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.
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Our breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
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“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
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Additionally, each book published by IntechOpen contains original content and research findings.
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We 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.
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\n
Simba 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\n
IntechOpen, 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\n
Since the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\n
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\n
Our 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\n
Additionally, each book published by IntechOpen contains original content and research findings.
\n\n
We 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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\r\n\tQuality practices began to include processes at the beginning of the 20th century. As a group of activities, a "process" is seen as taking an input, adding value to it, and delivering it as an output. Shewhart started focusing on controlling processes during the mid-1920s, making quality relevant not just for the final product, but also for the processes that led to it. Statistical techniques can be used to analyze industrial data to determine whether a process is stable and in control, or if it has been influenced by a special cause that needs to be addressed. Shewhart established the basis for modern-day control charts. As a statistician for the U.S. Department of Agriculture and Census Bureau, W. Edwards Deming was a proponent of Shewhart's Statistical Quality Control (SQC) methods and ultimately led the quality movement in both Japan and the U.S. According to Joseph M. Juran, who helped establish the field of quality management, created the 80-20 rule, and wrote the "Quality Control Handbook," the quality of Japanese goods would surpass that of U.S. goods by the mid-1970s. \r\n\tThe Japanese were revolutionizing quality improvement. As a result, Japan adopted a "total quality" approach to its strategies. In the United States, Total Quality Management (TQM) encompasses not only statistics but also approaches that encompass the entire organization. There were several subsequent quality-management initiatives. \r\n\tIn 1986, Motorola developed Six Sigma to improve its business processes by minimizing defects. A philosophy that views all work as a process, which can be identified, measured, analyzed, improved, and controlled. Generally, "Six Sigma quality" is an indicator that a process is well controlled.
\r\n
\r\n\tLean manufacturing (1988), also known as just-in-time manufacturing, derives from Toyota's 1930 operating model "The Toyota Way." Lean describes a set of management practices that reduce waste and increase productivity. \r\n\tThe ISO 9000 series of quality-control standards appeared in 1987. ISO 9001 integrates a process-oriented approach into enterprise management based on the plan-do-check-act method. The quality movement has matured as we enter the 21st century. ISO 9000 was revised in 2000 to emphasize customer satisfaction. The fifth edition of ISO 9001, published in 2015, emphasizes risk-based thinking to improve the application of the process approach. In addition to the manufacturing sector, quality has moved into service, healthcare, education, and government. For example, through standards such as ISO/IEC 17025 for testing and calibration laboratories and ISO 15189 for medical laboratories. \r\n\tMore recently, it has been recognized that the Fourth Industrial Revolution, Industry 4.0, best defines the present industry model. As its part, "Quality 4.0" refers to the future of quality and organizational excellence.
\r\n
\r\n\tThe book will aim to introduce a comprehensive overview of the up-to-date models used in quality management systems by experts in the field.
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1. Introduction
Gene amplification is a copy number increase of a restricted region of a chromosome arm. Amplified chromosomal regions are present in acentric mini extra-chromosome (double minutes, DMs) or within a chromosome as repetitive arrays (homogeneously staining regions, HSRs); or distributed at various locations in the genome (scattered-type) (Fig. 1).
Figure 1.
Typical amplification products in mammalian cells.
A schematic illustration of four-chromosome genome (above) and three types of amplification products (below) are depicted. Amplified regions are indicated in red, and black circles represent centromeres. See text for details.
Figure 2.
Breakage-fusion-bridge (BFB) cycles
The BFB cycle can be initiated by a DNA double-strand break. After DNA replication, the ends of the sister chromatids can fuse, giving rise to a dicentric chromosome. At anaphase, if the two centromeres go to the two opposite poles of the mitotic spindle, the dicentric chromosome can be broken. An asymmetric break will lead to a formation partially deleted or duplicated broken chromosomes. Subsequent cycles involving the chromosome with the duplication cause the increase in the copy number of the region of interest as inverted repeats. BFB cycles end when the broken chromosome ends are stabilized.
Oncogene amplification is common in human cancers and contributes to tumor progression and therapeutic resistance (Albertson, 2006; Tanaka and Yao, 2009). For example, ERBB2 amplification is often detected in advanced breast cancers, and overproduction of ERBB2 can accelerate tumor progression (Di Fiore et al., 1987; Muller et al., 1988; Slamon et al., 1987). Amplifications of MYC, CCND1, EGFR, MDM2, MYCN, JUN, TNK2, or ESR1 are also associated with aggressive phenotypes of tumors. BCR-ABL fusion gene is amplified in patients showing therapeutic resistance to Imatinib mesylate (Gorre et al., 2001). Amplifications of DHFR, TYMS, or MET are also associated with therapeutic resistance.
A variety of models are proposed to explain the amplification process, including unequal sister-chromatid exchange, localized over replication, fold-back priming, rolling-circle replication, and breakage-fusion-bridge (BFB) cycle (Kobayashi et al., 2004; McClintock, 1941; Rattray et al., 2005; Tower, 2004; Watanabe and Horiuchi, 2005). Cytogenetic features of BFB cycle have been repeatedly observed in tumor cells (Fig.2). BFB cycle is the most popular model to explain intra-chromosomal amplification (Mondello et al., 2010; Tanaka and Yao, 2009), especially in the early stage of the amplification. In cancer cells, HSRs are often organized as an inverted ladder associated with a deletion that spans from the amplicon toward a telomere (Debatisse and Malfor, 2005). According to the BFB model, such a complex rearrangement results from the following repeating cycle: an initial DSB; replication of the broken molecule; fusion of sister chromatids; formation of a bridge during anaphase; and asymmetrical breakage due to mechanical tension, which generates one chromatid with an inverted repeat at the broken end.
In extra-chromosomal amplification, replication-based models are often proposed. Breakage at stalled replication forks is proposed to cause DMs formation including EGFR gene (Vogt et al., 2004). Extra-rounds of replication are thought to lead to DMs containing N-myc gene. In N-myc amplification, extra-round of replication is expected to form an extra-chromosomal element leading to integration followed by intra-chromosomal amplification (Savelyeva and Schwab, 2001). However, only by these amplification models themselves, it is difficult to explain the entire processes of the amplification.
2. Barrier to efficient analyses
Despite their biological and clinical importance, mechanisms for amplifying oncogenes remain largely unknown. This is because the whole process of gene amplification has been difficult to analyze because of additional kinds of amplification processes and secondary chromosome rearrangements (Haber and Debatisse, 2006). There are at least three reasons for this difficulty: (1) previous approaches to understand mechanisms for amplification were based on the structural analysis of complex end products; (2) few model systems for gene amplification are available that allow chromosomal engineering, as is possible in yeast (Lengauer et al., 1998); (3) spontaneous gene amplification occurs at very low frequency.
The use of genome-wide scanning techniques, such as array comparative genomic hybridization (array CGH) and next-generation DNA sequencing, has recently demonstrated that most solid tumors contain amplified portions of their genomes (Albertson, 2006). However, even these recent genomic technologies cannot unambiguously assign sequences in amplified regions and accurately resolve their chromosomal structure. Thus, amplified regions have been largely refractory to standard human genetic analyses.
3. Model systems for understanding common features of gene amplification
3.1. DSB and inverted repeats
Long series of studies have shown that DNA double-strand break (DSB) and inverted repeats play an important role in gene amplification. DNA double-strand break (DSB) is one of the harmful forms of DNA damage, and can induce several types of chromosomal aberrations, including gene amplification, when not correctly repaired. Amplification is triggered by DNA-damaging agents, which can directly or indirectly cause DSBs (Kuo et al., 1994; Paulson et al., 1998; Poupon et al., 1996; Yunis et al., 1987). In mammalian genomes, there are regions prone to breakage known as common fragile sites (CFSs) (Debatisse et al., 2012; Glover et al., 2005). CFSs are involved in chromosomal aberrations, including gene amplification, and have been shown to play a major role in the early steps in gene amplification (Ciullo et al., 2002; Coquelle et al., 1997; Hellman et al., 2002; Kuo et al., 1998). In cooperation with DSBs, short inverted repeats could generate a palindromic dicentric chromosome, leading to gene amplification.
Model systems that use site-specific endonucleases, such as I-SceI or HO endonucleases, have been constructed in yeast and in mammalian cells. Yao\'s group first constructed a plasmid-based system in yeast containing an HO endonuclease cutting site and an adjacent inverted repeat (Butler et al., 1996). This system efficiently formed a palindromic mini-chromosome after induction of the endonuclease. They next used Chinese hamster ovary (CHO) cells and inserted a DHFR transgene into a chromosome of the cells with an I-Scel cutting site and an adjacent inverted repeat (Tanaka et al., 2002). This system formed a palindromic dimer after I-Scel cutting and consequently caused intra-chromosomal amplification, suggesting the formation of a dicentric chromosome and the involvement of subsequent BFB cycles.
We developed a new approach in which we design amplification processes and test whether the processes can produce the amplification seen in nature. Previously, in yeast, we constructed a system designed to induce a rapid amplification mode, double rolling-circle replication (DRCR) via chromosomal breaks induced by HO endonuclease (Watanabe and Horiuchi, 2005) (Fig.3). DRCR is a continuous process in which two replication forks chase each other (Fig.3A), and was first confirmed by Volkert and Broach for amplification of yeast 2μ plasmid (Volkert and Broach, 1986). To induce DRCR, we used break-induced replication (BIR), a nonreciprocal recombination-dependent replication process that is an effective mechanism to repair a broken chromosome (Fig.3B). The DRCR amplification is selected with an amplification marker, leu2d, which has a slight transcription activity and complements leucine auxotrophy if amplified (Erhart and Hollenberg, 1983). This system produced intra-/extra-chromosomal products resembling HSR and DMs seen in mammalian cells (Fig.3C). The HSR-type products contain up to ~100 copies of leu2d gene, which occupies 730kb (the rest of chromosome VI comprises 275 kb). Interestingly, HSR/DMs products were generated at low frequency without deliberate DNA cleavage, depending on the chromosome structure with the inverted repeats. These features strongly suggest that the processes described here may contribute to natural gene amplification in higher eukaryotes and natural amplification involves DRCR.
Lobachev et al constructed a yeast strain having an inverted repeat of Alu sequences, and showed that the repeat are fragile sites (Lobachev et al., 2002). The Alu inverted repeats can be cleaved and subsequently generate hairpin ends, which can be opened up by the Mre11/Rad50/Xrs2 complex in concert with the Sae2 protein. His group next demonstrated that Alu inverted repeats can trigger intra- and extra-chromosomal amplification in yeast (Narayanan et al., 2006).
Figure 3.
Gene amplification system based on DRCR utilizing break-induced replication (BIR).
(A) Double rolling-circle replication (DRCR). Two replication forks chase each other. One replication fork can replicate a template for the other fork and so amplification proceeds. (B) Structure of the amplification cassette and a model for DRCR amplification. This cassette contains two PCR-amplified sequences (white and gray arrows) derived from the nearby genomic region, forming two inverted pairs (a) and (b). The amplification marker, leu2d, has a slight transcription activity, and it will complement leucine auxotrophy if amplified. This yeast strain has galactose-inducible HO endonuclease gene. Following HO cutting, two chromosomal ends can invade each other, initiating two break-induced replication (BIR) events as in the insert box and subsequent DRCR. The DRCR process would terminate by recombination between bidirectionally elongated arms. (C) Southern analysis of uncut chromosomal DNA from Leu+ survivors with the leu2d probe. The expression of HO endonuclease was induced on galactose medium without leucine (HO-induced). PFGE was performed with higher and lower size ranges. The lanes marked in red and green indicate intra- and extra-chromosomal amplification, respectively. Pre-ind.: preinduction conditions (cultured on glucose plates containing leucine). (D) Model for the production of extra-chromosomal products. These products are proposed to result from degradation of one broken end and the subsequent intramolecular BIR.
3.2. Replication stress within repeated sequences
Recently, DNA replication stress within repeated sequences is reported to contribute importantly to genome instability. Two recent yeast papers have shown that nearby inverted repeats recombine spontaneously to fuse, leading to the formation of dicentric and acentric chromosomes (Branzei and Foiani, 2010a; Mizuno et al., 2009; Paek et al., 2009). This fusion process does not appear to require DSB formation, and is likely caused by DNA replication-based mechanism involving an aberrant switch of replication templates.
Another example involves the re-replication event, the inappropriate firing of replication origins. Green et al. developed an elegant system in yeast that enables a locus-specific and transient re-replication by conditionally deregulating the replication origin (Green et al., 2010). They demonstrate that re-replication can generate duplication in cooperation with Ty repetitive elements, suggesting that this process is a potent inducer of gene amplification.
We have examined whether gene amplification can be induced when recombinational processes between inverted sequences are coupled with DNA replication. To efficiently induce the recombinational processes, Cre-lox site-specific recombination was used to design amplification system based on DRCR (Watanabe et al., 2011). This system successfully yielded HSR/DM-type products in yeast (Fig.4) and Chinese hamster ovary (CHO) cells (Fig.5). We first predicted that, if recombination occurs between un-replicated and recently replicated regions during replication (Fig.4A), the replication fork would make an additional copy of the replicated region. To induce DRCR, two sets of the recombinational process were utilized (Fig.4B and 4C). In yeast, the Cre induction caused a >7000-fold increase in the frequency of survivors and, surprisingly, over 10% of the Cre recombination-induced cells undergo gene amplification (Fig.4D). The HSR-type products appear to contain approximately 90-140 copies of the leu2d gene, corresponding to a 3.6~5.6-fold increase in the length of the original (275 kb) chromosome VI (Fig.4E).
For DRCR system in CHO cells, we constructed an amplification cassette on a rat genomic bacterial artificial chromosome (BAC), and integrated it into a specific site on a CHO cell chromosome using the Flp-FRT (Flp recombination target site) system (Fig.5A). An amplification marker, a mouse dihydrofolate reductase (DHFR) gene, provides methotrexate (MTX) resistance when amplified. This system successfully produced HSR/DM/Scattered-type amplification (Fig.5B-K).
Figure 4.
Gene amplification in yeast induced by Cre recombination.
(A) Recombinational process coupled with replication. The gray and black lines indicate the un-replicated and recently-replicated regions at the time of recombination, respectively. If recombination occurs between loxP sites marked red and blue (i), the replication template is switched and thereafter the replicated region is replicated again (ii). (B) DRCR induction. If both bidirectional DNA replications undergo the processes as described in (A), DRCR can be induced. Two different types of lox sequence, the wild-type loxP (lox for short) and a mutant-type loxm2 (m2 for short) were used. Cre recombination occurs between identical sites (lox-lox or m2-m2) but not between different sites (lox-m2). (C) Structure of the amplification cassette and a model for DRCR amplification. (D) Frequency of Leu+ colony formation. (E) Southern analysis of uncut chromosomal DNA from Leu+ survivors with the leu2d probe. The expression of Cre recombinase was induced in galactose medium for 90 min (Cre-induced). PFGE was performed with a wide-size range. The lanes marked in red and green indicate intra- and extra-chromosomal amplification, respectively. (D) Model for the production of extra-chromosomal products. These products are proposed to result from a single recombinational process coupled with DNA replication.
Figure 5.
Gene amplification in CHO cells induced by Cre recombination.
(A) Structure of the modified BAC and construction of the CHO strain for gene amplification. The sizes (kb) of the three regions in the structure are indicated below. (B) to (K) Metaphase FISH analysis with FITC-labeled probes (green). As a positive control (B), the CHO DR1000L-4N strain that contains ~170 copies of DHFR was probed with a pSV2-dhfr plasmid. The BAC-CHO strain (C; negative control) without Cre induction and MTX selection and MTX-resistant clones (D-K) were probed with the BAC in (A). DNA is counterstained with DAPI (blue). The scale bars represent 10 µm. These amplified products would be derived from the integrated BAC construct.
Figure 6.
Model for HSR/DM production in the CHO system.
A model for the HSR and DMs production by Cre recombination coupled with replication. See in the text.
Our Cre-lox system can induce tissue-specific amplification, and therefore may allow a direct approach to examine which genetic elements contribute to oncogenesis or malignant potential in each tissue when amplified. In addition, our CHO system showed scattered-type amplification products resembling those seen in cancer cells, although in non-cancerous cell line. From these results, we reasoned that DRCR are centrally involved in amplification of drug-resistance genes and oncogene. This system can serve as a good model for amplification in mammalian cells and contribute to a better understanding of oncogene amplification and development of anticancer strategies in the future.
The formation of HSR/DM-type products can be explained by Cre recombination coupled with replication in two alternative ways, by trans- or cis-recombination, which can induce either DRCR or convergent replication, respectively (Fig.6). The scattered-type amplification may be generated by reintegration of DM-type products into ectopic chromosomes through interspersed repetitive elements. In gene amplification in mammalian cells, BFB cycles would form megabase-sized inverted repeats, which may induce DRCR if homology-based recombination is coupled with DNA replication. Recently, a similar process, replication template exchange, was reported to lead to acentric or dicentric chromosome formation in yeast, indicating an important contribution to genome instability (Branzei and Foiani, 2010a; Mizuno et al., 2009; Paek et al., 2009). We propose that such processes can occur in cultured cells and tumor cells through genome instability associated with deregulated replication (Aguilera and Gomez-Gonzalez, 2008; Branzei and Foiani, 2010b).
3.3. Rearrangements in amplified regions
In amplified chromosomal regions, intensive chromosome rearrangements are frequently observed, leading to the increase in the gene copy number and to the decrease in size of the amplification unit (Debatisse and Malfor, 2005; Mondello et al., 2010). Nuclear blebs and micronuclei are frequently observed in cells with gene amplification and found to contain amplified sequences and thus may be a location for rearrangement of amplified region. However, how the rearrangements proceed is a long-standing question. In oncogene amplification, the complex patterns of amplification generated by the rearrangements are closely associated with poor prognosis in cancer (Chin et al., 2006; Hicks et al., 2006). Interestingly, we have observed the rearrangement in all our DRCR systems (Fig.7A and 7B). Sequences flanked by inverted repeats, which are formed by DRCR amplification, were subject to frequent inversion. We call this phenomenon DRCR-dependent inversion. To explore the link between the rearrangements and the DRCR process, we constructed a system that can turn on or off the occurrence of DRCR, using yeast 2μ plasmid (Okamoto et al., 2011). This system demonstrated that inversions, deletions, or duplications could be intensively induced in a DRCR-dependent manner. This result suggests that DRCR may cause the rearrangements in amplification in nature.
DRCR-dependent inversion is an interesting phenomenon, but the mechanism remains unknown. DRCR is expected to form an unstable structure, a palindromic structure. We propose that DRCR-dependent inversion may disrupt the palindromic structure and substantially stabilize the highly repetitive array (Fig.7B). We also proposed a model in which DRCR markedly stimulates recombinational events (Fig.7C). In eukaryotes, a protein complex, cohesin, bundles newly replicated sister chromatids until anaphase and regulates the separation of sister chromatids during cell division (Nasmyth, 1999). In DRCR process, however, one of newly replicated sister chromatids is used as a template for another replication fork, and therefore cohesin would fail to bundle the sister chromatids together. These cohesion-free regions are expected to be recombinogenic based on some data indicating activated recombination under cohesion-deficient conditions (Grossenbacher-Grunder & Thuriaux, 1981; Kobayashi et al. 2004).
Recently, a chromosome catastrophe phenomenon termed chromothripsis, in which numerous rearrangements are apparently acquired in one single catastrophic event, was observed in multiple cancers (Liu et al., 2011). The formation of intensive rearrangements has been proposed to involve a replication-based mechanism, the fork stalling and template switching (FoSTeS) model (Lee et al., 2007). The FoSTeS process may be engaged also in the intensive rearrangements in amplified chromosomal regions.
In cancer and drug-resistant cells, BFB cycles form large regular inverted repeats in the early stages of amplification, and thereafter these repeats rapidly change into shorter highly amplified units. However, it remains largely unknown how complex end products can be rapidly generated after BFB cycles. We expect that DRCR process play a key role in linking BFB cycles to complex end products. DRCR process may be initiated by DSBs or DNA replication stress within inverted chromosome regions formed through BFB cycles. This involvement of DRCR is supported by a recent data that HSR was lengthened more rapidly than expected from BFB cycle model (Harada et al., 2011).
Figure 7.
DRCR-dependent rearrangements
(A) Southern analysis of XhoI-digested DNA of some HSR-type samples in our BIR-based DRCR system with the leu2d probe. The fragment sizes in black and red indicate the expected and unexpected band. (B) Schematic representation of the expected structure derived through the DRCR process and XhoI-restriction maps of the representative HSR-type structure. (C) Model of the recombinogenic feature of DRCR. While cohesin complexes bundle newly replicated sister chromatids in normal DNA replication, in DRCR, cohesin would fail to bundle the sister chromatids together, leading to the exposure of recombinogenic region.
4. Concluding remarks
The processes of oncogene amplification are difficult to analyze because of the infrequency of amplification and the plasticity of amplified products. The development of model systems is one of the best approaches to overcome the difficulties in elucidating the molecular mechanisms. The model systems can serve as a good model for a better understanding of oncogene amplification and contribute to development of anticancer strategies in future.
Gene amplification is a hallmark of most advanced solid tumors and amplified genes are useful therapeutic targets. Immortalized cells can undergo amplification when selected with appropriate drugs (10-4 to 10-7), whereas gene amplification has never been detected in normal cells (<10-9) (Tlsty et al., 1989; Wright et al., 1990). This observation strongly suggests the defect in control of genome integrity in cancer cells.
Furthermore, cancer cells are often dependent on (addicted to) only one or a few genes conferring malignancy and growth advantage, although the cells involve multiple genetic and epigenetic abnormalities (Weinstein and Joe, 2006). This phenomenon, called ‘oncogene addiction’, is frequently observed with oncogenes associated with amplification, such as MYC, ERBB2, CCND1, and BCR-ABL, indicating that the enhanced expression of amplified genes would become a meaningful therapeutic targets.
The direct involvement of DRCR-related processes in oncogene amplification has yet to be demonstrated. Amplified oncogenes manifest a structural diversity. MYC gene is thought to amplify first as DMs, and thereafter integration into a chromosome can lead to HSR amplification consisting of direct or inverted repeats. Although many tumor cells would undergo BFB cycles, which form inverted array, amplification of MYCN and ERBB2 can be found as HSR with direct tandem repeats (Albertson, 2006). Amplified EGFR genes are present on DMs (Albertson, 2006), and BCR-ABL amplification was found on a chromosome (Gorre et al., 2001). These amplifications could not be explained by only one versatile process, but DRCR-related process may contribute to a variety of oncogene amplification. HSR and DMs in MYC amplification might be produced via DRCR and its related process like convergent replication, respectively (Fig.6). Furthermore, Our system can be adapted to simple rolling-circle replication (RCR) by replacing inverted sequences in our amplification cassettes to direct ones. This RCR forms direct tandem array as seen in amplification of MYCN and ERBB2. The DRCR-related processes can be initiated by any important triggers, such as DSB, inverted repeats, and replication stress, which genome instability in tumor or cancer cells could provide. These trigger reactions may occur via interspersed repetitive elements, including Alus, and short or long interspersed nucleotide element (SINE/LINE). The DRCR-related processes can generate intensive chromosome rearrangement, a common feature of oncogene amplification. Thus, we propose that DRCR-related processes can provide broad contributions to oncogene amplification at multiple phases.
We also believe that optimization and improvement of the model amplification systems could provide benefits for the production of therapeutic proteins. Thus, works that utilize the model systems will have great impact not only on scientific understanding but also in the medical, industrial and economic fields.
Acknowledgement
I am grateful to Prof. Takashi Horiuchi for his supervision in National Institute for Basic Biology (NIBB). I would like to thank all students, technicians, technologist, and faculty who have been supporting and guiding me. I appreciate Dr. Hisashi Tanaka giving me helpful discussion in Cleveland Clinic Lerner Research Institute. This was supported by Grant-in-Aid for Young Scientists (Japan Society for the Promotion of Science); Adaptable and Seamless Technology Transfer Program (Japan Science and Technology Agency); Research Project of the Center for the Promotion of Integrated Sciences of Sokendai.
\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/42311.pdf",chapterXML:"https://mts.intechopen.com/source/xml/42311.xml",downloadPdfUrl:"/chapter/pdf-download/42311",previewPdfUrl:"/chapter/pdf-preview/42311",totalDownloads:2157,totalViews:120,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,introChapter:null,impactScore:0,impactScorePercentile:12,impactScoreQuartile:1,hasAltmetrics:0,dateSubmitted:"December 8th 2011",dateReviewed:"November 19th 2012",datePrePublished:null,datePublished:"January 24th 2013",dateFinished:"January 24th 2013",readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/42311",risUrl:"/chapter/ris/42311",book:{id:"2883",slug:"oncogene-and-cancer-from-bench-to-clinic"},signatures:"Takaaki Watanabe",authors:[{id:"146616",title:"PhD.",name:"Takaaki",middleName:null,surname:"Watanabe",fullName:"Takaaki Watanabe",slug:"takaaki-watanabe",email:"watatka@nibb.ac.jp",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"National Institute for Basic Biology",institutionURL:null,country:{name:"Japan"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Barrier to efficient analyses",level:"1"},{id:"sec_3",title:"3. Model systems for understanding common features of gene amplification",level:"1"},{id:"sec_3_2",title:"3.1. DSB and inverted repeats",level:"2"},{id:"sec_4_2",title:"3.2. Replication stress within repeated sequences",level:"2"},{id:"sec_5_2",title:"3.3. Rearrangements in amplified regions",level:"2"},{id:"sec_7",title:"4. Concluding remarks",level:"1"},{id:"sec_7_2",title:"Acknowledgement",level:"2"}],chapterReferences:[{id:"B1",body:'AguileraAand Gomez-gonzalezB2008Genome instability: a mechanistic view of its causes and consequencesNat Rev Genet\n\t\t\t\t\t9204217'},{id:"B2",body:'AlbertsonD. 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1. Introduction
Metformin or 1,1-dimethylbiguanide is a derivate of isoamylene guanidine, a substance found in the plant Galega officinalis [1]. This drug is widely used in metabolic disorders as type 2 diabetes mellitus, metabolic syndrome, and gestational diabetes [2, 3]. Besides, metformin is used as a treatment for polycystic ovarian syndrome [4], which is characterized by the dysfunction of reproductive tissues such as the ovary and endometrium. In this context, metformin improves ovarian follicle dynamics and frequency of ovulation [5, 6], and it increases the expression of endometrial GLUT4 (insulin-regulated glucose transporter), which may improve endometrial physiology in these patients [7].
In the last decades, metformin has been studied in the context of cancer, especially after an initial report by Evans et al., performed with a Scottish database, who found that metformin intake reduces the risk of cancer in type 2 diabetic patients [8].
Type 2 diabetes and obesity affect a significant percentage of the world population [9, 10] whose food habits and lifestyle have been changing in the last decades. Both obesity and type 2 diabetes are pathologies associated with increased incidence and poor prognosis of ovarian cancer by several authors [11, 12, 13]. These observations could be explained because obesity and type 2 diabetes are characterized by molecular changes that could encourage tumoral transformation and progression, such as hyperinsulinemia, hyperglycemia, dyslipidemia, increased insulin-like growth factors (IGF), adipose tissue factors, and inflammatory components [14, 15, 16, 17, 18, 19].
By its chemical nature, metformin gets into the cell through organic cation transporters (OCTs) and multidrug and toxin extrusion transporters [20]. Because metformin cannot be metabolized, almost its entirety is excreted by the kidneys; the plasmatic levels of this drug do not reflect its intracellular concentration, mainly by its high apparent volume of distribution and prolonged half-life [21, 22]. Therefore, metformin is accumulated in tissues, and its plasmatic concentration is probably lower than of organs that express OCT transporters. This observation supports most in vitro studies that use high concentrations of metformin to study its antitumoral properties. Importantly, these transporters are present in the ovary [23, 24], so ovarian cancer cells could be a target for metformin action.
2. Indirect antitumoral effects of metformin in cancer
It is discussed that metformin could display direct and indirect antitumoral effects. The systemic effects of this drug include the decrease of blood glucose and insulin levels by action in its classical target organs: liver, muscle, and fat tissues. In humans, metformin decreases the hepatic gluconeogenesis and the release of glucose from hepatic reserves, which produces an increase in the peripheral uptake of glucose and its metabolism, decreasing patients’ hyperglycemia and hyperinsulinemia [1, 2, 25]. These conditions (hyperglycemia and hyperinsulinemia) favor tumoral growth and are associated with cancer incidence, by two possible mechanisms: (1) high availability of glucose for cancer cells and (2) high levels of insulin, which could act in insulin-like growth factor (IGF) receptors [14, 15, 16]. IGF/IGF receptors display an important role in the ovary, because 100% of the ovarian carcinomas express IGF receptors [26].
In fat tissue, metformin decreases the activity of lipogenic enzymes such as HMG-CoA reductase, acetyl-CoA carboxylase (ACC), and fatty acid synthase, decreasing the endogen production of cholesterol and the fatty acid synthesis [1, 27, 28]. This produces a decrease in the plasma levels of lipids in patients using metformin [29, 30, 31, 32], which in addition to metformin-hypoglycemic properties, decreases the readiness of energy substrates of tumoral cells.
All these metformin-mediated changes impair survival and mitogenic signaling and decrease nutrient availability for ovarian cancer cells.
3. Effects of metformin in ovarian cancer
3.1 Direct effects of metformin in ovarian cancer cells: role of AMPK
Several studies have shown that metformin displays direct antitumoral effects. Most of these studies have been performed in ovarian cancer cell lines, where metformin impairs cell proliferation, migration, and angiogenesis potential and enhances the chemotherapy sensibility [33, 34, 35, 36].
The direct antitumoral effects of metformin are commanded by metabolic changes in cancer cells. Because metformin is a drug with pleiotropic effects, several molecular targets at different levels of the tumoral cell have been described. One of the most studied targets for metformin is the adenosine monophosphate-activated protein kinase (AMPK), a key sensor of the energetic status of the cell [37], and it was described that metformin treatment can activate AMPK in in vitro and in vivo experiments of ovarian cancer models [33, 38]. The activation of AMPK occurs by increasing the AMP/ATP ratio [39] which exposes the activation loop of AMPK to be phosphorylated in the residue threonine 172 by serine/threonine kinases such as liver kinase B1 (LKB1) [40]. Activated AMPK phosphorylates several proteins; the phosphorylation can either activate or repress protein function at the cellular level [41, 42]. Despite that an important part of the studies indicates that the antitumoral effect of metformin could be AMPK-dependent; in the absence of AMPK, metformin preserves most of its antitumoral effects [43], indicating that the mechanism of this drug is more complex.
3.2 Antiproliferative mechanism of metformin in ovarian cancer cells
One of the characteristic hallmarks of cancer cells is an increased cell proliferation. To do so, ovarian cancer cells overexpress several growth factors and its receptors, which produce an enhanced cell signaling related with survival and proliferation in these cells [44, 45, 46].
In ovarian cancer, growth factors can activate protein kinase B (AKT) and the extracellular signal-regulated kinase (ERK) signaling pathways, among others [47, 48, 49]. These signaling pathways are associated with an increase of cell proliferation in most kinds of cancer cells [50, 51]. Some studies have shown that metformin treatment decreases IGF-1 and insulin levels, in a mice model with ovarian cancer [51], and also metformin treatment blocks the pro-tumoral effects of the nerve growth factor (NGF) in epithelial ovarian cancer cells [35] or the insulin/IGF-I signaling in uterine serous carcinoma [52].
The activation by growth factors of AKT and ERK signaling in ovarian cancer cells induces the activation of mechanistic target of rapamycin complex 1 (mTORC1), which controls protein translation and cell growth [53, 54, 55]. It is described that metformin-activated AMPK inhibits mTORC1 signaling in ovarian cancer cells [56, 57], which could impair its cell potential to proliferate and fend it in unfavorable conditions. Additionally, one key point in the antitumoral effect of metformin is that AMPK decreases the signaling pathways mediated by AKT and ERK in several types of cells, including cancer cells [38, 57, 58]. These signaling pathways are associated with the increase of most oncoproteins, for example, the transcription factor c-MYC and the inhibitory apoptotic protein survivin (BIRC5) [59, 60, 61, 62]. c-MYC is a proto-oncogene that controls several genes related with cell growth and cell proliferation, and some reports show that metformin decreases c-MYC protein levels in ovarian cancer cell lines [63, 64]. In addition, metformin decreases the mRNA levels of survivin in metastatic ovarian cancer cells [65].
According to current evidences, c-MYC controls the transcription and cell cycle inhibitors [66]. In agreement with the metformin-depending decrease of c-MYC in ovarian cancer cells, metformin induces the degradation of cyclin D1 [33, 38], a protein required for progression from G1 to S phase of the cell cycle, and increases p21 expression (a negative regulator of cell cycle) [67]. These results are consistent with experiments performed in primary ovarian cancer cell cultures and ovarian cancer cell lines, which show that metformin induces cell cycle arrest in the G0/G1 phase and decreases the percentage of cells in S phase of the cellular cycle [35, 68, 69]. These findings highly suggest that metformin decreases the progression of the cell cycle in ovarian cancer cells.
Even more, several authors have shown that metformin can elicit cytostatic or cytotoxic effects in ovarian cancer cells. A key point for a better understanding of these differences is that metformin inhibits tumor cell proliferation in the presence of glucose (with a cytostatic effect) but induces apoptosis in low-glucose conditions [70]. For example, ovarian cancer cells are more sensitive to metformin at concentrations of 2.5 millimolar than in 25 millimolar of glucose (found in culture conditions). This is a consequence of reactive oxygen species accumulation, which increase cell apoptosis and endoplasmic reticulum stress and decrease of c-MYC protein levels [63, 70].
3.3 Effect of metformin in lipid metabolism of ovarian cancer cells
For cell proliferation, the cancer cell has high requirements of substrates for synthesis of structural components and signaling. One target of AMPK is the sterol regulatory element-binding protein 1 (SREBP1), a lipogenic transcription factor [71], which increases cellular biosynthesis of fatty acids and cholesterol by transcription of the enzymes ACC, HMG-CoA reductase, and fatty acid synthase [72], not only in fat tissue but also in ovarian cancer cells [73]. Because ACC is involved in the taxol-mediated cytotoxic effect of ovarian cancer cells [74], besides the fact that the inhibition of ACC suppresses ovarian cancer cell growth in vivo and in vitro [75], it is possible to conclude that ACC inhibition could contribute to an important part of the antitumoral effects of metformin.
3.4 Anti-angiogenic activity of metformin in ovarian cancer
Angiogenesis, defined as the generation of new blood vessels from preexisting ones [76], is an essential process to supply oxygen and nutrients to normal and tumoral ovarian cells. Unfortunately, this process is exacerbated in ovarian cancer cells, which overexpress some growth factors, such as vascular endothelial growth factor (VEGF) or NGF [77, 78] which promotes angiogenesis.
The relevance of metformin in the vascular context is recognized; however, its action depends on the cell type, metabolic status, and nutrient availability. For example, some pro-angiogenic properties have been attributed to metformin under hypoxia and hyperglycemia, similar characteristics to myocardial infarction in diabetic patients. In this context, metformin enhances endothelial cell survival, migration, and apoptosis inhibition [79, 80]; this strongly suggests that the use of metformin could be beneficial in the context of cardiovascular diseases in diabetic patients. On the other hand, metformin could have an opposite effect in endothelial cells under hypoglycemic conditions (as tumor endothelial cells), where metformin produces an inhibition of its cell proliferation and angiogenesis potential, as will be discussed later.
In the ovary, the correct formation and regression of blood vessels during each ovarian cycle is indispensable for proper follicular development, ovulation, and corpus luteum formation, so that angiogenesis displays a key role in ovarian homeostasis and pathogenesis [81]. In patients with polycystic ovary syndrome, an increased expression of VEGF is described, and it is hypothesized that part of the beneficial metformin-associated effects will be mediated by a decrease or normalization of its VEGF levels. For example, it is described that in a rat model with dehydroepiandrosterone-induced polycystic ovaries, metformin administration restores the ovarian-increased levels of VEGF and angiopoietin 1, both angiogenic factors [82]. In addition, women with polycystic ovarian syndrome who take metformin have decreased their levels of plasmatic endothelin 1 and plasminogen activator inhibitor-1 [83, 84], molecules that also promote angiogenesis.
The angioprotection is an antitumoral mechanism that has been explored in ovarian cancer. Considering that the most studied angiogenic factor is VEGF, a monoclonal antibody against VEGF called bevacizumab has been developed and was approved for the use in advanced stages of ovarian cancer [85, 86]. In ovarian cancer models, the main knowledge of anti-angiogenic characteristics of metformin comes from VEGF modulation. Several in vitro models have shown that metformin decreases both VEGF mRNA and protein levels in ovarian cancer cell lines and then, its angiogenic potential [33, 64]. In a mice model with ovarian cancer, metformin decreases VEGF levels in plasma and ascitic fluid, with a consistent decrease of the ovarian tumor growth [51]. Interestingly, metformin reduces the vascular density (showed by CD31 staining) of ovarian cancer xenografts in mice, and metformin-/cisplatin-treated mice have significantly less vascular density than either metformin or cisplatin alone [33]. Because cisplatin/carboplatin and paclitaxel are drugs used in the first-line chemotherapy in ovarian cancer [87, 88], these results suggest that metformin could potentiate the anti-angiogenic effects of chemotherapy during ovarian cancer treatment.
On the other hand, metformin treatment (in millimolar concentrations) displays direct effects in the endothelial cells, by reducing cell proliferation in human umbilical vein endothelial cells (HUVEC) and endothelial progenitor cells [89, 90]. Similar results were replicated by our group where metformin decreases cell proliferation of the endothelial cell line EA.hy926, in a dose-dependent manner [35], as well as, the endothelial cell differentiation (Figure 1). These results suggest that metformin affects in a direct manner the angiogenesis potential of endothelial cells.
Figure 1.
Effect of metformin on the differentiation of endothelial cells. Metformin reduces the multicellular junctions and polygonal structures of endothelial cells EA.hy926 in a matrigel assay (4 h). Upper insert: positive control (NGF 100 ng/ml). Magnification bar: 50 μm.
3.5 Posttranscriptional regulation by metformin in ovarian cancer cells
In the ovarian cell, posttranscriptional regulations control gene expression at RNA level [91]. The micro-RNAs (miRs) are short non-codificant RNAs that regulate the expression of approximately 60% of protein-coding genes of the human genome [92]. miRs bind to a messenger RNA target, producing its degradation or translational repression depending of complementary degree [93]. The machinery for expression, processing, and exportation of miRs depends on several proteins as RNAse III DICER and exportins [93]. It is described that DICER downregulation is an oncogenic event that enhances epithelial-mesenchymal transition (EMT) and metastatic dissemination in cancer cells [94]. An important antecedent is that metformin elicits anticancer effects through the sequential modulation of DICER and c-MYC in breast cancer cells, increasing oncosuppressor miRs [95]. These mechanisms have not been investigated in ovarian cancer cells; nevertheless, preliminary results from our group show that metformin increases the oncosuppressor miRs 23-b and miR-145 in the epithelial ovarian cells [96].
As already mentioned in point 3.3, the activation of AMPK by metformin produces an inhibitory phosphorylation of acetyl-CoA carboxylase, an enzyme that regulates lipid metabolism. Importantly, intermediaries of lipid metabolism participate in cell signaling and chromatin structure, modulating processes as cell histone acetylation that depends on cytosolic acetyl-CoA [97]. The decrease of the conversion of acetyl-CoA to malonyl-CoA leads to an increase in the acetylation of histones in the chromatin and altered gene expression in ovarian cancer cells [67]. Because acetylation of nucleosomal histones is linked to nuclear processes as transcription, replication, and repair among other functions [98], it is possible that several antitumoral effects of metformin could be regulated by protein acetylation and transcriptional regulation of several oncosuppressor proteins.
The summary of the main studied antitumoral effects of metformin is shown in Figure 2.
Figure 2.
Main antitumoral mechanism of metformin in ovarian cancer cells. Metformin enters the cell through organic cationic transporters (OCT) and produces the activation of liver kinase B1 (LKB1) and an increase of AMP/ATP ratio, which results in the activation of AMPK. This kinase has several targets as sterol regulatory element-binding protein 1 (SREBP) and acetyl-CoA carboxylase (ACC); the mechanistic target of rapamycin complex 1 (mTORC1) and AKT/ERK signaling; key proteins in the fatty acid synthesis and cell growth, survival, proliferation, and migration; and the processes of epithelial-mesenchymal transition (EMT). On the other hand, metformin can block the growth factor (GF) signaling dependent or independent of AMPK activation. Also metformin decreases the angiogenic potential of ovarian cancer cells, impairs the expression of vascular endothelial growth factor (VEGF), or acts directly on the endothelial cells.
3.6 Studies of metformin in diabetic patients with ovarian cancer
A recent meta-analysis shows that among available studies of relationship between metformin intake with ovarian cancer incidence and prognosis in diabetic patients, the majority of the studies indicate a negative correlation between the use of metformin and the incidence of ovarian cancer, as well as, a positive correlation with better prognosis [99]. The same study shows that metformin treatment in diabetic patients has a reduction of 24% risk of ovarian cancer occurrence and also a 42% of reduction in mortality [99]. The main studies that showed metformin benefits in the context of ovarian cancer diabetic patients are summarized in Table 1.
Case-control study 1611 cases (OvCa) and 9170 controls (non-OvCa), UK
Metformin use was associated with a decreased of risk of OvCa
Table 1.
Summary of studies that evaluated incidence and prognosis of ovarian cancer (OvCa) patients using and not using metformin.
PFS: progression-free survival (length of time during and after the treatment of OvCa that a patient lives with the disease but it does not get worse).
DSS: disease-specific survival (percentage of people in a study or treatment group who have not died from OvCa in a defined period of time).
Although several observational studies show positive effects of metformin in diabetic patients, it has not yet been elucidated if metformin could be beneficial in nondiabetic patients. In addition, ovarian cancer has a low incidence, and the number of participants in some of the available studies is low; therefore, the evidence should be interpreted with caution.
Because of the increased interest in the possible use of metformin in nondiabetic patients, there are currently six clinical trials inscribed in NIH ClinicalTrials.gov database to study metformin intake in association with carboplatin and paclitaxel (first-line chemotherapy) in nondiabetic woman with ovarian cancer (NCT02312661, NCT02437812, NCT03378297, NCT02122185, NCT01579812, and NCT02201381) from phase 0 to phase III of the study. The results of one of these trials show that metformin was well tolerated and the outcome results were favorable, because tumors from metformin-treated women have a threefold decrease in specific subpopulations of ovarian cancer stem cells with an increased sensitivity to cisplatin in vitro [100], supporting the use of metformin in the following phases of the study.
3.7 Role of metformin in metastasis and chemoresistance
Besides the abovementioned benefits, metformin treatment has a relevant role in the metastasis and chemoresistance prevention of several ovarian cancer models. For example, in vitro experiments have shown that metformin decreases the adhesion capacity, invasion, and migration of ovarian cancer cell lines [101]. In rodents, metformin treatment inhibits the growth of metastatic nodules in the lung product of ovarian cancer [33], and importantly, the use of metformin in diabetic women decreases the probability of disease recurrence [102].
The cancer stem cells, recently called “tumor-initiating cells,” are a tumoral cell subpopulation with critical role in therapy resistance and metastasis [103, 104, 105]. There are several markers to identify them, as lactate dehydrogenase (LDH), aldehyde dehydrogenase (ALDH), or cell-surface antigens as CD44, CD133, or CD117 [106, 107, 108]. Metformin treatment decreases the abundance of ovarian cancer LDH+ and decreases its ability to form tumor spheres, an attachment-independent growth characteristic of these kinds of cells [109]. At the same time, a low dose of metformin (micromolar concentration) decreases the abundance of CD44+/CD117+ ovarian cancer cells selectively, whereas CD133+ or ALDH+ cell subpopulation were more sensitive to millimolar concentration of this drug [109, 110].
Another key point is that metformin decreases the expression of classical markers related with EMT. This process is necessary to confer an increased migratory capacity to tumor cells, participating in the intra-/extravasation and hence, in the tumor cell dissemination. In CD44+/CD117+ ovarian cancer cells, metformin treatment decreases snail2, twist, and vimentin protein levels (these are mesenchymal markers), increasing E-cadherin protein levels (a known epithelial marker) [110]. These observations are related with a study performed in diabetic patients with endometrial cancer, where in the biopsies of these patients using metformin were found increased levels of E-cadherin [111]. These findings suggest that metformin decreases the process of EMT in ovarian cancer cells, affecting preferentially tumor-initiating cells, which constitutes a relevant advantage, because this type of cells is not affected by traditional chemotherapy.
One important aspect in ovarian cancer treatment is the high percentage of chemoresistance developed by patients. In this context, metformin stands as a promising drug, since several studies showed that it could increase the susceptibility of ovarian cancer cells to chemotherapy and revert its acquired chemoresistance [34, 112, 113]. One recent study performed in ovarian cancer cell lines treated for 6 months with cisplatin and paclitaxel (for the acquirement of chemoresistance phenotype) shows that metformin treatment increases drug sensitivity and reduces migratory abilities of these ovarian cancer cells. In addition, the same study shows that metformin decrease the ovarian cancer stem cell population and the expression of specific biomarkers of pluripotent genes [112].
3.8 Main conclusions
Metformin is an antidiabetic drug that displays antitumoral effects in several in vivo and in vitro models of cancer, including ovarian cancer. The mechanism of its antitumoral effects could be either dependent or independent of AMPK, a key sensor of the cell energetic status. Metformin has several cell targets which include transcription factors and cell cycle regulators; wherewith it impairs cell proliferation by the arrest of the cell cycle. In addition, metformin modulates enzymes of metabolic pathways and lipid metabolism, as well as epigenetic and posttranscriptional regulation of the ovarian cancer cells, which can explain its pleiotropic actions. Another important point is that metformin regulates angiogenesis in the ovarian cancer cells, mainly decreasing VEGF expression, which impairs the angiogenic potential of these cells. On the other hand, metformin acts directly in endothelial cells, decreasing its proliferation, migration and differentiation, which complement its anti-angiogenic effect.
An important niche for metformin treatment could be its selective effect in ovarian cancer cells with stem cell phenotype, which are responsible for ovarian cancer dissemination and chemotherapy resistance. Several studies show that metformin reduces ovarian cancer stem cells abundance and that it could have a chemosensitivity role when used in combination with first-line chemotherapy agents. This opens the possibility to the potential use of metformin as a coadjuvant agent in ovarian cancer treatment.
Finally, there are several observational studies in diabetic women with ovarian cancer which show that metformin is associated with less ovarian cancer incidence and better prognosis. However, it is important to consider that the number of participants using metformin in some of these studies is low and that several in vitro experiments have shown that metformin action depends on the metabolic context and nutrient and oxygen availability of ovarian cancer cells. For these reasons, the use of metformin in nondiabetic women with ovarian cancer should be considered with caution.
Currently, there are several clinical trials performed in women with ovarian cancer. These trials are studying the effect of metformin treatment together with standard chemotherapy in the ovarian cancer prognosis and clinic-pathological markers, which could be helpful to elucidate whether this drug could be considered as a coadjuvant alternative in the treatment of ovarian cancer.
Acknowledgments
The authors would like to thank the National Fund for Scientific and Technological Development (FONDECYT) #1160139.
Conflict of interest
The authors declare no conflict of interest.
Appendices and nomenclature
ACC
acetyl-CoA carboxylase
AKT
activate protein kinase B
AMPK
adenosine monophosphate-activated protein kinase
ALDH
aldehyde dehydrogenase
EMT
epithelial-mesenchymal transition
ERK
extracellular signal-regulated kinase
HUVEC
human umbilical vein endothelial cells
IGF
insulin-like growth factor
LDH
lactate dehydrogenase
LKB1
liver kinase B1
mTORC1
mechanistic target of rapamycin complex 1
miRs
micro-RNAs
NGF
nerve growth factor
OCTs
organic cationic transporters
SREBP1
sterol regulatory element-binding protein 1
VEGF
vascular endothelial growth factor
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Introduction",level:"1"},{id:"sec_2",title:"2. Indirect antitumoral effects of metformin in cancer",level:"1"},{id:"sec_3",title:"3. Effects of metformin in ovarian cancer",level:"1"},{id:"sec_3_2",title:"3.1 Direct effects of metformin in ovarian cancer cells: role of AMPK",level:"2"},{id:"sec_4_2",title:"3.2 Antiproliferative mechanism of metformin in ovarian cancer cells",level:"2"},{id:"sec_5_2",title:"3.3 Effect of metformin in lipid metabolism of ovarian cancer cells",level:"2"},{id:"sec_6_2",title:"3.4 Anti-angiogenic activity of metformin in ovarian cancer",level:"2"},{id:"sec_7_2",title:"3.5 Posttranscriptional regulation by metformin in ovarian cancer cells",level:"2"},{id:"sec_8_2",title:"3.6 Studies of metformin in diabetic patients with ovarian cancer",level:"2"},{id:"sec_9_2",title:"3.7 Role of metformin in metastasis and chemoresistance",level:"2"},{id:"sec_10_2",title:"3.8 Main conclusions",level:"2"},{id:"sec_12",title:"Acknowledgments",level:"1"},{id:"sec_15",title:"Conflict of interest",level:"1"},{id:"sec_12",title:"Appendices and nomenclature",level:"1"}],chapterReferences:[{id:"B1",body:'Rena G, Hardie DG, Pearson ER. 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Metformin increases E-cadherin in tumours of diabetic patients with endometrial cancer and suppresses epithelial-mesenchymal transition in endometrial cancer cell lines. International Journal of Gynecological Cancer. 2016;26(7):1213-1221'},{id:"B112",body:'Bishnu A, Sakpal A, Ghosh N, Choudhury P, Chaudhury K, Ray P. Long term treatment of metformin impedes development of chemoresistance by regulating cancer stem cell differentiation through taurine generation in ovarian cancer cells. The International Journal of Biochemistry & Cell Biology. 2019;107:116-127'},{id:"B113",body:'Kim NY, Lee HY, Lee C. Metformin targets Axl and Tyro3 receptor tyrosine kinases to inhibit cell proliferation and overcome chemoresistance in ovarian cancer cells. International Journal of Oncology. 2015;47(1):353-360'},{id:"B114",body:'Bar D, Lavie O, Stein N, Feferkorn I, Shai A. The effect of metabolic comorbidities and commonly used drugs on the prognosis of patients with ovarian cancer. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2016;207:227-231'},{id:"B115",body:'Tseng CH. Metformin reduces ovarian cancer risk in Taiwanese women with type 2 diabetes mellitus. Diabetes/Metabolism Research and Reviews. 2015;31(6):619-626'},{id:"B116",body:'Kumar S, Meuter A, Thapa P, Langstraat C, Giri S, Chien J, et al. Metformin intake is associated with better survival in ovarian cancer: A case-control study. Cancer. 2013;119(3):555-562'},{id:"B117",body:'Bodmer M, Becker C, Meier C, Jick SS, Meier CR. Use of metformin and the risk of ovarian cancer: A case-control analysis. Gynecologic Oncology. 2011;123(2):200-204'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Maritza P. Garrido",address:null,affiliation:'
Laboratory of Endocrinology and Reproduction Biology, Clinical Hospital University of Chile, Obstetrics and Gynecology Department, Faculty of Medicine, University of Chile, Santiago, Chile
Laboratory of Endocrinology and Reproduction Biology, Clinical Hospital University of Chile, Obstetrics and Gynecology Department, Faculty of Medicine, University of Chile, Santiago, Chile
Laboratory of Endocrinology and Reproduction Biology, Clinical Hospital University of Chile, Obstetrics and Gynecology Department, Faculty of Medicine, University of Chile, Santiago, Chile
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Chronic and recurrent seizures may give rise to cell necrosis, astrocyte activation, neuron death, reactive oxygen species (ROS) production, and mitochondria dysfunction. Recent studies have shown that cell-based therapy is a promising treatment option for epilepsy. Various stem cell types were used for treatment of epilepsy in basic and experimental researches. It is especially vital to gauge the efficacy of distinct donor cell types, such as the embryonic stem cells and induced pluripotent stem cells (iPSCs), mesenchymal stem cells (MSCs), hippocampal precursor cells, γ-aminobutyric acid-ergic progenitors, neural stem cells. The goal of this chapter is to evaluate the progress made hitherto in this area and to discuss the prospect for cell-based therapy for epilepsy.",signatures:"Huifang Zhao and Zhiyuan Li",authors:[{id:"102881",title:"Dr.",name:"Zhiyuan",surname:"Li",fullName:"Zhiyuan Li",slug:"zhiyuan-li",email:"li_zhiyuan@gibh.ac.cn"},{id:"325855",title:"Dr.",name:"Huifang",surname:"Zhao",fullName:"Huifang Zhao",slug:"huifang-zhao",email:"zhao_huifang@gibh.ac.cn"}],book:{id:"9519",title:"Epilepsy",slug:"epilepsy-update-on-classification-etiologies-instrumental-diagnosis-and-treatment",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"31988",title:"Prof.",name:"Kaneez",surname:"Fatima Shad",slug:"kaneez-fatima-shad",fullName:"Kaneez Fatima Shad",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRhwqQAC/Profile_Picture_1643703122186",biography:"Professor Kaneez Fatima Shad, an Australian neuroscientist with a medical background, obtained a Ph.D. from the Faculty of Medicine, University of New South Wales (UNSW), Australia, in 1994, followed by a postdoc at the Allegheny University of Health Sciences, Philadelphia, USA. She taught medical and biological sciences at various universities in Australia, the United States, United Arab Emirates, Bahrain, Pakistan, and Brunei. During this period, she was also engaged in research by obtaining local and international grants (a total of more than $3 million USD) and developing products such as a rapid diagnostic test for stroke and other vascular disorders (i.e., schizophrenia). She has published more than sixty-eight articles in refereed journals, edited nine books, authored ten book chapters, presented at more than ninety international conferences, and mentored thirty-four postgraduate students. 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During the past 15 years, Dr. Robson has been working with the purinergic receptors, especially P2X7R, and the action of synthetic molecules and derivatives of natural products to discover new prototypes capable of treating neglected diseases.",institutionString:null,institution:{name:"Oswaldo Cruz Foundation",institutionURL:null,country:{name:"Brazil"}}},{id:"101772",title:"Dr.",name:"Takashi",surname:"Kawano",slug:"takashi-kawano",fullName:"Takashi Kawano",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kochi Medical School Hospital",institutionURL:null,country:{name:"Japan"}}},{id:"102309",title:"Prof.",name:"Manabu",surname:"Kubokawa",slug:"manabu-kubokawa",fullName:"Manabu Kubokawa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Iwate Medical University",institutionURL:null,country:{name:"Japan"}}},{id:"103309",title:"Prof.",name:"Anton",surname:"Hermann",slug:"anton-hermann",fullName:"Anton Hermann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Salzburg",institutionURL:null,country:{name:"Austria"}}},{id:"103723",title:"Prof.",name:"Péter",surname:"Nánási",slug:"peter-nanasi",fullName:"Péter Nánási",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Debrecen",institutionURL:null,country:{name:"Hungary"}}},{id:"110140",title:"Dr.",name:"Tamas",surname:"Banyasz",slug:"tamas-banyasz",fullName:"Tamas Banyasz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Debrecen",institutionURL:null,country:{name:"Hungary"}}},{id:"115461",title:"Prof.",name:"Norio",surname:"Akaike",slug:"norio-akaike",fullName:"Norio Akaike",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kumamoto Health Science University",institutionURL:null,country:{name:"Japan"}}},{id:"141074",title:"Dr.",name:"Thomas M",surname:"Weiger",slug:"thomas-m-weiger",fullName:"Thomas M Weiger",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"141075",title:"Dr.",name:"Guzel F",surname:"Sitdikova",slug:"guzel-f-sitdikova",fullName:"Guzel F Sitdikova",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"OA-publishing-fees",title:"Open Access Publishing Fees",intro:"
The Open Access model is applied to all of our publications and is designed to eliminate subscriptions and pay-per-view fees. This approach ensures free, immediate access to full text versions of your research.
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XML Typesetting and pagination - web (PDF, HTML) and print files preparation
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Permanent and unrestricted online access to your work
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Open Access Funding
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Proven world leader in Open Access book publishing with over 10 years experience
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The Open Access Publishing Fee (OAPF) is payable only after your book chapter, monograph or journal article is accepted for publication.
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OAPF Publishing Options
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850 GBP Journal Article (Across Portfolio)
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During the launching phase journals do not charge an APC, rather they will be funded by IntechOpen.
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*These prices do not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT as long as provision of the VAT registration number is made during the application process. This is made possible by the EU reverse charge method.
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Services included are:
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An online manuscript tracking system to facilitate your work
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Personal contact and support throughout the publishing process from your dedicated Author Service Manager
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Assurance that your manuscript meets the highest publishing standards
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English language copyediting and proofreading, including the correction of grammatical, spelling, and other common errors
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XML Typesetting and pagination - web (PDF, HTML) and print files preparation
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Discoverability - electronic citation and linking via DOI
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Permanent and unrestricted online access to your work
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What isn't covered by the Open Access Publishing Fee?
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If your manuscript:
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Exceeds the number of pages defined by the publishing guidelines, an additional fee per page may be required
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If a manuscript requires Heavy Editing or Language Polishing, this will incur additional fees.
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Your Author Service Manager will inform you of any items not covered by the OAPF and provide exact information regarding those additional costs before proceeding.
\n\n
Open Access Funding
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To explore funding opportunities and learn more about how you can finance your IntechOpen publication, go to our Open Access Funding page. IntechOpen offers expert assistance to all of its Authors. We can support you in approaching funding bodies and institutions in relation to publishing fees by providing information about compliance with the Open Access policies of your funder or institution. We can also assist with communicating the benefits of Open Access in order to support and strengthen your funding request and provide personal guidance through your application process. You can contact us at funders@intechopen.com for further details or assistance.
\n\n
For Authors who are still unable to obtain funding from their institutions or research funding bodies for individual projects, IntechOpen does offer the possibility of applying for a Waiver to offset some or all processing feed. Details regarding our Waiver Policy can be found here.
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Added Value of Publishing with IntechOpen
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Choosing to publish with IntechOpen ensures the following benefits:
\n\n
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Indexing and listing across major repositories, see details ...
\n\t
Long-term archiving
\n\t
Visibility on the world's strongest OA platform
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Live Performance Metrics to track readership and the impact of your chapter
\n\t
Dissemination and Promotion
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Benefits of Publishing with IntechOpen
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Proven world leader in Open Access book publishing with over 10 years experience
\n\t
+5,700 OA books published
\n\t
Most competitive prices in the market
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Fully compliant with OA funding requirements
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Optimized processes that assure your research is made available to the scientific community without delay
\n\t
Personal support during every step of the publication process
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+184,650 citations in Web of Science databases
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Currently strongest OA platform with over 175 million downloads
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Over the past few decades, no major new types of antibiotics have been produced and almost all known antibiotics are increasingly losing their activity against pathogenic microorganisms. The levels of multi-drug resistant bacteria have also increased. It is known that worldwide, more than 60% of all antibiotics that are produced find their use in animal production for both therapeutic and non-therapeutic purposes. The use of antimicrobial agents in animal husbandry has been linked to the development and spread of resistant bacteria. Poultry products are among the highest consumed products worldwide but a lot of essential antibiotics are employed during poultry production in several countries; threatening the safety of such products (through antimicrobial residues) and the increased possibility of development and spread of microbial resistance in poultry settings. This chapter documents some of the studies on antibiotic usage in poultry farming; with specific focus on some selected bacterial species, their economic importance to poultry farming and reports of resistances of isolated species from poultry settings (farms and poultry products) to essential antibiotics.",book:{id:"6978",slug:"antimicrobial-resistance-a-global-threat",title:"Antimicrobial Resistance",fullTitle:"Antimicrobial Resistance - A Global Threat"},signatures:"Christian Agyare, Vivian Etsiapa Boamah, Crystal Ngofi Zumbi and\nFrank Boateng Osei",authors:[{id:"182058",title:"Dr.",name:"Christian",middleName:null,surname:"Agyare",slug:"christian-agyare",fullName:"Christian Agyare"},{id:"261271",title:"MSc.",name:"Crystal Ngofi",middleName:null,surname:"Zumbi",slug:"crystal-ngofi-zumbi",fullName:"Crystal Ngofi Zumbi"},{id:"261272",title:"MSc.",name:"Frank Boateng",middleName:null,surname:"Osei",slug:"frank-boateng-osei",fullName:"Frank Boateng Osei"},{id:"261273",title:"Dr.",name:"Vivian Etsiapa",middleName:null,surname:"Boamah",slug:"vivian-etsiapa-boamah",fullName:"Vivian Etsiapa Boamah"}]},{id:"49246",doi:"10.5772/61300",title:"Chitosan as a Biomaterial — Structure, Properties, and Electrospun Nanofibers",slug:"chitosan-as-a-biomaterial-structure-properties-and-electrospun-nanofibers",totalDownloads:4720,totalCrossrefCites:27,totalDimensionsCites:63,abstract:"Chitosan is a polysaccharide derived from chitin; chitin is the second most abundant polysaccharide in the world, after cellulose. Chitosan is biocompatible, biodegradable and non-toxic, so that it can be usedin medicalapplications such as antimicrobial and wound healing biomaterials. It also used as chelating agent due to its ability to bind with cholesterol, fats, proteins and metal ions.",book:{id:"4648",slug:"concepts-compounds-and-the-alternatives-of-antibacterials",title:"Concepts, Compounds and the Alternatives of Antibacterials",fullTitle:"Concepts, Compounds and the Alternatives of Antibacterials"},signatures:"H. M. Ibrahim and E.M.R. El- Zairy",authors:[{id:"90645",title:"Dr.",name:"Hassan",middleName:null,surname:"Ibrahim",slug:"hassan-ibrahim",fullName:"Hassan Ibrahim"},{id:"175694",title:"Dr.",name:"Enas",middleName:null,surname:"El- Zairy",slug:"enas-el-zairy",fullName:"Enas El- Zairy"}]},{id:"70919",doi:"10.5772/intechopen.90891",title:"Antimicrobial Effect of Titanium Dioxide Nanoparticles",slug:"antimicrobial-effect-of-titanium-dioxide-nanoparticles",totalDownloads:1802,totalCrossrefCites:21,totalDimensionsCites:46,abstract:"The widespread use of antibiotics has led to the emergence of multidrug-resistant bacterial strains, and therefore a current concern for food safety and human health. The interest for new antimicrobial substances has been focused toward metal oxide nanoparticles. Specifically, titanium dioxide (TiO2) has been considered as an attractive antimicrobial compound due to its photocatalytic nature and because it is a chemically stable, non-toxic, inexpensive, and Generally Recognized as Safe (GRAS) substance. Several studies have revealed this metal oxide demonstrates excellent antifungal and antibacterial properties against a broad range of both Gram-positive and Gram-negative bacteria. These properties were significantly improved by titanium dioxide nanoparticles (TiO2 NPs) synthesis. In this chapter, latest developments on routes of synthesis of TiO2 NPs and antimicrobial activity of these nanostructures are presented. Furthermore, TiO2 NPs favor the inactivation of microorganisms due to their strong oxidizing power by free radical generation, such as hydroxyl and superoxide anion radicals, showing reductions growth against several microorganisms, such as Escherichia coli and Staphylococcus aureus. 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Aggregation continues with the maturation of biofilm. Dispersion is started by certain conditions such as phenol-soluble modulins (PSMs). By this way, sessile bacteria turn back into planktonic form. Bacteria embedded in biofilm (sessile form) are more resistant to antimicrobials than planktonic bacteria. So it is hard to treat biofilm-embedded bacteria than planktonic forms. For this reason, it is important to detect biofilm. There are a few biofilm detection and biofilm production methods on prosthetics, methods for screening antibacterial effect of agents against biofilm-embedded microorganism and antibiofilm effect of agents against biofilm production and mature biofilm. The aim of this chapter is to overview direct and indirect methods such as microscopy, fluorescent in situ hybridization, and Congo red agar, tube method, microtiter plate assay, checkerboard assay, plate counting, polymerase chain reaction, mass spectrometry, MALDI-TOF, and biological assays used by antibiofilm researches.",book:{id:"8427",slug:"antimicrobials-antibiotic-resistance-antibiofilm-strategies-and-activity-methods",title:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods",fullTitle:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods"},signatures:"Sahra Kırmusaoğlu",authors:[{id:"179460",title:"Associate Prof.",name:"Sahra",middleName:null,surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"}]},{id:"63397",doi:"10.5772/intechopen.80624",title:"Antibiotic Resistance in Lactic Acid Bacteria",slug:"antibiotic-resistance-in-lactic-acid-bacteria",totalDownloads:2480,totalCrossrefCites:12,totalDimensionsCites:21,abstract:"Most starter cultures belong to the lactic acid bacteria group (LAB) and recognized as safe by the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA). However, LAB may act as intrinsic or extrinsic reservoirs for antibiotic resistance (AR) genes. This fact may not constitute a safety concern itself, as the resistance gene transfer is vertical. Nevertheless, external genetic elements may induce changes that favor the horizontal transfer transmission of resistance from pathogens as well as from the human intestinal microbiota, which represents a severe safety issue. Some genus of AR LAB includes Enterococcus, Lactobacillus, Lactococcus, Leuconostoc, Pediococcus, and Streptococcus isolated from fermented meat and milk products. Currently, the WHO recommends that LAB used in the food industry should be free of resistance. Therefore, the objective of this chapter is to present an overview of the LAB antibiotic resistance and some methods to determine the same.",book:{id:"6978",slug:"antimicrobial-resistance-a-global-threat",title:"Antimicrobial Resistance",fullTitle:"Antimicrobial Resistance - A Global Threat"},signatures:"Yenizey M. 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After attachment, aggregation of bacteria is started by cell-cell adhesion. Aggregation continues with the maturation of biofilm. Dispersion is started by certain conditions such as phenol-soluble modulins (PSMs). By this way, sessile bacteria turn back into planktonic form. Bacteria embedded in biofilm (sessile form) are more resistant to antimicrobials than planktonic bacteria. So it is hard to treat biofilm-embedded bacteria than planktonic forms. For this reason, it is important to detect biofilm. There are a few biofilm detection and biofilm production methods on prosthetics, methods for screening antibacterial effect of agents against biofilm-embedded microorganism and antibiofilm effect of agents against biofilm production and mature biofilm. 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Over the past few decades, no major new types of antibiotics have been produced and almost all known antibiotics are increasingly losing their activity against pathogenic microorganisms. The levels of multi-drug resistant bacteria have also increased. It is known that worldwide, more than 60% of all antibiotics that are produced find their use in animal production for both therapeutic and non-therapeutic purposes. The use of antimicrobial agents in animal husbandry has been linked to the development and spread of resistant bacteria. Poultry products are among the highest consumed products worldwide but a lot of essential antibiotics are employed during poultry production in several countries; threatening the safety of such products (through antimicrobial residues) and the increased possibility of development and spread of microbial resistance in poultry settings. 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Kocazeybek",authors:[{id:"179460",title:"Associate Prof.",name:"Sahra",middleName:null,surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"},{id:"248288",title:"Prof.",name:"Bekir",middleName:null,surname:"Kocazeybek",slug:"bekir-kocazeybek",fullName:"Bekir Kocazeybek"},{id:"406463",title:"Dr.",name:"Nesrin",middleName:null,surname:"Gareayaghi",slug:"nesrin-gareayaghi",fullName:"Nesrin Gareayaghi"}]},{id:"63397",title:"Antibiotic Resistance in Lactic Acid Bacteria",slug:"antibiotic-resistance-in-lactic-acid-bacteria",totalDownloads:2486,totalCrossrefCites:12,totalDimensionsCites:21,abstract:"Most starter cultures belong to the lactic acid bacteria group (LAB) and recognized as safe by the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA). However, LAB may act as intrinsic or extrinsic reservoirs for antibiotic resistance (AR) genes. This fact may not constitute a safety concern itself, as the resistance gene transfer is vertical. Nevertheless, external genetic elements may induce changes that favor the horizontal transfer transmission of resistance from pathogens as well as from the human intestinal microbiota, which represents a severe safety issue. Some genus of AR LAB includes Enterococcus, Lactobacillus, Lactococcus, Leuconostoc, Pediococcus, and Streptococcus isolated from fermented meat and milk products. Currently, the WHO recommends that LAB used in the food industry should be free of resistance. Therefore, the objective of this chapter is to present an overview of the LAB antibiotic resistance and some methods to determine the same.",book:{id:"6978",slug:"antimicrobial-resistance-a-global-threat",title:"Antimicrobial Resistance",fullTitle:"Antimicrobial Resistance - A Global Threat"},signatures:"Yenizey M. 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It also used as chelating agent due to its ability to bind with cholesterol, fats, proteins and metal ions.",book:{id:"4648",slug:"concepts-compounds-and-the-alternatives-of-antibacterials",title:"Concepts, Compounds and the Alternatives of Antibacterials",fullTitle:"Concepts, Compounds and the Alternatives of Antibacterials"},signatures:"H. M. Ibrahim and E.M.R. El- Zairy",authors:[{id:"90645",title:"Dr.",name:"Hassan",middleName:null,surname:"Ibrahim",slug:"hassan-ibrahim",fullName:"Hassan Ibrahim"},{id:"175694",title:"Dr.",name:"Enas",middleName:null,surname:"El- Zairy",slug:"enas-el-zairy",fullName:"Enas El- Zairy"}]}],onlineFirstChaptersFilter:{topicId:"897",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81704",title:"Quorum Sensing Inhibition Based Drugs to Conquer Antimicrobial Resistance",slug:"quorum-sensing-inhibition-based-drugs-to-conquer-antimicrobial-resistance",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.104125",abstract:"Quorum sensing is the cell to cell communication mechanism in microorganism through signalling molecules. Regulation of virulence factor, sporulation, proteolytic enzymes production, biofilm formation, auto-inducers, cell population density are key physiological process mediated through quorum-sensing (QS) signalling. Elevation of innate immune system and antibiotic tolerance of pathogens is highly increased with perspective of quorum-sensing (QS) activity. Development of novel drugs is highly attractive scenario against cell-cell communication of microbes. Design of synthetic drugs and natural compounds against QS signal molecules is vital combat system to attenuate microbial pathogenicity. Quorum sensing inhibitors (QSIs), quorum quenchers (QQs), efflux pump inhibitors (EPIs) act against multi-drug resistance strains (MDR) and other pathogenic microbes through regulation of auto-inducers and signal molecule with perceptive to growth arrest both in-vitro and in-vivo. QQs, QSIs and EPIs compounds has been validated with various animal models for high selection pressure on therapeutics arsenal against microbe’s growth inhibition. Promising QSI are phytochemicals and secondary metabolites includes polyacetylenes, alkaloids, polyphenols, terpenoids, quinones.",book:{id:"11373",title:"The Global Antimicrobial Resistance Epidemic - Innovative Approaches and Cutting-Edge Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11373.jpg"},signatures:"Kothandapani Sundar, Ramachandira Prabu and Gopal Jayalakshmi"},{id:"82372",title:"Unlocking the Potential of Ghost Probiotics in Combating Antimicrobial Resistance",slug:"unlocking-the-potential-of-ghost-probiotics-in-combating-antimicrobial-resistance",totalDownloads:20,totalDimensionsCites:0,doi:"10.5772/intechopen.104126",abstract:"Antimicrobial resistance is a global concern that requires immediate attention. Major causes of development of antimicrobial resistance in microbial cells are overuse of antimicrobials along the food chain especially in livestock, in preventing infections as well as misuse of antimicrobials by patients. Probiotics could be a viable alternative to antibiotics in the fight against antimicrobial resistance. Probiotic strains can act as a complement to antimicrobial therapy, improving antimicrobial function and enhancing immunity. However, there are safety concerns regarding the extensive use of live microbial cells especially in immunocompromised individuals; these include microbial translocation, inhibition of other beneficial microorganisms and development of antimicrobial resistance, among other concerns. Inevitably, ghost probiotics have become the favored alternative as they eliminate the safety and shelf-life problems associated with use of probiotics. Ghost probiotics are non-viable microbial cells (intact or broken) or metabolic products from microorganisms, which when administered in adequate amounts have biologic activity in the host and confer health benefits. Ghost probiotics exert biological effects similar to probiotics. However, the major drawback of using ghost probiotics is that the mechanism of action of these is currently unknown, hence more research is required and regulatory instruments are needed to assure the safety of consumers.",book:{id:"11373",title:"The Global Antimicrobial Resistance Epidemic - Innovative Approaches and Cutting-Edge Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11373.jpg"},signatures:"Abigarl Ndudzo, Sakhile Ndlovu, Nesisa Nyathi and Angela Sibanda Makuvise"},{id:"82178",title:"Managing Antimicrobial Resistance beyond the Hospital Antimicrobial Stewardship: The Role of One Health",slug:"managing-antimicrobial-resistance-beyond-the-hospital-antimicrobial-stewardship-the-role-of-one-heal",totalDownloads:16,totalDimensionsCites:0,doi:"10.5772/intechopen.104170",abstract:"Infections caused by micro-organisms affect the health of people and animals, causing morbidity and mortality, with Asia and Africa as the epicenters. Some of the infectious diseases are emerging and re-emerging in nature. Examples include viral hepatitis, Lassa fever, Ebola, yellow fever, tuberculosis, covid-19, measles, and malaria, among others. Antimicrobials have been playing an important role in the treatment of infections by these microbes. However, there has been a development of resistance to these antimicrobials as a result of many drivers. This write-up used secondary data to explore the management of antimicrobial resistance (AMR) beyond the hospital antimicrobial resistance steward using the one health concept. The findings showed AMR to be a transboundary, multifaceted ecosystem problem affecting both the developed and developing countries. It is also one of the top ten global public health threats facing mankind. Globally, AMR will cost over US$100 trillion in output loss by 2050, about 700,000 deaths a year, and 4,150,000 deaths in Africa by 2050. About 2.4 million people could die in high-income countries between 2015 and 2050 without a sustained effort to contain AMR. The drivers of AMR are beyond the hospital and hospital AMR stewardship. Therefore, the need for one health concept to manage it.",book:{id:"11373",title:"The Global Antimicrobial Resistance Epidemic - Innovative Approaches and Cutting-Edge Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11373.jpg"},signatures:"Istifanus Anekoson Joshua, Mathew Bobai and Clement Sokfa Woje"},{id:"81918",title:"Machine Learning for Antimicrobial Resistance Research and Drug Development",slug:"machine-learning-for-antimicrobial-resistance-research-and-drug-development",totalDownloads:52,totalDimensionsCites:0,doi:"10.5772/intechopen.104841",abstract:"Machine learning is a subfield of artificial intelligence which combines sophisticated algorithms and data to develop predictive models with minimal human interference. This chapter focuses on research that trains machine learning models to study antimicrobial resistance and to discover antimicrobial drugs. An emphasis is placed on applying machine learning models to detect drug resistance among bacterial and fungal pathogens. The role of machine learning in antibacterial and antifungal drug discovery and design is explored. Finally, the challenges and prospects of applying machine learning to advance basic research on and treatment of antimicrobial resistance are discussed. Overall, machine learning promises to advance antimicrobial resistance research and to facilitate the development of antibacterial and antifungal drugs.",book:{id:"11373",title:"The Global Antimicrobial Resistance Epidemic - Innovative Approaches and Cutting-Edge Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11373.jpg"},signatures:"Shamanth A. Shankarnarayan, Joshua D. Guthrie and Daniel A. Charlebois"},{id:"81891",title:"Alternatives to Antibiotics in Semen Extenders Used in Artificial Insemination",slug:"alternatives-to-antibiotics-in-semen-extenders-used-in-artificial-insemination",totalDownloads:27,totalDimensionsCites:0,doi:"10.5772/intechopen.104226",abstract:"Antimicrobial resistance is a serious global threat requiring a widespread response. Both veterinarians and medical doctors should restrict antibiotic usage to therapeutic use only, after determining the sensitivity of the causal organism. However, the addition of antibiotics to semen extenders for animal artificial insemination represents a hidden, non-therapeutic use of antimicrobial substances. Artificial insemination for livestock breeding is a huge global enterprise with hundreds of million sperm doses prepared annually. However, reporting of antimicrobial resistance in semen is increasing. This review discusses the consequences of bacteria in semen samples, as well as the effect of antimicrobial substances in semen extenders on bacteria in the environment and even on personnel. Alternatives to antibiotics have been reported in the scientific literature and are reviewed here. The most promising of these, removal of the majority of bacteria by colloid centrifugation, is considered in detail, especially results from an artificial insemination study in pigs. In conclusion, colloid centrifugation is a practical method of physically removing bacteria from semen, which does not induce antibiotic resistance. Sperm quality in stored semen samples may be improved at the same time.",book:{id:"11373",title:"The Global Antimicrobial Resistance Epidemic - Innovative Approaches and Cutting-Edge Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11373.jpg"},signatures:"Jane M. Morrell, Pongpreecha Malaluang, Aleksandar Cojkic and Ingrid Hansson"},{id:"81699",title:"Efflux Pumps among Urinary E. coli and K. pneumoniae Local Isolates in Hilla City, Iraq",slug:"efflux-pumps-among-urinary-e-coli-and-k-pneumoniae-local-isolates-in-hilla-city-iraq",totalDownloads:10,totalDimensionsCites:0,doi:"10.5772/intechopen.104408",abstract:"Urinary tract infections (UTI) are the most common bacterial infections affecting humans. Escherichia coli and Klebsiella pneumoniae were common enterobacteria engaged with community-acquired UTIs. Efflux pumps were vital resistance mechanisms for antibiotics, especially among enterobacteria. Overexpression of an efflux system, which results in a decrease in antibiotic accumulation, is an effective mechanism for drug resistance. The ATP-binding cassette (ABC) transporters, small multidrug resistance (SMR), and multidrug and toxic compound extrusion (MATE) families, the major facilitator superfamily (MFS), and the resistance-nodulation- cell division (RND) family are the five superfamilies of efflux systems linked to drug resistance. This chapter highlights the results of studying the prevalence of efflux pump genes among local isolates of E. coli and K. pneumoniae in Hilla City, Iraq. class RND AcrAB-TolC, AcrAD-TolC, and AcrFE-TolC genes detected by conventional PCR of E. coli and K. pneumoniae respectively. The result revealed approximately all studied efflux transporter were found in both E. coli and K. pneumoniae in different percentages. Biofilm formation were observed in 50(100%) of K. pneumoniae and 49(98%) of E. coli isolates were biofilm former and follow: 30(60%), 20(40%) were weak, 12(24%), 22(44%) were moderate and 7(14%) and 8(16%) were Strong biofilm former for E. coli and K. pneumoniae, respectively.",book:{id:"11373",title:"The Global Antimicrobial Resistance Epidemic - Innovative Approaches and Cutting-Edge Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11373.jpg"},signatures:"Hussein Al-Dahmoshi, Sahar A. Ali and Noor Al-Khafaji"}],onlineFirstChaptersTotal:13},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"13",title:"Veterinary Medicine and Science",doi:"10.5772/intechopen.73681",issn:"2632-0517",scope:"Paralleling similar advances in the medical field, astounding advances occurred in Veterinary Medicine and Science in recent decades. These advances have helped foster better support for animal health, more humane animal production, and a better understanding of the physiology of endangered species to improve the assisted reproductive technologies or the pathogenesis of certain diseases, where animals can be used as models for human diseases (like cancer, degenerative diseases or fertility), and even as a guarantee of public health. Bridging Human, Animal, and Environmental health, the holistic and integrative “One Health” concept intimately associates the developments within those fields, projecting its advancements into practice. This book series aims to tackle various animal-related medicine and sciences fields, providing thematic volumes consisting of high-quality significant research directed to researchers and postgraduates. It aims to give us a glimpse into the new accomplishments in the Veterinary Medicine and Science field. By addressing hot topics in veterinary sciences, we aim to gather authoritative texts within each issue of this series, providing in-depth overviews and analysis for graduates, academics, and practitioners and foreseeing a deeper understanding of the subject. Forthcoming texts, written and edited by experienced researchers from both industry and academia, will also discuss scientific challenges faced today in Veterinary Medicine and Science. In brief, we hope that books in this series will provide accessible references for those interested or working in this field and encourage learning in a range of different topics.",coverUrl:"https://cdn.intechopen.com/series/covers/13.jpg",latestPublicationDate:"August 7th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:11,editor:{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",institutionURL:null,country:{name:"Portugal"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:2,paginationItems:[{id:"1",title:"Oral Health",coverUrl:"https://cdn.intechopen.com/series_topics/covers/1.jpg",isOpenForSubmission:!0,editor:{id:"173955",title:"Prof.",name:"Sandra",middleName:null,surname:"Marinho",slug:"sandra-marinho",fullName:"Sandra Marinho",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRGYMQA4/Profile_Picture_2022-06-01T13:22:41.png",biography:"Dr. Sandra A. Marinho is an Associate Professor and Brazilian researcher at the State University of Paraíba (Universidade Estadual da Paraíba- UEPB), Campus VIII, located in Araruna, state of Paraíba since 2011. She holds a degree in Dentistry from the Federal University of Alfenas (UNIFAL), while her specialization and professional improvement in Stomatology took place at Hospital Heliopolis (São Paulo, SP). Her qualifications are: a specialist in Dental Imaging and Radiology, Master in Dentistry (Periodontics) from the University of São Paulo (FORP-USP, Ribeirão Preto, SP), and Doctor (Ph.D.) in Dentistry (Stomatology Clinic) from Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul (HSL-PUCRS, Porto Alegre, RS). She held a postdoctoral internship at the Federal University from Jequitinhonha and Mucuri Valleys (UFVJM, Diamantina, MG). She is currently a member of the Brazilian Society for Dental Research (SBPqO) and the Brazilian Society of Stomatology and Pathology (SOBEP). Dr. Marinho's experience in Dentistry mainly covers the following subjects: oral diagnosis, oral radiology; oral medicine; lesions and oral infections; oral pathology, laser therapy and epidemiological studies.",institutionString:null,institution:{name:"State University of Paraíba",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null},{id:"2",title:"Prosthodontics and Implant Dentistry",coverUrl:"https://cdn.intechopen.com/series_topics/covers/2.jpg",isOpenForSubmission:!0,editor:{id:"179568",title:"Associate Prof.",name:"Wen Lin",middleName:null,surname:"Chai",slug:"wen-lin-chai",fullName:"Wen Lin Chai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRHGAQA4/Profile_Picture_2022-05-23T14:31:12.png",biography:"Professor Dr. Chai Wen Lin is currently a lecturer at the Department of Restorative Dentistry, Faculty of Dentistry of the University of Malaya. She obtained a Master of Dental Science in 2006 and a Ph.D. in 2011. Her Ph.D. research work on the soft tissue-implant interface at the University of Sheffield has yielded several important publications in the key implant journals. She was awarded an Excellent Exchange Award by the University of Sheffield which gave her the opportunity to work at the famous Faculty of Dentistry of the University of Gothenburg, Sweden, under the tutelage of Prof. Peter Thomsen. In 2016, she was appointed as a visiting scholar at UCLA, USA, with attachment in Hospital Dentistry, and involvement in research work related to zirconia implant. In 2016, her contribution to dentistry was recognized by the Royal College of Surgeon of Edinburgh with her being awarded a Fellowship in Dental Surgery. She has authored numerous papers published both in local and international journals. She was the Editor of the Malaysian Dental Journal for several years. Her main research interests are implant-soft tissue interface, zirconia implant, photofunctionalization, 3D-oral mucosal model and pulpal regeneration.",institutionString:null,institution:{name:"University of Malaya",institutionURL:null,country:{name:"Malaysia"}}},editorTwo:{id:"479686",title:"Dr.",name:"Ghee Seong",middleName:null,surname:"Lim",slug:"ghee-seong-lim",fullName:"Ghee Seong Lim",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003ScjLZQAZ/Profile_Picture_2022-06-08T14:17:06.png",biography:"Assoc. Prof Dr. Lim Ghee Seong graduated with a Bachelor of Dental Surgery from University of Malaya, Kuala Lumpur in 2008. He then pursued his Master in Clinical Dentistry, specializing in Restorative Dentistry at Newcastle University, Newcastle, UK, where he graduated with distinction. He has also been awarded the International Training Fellowship (Restorative Dentistry) from the Royal College of Surgeons. His passion for teaching then led him to join the faculty of dentistry at University Malaya and he has since became a valuable lecturer and clinical specialist in the Department of Restorative Dentistry. He is currently the removable prosthodontic undergraduate year 3 coordinator, head of the undergraduate module on occlusion and a member of the multidisciplinary team for the TMD clinic. He has previous membership in the British Society for Restorative Dentistry, the Malaysian Association of Aesthetic Dentistry and he is currently a lifetime member of the Malaysian Association for Prosthodontics. Currently, he is also the examiner for the Restorative Specialty Membership Examinations, Royal College of Surgeons, England. He has authored and co-authored handful of both local and international journal articles. His main interest is in prosthodontics, dental material, TMD and regenerative dentistry.",institutionString:null,institution:{name:"University of Malaya",institutionURL:null,country:{name:"Malaysia"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:47,paginationItems:[{id:"82938",title:"Trauma from Occlusion: Practical Management Guidelines",doi:"10.5772/intechopen.105960",signatures:"Prashanth Shetty, Shweta Hegde, Shubham Chelkar, Rahul Chaturvedi, Shruti Pochhi, Aakanksha Shrivastava, Dudala Lakshmi, Shreya Mukherjee, Pankaj Bajaj and Shahzada Asif Raza",slug:"trauma-from-occlusion-practical-management-guidelines",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}},{id:"82654",title:"Atraumatic Restorative Treatment: More than a Minimally Invasive Approach?",doi:"10.5772/intechopen.105623",signatures:"Manal A. Ablal",slug:"atraumatic-restorative-treatment-more-than-a-minimally-invasive-approach",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Caries - The Selection of Restoration Methods and Restorative Materials",coverURL:"https://cdn.intechopen.com/books/images_new/11565.jpg",subseries:{id:"1",title:"Oral Health"}}},{id:"82608",title:"Early Management of Dental Trauma in the Era of COVID-19",doi:"10.5772/intechopen.105992",signatures:"Khairul Bariah Chi Adam, Haszelini Hassan, Pram Kumar Subramaniam, Izzati Nabilah Ismail, Nor Adilah Harun and Naziyah Shaban Mustafa",slug:"early-management-of-dental-trauma-in-the-era-of-covid-19",totalDownloads:2,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}},{id:"82767",title:"Teeth Avulsion",doi:"10.5772/intechopen.105846",signatures:"Manal Abdalla Eltahir, Randa Fath Elrahman Ibrahim and Hanan Alharbi",slug:"teeth-avulsion",totalDownloads:20,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}}]},overviewPagePublishedBooks:{paginationCount:9,paginationItems:[{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}]},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. 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\r\n\tThe Business and Management series topic focuses on the most pressing issues confronting organizations today and in the future. Businesses are trying to figure out how to lead in a time of global uncertainty. In emerging markets, issues such as ill-defined or unstable policies, as well as corrupt practices, can be hugely problematic. Changes in governments can result in new policy, regulations, and interest rates, all of which can be detrimental to foreign businesses and investments. A growing trend towards economic nationalism also makes the current global political landscape potentially hostile towards international businesses.
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\r\n\tThe demographic shifts are creating interesting challenges. People are living longer, resulting to an aging demographic. We have a large population of older workers and retirees who are living longer lives, combined with a declining birthrate in most parts of the world. Businesses of all types are looking at how technology is affecting their operations. Several questions arise, such as: How is technology changing what we do? How is it transforming us internally, how is it influencing our clients and our business strategy? It is about leveraging technology to improve efficiency, connect with customers more effectively, and drive innovation. The majority of innovative companies are technology-driven businesses. Realizing digital transformation is today’s top issue and will remain so for the next five years. Improving organizational agility, expanding portfolios of products and services, creating, and maintaining a culture of innovation, and developing next -generation leaders were also identified as top challenges in terms of both current and future issues.
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\r\n\tThe most sustained profitable growth occurs when a company expands its core business into an adjacent space. This has significant implications for management because innovation in business ecosystems differs from traditional, vertically integrated firms. Every organization in the ecosystem must be aware of the bigger picture. Innovation in ecosystems necessitates collaborative action to invent and appraise, efficient, cross-organizational knowledge flows, modular architectures, and good stewardship of legacy systems. It is built on multiple, interconnected platforms. Environmental factors have already had a significant impact in the West and will continue to have an impact globally. Businesses must take into account the environmental impact of their daily operations. The advantage of this market is that it is expected to grow more rapidly than the overall economy. Another significant challenge is preparing the next generation of leaders to elevate this to the number one priority within the next five years. There can be no culture of innovation unless there is diverse leadership or development of the next generation of leaders; and these diverse, next-generation leaders are the ones who will truly understand the digital strategies that will drive digital transformation.
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The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"chapter.detail",path:"/chapters/42311",hash:"",query:{},params:{id:"42311"},fullPath:"/chapters/42311",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()