Comparison of the effectiveness of interferon in chronic myeloproliferative disorders.
\r\n\tThe purpose of the book is to bring together the latest knowledge about genetic diversity by presenting the studies of some of the scientists who are engaged in development of new tools and ideas used to reveal genetic diversity, often from very different perspectives. The book should prove useful to students, researchers and experts in the area of biology, medicine and agriculture.
",isbn:"978-1-80356-945-1",printIsbn:"978-1-80356-944-4",pdfIsbn:"978-1-80356-946-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"0b1e679fcacdec2448603a66df71ccc7",bookSignature:"Prof. Mahmut Çalışkan and Dr. Sevcan Aydin",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11643.jpg",keywords:"PCR Based Methods, Protein Based Methods, Sequencing, Conservation of Genetic Resources, Natural Variation, Molecular Markers, Genetic Manipulation in Animals, Resistance to Disease, Genetic Manipulation in Plants, Use of Microorganisms in Biotechnology, Genetic Differentiation, Gene Therapy and Gene Editing",numberOfDownloads:16,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 7th 2022",dateEndSecondStepPublish:"June 16th 2022",dateEndThirdStepPublish:"August 15th 2022",dateEndFourthStepPublish:"November 3rd 2022",dateEndFifthStepPublish:"January 2nd 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Professor of genetics and molecular biology and Head of Biotechnology division at İstanbul University in Turkey whose main research areas include plant molecular genetics, microbial biotechnology and characterization and biotechnological use of halophilic archaeal strains.",coeditorOneBiosketch:"Associate Professor of Biotechnology Division in Department of Biology at Istanbul University in Turkey whose main research areas include genetics, environmental biotechnology and bioengineering.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"51528",title:"Prof.",name:"Mahmut",middleName:null,surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan",profilePictureURL:"https://mts.intechopen.com/storage/users/51528/images/system/51528.png",biography:"Mahmut Çalışkan is a Professor of Genetics and Molecular Biology in the Department of Biology, Biotechnology Division, Istanbul University, Turkey. He obtained a BSc from Middle East Technical University, Ankara, and a Ph.D. from the University of Leeds, England. His main research areas include the role of germin gene products during early plant development, analysis of genetic variation, polymorphisms, and the characterization and biotechnological use of halophilic archaea.",institutionString:"Istanbul University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"8",institution:{name:"Istanbul University",institutionURL:null,country:{name:"Turkey"}}}],coeditorOne:{id:"462767",title:"Dr.",name:"Sevcan",middleName:null,surname:"Aydin",slug:"sevcan-aydin",fullName:"Sevcan Aydin",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003QRfRpQAL/Profile_Picture_2022-03-24T08:49:06.jpg",biography:"Sevcan Aydın is an Associate Professor of Biotechnology Division in Department of Biology at Istanbul University in Türkiye. She obtained her bachelor's degree from Biology Department of Ege University. She obtained her Ph.D. in Biotechnology Programme of Istanbul Technical University. 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From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"2252",title:"Genetic Diversity in Plants",subtitle:null,isOpenForSubmission:!1,hash:"f2540f35e6516d6946f6953469c61ff3",slug:"genetic-diversity-in-plants",bookSignature:"Mahmut Çalişkan",coverURL:"https://cdn.intechopen.com/books/images_new/2252.jpg",editedByType:"Edited by",editors:[{id:"51528",title:"Prof.",name:"Mahmut",surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2253",title:"Genetic Diversity in Microorganisms",subtitle:null,isOpenForSubmission:!1,hash:"209e2075adb4614d4061ea69f1cb3c99",slug:"genetic-diversity-in-microorganisms",bookSignature:"Mahmut Caliskan",coverURL:"https://cdn.intechopen.com/books/images_new/2253.jpg",editedByType:"Edited by",editors:[{id:"51528",title:"Prof.",name:"Mahmut",surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2251",title:"The Molecular Basis of Plant Genetic Diversity",subtitle:null,isOpenForSubmission:!1,hash:"f095bc4b74c32e0e266755bb77f00171",slug:"the-molecular-basis-of-plant-genetic-diversity",bookSignature:"Mahmut Caliskan",coverURL:"https://cdn.intechopen.com/books/images_new/2251.jpg",editedByType:"Edited by",editors:[{id:"51528",title:"Prof.",name:"Mahmut",surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1610",title:"Analysis of Genetic Variation in Animals",subtitle:null,isOpenForSubmission:!1,hash:"2dbc70699ec1ca38dc2175c6aeebe710",slug:"analysis-of-genetic-variation-in-animals",bookSignature:"Mahmut Caliskan",coverURL:"https://cdn.intechopen.com/books/images_new/1610.jpg",editedByType:"Edited by",editors:[{id:"51528",title:"Prof.",name:"Mahmut",surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5508",title:"Carbohydrate",subtitle:null,isOpenForSubmission:!1,hash:"e594b777fe1d4981c5b1adbe5a40f19c",slug:"carbohydrate",bookSignature:"Mahmut Caliskan, I. Halil Kavakli and Gul Cevahir Oz",coverURL:"https://cdn.intechopen.com/books/images_new/5508.jpg",editedByType:"Edited by",editors:[{id:"51528",title:"Prof.",name:"Mahmut",surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4534",title:"Molecular Approaches to Genetic Diversity",subtitle:null,isOpenForSubmission:!1,hash:"47e298294c997622c48b72b4f6d06f41",slug:"molecular-approaches-to-genetic-diversity",bookSignature:"Mahmut Caliskan, Guul Cevahir Oz, I. Halil Kavakli and Birguul Ozcan",coverURL:"https://cdn.intechopen.com/books/images_new/4534.jpg",editedByType:"Edited by",editors:[{id:"51528",title:"Prof.",name:"Mahmut",surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7947",title:"The Recent Topics in Genetic Polymorphisms",subtitle:null,isOpenForSubmission:!1,hash:"d77e0df1c9ae7d3721747744650bfcd3",slug:"the-recent-topics-in-genetic-polymorphisms",bookSignature:"Mahmut Çalışkan, Osman Erol and Gül Cevahir Öz",coverURL:"https://cdn.intechopen.com/books/images_new/7947.jpg",editedByType:"Edited by",editors:[{id:"51528",title:"Prof.",name:"Mahmut",surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10886",title:"Genetic Polymorphisms",subtitle:"New Insights",isOpenForSubmission:!1,hash:"a71558dd7dfd16ad140168409f887f7e",slug:"genetic-polymorphisms-new-insights",bookSignature:"Mahmut Çalışkan",coverURL:"https://cdn.intechopen.com/books/images_new/10886.jpg",editedByType:"Edited by",editors:[{id:"51528",title:"Prof.",name:"Mahmut",surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6694",title:"New Trends in Ion Exchange Studies",subtitle:null,isOpenForSubmission:!1,hash:"3de8c8b090fd8faa7c11ec5b387c486a",slug:"new-trends-in-ion-exchange-studies",bookSignature:"Selcan Karakuş",coverURL:"https://cdn.intechopen.com/books/images_new/6694.jpg",editedByType:"Edited by",editors:[{id:"206110",title:"Dr.",name:"Selcan",surname:"Karakuş",slug:"selcan-karakus",fullName:"Selcan Karakuş"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"51182",title:"Syntheses and Applications of Titanium Compound Nanofiber Thin Films",doi:"10.5772/64072",slug:"syntheses-and-applications-of-titanium-compound-nanofiber-thin-films",body:'\nVigorous efforts have been made in recent years to control the structure and morphology of ceramic nanoparticles. The formation of peculiar nanostructures and morphologies can expose a specific crystal surface or cause a high specific surface area or characteristic pore diameter distribution, which can result in the manifestation of various peculiar physical and chemical properties. Vigorous efforts have been made to form the thin film comprised of nanoparticles, which should help peculiar physical and chemical properties of nanoparticles manifest more efficiently. The dip‐coating, spin‐coating, and electrophoretic deposition methods are commonly used to form the thin film, but they tend to cause nanoparticles to be randomly deposited on substrates, and the adhesion between the particles and substrate is often not good. An alternative method to form the thin film involves forming a nanostructured metal compound thin film on a metal surface where the metal itself is used as the raw material. Because the metal compound grows crystals directly on the metal surface in the nanostructured metal compound thin film/metal composites, superior adhesion between the metal and the thin film can be expected. In addition, the particle arrangement can be controlled by aligning the crystal orientations of the particles to some degree. The superior electrical conductivity and mechanical properties of the metal and the peculiar physical and chemical properties of the nanostructured metal compound thin film can potentially provide a superior functional material that combines all such properties. Vigorous research efforts have been made on this aspect, particularly with regard to the synthesis of a nanostructured titanium compound thin film/titanium composite. This is because titanium compounds such as titanium dioxide and titanate feature superior characteristics for a broad range of applications, e.g., photocatalysts [1], dye‐sensitized solar cells [2], lithium‐ion batteries [3, 4], and biomaterials [5, 6]. Titanium dioxide and titanate are also extremely attractive because they are available at relatively low prices and are safe materials with no toxicity. Titanium dioxide and titanate have reportedly been used in such syntheses as the formation of a titanium dioxide nanotube thin film on a titanium metal surface with an electrochemical method (anodic oxidation of titanium metal) [6, 7], the formation of nanostructured titanate (nanotube, nanofiber, nanosheet, etc.) thin films on titanium metal surfaces by the reaction of titanium metal in an alkaline aqueous solution, and their conversions into nanostructured titanium dioxide thin film [5, 8–11]. For example, known applications of composites that utilize the superior electrical conductivity of titanium include electrode materials of dye‐sensitized solar cells [12], lithium‐ion batteries [13], and sodium‐ion batteries [14]. Superior electrical conductivity can be secured by using titanium dioxide or titanate with one‐dimensional morphologies, such as nanorods, nanotubes, or nanofibers, while electrodes can be prepared without using binders or conducting agents. Applied research on field emission materials [15] and electrochromic materials [16] of composites is also underway. On the other hand, biomaterials are a known application that utilizes the superior mechanical properties and safety of titanium metal. Titanium and titanium alloys are used as artificial joints based on their mechanical properties and safety inside the living body. Using composites adds osteoconductivity derived from titanium dioxide or titanate and antibacterial properties to titanium and titanium alloys, which facilitates the safe adhesion of bones and artificial joints in a short period of time [5, 6]. Antibacterial biomaterials are also desirable for medical sites; infections occur in 1–2% of artificial joint replacement surgeries and are a major problem [17, 18]. The present chapter evaluated the synthesis and antibacterial properties of titanate nanofiber thin film/titanium metal composites as an example application for biomaterials [10]. Various crystal structures such as Ti(HPO4)2·H2O and Ti(H2PO4)PO4·2H2O are known to exist with titanium phosphate. Morphology controls to shape nanotubes [19], nanofibers [20], elongated hexagonal nanoplates [21], and so on are also being developed. Applications of titanium phosphate include not just fundamental research on topics such as ion exchange and intercalation reactions but also catalysts [22], selective absorbents for toxic substances (e.g., Pb2+, Cd2+) [23, 24], the support and release of drugs [25], sodium batteries [26], and solar cells [27]. However, examples of reports on such efforts are primarily about particles, and there have not been many examples of studies on thin films. In particular, there are only three reports on the synthesis of titanium phosphate thin film on the surface of titanium, including the research of the present author. Lu et al. [28] immersed titanium in a phosphoric acid aqueous solution and induced a hydrothermal reaction at 250°C, while Park et al. [29] also immersed titanium in a phosphoric acid aqueous solution and induced a hydrothermal reaction at 180°C to form Ti2O(PO4)2(H2O)2 nanorod thin films on the titanium surface. Park et al. [29] revealed that such a thin film has superior osteoconductivity. The present author added to these prior studies by discovering that titanium phosphate featuring a variety of crystal structures and morphologies is generated on the surface of a titanium plate immersed in an aqueous solution of hydrogen peroxide and phosphoric acid to produce a hydrothermal reaction [30]. This book is focused on nanofibers; this chapter narrows the focus to the titanium phosphate nanobelt thin film/titanium metal composite by introducing the formation mechanism and wettability.
\nA titanium plate (20 mm × 20 mm × 0.5 mm) was scoured by using an abrasive paper and then immersed in 10 mL of an aqueous solution of 2 mol/L hydrogen fluoride for 10 min at room temperature to remove the surface‐oxidized phase. It was then repeatedly washed with distilled water. A synthesis experiment of titanium phosphate thin film was performed with the derived plate. This experimental manipulation was performed in order to obtain a homogeneous titanium surface. This manipulation changed the morphology of the surface from that shown in Figure 1a to that shown in Figure 1b with a homogeneous surface morphology derived for each experiment. This plate was immersed in a mixture comprising 9.2 mL of 30 wt% H2O2 solution and 0.5 g of 85 wt% H3PO4 solution and left to react for 24 h at 120°C. Depending on the synthesis conditions (e.g., the raw material ratio or reaction temperature), this reaction generates high pressure inside the reaction container due to the generated gas, particularly when the hydrothermal reaction takes place at 100°C or higher. A reactor vessel that can measure the internal gas pressure while a reaction occurs inside and that is equipped with a safety valve to release the gas when required is desired. The obtained product was repeatedly washed with distilled water after the reaction. Because titanium phosphate particles that were generated in the solution during reaction deposited on the upper surface (front face), it was not possible to accurately evaluate the morphology of the titanium phosphate thin film growing from the titanium plate. Thus, a detailed evaluation was performed on the lower surface (back face) on which particles did not deposit. A thin film formed evenly on the surface of the titanium plate, as shown in Figure 2a. The thin film is composed of nanobelts with approximate widths of 30–270 nm and lengths of a few microns or more formed on the surface of the titanium plate, as shown in Figure 2b and c. The TEM image (Figure 2c) confirmed that the particles constituting the thin film were nanobelts because they were thin one‐dimensional in morphology. Diffraction peaks that were attributed to titanium metal and Ti2O3 (H2PO4)2·2H2O were observed in the X‐ray diffraction measurements (Figure 3). They revealed that the nanobelts were made of Ti2O3 (H2PO4)2·2H2O. Korösi et al. [25] reported on rectangular Ti2O3(H2PO4)2·2H2O nanoparticles with dimensions of 15 ± 3 nm × 20–150 nm. The nanobelts observed during this experiment, however, had nanoparticles with significant growth in the long axis direction. The thin film thickness was about 8 µm at the reaction time of 24 h but this thin film thickness became broader and reached 20 µm when the reaction time was extended to 72 h. SEM image of the thin film cross‐section at the reaction time of 72 h are shown in Figure 2d. A phase comprising nanobelts was observed from the top surface of the thin film down to a depth of about 18 µm. On the side closer to the titanium plate of the thin film, however, a phase of about 2 µm that was relatively dense was observed.
SEM images of the titanium plates before (a) and after (b) the HF treatment.
SEM images (a, b, and d) and a TEM image (c) of the titanium phosphate nanobelt thin films formed on titanium plates.
XRD pattern of the titanium phosphate nanobelt thin film.
The role of hydrogen peroxide was examined in order to consider the formation mechanism of nanobelts. This is because past studies that did not involve the use of hydrogen peroxide did not generate Ti2O3 (H2PO4)2·2H2O, as described earlier [28, 29]. In order to investigate the impact of hydrogen peroxide on the formation of the thin film, synthesis was performed with a fixed reaction temperature, reaction time, and phosphoric acid quantity of 120°C, 24 h, and 0.5 g, respectively, with varying quantities of hydrogen peroxide and water. When 9.2 mL of water was used for synthesis instead of hydrogen peroxide, the thin film did not form, and the formation of TiH2 was observed in the XRD measurement. This confirmed that hydrogen peroxide plays an important role in the formation of the Ti2O3(H2PO4)2·2H2O nanobelt thin film. Figure 4 shows a schematic representation of the formation mechanism for nanostructured titanium phosphate thin films based on the above results. Hydrogen peroxide has two primary roles. First, it acts as an oxidizer. Hydrogen peroxide acts as an oxidizer in acid solutions according to the following reaction formula:\n
Schematic representation of the formation mechanism of the nanostructured titanium phosphate thin film formed on a titanium plate.
Therefore, hydrogen peroxide promotes the generation of Ti4+ from the titanium plate, as described by the following equation:\n
Although Ti4+ can be generated according to the following reaction formula by H+ or dissolved oxygen in the aqueous solution, hydrogen peroxide has the greatest effect on promoting Ti4+ generation:\n
Ti4+ eluted from Ti into the reaction solution immediately starts to react with H2O2. Ti4+ is known to react with hydrogen peroxide when pH <1 [31].\n
Furthermore, binuclear complexes such as Ti2O5 (OH)x(2-X) (x = 1–6) are known to be generated when pH >1 [31]. These are referred to as peroxotitanic acid complexes and are indicated by a yellow color in the aqueous solution. The color of the solution after synthesis of the titanium phosphate nanobelt thin film was actually yellow, as shown in Figure 5, which indicates that a peroxotitanic acid complex was formed. Therefore, the second role of hydrogen peroxide is the formation of chemical species that contain Ti–O bonds. When such chemical species react with H2PO4- ions, a relatively dense phase is formed first as an amorphous or low‐crystalline titanium phosphate phase precipitates on the titanium plate. The nanobelt thin film forms next as high‐crystalline Ti2O3(H2PO4)2·2H2O, which is the most stable phase, grows on the surface of the dense phase. The formation of such a dense amorphous phase is important to link the titanium metal with Ti2O3(H2PO4)2·2H2O, which has a completely different crystal structure. The phenomenon of a peculiar nanostructured thin film forming via the formation of a relatively dense phase on a metal surface has also been observed for the formation of sodium titanate thin films on titanium plate surfaces [9], which is described later. Synthesis using a mixture comprising 2.3 mL of hydrogen peroxide and 6.9 mL of water instead of 9.2 mL of hydrogen peroxide led to a flower‐like aggregate of semispherical morphologies having a diameter of about a few tens of microns while the composition remained the same as Ti2O3(H2PO4)2·2H2O. This means that a thin film comprising microflowers was generated (Figure 6a). Observation of the cross‐section revealed that the thickness of the thin film was about 30 µm, and the microflower comprised particles with a nanoplate morphology about 400–700 nm wide and about 30–40 µm long growing in a radial pattern. A thin film of Ti2O3(H2PO4)2·2H2O having an intermediate morphology between the nanobelt thin film (Figure 2b) and microflower thin film (Figure 6a) was formed by using a mixture comprising 4.6 mL of hydrogen peroxide and 4.6 mL of water instead of 9.2 mL of hydrogen peroxide, as shown in Figure 6b. These results indicate the following formation process. The number of nuclei of Ti2O3(H2PO4)2·2H2O formed on the titanium plate decreased significantly once the amount of hydrogen peroxide in the reaction solution decreased. The microflower thin film was believed to have been formed as a large number of Ti2O3(H2PO4)2·2H2O crystals slowly grew radially from these nuclei, which were just a few in number. Therefore, the morphology of the thin film can clearly be controlled in a variety of ways while the composition of Ti2O3(H2PO4)2·2H2O is maintained by controlling the synthesis conditions as described above.
Digital camera images of the solutions before (a) and after (b) the reaction.
SEM images of Ti2O3(H2PO4)2·2H2O thin films formed on titanium plates.
Thin films with compositions other than Ti2O3(H2PO4)22H2O or of various morphologies other than nanobelts can be generated by controlling the raw material ratios and reaction temperatures, although no detailed descriptions are provided here because this chapter is focused on nanobelts. For instance, a thin film composed of anatase‐type titanium dioxide and about 2 µm thick, a few tens of nanometers wide, and about 2 µm long—similar to that reported by Wu et al. [32]—was generated when synthesis was performed with a reaction temperature of 120°C, 9.2 mL of 30 wt% H2O2 solution, 0 g of 85 wt% H3PO4 solution, and reaction time of 24 h. A thin film about 8 µm thick, which appears to have been composed of hexagonal Ti(HPO4)2·H2O nanoplates a few microns in size, was derived when synthesis was performed with a reaction temperature of 120°C, 9.2 mL of 30 wt% H2O2 solution, 5 g of 85 wt% H3PO4 solution, and reaction time of 24 h (Figure 7a). A 2‐µm‐thick thin film composed of low‐crystalline Ti2O3(H2PO4)22H2O nanosheets about a few hundred nanometers to 2 µm in size was formed when synthesis was performed with a reaction temperature of 80°C, 9.2 mL of 30 wt% H2O2 solution, 0.5 g of 85 wt% H3PO4 solution, and reaction time of 24 h (Figure 7b). A thin film about 20 µm thick composed of Ti2O(PO4)2H2O nanorods about 80–200 nm in diameter and a dozen or so microns long was formed when synthesis was performed with a reaction temperature of 160°C, 9.2 mL of 30 wt% H2O2 solution, 0.5 g of 85 wt% H3PO4 solution, and reaction time of 24 h (Figure 7c).
SEM images of the hexagonal Ti(HPO4)2·H2O nanoplate thin film (a), the Ti2O3(H2PO4)22H2O nanosheet thin film (b), and the Ti2O(PO4)2H2O nanorod thin film (c).
The wettability of these thin films was investigated since titanium phosphate thin films having a diverse range of surface morphologies were derived, as described above. The wettability of a surface is generally determined by the surface energy and uneven structure of the surface [33]. In cases where the surface energy is high, the thin film tends to be hydrophilic; when the surface energy is low, it tends to be hydrophobic. Furthermore, the wettability is enhanced when an uneven structure is formed on a surface. When a water droplet was dropped on a synthesized titanium phosphate thin film, the droplet spread instantaneously, which indicates super‐hydrophilicity. When the thin film was immersed in a 0.1 mol/L n‐dodecyl decylamine hydrochloride solution of 2‐propanol, on the other hand, the hydrophilicity decreased because the surface energy decreases when dodecylamine is adsorbed on the surface of titanium phosphate. The contact angle was 25° with the nanobelt thin film, 98° with the microflower thin film, 151° with the nanorod thin film, 151° with the nanoplate thin film, and 128° with the nanosheet thin film. Thus, the contact angle varies significantly depending on the composition and morphology of the thin film. Common features of test specimens with larger contact angles (nanorod thin film, nanoplate thin film and nanosheet thin film) were that the gap between protruding parts was narrow, and the spacing was uniform. With the nanobelt thin film, on the other hand, there were portions where the spacing between protruding parts was narrow and others where they were wide since the nanobelts were bent. The wider sections in such instances decreased the contact angle. Furthermore, the contact angle may have been reduced because there were portions on the microflower thin film where titanium phosphate microflowers were not generated and water was absorbed.
\nA titanium plate (20 mm × 20 mm × 2 mm) was immersed in 20 mL of a NaOH aqueous solution in a Teflon container; a hydrothermal reaction occurred at 160°C for 20 h. The derived product was then washed repeatedly with water to produce a titanium plate covered by a sodium titanate nanofiber thin film on the surface, i.e., a sodium titanate nanofiber thin film/titanium metal composite. A digital camera photograph and a SEM image (Figure 8a) confirmed that nanofibers were formed uniformly on the surface of the titanium metal. SEM observation of the cross‐section revealed that the thin film thickness was about 5 µm. Furthermore, the TEM images revealed that the nanofibers were a few tens to a hundred nanometers in width and a few microns in length (Figure 8b). The diffraction peaks attributed to titanate were observed in the X‐ray diffraction pattern of the thin film. A Na:Ti:O molar ratio of 1:3.04:6.08 was determined from the EDS analysis of the thin film. This approximates the molar ratio for Na2Ti6O13. Thus, the thin film was considered to be a Na2Ti6O13 nanofiber thin film. The morphology of the sodium titanate thin film can be controlled according to the concentration and reaction temperature of the aqueous solution of NaOH. Using 1 mol/L NaOH aqueous solution instead of 4 mol/L NaOH aqueous solution resulted in the generation of a nanosheet thin film (Figure 9a) [10]. Using 10 mol/L NaOH aqueous solution resulted in the generation of a nanotube thin film (Figure 9b) [9]. Using 5 mol/L NaOH aqueous solution for a reaction at 60°C for 24 h resulted in the generation of a thin film with a porous network structure [5, 34].
SEM images (a and c) and TEM images (b and d) of the sodium titanate nanofiber thin film (a and b) and the silver nanoparticles/silver titanate nanofiber thin film (c and d). Insets are photographs taken with a digital camera [
SEM images of the sodium titanate nanosheet thin film (a), the sodium titanate nanotube thin film (b) [
The antibacterial activity of sodium titanate nanofiber thin film against methicillin‐resistant staphylococcus aureus (MRSA) was investigated. MRSA is one of principal causative agents for nosocomial infection. Two types of tests were performed for the antibacterial test: the test specimen was irradiated and not irradiated with ultraviolet rays with the expectation of photocatalytic activity. Refer to the authors’ previous paper for details on the methods used in the antibacterial tests [34]. The antibacterial activity value was used as an index for evaluation. The antibacterial activity value R is defined by the following equation; the antibacterial activity is considered to exist when R ≥ 2.\n
Here, A is the viable bacterial count immediately after inoculation, B is the viable bacterial count of a blank test specimen 24 h later, and C is the viable bacterial count of the nanostructured titanate thin film 24 h later.
\nA high antibacterial activity value of 5.9 was recorded during the first round of antibacterial tests conducted under exposure to ultraviolet irradiation. Surprisingly, an extremely high antibacterial activity value of 5.8 was recorded even when a similar antibacterial test was conducted with no exposure to ultraviolet rays. This means that a high level of antibacterial activity was recorded for the nanofiber thin film during the first round of antibacterial tests regardless of whether or not the test specimen was exposed to ultraviolet rays. The antibacterial test was repeatedly performed using the same test specimen with and without (i.e., in a dark place) exposure to ultraviolet rays. Extremely high values of 7.7 and 6.6 were recorded for antibacterial activity during the second and third rounds of tests conducted under exposure to ultraviolet rays. Extremely low values of 1.0 and 0.3 were recorded for antibacterial activity during the second and third rounds of antibacterial tests conducted without exposure to ultraviolet rays. The above results revealed that (1) a high level of antibacterial activity manifested with the sodium titanate nanofiber thin film due to photocatalysis effects with exposure to ultraviolet rays and that (2) the sodium titanate nanofiber thin film has a high level of antibacterial activity immediately after synthesis, even when they are not exposed to any ultraviolet rays. Only the sodium titanate nanofiber thin film indicating a high level of antibacterial activity is extremely peculiar because the antibacterial activity of the sodium titanate nanosheet thin film and nanotube thin film described above were 2.1 [10] and 1.7 [34], respectively. Treating such sodium titanate nanofiber thin film with a hydrochloric acid aqueous solution or heat‐treating it at 600°C reduced the antibacterial activity value to 0.9 and 1.3, respectively, which eliminated the antibacterial activity. Because bacteria are known to have different properties that classify them as gram‐positive or gram‐negative depending on their structures, antibacterial tests regarding such individual bacteria types were also conducted. The antibacterial activity value of the sodium titanate nanofiber thin film was 5.5 against
SEM images of sodium titanate nanofiber thin films synthesized following different reaction times; the titanium plate before the synthesis (a), and after 1 h (b), 5 h (c), and 12 h (d) reaction times [
XRD patterns of sodium titanate nanofiber thin films following different reaction times; the titanium plate before the synthesis (a), and after 1 h (b), 5 h (c), 12 h (d), and 20 h (e) reaction times. Peak assignment: ●, sodium titanate; ▲, titanium [
Sodium titanate nanofiber thin film is considered to have poor practicality at the current point in time; while superior antibacterial activity was indicated during the first round of tests, the results from the second and subsequent rounds were not good, and there are many unknown aspects about the antibacterial mechanism. Silver, which is already being used in many studies on antibacterial materials, was therefore considered as an antibacterial component based on three considerations: (1) the superior antibacterial activity, (2) some degree of safety for living organisms, and (3) the relative lack of reports regarding the manifestation of drug‐resistant bacteria [36]. Sodium titanate is a cation exchanger with a layered structure and can support silver in the titanate by exchanging Na+ in sodium titanate with Ag+. A composite treated with silver ion exchange was derived by immersing the sodium titanate nanofiber thin film/titanium metal composite generated with a reaction time of 20 h in 12 mL of a 0.05 mol/L silver acetate aqueous solution at 40°C for 3 h, which was then washed repeatedly with distilled water and dried in a cool and dark location. The thin film derived after the silver ion exchange process remained firmly attached to the titanium plate, as shown in the digital camera photographs and SEM images in Figure 8c. There were no changes in the morphology, which had dimensions on the scale of microns. The TEM images, however, revealed precipitation of nanoparticles with dimensions of a few nanometers to a few tens of nanometers on the surface of the nanofiber (Figure 8d). These particles were considered to be silver nanoparticles, but no diffraction peaks attributed to silver were observed in the X‐ray diffraction pattern (Figure 12). This may have been due to the small amount of precipitation that occurred because of the small diameters of the silver nanoparticles. No sodium was detected from the thin film after the silver ion exchange process, but silver was detected when the EDS analysis was conducted. A silver‐to‐titanium molar ratio of 0.638 was detected; this is greater than the sodium‐to‐titanium molar ratio of 0.329 before the silver ion exchange process. Such results of the EDS analysis correspond to the precipitation of silver particles on the surface of nanofiber when Na+ in the sodium titanate nanofiber was exchanged with Ag+. The X‐ray diffraction pattern after the silver ion exchange process indicates the disappearance of the diffraction peak of 2θ = 8.78°, which was caused by the layered structure observed with sodium titanate (Figure 12). Significant changes in the position and strength of the diffraction peaks at 2θ ≥ 15°owing to the crystal structure of titanate were observed compared to before the silver ion exchange process (Figure 12). Such results indicate that the crystal structure of titanate changed from a two‐dimensional layered structure to a three‐dimensional crystal structure. The above results reveal that silver nanoparticles and silver titanate nanofiber thin film are generated by the silver ion exchange process of the sodium titanate nanofiber thin film. Such precipitation of silver nanoparticles on the surface of titanate and change in crystal structure caused by the silver ion exchange process have also been observed with the sodium titanate nanotube thin film and the sodium titanate thin film with a porous network structure [34]. This suggests that these are reaction behaviors common to layered titanates.
XRD patterns of the thin film before (a) and after (b) the silver ion exchange treatment. Peak assignment: ●, sodium titanate; ▲, titanium; ○, silver titanate [
The antibacterial activity value of the silver nanoparticles/silver titanate nanofiber thin film with respect to MRSA is 7.9, which is extremely high. This value is greater than the antibacterial activity value of 6.3 for a silver nanoparticles/silver titanate nanotube thin film or 7.8 for a silver nanoparticles/silver titanate thin film with a porous network structure [34]. The elution behavior of silver was investigated in fetal bovine serum (FBS) to simulate the environment of a living body because it was presumed to impact the antibacterial activity in a significant manner. Please refer to the authors’ previous paper for details on the experimentation methods. Elution of 110 ppm was observed with silver nanoparticles/silver titanate nanofiber thin film, 94 ppm was observed with the silver nanoparticles/silver titanate nanotube thin film, and 68 ppm was observed with the silver particles/silver titanate thin film with a porous network structure on the first day. The greatest amount of silver was clearly eluted by silver nanoparticles/silver titanate nanofiber thin film with the highest level of antibacterial activity. The orders of antibacterial activity and elution quantity for silver did not match completely. Therefore, antibacterial activity cannot be explained solely by the elution amount of silver. Although a clear examination is not possible at the present point in time, the surface morphology of the thin film is considered to be somehow related to the antibacterial activity. Chronologically, the amount of silver elution was 110 ppm on the first day, decreased to 77 ppm by the second day, and gradually decreased with subsequent days to 20 ppm by the tenth day. The elution of silver from silver nanoparticles and from silver titanate nanofiber due to the ion exchange reaction were considered as sources of silver elution from the thin film. FBS is known to contain a large amount of proteins and cations that readily bond with Ag+, and the ion exchange reaction is known to be extremely rapid. This means that it is extremely likely that the large amount of silver elution on the first day was due to the silver elution from the ion exchange reaction of silver titanate nanofibers. The contribution to silver elution by the silver titanate nanofibers decreased with time; instead, the silver elution from silver nanoparticles increased in their place. The antibacterial activity can be expected to be sustained over a long period since the silver nanoparticles/silver titanate nanofiber thin film can continue to elute silver in this manner for over 10 days.
\nThis chapter introduces the generation of titanium compounds with various nanostructures, including titanium phosphate nanobelts and titanate nanofibers on the surface of titanium metal plate, from the treatment of a titanium metal plate in aqueous solutions of various compositions. Because aqueous solutions of various compositions and concentrations and different reaction temperatures and times can be combined for chemical processes involving titanium metal, novel titanium compounds/titanium metal composites with various compositions and nanostructures are expected to be synthesized in the future. It is important to continue with applied research on developing composites that feature the characteristics of both nanostructured titanium compounds and titanium metal, as described in Section “Introduction.” In this manner, characteristics that surpass those of the nanostructured titanium compound particles can be derived. Research is expected to continue with applications including biomaterials and electrode materials intended for dye‐sensitized solar cells, lithium‐ion batteries, and sodium‐ion batteries.
\nThis research was partially supported by KAKENHI (19750172, 25420732). The author gives special thanks to Dr. Yuko Inoue, Miss Ayako Sakamoto, Miss Misaki Maeda, and Mr. Tomohiro Morita for their supports.
\nChronic myeloproliferative disorders are a group of clonal diseases of the stem cell. It is a group of several diseases with some common features. They derive from a multipotential hematopoietic stem cell. A clone of neoplastic cells in all these neoplams is characterized by a lower proliferative activity than that of acute myeloproliferative diseases. In each of these diseases, leukocytosis, thrombocythemia, and polyglobulia may appear at some stage, depending on the diagnosis [1, 2].
The research on interferon has been going on since the 1950s [3]. Then, the attention was paid to its influence on the immune system. It has been noted that it can exert an antiproliferative effect by stimulating cells of the immune system [4]. In 1987, a publication by Ludwig et al. was published, which reported the effectiveness of interferon alpha in the treatment of chronic myeloproliferative disorders [5].
More and more new studies have been showing the effectiveness of interferon alpha in reducing the number of platelets, reducing the need for phlebotomies in patients with polycythemia vera and also in reducing the number of leukocytes. Moreover, interferon reduced the symptoms of myeloproliferative disorders such as redness and itching of the skin. Additionally, it turned out to be effective in reducing the size of the spleen.
Further studies on the assessment of remission using molecular-level response assessments indicate that the interferon action in chronic myeloproliferation diseases targets cells from the mutant clone with no effect on normal bone marrow cells [6].
Over the years, interferon alpha-2a and interferon alpha-2b have been introduced into the treatment of chronic myeloproliferation, followed by their pegylated forms. The introduction of pegylated forms allowed for a reduction in the number of side effects and less frequent administration of the drug to patients. In recent years, monopegylated interferon alpha-2b has been used to further increase the interval between drug administrations while maintaining its antiproliferative efficacy.
The exact mechanism of action of interferon alpha in the treatment of chronic myeloproliferative disease is still not fully understood, but it has an impact on JAK2 (Janus Kinase) signal transducers and activates the STAT signal pathway (Janus Kinase/SignalTransducer and Activator of Transcription).
Interferon alpha binds to IFNAR1 and IFNAR2c, which are type I interferon receptors. Interferon alpha has an impact on JAK2(Janus Kinase) signal transducers and activates the STAT signal pathway. The disturbances in this signaling pathway are observed in chronic myeloproliferative disorders [7].
Interferon inhibits the JAK-STAT signaling pathway by directly inhibiting the action of thrombopoietin in this pathway [8].
So far, three driver mutations have been described in the course of chronic myeloproliferative diseases that affect the functioning of the JAK-STAT pathway.
JAK2 kinase and JAK1, JAK3, and TYK2 kinases belong to the family of non-receptor tyrosine kinases. They are involved in the intracellular signal transduction of the JAK-STAT pathway. It is a system of intracellular proteins used by growth factors and cytokines to express genes that regulate cell activation, proliferation, and differentiation. The mechanism of JAK activation is based on the autophosphorylation of tyrosine residues that occurs after ligand binds to the receptor. JAK2 kinase transmits signals from the hematopoietic cytokine receptors of the myeloid lineage (erythropoietin, granulocyte-colony stimulating factor thrombopoietin, and lymphoid lineage [9].
A somatic G/T point mutation in exon 14 of the JAK2 kinase gene converts valine to phenylalanine at position 617 (V617F) in the JAK2 pseudokinase domain, which allows constitutive, ligand-independent activation of the receptor to trigger a proliferative signal [10].
Mutation of the MPL gene, which encodes the receptor for thrombopoietin, increases the sensitivity of magekaryocytes to the action of thrombopoietin, which stimulates their proliferation [11].
Malfunction of calreticulin as a result of mutation of the CARL gene leads to the activation of the MPL-JAK/STAT signaling pathway, which is independent of the ligand, as calreticulin is responsible, for the proper formation of the MPL receptor. Consequently, there is a clonal proliferation of hematopoietic stem cells [12].
Below, we provide an overview of some clinical studies on the efficacy of interferon in chronic myeloproliferative disorders.
Polycythemia vera (PV) is characterized by an increase in the number of erythrocytes in the peripheral blood.
Polycythemia vera is caused by a clonal mutation in the multipotential hematopoietic stem cell of the bone marrow. The mutation leads to an uncontrolled proliferation of the mutated cell clone, independent of erythropoietin and other regulatory factors. As the mutation takes place at an early stage of hematopoiesis, an increase of the number of erythrocytes as well as of leukocytes and platelets is observed in the peripheral blood. The cause of proliferation in PV independent from external factors is a mutation in the Janus 2 (JAK2) tyrosine kinase gene. The V617F point mutation in the JAK2 gene is responsible for about 96% mutation, and in the remaining cases the mutation arises in exon 12. Both mutations lead to constitutive activation of the JAK-STAT signaling pathway [13].
As a result of the uncontrolled proliferation, blood viscosity increases, which generates symptoms such as headaches and dizziness, visual disturbances, or erythromelalgia. As the number of all hematopoietic cells, including the granulocytes ones, increases, the difficult to control symptoms of their hyperdegranulation may appear, among which gastric ulcer or skin itching is often observed. During the disease progression, the spleen and liver become enlarged.
The most common complication of the disease is episodes of thrombosis, especially arterial one. During the course of the disease, it can also evolve into myelofibrosis or acute myeloid leukemia.
The treatment of PV is aimed at preventing thromboembolic complications, relieving the general symptoms, the appearance of hepatosplenomegaly as well as preventing its progression.
Each patient should receive an antiplatelet drug chronically, and usually acetylsalicylic acid is the choice. Most often, the treatment is started with phlebotomy in order to rapidly lower the hematocrit level. If cytoreductive therapy is necessary, the drugs of first choice are hydroxycarbamide and interferon [2].
However, the research on the mechanism of the action of interferons is still ongoing. In vitro studies with CD34+ cells from peripheral blood of patients diagnosed with polycythemia vera showed that interferon inhibits clonal changed cells selectively. It was found that interferon alpha-2b and pegylated interferon alpha-2a reduce the percentage of cells with JAK2 V617F mutation by about 40%. Pegylated interferon alpha-2a works by activating mitogen-activated protein kinase P38. It affects CD34+ cells of patients with polycythemia vera by increasing the rate of their apoptosis [6].
A case of a patient with PV with a confirmed chromosomal translocation t(6;8) treated with interferon alpha-2b, which resulted in a reduction of the clone with translocation by 50% from the baseline value, was also described [14].
In 2019, the results of a phase II multicenter study were published, which aimed at assessing the effectiveness of recombinant pegylated interferon alpha-2a in cases of refractory to previously hydroxycarbamide therapy. The study included 65 patients with essential thrombocythemia (ET) and 50 patients with polycythemia vera. All patients had previously been treated with hydroxycarbamide and showed resistance to this drug or its intolerance.
The assessment of the response was performed after 12 months of treatment. Overall response rate to interferon was higher in patients diagnosed with ET than in patients with polycythemia vera. In essential thrombocythemia, the percentage of achieved complete remissions was 43 and 26% of partial remissions. The remission rate in ET patients was higher if calreticulin CALR gene mutation was present. Patients with polycythemia vera achieved complete remission in 22% of cases and partial remission in 38% of cases.
Treatment-related side effects that follow to discontinuation of treatment were reported in almost 14% of patients [15].
The duration of response to treatment with pegylated interferon alpha-2a and the assessment of its safety in long-term use in patients with chronic myeloproliferative disorders was the goal of a phase II of the single-center study. Forty-three adult patients with polycythemia vera and 40 patients with essential thrombocythemia were enrolled in the study. The complete hematological response was defined as a decrease in hemoglobin concentration below 15.0 g/l, without phlebotomies, a resolution of splenomegaly, and no thrombotic episodes in the case of PV, and for essential thrombocythemia—a decrease platelet count below 440,000/μl and two other conditions as above. The assessment of the hematological response was performed every 3–6 months. The median follow-up was 83 months.
The hematological response was obtained in 80% of cases for the entire group. In patients with polycythemia vera, 77% of patients achieved a complete response (CR) while 7% a partial response (PR). The duration of response averaged 65 months for CR and 35 months for PR. In the group of patients diagnosed with essential thrombocythemia, CR was achieved in 73% and PR in 3%. The durance of CR was 58 months and PR was 25 months.
The molecular response for the entire group was achieved in 63% of cases.
The overall analysis showed that the duration of hematological remission and its achievement with pegylated interferon alpha-2a treatment is not affected neither by baseline disease characteristics nor JAK2 allele burden and disease molecular status. There was also no effect on age, sex, or the presence of splenomegaly.
During the course of the study, 22% of patients discontinued the treatment, because of toxicity. Toxicity was the greatest at the beginning of treatment. The starting dose was 450 μg per week and was gradually tapered off.
Thus, on the basis of the above observations, the researchers established that pegylated interferon alpha-2a may give long-term hematological and molecular remissions [16].
The assessment of pegylated interferon alpha-2a in group of patients diagnosed with polycythemia vera only was performed. The evaluation was carried out on a group of 27 patients. Interferon decreased the JAK2 V617F allele burden in 89% of cases. In three patients who were JAK2 homozygous at baseline, after the interferon alpha-2a treatment wild-type of JAK2 reappeared. The reduction of the JAK2 allele burden was estimated from 49% to an average 27%, and additional in one patient the mutant JAK2 allele was not detectable after treatment. It can therefore be postulated that the action of pegylated interferon alpha-2a is directed to cells of the polycythemia vera clone [17].
In 2005, the results of treatment by pegylated interferon alpha-2b of 21 patients diagnosed with polycythemia vera and 21 patients diagnosed with essential thrombocythemia were published. In the case of polycythemia vera in 14 patients, PRV-1 gene mutation was initially detected. In 36% of cases, PRV-1 expression normalized after treatment with pegylated interferon alpha-2b. For the entire group of 42 patients, the remission assessment showed that complete remission was achieved in 69% cases after 6 months of treatment. However, only in 19 patients remission was still maintained 2 years after the start of the study. Pegylated interferon alpha-2b was equally effective in patients with PV and ET. The use and the type of prior therapy did not affect the achievement of remission [18].
Another study with enrolled only PV patients included 136 patients. They were divided into two arms. One group received interferon alpha-2b and the other group received hydroxycarbamide. Interferon dosage was administered in 3 million units three times a week for 2 years and then 5 million units two times a week. Hydroxycarbamide was administered at a dose between 15 and 20 mg/kg/day.
In the group of patients treated with interferon, a significantly lower percentage of patients developed erythromelalgia (9.4%) and distal parasthesia (14%) compared with the group treated with hydroxycarbamide, for whom these percentages were respectively: 29 and 37.5%. Interferon alpha-2b was found to be more effective in inducing a molecular response, which was achieved in 54.7% of cases, in comparison with hydroxycarbamide—19.4% of cases, despite the fact that the percentage of achieved general hematological responses did not differ between the groups and amounted about 70%. The 5-year progression free period in the interferon group was achieved in a higher percentage (66%) than in the hydroxycarbamide group (46.7%) [19].
The most recent form of interferon approved by the
Thanks to these changes to the structure of the molecule, it was possible to achieve a significant increase in its half-life. Ropeginterferon can be administered subcutaneously to patients every 14 days. The clinical trials conducted so far have assessed the ropeginterferon dose from 50 micrograms to a maximum dose of 500 microgams administered as standard every 2 weeks. The possible dose change in case of side effects includes not only the reduction of the drug dose itself, but also the extension of the interval between doses. The extension of the dosing interval up to 4 weeks was assessed.
Ropeginterforn was approved in 2019 by the EMA for the use in patients diagnosed with polycythemia vera without splenomegaly, as monotherapy.
Ropeginterferon, like the previous forms of interferons used in treatment, is contraindicated in patients with severe mental disorders, such as severe depression. It is also a contraindication in patients with noncompensatory standard treatment of disorders of the thyroid gland as well as severe forms of autoimmune diseases. The safety profile of ropeginterferon is similar to that of other forms of alpha interferons. The most common side effects are flu-like symptoms [20].
Ropeginterferon has been shown to exhibit in vitro activity against JAK2-mutant cells. The activity of ropeginterferon against JAK2-positive cells is similar to that of other forms of interferons used actually for standard therapy. Ropeginterferon has an inhibitory effect on erythroid progenitor cells with a mutant JAK2 gene. At the same time, it has almost no effect on progenitor cells without the mutated allele (JAK2-wile-type) and normal CD34+ cells. A gradual decrease of JAK2-positive cells was observed in patients with PV during ropeginterferon treatment. The examination was performed after 6 and 12 months of treatment. In comparison, the reduction in the percentage of JAK2 positive cells in patients treated with hydroxycarbamide was significantly lower.
These results may suggest that ropeginterferon may cause elimination of the mutant clone, but further prospective clinical trials are needed to confirm this theory. The evaluation was performed on a group of patients enrolled in the PROUD-PV study who were treated in France [21].
In 2017, a multicenter study was opened in Italy. The study was of the second phase. In total, 127 patients with polycythemia vera were included in the study. All patients enrolled on the study had low-risk PV. The clinical trial consisted of two arms. Patients received phlebotomies and low-dose aspirin in one arm and ropeginterferon in the other arm. The aim of the study was to achieve a hematocrit of 45% or lower without any evidence of disease progression. Ropeginterferon was administered every 2 weeks at a constant dose of 100 μg.
The response to the treatment was assessed after 12 months. The reduction of hematocrit to the assumed level was achieved in significantly higher percentage of patients in the ropeginterferon group than of patients who received only phlebotomies and aspirin. In addition, none of the patients treated with ropeginterferon experienced disease progression during the course of the study, while among those treated with phlebotomies, 8% of patients progressed.
Grade 4 or 5 adverse events were not observed in patients treated with ropeginterferon, and the incidence of remaining adverse event (AE) was small and comparable in both arms. The most common side effects in the ropeginterferon group were flu-like symptoms and neutropenia; however, the third-grade neutropenia was the most common (8% of cases) [22].
One of the most important clinical studies on the use of ropeginterferon was the PROUD-PV study and its continuation: the CONTINUATION-PV study. These were three-phase, multicenter studies. The aim of the study was to compare the effectiveness of ropeginterferon in relation to hydroxycarbamide. The study included adult patients diagnosed with polycythemia vera treated with hydroxycarbamide for less than 3 years and no cytoreductive treatment at all. In total, 257 patients received this treatment. The patients were divided into two groups: those receiving ropeginterferon or the other being given hydroxycarbamide.
During the PROUD-study, drug doses were increased until the hematocrit was achieved below 45% without the use of phlebotomies, and the normalization of the number of leukocytes and platelets was reached.
The PROUD-PV study lasted 12 months. After this time, the patients continued the treatment under the CONTINUATION-PV study for further 36 months. After the final analysis performed in the 12th month at the end of PROUD study, it was found that the hematological response rates did not differ between the ropeginterferon and hydroxycarbamide treatment groups. These were consecutively 43% in the ropeginterferon arm and 46% in the control arm.
However, after analyzing the CONTINUATION- PV study, it turned out that after 36 months of treatment, the rates of hematological responses begin to prevail in the group of patients receiving ropeginterferon, 53% versus 38% in the control group. Thus, from the above data, it can be seen that the response rate to ropeginterferon increases with the duration of treatment [23].
Another analysis of patients participating in the PROUD and CONTINUATION studies was based on the assessment of treatment results after 24 months, dividing patients into two groups according to age (under and over 60 years).
The initial comparison of both groups of patients showed that older patients had a more aggressive course of the disease. Patients over 60 years of age had a higher percentage of cells with a mutant JAK2 allele. They experienced both general symptoms and some complications, such as thrombosis, more frequently. Both patients under 60 years of age and over 60 years of age in the ropeginterferon arm had a higher rate of molecular response, namely 77.1 and 58.7% compared with the HU remission: 33.3 and 36.1%, respectively. Significantly higher reductions in the JAK2 allele were observed in both groups of patients after ropeginterferon treatment: it was 54.8% for younger patients and 35.1% for elderly patients. For comparison, this difference in the group of patients treated with HU was 4.5 and 18.4%, respectively.
What is more, the age did not affect the frequency of ropeginterferon side effects. In addition, the incidence of adverse ropeginterferon disorders was similar to that observed in the hydroxycarbamide group [24].
Essential thrombocythemia is a clonal growth of multipotential stem cells in the bone marrow. The consequence of this is increased proliferation of megakaryocytes in the bone marrow and an increase in the number of platelets in the peripheral blood. The level of platelets above 450,000/μl is considered a diagnostic criterion.
Essential thrombocythemia may progress over time to a more aggressive form of myeloproliferation, i.e., myelofibrosis. The disease can also evolve into acute myeloid leukemia or myelodysplastic syndrome, both with very poor prognosis. Thromboembolic complications are serious, and they concern over 20% of patients. Thrombosis occurs in the artery and venous area. Moreover, in patients with a very high platelet count, above 1,000,000/μl, bleeding may occur as a result of secondary von Willebrand syndrome [1, 2].
The treatment of ET is primarily aimed to prevent thrombotic complications.
In low-risk patients, only acetylsalicylic acid is used. In cases of high-risk patients, hydroxycarbamide is the first-line drug for most patients. Anagrelide and interferon are commonly used as second-line drugs.
Due to the possible effects of hydroxycarbamide of cytogenetic changes in the bone marrow cells after long-lasting usage, some experts recommend the use of interferon in younger patients in the first line. Interferon is also used as the drug of choice in patients planning a pregnancy [25].
The efficacy of pegylated interferon alpha-2a was assessed on the basis of the group of 39 patients with essential thrombocythemia and 40 patients with polycythemia vera.
Of the overall group, 81% of patients were previously treated prior to the study entry. The patients received pegylated interferon alpha-2a in a dose of 90 μg once a week. The dose of 450 μg was associated with a high percentage of intolerance.
In patients with essential thrombocythemia, the complete remission was achieved in 76%, while the overall hematological response rate brought 81%. Moreover, the molecular remission was achieved in 38%, in 14% of cases, JAK2 transcript became not detectable.
Patients diagnosed with polycythemia vera achieved 70% complete hematological remission and 80% general hematological response to treatment. JAK2 transcript was undetectable in 6% of patients. Molecular remission was achieved in 54% of cases.
Pegylated interferon alpha-2a at the dose of 90 μg per week was very well tolerated. In total, 20% of patients experienced a grade of 3 or 4 of adverse reaction, which was neutropenia. In addition, an increase in liver function tests was observed. Grade 4 of AE was not observed among patients who started the treatment with 90 μg/week while grade 3 neutropenia was an adverse event in only 7% of cases [26].
The effect of interferon alpha-2b treatment in patients with ET and PV was investigated. The study was prospective. Some of the results concerning the group of patients with polycythemia vera are presented in the subsection on polycythemia vera. In total, 123 patients with diagnosed essential thrombocythemia participated in the study. All of them received interferon alpha-2b. The patients were divided into two groups depending on the presence of the JAK2 V617F mutation. The enrolled patients were between 18 and 65 years of age. The treatment they received was, sequentially, interferon alpha-2b in the dose of 3 million units three times a week for the first 2 years, after which time the dose was changed into a maintenance dose, which amounted to 5 million units two times a week.
The analysis showed that the patients with the JAK2 V617F mutation present in a higher percentage achieved an overall hematological response as well as a complete hematological response. The overall hematological response was achieved in 83% of patients with JAK2 mutation, and the complete hematological remission was achieved in 23 cases. In the group of ET patients without the JAK2 V617F mutation, overall hematological response was achieved in 61.4%, while the complete hematological remission was achieved in 12 patients. The 5-year progression-free survival was obtained in 75.9% in the JAKV617F group and only in 47.6% without the mutation.
A significant proportion of patients experienced mild side effects. Grade 3 and 4 of adverse events were severe, most of them being a fever. The isolated cases of elevated liver tests and nausea have also been reported [19].
Pegylated interferon alpha-2b in patients with essential thrombocythemia who were previously treated with hydroxycarbamide, anagrelide, and other forms of interferon alpha, however, due to the lack of efficacy or toxicity, the patients required a change of treatment, was assessed. Pegylated interferon alpha-2b turned out to be effective in these cases. It led to the complete hematological remission in 91% of patients after 2 months of therapy, and in 100% of patients after 4 months. However, merely 11 patients participated in the study. Also only two patients required treatment discontinuation due to the side effects such as depression and general fatigue grade 3 [27].
In case of pregnant patients, interferon is currently considered the only safe cytoreductive drug. Over the years, several analyses of the results of interferon treatment during pregnancy have been carried out.
The assessment of 34 pregnancies in 23 women diagnosed with ET was performed retrospectively. All the pregnancies included in the analysis were of high risk. This high risk was associated with a high platelet count above 1,500,000/μl, a history of thrombotic episode, severe microcirculation disorders, or a history of major hemorrhage.
It turned out that the use of interferon allowed the birth of an alive child in 73.5% of cases. There was no difference in efficacy between the basic and pegylated forms of interferon alpha. In pregnancies without interferon treatment, the percentage of live births was only 60%. Moreover, it was not found if the presence of the JAK2 V617F mutation had any influence on the course of pregnancy [28].
An analysis of the course of pregnancy in patients with ET was assessed in Italy. Data from 17 centers were taken into account. Data from 122 pregnancies were collected from 92 women. In patients diagnosed with essential thrombocythemia, the risk of the spontaneous loss of pregnancy is about 2.5 times higher than among the general population. In the contrary to the study quoted above, it was found that the presence of the JAK2 mutation increases the risk of pregnancy loss. The proportion of live births in patients exposed to interferon during pregnancy was 95%, compared with 71.6% in the group of patients not treated with interferon.
The multivariate analysis also showed that the use of acetylsalicylic acid during pregnancy had no effect on the live birth rate of patients with ET [29].
Whatever its form, interferon is the drug of first choice in pregnancy. Hydroxycarbamide and anagrelide should be withdrawn for about 6 months, and at least for 3 months, before the planned conception. Experts recommend the use of interferon in high-risk pregnancies [30]. A Japanese analysis of 10 consecutive pregnancies in ET patients showed 100% live births in patients who received interferon [31].
In myelofibrosis (MF), monoclonal megakaryocytes produce cytokines that stimulate the proliferation of normal, non-neoplastic fibroblasts and stimulate angiogenesis. The consequence of this is the gradual fibrosis of the bone marrow, impaired hematopoiesis in the bone marrow, and the formation of extramedullary location mainly in the sites of fetal hematopoiesis, i.e., in the spleen and the liver.
The production of various cytokines by neoplastic megakaryocytes leads to the proliferation of normal, noncancerous fibroblasts as well as to increased angiogenesis.
Progressive bone marrow fibrosis leads to worsening anemia and thrombocytopenia. On the other hand, the production of proinflammatory cytokines by megakaryoblasts leads to the general symptoms such as weight loss, fever, joint pain, night sweats, and consequently, progressive worsening of general condition.
The prognosis for myelofibrosis is poor. In about 20% of patients, myelofibrosis evolves into acute myeloid leukemia with poor prognosis.
Currently, the only effective method of treatment that gives a chance to prolong the life is allogeneic bone marrow transplantation. However, this method is only available to younger patients.
The goal of treatment of patients who have not been qualified for allotranspalntation is to reduce the symptoms and to improve the patient’s quality of life. In case of leukocytosis cytoreducing drugs, such as hydroxycarbamide, melphalan, or cladribine can be used. They cause a reduction in the number of leukocytes and may, to some extent, inhibit splenomegaly. Interferon alpha has been used successfully for the treatment of myelofibrosis for many years. The results of its effectiveness will be presented below [2].
Currently, the JAK2 inhibitor ruxolitinib is approved for the treatment of myelofibrosis with enlarged spleen in intermediate and high-risk patients. Ruxolitinib reduces the size of the spleen, reduces general symptoms, and improves the quality of life; however, it does not prolong the overall survival of patients [32].
In 2015, the results of a retrospective study were published to compare the histological parameters of the bone marrow before and after interferon treatment. Twelve patients diagnosed with primary myelofibrosis as well as post-PV MF and post-ET MF were enrolled in the study. Patients were treated with pegylated recombinant interferon alpha-2a or recombinant interferon alpha-2b in standard doses. The time of treatment was from 1 to 10 years. Some patients had previously been treated with hydroxycarbamide or anagrelide. In all cases, karyotype was normal. The prognostic factor of Dynamic International Prognostic Scoring System (DIPSS) was assessed at the beginning as well as during the treatment.
Bone marrow cellularity decreased in cases with increased bone marrow cellularity before the treatment. After the interferon treatment, a reduction in the degree of bone marrow fibrosis was found. The parameters, such as the density of naked nuclei and the density of megakaryocytes in the bone marrow, also improved.
It proves that if the JAK2 V617F mutation had been present, DIPSS was decreased after interferon treatment. This relationship was not observed in patients without the JAK2 V617F mutation. The improvement in peripheral blood morphological parameters and the overall clinical improvement correlated with the improvement in the assessed histological parameters of the bone marrow.
Before the initiation of interferon, seven patients had splenomegaly. During the treatment with interferon, the complete resolution of splenomegaly was achieved in 17% of patients (two cases), and its size decreased in 25% (three cases). A good clinical response was achieved in 83% during interferon therapy. There was no significant difference in response between the two types of interferon used [33].
A prospective study was also conducted in patients with low and intermediate-1 risk group myelofibrosis. Seventeen patients were enrolled. Patients received interferon alpha-2b (0.5–3 milion units/three times a week) or pegylated interferon alpha-2a (45–90 μg/week). The duration of therapy was on average 3.3 years.
Most of the patients responded to the treatment. Partial remission was found in seven patients and complete remission in two patients. Moreover, in four cases, the disease was stabilized and in one case the clinical improvement was achieved. Three patients did not respond to treatment at all and progressed to myelofibrosis. Additionally, the assessment in reducing spleen size was performed. At baseline, 15 patients have splenomegaly, nine of them achieved the compete regression of spleen size [34].
However, the efficacy of interferon in the treatment of myelofibrosis appears to be limited only to a less advanced form, when the bone marrow still has an adequate percentage of normal hemopoiesis and the marrow stroma is not significantly fibrotic. In more advanced stages, interferon was not shown to have any significant effect on the regression of the fibrosis process [35].
In 2020, the results of the COMBI study were published. That was a two-phase, multicenter, single-arm study that investigated the efficacy and safety of the combination of ruxolitinib and pegylated interferon alpha. Thirty-two patients with PV and 18 patients with primary and secondary myelofibrosis participated in the study. The patients were at age 18 and older. Remission was achieved in 44% of myelofibrosis cases, including 28% (5 patients) of complete remission. In patients with PV, the results were slightly worse: 31% of remissions, including 9% of complete remissions. Patients received pegylated interferon alpha-2a (45 μg/week) or pegylated interferon alpha-2b (35 μg/week) in low doses and ruxolitinib in doses of 5–20 mg twice a day.
For the entire group of patients (with PV and MF), the initial JAK2 allele burden was 47% at baseline, and after 2 years of treatment with interferon and ruxolitinib, it decreased to 12%.
The treatment toxicity was low. The highest incidence of side effects occurred at initiation of therapy. It was mostly anemia and thrombocytopenia.
The observations from the COMBI study show that, for the combination of interferon in lower doses with ruxolitinib, it may be effective and well tolerated even in the group of patients who had intolerance to interferon used as the only drug in higher doses. The combined treatment improved the bone marrow in terms of fibrosis and its cellularity. It also allowed to improve the value of peripheral blood counts [36].
It is currently known that some of the additional mutations are associated with a worse prognosis in patients with myelorpoliferation, including patients with myelofibrosis. Some of these mutations have been identified as high-risk molecular mutations. These are ASXL1, EZH2, IDH1/2, or SRSF2. Earlier studies have shown their association with a more aggressive course of the disease, worse prognosis, and shorter survival of patients, as well as a poorer response to treatment. Due to their importance, they have been included in the diagnostic criteria of myelofibrosis [37].
It is also known that the presence of driver mutations, i.e., JAK2, CALR, and MPL or triple negativity, may affect the course of myeloproliferation, including the incidence of thromboembolic complications.
The assessment of the influence of driver mutations and a panel of selected additional mutations on the effectiveness of interferon treatment in patients with myelofibrosis was performed on a group of 30 patients. Only the patients with low- and intermediate-1-risk were enrolled in the study. The treatment with pegylated interferon alpha-2a or interferon alpha-2b resulted in a complete remission in two patients and partial remission in nine patients. The disease progressed in three cases. One patient relapsed and four died. The remaining patients achieved a clinical improvement or disease stabilization. In the studied group, it was not found if the effectiveness of interferon treatment was influenced by the lack of driver mutations. Among the group of four patients with additional mutations, two died and one had disease progression. It was a mutation of ASXL1 and SRSF2. The treatment with interferon in patients without additional molecular mutations in the early stages of the disease may prevent further progression of the disease [38].
The side effects of interferon in the group of patients with myelofibrosis are similar to those occurring after the treatment of other chronic myeloproliferative diseases. The most frequently described are hematological toxicity- anemia and thrombocytopenia, less often is the appearance of leukopenia. Hematological toxicity usually resolves with dose reduction or extension of the dose interval. The most frequently nonhematological toxicity was fatigue, muscle pain, weakness, and depression symptoms. All symptoms are usually mild and do not exceed grade 2 [38].
However, the use of interferon in the treatment of myelofibrosis has not been recommended as a standard therapy. Interferon is still being evaluated in clinical trials, or it is used in selected patients as a nonstandard therapy in this diagnosis.
Mastocytosis is characterized by an excessive proliferation of abnormal mast cells and their accumulation in various organs.
The basis for the development of mastocytosis is ligand-independent activation of the KIT receptor, resulting from mutations in the KIT proto-oncogene. The KIT receptor is a trans membrane receptor with tyrosine kinase’s activity. Its activation stimulates the proliferation of mast cells. That excessive numbers of mast cells infiltrate tissues and organs and release mediators such as histamine, interleukine-6, tryptase, heparin, and others, which are responsible for the appearance of symptoms typical of mastocytosis. In addition, the infiltration of tissues for mast cells itself causes damage to the affected organs.
The prognosis of mastocytosis depends on the type of the disease. In the case of cutaneous mastocytosis (CM), in the majority of cases prognosis is good and the disease does not shorten the patient’s life, but in aggressive systemic mastocytosis (ASM), the average follow-up is about 40 months. Mast cell leukemia has a poor prognosis with a median follow-up of approximately 1 year.
Systemic mastocytosis usually requires the implementation of cytoreductive therapy. The first line of therapy is interferon alone or its combination with corticosteroids. In aggressive systemic mastocytosis, the first line in addition to interferon 2-CdA can be used. An effective drug turned out to be midostaurin in the case of the present KIT mutation. In patients without the KIT D816V mutation, treatment with imatinib may be effective. In the case of mast cell leukemia, multidrug chemotherapy is most often required, as in acute leukemias, followed by bone marrow transplantation [39].
Systemic mastocytosis requiring treatment is a rare disease, this is why the studies available in the literature evaluating various therapies concern mostly small groups of patients.
In 2002, the French authors presented their experiences on the use of interferon in patients with systemic mastocytosis. They included 20 patients. The patients received interferon alpha-2b in gradually increased doses.
The patients were assessed after 6 months. In cases in which bone marrow was infiltrated for mast cells at baseline, it still remained infiltrated after 6 months of treatment.
However, the responses were obtained in terms of symptoms related to mast cell degranulation. Partial remission was achieved in 35% of patients and minor remission in 30%. It concerns mainly skin lesions and vascular congestion. Moreover, the assessment of the histamine level in the plasma revealed a decrease of it in patients who previously presented symptoms related to the degranulation of mast cells, such as gastrointestinal disorders and flushing.
A high percentage of side effects were found during treatment. They concerned 35% of patients. Depression and cytopenia were most frequent ones [40].
Another analysis was a report of five patients with systemic mastocytosis treated with interferon and prednisolone. All patients received interferon alpha-2b in a dose of 3 million units three times a week and four patients additionally received prednisolone. Four patients responded to interferon treatment at varying degrees. One patient, who at baseline had bone marrow involvement by mast cells in above 10%, progressed to mast cell leukemia. In two patients, the symptoms C resolved completely and in one of them they partially disappeared. In one case, stabilizing disease was achieved [41].
In 2009, a retrospective analysis of patients treated with cytoreductive therapy due to mastocytosis was published. The authors collected data from 108 patients treated at the Mayo Clinic. This analysis allowed for the comparison of the efficacy of four drugs used in systemic mastocytosis. There were interferon alpha alone or in the combination with prednisone—among 40 patients, hydroxycarbamide—among 26 ones, imatinib—among 22 persons, and 2-chlorodeoxyadenosine (2-CdA)—among 22 patients.
After dividing the patients into three additional groups on the basis of the type of mastocytosis—indolent systemic mastocytosis, aggressive systemic mastocytosis, and systemic mastocytosis associated with another clonal hematological nonmast cell lineage disease (SM-AHNMD)—the effectiveness of each of type of therapy was assessed.
The highest response rates in indolent and aggressive mastocytosis were achieved with interferon treatment. They were 60% of the responses in both groups, and in the SM-AHNMD group of patients, the percentage was also one of the highest and amounted to 45%. The second most effective drug was 2-CdA. The response rates were 56% for indolent MS, 50% for aggressive MS, and 55% for SM-AHNMD. The patients treated with imatinib achieved response in 14, 50, and 9% by following groups, respectively. In contrast, patients with indolent and aggressive systemic mastocytosis did not respond to hydroxycarbamide treatment at all. The response rate in both groups was 0%. However, patients with MS associated with another clonal hematological nonmast cell lineage disease achieved 21% response to hydroxycarbamide. Additionally, it was found that only interferon relieved symptoms caused by the release of inflammatory mediators by mast cells.
The additional analysis showed no influence of the TET 2 mutation on the response to treatment [42].
In the literature, there are also single cases of mastocytosis presenting trials of nonstandard treatment. That is description of a patient with systemic mastocytosis with mast cell bone marrow involvement. Mutation of c-kit Asp816Val was present. Patient progressed despite treatment with dasatinib and 2-chlorodeoxyadenosine. The patient developed symptoms related to the degranulation of mast cells and increased ascites.
The patient was treated with pranlukast, which is an anti-leukotriene receptor antagonist due to an asthma episode. The rate of ascites growth decreased significantly after one administration. The patient required paracentesis every 10 days and not every 3 days, as before starting to take the drug. After 15 days of treatment with pranlukast, the patient received interferon alpha, which resulted in complete regression of ascites, resolution of pancytopenia, and complete disappearance of the c-kit mutation clone. The infiltration of mast cells in the bone marrow significantly decreased [43].
Interferon alpha was also effective in a patient with systemic mastocytosis associated with myelodysplastic syndrome with the c-kit D816V mutation, which was refractory to imatinib treatment [44].
Interferon alpha also proved to be effective in the treatment of osteoporotic lesions appearing in the course of mastocytosis.
The series of 10 cases with resolved mastocytosis and osteoporosis-related fractures was presented in 2011. The patients received interferon alpha in a dose of 1.5 million units three times a week as well as pamindronic acid. The patients were treated for an average of 60 months. For the first 2 years, pamindronate was given at a dose of 1 mg/kg every month, and then every 3 months.
During the course of the study, no patient had a new-bone fracture. The level of alkaline phosphatase decreased by 25% in relation to the value before treatment and tryptase by 34%. Bone density increased during treated with interferon and pamindronate. The increase was on average 12% in the spine bones and 1.9% in the hip bones. At the same time, there was no increase in the density of the hip bone and a minimal increase in the density of the spine in patients treated with pamindronate alone.
The results of this observation suggest that it is beneficial to add low doses of interferon alpha to pamindronate treatment in terms of bone density increase [45].
That experiences show that interferon used in systemic mastocytosis significantly improves the quality of life of patients by inhibiting the symptoms caused by degranulation of mast cells. They prevent bone fractures and, in some patients, they cause remission of bone marrow infiltration by mast cells.
Chronic neutrophilic leukemia (CNL) is a very rare disease. It is characterized by the clonal proliferation of mature neutrophils.
The diagnostic criteria proposed by the World Health Organization (WHO) comprise leukocyte counts above 25,000/μl (including more than 80% of rod and segmented
Physical examination often shows enlargement of the liver and spleen, moreover, patients complain on weight loss and weakness [1].
The prognosis varies. The average survival time for patients with CNL is less than 2 years.
Only few descriptions of chronic neutrophilic leukemia are available in the literature, and these are mostly single case reports.
Because it is an extremely rare disease, there are no established and generally accepted treatment standards. In most cases, patients are given hydroxycarbamide or interferon. Patients who are eligible for a bone marrow transplant may benefit from this treatment. Bone marrow allotransplantation remains the only method that gives a chance for a significant extension of life.
The German authors presented a series of 14 cases of chronic neutrophilic leukemia. The group of patients consisted of eight women and six men. The average age was 64.7 years. From the entire group of patients, longer survival was achieved only in three cases. One of these patients was treated with interferon alpha and achieved hematological remission, the other underwent bone marrow allotransplantation from a family donor, and the third one was treated with hydroxycarbamide and transfusions as needed. The follow-up period of the patient after allogeneic matched related donor transplantation (allo-MRD) was 73 months, and for the patient after interferon treatment it was 41 months.
The remaining patients died within 2 years of diagnosis. Six patients, the largest group, died due to intracranial bleeding, three patients died because of leukemia cell tissue infiltration, one patient because of the disease transformation into leukemia, and one patient because of pneumonia [46].
It can be seen from these experiences that treatment with interferon alpha can significantly extend the survival time of patients.
The case of a 40-year-old woman diagnosed with chronic neutrophilic leukemia is presented by Yassin and coauthors. Initially, the patient had almost 41,000 leukocytes in the peripheral blood. In a physical examination, splenomegaly and hepatomegaly were not present. Patient received pegylated interferon alpha-2a. The initially dose was 50 μg once a week for the first 2 weeks, then the dose was increased to 135 μg weekly for 6 weeks, and then the dose interval was extended to another 2 weeks. As a result of the treatment, the general condition of the patient improved and the parameters of peripheral blood counts were normalized [47].
Another case report presented in the literature describes a 41-year-old woman diagnosed with CNL accompanied by focal segmental glomerulosclerosis (FSGS). The patient had increasing leukocytosis for several months. On the admission to the hospital, leukocytosis was 94,000/μl. Moreover, the number of platelets in the morphology exceeded 1,000,000/μl. More than a year earlier, the patient had splenectomy due to splenomegaly and spleen infraction.
Additionally, JAK2 V617F mutation was found. Some authors suggest that the presence of JAK2 mutation may be associated with longer survival in CNL.
The patient received hydroxycarbamide for 3 months and reduction in the number of leukocytes was achieved. After this time, interferon alpha-2b was added to hydroxycarbamide. As a result, focal segmental glomerulosclerosis disappeared and the renal tests improved [48].
Another case of chronic neutrophilic leukemia with a JAK2 gene mutation concerns a 53-year-old man. The patient’s baseline leukocytosis was 33,500/μl, including the neutrophil count of 29,700/μl. The patient also had splenomegaly.
The treatment with interferon alpha-2b at a dose of 3 million units every other day was started. After a month of treatment, the number of leukocytes was reduced to less than 10,000/μl. Then the patient was treated chronically with interferon alpha-2b in doses of 3 million units every 2 weeks. As a result of the therapy, the number of leukocytes remains between 8 and 10,000/μl. The patient remains in general good condition [49].
A series of two CNL cases are also shown. The first patient was a 70-year-old woman with stable leukocytosis of about 35,000/μl and the remaining morphology parameters in normal range. The patient was only observed for 5 years until hepasplenomegaly progressed rapidly. Then, interferon alpha-2b was included. Due to the treatment, the rapid regression of hepatosplenomegaly was achieved.
The second case is a 68-year-old woman with baseline leukocytosis of almost 14,000/μl. In this case, the treatment with hydroxycarbamide was started immediately. However, no improvement was achieved. After 6 weeks of HU treatment, interferon alpha-2b 3 million units 3 times a week was implemented and leukocytosis decreased. Due to the interferon treatment, the disease stabilized for a long time. Because the patient experienced an adverse reaction, a severe flu-like syndrome, interferon was discontinued. After interferon withdrawal, the disease progressed gradually and the treatment attempts by busulfan and 6-mercaptopurine were unsuccessful. Therefore, interferon was readministered and the disease went into remission. Interferon treatment was continued at a reduced dose. The disease regression was achieved again.
Additionally, the patient showed an improvement in the function of granulocytes in terms of phagocytosis and an improvement in neutral killer (NK) cell function after treatment with interferon [50].
The above examples show that interferon alpha is effective in the treatment of chronic neutrophilic leukemia. The side effects are rare and can be managed with dose reductions. Moreover, in these cases, interferon is also effective in a reduced dose. Disease remission or regression can be achieved without typical of CNL complications, such as intracranial bleeding.
Interferon has been used in the past to treat chronic myeloid leukemia. The treatment with tyrosine kinase inhibitors is now a standard practice. However, in a small number of patients, they are ineffective or exhibit unmanageable toxicity. Therefore, the attempts are underway to use interferon in combination with TKI in lower doses, which is to ensure the enhancement of the antiproliferative effect while reducing the toxicity.
There are ongoing attempts to use ropeginterferon in patients diagnosed with chronic myeloid leukemia, in whom treatment with imatinib alone has not led to deep molecular response (DMR). The first phase study was conducted in a small group of patients with chronic myeloid leukemia. The patients in first chronic phase treated with imatinib who did not achieve DMR, but in complete hematologic remission and complete cytogenetic remission, were included in the study. Patients have been treated with imatinib for at least 18 months. Twelve patients were enrolled in the study, and they completed the study according to the protocol. These patients received additional ropeginterferon to imatinib and four achieved DMR. Low toxicity was observed during the treatment. Among the hematological toxicities, neutropenia was the most common. There was no nonhematological toxicity with a degree higher than 1/2 during the treatment. Moreover, it has been found that better effects and fewer side effects are obtained when ropeginterferon is administered for a longer time, but in lower doses. The comparison of the effectiveness of interferon in chronic myeloproliferative disorders based on selected articles is presented in Table 1 [51].
Source | Type of trial | Interferon | Diagnosis | No. | Prior treatment status | Response rate |
---|---|---|---|---|---|---|
Yacoubet al. [15] | Phase II, multicenter | Pegylated IFN alfa-2a | PV | 50 | Resistance to HU or HU intolerance | CR:22% PR:38% |
ET | 65 | CR:43% PR:26% | ||||
Masarova et al. [16] | Phase II, single-center | Pegylated IFN alfa-2a | PV | 43 | Untreated or previously treated with cytoreductive therapy | CR:77% PR:7% |
ET | 40 | CR:73% PR:3% | ||||
Samuelsson et al. [18] | Phase II | Pegylated IFN alfa-2b | PV | 21 | Untreated or previously treated with cytoreductive therapy | CR: 69% for the entire group |
ET | 21 | |||||
Huang BT et al. [19] | Open label, multicenter | IFN alfa-2b | PV | 136 | Untreated or previously treated with cytoreductive therapy | OHR:70% Molecular response:54.7% |
ET | 123 | OHR (JAK2+ patients):83% CHR:23 cases OHR (JAK2-patients): 61.4% CHR:12 cases | ||||
Gisslinger et al. [23] | phase III, multicenter | Ropeginterferon | PV | 257 | Previously treated | OHR:53% |
Quintás-Cardama et al. [26] | phase II | Pegylated IFN alfa-2a | PV | 40 | Untreated or previously treated with cytoreductive therapy | OHR:80% CR:70% Molecular remission:54% |
ET | 39 | OHR:81% CR:76% Molecular remission:38% | ||||
Sørensen et al. [36] | Phase III, multicenter, COMBI | Pegylated IFN alfa-2a with ruxolitinib or Pegylated IFN alfa-2b with ruxolitinib | PV | 32 | Untreated or previously treated with cytoreductive therapy | OHR:44% CR:28% |
MF | 18 | OHR:31% CR:9% | ||||
Casassus et al. [40] | Open label, multicenter | IFN alpha-2b | Mastocytosis | 20 | Untreated and previously treated | PR:35% Minor remission: 30% |
Comparison of the effectiveness of interferon in chronic myeloproliferative disorders.
PV: polycythemia vera; ET: essential thrombocythemia; MF: myelofibrosis; HU: hydroxycarbamide/hydroxyurea; CR: complete remission; PR: partial remission; and OHR: overall hematological response.
Interferon alpha appears to be an effective and safe drug in the most type of chronic myeloproliferative disorders. Nowadays, all forms of its using have similar effectiveness. Interferon alpha can be effective even in cases of resistance for first-line treatment. Trial research is currently underway to combine it with some new drugs, such as ruxolitinib, and to add it to the already well-established therapy, it is a promising option for patients with refractory disease.
From time to time, new forms of interferon, such as ropeginterferon, are introduced, which gives hope for better effectiveness, better safety profile, and greater comfort in its use for patients who have to be treated for many years. In the case of the use of interferons alpha in the treatment of chronic myeloproliferative diseases, there are still opportunities to extend its use and to study its combination with newly introduced drugs.
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Researchers and students will find the chapter appealing with a preliminary description of P300 ERP. This chapter also appreciates the importance and advantages of noninvasive ERP technique. In noninvasive BCI, the P300 ERPs are extracted from brain electrical activities [electroencephalogram (EEG)] as a signature of the underlying electrophysiological mechanism of brain responses to the external or internal changes and events. As the chapter proceeds, topics are covered on more relevant scholarly works about challenges and new directions in P300 BCI. Along with these, articles with the references on the advancement of this technique will be presented to ensure that the scholarly reviews are accessible to people who are new to this field. To enhance fundamental understanding, stimulation as well as signal processing methods will be discussed from some novel works with a comparison of the associated results. 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However, despite AD being one of the most prevalent neurodegenerative diseases in aging societies, no clinically successful therapeutic strategies for its treatment or prevention have been reported to date. Studies have indicated that gut microbial alterations are linked to AD. Probiotics are living microorganisms that are known to confer health benefits to the host when ingested in adequate amounts. Certain strains of probiotics appear to influence the central nervous system (CNS) and behavior via the microbiota-gut-brain axis. Increasing evidence from preclinical and clinical studies has demonstrated that probiotics possess preventive as well as therapeutic potential for AD. It is speculated that probiotics could ameliorate the progression of AD by modulating the inflammatory process, counteracting oxidative stress, and other possible mechanisms, although further studies are needed to understand the details. 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It is enshrined in posterior cranial fossa behind the pons and medulla oblongata and separated from these structures by cavity of fourth ventricle. It is connected to brainstem by three fibre tracts known as cerebellar peduncles. Cerebellum controls the same side of body. It precisely coordinates skilled voluntary movements by controlling strength, duration and force of contraction, so that they are smooth, balanced and accurate. It is also responsible for maintaining equilibrium, muscle tone and posture of the body. This is achieved through the use of somatic sensory information in modulating the motor output from the cerebrum and brainstem. Sherrington regarded cerebellum as the head ganglion of the proprioceptive system. Dysfunction of cerebellum along with degenerative diseases of cerebellum such as spinocerebellar ataxia, multiple sclerosis, malignant tumours, etc. may culminate into disequilibrium, hypotonia, difficulty in talking, sleeping, maintaining muscular coordination and dyssynergia which at times may be life threatening. Hence, knowledge of anatomy of cerebellum is imperative for neuroanatomists and neurosurgeons.",book:{id:"9157",slug:"neurodegenerative-diseases-molecular-mechanisms-and-current-therapeutic-approaches",title:"Neurodegenerative Diseases",fullTitle:"Neurodegenerative Diseases - Molecular Mechanisms and Current Therapeutic Approaches"},signatures:"Rajani Singh",authors:[{id:"319468",title:"Dr.",name:"Rajani",middleName:null,surname:"Singh",slug:"rajani-singh",fullName:"Rajani Singh"}]},{id:"55773",title:"Event-Related Potentials for the Study of Cognition",slug:"event-related-potentials-for-the-study-of-cognition",totalDownloads:1550,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Despite the vast literature on event-related potentials (ERPs), many clinical professionals are still unaware of the huge variety of possible applications they offer. The aim of this chapter is not to show the classical use of ERPs, focused on analyzing the first steps of information processing (sensory pathways). On the contrary, this chapter will be focused on the use of these ERPs in the assessment of cognitive function. In particular, this chapter is mainly focused on the use of ERPs to better understand the neural bases of cognitive impairment from the electrical activity of the brain. Describing all the possible ERP components and their cognitive meaning is a huge endeavor, and this chapter will only be focused on three of them: contingent negative variation (CNV), mismatch negativity (MMN), and P300. To improve the reader’s knowledge about these ERPs in cognition, a specific description will be given about the stimulation required to obtain the specific component, the topography, and latency shown. Moreover, a description of the neurophysiological bases of the component, its relationship with psychological processes and neural sources will be also included. Pathological alterations suffered by the component will also be briefly described.",book:{id:"5751",slug:"event-related-potentials-and-evoked-potentials",title:"Event-Related Potentials and Evoked Potentials",fullTitle:"Event-Related Potentials and Evoked Potentials"},signatures:"Manuel Vazquez-Marrufo",authors:[{id:"189375",title:"Dr.",name:"Manuel",middleName:null,surname:"Vazquez-Marrufo",slug:"manuel-vazquez-marrufo",fullName:"Manuel Vazquez-Marrufo"}]},{id:"46092",title:"A Practical Guide to an fMRI Experiment",slug:"a-practical-guide-to-an-fmri-experiment",totalDownloads:3180,totalCrossrefCites:0,totalDimensionsCites:1,abstract:null,book:{id:"4461",slug:"advanced-brain-neuroimaging-topics-in-health-and-disease-methods-and-applications",title:"Advanced Brain Neuroimaging Topics in Health and Disease",fullTitle:"Advanced Brain Neuroimaging Topics in Health and Disease - Methods and Applications"},signatures:"Nasser Kashou",authors:[{id:"77988",title:"Dr.",name:"Nasser",middleName:"H",surname:"Kashou",slug:"nasser-kashou",fullName:"Nasser Kashou"}]}],onlineFirstChaptersFilter:{topicId:"1059",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:11,numberOfPublishedChapters:91,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:333,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:11,numberOfPublishedChapters:144,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:124,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:113,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:23,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:12,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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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. 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