\r\n\tTo further unravel critical mechanisms triggering metastasis and spontaneous regression of neuroblastoma, the key players and associated signalling pathways that dominate these mechanisms should be fully characterized. The genomic alterations, oncogenes and tumour suppressors, which affect cellular pathways, such as cell growth, proliferation, angiogenesis, metastasis, apoptosis and differentiation, play a major role in determining tumoural behaviour of neuroblastoma. This book will focus on key players and mechanisms of metastasis and spontaneous regression of neuroblastoma.
",isbn:null,printIsbn:null,pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"79a60ba88e02272c74e9c290e102cb99",bookSignature:"Dr. Nevim Aygun and Dr. Akira Nakagawara",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/7697.jpg",keywords:"neuroblastoma, metastasis, spontaneous regression, mechanisms, epithelial to mesenchymal transition (EMT), migration, invasion, intravasation, extravasation, signalling pathways, MYCN amplification, 1p deletion, other deletions, other chromosomal abnormalities, chromothripsis, genomic alterations, oncogenes, tumour suppressors, proliferation, angiogenesis, apoptosis, DNA repair, differentiation, epigenetic control, immunity, telomerase",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 26th 2018",dateEndSecondStepPublish:"May 14th 2018",dateEndThirdStepPublish:"July 13th 2018",dateEndFourthStepPublish:"October 1st 2018",dateEndFifthStepPublish:"November 30th 2018",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"4 years",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"195365",title:"Dr.",name:"Nevim",middleName:null,surname:"Aygun",slug:"nevim-aygun",fullName:"Nevim Aygun",profilePictureURL:"https://mts.intechopen.com/storage/users/195365/images/system/195365.jpeg",biography:"Nevim Aygun received her Medical Biology and Genetics Ph.D. in Health Sciences. She is interested in cancer, molecular biology, human genetics, cytogenetics, molecular cytogenetics, genomics, and bioinformatics. She has participated in many research projects on neuroblastoma, human gross gene deletions, non-B DNA-forming sequences, solid tumors, HCV, and leukemia, resulted in six articles, one book chapter, and numerous reports. She performed many molecular biological methods: PCR, real-time PCR, bacterial transformation, plasmid vector transfection, RNA interference, fluorescence in situ hybridization (FISH), cytogenetic, DNA sequencing, and cell culture. She also performed genomics and biostatistics analyses using some bioinformatics tools and SPSS program. She reviewed several manuscripts for some medical, genetics, and genomics journals. 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\n
1. Introduction
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The hallmarks of embryonic stem cells (ESC) are their potential for self-renewal and their pluripotent status. The latter ensures that they can differentiate toward the three germ layers (endoderm, mesoderm, and ectoderm) and primordial germ cells, and eventually to all different cell types of an adult organism.
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The first mouse ESC (mESC) were derived in 1981, independently by two different research groups [1, 2]. The first human ESC (hESC) in culture followed almost 20 years later [3]. Up to date, also for the derivatization of ESC from other species considerable research efforts have been made [4]. As ESC are being derived from the inner cell mass of a blastocyst, they provide a good model to study fundamental processes in early development and cellular differentiation.
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Equally important is that they also served as a template for the generation of induced pluripotent stem cells (iPSC) and contribute to a better (clinical) application of these cells in the future. As such, also in the field of induced pluripotency, tremendous progress has been made over the last decade. In 2006 and 2007, respectively, the research group led by Shinya Yamanaka developed a reprogramming cocktail for the establishment of mouse and human iPSC [5, 6].
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Nevertheless, as the comparison of the different ESC and iPSC types teaches us, pluripotency comes in different intensities, instead of a single definition as was firstly assumed [7]. mESC are considered as ‘true’ pluripotent ESC and find themselves in a ground pluripotent state, as does the early preimplantation epiblast. hESC on the other hand, are primed pluripotent cells and resemble more to mouse epiblast stem cells (mEpiSC), which are derived from a postimplantation epiblast, in terms of culture requirements and molecular profile among other factors.
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This chapter will give an overview on those different types of pluripotency and their according characteristics, and will then further elaborate on how these features can be monitored in order to keep track of the pluripotent status of ESC in culture.
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2. Primed versus naïve pluripotency
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hESC are considered to be primed, in that they are already predestined for one lineage or another, despite their remaining broad differentiation potential. In contrast, mESC are termed as ‘naïve’ pluripotent cells, while mEpiSC form the primed counterpart. It is clear that these different types possess different characteristics, which can be monitored via a range of different features and techniques, as is outlined below in more detail.
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2.1. Pluripotent ESC morphology
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A first distinctive feature is the difference in morphology. Naïve mESC form dome-shaped colonies, as do miPSC. However, primed hESC show a more flat morphology, with round individual cells having a high nucleus-to-cytoplasm ratio, as such resembling mEpiSC. These distinct appearances thus illustrate the different developmental states of the different cell types. The conversion of hiPSC to their naïve form changes the morphology from flat to domed [8]. It is remarkable how well these iPSCs resemble ESC in terms of morphology, even on an ultrastructural level [9, 10]. The latter reference describes the comparison of mESC, mouse embryonic fibroblasts (MEF), and iPSC derived thereof: after reprogramming, the accompanying morphological changes that the iPSC undergo make them virtually indistinguishable from ESC. Nevertheless, within the population of morphologically similar miPSC colonies, there still appears to be considerable variation in terms of molecular pluripotency, in contrast to hiPSC, which show a much higher homogeneity among the colonies that are selected on analogous morphology [11]. Moreover, true hiPSC colonies have a typical hESC morphology that is very distinct from non-hiPSC colonies, hence morphology can very well serve as a criterion for identifying the real hiPSC colonies.
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It is important to monitor the colonies\' morphology in culture, as this will quickly visualize potential spontaneous differentiation. E.g. for hESC, if two or more colonies come into contact with one another, differentiation sets in at the contact area, and cells will start to pile up and acquire a more lengthened shape. Also in the center of a colony, cells might start to accumulate in multiple layers. As hESCs typically form flat colonies, timely passaging (at least on weekly basis, dependent on the culture system) is crucial to prevent overgrowing colonies and consequential spontaneous differentiation [12].
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2.2. Pluripotency on a molecular level
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2.2.1. Signalling pathways
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The pluripotent state is regulated and maintained via several signaling pathways. As such, four major pathways involved in pluripotency can be distinguished for hESC: (1) the transforming growth factor β (TGFβ)-Activin-Nodal pathway, (2) the phosphatidylinositol 3-kinase (PI3K) pathway, (3) the Ras-Raf-mitogen activated protein kinase (MEK)-extracellular signal-regulated kinase (ERK) (or MAPK/ERK) pathway, and (4) Wnt signaling [13–16].
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TGFβ activates the TGFβ-Activin-Nodal pathway through the signal transducer SMAD2/3. The latter forms a complex with Smad4 and then translocates to the nucleus to trigger the expression of NODAL among other factors, which in turn stimulates self-renewal and inhibits differentiation. Also, the addition of activin A to hESC culture enables the activation of this pathway [14].
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Addition of fibroblast growth factor (FGF; basic FGF; bFGF) on the other hand activates the PI3K pathway and the Ras-Raf-MEK-ERK pathway. In short, for the PI3K pathway, phosphatidylinositol 4,5-bisphosphate becomes phosphorylated by means of PI3K during activation. The resulting phosphatidylinositol 3,4,5-triphosphate subsequently binds with Akt (also known as protein kinase B). Activation of this pathway results in increased concentrations of Oct3/4, Nanog and Sox2 and thus in the maintenance of pluripotency [16, 17]. Additionally, activation of the Ras-Raf-MEK-ERK pathway leads to the activation of Ras (a GTPase), which in turn binds with Raf. This kinase phosphorylates another kinase, MEK, which then phosphorylates ERK (or MAPK). The latter translocates to the nucleus, leading to the phosphorylation of c-Myc, c-Jun, and c-Fos, factors involved in stem cell renewal [18, 19].
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The Wnt signaling pathway can be activated by several Wnt ligands and is stimulated in culture e.g. by by 6-brominedirubin-3′-oxime. This agent inhibits glycogensynthase kinase-3 β which normally promotes the degradation of β-catenin in a complex with axin and adenomatous polyposis coli protein, by making it a target for the proteasome [19, 20]. As a consequence of this inhibition, β-catenin accumulates in the cytoplasm and a portion of this pool translocates to the cell nucleus and interacts with genes important for keeping hESC undifferentiated [15].
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Importantly, reasonable differences exist between mESC and hESC in terms of signaling pathways. In hESC, endogenous BMP signals (interacting with the TGFβ-Activin-Nodal pathway) need to be suppressed [21], while on the contrary this pathway in mESC helps in maintaining the pluripotent state and BMP-4 can be added to their culture medium. Analogously, leukemia inhibitory factor (LIF) is added to mESC media, which promotes self-renewal by influencing Jak/Stat3 signaling, one of the downstream FGF/ERK pathways [13, 21]. hESC on the other hand, are not dependent on LIF supplementation.
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2.2.2. Transcription factors
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As was already pointed out in the previous paragraph, the transcription factors Oct3/4, Nanog, and Sox2 are part of the core pluripotency network. Oct3/4 (Octamer4 or Oct4, encoded by POU5F1) has been termed the gatekeeper at the start of mammalian development. This member of the Pit-Oct-Unc (POU) transcription factor family can activate its target genes\' expression through binding on an octameric sequence motif (consensus sequence AGTCAAAT) [22]. Although not being totally exclusive for ESC, it is nevertheless considered as one of the most important features to define a pluripotent cell state. In early embryos, loss of POU5F1 expression causes the cells that were predisposed to form the ICM, to differentiate toward trophectoderm cells. Also, in ESC, lowering Oct3/4 levels to ≤50% or an increased expression above 150% leads to differentiation to trophectoderm or primitive endoderm cells, respectively [13]. Oct3/4 also appears to support the maintenance of mammalian germ cells, as apoptosis is induced when its expression is abrogated. Sox2 (SOX2) is a member of the SRY-related high-mobility group box-containing family and cooperatively functions with Oct3/4. However, its role goes further than just being a synergistic factor. Sox2-null embryos fail to give rise to ESC, but differentiate primarily to trophectoderm instead. Deletion of SOX2 in hESC and mESC leads to differentiation, confirming Sox2 to be essential in itself to maintain the pluripotent state [23]. Nanog (NANOG) is another crucial pluripotency- and self-renewal-maintaining factor in both mESC and hESC. It was for instance shown that deletion of NANOG resulted in loss of pluripotency and induced differentiation, both in mouse ICM and ESC [24]. Its ability to maintain pluripotency is found to be independent of LIF supplementation to the cell culture. One of the possible mechanisms for self-renewal maintenance may be that Nanog represses the transcription of differentiation-promoting genes such as GATA4 and GATA6 [13, 24, 25].
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Oct3/4, Nanog and Sox2 are involved in an intensive autoregulatory loop, as was for instance shown by the fact that knockdown of Sox2 led to a reduced expression of Oct3/4 and Nanog [23]. Additionally, they share a whole number of target genes, both in an activating or inhibitory manner. They stimulate genes involved in chromatin remodeling, histone posttranslational modifications, TGFβ signaling, etc., and other ESC transcription factors, among which also themselves. They are able to inhibit the expression of many genes promoting ectoderm, mesoderm, or endoderm differentiation [26]. It was found recently that among other factors, the hypoxia inducible factor 2-α (HIF 2-α) is an upstream regulator of these key transcription factors, as it binds directly to predicted hypoxic response elements in the proximal promotor of POU5F1, NANOG, and SOX2 [27].
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This list of core pluripotency factors can be completed with Klf4, a member of the Krupple-like Factor family. Together with other members of its family, it helps in maintaining ESC self-renewal and regulating the expression of several other genes such as NANOG. It is also one of the components included for iPSC generation starting from human or mouse cells, in combination with POU5F1, SOX2, and c-MYC. Alternatively, a combination of POU5F1, NANOG, LIN28, and SOX2 is applied for reprogramming.
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Besides the aforementioned factors, there is a whole series of other transcription factors that are involved in pluripotency regulation and maintenance. For instance, for hESC, the expression of REX1, FOXD3, GDF3, GABRB3, EBAF, POXDL, NODAL, ZFP42, LIN28, TCF3, EOMES, and SFPR2 is highly correlated to the expression of NANOG or are potential Nanog targets, as was elaborately described in [28]. Of note, there was also a number of genes found to be highly negatively correlated with NANOG expression, including CDX2 and CGB (associated with trophectoderm differentiation), GATA6 and AFP (extraembryonic endoderm), and PAX6 and NEUROD1 (neural lineage), once more confirming the role of Nanog in pluripotency regulation [28]. In mESC, the sustaining of the pluripotent status relies both on similar (e.g. NANOG, POU5F1, SOX2, REX1, and FOXD3) and different (e.g. PECAM1 and STELLA) factors.
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Yeo et al. [29] proposed the monitoring of DNA methylation patterns as a possible means to study the extent of hESC differentiation. DNA methylation is mostly associated with transcriptional repression, whether established via chromatin remodeling complexes or by direct blocking of transcription factor binding, and is as such involved in cellular programming events [30, 31]. During the hESC differentiation process toward embryoid bodies, the promotor regions of POU5F1 and NANOG undergo substantial methylation, in contrast to those of SOX2, REX1, and FOXD3 [29].
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2.2.3. Pluripotency on RNA level
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Besides the well-described transcription factors and cell surface markers, also long noncoding RNAs (lncRNAs) take up their role in pluripotency maintenance [32]. lncRNA molecules are transcripts from RNA polymerase II, that are over 200 nucleotides in size and that do not serve as a template for protein production. Instead, they prove to be involved in processes such as mRNA stability and translation modulation, and related epigenetic regulatory processes [33]. Both for mESC and hESC a characteristic set of lncRNAs has yet been identified, of which some are under the direct control of the core pluripotency transcription factor network [32]. The authors of the latter publication provide an elaborate overview of the different lncRNAs involved in the maintenance of ESC self-renewal and the preventing of differentiation. The interaction of lncRNAs with histone modifiers and other chromatin-associated proteins has been described in ESC, and they might serve as a scaffold to connect different chromatin modifying complexes.
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2.2.4. Lamins
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Also the expression of certain lamin proteins may serve as a marker for ESC differentiation [34]. Nuclear lamins are intermediate filament proteins within the nuclear lamina, that not only fulfill their role in the structural organization and support to the nuclear envelope but also participate in processes such as DNA replication and transcription. This family of proteins can be divided into 2 subgroups: lamins of the B-type (B1, B2, and B3) and of the A-type (A, AΔ10, C, and C2). Lamins B1 and B2 are expressed in both embryonic and adult cells, while A-type lamins are primarily found in differentiated cells, as was described for mouse and human cells. Nevertheless, when neuronal differentiation was induced in hESC, the expression of lamins A/C increased, as was also the case when differentiating toward cardiomyocytes. The authors hypothesize that the mechanism of action can be two-fold. A/C lamins might keep the differentiated state by directly influencing the nuclear structure and making it more rigid and thus less prone to chromatin remodeling, a process occurring during cellular differentiation. Alternatively or in complement, these lamins might also indirectly lock a specific gene expression pattern, by affecting the expression of other genes, as their interactions with several transcription factors have yet been described. In those hESC differentiation experiments, the authors could not point out a direct link with the expression of Oct3/4, as the expression of both markers overlapped in most cells, both in a high or low expression level or as one marker being more abundant than the other. The fact that A-type lamins are already present before total Oct3/4 decrease, makes these lamins a good marker for the indication of early differentiation. Of note, there was no overlapping expression found with TRA-1-60, TRA-1-81 or SSEA-4. For mESC, it has been described that they do show very low but yet detectable levels of Lamin A/C even when pluripotent, albeit in a much lower pattern than for differentiated cells [35].
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2.2.5. Cell surface markers
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Surface antigens are a valuable tool not only for the monitoring of the (non-)differentiation of stem cells but also for the isolation of a subset of cells. The function of most of these markers is not yet fully elucidated, a search that is further hampered because of their different expression patterns in different pluripotent cell types. Some antigens are associated with carbohydrate epitopes, linked with glycolipids (e.g. SSEA-3) or with glycoproteins (e.g. TRA-1-60), and it has been hypothesized that the core structures of these antigens are essential for the cellular function. For instance, the Lewis-X carbohydrate structure recognized as SSEA-1 may be important for compaction at the morula stage during mouse embryonic development [36].
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One of the most well-known types of ESC surface markers is the class of stage-specific embryonic antigens (SSEA), which are of the glycosphingolipid-type. Undifferentiated hESC express SSEA-3 and -4 (globoseries structure), while SSEA-1 (lactoseries structure) is only expressed in low levels [36, 37]. Upon hESC differentiation, the expression of these markers is quickly downregulated, with SSEA-3 disappearing faster than SSEA-4. On top of that, there is a significant increase in SSEA-1 [38]. Contrastingly, the reversed pattern is seen in pluripotent mESC [36, 39]. Also another SSEA-molecule, namely, SSEA-5, has been identified on the surface of hESC, which undergoes an even larger reduction upon differentiation than SSEA-3 or -4 [40]. Their expression depends on the combined actions of the different enzymes that are involved in their synthesis. Also the modified expression profile upon differentiation is primarily directed by an altered expression of the key glycosyltransferases (GT), with an upregulation of ganglio-related GT and simultaneous downregulation of globo- and lacto-series-related GT [41]. Of note, this list of glycosphingolipids is far from complete; hESC additionally express several other, less well-known markers of this type, of which the expression rapidly diminishes upon differentiation [38]. Although the SSEA have been challenged not to be essential for pluripotency maintenance [42], but to fulfill a role in cellular differentiation instead, their presence is nevertheless still considered as one of the criteria that must be fulfilled to categorize a cell as pluripotent.
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TRA-1-60 and TRA-1-81 are surface carbohydrate antigens present on hESC [36, 37], but not in mESC [36, 39]. Retinoic acid-induced hESC differentiation significantly downregulates their expression [37]. They have been shown to interact with keratan sulphated proteoglycans, although the exact structural determinants of their epitopes remain unknown [43]. Their expression is related to that of podocalyxin, a transmembrane glycoprotein, which has yet been found to be highly expressed in both ESC and iPSC, and might serve as a carrier for the TRA-antigens [44]. Cell surface glycans on ESC might play a role in the modulation of multiple signaling pathways [43].
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Besides the more frequently indicated SSEA- and TRA-markers, also several other categories of surface molecules have been described. Cluster of differentiation (CD) antigens can be subdivided into several classes such as integrins, adhesion molecules, glycoproteins, and receptors [36]. Some of them such as CD9, CD24, and CD133 are associated with mESC and hESC [36]. Of note, CD133 is also expressed in other cell lines like embryonic carcinoma cells and hematopoietic stem cells [36]. Integrins are important for keeping ESC undifferentiated. These cell surface receptors can bind several extracellular matrix proteins such as fibronectin, vitronectin, collagen, and laminin and provide in this way the cell-matrix interaction [36, 45].
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Next to the pluripotency cell surface markers, a range of markers for differentiation has been described. Depending on the differentiation protocol applied, specific markers can be investigated. On top of the markers already mentioned under paragraph 2.2.2, SSEA-1 and Gata4 for example indicate hESC endoderm differentiation, and the possibilities are still expanding. For instance, Holtzinger et al. recently described new markers for hepatocyte differentiation from hESC and hiPSC [46].
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2.2.6. Alkaline phosphatase
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Tissue-nonspecific alkaline phosphatase (TNAP or AP) is a membrane-bound glycosylated enzyme which is highly expressed in pluripotent ESC [3, 47], and is rapidly upregulated upon the reprogramming of somatic cells into iPSC. Of note, the expression of AP is absent in mEpiSC [48]. AP expression significantly decreases during differentiation, making it a suitable marker for pluripotency assessment. One way to monitor AP in hESC is detection with TRA-2-29 and TRA-2-54 antibodies [36, 49]. Its specific function is not totally elucidated, but its importance for ESC is ascribed to its role in the metabolism of vitamin B6 and thus also of the neurotransmitter γ-aminobutyric acid (GABA), a process that is considered to be imperative for ESC proliferation and self-renewal regulation. Additionally, it is very likely that because of the high proliferative rate of ESC, their need for substrate dephosphorylation is considerably higher than in somatic cells [48]. The activity of AP is highly correlated with its expression, which is mainly driven by the actual microenvironment of the cell, instead of via specific signaling pathways. MAPK p38 might play a role in AP’s expression regulation, as deletion of p38 in ESC led to a decreased AP expression and activity, but the precise mechanism remains unknown.
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2.3. Other pluripotency features
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A high level of telomerase activity is also one of the typical ESC characteristics [3]. Telomerase is involved in maintaining telomere length and is able to add telomere repeats to chromosome ends. As such it plays an important role in sustaining the replicative time-span and self-renewal of ESC. Somatic cells do not display any telomerase activity, leading to shortened telomeres over time and entering senescence after a certain number of cell divisions. Even in adult stem cells only low levels of telomerase activity can be found, in contrast to ESC [50].
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Pluripotent hESC also display an abbreviated cell cycle of about 16 h, in comparison to differentiated cells, due to a shortened G1 phase [51, 52]. Similarly, also mESC proliferate quickly and have a lengthening cell cycle upon differentiation. Because of their high proliferative pace, both mESC and hESC cultures need to be passaged very frequently, although the passaging technique is different between those two culture types: naïve cells are way more tolerant for single cell passaging than primed cells and thus allow better for bulk culture.
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Besides confirming the presence or absence of certain characteristic traits, the most stringent way to show pluripotent potential is chimera formation. However, as hereby ESC are injected into a developing embryo, this is for obvious ethical reasons not possible for hESC. Additionally, pluripotency can be investigated through spontaneous ESC differentiation in vivo (teratoma formation) and/or in vitro (embryoid body formation). Alternatively, also the directed differentiation under stimulation by specific growth factors, small molecules, gene manipulation, etc. toward specific cell types can be assessed.
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3. Pluripotency monitoring
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3.1. Overview
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The pluripotent state and cellular differentiation can be followed by means of multiple techniques, depending on the cell lines used, the experimental set-up, etc. As a start, microscopy is a very important asset in this monitoring process. Cell cultures\' performance, colony, and individual cell morphology (whether or not during differentiation) can be checked by means of light microscopy. With the implementation of additional stainings with fluorescently labelled antibodies and nuclear stains (e.g. DAPI), a whole range of other parameters like nuclear morphology, the presence of core transcription factors, cell surface molecules, and intracellular markers can be assessed with fluorescence microscopy. Often specific kits are available for a defined marker panel for pluripotency assessment of both ESC and iPSC lines, such as the Fluorescent hESC/hiPSC Characterization Kit provided by Millipore [53]. A noninvasive method for daily check-up of hESC cultures with microscopy is further described in Section 3.2. As an alternative, flow cytometry analysis after immunostaining can be applied for monitoring those markers. This technique is also applied for the analysis of cell proliferation rates and the distribution of a cell population across the different cell cycle phases.
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A relatively quick way to obtain gene expression data of the described pluripotency factors, differentiation markers, lncRNAs, lamin proteins, etc., is the application of reverse transcription-quantitative PCR (RT-qPCR); one such protocol for relative quantification is described under paragraph 3.3. Larger transcriptomics experiments can be set up by means of microarray analysis and next-generation sequencing. To detect these markers\' expression on a protein level, also multiple techniques are available such mass spectrometry, or 1D or 2D gel electrophoresis combined with Western blotting.
\n
Enzymatic activities of e.g. alkaline phosphatase and telomerase can be determined with specific kits available for cells of both human and murine origin. Telomerase activity is most often checked by means of a TRAP assay, or telomeric repeat amplification protocol, in which the telomerase activity is (semi-)quantified with qPCR after an initial enzymatic incubation step. Also ELISA-based methods have been described, whether or not in combination with TRAP (elaborately reviewed in [54]). AP activity detection is often based on colorimetric assays, e.g. performed on the supernatant of cell cultures. Even live stains are available, that allow noninvasive monitoring with microscopy. Hereby a non-fluorescent substrate is added to the cell culture, that becomes fluorescent after dephosphorylation by AP. Such a cell-permeable and non-toxic fluorescent substrate does not accumulate in the cells but diffuses out of the cells after 2 h [49], and thus does not yield any problems for following analyses.
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3.2. Noninvasive monitoring
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\n
3.2.1. Background
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As described above, immunostaining and RT-qPCR are most often used methods for pluripotency and differentiation screening. Nevertheless, for those methods, ESC need to be harvested, which thus makes it impossible to monitor the same colony over and over again on a daily basis, as new samples have to be collected for each analysis. We present a method enabling pluripotency monitoring of the same specific colonies during a time-lapse experiment by using a reporter ESC line, as was published by Scheerlinck et al. [55].
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3.2.2. Experimental aspects and workflow
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A commercially available Oct3/4-eGFP Knock-In hESC line was used, in which the transcription of enhanced green fluorescent protein (eGFP) is coupled to the transcription of POU5F1 [56]. After eGFP translation, a fluorescent signal (ex. 489 nm, em. 511 nm) is detected, which can be measured using a flow cytometer (FC) or fluorescence microscope (FM) [57]. When using the latter, not only the pluripotency can be measured but also the morphology can be examined. FC can then be used to validate the FM results obtained and was thus used as a reference. However, FC was only used at the end of the experiments, because it requires cell harvesting and fresh samples, making the monitoring of the same specific colonies on a daily basis impossible.
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This method can be applied both for feeder and feeder-free hESC culture conditions. Hence, a comparison was made between hESC cultured on MEF with regular DMEM/F-12 medium (with 4 ng/mL bFGF) on one hand and hESC on vitronectin-coated plates in combination with Essential 8 medium on the other. Both culture conditions were kept undifferentiated as for a regular ESC culture. Simultaneously, a differentiation experiment was set up, where differentiation was induced in case of MEF culture by omitting bFGF from the culture medium (spontaneous differentiation), whether or not combined with the addition of 2 μM retinoic acid (forced ectoderm differentiation). For feeder-free culture, only the latter condition with retinoic acid was applied. As such, there were in total three MEF conditions and two feeder-free conditions analyzed. The resolving power of the FM to compare differentiation status differences was determined by the comparison of those five conditions, of which only the ones containing bFGF are assumed to keep the hESC pluripotent. The resolving power of FC was determined by a complete 15-day differentiation of the Oct3/4 reporter cell line: the fluorescent signal quickly decreased during the first week and completely disappeared after 15 days in culture, falling back to the same level as UGENT2-cells, a non-reporter hESC line.
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Importantly, possible auto-fluorescence of both the medium and the cells themselves needs to be investigated. Several amino acids (tryptophan, tyrosine, and phenylalanine) and vitamins (riboflavin) among other factors, all present in DMEM/F-12, are known to cause auto-fluorescence [58–60]. Subsequently, also non-reporter hESC (in our case the UGENT2 cell line) and MEF in case of feeder cultures need to be analyzed. When using FM, the signal-to-noise (S/N) ratio for each hESC colony can be determined by dividing the densitrometric mean of the colony (signal) by that one of its background (noise). For FC analysis of feeder cultures, it was not possible to distinguish the MEF population from the hESC in terms of FS/SS. Ideally, these MEF should be isolated by means of fluorescence-activated cell sorting after immunostaining for a specific marker such as vimentin or CD90 [61]. However, as FC is only used at the end of the experiment only a small contribution of the MEF (<10%) to the fluorescence histogram is expected, as the relative portion of the inactivated MEF gradually reduces over time compared to the growing hESC colonies.
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3.2.3. Outcome
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As stated above, the UGENT2 cell line and MEF were included in the analysis to determine the background auto-fluorescence. For FM, the MEF did not yield a detectable auto-fluorescence signal and did thus not impact the S/N ratio in comparison to feeder-free cultured hESC, although FC analysis revealed a low but present MEF auto-fluorescence intensity (Figure 1A).
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Figure 1.
Noninvasive monitoring of hESC colonies. (A) Auto-fluorescence assessment by FC. (B) Results obtained by FM, expressed as S/N ratios. The differentiating conditions clearly show a decreased S/N ratio in comparison to the cells kept pluripotent. (C) FC results obtained at the end of the differentiation experiment, confirming the FM results. (D) Microscopic fluorescent images of a hESC colony in MEF culture conditions, under spontaneous (left) and retinoic acid-induced (right) differentiation.
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For FM assessment, colony fluorescence was measured daily for 5 or 6 colonies per condition, during 6 days. The experiment was performed in triplicate and the obtained results are expressed as S/N ratios. As expected, addition of retinoic acid (directed differentiation) caused a significant decrease in S/N ratio over time both in feeder and feeder-free culture conditions, indicating a lowering expression of Oct3/4 in the course of the differentiation process. Also only omitting bFGF from the culture medium definitely leads to differentiation, as was confirmed by the decreasing S/N ratios, albeit in a slower rate than when also retinoic acid is added. No significant S/N ratio differences were found between feeder and feeder-free hESC cultures for both the non-differentiating and the differentiating conditions, confirming the low impact of MEF auto-fluorescence on FM measurements. Of note, for both undifferentiated culture conditions, an increase in fluorescence was seen toward the end of the experiment, which might be explained by an increase in eGFP/cell or more plausibly by the formation of multilayers (3D growth) resulting in an accumulation of fluorescent signal (Figure 1B).
\n
The FM data were compared to the results of a FC hESC analysis (Figure 1C). As mentioned above, because of the destructive nature of this technique, this measurement is only performed at the end of the experiment. Both feeder-free and MEF grown hESC in the presence of bFGF retained their undifferentiated status. Of note, a small portion of cells in the latter population had a lower eGFP expression, most probably MEF as mentioned earlier (auto-fluorescence between 100 and 101, asterisk in Figure 1C). The finding that the eGFP signal/cell remained constant in the undifferentiated conditions indeed confirms that the daily increase in fluorescence as observed by FM is rather due to a multilayer effect resulting in an accumulated fluorescent signal. In the MEF condition without bFGF, most of the cells were still undifferentiated after 6-day culture (signal >101) but in comparison, in the condition with bFGF a significantly higher number of cells with a 100 and 101 eGFP expression were observed. These results are in line with the FM measurements, in which it was shown that there is indeed a mix of differentiated (low fluorescence; S/N ratio = 2.26) and undifferentiated hESC (high fluorescence, S/N ratio = 13.75) on day 5 of spontaneous differentiation (Figure 1D left). The conditions with retinoic acid showed a clear drop in fluorescence toward the end of the experiment, as also confirmed by the FM results. Remarkably, FM images of retinoic acid differentiated hESC colonies on MEF revealed the existence of demarcated zones with highly accumulated fluorescence (S/N ratio = ca. 24) (Figure 1D right). This small population of high fluorescent ‘islands’ could not be discriminated using FC as these individual highly fluorescent cells were somewhat hidden in the tail of the fluorescence histogram.
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In conclusion, it is important to bear in mind that for FM assessment, an increasing fluorescence intensity of a hESC colony does not correlate with an increased eGFP signal per cell, but with hESC growing in multiple layers. As such, only a decrease in signal can be directly interpreted as ongoing differentiation. A flat signal can be considered as an hESC culture with both pluripotent and differentiating cells [55].
\n
Despite its usefulness, this method still has some limitations. One issue is the auto-fluorescence of the medium, necessitating the use of a different medium than that used for regular culture. In this experiment, hESC colonies were analyzed by using no medium at all, although this evokes stress to the cells. ThermoFisher has recently developed an auto-fluorescence-free medium called FluoroBrite DMEM, which can be used as basal medium for analysis during fluorescence [58]. It should nevertheless be further investigated whether this medium can also be used for hESC. Secondly, ideally the analysis should be done in the same conditions as during culture, meaning that a cell imaging system with regulated O2 and CO2 supply would be more appropriate. Different companies such as Zeiss could offer a solution in this regard. Nevertheless, even if a microscope as described in the experiments above is used, the fact that the cells are monitored in culture enables an immediate follow-up of their behavior.
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3.2.4. Applications
\n
The application of this method is definitely not restricted to an Oct3/4-eGFP ESC line but can be used for any reporter cell line, as long as potential auto-fluorescence is overcome, e.g. by the implementation of an auto-fluorescence-free cell culture medium. For instance, also Nanog-eGFP reporter hESC lines are available [62], as is an hRex-GFP hESC line [63]. Additionally, reporters for specific differentiation markers have been generated, with an increasing GFP expression during the course of the differentiation process, e.g. [64, 65]. The production of a Nanog-eGFP reporter to monitor fibroblast reprogramming has been published, too [66]. A reporter cell line including multiple markers clearly strengthens the use of the method described above. For example, Maass et al. created a reporter mESC line harboring Cntn2-eGFP and MHCα-mCherry, which will be upregulated during directed cardiac differentiation, as such allowing to monitor the development of cardiac progenitors [67]. However, to our knowledge, the development of a dual reporter ESC line combining two pluripotency markers has not been published. Furthermore, most reporter ESC lines described express (e)GFP, thus ruling out a possible combination with GFP-based alkaline phosphatase live stain [68]. However, ActivMotiv provides a CDy1 Dye (ex. 544 nm/em. 577 nm) to detect pluripotent stem cells live in culture, that can be combined with GFP expression [69, 70].
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3.3. Quantitative PCR monitoring
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\n
3.3.1. Background
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As mentioned above, one other efficient method to monitor the expression profile of multiple target genes (e.g. the core pluripotency transcription factors) is RT-qPCR. This technique allows to analyze samples in high throughput, at a relatively low cost. In this way, it can easily be applied for e.g. pluripotency monitoring of (long term) ESC cultures, as was recently elaborately described for hESC by Galán and Simón [71]. Besides culture monitoring, it can also be applied for the comparison of pluripotent and differentiating ESC. Importantly, as goes for all experimental work, also here an adequate set-up is of utmost importance. During RT-qPCR data analysis, a suitable normalization factor should be taken into account, to correct for potential technical variabilities that were included along the experimental process. To this end, multiple strategies have been used. Normalization to the number of cells might not be accurate and cell enumeration is particularly less easy when dealing with adherent cell cultures such as ESC [72]. Moreover, this normalization strategy does not take into account the variability that might have been included during sample preparation such as potentially insufficient enzymatic reaction efficiencies. Alternatively, correcting toward RNA mass quantity has been described, but also here the same issue applies, as potential technical variation from the complementary DNA (cDNA) preparation from messenger RNA (mRNA) is not considered. Ribosomal RNA (rRNA) makes up the major part of the total RNA pool and may be prone to regulation, which will cause a variable ratio between rRNA and mRNA. Hence, normalization for the total RNA content may not be representative for the amount of mRNA [72, 73]. The by far mostly favored method for data normalization is correcting to one or preferentially multiple reference or so-called housekeeping genes. This allows the researcher to correct for any variation between samples that might have been implemented along the protocol. These reference genes are expected to be expressed in a stable manner throughout all samples of a given experimental set-up.
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3.3.2. Experimental aspects and workflow
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To determine which references need to be included, different algorithms are available such as BestKeeper or Normfinder, but the most widely used is the geNorm algorithm, included in the qBase software (Biogazelle) [74]. We applied the latter to find suitable reference genes to be used for the comparison between pluripotent and differentiating hESC [75]. After putting in all RT-qPCR data, the software calculates a so-called stability value (designated ‘M value’) for each candidate, with a low M value indicating a higher gene expression stability throughout all samples. Afterwards, all reference candidates are ranked according to that value and the most adequate reference genes can be selected.
\n
A differentiation experiment was set up, in which hESC samples from two different cell lines (UGENT1 and UGENT2) were collected daily during 8 days after retinoic acid-induction, plus an extra sample on day 12 of differentiation (Experiment 1). This was repeated in two more experiments, albeit in a different time window: in Experiment 2 samples were collected daily during 6 days and in Experiment 3, cells were harvested every 4 h during day 3, 4, and 5 after onset of differentiation. After RNA isolation, quality control and cDNA preparation, RT-qPCR reactions were run in duplo, on an ABI Prism 7000 Sequence Detection System (Applied Biosystems) and a LightCycler 480 (Roche). Twelve reference loci candidates were included, mainly with SYBR Green detection (allowing melting curve analysis), except for GAPDH and PPIA, for which specific probes were used. All data were imported in geNorm and assessed for expression stability.
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3.3.3. Outcome
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Figure 2.
Reference genes selection and their application. A geNorm stability analysis was performed for 12 candidate reference genes; the table shows the resulting ranking. B2M, RPL13A, and Alu repeats appeared to be the most suitable references, performing significantly better than the more classic reference genes GAPDH, ACTB, and PPIA as is illustrated in the graph (fold change in expression over time during differentiation).
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According to the geNorm analysis performed for all three differentiation experiments, the most stable reference loci among the 12 included candidates were B2M, RPL13A, and Alu repeats. In contrast, the more classic reference genes such as GAPDH or ACTB did not perform so well (all M values listed in Figure 2) [75]. These findings were corroborated by the results obtained from the use of other algorithms for reference gene stability determination.
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It is important to bear in mind that different experimental settings may require different references; e.g. one differentiation-inducing agent will not have the same influence on gene expression in general as another. Previously defined reference loci might thus not be blindly extrapolated to new experimental conditions. The difference in reference gene performance is illustrated by the comparison between to reference sets: B2M, RPL13A, and Alu repeats on one hand and GAPDH, PPIA, and ACTB on the other. These sets were used to normalize the expression of the pluripotency factors POU5F1 and NANOG, which are supposed to decrease considerably after differentiation is induced. However, that decrease was significantly less pronounced (p-value = 1.30e-05) when applying the more classic reference genes, once more pointing out the importance of an adequate reference gene selection (graph Figure 2).
\n\n
The fact that B2M, RPL13A, and Alu repeats are found to be the most stable genes is nevertheless not too surprising. B2M is expressed in every nucleated cell as it is a component of the major histocompatibility complex I. It is thus a very good candidate to apply as a normalization scalar for RT-qPCR analysis (e.g. [76]). Also RPL13A, involved in the protein translation process, has been widely used as a reference gene (e.g. [77]). The applicability of both genes was confirmed by our own data analysis. The Alu repeats are of particular interest, as their application provides a rather novel approach for data normalization [78]. These short interspersed elements are distributed genome-wide, which implies that a variation in the expression of a single gene will not substantially influence the total expression profile of these elements.
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3.3.4. Applications
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The setting described here specifies the monitoring of the pluripotency factors Oct3/4 and Nanog, but obviously any other marker of which the expression should be monitored and relatively quantified can be included. It is recommended to revaluate the reference genes\' stability if an experimental set-up would be modified, but once the most suitable references have been established, any target gene can be implemented in this assay. As such, on top of the pluripotency markers, also the expression of specific differentiation markers can be monitored to follow development toward a certain cell lineage. This technique can as well be used for the assessment of noncoding RNA genes.
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4. Conclusion
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This chapter gives an overview on a number of typical characteristics which can be monitored to keep track of the pluripotent status of ESC cultures. Nevertheless, this list is far from complete and it is most likely that in time new biomarkers will be found while known features will be revaluated, as new culturing techniques are developed and the research field of induced pluripotency and naïve pluripotency further expands. Also from a technological point of view, novel methods will enhance these markers\' detection and facilitate the discovery of new molecules.
\n
\n\n',keywords:"Embryonic stem cells, Pluripotency, Pluripotency assessment, Noninvasive monitoring, RT-qPCR",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/50265.pdf",chapterXML:"https://mts.intechopen.com/source/xml/50265.xml",downloadPdfUrl:"/chapter/pdf-download/50265",previewPdfUrl:"/chapter/pdf-preview/50265",totalDownloads:1654,totalViews:231,totalCrossrefCites:1,totalDimensionsCites:1,totalAltmetricsMentions:0,introChapter:null,impactScore:1,impactScorePercentile:67,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"November 3rd 2015",dateReviewed:"February 22nd 2016",datePrePublished:null,datePublished:"July 20th 2016",dateFinished:"April 7th 2016",readingETA:"0",abstract:"Embryonic stem cells are defined by their pluripotent status, which allows them to differentiate toward all cell types of an adult organism. This pluripotency can be characterized through many parameters, ranging from morphological traits, over certain enzymatic activities, to the expression of specific pluripotency factors, taken into account that these parameters may vary depending on the pluripotent stem cell type. As such, considerable differences are seen between human and mouse embryonic stem cell (ESC), or more generally stated, between primed and naïve pluripotent stem cells. This chapter offers an overview of the markers involved and the molecular biology techniques to monitor them during both ESC culture maintenance or differentiation experiments.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/50265",risUrl:"/chapter/ris/50265",book:{id:"5207",slug:"pluripotent-stem-cells-from-the-bench-to-the-clinic"},signatures:"Liesbeth Vossaert, Ellen Scheerlinck and Dieter Deforce",authors:[{id:"181099",title:"Dr.",name:"Liesbeth",middleName:null,surname:"Vossaert",fullName:"Liesbeth Vossaert",slug:"liesbeth-vossaert",email:"liesbeth.vossaert@ugent.be",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Ghent University",institutionURL:null,country:{name:"Belgium"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Primed versus naïve pluripotency",level:"1"},{id:"sec_2_2",title:"2.1. Pluripotent ESC morphology",level:"2"},{id:"sec_3_2",title:"2.2. Pluripotency on a molecular level",level:"2"},{id:"sec_3_3",title:"2.2.1. Signalling pathways",level:"3"},{id:"sec_4_3",title:"2.2.2. Transcription factors",level:"3"},{id:"sec_5_3",title:"2.2.3. Pluripotency on RNA level",level:"3"},{id:"sec_6_3",title:"2.2.4. Lamins",level:"3"},{id:"sec_7_3",title:"2.2.5. Cell surface markers",level:"3"},{id:"sec_8_3",title:"2.2.6. Alkaline phosphatase",level:"3"},{id:"sec_10_2",title:"2.3. Other pluripotency features",level:"2"},{id:"sec_12",title:"3. Pluripotency monitoring",level:"1"},{id:"sec_12_2",title:"3.1. Overview",level:"2"},{id:"sec_13_2",title:"3.2. Noninvasive monitoring",level:"2"},{id:"sec_13_3",title:"3.2.1. Background",level:"3"},{id:"sec_14_3",title:"3.2.2. Experimental aspects and workflow",level:"3"},{id:"sec_15_3",title:"3.2.3. Outcome",level:"3"},{id:"sec_16_3",title:"3.2.4. Applications",level:"3"},{id:"sec_18_2",title:"3.3. Quantitative PCR monitoring",level:"2"},{id:"sec_18_3",title:"3.3.1. Background",level:"3"},{id:"sec_19_3",title:"3.3.2. Experimental aspects and workflow",level:"3"},{id:"sec_20_3",title:"3.3.3. Outcome",level:"3"},{id:"sec_21_3",title:"3.3.4. Applications",level:"3"},{id:"sec_24",title:"4. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'\nEvans MJ, Kaufman MH. Establishment in culture of pluripotential cells from mouse embryos. Nature 1981;292:154–6.\n'},{id:"B2",body:'\nMartin GR. Isolation of a pluripotent cell line from early mouse embryos cultured in medium conditioned by teratocarcinoma stem cells. Proc Natl Acad Sci U S A 1981;78:7634–8.\n'},{id:"B3",body:'\nThomson JA, Itskovitz-Eldor J, Shapiro SS, Waknitz MA, Swiergiel JJ, Marshall VS, et al. Embryonic stem cell lines derived from human blastocysts. Science (80-) 1998;282:1145–7.\n'},{id:"B4",body:'\nEzashi T, Yuan Y, Roberts RM. Pluripotent stem cells from domesticated mammals. Annu Rev Anim Biosci 2016;4: 223–53. doi:10.1146/annurev-animal-021815-111202.\n'},{id:"B5",body:'\nTakahashi K, Yamanaka S. Induction of pluripotent stem cells from mouse embryonic and adult fibroblast cultures by defined factors. Cell 2006;126:663–76. doi:10.1016/j.cell.2006.07.024.\n'},{id:"B6",body:'\nTakahashi K, Tanabe K, Ohnuki M, Narita M, Ichisaka T, Tomoda K, et al. Induction of pluripotent stem cells from adult human fibroblasts by defined factors. Cell 2007;131:861–72. doi:10.1016/j.cell.2007.11.019.\n'},{id:"B7",body:'\nNichols J, Smith A. Naive and primed pluripotent states. Cell Stem Cell 2009;4:487–92. doi:10.1016/j.stem.2009.05.015.\n'},{id:"B8",body:'\nRobinton DA, Daley GQ. The promise of induced pluripotent stem cells in research and therapy. Nature 2012;481:295–305. doi:10.1038/nature10761.\n'},{id:"B9",body:'\n Lai D, Bu S. Comparison of the ultrastructures of primed and naïve mouse embryonic stem cells. Cell Reprogram 2016;18(1): 48–53. doi:10.1089/cell.2015.0063.\n'},{id:"B10",body:'\nZeuschner D, Mildner K, Zaehres H, Schöler HR. Induced pluripotent stem cells at nanoscale. Stem Cells Dev 2010;19:615–20. doi:10.1089/scd.2009.0159.\n'},{id:"B11",body:'\nManian K V, Aalam SMM, Bharathan SP, Srivastava A, Velayudhan SR. Understanding the molecular basis of heterogeneity in induced pluripotent stem cells. Cell Reprogram 2015;17:427–40. doi:10.1089/cell.2015.0013.\n'},{id:"B12",body:'\nHoffman LM, Carpenter MK. Characterization and culture of human embryonic stem cells. Nat Biotechnol 2005;23:699–708. doi:10.1038/nbt1102.\n'},{id:"B13",body:'\nMedvedev SP, Shevchenko a I, Mazurok N a, Zakiian SM. OCT4 and NANOG are the key genes in the system of pluripotency maintenance in mammalian cells. Genetika 2008;44:1589–608. doi:10.1134/S1022795408120016.\n'},{id:"B14",body:'\nJames D, Levine AJ, Besser D, Hemmati-Brivanlou A. TGFbeta/activin/nodal signaling is necessary for the maintenance of pluripotency in human embryonic stem cells. Development 2005;132:1273–82. doi:10.1242/dev.01706.\n'},{id:"B15",body:'\nSato N, Meijer L, Skaltsounis L, Greengard P, Brivanlou AH. Maintenance of pluripotency in human and mouse embryonic stem cells through activation of Wnt signaling by a pharmacological GSK-3-specific inhibitor. Nat Med 2004;10:55–63. doi:10.1038/nm979.\n'},{id:"B16",body:'\nMcLean AB, D’Amour K a, Jones KL, Krishnamoorthy M, Kulik MJ, Reynolds DM, et al. Activin A efficiently specifies definitive endoderm from human embryonic stem cells only when phosphatidylinositol 3-kinase signaling is suppressed. Stem Cells 2007;25:29–38. doi:10.1634/stemcells.2006-0219.S.\n'},{id:"B17",body:'\nArmstrong L, Hughes O, Yung S, Hyslop L, Stewart R, Wappler I, et al. The role of PI3K/AKT, MAPK/ERK and NFκβ signalling in the maintenance of human embryonic stem cell pluripotency and viability highlighted by transcriptional profiling and functional analysis. Hum Mol Genet 2006;15:1894–913. doi:10.1093/hmg/ddl112.\n'},{id:"B18",body:'\nMcCain J. The MAPK (ERK) Pathway: Investigational combinations for the treatment of BRAF-mutated metastatic melanoma. P T 2013;38:96–108.\n'},{id:"B19",body:'\nDing VMY, Ling L, Natarajan S, Yap MGS, Cool SM, Choo ABH. FGF-2 modulates Wnt signaling in undifferentiated hESC and iPS cells through activated PI3-K/GSK3β signaling. J Cell Physiol 2010;225:417–28. doi:10.1002/jcp.22214.\n'},{id:"B20",body:'\nWalsh J, Andrews PW. Expression of Wnt and Notch pathway genes in a pluripotent human embryonal carcinoma cell line and embryonic stem cell. APMIS 2003;111:197–210; discussion 210–1. doi:10.1034/j.1600-0463.2003.1110124.x.\n'},{id:"B21",body:'\nXu R-H, Peck RM, Li DS, Feng X, Ludwig T, Thomson J a. Basic FGF and suppression of BMP signaling sustain undifferentiated proliferation of human ES cells. Nat Methods 2005;2:185–90. doi:10.1038/nmeth744.\n'},{id:"B22",body:'\nPan GJ, Chang ZY, Scholer HR, Pei D. Stem cell pluripotency and transcription factor Oct4. Cell Res 2002;12:321–9. doi:10.1038/sj.cr.7290134.\n'},{id:"B23",body:'\nFong H, Hohenstein KA, Donovan PJ. Regulation of self-renewal and pluripotency by Sox2 in human embryonic stem cells. Stem Cells 2008;26:1931–8. doi:10.1634/stemcells.2007-1002.\n'},{id:"B24",body:'\nMitsui K, Tokuzawa Y, Itoh H, Segawa K, Murakami M, Takahashi K, et al. The homeoprotein Nanog is required for maintenance of pluripotency in mouse epiblast and ES cells. Cell 2003;113:631–42.\n'},{id:"B25",body:'\nSingh AM, Hamazaki T, Hankowski KE, Terada N. A heterogeneous expression pattern for Nanog in embryonic stem cells. Stem Cells 2007;25:2534–42. doi:10.1634/stemcells.2007-0126.\n'},{id:"B26",body:'\nBoyer LA, Lee TI, Cole MF, Johnstone SE, Levine SS, Zucker JP, et al. Core transcriptional regulatory circuitry in human embryonic stem cells. Cell 2005;122:947–56. doi:10.1016/j.cell.2005.08.020.\n'},{id:"B27",body:'\nPetruzzelli R, Christensen DR, Parry KL, Sanchez-Elsner T, Houghton FD. HIF-2α regulates NANOG expression in human embryonic stem cells following hypoxia and reoxygenation through the interaction with an Oct-Sox Cis regulatory element. PLoS One 2014;9:e108309. doi:10.1371/journal.pone.0108309.\n'},{id:"B28",body:'\nAdewumi O, Aflatoonian B, Ahrlund-Richter L, Amit M, Andrews PW, Beighton G, et al. Characterization of human embryonic stem cell lines by the International Stem Cell Initiative. Nat Biotechnol 2007;25:803–16. doi:10.1038/nbt1318.\n'},{id:"B29",body:'\nYeo S, Jeong S, Kim J, Han JS, Han YM, Kang YK. 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Biochim Biophys Acta 2008;1780:325–46. doi:10.1016/j.bbagen.2007.08.015.\n'},{id:"B42",body:'\nBrimble SN, Sherrer ES, Uhl EW, Wang E, Kelly S, Merrill AH, et al. The cell surface glycosphingolipids SSEA-3 and SSEA-4 are not essential for human ESC pluripotency. Stem Cells 2007;25:54–62. doi:10.1634/stemcells.2006-0232.\n'},{id:"B43",body:'\nLanctot PM, Gage FH, Varki AP. The glycans of stem cells. Curr Opin Chem Biol 2007;11:373–80. doi:10.1016/j.cbpa.2007.05.032.\n'},{id:"B44",body:'\nSchopperle WM, DeWolf WC. The TRA-1-60 and TRA-1-81 human pluripotent stem cell markers are expressed on podocalyxin in embryonal carcinoma. Stem Cells 2007;25:723–30. doi:10.1634/stemcells.2005-0597.\n'},{id:"B45",body:'\nMiyazaki T, Futaki S, Hasegawa K, Kawasaki M, Sanzen N, Hayashi M, et al. Recombinant human laminin isoforms can support the undifferentiated growth of human embryonic stem cells. Biochem Biophys Res Commun 2008;375:27–32. doi:10.1016/j.bbrc.2008.07.111.\n'},{id:"B46",body:'\nHoltzinger A, Streeter PR, Sarangi F, Hillborn S, Niapour M, Ogawa S, et al. New markers for tracking endoderm induction and hepatocyte differentiation from human pluripotent stem cells. Development 2015;142:4253–65. doi:10.1242/dev.121020.\n'},{id:"B47",body:'\nPalmqvist L, Glover CH, Hsu L, Lu M, Bossen B, Piret JM, et al. Correlation of murine embryonic stem cell gene expression profiles with functional measures of pluripotency. Stem Cells 2005;23:663–80. doi:10.1634/stemcells.2004-0157.\n'},{id:"B48",body:'\nŠtefková K, Procházková J, Pacherník J. Alkaline phosphatase in stem cells. Stem Cells Int 2015;2015:628368. doi:10.1155/2015/628368.\n'},{id:"B49",body:'\nSingh U, Quintanilla RH, Grecian S, Gee KR, Rao MS, Lakshmipathy U. Novel live alkaline phosphatase substrate for identification of pluripotent stem cells. Stem Cell Rev 2012;8:1021–9. doi:10.1007/s12015-012-9359–6.\n'},{id:"B50",body:'\nHiyama E, Hiyama K. Telomere and telomerase in stem cells. Br J Cancer 2007;96:1020–4. doi:10.1038/sj.bjc.6603671.\n'},{id:"B51",body:'\nBecker KA, Ghule PN, Therrien JA, Lian JB, Stein JL, van Wijnen AJ, et al. Self-renewal of human embryonic stem cells is supported by a shortened G1 cell cycle phase. J Cell Physiol 2006;209:883–93. doi:10.1002/jcp.20776.\n'},{id:"B52",body:'\nKapinas K, Grandy R, Ghule P, Medina R, Becker K, Pardee A, et al. The abbreviated pluripotent cell cycle. J Cell Physiol 2013;228:9–20. doi:10.1002/jcp.24104.\n'},{id:"B53",body:'\nFluorescent Human ES/iPSC characterization kit - Millipore n.d. http://www.merckmillipore.com/BE/en/product/Fluorescent-Human-ESiPS-Cell-Characterization-Kit-,MM_NF-SCR078.\n'},{id:"B54",body:'\nSkvortsov DA, Zvereva ME, Shpanchenko O V, Dontsova OA. Assays for detection of telomerase activity. Acta Naturae 2011;3:48–68.\n'},{id:"B55",body:'\nScheerlinck E, Van Steendam K, Vandewoestyne M, Lepez T, Gobin V, Meert P, et al. Detailed method description for noninvasive monitoring of differentiation status of human embryonic stem cells. Anal Biochem 2014;461:60–6. doi:10.1016/j.ab.2014.05.026.\n'},{id:"B56",body:'\nZwaka TP, Thomson JA. Homologous recombination in human embryonic stem cells. Nat Biotechnol 2003;21:319–21. doi:10.1038/nbt788.\n'},{id:"B57",body:'\nHeim R, Tsien RY. Engineering green fluorescent protein for improved brightness, longer wavelengths and fluorescence resonance energy transfer. Curr Biol 1996;6:178–82. doi:10.1016/S0960-9822(02)00450-5.\n'},{id:"B58",body:'\nSpencer VA, Kumar S, Paszkiet B, Fein J, Zmuda JF. Cell culture media for fluorescence imaging. Genet Eng Biotechnol News 2014;34:16, 18. doi:10.1089/gen.34.10.09.\n'},{id:"B59",body:'\nDMEM/F-12 - Thermo Scientific n.d. http://www.thermofisher.com/be/en/home/technical-resources/media-formulation.55.html.\n'},{id:"B60",body:'\nAubin JE. Autofluorescence of viable cultured mammalian cells. J Histochem Cytochem 1979;27:36–43. doi:10.1177/27.1.220325.\n'},{id:"B61",body:'\nYusuf B, Gopurappilly R, Dadheech N, Gupta S, Bhonde R, Pal R. Embryonic fibroblasts represent a connecting link between mesenchymal and embryonic stem cells. Dev Growth Differ 2013;55:330–40. doi:10.1111/dgd.12043.\n'},{id:"B62",body:'\nFischer Y, Ganic E, Ameri J, Xian X, Johannesson M, Semb H. NANOG reporter cell lines generated by gene targeting in human embryonic stem cells. PLoS One 2010;5:e12533. doi:10.1371/journal.pone.0012533.\n'},{id:"B63",body:'\nZhong JF, Weiner L, Jin Y, Lu W, Taylor CR. A real-time pluripotency reporter for human stem cells. Stem Cells Dev 2010;19:47–52. doi:10.1089/scd.2008.0363.\n'},{id:"B64",body:'\nNoisa P, Urrutikoetxea-Uriguen A, Li M, Cui W. Generation of human embryonic stem cell reporter lines expressing GFP specifically in neural progenitors. Stem Cell Rev 2010;6:438–49. doi:10.1007/s12015-010-9159-9.\n'},{id:"B65",body:'\nJames D, Nam H, Seandel M, Nolan D, Janovitz T, Tomishima M, et al. Expansion and maintenance of human embryonic stem cell-derived endothelial cells by TGFbeta inhibition is Id1 dependent. Nat Biotechnol 2010;28:161–6. doi:10.1038/nbt.1605.\n'},{id:"B66",body:'\nLei L, Li L, Du F, Chen C-H, Wang H, Keefer CL. Monitoring bovine fetal fibroblast reprogramming utilizing a bovine NANOG promoter-driven EGFP reporter system. Mol Reprod Dev 2013;80:193–203. doi:10.1002/mrd.22147.\n'},{id:"B67",body:'\nMaass K, Shekhar A, Lu J, Kang G, See F, Kim EE, et al. Isolation and characterization of embryonic stem cell-derived cardiac Purkinje cells. Stem Cells 2015;33:1102–12. doi:10.1002/stem.1921.\n'},{id:"B68",body:'\nAlkaline Phosphatase Live Stain - ThermoFisher Scientific n.d. https://www.thermofisher.com/order/catalog/product/A14353.\n'},{id:"B69",body:'\nStem Cell CDy1 Dye - ActiveMotif n.d. https://www.activemotif.com/catalog/895/stem-cell-cdy1-dye.\n'},{id:"B70",body:'\nKang N-Y, Yun S-W, Ha H-H, Park S-J, Chang Y-T. Embryonic and induced pluripotent stem cell staining and sorting with the live-cell fluorescence imaging probe CDy1. Nat Protoc 2011;6:1044–52. doi:10.1038/nprot.2011.350.\n'},{id:"B71",body:'\nGalán A, Simón C. Monitoring stemness in long-term hESC cultures by real-time PCR. Methods Mol Biol 2016;1307:89–104. doi:10.1007/7651_2014_131.\n'},{id:"B72",body:'\nHuggett J, Dheda K, Bustin S, Zumla A. Real-time RT-PCR normalisation; strategies and considerations. Genes Immun 2005;6:279–84. doi:10.1038/sj.gene.6364190.\n'},{id:"B73",body:'\nSolanas M, Moral R, Escrich E. Unsuitability of using ribosomal RNA as loading control for Northern blot analyses related to the imbalance between messenger and ribosomal RNA content in rat mammary tumors. Anal Biochem 2001;288:99–102. doi:10.1006/abio.2000.4889.\n'},{id:"B74",body:'\nVandesompele J, De Preter K, Pattyn F, Poppe B, Van Roy N, De Paepe A, et al. Accurate normalization of real-time quantitative RT-PCR data by geometric averaging of multiple internal control genes. Genome Biol 2002;3:Research0034.1–0034.11.\n'},{id:"B75",body:'\nVossaert L, O Leary T, Van Neste C, Heindryckx B, Vandesompele J, De Sutter P, et al. Reference loci for RT-qPCR analysis of differentiating human embryonic stem cells. BMC Mol Biol 2013;14:21. doi:10.1186/1471-2199-14-21.\n'},{id:"B76",body:'\nPiehler AP, Grimholt RM, Ovstebø R, Berg JP. Gene expression results in lipopolysaccharide-stimulated monocytes depend significantly on the choice of reference genes. BMC Immunol 2010;11:21. doi:10.1186/1471-2172-11-21.\n'},{id:"B77",body:'\nCurtis KM, Gomez L a, Rios C, Garbayo E, Raval AP, Perez-Pinzon M a, et al. EF1alpha and RPL13a represent normalization genes suitable for RT-qPCR analysis of bone marrow derived mesenchymal stem cells. BMC Mol Biol 2010;11:61. doi:10.1186/1471-2199-11-61.\n'},{id:"B78",body:'\nMarullo M, Zuccato C, Mariotti C, Lahiri N, Tabrizi SJ, Di Donato S, et al. Expressed Alu repeats as a novel, reliable tool for normalization of real-time quantitative RT-qPCR data. Genome Biol 2010;11:R9. doi:10.1186/gb-2010-11-1-r9.\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Liesbeth Vossaert",address:"liesbeth.vossaert@ugent.be",affiliation:'
Laboratory of Pharmaceutical Biotechnology, Ghent University, Ottergemsesteenweg, Gent, Belgium
Laboratory of Pharmaceutical Biotechnology, Ghent University, Ottergemsesteenweg, Gent, Belgium
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1. Introduction
Antiparasitic chemotherapeutics can be categorized as anthelmintics, ectoparasiticides (insecticides and acaricides), and antiprotozoals. Anthelmintics are those agents used to destroy worms and are used as anticestodal, antinematodal, and antinematodal agents [1].
The use of chemical agents against nematodes traced back to the 1990s and those agents were having less effectiveness. Chemicals used for nematode destruction were arsenic compounds, cupric sulfate, nicotine, Chenopodium oil like alkaloids. These chemical compounds were found less effective and more toxic for livestock. Synthetic drug phenothiazine antinematodal characteristics were first reported in the United States and were used as broad-spectrum medicine for nematode treatment in horses, ruminants, and chickens. Phenothiazine is removed from the therapeutic inventory in many countries [1].
From that time scientists were trying to produce an ideal anthelmintic drug that could be used as broad-spectrum dewormers and result in the use of organophosphorus compounds, imidazoles, and tetrahydro pyrimidines. Thiabendazole (TBZ) was developed in 1961 after two decades, and this drug is having high efficiency and safety and broad-spectrum. It was the first-generation benzimidazole group and used against a wide range of hosts, i.e., goats, poultry, sheep, cattle, pigs, horses, and humans against gastrointestinal nematodes, and it shows ovicidal, larvicidal, and adulticidal activities. After TBZ’s success, it was planned to structurally modify it toward evolving drugs with excellent properties. Levamisole was discovered in 1966 and was marketed with the name of hydrochloride (HCL) salt having broad-spectrum antinematodal activities and immunomodulator effects [2].
Macrocyclic lactone derivatives including ivermectin (IVM) were discovered in 1981 broad-spectrum insecticidal activities. After this in 2009 after 28 years, monepantel was commercially released [3]. Broad-spectrum antinematodal synthetic compounds are divided into four major groups, i.e., macrocyclic lactone derivatives including milbemycins/ivermectin, benzimidazole/pro-benzimidazole group, tetrahydro pyrimidines group including morantel, pyrantel tartrate, and imidazothiazoles group including tetramisole and levamisole [1].
Commonly used chemotherapeutic groups are briefly reviewed in this review.
2. Benzimidazoles/pro-benzimidazoles and their mode of action
Compounds of this group are metabolized in the body and activate BZ metabolites. Members of this group are oxfendazole, ricobendazole, albendazole, thiabendazole, mebendazole, triclabendazole, oxibendazole, cambendazole, and other chemicals belonging to pro-benzimidazole, i.e., thiophanate, febantel, and netobimin [1].
Benzimidazole is effective against adult nematodes in ruminants and also has ovicidal and larvicidal activities. Some benzimidazole also exhibits anti-trematode and anticestodal activities. They are used in various hosts such as bovine, canine, equine, ovine, feline, reptiles, caprine, birds, and human species. In the case of humans, thiabendazole, mebendazole, and albendazole are used. They are having low toxicity and in some cases can be drenched 10 times than the calculated standard dose rate [2, 4].
All members of this group are having the same mode of action and disturb the energy metabolism of parasitic nematodes through binding with tubulin protein (alpha and beta molecules). This protein is present in plasma and microtubules and forms heterodimers and constructs blocks in polymeric microtubules [1]. Microtubules formation is a dynamic process affected by tubulin ring polymerization and depolymerization. Microtubules play an important role in cell division, energy metabolism, shape, and transport of substrate and protein assemblage. Benzimidazole group members bundle with β-tubulin, and this complex integrates at the propagating ends of the microtubules and inhibits the assemblage of extra microtubules. This whole process is known as capping [5, 6, 7].
They cause parasite undernourishment (due to failure in glucose uptake, the proliferation of microtubules, and protein secretion), reduction in acetylcholinesterase enzyme secretion, reduction in carbohydrate catabolism through fumarate reductase enzyme. Histological investigation of benzimidazole pharmacodynamics also reports their role in disturbance of microtubule aggregation in nematodes at those concentrations that do not influence mammalian cells (Figure 1) [1, 6, 8].
Figure 1.
Illustration of four different mechanisms of action by benzimidazoles against GI parasites.
3. Imidazothiazoles and their mode of action
Imidazothiazoles consist of two drugs, i.e., tetramisole and levamisole HCL (LEV). Levamisole is a Levo isomer and has true antinematodal activity while tetramisole is a mixture of Levo and destroys forms. That is why the calculated dose of levamisole is half that of tetramisole.
Levamisole is mostly used in goats, sheep, swine, and cattle while in the case of horses, it is contraindicated. This drug is having potency against both mature and immature stages. That’s why the calculated dosage of LEV is half that of tetramisole with a safety index of twice.
In sheep, goat, cattle, and swine, LEV is administrated, and in horses, mostly it is contraindicated. In several mature and immature stages of alimentary tract nematodes and lungworms, LEV has shown great potential. Whereas LEV is not anticestodal nor it is anti-trematode. LEV has not shown any ovicidal activity such as BZs. Whereas the remedial index of LEV is relatively lower than that of other antinematodal. LEV has also been found effective against hypobiotic larvae of the sheep parasitic nematode, H. contortus [1, 4].
The working mode of action of levamisoles has depicted that it works as a cholinergic agonist; it acts as nicotinic acetylcholine receptors on the surface of the nematode muscle cells along with neuromuscular junction. The antinematodal potential of LEV is mostly associated with its ganglion stimulant activity. It induces ganglion-like structure in somatic muscle cells of nematodes. The induction ultimately results in determining muscle contractions that are in line with the depolarizing barricades causing paralysis.
The pharmacodynamics of the compound plays an important role in the paralysis that leads to the elimination of helminths promptly through normal intestinal peristalsis (Figure 2) [1, 2].
Figure 2.
Illustration of the mechanism of actions of levamisole and ivermectin against GI parasites.
4. Macrocyclic lactones (avermectins/milbemycins) and their mode of action
Macrocyclic lactones have different commercialized products that show insecticidal activity against a broad range of parasitic nematodes and ectoparasites (ticks, mites, lice) that infest domestic animals [9, 10]. Avermectins that include doramectin, ivermectin, abamectin, and eprinomectin are the fermented products of actinomycete Streptomyces avermitilis. On the other hand, milbemectins including moxidectin and selamectin are the fermented products of Streptomyces cyanogriseus. On a chemical basis, avermectins differ based on the side chain of the lactone ring while milbemycins differ from each other because of the lactone skeleton [1].
The unequal larvicidal and adulticidal activity of IVM against Gastro-Intestinal Tract (GIT) roundworms and lungworms of ruminantia, porcine, and equine is its main factor of characterization [10, 11]. The control of microfilariae of canine heartworm Dirofilaria immitis is also achieved by the same chemical [1]. These chemicals do not have any anticestodal or antitrematodal activity nor are they ovicidal. Because of the nematicidal, acaricidal, and insecticidal activity of IVM, it is frequently used in sheep in different countries [4].
IVM along with other ML derivatives such as moxidectin is frequently used against haemonchosis in sheep due to its mode of action [1]. This increases their influence by binding to glutamate and GABA-gated chloride channel receptors in nematode and arthropod nerve cells. The whole process results in the opening of the channel and allows the entry of chloride ions (Cl−). This will lead to the paralysis of the body wall, pharyngeal muscles, and uterine muscles in nematodes [12]. It is stated that the sensitivity of dissimilar chloride channel subunits to MLs and expression location are variable characters, and it can be accounted for the paralytic effect of different concentrations of MLs on the neuromuscular systems. It is also stated that nematode paralysis and body wall muscle paralysis can be proved serious for prompt exclusion, also pharyngeal muscle paralysis is more sensitive [13]. It has also been revealed that MLs cause the flaccid paralysis of the pharynx of nematodes along with moxidectin and IVM as it is more sensitive than somatic musculature, which shows that the target is the nervous system of parasites. If the concentration of MLs drops, then the motility of the parasites can be recuperated. As compared with somatic muscles, the paralysis of the pharyngeal muscles, as well as consequential inhibition of nourishing, can be longer. The reason for the ineffectiveness of ML derivatives against trematode and cestode parasites is that these worms do not have receptors at their glutamate-gated chloride channel.
5. Anthelmintic resistance of GIT nematodes
Resistance development against anthelmintics consists of a certain phase, i.e., during first phase, number of parasites developing resistance against specific anthelmintics is less; there is a gradual increase, and heterozygous parasites develop resistance and lead to the final phase where individuals become resistant against those anthelmintics, and the population becomes homozygous parasites population. It is also observed that parasite resistance against a specific anthelmintic also brings resistance against some other anthelmintics groups [14].
Resistance is a drug tolerance ability of a worm and survives in the recommended doses of anthelmintics that are normally an effective dose [15]. Parasitic resistance was first described in 1957, and firstly studied anthelmintic agents were organophosphates, phenothiazine, rafoxanide, thiabendazole, and macrocyclic lactones [16]. Recently different GIT parasites especially H. contortus resistance are studied against different anthelmintics groups, i.e., rafoxanide, macrocyclic lactones, phenothiazine, organophosphates, levamisole, ivermectin, and thiabendazole in small ruminants [17]. It is also noted that resistance development started after a few years of drug development especially in H. contortus [18]. But, the resistance of the parasites against a broad spectrum of anthelmintics is increasing gradually within days; multiple factors are involved in developing resistance such as excessive and repeated use of the same anthelmintic, underdosing, poor management, etc. [19, 20]. Resistance of some GI parasites, specifically of H. Contortus against diverse groups of drugs, namely rafoxanide, organophosphates, phenothiazine, macrocyclic lactones (ivermectin), thiabendazole, and levamisole in small ruminants, has been reported worldwide [18]. Currently, numerous tests are available for the detection of anthelmintic resistance of GI parasites including in vitro egg hatch assay, fecal egg count reduction test, in vivo anthelmintic efficiency assay (AEA), and tubulin binding assay (TBA) [21]. The prominent anthelmintic classes reported for resistance of H. contortus in sheep [3, 22] have been presented in the Table 1.
Imidazothiazoles (Levamisole HCL)
Benzimidazoles (most members)
Tetrahydropyrimidines (Morantel and Pyrantel)
Common
Very common
Less common
Salicylanilides (Closantel)
Avermectines (Ivermectin and Moxidectin)
Amino acetonitrile derivatives (Monepantel)
Common
Common
Less common
Table 1.
The renowned anthelmintic classes (with drug examples) reported resistance [3, 22].
6. Geographic regions where resistance has developed
Initially, the development of resistance against nematicidal drugs was reported in the Southern hemisphere, and the most resistant was studied on H. contortusnematode. The development of resistance has differed geographically based on various factors such as weather conditions, species of parasite, mode of therapy, use of variable drugs, etc. The resistance rate is slightly lower in temperate zones in the Northern hemisphere [1, 23]. Prominently in the previous three decades, anthelmintic resistance is reaching its peak and becoming a great issue in livestock development, and the resistance is being reported around the globe including South Pacific, Australia, Latin America, North America, Africa, Eastern Union, and Southeast Asia [23]. Several studies reporting the occurrence of antinematodal resistance against various chemotherapeutic agents residing in sheep abomasa from different parts of the world are shown in Table 2:
Hence, the growing anthelmintic resistance is threatening livestock production, increasing the toxic level in the environment, and ultimately reducing the food availability for human beings [23, 40]. Therefore, the scientists and parasitologists are performing the duty to raise one’s hope by launching alternatives to overcome the developing resistance such as biological control (phytotherapy) [33].
7. Globally applicable gastrointestinal nematodes control measures/strategies
Control of gastrointestinal nematode parasite (GINP).
Numerous techniques and plans have been utilized to lower the gastrointestinal (GI) nematode parasites of small ruminants across the world. Some of the techniques and methods are appropriate, and a few of them have limitations. Moreover, new methods and new approaches are being evaluated and established. The prime methodologies that have been used routinely to reduce the burden of GI nematodes are reviewed here.
7.1 Chemical control methods
7.1.1 Chemotherapy (anthelmintic)
Anthelmintics are those drugs that kill the helminths and are playing a toxic role to the worms and can be achieved by exposing the nematodes to a higher concentration of anthelmintics. This higher concentration is for worms not for the host body cells. This higher concentration inhibits the vital metabolic processes of the worms and kills the worm either by starving it or paralyzing it [23]. Resistance is a reduction in the efficacy of certain anthelmintics against parasites that are susceptible to anthelmintics in normal conditions [41]. Chemotherapeutic application is a very common and primitive method (conventional) to control the GINP around the globe. The agents have been used for both therapy and prophylaxis. Benzimidazole, Ivermectin, and Imidathiazole are three major chemical groups that have been used frequently for decades.
Several reports are published that demonstrate the resistance generation of GI nematodes to these chemicals worldwide [23]. Few studies reported the higher level of resistance produced against the broad-spectrum anthelmintics and also reported the side effects at higher dose levels [41]. A higher level of resistance in H. contortus is developed in the endemic areas of haemonchosis. Nevertheless, the side effects and resistance produced by the excessive use urged scientists to adapt alternative GI nematode control methods to reduce the risk of environmental pollution. The consumer requested “clean and green” by-products that are free from residuals and growth promoters and cost-effective, and scientists were appealed to work for the launching of new and effective drugs and strategies [23]. Various factors such as frequent dosing of the same brand to infected and noninfected without discrimination, wrong choice, inappropriate administration massively involved in the development of resistance and reoccurrence of disease with re-exposure of the parasites [41]. H. contortus (roundworm) has been reported as resistant to all broad-spectrum families of anthelmintics [33, 35, 42].
Resistance is a global issue, and some regions are more exposed to it as compared with others, e.g., tropical and subtropical regions are more affected by the resistance of GI nematodes [33]. Soli et al., [40] reported multiple anthelmintic resistance in goats from Punjab Pakistan, and various other researchers also reported anthelmintic resistance in goats [33, 35, 42]. The most extensively used model for the control of nematode parasites is the use of chemical agents, and among these the most commonly used chemicals are benzimidazoles and avermectin. However, resistance development against these anthelmintics results in difficulty in the use of these chemicals as a control measure at the farm level [23]. High-degree resistance is reported in parasites against multiple chemical agents [43]. Along with H. contortus, some other nematode parasites develop resistance and are studied well, e.g., Trichostrongylus spp. and Ostertagia spp. [23]. Due to resistance development, the introduction of new administered drugs shows reduced efficacy [41].
Regions where haemonchosis is endemic and anthelmintic treatment is frequently used at the farm level are exhibiting more resistance in H. contortus. So, the use of alternative strategies is the necessity of time to control parasite burden at farm level, and also consumer demand is changed; they need cost-effective and residual-free strategies for control [23]. Some other methods are also used for the control of parasites in the animal industry, which are still underutilized and can be a more successful alternative against resistance development issues.
7.1.2 Copper oxide wire particles
In grazing ruminants, copper is administered along with diet as a feed additive to overcome the deficiency symptoms. The use of copper started in the 1900s, in various forms to minimize the worm load (SCSRPC). The use of copper oxide wire particles (COWPs) was found more successful in reducing nematodes, more precisely H. contortus [40, 43]. Following administration of COWP, it enters the abomasum along with the ingesta and sticks to the mucosal folds [44]. In the acidic conditions of the abomasum, stuck elements take several weeks to dissolve, and free copper is released slowly, which augments the soluble copper concentrations. Ultimately, copper reserve of the liver increases. The copper mode of action is yet to be understood, but researchers assumed that it alters the abomasum conditions that hinder nematode attachment and cause their death or expulsion. Following the COWP ingestion, an increase in packed cell volume (PCV) and a decline in EFC have been observed. The efficacy of COWP is higher against adult worms of abomasum but ineffective in the case of intestinal helminths [43]. Therefore, fecal culture is recommended to explore the higher population of H. contortus, before COWP administration [45]. The COWP is found to be equally effective against nematodes in both sheep and goats [40].
In this perspective, the naturally found pest antagonist organisms are used to control the pest population. Grønvold et al. [47] ascertain the role of fungi as nematophagous, earthworm, and dung beetle as anthelmintic [48], and these are potentially effective biological agents. Biological control is an effective way of overcoming the GI helminths. Mainly nematophagous fungus, Duddingtonia flagrans, is used to control the nematodes infesting GI tract. During the field trial, it shows encouraging results toward sheep and goats’ GI nematode parasite control [42]. The fungal spores are fed to animals along with a diet that passes through the GI tract without harming the gut mucosa. Fungus sporulates in animal feces and their hyphae kill the nematode larvae in fecal material; hence, diminished the pasture burden of nematodes larval stage [49, 50, 51, 52]. The use of nematophagous fungi is an effective alternative approach, but there is a limitation regarding delivery to animals and antagonist role of other drugs, namely benzimidazole as an antifungal agent. Duddingtonia flagrans also show their effectiveness toward the larvae that escape out after the COWP treatment, which proposes another application of biological control for helminths [43].
The biological control strategies were proposed to reduce the parasite population below the economic threshold and clinical level above that considerable production losses are there. High efficacy of D. flagrans was noticed against larval stages of various nematodes of cattle [47], sheep [53], and horses [52]. It has been proven by field trials that among grazing animals, daily fungal spores feeding for 3–4 months hinder the build-up of various larvae up to dangerous levels on pasture.
Sheep feeding supplemented with D. flagrans chlamydospores lowers the egg counts and improves animal weight gain in comparison with untreated animals [54]. For the application of nematode-trapping fungi against GINs of ruminants, a strategy was formulated [55]. D. flagrans can produce a large quantity of thick-walled chlamydospores, which makes them more effective against nematodes in comparison with other nematode-trapping fungi [56]. D. flagrans is used as a biological agent against nematode such as H. contortus in grazing animals [42].
7.3 Control through monitoring
7.3.1 Parasite monitoring strategies
Strategies for worm load investigation: FEC, larval developmental assays (LDA), FEC reduction test, and fecal larval culture (FLC) have proved valuable linkage with monitoring and control of worm infection. Mainly FEC is used for monitoring and management of GIN parasites. LDA is used for nematode species identification and to explore the resistance level [57]. FLC helps in identifying worm species, seasonal variation, and enclosure of GIN population. FECRT is the most authentic approach to determine anthelmintic resistance, but it is expensive and labor-intensive [57]. The demands for the exploration of alternative strategies toward helminth control have been augmented due to the lack of new anthelmintics. The applications of plants having condensed tannins, COWP, nematophagous fungi, and other biological approaches in combination with anthelmintics, animal management, control of ecological factors, and GIN level monitoring strategies could be effective to overcome GIN resistance in small ruminants.
7.3.2 FAMACHA chart and mac master technique
Among TST methods FAMACHA chart and McMaster are mainly used way to identify the worm-infected animals and require treatment. The former method is used to diagnose anemic animals by comparing their eye (conjunctiva) color with the chart. The latter method provides a real-time picture of parasite burden via egg counting in fecal material. In the McMaster method, fecal material is suspended in floatation solution and supernatants are taken on a specific glass slide (Mc Master chamber) and observed under a microscope for egg counting. For reducing anthelmintic resistance among GI parasites, selective therapy is highly effective. By using the aforementioned methods, medicinal cost of animals declines because they selectively purchase few anthelmintics and animals are responsive against these drugs. On the other hand, selective therapy is laborious and time-taking, farmers have to perform the FAMACHA check once a month. Routine-wise performance of McMaster is mandatory because sometimes with FAMACHA check animals found healthy while through McMaster they were found with high worm burden, and such animals should be treated because these animals may act as a source for others. The FAMACHA score system is found to be highly effective in the selection of worm-resilient animal breeds [58].
For the control of GI nematodes infections, two most commonly used methods include the use of anthelmintics and pasture management; they are associated with reduction of production losses because of nematodes infections. Two ways of producing safe pastures and reducing the infectivity of pasture include rotational grazing and pasture spelling, this strategy is very [59]. In rotational grazing, it is assumed that significant larval mortality occurs because of break-in grazing. But, unfortunately, the period in between animal rotations makes the best use of available and nutritious forage coincides with the period during that high concentration of L3 becoming available for reinfection. In the United States, a study was conducted at a farm and reported that lambs raised under a rotational grazing system were highly infested with helminths in comparison with others. Most of them were infected with nematodes, H. contortus, and gained less weight in comparison with control (non-grazing). It is therefore concluded that rotational grazing is not a good option in sheep. In some situations, it is recommended to extend the periods between the rotations of (60–90 days) as it may significantly lessen the parasitic infection. Rotation of younger susceptible animals with highly resistant older animals may prove to be beneficial. But such a strategy may not be possible due to practical restraints [35].
7.4.2 Manipulating supplementation of nutrients
With the provision of a good and high level of nutrition, the productivity of animals can be improved with an increase in the immune response against parasites. With an increase in the level of proteins in the diet, an increase in the resistance and resilience of lamb against H. contortus has been observed [60]. The supplementation of a meal with sorghum and soybean for the grazing kids has shown increased resilience against helminth parasites [61]. Indeed, improvement in nutrition is an efficient strategy to lessen and compensate for the negative impacts of parasitic infection. Whereas approach to urea molasses increases both resistance and resilience in grazing East African goat kids in an environment overshadowed by H. contortus [62]. In a review by Hoste et al., [63], it has been discussed that the supplementary feeding to the goats has shown an increased response concerning resilience, whereas the effects on host resistance were less prominent.
7.5 Control through medicinal plants
In ethnoveterinary medicine, medicinal plants are used for the prevention and treatment of gastrointestinal parasitism. There is a wide range of medicinal plants or plant extracts that are used to treat almost every kind of livestock disease related to parasites. There are so many studies and available literature on the anthelmintic properties of plants and their extracts, which confirms the antinematodal effects of these plants [33, 42, 64, 65, 66, 67]. In comparison to synthetic drugs the herbal preparations are way cheaper and easily available and thus have been used for a long time in the therapy of livestock diseases of helminth parasites [68].
Many plants and herbs are used as control agents for human and veterinary endoparasites, and the efficacy of each plant depends upon the chemical composition and secondary metabolites composition. The composition of a plant is a variable character depending upon soil properties, climatic conditions, geographical variability, and environmental conditions. Anthelmintic activity of a plant is variable in different areas of the world and depends upon the harvest of the plant, plant parts, which are used as anthelmintics, storage of the plant, and combination of different plant extracts [68]. Choice of extraction solvent is also an important factor that affects the solubility of secondary metabolites of the target plants usually water and methanol are used as extraction solvents. Ethanolic extracts are considered a better choice as they can easily enter the body of the parasite through absorption [69].
To determine the plant properties, two different study types are used. i.e., in vitro and in vivo, and each study type has some merits and demerits. In vitro studies are cost-effective and can study a variety of plants at the same time, allowing the study of specific parasites and their lifecycle stages [70]. While in vivo studies are lengthy processes and can study a single plant at a time. Sometimes the result of the in vivo and in vitro can be different as the outcome of the study depends on the internal factor of the host and plant species, e.g., the digestive system of the host [71].
Till today 25% of modern pharmacopeia use plant-derived drugs and some semisynthetic using plant as prototype compound [72]. Anthelmintic efficacy of plants is derived from different parts, e.g., saponins (can cause teguments degradation and vacuolization), tannins, and polyphenols can form a protein complex in the rumen and increase the protein supply, interfere with energy generation, reduction in gastrointestinal metabolism, and ultimately death of the helminth and alkaloids (effect the transport of sucrose transfer from the stomach to the intestine and helminth glucose support is disturbed causing paralysis) [73].
7.5.1 Condensed tannins
Tannins are compounds that attach with proteins and other molecules and are used as a biological alternative against chemical anthelmintic; many plants naturally contain condensed tannins. There are two main groups in which tannins are divided: one is hydrolyzable tannins (HTs) and the other one is condensed tannins (CTs). Among the two of these groups, condensed tannins are more abundant and are naturally present in browse, legumes, plants, and forage. The concentration of CT, type of animal consuming CT, the plant itself, and the concentration of CT in the plant are the factors that stimulate the effects of CTs. The high concentration of CT can have negative effects, and the noticeable negative effect is reduced palatability that ultimately causes a reduction in intake and digestion, which exerts a negative impact on productivity [46]. There are several benefits of CT intake that include increased wool growth and growth rate, increased amount of bypass protein, reduced bloating, high milk production, as well as a high rate of ovulation.
The prominent and most important benefit of CTs is their positive impact on the GIN infection. It has been observed that CTs specifically H. contortus reduce the GIN infection, it also reduces the overall egg output through the reduction in female fecundity. In addition to this, there is also a decrease in the GIN egg hatchability and the development of larva in the feces. Concerning reduction in GIN infection, the most important and researched CTs include big trefoil, sericea lespedeza, sulla, and sanfoin [46]. When the animals are allowed to graze SL management benefits have been observed that are less exposure to GIN as the plant grows off the ground, and since there is also an increase in the level of proteins that causes a potential increase in the resilience and resistance.
7.5.2 Plants as nutraceuticals
The nutritional combination of animal feed affects the biodiversity of GIT fauna, which may affect the parasite fitness by altering the intestinal environment in which the parasites propagate [63]. Tannins, flavonol glycosides, sesquiterpene, and secondary metabolites are potential candidates for integrated nematode control at the farms level [63, 74, 75]. The plants having these properties are known as nutraceuticals, which are considered for both the nutritional value and as an anthelmintic. It has been reported that supplementation of bioactive plants to goats played role in the regulation of bionomics of resistant parasitic populations along with enhancing the ability of the goat to withstand negative effects of the pathophysiology of parasitic infections [63]. An increase in post-ruminal protein availability playing role in reducing the parasitic infections in large ruminants has also been reported, which may be attributed to the availability of condensed tannins (CTs) or proanthocyanidins and polymers of flavonoid units [48].
7.6 Control through immunological interventions
7.6.1 Vaccines (immunization and vaccination)
The most effective way of controlling infection is vaccination; therefore, demand for vaccine development against GI parasites rises. In disparity with vaccines of viral and bacterial pathogens, vaccine development against parasites did not gain similar success although parasitologists are working in this regard for the last 30 years. The vaccine has been developed against tapeworm and lungworm sheep and cattle respectively. Studies have been conducted in the identification of various antigens of nematodes as vaccine agents [76]. Gut-associated antigens have been reported as vaccine candidates, namely H-gal-GP and H11 of H. contortus [77]. Fecal egg count has been markedly declined in goat kids with the use of vaccine candidates. Secretory and excretory products of parasites have been found as effective vaccine candidates. It has been reported that the use of secretory and excretory antigens as vaccine candidates in infection of H. contortus results in enhancing the immunity of the host, thereby reducing the FEC and worm burden by 70% [78]. It has been reported that the use of H-11 and H-gal reduces 60–75% of worm burden and 80–90% FEC, and they can be good candidates for vaccine development [79]. Both of these candidates have been reported to induce protective immunity in terms of IgG production, PCV maintenance, FEC, and worm burden reduction in lambs and kids [77].
Traditional use of chemotherapeutic agents against infection of ectoparasites as well as endoparasites leads to the development of resistance against these therapeutic agents. It converges the scientists for exploring the nontraditional ways of controlling GI parasites; development of a resistant breed of the host through selective breeding, vaccine development, implementation of other control measures (alternate pasture grazing and rotational grazing), and synergistic use of anthelmintics [80].
In vaccines, acquired immunity plays a pivotal role in the protection of the host against pathogens, and it needs to be explored for the development of a vaccine. In the case of parasites, the role of acquired immune response is not fully explored. Therefore, vaccine development against GI parasites for protection remains ineffective [81].
Some fungi of Arthrobottrys spp. have been reported to attack and kill the larvae of nematodes in fecal pats, but these fungi are being killed by passage through the gut and therefore are of no great importance, but nowadays, a new fungus D. flagrans has been reported, which will grow and pass through the gut harmlessly and is active against larvae of nematodes in fecal pats [13].
8. Alternatives
Gastrointestinal nematode resistance to anthelmintics has been growing day by day, gaining currency to consider it for adopting control measures shortly of the domestic livestock industry. The use of chemical anthelmintics in combination with bioactive plants as nutraceuticals seems to be a potential strategy for parasitic control. Alternate strategies, i.e., use of plants containing condensed tannins, plant-based vaccines, COWP, and biological control through nematode-trapping fungi along with husbandry management may prove helpful in minimizing the mortality and morbidity of parasitic diseases in small ruminants. However, animal breeds selected based on their response to nematodes present in the gastrointestinal tract are an alternate control strategy toward minimizing gastrointestinal problems in goats [43].
8.1 Breeding for resistance
Identification of resistant individuals is necessary for the production of parasitic-resistant breeds. Two parameters are mostly reported for the selection of resistant breeds, i.e., FEC, which is an indirect parameter for measurement of the relative level of infection [82]. Hematocrit and PCV are being used for the identification of worm burden, especially in the case of H. contortus. In Australia, FEC both in natural and artificial infections has been used for many years to select the animals for parasitic resistance [83].
The researchers cannot divide the magnitude of resistance into discrete genetic units; therefore, the resistance is described in the form of heritability estimates [84]. The phenotype of quantitative traits is regulated by the additive effect of specialized genes [85], which are yet to be identified. The resulting resistance may be attributed to the effect of a combination of many small genes or a group of major genes that are being regulated not only by additive effects but also by the environmental effects [84].
8.2 Genetic and phenotypic parameters for worm resistance
Packed cell volume and fecal egg count are the most useful markers/parameters to estimate the response of host challenge and natural infection with nematodes present in GI in general and specifically H. contortus. Both PCV and FEC are heritable traits. Heritability of FEC ranges from 0.04 to 0.37. Morris et al. [86] described a heritability estimate of 0.05 in Saanen goats at the age of 12 months in New Zealand, and Woolaston et al. [87] described a heritability estimate of 0.04 and 0.08 in Fijian goats at 12 months of age in Fiji. [88]. Similar studies have been conducted in Kenya where they found FEC heritability estimates of 0.15, 0.16, and 0.12 in small East African goats at the age of 4, 5, 8, and 10 months, respectively. Some more studies have been conducted by Vagenas et al., [89] in Scotland, and they found 0.37 and 0.32 estimates of heritability for FEC in Scottish Cashmere goat’s breed.
8.3 Genetic and phenotypic correlation between resistant traits
Estimations of phenotypic and genetic correlation explained the amount to which genes affect two different traits and the phenotypic correlation guides the number of relations between two traits. Correlation evaluations are important in the measurement of the appropriateness of indicator traits as indirect criteria in programs related to breeding. Mandonnet et al., [88] under tropical conditions, stated positive (0.37–0.58) and negative (0.56–0.79) genetic correlations between FEC and PCV and eosinophil and FEC amount in goats. Costa et al., [66] in Brazil also describe a highly negative and significant relationship between changed PCV and FEC or hemoglobin −0.53 and − 0.45 in H. contortus infected goats. Very strong negative correlations between IgA activity and FEC have been found in Teladorsagia circumcincta infected Scottish Blackface lambs (−0.97, s.e. 0.11 and − 0.78, s.e. 0.18, respectively) and also in resistance-related traits and burdens of worms [90].
8.4 Genetic and phenotypic parameters for production traits
Host live weight is a production trait that has been considered as an important parameter while assessing the genetic resistances of the host toward GI nematode parasites. The heritability estimates of live weight (LWT) varied widely ranging from 0.13 in Australian Angora goats to 0.50 in Texan Angora goats [91]. Likewise, heritability estimates have been reported in South Africa goats breed as 0.29 and 0.35 [92]. It has been shown that resistance to infection by nematode parasites may not necessarily equate to resistance to the effects of the parasite challenge in grazing animals [86]. The association between FEC and productivity varies in magnitude and direction depending on the breed and the environment in which the evaluation was done. The genetic correlations between packed cell volume (PCV) and packed cell volume decline (PCVD) and production (live weight and wool growth) are either negligible or favorable [93].
Several studies around the globe have been conducted to assess the genetic potential of sheep and goats breeds that are resistant to gastrointestinal nematodes in the last three to four decades [82, 83, 87, 93]. The selection of breeds that are resistant to gastrointestinal nematode parasites is assuming the most promising alternate control method of gastrointestinal nematodes. Improved resistance toward nematodes control leads to reduced cost of anthelmintic treatment and diminished production losses associated with worm burden. Australia and New Zealand initiate programs on breeding for resistance and adopt them successfully by utilizing phenotypic markers [94]. Approximately 96% of the world’s goat population is kept by smallholders in developing countries, and genetic improvement programs are rare [95].
8.5 Phenotypic traits as indicators of GI resistance
Host selection for resistance has based mostly on quantitative measurement of phenotypic traits. These traits have been measured to check the response of the host being evaluated for resistance, which are biochemical, immunological, parasitological, and pathological features [84]. For the development of high-resistant breeds, it is necessary to identify the high-resistant individuals. Criteria for the selection of parasitic resistance are commonly based on two traits, i.e., packed cell volume, which indicates anemia, and fecal egg count, which measures the amount of infection. There is variation in the development of resistance between the animals of different breeds and within the same breeds, which is because of their genetic makeup. The scientists are working to investigate the cause of the development of resistance, and up to some extent they succeeded in finding some reasons while the others are under investigation [84].
9. Conclusion
According to the best of our knowledge about different factors that are responsible for GI parasitism, it is hard to develop control measures. So, the epidemiology of each parasitic disease is needed to be studied at the regional level to recommend an effective strategy for the control of parasitic diseases, which is not completely dependent on anthelmintic therapy [11]. Keeping in mind the subtropical and tropical areas in which dry seasons are more might be grazing management, rational use of anthelmintics, and use of resistant breeds.
Acknowledgments
The author wishes to thank all other coauthors for providing guidance and support.
Conflict of interest
The authors declare that they have no conflict of interest.
\n',keywords:"gastrointestinal parasitism, anthelmintic resistance, chemical Control, alternative control, future trends in livestock",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/81393.pdf",chapterXML:"https://mts.intechopen.com/source/xml/81393.xml",downloadPdfUrl:"/chapter/pdf-download/81393",previewPdfUrl:"/chapter/pdf-preview/81393",totalDownloads:40,totalViews:0,totalCrossrefCites:0,dateSubmitted:"February 8th 2022",dateReviewed:"March 3rd 2022",datePrePublished:"May 18th 2022",datePublished:null,dateFinished:"April 19th 2022",readingETA:"0",abstract:"Anthelmintic, ectoparasiticides (insecticides, acaricides), and antiprotozoal chemotherapeutic drugs target parasites. Chenopodium oil like alkaloids, arsenic compounds, cupric sulfate, nicotine, and cupric silicate were used to destroy nematodes. Unfortunately, these chemicals were less effective and less safe for livestock. The four major groups of broad-spectrum antinematodal compounds are macrocyclic lactones such as milbemycins/ivermectin, benzimidazole/pro-benzimidazole, tetrahydro pyrimidines such as morantel, pyrantel tartrate, and imidazothiazoles such as tetramisole and levamisole. The various factors responsible for gastrointestinal (GI) parasitism make it difficult to develop effective control measures, to the best of our knowledge. Hence, an effective strategy for the control of parasitic diseases that do not solely rely on anthelmintic therapies needs to be developed at the regional level, based on the epidemiology of the disease. This book chapter aims to elaborate on the various other ways to control parasitic diseases due to Anthelmintic drug resistance.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/81393",risUrl:"/chapter/ris/81393",signatures:"Muhammad Abdullah Malik, Muhammad Sohail Sajid, Rao Zahid Abbas, Muhammad Tahir Aleem, Faisal Rasheed Anjum, Asad Khan, Muhammad Farhab, Mahvish Maqbool, Muhammad Zeeshan, Kashif Hussain, Namrah Rehman, Rana Hamid Ali Nisar, Hafiz Muhammad Rizwan and Urfa Bin Tahir",book:{id:"11380",type:"book",title:"Parasitic Helminths and Zoonoses - From Basic to Applied Research",subtitle:null,fullTitle:"Parasitic Helminths and Zoonoses - From Basic to Applied Research",slug:null,publishedDate:null,bookSignature:"Prof. Jorge Morales-Montor, Dr. Víctor Hugo Del Río-Araiza and Dr. Romel Hernández Bello",coverURL:"https://cdn.intechopen.com/books/images_new/11380.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-568-3",printIsbn:"978-1-80355-567-6",pdfIsbn:"978-1-80355-569-0",isAvailableForWebshopOrdering:!0,editors:[{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Benzimidazoles/pro-benzimidazoles and their mode of action",level:"1"},{id:"sec_3",title:"3. Imidazothiazoles and their mode of action",level:"1"},{id:"sec_4",title:"4. Macrocyclic lactones (avermectins/milbemycins) and their mode of action",level:"1"},{id:"sec_5",title:"5. Anthelmintic resistance of GIT nematodes",level:"1"},{id:"sec_6",title:"6. Geographic regions where resistance has developed",level:"1"},{id:"sec_7",title:"7. Globally applicable gastrointestinal nematodes control measures/strategies",level:"1"},{id:"sec_7_2",title:"7.1 Chemical control methods",level:"2"},{id:"sec_7_3",title:"7.1.1 Chemotherapy (anthelmintic)",level:"3"},{id:"sec_8_3",title:"7.1.2 Copper oxide wire particles",level:"3"},{id:"sec_10_2",title:"7.2 Nonchemical methods to control GI parasitism",level:"2"},{id:"sec_10_3",title:"7.2.1 Biological control",level:"3"},{id:"sec_12_2",title:"7.3 Control through monitoring",level:"2"},{id:"sec_12_3",title:"7.3.1 Parasite monitoring strategies",level:"3"},{id:"sec_13_3",title:"7.3.2 FAMACHA chart and mac master technique",level:"3"},{id:"sec_15_2",title:"7.4 Control through management",level:"2"},{id:"sec_15_3",title:"7.4.1 Pasture management, grazing management, rotational grazing",level:"3"},{id:"sec_16_3",title:"7.4.2 Manipulating supplementation of nutrients",level:"3"},{id:"sec_18_2",title:"7.5 Control through medicinal plants",level:"2"},{id:"sec_18_3",title:"7.5.1 Condensed tannins",level:"3"},{id:"sec_19_3",title:"7.5.2 Plants as nutraceuticals",level:"3"},{id:"sec_21_2",title:"7.6 Control through immunological interventions",level:"2"},{id:"sec_21_3",title:"7.6.1 Vaccines (immunization and vaccination)",level:"3"},{id:"sec_24",title:"8. Alternatives",level:"1"},{id:"sec_24_2",title:"8.1 Breeding for resistance",level:"2"},{id:"sec_25_2",title:"8.2 Genetic and phenotypic parameters for worm resistance",level:"2"},{id:"sec_26_2",title:"8.3 Genetic and phenotypic correlation between resistant traits",level:"2"},{id:"sec_27_2",title:"8.4 Genetic and phenotypic parameters for production traits",level:"2"},{id:"sec_28_2",title:"8.5 Phenotypic traits as indicators of GI resistance",level:"2"},{id:"sec_30",title:"9. Conclusion",level:"1"},{id:"sec_31",title:"Acknowledgments",level:"1"},{id:"sec_34",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Taylor MA, Coop RL, Wall RL, editors. Veterinary Parasitology. 4th ed. London: Blackwell Publishing; 2007. pp. 356-447'},{id:"B2",body:'Einstein R, Jones RS, Knifton A, Starmer GA. Hypnotics and sedatives. In: Principles of veterinary therapeutics. England: Longman Scientific & Technical; 1994:121124'},{id:"B3",body:'Beech RN, Silvestre A. 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Faculty of Veterinary Science, Department of Parasitology, University of Agriculture, Pakistan
MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, P.R. China
MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, P.R. China
Faculty of Veterinary Science, Department of Epidemiology and Public Health, University of Agriculture, Pakistan
'},{corresp:null,contributorFullName:"Rana Hamid Ali Nisar",address:null,affiliation:'
Faculty of Veterinary Science, Department of Parasitology, University of Agriculture, Pakistan
'},{corresp:null,contributorFullName:"Hafiz Muhammad Rizwan",address:null,affiliation:'
Department of Pathobiology, Section of Parasitology, KBCMA College of Veterinary and Animal Sciences, Lahore
'},{corresp:null,contributorFullName:"Urfa Bin Tahir",address:null,affiliation:'
Faculty of Veterinary Science, Department of Parasitology, University of Agriculture, Pakistan
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IntechOpen chapters and articles are distributed under CC BY 3.0 licences allowing users to “copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship...” and there is no non-commercial restriction.
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A such system includes regulation and legal compliance procedures, actions and monitoring for ensuring workplace safety, incentives and motivation for the air traffic controller and associate personnel health and wellbeing. By a systemic approach, the key characteristics of OHS towards air traffic management are presented, highlighting the key aspects for implementing a quality management system in air traffic control, which is the cornerstone of airport operation efficiency and productivity on one hand; and the nature of job and the intensive working environment is well recognised. Based on air traffic providers functional analysis the key occupational aspects for air traffic control are taken into consideration, providing the benefits for implementing quality management systems (QMS) and OHS is real business. Conventional wisdom is to highlight the importance for establishing and incorporating a modern custom-made OHS system in accordance with the requirements addressed by OHSAS 18001 to develop and implement a QMS for air traffic services. Contribution of this paper is to highlight the key priorities for managers and decision makers in field of air traffic services providers, depicting ways and recommendation for adopting an efficient path for implementing OHS in a QMS environment.",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Dimitrios Dimitriou and Stylianos Zantanidis",authors:[{id:"207943",title:"Prof.",name:"Dimitrios",middleName:null,surname:"Dimitriou",slug:"dimitrios-dimitriou",fullName:"Dimitrios Dimitriou"},{id:"417813",title:"Dr.",name:"Stylianos",middleName:null,surname:"Zantanidis",slug:"stylianos-zantanidis",fullName:"Stylianos Zantanidis"}]},{id:"78059",doi:"10.5772/intechopen.99600",title:"Behavioral Modeling Paradigm for More Electric Aircraft Power Electronic Converters",slug:"behavioral-modeling-paradigm-for-more-electric-aircraft-power-electronic-converters",totalDownloads:127,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"To control the power flow among various energy sources and loads of a power system of modern more electric aircrafts, power electronics converters are employed. 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The chapter would cover dynamic behavioral modeling technique for power electronics systems to be employed in more electric aircrafts, which do not require any prior information about the internal details of the system.",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Husan Ali",authors:[{id:"420730",title:"Dr.",name:"Husan",middleName:null,surname:"Ali",slug:"husan-ali",fullName:"Husan Ali"}]},{id:"78139",doi:"10.5772/intechopen.99612",title:"Understanding Aviation English: Challenges and Opportunities in NLP Applications for Indian Languages",slug:"understanding-aviation-english-challenges-and-opportunities-in-nlp-applications-for-indian-languages",totalDownloads:144,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"English is a language that is understood, spoken and used by citizens of a diverse array of countries. 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This chapter summarizes conventional and deep learning technique used for classification of radar target.",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Rashmi Narasimhamurthy and Osamah Ibrahim Khalaf",authors:[{id:"426189",title:"Dr.",name:"Rashmi",middleName:null,surname:"Narasimhamurthy",slug:"rashmi-narasimhamurthy",fullName:"Rashmi Narasimhamurthy"}]},{id:"78211",doi:"10.5772/intechopen.99640",title:"Human Factors Quality Control in Air Traffic",slug:"human-factors-quality-control-in-air-traffic",totalDownloads:160,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Every living person, from infants to older people, gets affected by internal and external factors. There are numerous researches and writings related to humans and these various factors. Human factors are recognized since the start of the human race. The awareness of the impacts of our environment is not new to humans. The focus in this chapter is upon those factors which can create an impact on aircraft mechanisms and air traffic controllers. These factors include human, psychological, work conditions, training, health conditions, environment, societal, and training. These factors must be quality controlled to minimize the errors in the critical domain of air traffic. A reduction in the number of errors will allow the performance to be higher and lowers the chances of fatal accidents.",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Muhammad Usman Tariq",authors:[{id:"416758",title:"Associate Prof.",name:"Muhammad",middleName:null,surname:"Usman",slug:"muhammad-usman",fullName:"Muhammad Usman"}]}],mostDownloadedChaptersLast30Days:[{id:"78059",title:"Behavioral Modeling Paradigm for More Electric Aircraft Power Electronic Converters",slug:"behavioral-modeling-paradigm-for-more-electric-aircraft-power-electronic-converters",totalDownloads:127,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"To control the power flow among various energy sources and loads of a power system of modern more electric aircrafts, power electronics converters are employed. The integration of multiple sources into distribution system and their interconnection with variety of loads through power electronic converters results in a complex dynamic system. Modeling of these systems prior to implementation becomes necessary to analyze and predict system’s behavior. The classical modeling approaches require detail knowledge about the topology and parameters of the active and passive components of the power electronics converters. While in modern system, most of the power electronics converters are ready to use power electronics modules. These modules come from different manufacturers, lacking the necessary information to build the conventional switch or average models. The chapter would cover dynamic behavioral modeling technique for power electronics systems to be employed in more electric aircrafts, which do not require any prior information about the internal details of the system.",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Husan Ali",authors:[{id:"420730",title:"Dr.",name:"Husan",middleName:null,surname:"Ali",slug:"husan-ali",fullName:"Husan Ali"}]},{id:"78183",title:"Deep Learning Network for Classifying Target of Same Shape using RCS Time Series",slug:"deep-learning-network-for-classifying-target-of-same-shape-using-rcs-time-series",totalDownloads:145,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The main intension of this work is to find the warhead and decoy classification and identification. Classification of radar target is one of the utmost imperatives and hardest practical problems in finding out the missile. Detection of target in the pool of decoys and debris is one of the major radas technologies widely used in practice. In this study we mainly focus on the radar target recognition in different shapes like cone, cylinder and sphere based on radar cross section (RCS). RCS is a critical element of the radar signature that is used in this work to identify the target. The concept is to focus on new technique of ML for analyzing the input data and to attain a better accuracy. Machine learning has had a significant impact on the entire industry as a result of its high computational competency for target prediction with precise data analysis. We investigated various machine learning classifiers methods to categorize available radar target data. This chapter summarizes conventional and deep learning technique used for classification of radar target.",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Rashmi Narasimhamurthy and Osamah Ibrahim Khalaf",authors:[{id:"426189",title:"Dr.",name:"Rashmi",middleName:null,surname:"Narasimhamurthy",slug:"rashmi-narasimhamurthy",fullName:"Rashmi Narasimhamurthy"}]},{id:"78211",title:"Human Factors Quality Control in Air Traffic",slug:"human-factors-quality-control-in-air-traffic",totalDownloads:160,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Every living person, from infants to older people, gets affected by internal and external factors. There are numerous researches and writings related to humans and these various factors. Human factors are recognized since the start of the human race. The awareness of the impacts of our environment is not new to humans. The focus in this chapter is upon those factors which can create an impact on aircraft mechanisms and air traffic controllers. These factors include human, psychological, work conditions, training, health conditions, environment, societal, and training. These factors must be quality controlled to minimize the errors in the critical domain of air traffic. A reduction in the number of errors will allow the performance to be higher and lowers the chances of fatal accidents.",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Muhammad Usman Tariq",authors:[{id:"416758",title:"Associate Prof.",name:"Muhammad",middleName:null,surname:"Usman",slug:"muhammad-usman",fullName:"Muhammad Usman"}]},{id:"78855",title:"Online Estimation of Terminal Airspace Sector Capacity from ATC Workload",slug:"online-estimation-of-terminal-airspace-sector-capacity-from-atc-workload",totalDownloads:113,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Neural Partial Differentiation (NPD) approach is applied to estimate terminal airspace sector capacity in real-time from the ATC (Air Traffic Controller) dynamical neural model with permissible safe separation and affordable workload. A neural model of a multi-input-single-output (MISO) ATC dynamical system is primarily established and used to estimate parameters from the experimental data using NPD. Since the relative standard deviations of these estimated parameters are lesser, the predicted neural model response is well matched with the intervention of ATC workload. Moreover, the proposed neural network-based approach works well with the experimental data online as it does not require the initial values of model parameters that are unknown in practice.",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Majeed Mohamed",authors:[{id:"419366",title:"Dr.",name:"Majeed",middleName:null,surname:"Mohamed",slug:"majeed-mohamed",fullName:"Majeed Mohamed"}]},{id:"78139",title:"Understanding Aviation English: Challenges and Opportunities in NLP Applications for Indian Languages",slug:"understanding-aviation-english-challenges-and-opportunities-in-nlp-applications-for-indian-languages",totalDownloads:144,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"English is a language that is understood, spoken and used by citizens of a diverse array of countries. The speakers include both native and non-native speakers of English. 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Non-native English speakers take help of various NLP tools such as E-Dictionary, MT applications and others to better understand the English language and thus learn it better and faster. Aviation English poses a challenge to MT systems and understanding it as a whole requires specialized handling as it has own phonetic pronunciations and terminologies and constituent Out-Of-Vocabulary words. Dealing with Aviation English calls for teaming up of experts from Applied Linguistics, NLP and AI. As a result it becomes a cross-research discipline that covers situations that demand real time use of proper language, e.g. ATC communications. This Paper aims to discuss most recent research methodologies that deals with the Aviation English and reviews the problems posed by it. Being a specialized and structured form of English, the problems are faced by both native and non-native speakers of English Language. Discussion is carried out in the relevant and recent advances of methods in dealing with aviation English language challenges from both, the Human (ICAO/DGCA/AAI) as well as NLP angle. Lastly we have a look at how these challenges are linked to scope for development of applied technologies. Research in experiential Aviation English situations deals with both English for Specific Purposes - ESP (Aeronautics in our case) as well as situations in English as a Foreign Language i.e. EFL (English-Indian language pair).",book:{id:"10690",slug:"air-traffic-management-and-control",title:"Air Traffic Management and Control",fullTitle:"Air Traffic Management and Control"},signatures:"Saptarshi Paul",authors:[{id:"417288",title:"Assistant Prof.",name:"Saptarshi",middleName:null,surname:"Paul",slug:"saptarshi-paul",fullName:"Saptarshi Paul"}]}],onlineFirstChaptersFilter:{topicId:"681",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},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:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,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:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,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:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
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\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
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\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
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\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
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\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
",coverUrl:"https://cdn.intechopen.com/series/covers/24.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:1,editor:{id:"262440",title:"Prof.",name:"Usha",middleName:null,surname:"Iyer-Raniga",slug:"usha-iyer-raniga",fullName:"Usha Iyer-Raniga",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRYSXQA4/Profile_Picture_2022-02-28T13:55:36.jpeg",biography:"Usha Iyer-Raniga is a professor in the School of Property and Construction Management at RMIT University. Usha co-leads the One Planet Network’s Sustainable Buildings and Construction Programme (SBC), a United Nations 10 Year Framework of Programmes on Sustainable Consumption and Production (UN 10FYP SCP) aligned with Sustainable Development Goal 12. The work also directly impacts SDG 11 on Sustainable Cities and Communities. She completed her undergraduate degree as an architect before obtaining her Masters degree from Canada and her Doctorate in Australia. Usha has been a keynote speaker as well as an invited speaker at national and international conferences, seminars and workshops. Her teaching experience includes teaching in Asian countries. She has advised Austrade, APEC, national, state and local governments. She serves as a reviewer and a member of the scientific committee for national and international refereed journals and refereed conferences. She is on the editorial board for refereed journals and has worked on Special Issues. Usha has served and continues to serve on the Boards of several not-for-profit organisations and she has also served as panel judge for a number of awards including the Premiers Sustainability Award in Victoria and the International Green Gown Awards. Usha has published over 100 publications, including research and consulting reports. Her publications cover a wide range of scientific and technical research publications that include edited books, book chapters, refereed journals, refereed conference papers and reports for local, state and federal government clients. She has also produced podcasts for various organisations and participated in media interviews. She has received state, national and international funding worth over USD $25 million. Usha has been awarded the Quarterly Franklin Membership by London Journals Press (UK). Her biography has been included in the Marquis Who's Who in the World® 2018, 2016 (33rd Edition), along with approximately 55,000 of the most accomplished men and women from around the world, including luminaries as U.N. Secretary-General Ban Ki-moon. 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In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",country:{name:"Bulgaria"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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