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Di X, Martinez-Tellez B, Krekels EHJ, Jurado-Fasoli L, Osuna-Prieto FJ, Ortiz-Alvarez L, Hankemeier T, Rensen PCN, Ruiz JR, Kohler I. Higher Plasma Levels of Endocannabinoids and Analogues Correlate With a Worse Cardiometabolic Profile in Young Adults. J Clin Endocrinol Metab 2024; 109:1351-1360. [PMID: 37967236 PMCID: PMC11031222 DOI: 10.1210/clinem/dgad668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023]
Abstract
CONTEXT The endocannabinoid system (ECS) is a signaling system composed of endocannabinoids (eCBs), their receptors, and the enzymes involved in their synthesis and metabolism. Alterations in the ECS are linked to the development of cardiometabolic diseases. OBJECTIVE Here, we investigated the relationship between plasma levels of eCBs and their analogues with body composition and cardiometabolic risk factors. METHODS The study included 133 young adults (age 22.1 ± 2.2 years, 67% women). Fasting plasma levels of eCBs and their analogues were measured using liquid chromatography-tandem mass spectrometry. Body composition, brown adipose tissue (BAT) volume, glucose uptake, and traditional cardiometabolic risk factors were measured. RESULTS Plasma levels of eCBs and several eCB analogues were positively correlated with adiposity and traditional cardiometabolic risk factors (eg, serum insulin and triacylglyceride levels, all r ≥ 0.17 and P ≤ .045). Plasma levels of 2-arachidonoyl glycerol and N-pentadecenoylethanolamine were negatively correlated with BAT volume and glucose uptake (all r ≤ -0.17 and P ≤ .047). We observed that the plasma levels of eCBs and their analogues were higher in metabolically unhealthy overweight-obese participants than in metabolically healthy overweight-obese participants. CONCLUSION Our findings show that the plasma levels of eCBs and their analogues are related to higher levels of adiposity and worse cardiometabolic profile.
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Affiliation(s)
- Xinyu Di
- Metabolomics and Analytics Centre, Leiden Academic Centre for Drug Research (LACDR), Leiden University, 2333 CC Leiden, The Netherlands
| | - Borja Martinez-Tellez
- Department of Medicine, Division of Endocrinology, and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
- SPORT Research Group, CERNEP Research Center, University of Almería, 04120 Almería, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 18100 Granada, Spain
| | - Elke H J Krekels
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, 2333 CC Leiden, The Netherlands
| | - Lucas Jurado-Fasoli
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Francisco J Osuna-Prieto
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Lourdes Ortiz-Alvarez
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Thomas Hankemeier
- Metabolomics and Analytics Centre, Leiden Academic Centre for Drug Research (LACDR), Leiden University, 2333 CC Leiden, The Netherlands
| | - Patrick C N Rensen
- Department of Medicine, Division of Endocrinology, and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jonatan R Ruiz
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 18100 Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Isabelle Kohler
- Division of BioAnalytical Chemistry, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Center for Analytical Sciences Amsterdam, 1081 HZ Amsterdam, The Netherlands
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2
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Antoniades C, Tousoulis D, Vavlukis M, Fleming I, Duncker DJ, Eringa E, Manfrini O, Antonopoulos AS, Oikonomou E, Padró T, Trifunovic-Zamaklar D, De Luca G, Guzik T, Cenko E, Djordjevic-Dikic A, Crea F. Perivascular adipose tissue as a source of therapeutic targets and clinical biomarkers. Eur Heart J 2023; 44:3827-3844. [PMID: 37599464 PMCID: PMC10568001 DOI: 10.1093/eurheartj/ehad484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/03/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Obesity is a modifiable cardiovascular risk factor, but adipose tissue (AT) depots in humans are anatomically, histologically, and functionally heterogeneous. For example, visceral AT is a pro-atherogenic secretory AT depot, while subcutaneous AT represents a more classical energy storage depot. Perivascular adipose tissue (PVAT) regulates vascular biology via paracrine cross-talk signals. In this position paper, the state-of-the-art knowledge of various AT depots is reviewed providing a consensus definition of PVAT around the coronary arteries, as the AT surrounding the artery up to a distance from its outer wall equal to the luminal diameter of the artery. Special focus is given to the interactions between PVAT and the vascular wall that render PVAT a potential therapeutic target in cardiovascular diseases. This Clinical Consensus Statement also discusses the role of PVAT as a clinically relevant source of diagnostic and prognostic biomarkers of vascular function, which may guide precision medicine in atherosclerosis, hypertension, heart failure, and other cardiovascular diseases. In this article, its role as a 'biosensor' of vascular inflammation is highlighted with description of recent imaging technologies that visualize PVAT in clinical practice, allowing non-invasive quantification of coronary inflammation and the related residual cardiovascular inflammatory risk, guiding deployment of therapeutic interventions. Finally, the current and future clinical applicability of artificial intelligence and machine learning technologies is reviewed that integrate PVAT information into prognostic models to provide clinically meaningful information in primary and secondary prevention.
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Affiliation(s)
- Charalambos Antoniades
- Acute Multidisciplinary Imaging and Interventional Centre, RDM Division of Cardiovascular Medicine, University of Oxford, Headley Way, Headington, Oxford OX39DU, UK
| | - Dimitris Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens, Greece
| | - Marija Vavlukis
- Medical Faculty, University Clinic for Cardiology, University Ss’ Cyril and Methodius in Skopje, Skopje, North Macedonia
| | - Ingrid Fleming
- Institute for Vascular Signalling, Centre of Molecular Medicine, Goethe University, Frankfurt, Germany
| | - Dirk J Duncker
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Etto Eringa
- Cardiovascular-Program ICCC, Research Institute—Hospital Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Olivia Manfrini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alexios S Antonopoulos
- Acute Multidisciplinary Imaging and Interventional Centre, RDM Division of Cardiovascular Medicine, University of Oxford, Headley Way, Headington, Oxford OX39DU, UK
- 1st Cardiology Department, National and Kapodistrian University of Athens, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Department, National and Kapodistrian University of Athens, Greece
| | - Teresa Padró
- Cardiovascular Program-ICCC, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- CiberCV, Institute Carlos III, Madrid, Spain
| | | | - Giuseppe De Luca
- Division of Cardiology, AOU Policlinico G. Martino, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Cardiologia Ospedaliera, Nuovo Galeazzi-Sant’Ambrogio, Milan, Italy
| | - Tomasz Guzik
- Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, UK
- Department of Medicine, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Edina Cenko
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ana Djordjevic-Dikic
- Medical Faculty, Cardiology Clinic, University Clinical Center, University of Belgrade, Serbia
| | - Filippo Crea
- Department of Cardiology and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Badimon L, Robinson EL, Jusic A, Carpusca I, deWindt LJ, Emanueli C, Ferdinandy P, Gu W, Gyöngyösi M, Hackl M, Karaduzovic-Hadziabdic K, Lustrek M, Martelli F, Nham E, Potočnjak I, Satagopam V, Schneider R, Thum T, Devaux Y. Cardiovascular RNA markers and artificial intelligence may improve COVID-19 outcome: a position paper from the EU-CardioRNA COST Action CA17129. Cardiovasc Res 2021; 117:1823-1840. [PMID: 33839767 PMCID: PMC8083253 DOI: 10.1093/cvr/cvab094] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been as unprecedented as unexpected, affecting more than 105 million people worldwide as of 8 February 2020 and causing more than 2.3 million deaths according to the World Health Organization (WHO). Not only affecting the lungs but also provoking acute respiratory distress, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is able to infect multiple cell types including cardiac and vascular cells. Hence a significant proportion of infected patients develop cardiac events, such as arrhythmias and heart failure. Patients with cardiovascular comorbidities are at highest risk of cardiac death. To face the pandemic and limit its burden, health authorities have launched several fast-track calls for research projects aiming to develop rapid strategies to combat the disease, as well as longer-term projects to prepare for the future. Biomarkers have the possibility to aid in clinical decision-making and tailoring healthcare in order to improve patient quality of life. The biomarker potential of circulating RNAs has been recognized in several disease conditions, including cardiovascular disease. RNA biomarkers may be useful in the current COVID-19 situation. The discovery, validation, and marketing of novel biomarkers, including RNA biomarkers, require multi-centre studies by large and interdisciplinary collaborative networks, involving both the academia and the industry. Here, members of the EU-CardioRNA COST Action CA17129 summarize the current knowledge about the strain that COVID-19 places on the cardiovascular system and discuss how RNA biomarkers can aid to limit this burden. They present the benefits and challenges of the discovery of novel RNA biomarkers, the need for networking efforts, and the added value of artificial intelligence to achieve reliable advances.
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Affiliation(s)
- Lina Badimon
- Cardiovascular Science Program-ICCC, IR-Hospital de la Santa Creu i Santa Pau, Ciber CV, Autonomous University of Barcelona, Barcelona, Spain
| | - Emma L Robinson
- Department of Cardiology, School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amela Jusic
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B rue Edison, L-1445 Strassen, Luxembourg
| | - Irina Carpusca
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B rue Edison, L-1445 Strassen, Luxembourg
| | - Leon J deWindt
- Department of Molecular Genetics, Faculty of Science and Engineering, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Costanza Emanueli
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Péter Ferdinandy
- Cardiometabolic Research Group and MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest,Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Wei Gu
- Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch sur Alzette, Luxembourg
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Mitja Lustrek
- Department of Intelligent Systems, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Fabio Martelli
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy
| | - Eric Nham
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ines Potočnjak
- Institute for Clinical Medical Research and Education, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Venkata Satagopam
- Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch sur Alzette, Luxembourg
| | - Reinhard Schneider
- Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch sur Alzette, Luxembourg
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover,Germany
- REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Yvan Devaux
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B rue Edison, L-1445 Strassen, Luxembourg
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van der Putten C, Buskermolen ABC, Werner M, Brouwer HFM, Bartels PAA, Dankers PYW, Bouten CVC, Kurniawan NA. Protein Micropatterning in 2.5D: An Approach to Investigate Cellular Responses in Multi-Cue Environments. ACS Appl Mater Interfaces 2021; 13:25589-25598. [PMID: 34032413 PMCID: PMC8193632 DOI: 10.1021/acsami.1c01984] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/12/2021] [Indexed: 05/22/2023]
Abstract
The extracellular microenvironment is an important regulator of cell functions. Numerous structural cues present in the cellular microenvironment, such as ligand distribution and substrate topography, have been shown to influence cell behavior. However, the roles of these cues are often studied individually using simplified, single-cue platforms that lack the complexity of the three-dimensional, multi-cue environment cells encounter in vivo. Developing ways to bridge this gap, while still allowing mechanistic investigation into the cellular response, represents a critical step to advance the field. Here, we present a new approach to address this need by combining optics-based protein patterning and lithography-based substrate microfabrication, which enables high-throughput investigation of complex cellular environments. Using a contactless and maskless UV-projection system, we created patterns of extracellular proteins (resembling contact-guidance cues) on a two-and-a-half-dimensional (2.5D) cell culture chip containing a library of well-defined microstructures (resembling topographical cues). As a first step, we optimized experimental parameters of the patterning protocol for the patterning of protein matrixes on planar and non-planar (2.5D cell culture chip) substrates and tested the technique with adherent cells (human bone marrow stromal cells). Next, we fine-tuned protein incubation conditions for two different vascular-derived human cell types (myofibroblasts and umbilical vein endothelial cells) and quantified the orientation response of these cells on the 2.5D, physiologically relevant multi-cue environments. On concave, patterned structures (curvatures between κ = 1/2500 and κ = 1/125 μm-1), both cell types predominantly oriented in the direction of the contact-guidance pattern. In contrast, for human myofibroblasts on micropatterned convex substrates with higher curvatures (κ ≥ 1/1000 μm-1), the majority of cells aligned along the longitudinal direction of the 2.5D features, indicating that these cells followed the structural cues from the substrate curvature instead. These findings exemplify the potential of this approach for systematic investigation of cellular responses to multiple microenvironmental cues.
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Affiliation(s)
- Cas van der Putten
- Department
of Biomedical Engineering, Eindhoven University
of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- Institute
for Complex Molecular Systems, Eindhoven
University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Antonetta B. C. Buskermolen
- Department
of Biomedical Engineering, Eindhoven University
of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- Institute
for Complex Molecular Systems, Eindhoven
University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Maike Werner
- Department
of Biomedical Engineering, Eindhoven University
of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- Institute
for Complex Molecular Systems, Eindhoven
University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Hannah F. M. Brouwer
- Department
of Biomedical Engineering, Eindhoven University
of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- Institute
for Complex Molecular Systems, Eindhoven
University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Paul A. A. Bartels
- Department
of Biomedical Engineering, Eindhoven University
of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- Institute
for Complex Molecular Systems, Eindhoven
University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Patricia Y. W. Dankers
- Department
of Biomedical Engineering, Eindhoven University
of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- Institute
for Complex Molecular Systems, Eindhoven
University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Carlijn V. C. Bouten
- Department
of Biomedical Engineering, Eindhoven University
of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- Institute
for Complex Molecular Systems, Eindhoven
University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Nicholas A. Kurniawan
- Department
of Biomedical Engineering, Eindhoven University
of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- Institute
for Complex Molecular Systems, Eindhoven
University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
- . Phone: +31-40-2472347
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5
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van der Wees PJ, Verkerk EW, Verbiest MEA, Zuidgeest M, Bakker C, Braspenning J, de Boer D, Terwee CB, Vajda I, Beurskens A, van Dulmen SA. Development of a framework with tools to support the selection and implementation of patient-reported outcome measures. J Patient Rep Outcomes 2019; 3:75. [PMID: 31889232 PMCID: PMC6937349 DOI: 10.1186/s41687-019-0171-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patient reported outcomes (PROs) provide information on a patient's health status coming directly from the patient. Measuring PROs with patient reported outcome measures (PROMs) has gained wide interest in clinical practice for individual patient care, as well as in quality improvement, and for providing transparency of outcomes to stakeholders through public reporting. However, current knowledge of selecting and implementing PROMs for these purposes is scattered, and not readily available for clinicians and quality managers in healthcare organizations. The objective of this study is to develop a framework with tools to support the systematic selection, implementation and evaluation of PROs and PROMs in individual patient care, for quality improvement and public reporting. METHODS We developed the framework in a national project in the Netherlands following a user-centered design. The development process of the framework contained five iterative components: (a) identification of existing tools, (b) identification of user requirements and designing steps for selection and implementation of PROs and PROMs, (c) discussing a prototype of the framework during a national workshop, (d) developing a web version, (e) pre-testing of the framework. A total of 40 users with different perspectives (clinicians, patient representatives, quality managers, purchasers, researchers) have been consulted. RESULTS The final framework is presented as the PROM-cycle that consists of eight steps in four phases: (1) goal setting, (2) selecting PROs and PROMs, (3) developing and testing of quality indicator(s), (4) implementing and evaluating the PROM(s) and indicator(s). Users emphasized that the first step is the key element in which the why, for whom and setting of the PROM has to be defined. This information is decisive for the following steps. For each step the PROM-cycle provides guidance and tools, with instruments, checklists, methods, handbooks, and standards supporting the process. CONCLUSION We developed a framework to support the selection and implementation of PROs and PROMs. Each step provides guidance and tools to support the process. The PROM-cycle and its tools are publicly available and can be used by clinicians, quality managers, patient representatives and other experts involved in using PROMS. Through periodic evaluation and updates, tools will be added for national and international use of the PROM-cycle.
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Affiliation(s)
- Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - Eva W Verkerk
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Marjolein E A Verbiest
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | | | - Carla Bakker
- Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Federation of University Medical Centres (NFU), Utrecht, the Netherlands
| | - Jozé Braspenning
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Dolf de Boer
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ildikó Vajda
- VSOP Dutch Genetic Alliance, Soest, the Netherlands
- STZ-Dutch Association of Top Clinical Hospitals, Utrecht, the Netherlands
| | - Anna Beurskens
- Maastricht University, Maastricht, the Netherlands
- Zuyd University of applied sciences, Heerlen, the Netherlands
| | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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