Nutraceuticals in the prevention of cardiovascular diseases [9].
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"6305",leadTitle:null,fullTitle:"Organizational Conflict",title:"Organizational Conflict",subtitle:null,reviewType:"peer-reviewed",abstract:"In this book, we learn about organizational conflict, highlighting different perspectives of conflict resolution and conflict management in different settings and areas, as well as different theoretical views on this subject. The authors from Norway, Estonia, Nigeria, Israel, USA, Slovakia, Turkey, Finland, Uruguay, and Italy bring ideas, studies, findings, and experiences to enhance our knowledge in the field of organizational conflict. The book is divided into two sections, and their respective chapters refer to two different perspectives of study. The first section covers Conceptual Frameworks on Organizational Conflict, considering management and conflict resolution, conflict in organizations as an indicator for organizational values, organizational trust as a conflict management tool, conflicts and social capital, and team conflict in complex adaptive systems. The second section deals with Empirical Studies on Organizational Conflict, emphasizing research on conflict resolution from the perspective of managers and project teams, resistance to change and conflict of interest, conflicts as a springboard for Metallica's success, drivers of innovation deployment affecting marketing relationships, and impacts of national culture on the use of bonuses for teamwork. Thus, we consider this book will be of interest to readers with a diverse group of interests in different specialties such as management, social psychology, education, law, and sociology.",isbn:"978-1-78923-505-0",printIsbn:"978-1-78923-504-3",pdfIsbn:"978-1-83881-389-5",doi:"10.5772/intechopen.69420",price:119,priceEur:129,priceUsd:155,slug:"organizational-conflict",numberOfPages:196,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"063f63db8b7aff55b3a6e5a5f01ca900",bookSignature:"Ana Alice Vilas Boas",publishedDate:"August 1st 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6305.jpg",numberOfDownloads:14018,numberOfWosCitations:7,numberOfCrossrefCitations:4,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:9,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:20,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 9th 2017",dateEndSecondStepPublish:"May 30th 2017",dateEndThirdStepPublish:"August 26th 2017",dateEndFourthStepPublish:"November 24th 2017",dateEndFifthStepPublish:"January 23rd 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"175373",title:"Dr.",name:"Ana Alice",middleName:null,surname:"Vilas Boas",slug:"ana-alice-vilas-boas",fullName:"Ana Alice Vilas Boas",profilePictureURL:"https://mts.intechopen.com/storage/users/175373/images/5450_n.jpg",biography:"Ana Alice Vilas Boas is a post-doctor by HEC-Montreal. She attended her PhD at the University of Reading – UK. She holds a Master in Management by the Federal University of Lavras. From 1993 up to 2008 she worked at the Federal University of Rio de Janeiro and then she moved back to Lavras – Minas Gerais – Brazil where she is Associated Professor in the Department of Management and Economics of the Federal University of Lavras - UFLA. She is an expert in Human Resources Management and related areas such as business strategy, entrepreneurship, quality of working life and distance learning. She supervised many Master dissertations and some PhD thesis. Author of papers, chapters and books published in Brazil and worldwide. Her main topics of interest nowadays are Quality of Working Life and Organizational Behavior.",institutionString:"Federal University of Lavras",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Federal University of Lavras",institutionURL:null,country:{name:"Brazil"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"440",title:"Organization Development",slug:"organization-development"}],chapters:[{id:"57835",title:"Management and Conflict Resolution: Conceptual Tools for Securing Cooperation and Organizational Performance",doi:"10.5772/intechopen.72132",slug:"management-and-conflict-resolution-conceptual-tools-for-securing-cooperation-and-organizational-perf",totalDownloads:1288,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In theories of conflict management, managers’ conflict resolution skills have often been understood as their relational attitudes and ability to communicate, but choices of conflict resolution strategies in organizational management should also depend on the types of conflicts managers face. Understanding how a complex conflict situation involves one or several conflict types is a matter of understanding the deep structure of the conflict. Knowledge of such deep structure is a key to realizing what the conflict is about and how it should be resolved. The chapter uses conflict theory to distinguish between six conflict types that are especially important from an organizational perspective: interpretation conflicts, argumentation conflicts, value conflicts, interest conflicts, role conflicts and personal conflicts. After having clarified their signifcance in an organizational context, the chapter elucidates how knowledge of the conflict types and how they are logically related to each other can be used in managers’ conflict resolution practices. The last part of the chapter uses the conflict types to develop a model for practical conflict resolution in management. The model can be used as a tool for analyzing conflict situations—to gain a deeper and more systematic understanding of how the situations should be resolved in accordance with the best interest of the organization.",signatures:"Halvor Nordby",downloadPdfUrl:"/chapter/pdf-download/57835",previewPdfUrl:"/chapter/pdf-preview/57835",authors:[{id:"212169",title:"Prof.",name:"Halvor",surname:"Nordby",slug:"halvor-nordby",fullName:"Halvor Nordby"}],corrections:null},{id:"60513",title:"Conflict in Organization: Indicator for Organizational Values",doi:"10.5772/intechopen.75496",slug:"conflict-in-organization-indicator-for-organizational-values",totalDownloads:1551,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Through the last decades, values have been one of the hot topics for researchers. Hundreds of researches and articles describe and analyze values of different level based on different theories. At the same time, construct of values has still remained a little bit mysterious, because we still do not fully understand and agree how the values shape and develop. Fortunately, most of the researchers agree on that organizational values and success (no matter how we define the success) are connected and dependent on each other. Often in organizations, the values are described and an effort made to propagate them to the employees and integrate into everyday actions. A more complex question remains how to evaluate if the desired values have imprinted themselves in the organization. The main aim of the chapter is to show how the conflicts in the organization might be used as the indicators of organizational real values. The chapter is based on the former researches of the authors and others. Results show that conflicts describe organizational real values and therefore organizational conflicts can be used as a tool to assess the implementation of organizational values.",signatures:"Eneken Titov, Anu Virovere and Karin Kuimet",downloadPdfUrl:"/chapter/pdf-download/60513",previewPdfUrl:"/chapter/pdf-preview/60513",authors:[{id:"198190",title:"Prof.",name:"Eneken",surname:"Titov",slug:"eneken-titov",fullName:"Eneken Titov"},{id:"212580",title:"Prof.",name:"Anu",surname:"Virovere",slug:"anu-virovere",fullName:"Anu Virovere"},{id:"212581",title:"MSc.",name:"Karin",surname:"Kuimet",slug:"karin-kuimet",fullName:"Karin Kuimet"}],corrections:null},{id:"58609",title:"Organizational Trust as a Conflict Management Tool in Contemporary Work Organizations",doi:"10.5772/intechopen.73092",slug:"organizational-trust-as-a-conflict-management-tool-in-contemporary-work-organizations",totalDownloads:1485,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Conflict between management and employees or among employees is an irresistible phenomenon in contemporary work organizations. Evidences gathered from past and present studies revealed that a lot of conflict situations have occurred in work organizations which have significantly impacted organizational performance and its survival in recent times. Consequently, several conventional strategies and techniques have been deployed to constructively manage conflict situation in work organization however, realities show that managing conflict in work organizations remain a challenge to managers in today’s world of work. This is partly due to the fact that conflict arises from different sources; hence it is inimical to subscribes to the idea of one-size-fit-all approach to management of conflict. Based on this momentum, this chapter examines organizational trust as a conflict management tool in contemporary work organizations using an explanatory design and a basic review of literature. The chapter therefore explains the concept of organizational conflict vis-a vis organizational trust within the context of work organization. It also discusses factors causing conflict situation. It examines the importance of trust and factors responsible for the development of trust in organizations. The chapter further examines some theories of trust and also develops a framework for dealing with conflict in work organization.",signatures:"Oludele Mayowa Solaja",downloadPdfUrl:"/chapter/pdf-download/58609",previewPdfUrl:"/chapter/pdf-preview/58609",authors:[{id:"211557",title:"Mr.",name:"Oludele",surname:"Solaja",slug:"oludele-solaja",fullName:"Oludele Solaja"}],corrections:null},{id:"58964",title:"Conflicts and Social Capital in Organizations",doi:"10.5772/intechopen.73387",slug:"conflicts-and-social-capital-in-organizations",totalDownloads:1085,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Social capital (SC) is a comprehensive concept, which refers to benefits derived from social interaction. In organizations, SC can be divided into 3 levels: personal SC, which refers to the benefits the individual receives from personal social connections, inside and outside the organization; intraorganizational SC, which refers to the benefits derived from good relationships within organizational units, and the organization as a whole; and external SC, which refers to the profits derived from interfaces of role holders, such as the CEO, with stakeholders. Organizational SC and conflicts in an organization are ostensibly very different in nature, whereas SC is an intangible that fits the positive psychology domain; conflicts are usually unwanted occurrences in organizations. Scholars noted that conflicts affect employee’s SC and usually reduce it, but the opposite was hardly investigated. This chapter examines how and why the conversion of social relationships into capital can result in conflicts at all organizational SC levels. To do this, the interface between the levels of SC in organizations and types of conflicts was examined. In conclusion, developing “C-type” conflicts, which are desirable conflicts, and avoiding “A-type” conflicts, which are destructive conflicts, depend on a good match between the different organizational SC levels.",signatures:"Batia Ben-Hador",downloadPdfUrl:"/chapter/pdf-download/58964",previewPdfUrl:"/chapter/pdf-preview/58964",authors:[{id:"211812",title:"Ph.D.",name:"Batia",surname:"Ben-Hador",slug:"batia-ben-hador",fullName:"Batia Ben-Hador"}],corrections:null},{id:"58821",title:"Complex Adaptive Systems: Adapting and Managing Teams and Team Conflict",doi:"10.5772/intechopen.72344",slug:"complex-adaptive-systems-adapting-and-managing-teams-and-team-conflict",totalDownloads:2642,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:1,abstract:"Complexity comes from dramatic structural changes to organizations and governments such as globalization, global competition, workforce diversity, and continual innovations. Complex adaptive systems (CAS) are organizations that are a composite of the interconnected whole. Teams must manage and operate in emerging ecosystems, understand factors that lead to team effectiveness when managing and facilitating teams and team conflict, and understand the development of conflict models. This chapter provides an overview of teams, CAS, conflict stages, and conflict models. This chapter presents adaptive leadership as one leadership style that offers organizations with the capabilities of reacting to changing environments quickly. Adaptive leadership offers a prescriptive approach for managers and leaders to follow when dealing with organizational conflict while operating in today’s complex and global environment.",signatures:"John R. Turner, Rose Baker and Mark Morris",downloadPdfUrl:"/chapter/pdf-download/58821",previewPdfUrl:"/chapter/pdf-preview/58821",authors:[{id:"211379",title:"Dr.",name:"John",surname:"Turner",slug:"john-turner",fullName:"John Turner"},{id:"211381",title:"Dr.",name:"Rose",surname:"Baker",slug:"rose-baker",fullName:"Rose Baker"},{id:"211383",title:"MSc.",name:"Mark",surname:"Morris",slug:"mark-morris",fullName:"Mark Morris"}],corrections:null},{id:"57429",title:"Conflict Resolution by Managers",doi:"10.5772/intechopen.71618",slug:"conflict-resolution-by-managers",totalDownloads:1012,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Conflicts occur in a variety of areas, not excluding the work life. Conflict resolution methods are essential for further development of the conflict in terms of its escalation or de-escalation. The proposed chapter focuses on the issue of dispositional vs. situational approach to exploring the ways of conflict resolution. Results of the presented research projects are based mostly on the theories distinguishing between five conflict resolution styles: avoiding, competing, compromising, accommodating, and collaborating. The chapter also includes the results of the research, in which an original methodology for identification and specification of the differences in the conflict resolution methods within various situational contexts was used. Model conflict situations were placed into three different environments (work, home, and among friends) and associated with two different conflicts (backbiting and false accusations). The results also confirmed the differences in use of the conflict resolution methods by managers both in terms of the environment in which the conflict occurred and the content of the conflict. Within the framework of these studies, gender-based comparisons have also been carried out confirming several gender specificities in the selection of ways to resolve conflicts between men and women.",signatures:"Miroslav Frankovský, Zuzana Birknerová and Lucia Zbihlejová",downloadPdfUrl:"/chapter/pdf-download/57429",previewPdfUrl:"/chapter/pdf-preview/57429",authors:[{id:"210937",title:"Prof.",name:"Miroslav",surname:"Frankovský",slug:"miroslav-frankovsky",fullName:"Miroslav Frankovský"},{id:"212397",title:"Dr.",name:"Zuzana",surname:"Birknerová",slug:"zuzana-birknerova",fullName:"Zuzana Birknerová"},{id:"212398",title:"M.A.",name:"Lucia",surname:"Zbihlejová",slug:"lucia-zbihlejova",fullName:"Lucia Zbihlejová"}],corrections:null},{id:"57527",title:"Resistance to Change and Conflict of Interest: A Case Study",doi:"10.5772/intechopen.71578",slug:"resistance-to-change-and-conflict-of-interest-a-case-study",totalDownloads:1757,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Change for organizations is a necessity. Today’s businesses are aware of the need to keep up with the environmental changes and change demands. If the change process is not handled properly in the business, it will bring major problems with it. Every change will absolutely and definitely face resistance. Similarly, conflicts are considered to be inherent in organizations. The important thing is to prevent conflicts from taking over organizational interests. If conflicts arise in situations where personal interests constitute a source, it is an issue that needs to be discussed seriously. This study is intended to reveal elements that create a potentially resilient potential, in particular protecting personal interests. A case study method was utilized in the study. This method is preferred because it is appropriate to examine in detail the history, current situation and environmental functioning of a particular person or group and to obtain appropriate information in order to provide statistical methods. In particular, the case study, which reveals a reflection of the conflict of interest that is valued as a consequence of the functions of exchange resistance and as a consequence thereof, reflects the relationship between resistance and conflict of interest.",signatures:"Cem Karabal",downloadPdfUrl:"/chapter/pdf-download/57527",previewPdfUrl:"/chapter/pdf-preview/57527",authors:[{id:"217906",title:"Dr.",name:"Cem",surname:"Karabal",slug:"cem-karabal",fullName:"Cem Karabal"}],corrections:null},{id:"57716",title:"Conflicts as Springboard for Metallica’s Success",doi:"10.5772/intechopen.71579",slug:"conflicts-as-springboard-for-metallica-s-success",totalDownloads:1360,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The purpose of this chapter is to understand how Metallica has utilized conflicts in creating changes in the music industry and growing as the biggest heavy metal band of the world and sustained in this position for 25 years. The study was conducted as a qualitative and longitudinal case study. The study confirmed that conflicts have been a crucial factor in Metallica’s success. The interpersonal conflicts and the conflicts between the band founders have been pivotal. The duo has competed and collaborated against and with each other, and this way urging Metallica to better achievements. The same type of action has extended to collaboration with other inner circle members of Metallica. Different kinds of conflict stimulation techniques have been used to increase conflicts. Many dysfunctional outcomes have also arisen but Metallica as a band has nearly always been above them. The ways of handling conflicts have changed during the band’s lifecycle. In the introduction phase, competing was emphasized; in the growth phase, collaboration increased and in the current mature phase, compromising and accommodating have strengthened. Nowadays, Metallica is still a relevant band with huge number of fans, but the best creative power has run dry.",signatures:"Erno Salmela",downloadPdfUrl:"/chapter/pdf-download/57716",previewPdfUrl:"/chapter/pdf-preview/57716",authors:[{id:"101139",title:"Dr.",name:"Erno",surname:"Salmela",slug:"erno-salmela",fullName:"Erno Salmela"}],corrections:null},{id:"57743",title:"Drivers of Innovation Deployment Affecting the Marketing and Sales Relationship",doi:"10.5772/intechopen.71987",slug:"drivers-of-innovation-deployment-affecting-the-marketing-and-sales-relationship",totalDownloads:883,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This study investigates the antecedents of information management and its effect on formalization and joint planning as drivers of the marketing-sales functions perceived relationship effectiveness during the formalized process of new product deployment (NPD). We examine the effect of communication as perceived by the marketing and sales functions based on two components: communication amount/frequency (CA) and communication quality (CQ). Finally, we investigate how process formalization and joint planning affect the perceived relationship effectiveness of marketing and sales during the NPD process. The quantitative study uses 152 matched responses from top-level managers, responsible for the innovation deployment of six South American subsidiaries of a global consumer packaged goods company. The qualitative research, via in-depth interviews, confirms the importance of various behaviors of sales and marketing staff during the process of new product launches in the market. While numerous studies have researched the drivers of innovation process, this is the first chapter that studies the NPD implementation process based on the cross-functional relationship between marketing and sales. These drivers can help managers implement effective team processes to enhance innovation deployment results.",signatures:"Teresa Cometto and Gaston J. Labadie",downloadPdfUrl:"/chapter/pdf-download/57743",previewPdfUrl:"/chapter/pdf-preview/57743",authors:[{id:"211657",title:"Ph.D.",name:"Teresa",surname:"Cometto",slug:"teresa-cometto",fullName:"Teresa Cometto"},{id:"211658",title:"Dr.",name:"Gaston J.",surname:"Labadie",slug:"gaston-j.-labadie",fullName:"Gaston J. Labadie"}],corrections:null},{id:"60296",title:"Impact of National Culture on the Bonus’ Use for Teamwork",doi:"10.5772/intechopen.75909",slug:"impact-of-national-culture-on-the-bonus-use-for-teamwork",totalDownloads:955,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Today, organizations use teams as primary work units adopting team rewards and incentives in which group members’ pay is at least partly contingent on measurable group performance. It is the process of compensating a group of employees based on their combined contribution to a particular project or goal. They could be monetary (for example: team bonuses, team commission, shopping vouchers for each team member, etc.) and nonmonetary (team celebration—gateaway bonding activity, team dinner, tickets to a sports event etc., team trip/holiday—may include spouses, team merchandise—team jacket, pin, emblem to build team identity, recognition certificates, team recognition award—public mention and appreciation, team time off away from work). This chapter overviews the empirical research on team-based bonuses and aims to understand if cultural dimensions can interfere or facilitate the diffusion of bonus for teams and suggests directions for future research. 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CVD has caused 6.2 million deaths worldwide in people aged 30–70 years in 2019 [1].
Regarding cardiovascular health, there are certain modifiable risk factors that can be intervened upon to improve health. These factors include: hypertension, elevated fasting plasma glucose, elevated low-density lipoprotein (LDL) or cholesterol, and alterations in renal function. Environmental factors such as air and household pollution, smoking, low physical activity, and overweight and obesity are also included. In addition, in the case of women, the consumption of oral contraceptives and the presence of polycystic ovaries syndrome increase the risk of suffering CVD [2].
There are numerous studies linking diet and health, and this is most evident in the case of cardiovascular risk. Both dietary patterns, such as a diet rich in antioxidants, fiber (from vegetables, whole grains, fruits, nuts, pulses) fish, poor in processed foods (with high content in sugar or animal fats), together with the food intake containing specific bioactive substances or nutrients can modulate the risk factors [3, 4]. Therefore, changes in lifestyle and diet can prevent these diseases [5].
CVD is linked to the development of atherosclerosis and is directly related with an inflammatory response. This response is prompted by bad diet habits, sedentary lifestyle, obesity, and stress [6].
Herbal measurements are used to develop new drugs with higher potency and fewer adverse effects targeting the modulation of biological activities.
Ginger (
The term nutraceutical is used for any food or ingredient with a beneficial effect on health beyond the traditional nutritional effects; further, it has a positive impact on health, physical or cognitive state [8]. Numerous nutraceuticals are used for the prevention of CVDs, including ginger (see Table 1).
Nutraceuticals | Properties |
---|---|
PUFA n-3 (polyunsaturated fatty acid) | Arrhythmias, sudden death, hypertriglyceridemia, antiplatelet agents, anti-inflammatories |
Q10 coenzyme | Antioxidant, antihypertensive |
Vitamin D | Depression, atherosclerosis, valvular calcification |
Resveratrol | Anti-inflammatories, antioxidant |
Red yeast rice | Improves dyslipidemia |
Phytosterols | Lowers cholesterol, LDL-C, antihypertensive |
Flavonoids | Antiplatelet agents, anti-inflammatories antioxidant, antihypertensive |
Dietary fiber | Dyslipidemia, metabolic syndrome decreases total cholesterol, LDL-C, triglycerides, blood glucose, and body weight |
Ginger | Anti-inflammatories, antioxidant antiplatelet agent, antihypertensive |
B complex | Reduces hyperhomocysteinemia |
Nutraceuticals in the prevention of cardiovascular diseases [9].
Apart from its cardioprotective effects, ginger has numerous properties such as antimicrobial, antioxidant, anti-inflammatory, anti-carcinogenic, and neurodegenerative diseases prevention. It prevents chemotherapy-induced emesis, nausea, and respiratory disorders [9, 10].
Ginger’s flavor and aroma come from its volatile oils (∼1–3% of the weight of fresh ginger) and nonvolatile pungent oleoresins. Further, the pharmacological properties are due to its oleoresin’s composition, rich in zingerone (ZGR), gingerols (6/8/10-gingerols), and shogaols (6/8/10-shogaols and 6-hydroshogaol). The spiciness character of dried ginger rhizome comes from the gingerols, especially 6-gingerol. During drying, gingerols transform into ZGR, reducing pungency and providing a spicy-sweet aroma, and shogaols concentration increases [11].
Ginger inhibits lipid peroxidation through its antioxidant effect. 6-Gingerol increases Beclin1 expression to promote autophagy in human endothelial cells and inhibits
Ginger could prevent atherosclerosis, since consumption of a ginger extract has been observed to improve lipoprotein results in hamsters thanks to an increased activity of the liver enzyme CYP7A1 and decreased mRNA levels of intestinal cholesterol absorption proteins such as MTP, ACAT2, and NPC1L1 [13].
6-Gingerol regulates lipogenesis, fatty acid oxidation, mitochondrial dysfunction, and oxidative stress of aging rats. Several authors observed that 8-gingerol due to its antioxidant properties could inhibit melanogenesis in murine melanoma cells. In addition, it increases the activity of the antioxidant enzyme superoxide dismutase (SOD) and decreases the levels of malondialdehyde (MDA), a marker of lipid peroxidation, in a concentration-dependent manner [14, 15].
Inflammation associated with CVD induces an increase in proinflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6). Several authors have observed that ginger significantly reduces TNF-α values, and 6-gingerol reduces the levels of inducible nitric oxide (NO) synthase enzyme and inflammatory factors [16].
Ginger can also be used in moderate obesity, a cardiovascular risk factor. Ginger increases lipolysis and thermogenesis and inhibits lipogenesis; therefore, it could be used to prevent obesity [17].
In summary, ginger consumption in the diet could improve cardiovascular health by lowering blood pressure, improving lipid profile, preventing obesity, improving glycemic control, and vascular health. The benefits of ginger on cardiovascular risk factors are mediated by transcription factors such as adenosine-monophosphate-activated protein kinase, peroxisome proliferator-activated receptors, peroxisome proliferator-activated protein kinase, and nuclear factor kappa B (NF-κB) [8, 18]. Having that in mind, the purpose of the present review chapter is to summarize the effects of bioactive compounds in ginger on CVD.
CVD is a group of disorders of the heart and blood vessels. It includes a large number of pathologies, among which it is worth highlighting: coronary heart disease, cerebrovascular diseases, peripheral arteriopathies, and rheumatic and congenital heart disease, among others. In most of them there is a common pathological process, atherosclerosis [19, 20]. This condition occurs when fat and cholesterol build up on the walls of blood vessels or in the arteries. This accumulation gives rise to atherosclerotic plaques. Over time, plaques can narrow blood vessels and cause problems throughout the body. If an artery becomes blocked, it can lead to a heart attack or stroke [21].
Cardiovascular risk factors are those that are associated with a greater probability of suffering from CVD. It is widely described that the most developed countries’ lifestyles entail an increased risk of suffering from CVD. There are many studies that showed that a significant percentage of CVD and its mortality can be prevented by acting on cardiovascular risk factors [3].
Atherosclerosis is a multifactorial disease, in which several risk factors are involved [22]. The prevalence and potency of these risk factors vary. Cardiovascular risk factors improve CVD by reducing plaque formation.
Two types of risk factors can be differentiated: modifiable and non-modifiable. Pencina et al. established the importance of both and determined that the non-modifiable factors (sex, age, and race) account for between 63 and 80% of the risk factors, while the weight of the modifiable factors is much lower. But, control of modifiable risk factors leads to substantial reductions of cardiovascular events [23, 24].
Non-modifiable risk factors are sex, age, race, and genotype. They are those that are not likely to be modified, therefore nothing can be done about them. It has been proven that cardiovascular risk is higher in men than in women, increases after 35 years, and Hispanics, Latinos, and Southeast Asians have a higher cardiovascular risk [24].
Modifiable risk factors are hypertension, hypertension; obesity and diabetes; dyslipidemias; chronic stress; diet; tobacco; and sedentary lifestyle [25]. They are those that are likely to be modified, where actions can be directed attempting to prevent and/or improve atherosclerosis and therefore CVD.
Hypertension is the most important CVD risk factor. There is a direct relationship between increased blood pressure and the development of CVD. When properly treated, CVD mortality is reduced. Its pathophysiology is very complex and different mechanisms are involved, including the central nervous system, the immune system, and the neurohumoral system [26].
The prevalence of obesity in the world is increasing in a very worrying way across all ages [27]. The relationship between obesity and CVD is clear. It has been shown how it contributes to atherosclerosis through different mechanisms. On the other hand, it must be taken into account that obesity is a risk factor for other comorbidities such as diabetes, sleep apnea, dyslipidemia, hypertension, and even cancer [28, 29].
Since lipids are involved in the formation of atherosclerotic plaque, especially LDL cholesterol and TG, increases of their plasmatic levels entail a risk of atherosclerosis and CVD. This is what happens in dyslipidemias. Reducing them is a fundamental therapeutic strategy to reduce CVD risk [30, 31].
It is one of the most important cardiovascular risk factors. Chronic stress is a situation maintained over time in which the body generates a nonspecific and systemic response as a result of exposure to negative external factors. The relationship between chronic stress and the risk of CVD has been widely demonstrated [32].
It is clear that diet influences the maintenance of good cardiovascular health. And it is an essential tool to control other risk factors such as diabetes, obesity, dyslipidemia, and even hypertension. It has been proven that diets such as the Mediterranean or DASH reduce cardiovascular risk. They are diets that improve markers of inflammation and oxidative stress and also contribute to improving the lipid and glycemic (improvement of insulin sensitivity) profiles, and endothelial function. In addition, they have proven antithrombotic properties. The consumption of fiber, omega-3 acids, vegetables and fruits, and whole grains seems to be decisive in reducing cardiovascular risk [33, 34, 35, 36].
Tobacco continues to be one of the most important cardiovascular risk factors. Since its consumption increases the formation of atherosclerotic plaque, through an enhanced inflammation, endothelial dysfunction, arterial stiffness, and lipid profile [37]. In addition, its consumption increases the heart rate; myocardial contractility; thrombus formation by increased platelet activation and adhesion and procoagulant profile [38].
Regular and moderate physical activity, which modifies muscle tissue and adipose tissue, has been shown to have a positive impact on health. It reduces systemic inflammation and has an antiatherogenic effect. Therefore, lack of physical activity is a cardiovascular risk factor [39].
Ginger, the rhizome of
The main pungent and most abundant compound, 6-gingerol, which is present in fresh ginger, attenuates various chronic disorders. By dehydration and after long storage, this compound is converted into 6-shogaol, which is more stable and has greater pharmacological effects than its precursor 6-gingerol [46, 47]. 6-Shogaol is converted to 6-paradol by bacterial metabolism, and both possess similar anti-inflammatory and antioxidant properties [40, 47]. Antioxidant, antitumoral, antilipidermic, antibacterial, and anti-inflammatory actions are attributed to ZGR, and it is synthesized by reverse aldolization of gingerols when heating fresh ginger [47, 48]. Figure 1 summarizes the metabolization pathways of 6-gingerol as a function of thermal processing.
Properties and metabolism of gingerols.
Zick et al. [49] observed that 6-shogaol and the 6-, 8-, and 10-gingerols have good bioavailability when consumed orally, being detected as sulfate and glucuronide conjugates. However, 6-gingerol has not been detected free in plasma after an oral dose of 2 g, despite it being the major compound in ginger extracts (2–64%) [50]. Pharmacokinetic studies showed that the half-life of the major compounds of ginger and its metabolites is approximately 1–3 hours. Based on bioavailability data, 6-, 8-, and 10-gingerol glucuronides and sulfates along with 6-shogaols could be good markers of ginger intake [50].
As for its therapeutic use, given its various anti-inflammatory, antimicrobial, anticancer, and antioxidant biological activities, ginger appears to be effective in the prevention and treatment of neurodegenerative, cardiovascular, obesity, diabetes mellitus, or respiratory disorders [45].
Oxidative stress is increased under the condition in which there is a decrease in the body’s antioxidant defenses; therefore, there is an imbalance between the production and elimination of reactive oxygen species (ROS). As a consequence of this imbalance, ROS accumulate, generating cellular damage in the different systems of the organism, since they produce lipid peroxidation [51, 52].
Ginger has great antioxidant activity; in fact, many of its therapeutic applications are due to this activity. That ginger has antioxidant activity is a fact that has been shown both in vitro and in vivo. Although studies on the effects to human are not as numerous, it is beginning to be verified that its intake is capable of increasing the concentration of antioxidant enzymes and decreasing oxidative stress markers in cancer patients [53]. Morvaridzadeh et al. carried out a systematic review and meta-analysis where they concluded that there is sufficient evidence to show that ginger intake increases the levels of oxidative stress parameters [54]. There are many bioactive compounds in ginger that exhibit antioxidant activity, such as 6-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol. Of all of them, the one with the highest antioxidant activity in vitro is 6-gingerol, followed by 6-shogaol [55].
The mechanism involved in its antioxidant activity has to do both with preventing the appearance of free radicals [56] and with being able to eliminate them [57]. 6-Gingerol has been shown to be capable of inhibiting xanthine oxidase, an enzyme that catalyzes the oxidation of hypoxanthine to xanthine and of xanthine to uric acid in the last stage of purine metabolic degradation, with the production of reactive oxygen species [58]. In addition, it has been proven that this compound is capable of increasing superoxide dismutase and catalase activity, two antioxidant enzymes [53].
It has been seen how the antioxidant activity depends on the time of harvest of ginger, if it is early, the antioxidant activity is higher, decreasing if the harvest is done later [59].
Another of the great biological activities attributed to ginger is its anti-inflammatory activity. Inflammation is one of the body’s first responses to a risk situation [60]. When that inflammation is maintained over time, is then problematic. Today it is known that there are many diseases in which inflammation plays a determining role, in fact it is being studied how low-grade systemic inflammation is related to the development of different pathologies (autoimmune diseases, metabolic diseases, CVDs, cancer) [61, 62]. In chronic or low-grade inflammation, different proinflammatory factors are released, such as cytokines and prostaglandins [61].
Many researchers have shown that ginger reduces different proinflammatory markers such as: NF-κB, signal transducer activators of transcription (STAT), proteins of the Nod-like receptor family (NLRP), receptors toll-like (TLR), mitogen-activated protein kinase (MAPK), and mTOR (mTOR) pathways, in addition to inhibiting several proinflammatory cytokines [19, 58].
In the systematic review and meta-analysis carried out by Jalali et al, it is shown how ginger is capable of significantly reducing the levels of different proinflammatory parameters such as IL-6, TAC, CRP, TNF-α, MDA, and the serum prostaglandin E2 (PGE2) [63]. Song et al. have examined how ginger extract is capable of reducing proinflammatory markers produced by
The most active compounds from the anti-inflammatory point of view of ginger are 6-shogaol, 6-gingerol, and 6-dehydroshogaol [45, 65, 66]. It has been described how 6-shogaol has an anti-inflammatory effect because it inhibits the production of PGE2 and proinflammatory cytokines (IL-1β and TNF-α) and decreases the expression of cyclooxygenase-2 (COX-2), p38 mitogen-activated protein kinase (MAPK), and nuclear NF-κB [45]. In other studies, 6-shogaol has been shown to inhibit LPS-induced iNOS and COX-2 expression in macrophages [67]. Furthermore, studies showed that 6-shogaol could protect against lipopolysaccharide (LPS)-induced toxicity in murine astrocytes [68].
Worldwide, obesity has become the main pandemic of the twenty-first century [69, 70], as the rates of this pathology have increased considerably during the last decades [71, 72]. According to the World Health Organization (WHO), obesity is characterized by an excessive accumulation of fatty tissue in the body, causing harmful effects on health [73]. Concerning problems associated with obesity are mainly its deleterious effect on other non-detectable diseases: CVDs, hypertension, nonalcoholic fatty liver disease, various types of cancer, and hyperlipidemia [74, 75]. In addition, it should be noted that patients with obesity show worse prognosis against COVID-19 infection and higher mortality rates [76, 77]. Additionally, it induces low-grade inflammation, oxidative stress, and contributes in the etiology of type 2 diabetes mellitus [78]. In recent years, natural compounds have aroused great interest in the prevention/treatment of obesity, and several studies have shown that ginger seems to be effective for this pathology [45].
It seems that gingerenone-A has a more potent inhibitory effect on adipogenesis and lipid accumulation than gingerols and 6-shogaol in 3T3-L1 preadipocyte cells, while it appears to activate the adenine monophosphate (AMP)-activated protein kinase (AMPK) pathway modulating fatty acid metabolism, thus attenuating obesity [79]. For its part, the daily dose of 2 g of ginger powder in obese women resulted in a decrease in body mass index (BMI) [80]. Daily dose of ginger powder also appears to increase fat oxidation in humans [81]. Several studies have shown that ginger can reduce body weight by increasing thermogenesis through catecholamines as well as lipolysis of white adipose tissue [78]. Therefore, it seems evident that both ginger and certain bioactive components are effective against obesity by enhancing lipolysis and inhibiting adipogenesis.
Diabetes is a serious metabolic disorder characterized by an abnormal increase in blood glucose. For this reason, several research studies have considered evaluating the possible effect of ginger and its main bioactive components in the reduction of blood glucose [82].
It has been shown that the administration of 6-gingerol stimulates the activity of glycogen synthase 1 and at the same time favors the translocation of the glucose transporter type 4 (GLUT-4) to the cell membrane, favoring insulin to allow glucose entry in skeletal muscles and subsequent storage as glycogen [83]. Ginger consumption seems to reduce our values of glycosylated hemoglobin (HbA1c), fasting plasma glucose, insulin, total cholesterol, and triglycerides in patients with type 2 diabetes mellitus [84].
The greatest cause of atherosclerosis is characterized by altered blood lipid values and consequently CVD. In addition, the factors previously mentioned, such as overweight/obesity and high blood glucose values, are factors that will have a greater effect on this pathology.
Impaired blood lipid values are the major cause of CVD. In a recent systematic review and meta-analysis of clinical trials in 2018, it was concluded that ginger has a favorable effect in reducing triglycerides and LDL cholesterol, without significant reductions in total cholesterol. However, doses lower than 2 g/day of dairy ginger powder seem to be more effective in lowering both triglycerides and total cholesterol [83]. Since it is a safe and inexpensive supplement, it could be used to improve the lipid profile of subjects and thus prevent CVD.
Clinical studies have been conducted to evaluate the effect of ginger supplementation on the lipid profile of different populations. Doses of up to 1.8 g/day have been shown to significantly reduce triglyceride, total and LDL cholesterol levels compared with placebo in obese patients treated with metformin (Table 2) [85].
Population | Intervention | Outcomes | Ref. |
---|---|---|---|
Obese Egyptian patients with new-onset T2DM ( | 600 mg 3 times/day 8 weeks | ↓ BMI, ↓ TC, ↓ LDL-C, ↓ TG ↑ HDL-C ginger vs. placebo | [86] |
Hyperlipidemic non diabetic patients ( | 3 g/day 45 days | ↓ TC, ↓ TG ginger vs. placebo | [87] |
Obese men ( 18–30 years | 1 g/day 10 weeks with/out resistance training | n.s. TC, TG, LDL-C, HDL-C ginger vs. placebo ↓ TC, ↓ fat mass training groups | [88] |
Obese women with breast cancer ( | 3 g/day, 6 weeks, with/out exercise training | ↓ LDL, ↓ TC, ↓ TG, ↑ HDL ginger + exercise | [89] |
T2DM patients ( 38–65 years | 2 g/day 8 weeks | ↓ LDL, ↓ TG | [90] |
T2DM patients ( 20–60 years | 1.6 g/day 12 weeks | ↓ TC, ↓ TG | [85] |
Obese women ( 18–45 years | 2 g/day 12 weeks vs. placebo | ↓ TG ginger vs. placebo Both groups: ↓ TC, ↓ TG, ↓ LDL/HDL ratio, ↓ TC/HDL ratio, ↑ HDL | [91] |
T2DM ( 20–60 years | 2 g/day 12 weeks | ↓ ApoB, ↓ ApoB/Apo A1 ratio, ↑ Apo A1 | [92] |
T2DM ( | 3 g/day 8 weeks | ↓ TC | [93] |
Hyperlipidemic patients ( | 3 g/day 30 days | ↓ TC | [94] |
T2DM ( | 2 g/day 10 weeks | ↓ LDL/HDL ratio ginger vs. placebo | [83] |
Menopausal women ( | 1 g/day 16 weeks vs. 900 mg/day garlic with/out aerobic exercise | No effects in ginger groups ↓ TC, ↓ LDL with garlic | [95] |
Summary of the effect of ginger supplementation on the lipid profile in different clinical trials and populations.
Significant lowering effect of ginger compared with placebo has also been observed in [86, 87]. However, other studies failed to observe a positive effect, and ginger supplementation exerted no effect on blood lipid profiles and body composition [88] and no significant differences in cholesterol lipoproteins profile between ginger and placebo [89]. In some cases, the results are inconsistent, with significant differences in some markers as LDL/HDL ratio after ginger intake and no changes on mean levels of total cholesterol or triglycerides [90], or reductions in levels of serum triglycerides and LDL with no effects on total cholesterol or high-density lipoprotein (HDL) [91].
Levels of apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio reduced and apolipoprotein A1 increased after ginger supplementation (2 g/day) for 12 weeks [92]. The overexpression of ApoA1 could explain the increases observed in HDL levels in some trials.
Discrepancies in the results could be due to the different characteristics of the populations studied, stage of the disease, pharmacological treatments, format of ginger administered.
Meta-analysis studies have concluded that ginger significantly increases HDL levels and reduces plasma levels of triglycerides and total cholesterol, with different extent depending on the clinical condition (hyperlipidemia and T2DM) [93, 94]. The analysis conducted by Pourmasoumi et al. [83] revealed a better effect of total cholesterol and triglycerides with doses < 2 g/day and a maximum of 50 days of supplementation.
Among the different mechanisms of action attributed to ginger components is the inhibition of intestinal lipase enzymes, thus avoiding fat hydrolysis and absorption and the increase in plasma levels of triglycerides. In case of cholesterol, its decrease in plasma concentrations has been related to an inhibition in cellular cholesterol synthesis and an increase of hepatic enzyme activity of cholesterol 7 α-hydrozylase CYP7A1a, implicated in the conversion of cholesterol into bile acids for its clearance by fecal excretion [95]. Ginger is implicated in the inhibition of expression of adipogenesis and lipogenesis genes as PPAR γ and carbohydrate-responsive element-binding protein (ChREBP) gene expression in the liver [66]. ChREBP reduced expression further decreases the expression of glucogenic and lipogenic enzymes (as fatty acid synthase, steatoryl-CoA-desaturase-1, acetyl-CoA carboxylase 1, among others [95].
It is well known that healthy diet and lifestyle can control blood pressure and endothelial dysfunction. Inflammation associated with cardiovascular events contributes to hypertension by affecting the renin-angiotensin system [96]. Elevated blood pressure (BP) has also been known to be a strong risk factor cardiovascular [97].
The compounds in ginger responsible for its antihypertensive effect are 6-shogaol and 9-gingerol. These compounds reduce cholesterol and LDL levels, inhibit atheroma plaque formation, and increase vessel elasticity. They also reduce the release of inflammatory mediators responsible for endothelial dysfunction by decreasing intercellular adhesion molecule 1 (ICAM-1) levels [98]. Several authors [99] show the antihypertensive effect of ginger in volunteers with mean ≤ 50 years, with ginger doses ≥ 3 g/day, and during an intervention period ≤ 8 weeks. This effect could be due to its antioxidant activity.
A systematic review with 345 participants from six clinical trials showed that ginger consumption has favorable effects on blood pressure. These authors observed that increasing ginger intake decreased the probability of ischemic heart disease and hypertension [100]. This result coincides with that observed in a clinical trial with 4628 participants in which the efficacy of ginger in coronary heart disease and as an antihypertensive was observed [101].
Platelet aggregation and activation play an important role in developing thrombosis and atherosclerosis. Numerous nutrients and bioactive compounds have a potential role in platelet function and may decrease cardiovascular risk. These include berries, caffeine, chocolate, garlic, ginger, the omega-3 polyunsaturated fatty acids (PUFA), onion, and tomato [102].
ZGR is a compound (phenolic alkanose) found in
Several authors [104] observed that consumption of a 10 g dose of powdered ginger after 4 hours significantly reduced ADP- and adrenaline-induced platelet aggregation. McEwen analyzed the
Ginger has a vascular protective effect mediated by different mechanisms such as reduction of inflammation and oxidative stress, increase of nitric oxide synthesis, which is a potent vasodilator, the promotion of autophagy, and inhibition of vascular smooth muscle cell [105].
Comparing different ginger compounds, several investigators have shown that 6-gingerol and 6-shogaol showed the most potent bioactivity against cholesterol (Chol), arachidonic acid (AA), thrombin, and PAF-induced platelet aggregation [106]. The 6-paradol, 10-dehydrogingerol, 10-gingerol showed the most significant inhibition of AA-induced aggregation [107].
Nurtjahja-Tjendraputra et al. observed that 8-paradol is the most effective anticoagulant, being a COX-1 inhibitor [108].
Thomson et al. fed rats with ginger aqueous extract and observed a decrease in triglyceride, thromboxane-B2 cholesterol and PGE2 levels, and in adenosine deaminase (ADA) activity of plaques, together with an increase in adenosine levels. In this way, it favors vasodilatation, reducing the complications of hypertension and preventing from unnecessary platelet aggregation [108].
Ginger contains diverse bioactive compounds and demonstrates multiple bioactive properties. It is a potent antioxidant, anti-inflammatory, regulator of lipid profile, inhibitor of VSMC proliferation, blocker of voltage-dependent Ca2+ channels, inhibitor of platelet aggregation, regulator of endothelial dysfunction and NO synthesis, enhancer of cholesterol efflux from macrophages, inhibitor of angiogenesis, and promoter of autophagy.
The biological activities, health benefits, and cardioprotective properties of ginger/ginger constituents along with related mechanisms of action gave new insights to show new avenues in the treatment of CVDs.
It is valuable to explore new anti-platelet aggregation drugs based on the skeleton of [ acetyl-CoA acetyltransferase 2 adenosine deaminase adenosine diphosphate adenine monophosphate activated protein kinase body mass index carbohydrate-responsive element-binding protein glucose transporter type 4 cyclooxygenase-1 cyclooxygenase-2 cardiovascular diseases dietary approaches to stop hypertension coagulation factor Xa glycosylated hemoglobin high-density lipoprotein human umbilical endothelial cells intercellular adhesion molecule 1 interleukin inducible NOS low-density lipoprotein lipopolysaccharide mitogen-activated protein kinase messenger ribonucleic acid mammalian target of rapamycin microsomal triglyceride transfer protein factor kappa B nod-like receptor oxide nitric oxide nitric synthase Niemann-Pick disease, type C1, gene-like 1 is a mouse monoclonal antibody prostaglandin E2 polyunsaturated fatty acids reactive oxidative species substrate S-2222 in a non-competitive inhibition model superoxide dismutase signal transducer activators of transcription receptors toll-like tumor necrosis tumoral alpha a stable thromboxane receptor (TP receptor) agonist) vascular smooth muscle cell World Health Organization zingeroneAcronyms and abbreviations
The authors declare no conflict of interest.
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Whizar-Lugo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9829",title:"Biosimilars",subtitle:null,isOpenForSubmission:!1,hash:"c72171c1d1cf6df5aad989cb07cc8e4e",slug:"biosimilars",bookSignature:"Valderilio Feijó Azevedo and Robert Moots",coverURL:"https://cdn.intechopen.com/books/images_new/9829.jpg",editedByType:"Edited by",editors:[{id:"69875",title:"Dr.",name:"Valderilio",middleName:"Feijó",surname:"Feijó Azevedo",slug:"valderilio-feijo-azevedo",fullName:"Valderilio Feijó Azevedo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:1834,seriesByTopicCollection:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],seriesByTopicTotal:3,mostCitedChapters:[{id:"19013",doi:"10.5772/21983",title:"Cell Responses to Surface and Architecture of Tissue Engineering Scaffolds",slug:"cell-responses-to-surface-and-architecture-of-tissue-engineering-scaffolds",totalDownloads:10483,totalCrossrefCites:132,totalDimensionsCites:303,abstract:null,book:{id:"314",slug:"regenerative-medicine-and-tissue-engineering-cells-and-biomaterials",title:"Regenerative Medicine and Tissue Engineering",fullTitle:"Regenerative Medicine and Tissue Engineering - Cells and Biomaterials"},signatures:"Hsin-I Chang and Yiwei Wang",authors:[{id:"45747",title:"Dr.",name:"Hsin-I",middleName:null,surname:"Chang",slug:"hsin-i-chang",fullName:"Hsin-I Chang"},{id:"53659",title:"Ms.",name:"Yiwei",middleName:null,surname:"Wang",slug:"yiwei-wang",fullName:"Yiwei Wang"}]},{id:"46479",doi:"10.5772/57353",title:"Floating Drug Delivery Systems for Eradication of Helicobacter pylori in Treatment of Peptic Ulcer Disease",slug:"floating-drug-delivery-systems-for-eradication-of-helicobacter-pylori-in-treatment-of-peptic-ulcer-d",totalDownloads:2838,totalCrossrefCites:136,totalDimensionsCites:293,abstract:null,book:{id:"3839",slug:"trends-in-helicobacter-pylori-infection",title:"Trends in Helicobacter pylori Infection",fullTitle:"Trends in Helicobacter pylori Infection"},signatures:"Yousef Javadzadeh and Sanaz Hamedeyazdan",authors:[{id:"94276",title:"Prof.",name:"Yousef",middleName:null,surname:"Javadzadeh",slug:"yousef-javadzadeh",fullName:"Yousef Javadzadeh"},{id:"98229",title:"Dr.",name:"Sanaz",middleName:null,surname:"Hamedeyazdan",slug:"sanaz-hamedeyazdan",fullName:"Sanaz Hamedeyazdan"}]},{id:"25512",doi:"10.5772/30872",title:"Epidemiology of Psychological Distress",slug:"epidemiology-of-psychological-distress",totalDownloads:8790,totalCrossrefCites:90,totalDimensionsCites:243,abstract:null,book:{id:"727",slug:"mental-illnesses-understanding-prediction-and-control",title:"Mental Illnesses",fullTitle:"Mental Illnesses - Understanding, Prediction and Control"},signatures:"Aline Drapeau, Alain Marchand and Dominic Beaulieu-Prévost",authors:[{id:"84582",title:"Dr.",name:"Aline",middleName:null,surname:"Drapeau",slug:"aline-drapeau",fullName:"Aline Drapeau"},{id:"84605",title:"Dr.",name:"Alain",middleName:null,surname:"Marchand",slug:"alain-marchand",fullName:"Alain Marchand"},{id:"84606",title:"Dr.",name:"Dominic",middleName:null,surname:"Beaulieu-Prévost",slug:"dominic-beaulieu-prevost",fullName:"Dominic Beaulieu-Prévost"}]},{id:"64762",doi:"10.5772/intechopen.82511",title:"Mechanism and Health Effects of Heavy Metal Toxicity in Humans",slug:"mechanism-and-health-effects-of-heavy-metal-toxicity-in-humans",totalDownloads:10236,totalCrossrefCites:100,totalDimensionsCites:229,abstract:"Several heavy metals are found naturally in the earth crust and are exploited for various industrial and economic purposes. Among these heavy metals, a few have direct or indirect impact on the human body. Some of these heavy metals such as copper, cobalt, iron, nickel, magnesium, molybdenum, chromium, selenium, manganese and zinc have functional roles which are essential for various diverse physiological and biochemical activities in the body. However, some of these heavy metals in high doses can be harmful to the body while others such as cadmium, mercury, lead, chromium, silver, and arsenic in minute quantities have delirious effects in the body causing acute and chronic toxicities in humans. The focus of this chapter is to describe the various mechanism of intoxication of some selected heavy metals in humans along with their health effects. Therefore it aims to highlight on biochemical mechanisms of heavy metal intoxication which involves binding to proteins and enzymes, altering their activity and causing damage. More so, the mechanism by which heavy metals cause neurotoxicity, generate free radical which promotes oxidative stress damaging lipids, proteins and DNA molecules and how these free radicals propagate carcinogenesis are discussed. Alongside these mechanisms, the noxious health effects of these heavy metals are discussed.",book:{id:"7111",slug:"poisoning-in-the-modern-world-new-tricks-for-an-old-dog-",title:"Poisoning in the Modern World",fullTitle:"Poisoning in the Modern World - New Tricks for an Old Dog?"},signatures:"Godwill Azeh Engwa, Paschaline Udoka Ferdinand, Friday Nweke Nwalo and Marian N. Unachukwu",authors:[{id:"241837",title:"Mr.",name:"Godwill Azeh",middleName:null,surname:"Engwa",slug:"godwill-azeh-engwa",fullName:"Godwill Azeh Engwa"},{id:"274194",title:"BSc.",name:"Paschaline Ferdinand",middleName:null,surname:"Okeke",slug:"paschaline-ferdinand-okeke",fullName:"Paschaline Ferdinand Okeke"},{id:"286975",title:"Dr.",name:"Friday",middleName:null,surname:"Nweke Nwalo",slug:"friday-nweke-nwalo",fullName:"Friday Nweke Nwalo"},{id:"286976",title:"Dr.",name:"Marian",middleName:null,surname:"Unachukwu",slug:"marian-unachukwu",fullName:"Marian Unachukwu"}]},{id:"27687",doi:"10.5772/29869",title:"Heavy Metals and Human Health",slug:"heavy-metals-and-human-health",totalDownloads:18954,totalCrossrefCites:83,totalDimensionsCites:191,abstract:null,book:{id:"1012",slug:"environmental-health-emerging-issues-and-practice",title:"Environmental Health",fullTitle:"Environmental Health - Emerging Issues and Practice"},signatures:"Simone Morais, Fernando Garcia e Costa and Maria de Lourdes Pereira",authors:[{id:"13875",title:"Prof.",name:"Simone",middleName:null,surname:"Morais",slug:"simone-morais",fullName:"Simone Morais"},{id:"79715",title:"Prof.",name:"Maria De Lourdes",middleName:null,surname:"Pereira",slug:"maria-de-lourdes-pereira",fullName:"Maria De Lourdes Pereira"},{id:"87294",title:"Prof.",name:"Fernando",middleName:null,surname:"Garcia E Costa",slug:"fernando-garcia-e-costa",fullName:"Fernando Garcia E Costa"}]}],mostDownloadedChaptersLast30Days:[{id:"64851",title:"Herbal Medicines in African Traditional Medicine",slug:"herbal-medicines-in-african-traditional-medicine",totalDownloads:14207,totalCrossrefCites:30,totalDimensionsCites:52,abstract:"African traditional medicine is a form of holistic health care system organized into three levels of specialty, namely divination, spiritualism, and herbalism. The traditional healer provides health care services based on culture, religious background, knowledge, attitudes, and beliefs that are prevalent in his community. Illness is regarded as having both natural and supernatural causes and thus must be treated by both physical and spiritual means, using divination, incantations, animal sacrifice, exorcism, and herbs. Herbal medicine is the cornerstone of traditional medicine but may include minerals and animal parts. The adjustment is ok, but may be replaced with –‘ Herbal medicine was once termed primitive by western medicine but through scientific investigations there is a better understanding of its therapeutic activities such that many pharmaceuticals have been modeled on phytochemicals derived from it. Major obstacles to the use of African medicinal plants are their poor quality control and safety. Traditional medical practices are still shrouded with much secrecy, with few reports or documentations of adverse reactions. However, the future of African traditional medicine is bright if viewed in the context of service provision, increase of health care coverage, economic potential, and poverty reduction. Formal recognition and integration of traditional medicine into conventional medicine will hold much promise for the future.",book:{id:"6302",slug:"herbal-medicine",title:"Herbal Medicine",fullTitle:"Herbal Medicine"},signatures:"Ezekwesili-Ofili Josephine Ozioma and Okaka Antoinette Nwamaka\nChinwe",authors:[{id:"191264",title:"Prof.",name:"Josephine",middleName:"Ozioma",surname:"Ezekwesili-Ofili",slug:"josephine-ezekwesili-ofili",fullName:"Josephine Ezekwesili-Ofili"},{id:"211585",title:"Prof.",name:"Antoinette",middleName:null,surname:"Okaka",slug:"antoinette-okaka",fullName:"Antoinette Okaka"}]},{id:"76640",title:"Control of Clinical Laboratory Errors by FMEA Model",slug:"control-of-clinical-laboratory-errors-by-fmea-model",totalDownloads:1131,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Patient safety is an aim for clinical applications and is a fundamental principle of healthcare and quality management. The main global health organizations have incorporated patient safety in their review of work practices. The data provided by the medical laboratories have a direct impact on patient safety and a fault in any of processes such as strategic, operational and support, could affect it. To provide appreciate and reliable data to the physicians, it is important to emphasize the need to design risk management plan in the laboratory. Failure Mode and Effect Analysis (FMEA) is an efficient technique for error detection and reduction. Technical Committee of the International Organization for Standardization (ISO) licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. FMEA model helps to identify quality failures, their effects and risks with their reduction/elimination, which depends on severity, probability and detection. Applying FMEA in clinical approaches can lead to a significant reduction of the risk priority number (RPN).",book:{id:"9808",slug:"contemporary-topics-in-patient-safety-volume-1",title:"Contemporary Topics in Patient Safety",fullTitle:"Contemporary Topics in Patient Safety - Volume 1"},signatures:"Hoda Sabati, Amin Mohsenzadeh and Nooshin Khelghati",authors:[{id:"340486",title:"M.Sc.",name:"Hoda",middleName:null,surname:"Sabati",slug:"hoda-sabati",fullName:"Hoda Sabati"},{id:"348872",title:"M.Sc.",name:"Amin",middleName:null,surname:"Mohsenzadeh",slug:"amin-mohsenzadeh",fullName:"Amin Mohsenzadeh"},{id:"348874",title:"MSc.",name:"Nooshin",middleName:null,surname:"Khelghati",slug:"nooshin-khelghati",fullName:"Nooshin Khelghati"}]},{id:"64762",title:"Mechanism and Health Effects of Heavy Metal Toxicity in Humans",slug:"mechanism-and-health-effects-of-heavy-metal-toxicity-in-humans",totalDownloads:10236,totalCrossrefCites:100,totalDimensionsCites:229,abstract:"Several heavy metals are found naturally in the earth crust and are exploited for various industrial and economic purposes. Among these heavy metals, a few have direct or indirect impact on the human body. Some of these heavy metals such as copper, cobalt, iron, nickel, magnesium, molybdenum, chromium, selenium, manganese and zinc have functional roles which are essential for various diverse physiological and biochemical activities in the body. However, some of these heavy metals in high doses can be harmful to the body while others such as cadmium, mercury, lead, chromium, silver, and arsenic in minute quantities have delirious effects in the body causing acute and chronic toxicities in humans. The focus of this chapter is to describe the various mechanism of intoxication of some selected heavy metals in humans along with their health effects. Therefore it aims to highlight on biochemical mechanisms of heavy metal intoxication which involves binding to proteins and enzymes, altering their activity and causing damage. More so, the mechanism by which heavy metals cause neurotoxicity, generate free radical which promotes oxidative stress damaging lipids, proteins and DNA molecules and how these free radicals propagate carcinogenesis are discussed. Alongside these mechanisms, the noxious health effects of these heavy metals are discussed.",book:{id:"7111",slug:"poisoning-in-the-modern-world-new-tricks-for-an-old-dog-",title:"Poisoning in the Modern World",fullTitle:"Poisoning in the Modern World - New Tricks for an Old Dog?"},signatures:"Godwill Azeh Engwa, Paschaline Udoka Ferdinand, Friday Nweke Nwalo and Marian N. Unachukwu",authors:[{id:"241837",title:"Mr.",name:"Godwill Azeh",middleName:null,surname:"Engwa",slug:"godwill-azeh-engwa",fullName:"Godwill Azeh Engwa"},{id:"274194",title:"BSc.",name:"Paschaline Ferdinand",middleName:null,surname:"Okeke",slug:"paschaline-ferdinand-okeke",fullName:"Paschaline Ferdinand Okeke"},{id:"286975",title:"Dr.",name:"Friday",middleName:null,surname:"Nweke Nwalo",slug:"friday-nweke-nwalo",fullName:"Friday Nweke Nwalo"},{id:"286976",title:"Dr.",name:"Marian",middleName:null,surname:"Unachukwu",slug:"marian-unachukwu",fullName:"Marian Unachukwu"}]},{id:"65467",title:"Anesthesia Management for Large-Volume Liposuction",slug:"anesthesia-management-for-large-volume-liposuction",totalDownloads:5965,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The apparent easiness with which liposuction is performed favors that patients, young surgeons, and anesthesiologists without experience in this field ignore the many events that occur during this procedure. Liposuction is a procedure to improve the body contour and not a surgery to reduce weight, although recently people who have failed in their plans to lose weight look at liposuction as a means to contour their body figure. Tumescent liposuction of large volumes requires a meticulous selection of each patient; their preoperative evaluation and perioperative management are essential to obtain the expected results. The various techniques of general anesthesia are the most recommended and should be monitored in the usual way, as well as monitoring the total doses of infiltrated local anesthetics to avoid systemic toxicity. The management of intravenous fluids is controversial, but the current trend is the restricted use of hydrosaline solutions. The most feared complications are deep vein thrombosis, pulmonary thromboembolism, fat embolism, lung edema, hypothermia, infections and even death. The adherence to the management guidelines and prophylaxis of venous thrombosis/thromboembolism is mandatory.",book:{id:"6221",slug:"anesthesia-topics-for-plastic-and-reconstructive-surgery",title:"Anesthesia Topics for Plastic and Reconstructive Surgery",fullTitle:"Anesthesia Topics for Plastic and Reconstructive Surgery"},signatures:"Sergio Granados-Tinajero, Carlos Buenrostro-Vásquez, Cecilia\nCárdenas-Maytorena and Marcela Contreras-López",authors:[{id:"273532",title:"Dr.",name:"Sergio Octavio",middleName:null,surname:"Granados Tinajero",slug:"sergio-octavio-granados-tinajero",fullName:"Sergio Octavio Granados Tinajero"}]},{id:"30178",title:"Chest Mobilization Techniques for Improving Ventilation and Gas Exchange in Chronic Lung Disease",slug:"chest-mobilization-techniques-for-improving-ventilation-and-gas-exchange-in-chronic-lung-disease",totalDownloads:31193,totalCrossrefCites:0,totalDimensionsCites:5,abstract:null,book:{id:"648",slug:"chronic-obstructive-pulmonary-disease-current-concepts-and-practice",title:"Chronic Obstructive Pulmonary Disease",fullTitle:"Chronic Obstructive Pulmonary Disease - Current Concepts and Practice"},signatures:"Donrawee Leelarungrayub",authors:[{id:"73709",title:"Associate Prof.",name:"Jirakrit",middleName:null,surname:"Leelarungrayub",slug:"jirakrit-leelarungrayub",fullName:"Jirakrit Leelarungrayub"}]}],onlineFirstChaptersFilter:{topicId:"3",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81607",title:"Does Physical Activity Mediate the Effect of Loneliness on Inflammatory and Metabolic Processes?",slug:"does-physical-activity-mediate-the-effect-of-loneliness-on-inflammatory-and-metabolic-processes",totalDownloads:1,totalDimensionsCites:null,doi:"10.5772/intechopen.104915",abstract:"The study to be presented in the chapter explores one potential behavioral mechanism by which loneliness affects inflammatory and metabolic processes in old age. Specifically, it addresses whether physical activity mediates the loneliness—inflammatory/metabolic dysregulation association. Multivariate linear regressions were applied to data derived from the Health and Retirement Study (HRS). The findings revealed that loneliness was prospectively associated with elevated values of log C-reactive protein (log-CRP) and with amplified levels of Glycated hemoglobin (HbA1c), Cystatin C (CysC), and Body Mass Index (BMI), after controlling for socio-demographics. Second, physical activity mediated the association between loneliness with prospective values of log-CRP and also mediated associations between loneliness and prospective levels of metabolic biomarkers. These findings affirm the contribution (i.e., the mediation), of physical activity to the associations between loneliness and immune and metabolic processes and provide insights concerning the mechanism by which this social—biological connection operates.",book:{id:"11226",title:"Geriatric Medicine and Healthy Aging",coverURL:"https://cdn.intechopen.com/books/images_new/11226.jpg"},signatures:"Sharon Shiovitz-Ezra, Ohad Parag and Howard Litwin"},{id:"81961",title:"Antioxidants as an Adjuncts to Periodontal Therapy",slug:"antioxidants-as-an-adjuncts-to-periodontal-therapy",totalDownloads:1,totalDimensionsCites:null,doi:"10.5772/intechopen.105016",abstract:"It has been established that periodontal diseases are related with the hyperactivity of neutrophils. Reactive oxygen species are produced mainly by neutrophils. In order to maintain the balance with reactive oxygen species, the need for antioxidants is increasing. As for supplements to the conventional periodontal therapy, different antioxidants have been applied in an attempt to provide new possibilities in the periodontal treatment. This chapter focused on recent studies that used different antioxidants as adjuncts to conventional periodontal treatments.",book:{id:"11567",title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg"},signatures:"Sura Dakhil Jassim and Ali Abbas Abdulkareem"},{id:"82345",title:"Cannabis Medicines: Guidance for the Selection, Purchase and Supply for Clinical Trials",slug:"cannabis-medicines-guidance-for-the-selection-purchase-and-supply-for-clinical-trials",totalDownloads:1,totalDimensionsCites:null,doi:"10.5772/intechopen.105682",abstract:"Cannabis medicines are in demand from the public for treating a range of diseases and symptoms; however, clinicians are reluctant to prescribe these products because of limited evidence and prescribing information. To generate this evidence, quality clinical trials of cannabis medicines must be undertaken, yet their design is a complex, often uncharted territory, and involves the cooperation and sharing of knowledge of multiple stakeholders. Before designing a clinical trial, researchers require a clear understanding of the potential therapeutic benefit cannabis medicines may have, the form and formulation of the product, and the dose to be investigated. Researchers must also be aware of the applicable pharmaceutical regulations in the country or jurisdiction where the research is to be undertaken, as well as manufacturing or licensing regulations that may be imposed at the source of the cannabis product. Importantly, collaborations with industry are a key to the successful outcome of cannabis medicines clinical trials. Without funding and sponsorship of clinical trials, the ability to generate quality data will be limited and the evidence for cannabis medicines to be registered as therapeutics lacking. Collaborations between researchers, industry, and regulators, working together in sharing knowledge, are therefore critical to generate high quality cannabis medicines research.",book:{id:"11714",title:"Cannabinoids - Recent Perspectives and Applications in Human Health",coverURL:"https://cdn.intechopen.com/books/images_new/11714.jpg"},signatures:"Peter Galettis, John Barlow, Jaroslav Boublik, Stefania Capra, Rachel Galettis, Myfanwy Graham, Courtney Hill, Paul Mavor, Jasminka Nikolajevic-Sarunac, Rosemary Richards, Janet Schloss, Melinda Thompson, Linda Truong, Berzenn Urbi, Katrina Weston-Green and Aaron K. Wong"},{id:"82444",title:"Epigenomics in Malignant Pleural Mesothelioma",slug:"epigenomics-in-malignant-pleural-mesothelioma",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.105408",abstract:"Malignant pleural mesothelioma (MPM) is a tumor with a relatively low incidence, but whose carcinogenesis, for the most part, involves epigenetic factors that keep its heterogeneity and sometimes are a therapeutic target or an obstacle to the effectiveness of the newest treatments. This chapter summarizes the principal epigenetic dysregulation mechanisms involved in the MPM pathogenesis. The most studied mechanism is hypermethylation mediated by DNA methyltransferases (DNMTs) in different tumor suppressor genes, and the relation with asbestos fiber exposure, which represents the main risk factor. Physiopathology is related to chronic inflammation mediated by free radicals that produce chromosomal alterations, genomic instability, increased angiogenesis, and tumor invasion factors like EGFR, FGFR, TGF-B, and PDGF. Additionally, independent methylation pathways that produce gene silencing such as polycomb complex and SWI/SNF mutation are reviewed. Finally, other mechanisms are described such as hypomethylation with imprint loss and pro-oncogenic gene activation that induce immunological responses, as well as acetylation, deacetylation, and demethylation in the chromatin and histone context.",book:{id:"10831",title:"Mesothelioma - Diagnostics, Treatment and Basic Research",coverURL:"https://cdn.intechopen.com/books/images_new/10831.jpg"},signatures:"Aldo Manuel Alvarez Moran, Pablo Alejandro Ávila Sánchez, Jorge Alejandro Torres Ríos and Lorena Vega Castillo"},{id:"82383",title:"The Role of Immune Checkpoints in Cancer Progression",slug:"the-role-of-immune-checkpoints-in-cancer-progression",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105628",abstract:"Immune checkpoint proteins are like two-faced swords that first act as gatekeepers of the immune system to protect the host from tissue damage. In contrast, these proteins can corroborate cancer progression by inhibiting tumor-specific immune responses. Here, we summarized the regulation and signaling cascade of immune checkpoints molecules (PD-1/PD-L1, CTLA-4, TIM3, TIGIT, LAG3, and BTLA), including their role in providing co-inhibitory signals for regulating T-cell response. The involvement of immune checkpoint molecules to drive cancer growth is elaborated with explanations about various anticancer strategies, such as (1) the overexpression of immune checkpoints in cancer cells, immune cells, or the surrounding environment leading to incapabilities of the tumor-specific immune response, (2) immune checkpoints interference to metabolic pathways then deplete nutrients needed by immune cells, (3) the interaction between immune checkpoints and regulatory T cells. Lastly, future challenges of immune checkpoint inhibitors are discussed briefly to get insight into their applicability in the clinical setting.",book:{id:"11278",title:"Regulatory T Cells",coverURL:"https://cdn.intechopen.com/books/images_new/11278.jpg"},signatures:"Rahmad Aji Prasetya and Devyani Diah Wulansari"},{id:"82331",title:"Diseases of Medicinal Plants Cultivated in Karnataka and Their Management",slug:"diseases-of-medicinal-plants-cultivated-in-karnataka-and-their-management",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.104632",abstract:"A broad spectrum of fungal diseases infecting selected 10 medicinal plants surveyed in Karnataka, India, was studied in the present research. We present a detailed review on previously reported as well as our present investigation’s details of fungal diseases, etiology, symptoms, and its management. Some of the commonly observed diseases are Anthracnose disease, Blight disease, Leaf spot, Root rot, Powdery mildew, Downy mildew, and Wilt disease. The detailed analysis of medicinal plants revealed that the medicinal plants are susceptible to diverse fungal phytopathogens. Therefore, sustainable management of the diseases is necessary for the successful cultivation of disease-free medicinal plants.",book:{id:"11299",title:"Medicinal Plants",coverURL:"https://cdn.intechopen.com/books/images_new/11299.jpg"},signatures:"P. Swetha and R. 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