the tightness of KEAP1-NRF2 protein-protein interaction. More importantly, dietary supplementation of RES also improves antioxidant capacity through a series of KEAP1-NRF2 pathway-related lncRNAs were found by RNA sequencing (RNA-seq). Altogether, this study demonstrated that RES improves meat quality traits by effectively increasing antioxidant levels via the lncRNA-KEAP1-NRF2 axis in vivo and/or in vitro. These results provide new insights into the molecular mechanisms by which RES, as a nutritional agent, regulates antioxidant capacity and improves meat quality in pigs.
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Affiliation(s)
- Sanbao Zhang
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China; Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, Guangxi University, Nanning 530004, Guangxi, China
| | - Peng Pan
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China
| | - Hongyue Xie
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China
| | - Chongwan Wei
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China
| | - Qian Wang
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China
| | - Bao Yang
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China
| | - Yanjie Sun
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China
| | - Yin Li
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China
| | - Yunyan Luo
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China
| | - Ying Song
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China; Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, Guangxi University, Nanning 530004, Guangxi, China
| | - Qinyang Jiang
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China; Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, Guangxi University, Nanning 530004, Guangxi, China.
| | - Yanna Huang
- College of Animal Science and Technology, Guangxi University, Nanning, Guangxi 530004, China.
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Wacewicz-Muczyńska M, Moskwa J, Puścion-Jakubik A, Naliwajko SK, Niczyporuk M, Socha K. Antioxidant Properties of Maqui Berry Extract ( Aristotelia chilensis (Mol.) Stuntz) and Its Potential Photoprotective Role on Human Skin Fibroblasts. Molecules 2023; 28:7802. [PMID: 38067532 PMCID: PMC10708373 DOI: 10.3390/molecules28237802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Maqui berry (Aristotelia chilensis) is characterized by antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the effect of maqui berry extracts on human skin fibroblasts (NHSFs) exposed to ultraviolet radiation (UVB). The photoprotective properties of the extracts were investigated via the determination of the total polyphenolic content (TPC) and antioxidant capacity (DPPH), and the chemical composition was assessed. The chemical purity of the extracts was studied via the evaluation of the toxic elements level. The water extract (MWE 57.75 ± 0.44 mg GAE/g) had the highest mean polyphenol content. The water (MWE) and ethanol (MEE70) extracts had the highest inhibitory activities against DPPH radical formation (283.63 ± 7.29 and 284.60 ± 4.31 mg Tx/L, respectively). The analyzed extracts were found to be safe in terms of toxic elements (arsenic, cadmium, lead). The tested extracts of maqui berry did not cause a cytotoxic effect on NHSF cells after 24, 48, and 72 h of incubation. When the NHSF cells were exposed to UVB radiation in the presence of maqui extracts, their viability was increased or maintained. The maqui berry extracts had a slightly protective effect against skin damage caused by UVB radiation. These were preliminary studies that require further research to determine which maqui compounds correspond with the photoprotective activity.
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Affiliation(s)
- Marta Wacewicz-Muczyńska
- Department of Specialist Cosmetology, Medical University of Bialystok, Akademicka 3 St., 15-267 Bialystok, Poland
| | - Justyna Moskwa
- Department of Bromatology, Medical University of Bialystok, Mickiewicza 2D St., 15-222 Bialystok, Poland
| | - Anna Puścion-Jakubik
- Department of Bromatology, Medical University of Bialystok, Mickiewicza 2D St., 15-222 Bialystok, Poland
| | - Sylwia K Naliwajko
- Department of Bromatology, Medical University of Bialystok, Mickiewicza 2D St., 15-222 Bialystok, Poland
| | - Marek Niczyporuk
- Department of Aesthetic Medicine, Medical University of Bialystok, Akademicka 3 St., 15-267 Bialystok, Poland
| | - Katarzyna Socha
- Department of Bromatology, Medical University of Bialystok, Mickiewicza 2D St., 15-222 Bialystok, Poland
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Jing Z, Li Y, Zhang H, Chen T, Yu J, Xu X, Zou Y, Wang X, Xiang K, Gong X, He P, Fu Y, Ren M, Ji P, Yang S. Tobacco toxins induce osteoporosis through ferroptosis. Redox Biol 2023; 67:102922. [PMID: 37826866 PMCID: PMC10571034 DOI: 10.1016/j.redox.2023.102922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
Clinical epidemiological studies have confirmed that tobacco smoking disrupts bone homeostasis and is an independent risk factor for the development of osteoporosis. The low viability and inferior osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) are important etiologies of osteoporosis. However, few basic studies have elucidated the specific mechanisms that tobacco toxins devastated BMSCs and consequently induced or exacerbated osteoporosis. Herein, our clinical data showed the bone mineral density (BMD) values of femoral neck in smokers were significantly lower than non-smokers, meanwhile cigarette smoke extract (CSE) exposure led to a significant decrease of BMD in rats and dysfunction of rat BMSCs (rBMSCs). Transcriptomic analysis and phenotype experiments suggested that the ferroptosis pathway was significantly activated in CSE-treated rBMSCs. Accumulated intracellular reactive oxygen species activated AMPK signaling, furtherly promoted NCOA4-mediated ferritin-selective autophagic processes, increased labial iron pool and lipid peroxidation deposition, and ultimately led to ferroptosis in rBMSCs. Importantly, in vivo utilization of ferroptosis and ferritinophagy inhibitors significantly alleviated BMD loss in CSE-exposed rats. Our study innovatively reveals the key mechanism of smoking-related osteoporosis, and provides a possible route targeting on the perspective of BMSC ferroptosis for future prevention and treatment of smoking-related bone homeostasis imbalance.
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Affiliation(s)
- Zheng Jing
- Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yuzhou Li
- Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - He Zhang
- Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Tao Chen
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Jinrui Yu
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Xinxin Xu
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Yulong Zou
- Department of Orthopedics, Second Affiliated Hospital of Chongqing Medical University, China
| | - Xu Wang
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Xiang
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Xuerui Gong
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Ping He
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Yiru Fu
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Mingxing Ren
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Ji
- Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Sheng Yang
- Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
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Zhong M, Wu Z, Chen Z, Ren Q, Zhou J. Advances in the interaction between endoplasmic reticulum stress and osteoporosis. Biomed Pharmacother 2023; 165:115134. [PMID: 37437374 DOI: 10.1016/j.biopha.2023.115134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023] Open
Abstract
The endoplasmic reticulum (ER) is the main site for protein synthesis, folding, and secretion, and accumulation of the unfolded/misfolded proteins in the ER may induce ER stress. ER stress is an important participant in various intracellular signaling pathways. Prolonged- or high-intensity ER stress may induce cell apoptosis. Osteoporosis, characterized by imbalanced bone remodeling, is a global disease caused by many factors, such as ER stress. ER stress stimulates osteoblast apoptosis, increases bone loss, and promotes osteoporosis development. Many factors, such as the drug's adverse effects, metabolic disorders, calcium ion imbalance, bad habits, and aging, have been reported to activate ER stress, resulting in the pathological development of osteoporosis. Increasing evidence shows that ER stress regulates osteogenic differentiation, osteoblast activity, and osteoclast formation and function. Various therapeutic agents have been developed to counteract ER stress and thereby suppress osteoporosis development. Thus, inhibition of ER stress has become a potential target for the therapeutic management of osteoporosis. However, the in-depth understanding of ER stress in the pathogenesis of osteoporosis still needs more effort.
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Affiliation(s)
- Mingliang Zhong
- College of Rehabilitation, Gannan Medical University, Ganzhou 341000, China
| | - Zhenyu Wu
- First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Zhixi Chen
- College of Pharmacy, Gannan Medical University, Ganzhou 341000, China
| | - Qun Ren
- College of Pharmacy, Gannan Medical University, Ganzhou 341000, China
| | - Jianguo Zhou
- Department of Joint Surgery, Ganzhou People's Hospital, Ganzhou 341000, China.
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Rinderknecht H, Mayer A, Histing T, Ehnert S, Nüssler A. Herbal Extracts of Ginseng and Maqui Berry Show Only Minimal Effects on an In Vitro Model of Early Fracture Repair of Smokers. Foods 2023; 12:2960. [PMID: 37569229 PMCID: PMC10419284 DOI: 10.3390/foods12152960] [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: 07/11/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Smoking is a major risk factor for delayed fracture healing, affecting several aspects of early fracture repair, including inflammation, osteogenesis, and angiogenesis. Panax ginseng (GE) and maqui berry extract (MBE) were shown in our previous studies to reduce smoke-induced cellular damage in late bone-healing in vitro models. We aimed here to analyze their effects on the early fracture repair of smokers in a 3D co-culture model of fracture hematomas and endothelial cells. Both extracts did not alter the cellular viability at concentrations of up to 100 µg/mL. In early fracture repair in vitro, they were unable to reduce smoking-induced inflammation and induce osteo- or chondrogenicity. Regarding angiogenesis, smoking-induced stress in HUVECs could not be counteracted by both extracts. Furthermore, smoking-impaired tube formation was not restored by GE but was harmed by MBE. However, GE promoted angiogenesis initiation under smoking conditions via the Angpt/Tie2 axis. To summarize, cigarette smoking strikingly affected early fracture healing processes in vitro, but herbal extracts at the applied doses had only a limited effect. Since both extracts were shown before to be very effective in later stages of fracture healing, our data suggest that their early use immediately after fracture does not appear to negatively impact later beneficial effects.
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Affiliation(s)
| | | | | | | | - Andreas Nüssler
- Siegfried-Weller Institute for Trauma Research, BG Trauma Center, University of Tuebingen, Schnarrenbergstrasse 95, 72070 Tuebingen, Germany; (H.R.); (A.M.); (T.H.); (S.E.)
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Ying M, Mao J, Sheng L, Wu H, Bai G, Zhong Z, Pan Z. Biomarkers for Prostate Cancer Bone Metastasis Detection and Prediction. J Pers Med 2023; 13:jpm13050705. [PMID: 37240875 DOI: 10.3390/jpm13050705] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/28/2023] Open
Abstract
Prostate cancer (PCa) causes deaths worldwide, ranking second after lung cancer. Bone metastasis (BM) frequently results from advanced PCa, affecting approximately 90% of patients, and it also often results in severe skeletal-related events. Traditional diagnostic methods for bone metastases, such as tissue biopsies and imaging, have substantial drawbacks. This article summarizes the significance of biomarkers in PCa accompanied with BM, including (1) bone formation markers like osteopontin (OPN), pro-collagen type I C-terminal pro-peptide (PICP), osteoprotegerin (OPG), pro-collagen type I N-terminal pro-peptide (PINP), alkaline phosphatase (ALP), and osteocalcin (OC); (2) bone resorption markers, including C-telopeptide of type I collagen (CTx), N-telopeptide of type I collagen (NTx), bone sialoprotein (BSP), tartrate-resistant acid phosphatase (TRACP), deoxypyridinoline (D-PYD), pyridoxine (PYD), and C-terminal pyridinoline cross-linked telopeptide of type I collagen (ICTP); (3) prostate-specific antigen (PSA); (4) neuroendocrine markers, such as chromogranin A (CgA), neuron-specific enolase (NSE), and pro-gastrin releasing peptide (ProGRP); (5) liquid biopsy markers, such as circulating tumor cells (CTCs), microRNA (miRNA), circulating tumor DNA (ctDNA), and cell-free DNA (cfDNA) and exosomes. In summary, some of these markers are already in widespread clinical use, while others still require further laboratory or clinical studies to validate their value for clinical application.
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Affiliation(s)
- Mingshuai Ying
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Jianshui Mao
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Lingchao Sheng
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Hongwei Wu
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Guangchao Bai
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Zhuolin Zhong
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Zhijun Pan
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 322000, China
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
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