Oxidoreductase enzymatic biosensors as diagnostic tools.
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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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Dobrzański"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"204968",title:"Dr.",name:"Neide",middleName:null,surname:"Pena Coto",fullName:"Neide Pena Coto",slug:"neide-pena-coto",email:"neidecoto@gmail.com",position:null,institution:null}]}},chapter:{id:"56614",slug:"systematic-study-of-ethylene-vinyl-acetate-eva-in-the-manufacturing-of-protector-devices-for-the-oro",signatures:"Reinaldo Brito e Dias, Neide Pena Coto, Gilmar Ferreira Batalha and\nLarissa Driemeier",dateSubmitted:"January 25th 2017",dateReviewed:"May 31st 2017",datePrePublished:null,datePublished:"February 14th 2018",book:{id:"5951",title:"Biomaterials in Regenerative Medicine",subtitle:null,fullTitle:"Biomaterials in Regenerative Medicine",slug:"biomaterials-in-regenerative-medicine",publishedDate:"February 14th 2018",bookSignature:"Leszek A. Dobrzański",coverURL:"https://cdn.intechopen.com/books/images_new/5951.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"15880",title:"Prof.",name:"Leszek A.",middleName:null,surname:"Dobrzański",slug:"leszek-a.-dobrzanski",fullName:"Leszek A. Dobrzański"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"204968",title:"Dr.",name:"Neide",middleName:null,surname:"Pena Coto",fullName:"Neide Pena Coto",slug:"neide-pena-coto",email:"neidecoto@gmail.com",position:null,institution:null}]},book:{id:"5951",title:"Biomaterials in Regenerative Medicine",subtitle:null,fullTitle:"Biomaterials in Regenerative Medicine",slug:"biomaterials-in-regenerative-medicine",publishedDate:"February 14th 2018",bookSignature:"Leszek A. Dobrzański",coverURL:"https://cdn.intechopen.com/books/images_new/5951.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"15880",title:"Prof.",name:"Leszek A.",middleName:null,surname:"Dobrzański",slug:"leszek-a.-dobrzanski",fullName:"Leszek A. Dobrzański"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"10496",leadTitle:null,title:"Feed Additives in Animal Nutrition",subtitle:null,reviewType:"peer-reviewed",abstract:"
\r\n\tIt is well known that the quality of animal origin foodstuffs (e.g. meat) is influenced by the quality of feed very strongly. Therefore, a very important area of animal nutrition research is focused on improving quality of animal products by feeding so that it can better meet the requirements of human nutrition.
\r\n\r\n\tAnimal nutrition in the 21st century aims to provide safe and good quality foodstuffs of animal origin and at the same time achieve a high efficiency of production and a low level of environmental pollution. These criteria, however, contribute to the complexity and rapid expansion of nutrition science. The continuously increasing demand of the human population needs to be supplied from a diminishing agricultural area, while maintaining the sustainability of production. According to the global trends, the challenges facing animal nutrition in the 21st century can be summarized as follows: more awareness and activity of participation is needed in animal production to supply quality and safe food in sufficient quantities, in accordance with the requirements of the society. Therefore, the efficiency of animal production needs to be improved. This can be achieved by enhancing 1) biological efficiency, 2) technological efficiency and 3) economic efficiency. Among many other factors, feed additives play a very important role in achieving the above objectives.
\r\n\tAnimal food additives are products used in animal nutrition for purposes of improving the quality of feed or to improve the animal’s performance and health. Other additives can be used to enhance digestibility or even flavour of feed materials. In addition, feed additives are known which improve the quality of compound feed production; consequently e.g. they improve the quality of the granulated mixed diet.
\r\n\tGenerally feed additives could be divided into five groups:
\r\n\t1.Technological additives which influence the technological aspects of the diet to improve its handling or hygiene characteristics.
\r\n\t2. Sensory additives which improve the palatability of a diet by stimulating appetite, usually through the effect these products have on the flavour or colour.
\r\n\t3. Nutritional additives, such additives are specific nutrient(s) required by the animal for optimal production.
\r\n\t4.Zootechnical additives which improve the nutrient status of the animal, not by providing specific nutrients, but by enabling more efficient use of the nutrients present in the diet, in other words, it increases the efficiency of production.
\r\n\t5. In poultry nutrition: Coccidiostats and Histomonostats which widely used to control intestinal health of poultry through direct effects on the parasitic organism concerned.
\r\n\tThe aim of the book is to present the impact of the most important feed additives on the animal production, to demonstrate their mode of action, to show their effect on intermediate metabolism and heath status of livestock and to suggest how to use the different feed additives in animal nutrition to produce high quality and safety animal origin foodstuffs for human consumer.
",isbn:"978-1-83969-404-2",printIsbn:"978-1-83969-403-5",pdfIsbn:"978-1-83969-405-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"8ffe43a82ac48b309abc3632bbf3efd0",bookSignature:"Prof. László Babinszky",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10496.jpg",keywords:"Technological Feed Additives, Feed Industry, Quality of Compound Feed, Non-Antibiotic Growth Promoter, Product Quality, Additive Enzymes, Digestibility of Nutrients, NSP Enzymes, Farm Animals, Livestock, Immunity, Microbiome",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 24th 2020",dateEndSecondStepPublish:"December 22nd 2020",dateEndThirdStepPublish:"February 20th 2021",dateEndFourthStepPublish:"May 11th 2021",dateEndFifthStepPublish:"July 10th 2021",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Professor Emeritus from the University of Debrecen, Hungary who authored 297 publications (papers, book chapters) and edited 3 books. Member of various committees and chairman of the World Conference of Innovative Animal Nutrition and Feeding (WIANF).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"53998",title:"Prof.",name:"László",middleName:null,surname:"Babinszky",slug:"laszlo-babinszky",fullName:"László Babinszky",profilePictureURL:"https://mts.intechopen.com/storage/users/53998/images/system/53998.jpg",biography:"László Babinszky is Professor Emeritus of animal nutrition at the University of Debrecen, Hungary. From 1984 to 1985 he worked at the Agricultural University in Wageningen and in the Institute for Livestock Feeding and Nutrition in Lelystad (the Netherlands). He also worked at the Agricultural University of Vienna in the Institute for Animal Breeding and Nutrition (Austria) and in the Oscar Kellner Research Institute in Rostock (Germany). From 1988 to 1992, he worked in the Department of Animal Nutrition (Agricultural University in Wageningen). In 1992 he obtained a PhD degree in animal nutrition from the University of Wageningen.He has authored 297 publications (papers, book chapters). He edited 3 books and 14 international conference proceedings. His total number of citation is 407. \r\nHe is member of various committees e.g.: American Society of Animal Science (ASAS, USA); the editorial board of the Acta Agriculturae Scandinavica, Section A- Animal Science (Norway); KRMIVA, Journal of Animal Nutrition (Croatia), Austin Food Sciences (NJ, USA), E-Cronicon Nutrition (UK), SciTz Nutrition and Food Science (DE, USA), Journal of Medical Chemistry and Toxicology (NJ, USA), Current Research in Food Technology and Nutritional Sciences (USA). From 2015 he has been appointed chairman of World Conference of Innovative Animal Nutrition and Feeding (WIANF).\r\nHis main research areas are related to pig and poultry nutrition: elimination of harmful effects of heat stress by nutrition tools, energy- amino acid metabolism in livestock, relationship between animal nutrition and quality of animal food products (meat).",institutionString:"University of Debrecen",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Debrecen",institutionURL:null,country:{name:"Hungary"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"25",title:"Veterinary Medicine and Science",slug:"veterinary-medicine-and-science"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"185543",firstName:"Maja",lastName:"Bozicevic",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/185543/images/4748_n.jpeg",email:"maja.b@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"7144",title:"Veterinary Anatomy and Physiology",subtitle:null,isOpenForSubmission:!1,hash:"75cdacb570e0e6d15a5f6e69640d87c9",slug:"veterinary-anatomy-and-physiology",bookSignature:"Catrin Sian Rutland and Valentina Kubale",coverURL:"https://cdn.intechopen.com/books/images_new/7144.jpg",editedByType:"Edited by",editors:[{id:"202192",title:"Dr.",name:"Catrin",surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"73831",title:"Applications of Oxidoreductases",doi:"10.5772/intechopen.94409",slug:"applications-of-oxidoreductases",body:'The various chemical transformations catalyzed by enzymes make these catalysts a key goal for utilization by the promising biotechnology industries. In the recent years, intense research in the field of enzyme technology has provided numerous approaches that facilitate the practical application of enzymes. This chapter emphasizes the application of oxidoreductases which catalyze the exchange of electrons amid the donor and acceptor molecules, in reactions involving electron transfer, proton/hydrogen extraction, hydride transfer, oxygen insertion, or other imperative steps. Oxidoreductases acquire advantage from the inclusion of different cofactors - for instance heme, flavin and metal ions - to catalyze redox reactions [1]. Majority of oxidoreductases are nicotinamide cofactor-dependent enzymes which have a high preference for nicotinamide adenine dinucleotide phosphate (NADP) or nicotinamide adenine dinucleotide (NAD) and they are further classified in six major classes which are oxidases, dehydrogenases, hydroxylases, oxygenases, peroxidases and reductases [2]. This chapter demonstrates the potential applications of oxidoreductases on the growth of oxidoreductase-based diagnostic tests and better biosensors, in the design of inventive systems for crucial coenzymes regeneration, and in the formation of oxidoreductase-based approaches for synthesis of polymers and oxyfunctionalized organic substrates.
The diagnosis and monitoring of a variety of diseases is extremely demanding nowadays for routine examination of clinical samples and other associated tests. The diagnostic enzymes are used for the detection/diagnosis or prognosis of disease conditions due to their substrate specificity and quantitated activity in the presence of other proteins, and are preferred in diagnosis, which can be used as a diagnostic tool for disease detection [3]. Depending on the verity of the disease, diseased state often leads to tissue damage. In such conditions, enzymes specific to diseased organs are released into blood circulation with augmented enzyme activity. The measurement of corresponding enzyme activities in blood/plasma, or any other body fluid, has been exploited in the diagnosis of diseased tissues/organs [3].
Jixu Wang et al. [4] investigated the expression and significance of glucose-6-phosphate dehydrogenase (G6PD) in human gastric cancer progression and prognosis. Apoptosis and necrosis are two major types of cell death in normal and disease pathologies. A key signature for necrotic cells is the permeabilization of the plasma membrane which can be quantified in tissue culture settings by measuring the release of the intracellular enzyme lactate dehydrogenase (LDH). It has been described that the measuring LDH release is a useful method for the detection of necrosis [5]. Two dehydrogenases, specifically, sorbitol dehydrogenase (SDH) and LDH, are used for cancer prognosis [3]. Reports suggested that in prostate cancer [6], and precancerous colorectal neoplasms [7], an abnormal serum concentration of SDH has been observed. Additionally, an enhanced level of SDH can be observed in acute liver damage and parenchymal hepaticdiseases [3]. It has been reported that LDH, marker of anaerobic metabolism, is associated with highly invasive and metastatic breast cancer and suggested that the association of activity of LDH in tumor tissue with mammographic characteristics could help in defining aggressive breast cancers [8]. The gene expression of LDH is studied in several human malignant tumors, collectively among colorectal cancer [9], lung cancer [10, 11, 12], breast cancer [13], oral cancer [14], prostate cancer [15], germ cell cancer [16], and pancreatic cancer [17]. In recent times, the prognostic value of the serum LDH level in cancer patients has been considered as a significant area of research. Additionally, LDH performs as a prognostic marker in patients with acute leukemia [18] and sickle cell disease [19].
A biosensor is an analytical tool that comprises a biological or biologically derived sensing matter with close proximity to the physico-chemical transducer [3]. The chief function of such a device is to produce a discrete or uninterrupted signal that is comparative to the concentration of the analyte [20]. Enzyme-based chemical biosensors are based on biological recognition and in order to function, the enzymes must be accessible to catalyze a specific biochemical reaction and be stable under the normal operating circumstances of the biosensor [21]. Generally the function of oxidoreductase biosensors is dependent on charge transport amid the enzyme and an electrode surface by means of coenzymes or redox mediators [22].
Over the years, various enzyme-based biosensors have been developed, however only a few of them are commercialized. The majority of the published work on enzymatic biosensors focuses on targeted blood glucose monitoring based on amperometric techniques [3]. The earliest glucose biosensor based on glucose dehydrogenase from Erwinia sp. and carbon paste was generated by Laurinavicius et al. [23] where the enzyme was incorporated in a polylysine-albumin gel, and the anchoring material was a paste of chemically adapted carbon powder, fumed silica, and binding material. A cellulose dehydrogenase based glucose biosensor from a mutant of Corynascus thermophilus has been developed, and a glassy carbon electrode (GCE) was acquired by direct electrode position of gold nanoparticles (AuNPs). The biosensor was used for the detection of glucose in human saliva samples, with successful results in terms of both revival and association with glucose blood levels [24]. This proposes the development of noninvasive glucose monitoring devices. The details of different oxidoreductase enzymatic biosensors applied for clinical diagnosis are listed in Table 1. The first marketable biosensor (glucose biosensor) was commenced in 1975 which was derived from the electrochemical recognition of hydrogen peroxide, and the glucose oxidase was employed for the improvement of the biosensor [3]. Subsequently, Clemens et al. [25] established a novel amperometric glucose biosensor in a bedside artificial pancreas, and it was marked underneath the brand name “Biostator” by Miles (Elkhart, Indiana).
Enzymes | Analyte | Test sample | Disease diagnosed | References |
---|---|---|---|---|
Glucose oxidase | Glucose | Blood plasma, blood serum, urine, and saliva | Diabetes, hypoglycemia | [26, 27, 28, 29] |
Oxalate oxidase | Oxalate | Blood serum and urine | Idiopathic urolithiasis and various intestinal diseases | [30] |
Cholesterol oxidase | Cholesterol | Blood serum | Coronary heart disease, myocardial and cerebral infarction (stroke) | [31, 32, 33, 34] |
Lactate oxidase | Lactate | Blood plasma, blood serum, drug and biological samples | Hyper lactatemia, cardiac arrest, resuscitation, sepsis, reduced renal excretion, decreased extra hepatic metabolism, intestinal infarction and lacticacidosis | [35, 36, 37, 38, 39, 40] |
Oxidoreductase enzymatic biosensors as diagnostic tools.
The most of oxidoreductases for catabolism and anabolism significantly require two natural nicotinamide-based coenzymes (NAD and NADP), respectively. The most NAD(P)-dependent oxidoreductases choose one coenzyme as an electron acceptor or donor to the other depending on their diverse metabolic functions [41]. Generally coenzymes are involved in these oxidoreductase-catalyzed reactions to transport electron, hydride, hydrogen, oxygen, or other atoms or small molecules in diverse enzymatic pathways [42, 43]. The nicotinamide adenine dinucleotide (NAD)/nicotinamide adenine dinucleotide phosphate (NADP), ubiquinone (CoQ), and flavin mononucleotide (FMN)/flavin adenine dinucleotide (FAD) are the typical coenzymes. Nicotinamide-based coenzymes for the electron transport and storage in the form of hydride groups are the most noteworthy in view of the fact that 80% of characterized oxidoreductases necessitate NAD as a coenzyme, and 10% of them require NADP as a coenzyme [44].
Nicotinamide coenzymes based dehydrogenases are of emergent importance for the production of chiral compounds, either by reduction of a prochiral precursor or via oxidative resolution of their racemate [45]. Nevertheless, the oxidized and reduced nicotinamide cofactors regeneration is an extremely critical step as the employ of these cofactors in stoichiometric amounts is too expensive for function. There are very few enzymes which are appropriate for the regeneration of oxidized nicotinamide cofactors. Glutamate dehydrogenase can be utilized for the oxidation of NADH in addition to NADPH while l-lactate dehydrogenase is able to oxidize NADH only [45]. The reduction of NAD+ is carried out by formate and FDH [45]. Glucose-6-phosphate dehydrogenase and glucose dehydrogenase are proficient to reduce both NAD+ and NADP+ [45]. It has been reported that ADH from horse liver reduces NAD+ whereas ADHs from Lactobacillus strains catalyze the reduction of NADP+ [45]. These enzymes can be applied by their inclusion in entire cell biotransformations by an NAD(P)+-dependent major reaction to achieve in situ regeneration of the consumed cofactor [45]. And for the regeneration of the reduced cofactors NADH and NADPH numerous systems for instance engineered formate dehydrogenase [46, 47], phosphite dehydrogenase [48, 49], glucose dehydrogenase [50, 51] plus cosubstrate are well established and extensively used.
Johannes et al. [52] reported the engineering of a highly stable and active mutant phosphite dehydrogenase (12x-A176R PTDH) from Pseudomonas stutzeri and evaluation of its potential as an effective NADPH regeneration system in an enzyme membrane reactor. They have utilized two practically imperative enzymatic reactions including xylose reductase-catalyzed xylitol synthesis and alcohol dehydrogenase-catalyzed (R)-phenylethanol synthesis as models, and the mutant PTDH was compared to the commercially available NADP+-specific Pseudomonas sp. 101 formate dehydrogenase (mut Pse-FDH) that is extensively employed for NADPH regeneration [52]. Soluble water-forming NAD(P)H oxidases comprise a promising NAD(P)+ regeneration scheme since they only require oxygen as cosubstrate and produce water as only byproduct [53]. In addition, the thermodynamic equilibrium of O2 reduction is a significant driving force for mostly energetically unfavorable biocatalytic oxidations [53]. Petschacher et al. [53] presented the generation of an NAD(P)H oxidase with high activity for both cofactors, NADH and NADPH. Applicability for cofactor regeneration is shown for coupling with alcohol dehydrogenase from Sphyngobium yanoikuyae for 2-heptanone production.
Enzyme catalyzed oxidation reactions have achieved growing concern in biocatalysis recently, reflected also by numerous outstanding reviews on this topic reported in the last years [54, 55, 56]. The group of oxidoreductases, to which all enzyme catalyzing oxidoreduction reactions, comprises numerous groups of biocatalysts such as dehydrogenases, monooxygenases, dioxygenases, oxidases, peroxidases, etc. [55]. Moreover, the enzymatic oxidative polymerizations have advantages of using nontoxic catalysts and mild reaction conditions, and the specific enzyme catalysis affords regio- and chemoselective polymerizations to construct functional materials [57]. It has been reported that peroxidases with the use of hydrogen peroxide as oxidant efficiently induce the oxidative coupling of phenols to phenolic polymers, the majority of which are scarcely attained by conventional chemical catalysts [57]. In addition, it has been published that laccase and peroxidase are helpful for production of cross-linked polymers such as artificial urushi and biopolymer hydrogel [57]. Kobayashi [58] established that the enzymatic polymerization as to be an efficient method of polymer synthesis. The polymerization uses hydrolases and oxidoreductases as catalysts and this new method of polymer synthesis afforded natural polysaccharides like cellulose, amylose, xylan, and chitin, and unnatural polysaccharides catalyzed by a glycosidase from well-designed monomers, varied functionalized polyesters catalyzed by lipase from a variety of monomers, and poly-aromatics materials catalyzed by an oxidoreductase and an enzyme model complex from phenols and anilines [58]. Furthermore, vinyl polymerization has been initiated by oxidoreductase [58].
Marjanovic et al. [59] reviewed the oxidative oligomerization and polymerization of various arylamines, e.g., aniline, substituted anilines, aminonaphthalene and its derivatives, catalyzed by oxidoreductases, such as laccases and peroxidases, in aqueous, organic, and mixed aqueous organic monophasic or biphasic media. Owing to the nontoxicity of oxidoreductases and their elevated catalytic effectiveness, as well as high selectivity of enzymatic oligomerizations/polymerizations under gentle conditions by means of primarily water as a solvent and often resulting in minimal byproduct formation enzymatic oligomerizations and polymerizations of arylamines are environmentally friendly and considerably contribute to a “green” chemistry of conducting and redox-active oligomers and polymers [59].
It has been also established that oxidative enzymes comprise privileged catalysts in organic synthesis [60]. Environmentally benign reaction conditions with high selectivity are the most fascinating characteristic exhibited by these biocatalysts in contrast to classical metal-based reagents. de Gonzalo et al. [60] reviewed the new perspectives and concepts derived from oxidative enzymatic processes, involving oxidative C-C bond forming reactions, atroposelective oxidations, oxidative dynamic processes, interconnected reactions, cyclic deracemizations, oxidative desymmetrizations and artificial oxidative enzymes. Oxidoreductases comprise an imperative group of biocatalysts as they facilitate not merely the broadly used stereoselective reduction of aldehydes and ketones but also the less well exploited oxidation of alcohols and amines [53]. In addition, oxidoreductases catalyzed oxidations are utilized for production of chiral alcohols and amines by deracemization [54, 60, 61, 62]. It has been reviewed thoroughly that the oxidoreductases enable chemists to perform highly selective and efficient transformations ranging from simple alcohol oxidations to stereoselective halogenations of non-activated C-H bonds [63]. Mifsud et al. [64] demonstrated for the first time that catalytic water oxidation mediated by robust TiO2 semiconductors can be productively coupled to oxidoreductases achieving photobiocatalytic redox reactions.
One of the major applications of oxidoreductase is a pharmaceutical synthesis of 3,4-dihydroxylphenyl alanine (DOPA), which is employed in the treatment of Parkinson’s disease and the industrial process that synthesizes DOPA make use of the oxidoreductase polyphenol oxidase [65]. It has been reported that the enantioselective reduction of C-4-substituted 3,5-dixocarboxylates can be carried out by using alcohol dehydrogenase from Lactobacillus brevis (LBADH) over-expressed in E. coli [66]. Laccase can be employed to synthesize numerous complex medicinal agents including triazolo(benzo)cycloalkyl thiadiazines, vinblastine, penicillin X dimer, cephalosporin antibiotics, and dimerized vindo-line [67]. In addition laccase can be used to synthesize a range of functional organic compounds including polymers with specific mechanical/electrical/optical properties, textile dyes, cosmetic pigments, flavor agents, and pesticides [68]. Biocatalysis is facilitating technology to organic synthesis chemistry by providing high selectivity of enzymatic reactions under mild conditions makes it a very valuable tool for green chemistry.
Due to the specificity and bio-based nature, potential applications of oxidoreductases in various fields are attracting active research efforts [69]. Several products generated by oxidoreductases are finding applications as antimicrobial, detoxifying, or active personal-care agents [69]. One potential application is laccase-based in situ generation of iodine, a reagent extensively used as disinfectant [67]. It has been described that laccase-iodide salt binary iodine-generating system (for sterilization) can have several advantages over the direct iodine application [69]. Peroxidases may replace laccase for the application, even though they would require H2O2 as cosubstrate [69]. The ClO¯ and Mn(III) species formed by haloperoxidase and Mn-peroxidase are extremely effective oxidants and antimicrobial agents [70]. Peroxidase can also be used to cross-link collagen which is beneficial to the healing of damaged skin [71]. The physiological activities of lysyl oxidase comprise the extracellular matrix construction which can hasten wound-healing [72, 73]. A glucose oxidase, lactoperoxidase, and iodide system has been tested for dental care and the oxidase produces H2O2 to feed the peroxidase, so that it can produce iodine that can kill plaque-causing bacteria [74]. It has been reported that the haloperoxidase can be used to oxidatively modify rubber latex surfaces, making them less allergenic [75]. A secreted oxidoreductase may even be developed as a vaccine against secretor microbes such as, Aspergillus oryzae catalase A protein has been studied as a potential aspergillosis vaccine [69]. It has been reported that low-molecular-mass laccase purified from the mushroom Tricholoma giganteumis possesses significant HIV-1 reverse transcriptase inhibitory activity [76]. As nature’s own catalysts, enzymes acquire very diverse specificity, reactivity, and other physicochemical, catalytic, and biological properties highly enviable for miscellaneous industrial and medical applications [69].
Tremendous progress has been made in the recent years in the field of applications of oxidoreductases. Oxidoreductases metabolism is a fundamental bio-process that plays a pivotal role in all species, including humans, plants, animals, and microorganisms, as their specific function is to catalyze oxidation and reduction reactions that occur within the cell. Abnormality in this metabolic system leads to a number of metabolic disorders. Thus, owing to the remarkable properties of oxidoreductases, they can be used for the diagnosis of disorders. They can provide insight into the diseased state by diagnosis, prognosis, or by assessment of response therapy. It has been established that oxidoreductases as biosensors are becoming popular potential tools in biotechnology due to their high specificity. With oxidoreductases, the conversion of a variety of aliphatic/aromatic molecules can be achieved; inert hydrocarbons can be functionalized (by hydroxylation, sulfoxidation, epoxidation, etc.); regio-, enantio- (on racemic substrates); enantiotopo– (on prochiral sub-strates); and chemo-selective reactions can be accomplished; important synthons from inexpensive and renewable biomaterials can be constructed; and the negative environment impact can be reduced [69]. Since numerous chemical and biochemical transformations engage oxidation/reduction processes, developing practical biocatalytic applications of oxidoreductases has long been an imperative target in biotechnology.
The author gratefully acknowledges the Department of Chemistry, Goalpara College (Assam), India.
The author declares no conflict of interest.
Loose connective tissue disorders include lipedema, Dercum’s disease (DD), familial multiple lipomatosis (FML) and multiple symmetric lipomatosis (MSL). All these disorders share many similarities with lipedema including painful lipomas, obesity, fibrosis, a risk of developing lymphedema and difficulty in losing the abnormal fat through diet and exercise. There are clinical characteristics specific for lipedema, including the onset of the disease, fat location and associated health issues (\nTable 1\n) [1, 2].
\nCharacteristic | \nLipedema | \nDD | \nMSL | \nFML | \nMSL | \n
---|---|---|---|---|---|
Abnormal fat location | \nLegs, arms, abdomen | \nGlobal | \nUpper; can be global | \nArms, thighs, trunk, abdomen | \nUpper; can be global | \n
Diet-resistant fat | \nYes | \nYes | \nYes | \nYes | \nYes | \n
Lipomas | \nYes | \nCommon | \nCommon in men | \nCommon | \nCommon in men | \n
Time fat change | \nPuberty; 3rd decade | \nChild-adult | \nAdult; child rare | \nChild-adult | \nAdult; child rare | \n
Painful fat | \nYes | \nYes | \nNot usually | \nLipoma | \nNot usually | \n
Sex predominance | \nFemale | \nFemale | \nMale | \nMale = female | \nMale | \n
Lymphatic dysfunction | \nYes | \nYes | \nYes | \nYes | \nYes | \n
Prevalence | \nPossibly common | \nPossibly common | \nRare | \nRare | \nRare | \n
Associated conditions | \nLymphedema | \nAutoimmune; diabetes | \nNeuropathy | \nMoles; neuropathy | \nNeuropathy | \n
Inheritance pattern | \nAutosomal dominant; incomplete penetrance | \nAutosomal dominant; sex-specific influence | \nAutosomal dominant or recessive | \nAutosomal dominant | \nAutosomal dominant or recessive | \n
Lipedema is often misdiagnosed as lifestyle-induced obesity that affects ~10% of women of European descent as well as other populations [3, 4]. Although both disorders are considered inflammatory diseases due to the presence of increased macrophages and hypertrophic adipocytes, there are significant differences between the two disorders. Among these is the location of the fat, primarily abdominal or spread widely over the body in obesity compared to the symmetric distribution in the lower extremities in lipedema, the texture of the skin (thin and soft in lipedema and thicker in obesity), easy bruising and pain upon the introduction of pressure in lipedema [5, 6].
\nThe focus of this review will be on the disease of lipedema, different stages and types, diagnosis and treatment, pathogenesis and current research in the field.
\nLipedema also referred to as lipedema, is a painful loose connective tissue disorder first described in 1940 by Allen and Hines [7]. Lipedema is characterized by symmetric enlargement of the buttocks, hips and legs due to deposition of loose connective tissue that includes fascia, adipocytes, immune cells and other structures; arms are also affected in 80% of patients [3, 4]. Feet are typically spared, but ankle cuffs are often noted in advanced stages of lipedema where the risk of lymphedema is also high [8, 9]. Patients with lipedema experience mobility issues, psychosocial distress, anxiety, eating disorders, sleep apnea and depression [1, 10].
\nLipedema is considered a hormone-related disorder affecting almost exclusively women during puberty, childbirth or menopause. Case reports of men with lipedema have been described in literature. Men with lipedema have elevated estrogen level and low to absent testosterone levels resulting in cirrhosis, gynecomastia and hypogonadism [11, 12, 13]. While the exact etiopathogenesis of this disease is unknown [10, 14], many studies have demonstrated that inflammatory cells, hypertrophic adipocytes, abnormal blood vessels and lymphatic dysfunction are associated with tissue damage and development of a fibrotic disease [14, 15, 16, 17].
\nLipedema consists of three stages characterized by the texture of skin and tissue formation. Stage 1 involves smooth skin over pearl-sized nodules in a hypertrophic fat layer; Stage 2 has skin indentations over a hypertrophic fat structure of pearl-to-apple-size masses; and Stage 3 includes pearl-sized nodules and much larger fat masses causing lobules of skin and fat to form mainly on the hips, thighs, and around the knees. Lymphedema, causing fluid accumulation in the limbs, may develop during any stage of lipedema and is referred to as lipo-lymphedema [1, 3, 10, 18, 19].
\nHealthcare providers often misdiagnose women with lipedema as they do not take into account the disproportionate size of the legs compared to trunk especially in Stage 1 and 2 along with the inability to lose fat from areas affected by lipedema. It is possible to confuse women with Stage 3 lipedema as having lifestyle-induced obesity due to fat involving more areas of the body.
\nIn addition to stages of lipedema, lipedema is also characterized by types determined by the area of the body that is affected. There are five types of lipedema; types I, II, and III are the most common. In Type I, fat is deposited in the areas of the buttocks and hips resembling saddle bags. In Type II, fat extends to the knees from the buttocks area with the formation of folds of fat around the inside of the knee. In Type III, fat spreads all over the lower body from the hips to the ankles. In Type IV, upper arms are affected causing difficulty in lifting the arm and stress on the shoulder. In Type V, fat is restricted to the lower legs. It is worth noting that patients with lipedema can clinically present with a mixture of types [3, 10].
\nPain, tenderness, bruising easily, symmetrical swelling of the legs, heaviness of affected limbs, burning sensations in the skin and fat, soft skin, negative stemmer’s sign and hypermobile joints are among the common symptoms observed in lipedema patients [2, 3, 6, 13]. Hypermobility in women with has been reported to contribute to joint damage and increase the risk of cardiovascular disease as seen in Ehlers Danlos Syndrome-Hypermobility Type (EDS-HT) with Beighton score higher than 5 [2, 3, 20, 21]. Thus, hypermobility causes structural changes in lipedema tissue resulting in increased fibrosis, dysfunction of blood vessels and accumulation of interstitial fluid.
\nWomen with lipedema also experience emotional symptoms due to unexplained weight gain including embarrassment, anxiety and depression that impact their overall quality of life [22, 23]. Symptoms may progress in advanced stages of lipedema that might be associated with increased cardiovascular and renal diseases. A study conducted by Herbst el al. in 2015 provides a detailed list of symptoms experienced by lipedema patients [3].
\nDiagnosis of lipedema involves a comprehensive physical exam based on the criteria listed by Wold and colleagues in 1951, [4] medical and surgical history, list of medications that might affect weight or fluid retention and family history. A physical examination includes assessment of the enlarged lower extremities carefully noting the texture of the affected areas such as velvety soft skin that can be found in hypermobility, nodular fat, pain when applying pressure, tenderness upon palpation and accumulation of fluid such as pitting or non-pitting edema which may indicate lymphedema [18, 24]. Bruising caused by increased capillary fragility [6], spider veins and telangiectasia showing on the surface of the skin due to venous insufficiency are also observed in lipedema patients [4, 10].
\nAlthough, there is no cure for lipedema, treatments like liposuction (tumescent and water jet) [25], complete decongestive therapy that includes manual lymphatic drainage [26, 27], compression garments, a healthy diet, physical activity, medications and supplements (statins, selenium, diosmin, amphetamines and butcher’s broom) have been shown to reduce pain, improve lymphatic function, decrease leakage from blood vessels, lessen inflammation and fibrosis and maintain a healthy gut [24, 28, 29, 30, 31, 32, 33, 34].
\nLiposuction is by far the most effective treatment to decrease the fibrotic lipedema fat and thereby maintain mobility which is essential for the welfare of women living with lipedema [35, 36, 37]. Water jet-assisted liposuction has been proven to be as effective as tumescent liposuction. Damage to the lymph vessels has not been show as evidenced in a histological study conducted by Stutz et al. on lipoaspirates collected from lipedema patients [32]. Nevertheless, special care should be taken with lipo-lymphedema patients, where accumulated lymph and or fibrotic tissue should be removed first. Furthermore, follow-up and compression therapy are advised for successful and effective treatment.
\nDeep tissue massage has also been demonstrated to improve the quality of subcutaneous adipose tissue by decreasing pain, fibrosis and fat tissue in women with lipedema [29, 38].
\nAdditionally, a healthy non-inflammatory diet is highly recommended, even though it will not reduce the lipedema tissue, but it might slow the progression of the disease by reducing inflammation and pain, lessen the swelling and ultimately improve quality of life. No one plan works for everyone but a ketogenic diet with low processed carbohydrate and mild physical exercises like walking, swimming, Pilates, yoga and other home excise programs are suggested by lipedema specialists. These activates will help the function of lymphatic pump and maintain a normal metabolism.
\nFinally, it is very important to detect and treat lipedema at early stages thus preventing the complications that might occur due to the progression of disease. These complications comprise eating disorders, sleep apnea, diabetes mellitus, arthritis, hypertension, cellulitis, cardiac and renal disease.
\nThere are distinctive criteria for lipedema which are absent in lymphedema including a negative Stemmer’s sign, minimal pitting edema, thin skin, easy bruising, tenderness and pain [14, 39, 40]. Although lymphatic microaneurysms might develop in the later stages of lipedema leading to secondary lymphedema, imaging techniques like high-resolution cutaneous ultrasonography and magnetic resonance imaging showed no defects in the lymphatic system in early stages [24, 41, 42, 43]. Other methods have also been successfully used to differentiate lipedema from lymphedema which includes tissue dielectric constant and dual-energy X-ray absorptiometry techniques [44, 45, 46, 47, 48].
\nDysfunction of lymphatic vessels results in accumulation of interstitial fluid (edema) in adipose tissues triggering inflammation by the recruitment of macrophages resulting in fibrosis and difficulty with weight loss. As a consequence, adipose tissue loses its elasticity suggesting that lipedema might be a connective tissue disorder [15, 49]. Studies have also indicated that edema might induce growth of lipedema fat as well as hypoxia resulting in adipocyte cell death [50].
\nFurther, morphologic changes in lymphatic vessels and accumulation of interstitial fluid are present in some women with lipedema, with no change in transport of lymphatic fluid, which suggests these individuals might have a higher risk of progressing to lipo-lymphedema especially in advanced stages of lipedema [15, 51]. Accurate diagnosis of lipedema in association with lymphedema is essential for treating and following up of lipedema patients.
\nHormones, genetic factors, leaky blood vessels, dysfunctional lymphatics system, inflammation, hypertrophic adipocytes and interstitial thickening are among the factors that contribute to the pathogenesis of lipedema [10, 12, 15].
\nHormones play an essential role in the etiology of the lipedema, but how they affect the metabolism and function of adipocytes function is still unknown. Studies have shown that hormones, like estrogen and progesterone, have a direct effect on lipogenesis, insulin levels and adipose tissue distribution in the body. Dysregulation of hormonal levels lead to fat dysregulation, impairment of the lipogenesis-lipolysis mechanism, hypertension, insulin resistance and hyperinsulinemia [13, 52, 53]. Hormones might also have an impact on the nervous system which might explain the pain experienced by lipedema patients. Szél et al. hypothesized that alteration in estrogen (or estrogen receptors) maybe involved in the pathogenesis of lipedema by suggesting a link between accumulation of adipose tissue, imbalanced estrogen levels and inflammation of the peripheral and sympathetic nerves of the disease [13].
\nLipedema fat tissue is characterized by hypertrophic adipocytes, inflammatory immune cells, dilation of subdermal blood and lymphatic vessels. We and others have shown a high number of infiltrating macrophages in lipedema adipose tissue detected by the CD68 marker and observed as around blood vessels or as crown-like structures surrounding necrotic adipocytes. In addition to macrophages, mast cells and T-lymphocytes were detected in hyper-vascular areas mainly around blood vessels in lipedema fat tissue which might contribute to capillary permeability and accumulation of interstitial fluid [15, 16, 54].
\nAn article published in 2004 by Taylor et al. showed that accumulation of mast cells in lipedema tissue contributed to increased interstitial fluid, deterioration of adipocytes and potentially elastic fiber fragmentation due to the release of elastase [55], confirming that lipedema is a connective tissue disorder. Adding to that, direct cell-cell interaction between hypertrophic adipocyte and macrophages as well as secreted paracrine factors such as vascular endothelial growth factor (VEGF), a marker of angiogenesis, previously reported in the blood of women with lipedema [56] might be associated with increase in the number of blood vessels, dilation of capillaries, hypoxia, inflammation and tissue fibrosis found in lipedema patients [15, 18, 57].
\nAdipose tissue-derived stem cells are widely studied for their immunomodulatory, anti-inflammatory, anti-fibrotic, anti-apoptotic and pro-angiogenic effects [58, 59, 60], but how ASCs contribute to the development of lipedema has not been investigated yet. Due to their high therapeutic potential, ASCs are now considered an indispensable tool in regenerative medicine [61, 62, 63, 64]. Studies have shown the successful treatment with ASCs for many disease including graft-versus-host disease [65], wound healing [66], cardiovascular [67], inflammatory bowel disease [68], diabetes mellitus [69] and several injuries including kidney and spinal cord [70], bone and craniofacial reconstruction [71, 72], liver cirrhosis [73], multiple sclerosis [74]. In addition to their self-renewal ability, ASCs have the ability to differentiate into multiple lineages, including adipocytes, osteoblasts, chondrocytes, and endothelial cells [75, 76]. Thus, ASCs might play a role in lipedema adiposity by inducing the expansion and differentiation of progenitor adipose-derived stem/progenitor cells (pre-adipocytes) into mature adipocytes (hyperplasia). Suga el at. have shown an increase in proliferation of adipose-derived stem/progenitor cell proliferation using Ki67 and CD34 markers suggesting an increase in adipogenesis, hypoxia, and adipocyte necrosis, at least in one case [16].
\nAdding to that, inflammatory cytokines secreted by hypertrophic adipocytes and factors in the interstitial fluid could stimulate ASC differentiation into mature adipocytes. Alternatively, ASCs produce a plethora of pro- and anti-inflammatory cytokines that might contribute to angiogenesis and inflammation resulting in leaky and fragile blood vessels [77, 78]. Priglinger et al. have characterized lipedema ASCs isolated from liposuction samples and showed an increasing number of endothelial/pericytic cells using CD146 marker in lipedema patients compared to healthy individuals proposing that this increase might be a marker of repair of leaky blood and lymphatic vessels in lipedema tissues [54].
\nAlthough, ASCs might induce adipogenesis in lipedema an in-depth characterization of ASCs is required to confirm this theory. Otherwise, if ASCs prove to have anti-inflammatory, anti-fibrotic or pro-angiogenic effects, then they might be used to lessen tissue damage caused by leaky vessels; hence autologous treatment might be a promising tool for lipedema patients.
\nLipedema is a painful fat disease that should be differentiated from obesity and lymphedema. It is the responsibility of the healthcare provider to determine the accurate diagnosis of the disease for successful treatment and management. Liposuction, hands-on therapy, exercise, and a healthy eating plan are recommended for lipedema patients. Although the etiology of lipedema is complicated, hypertrophic adipocytes, inflammatory cytokines, and macrophages, hypoxia, leaky vessels and accumulation of interstitial fluid contribute to the pathogenesis of the disease and may also help guide treatment.
\nThis work was funded by a grant from the Lipedema Foundation.
\nThe authors declare no conflict of interest.
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