",isbn:"978-1-80356-963-5",printIsbn:"978-1-80356-962-8",pdfIsbn:"978-1-80356-964-2",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"8eeb7ab232fa8d5c723b61e0da251857",bookSignature:"Dr. Soumen Dhara and Dr. Gorachand Dutta",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11513.jpg",keywords:"Fabrication Technologies, Applications, Characterizations, Case Studies, Various Gas Sensors, Improvement of Lifestyle, Societal Benefit, Bio-Sensors, Bioreceptor Molecules, Integration, Packaging, Lab-on-Chip",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 8th 2022",dateEndSecondStepPublish:"June 17th 2022",dateEndThirdStepPublish:"August 16th 2022",dateEndFourthStepPublish:"November 4th 2022",dateEndFifthStepPublish:"January 3rd 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"23 days",secondStepPassed:!1,areRegistrationsClosed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"A pioneering researcher in nanowire heterostructures and laser spectroscopy, recipient of JSPS (Govt. of Japan) and NPDF (Govt. of India) fellowships, and member of MRS(USA), MRS(India), IPA(India).",coeditorOneBiosketch:"Assistant Professor with the School of Medical Science and Technology, Indian Institute of Technology Kharagpur with research interests that include the design and characterization of portable biosensors, biodevices, and sensor interfaces for miniaturized systems and biomedical applications for point-of-care testing.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"196334",title:"Dr.",name:"Soumen",middleName:null,surname:"Dhara",slug:"soumen-dhara",fullName:"Soumen Dhara",profilePictureURL:"https://mts.intechopen.com/storage/users/196334/images/system/196334.jpeg",biography:"Dr. Dhara received his Ph. D in Physics in 2012 from Indian Institute of Technology Guwahati, India. Presently, he is associated with the Faculty of Science, Sri Sri University, India as an Assistant Professor in Physics. Prior to joining the current\naffiliation, he was a postdoctoral fellow at different renowned institutions, Kobe University Japan, S. N. Bose National Centre for Basic Sciences, India and Cardiff University, United Kingdom. He was awarded prestigious JSPS postdoctoral fellowship based on his research contribution on semiconducting nanowires. He has published more than 32 research articles including 1 review article in high profile international journals and 3 book chapters to his credit. His research trust areas of interests are semiconductor nanostructures, optoelectronics, solid state lighting and light sensors, spectroscopy of nanomaterials, thin-film transistors (TFTs) etc.",institutionString:"Sri Sri University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Sri Sri University",institutionURL:null,country:{name:"India"}}}],coeditorOne:{id:"442408",title:"Dr.",name:"Gorachand",middleName:null,surname:"Dutta",slug:"gorachand-dutta",fullName:"Gorachand Dutta",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Dr. Gorachand Dutta, PhD is an Assistant Professor with the School of MedicalScience and Technology, Indian Institute of Technology Kharagpur. His research interests include the design and characterization of portable\r\nbiosensors, biodevices and sensor interfaces for miniaturized systems and biomedical applications for point-of-care testing. He received his Ph.D in Biosensor and Electrochemistry from Pusan National University, South Korea,\r\nwhere he developed different class of electrochemical sensors and studied the electrochemical properties of gold, platinum, and palladium based metal electrodes. He completed his Post-doctoral fellowships in the Department of\r\nMechanical Engineering, Michigan State University, USA and Department of Electronic and Electrical Engineering at University of Bath, UK. 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\n
1. Introduction
\n
Vaccines are the most effective interventions against infectious diseases such as influenza. Many vaccines, however, are only effective at preventing onset and aggravation of symptoms, and less effective at preventing infection, particularly with respiratory infections. One reason for this is that the major administration routes of conventional vaccines, including subcutaneous (s.c.) and intramuscular (i.m.), induce neutralizing IgG antibody in blood but not mucosal IgA antibody, which is more effective at preventing infection. The efficacy of IgG antibody against variant or mutated viruses is very limited because it has highly restricted cross-protective capabilities. Conversely, IgA antibody on mucosa shows wide cross-protection and can block infection [1, 2]. When immunizations are delivered at the mucosa, IgA antibody is induced on mucosal surfaces throughout the body and IgG antibody is produced in the blood. Since mucosal vaccination induces immunity in both the systemic and mucosal compartments [3, 4], enhanced antigen-specific mucosal immunity is a clear goal for next-generation vaccines. Mucosal, especially nasal, vaccines are ideal because of their effectiveness in preventing infection via the respiratory tract. Nasal vaccines have the additional benefit of improved patient compliance and greater clinical convenience as well.
\n
One significant drawback of mucosal vaccines is that they generally do not induce strong enough immune responses. The recent component-split vaccines, while avoiding many negative patient reactions, tend to be less immunogenic by themselves even in the case of intravenous (i.v.) or i.m. administration. Generally, children and the elderly tend to respond less to vaccinations, which may lower the preventive power of the population [5]. Therefore, adjuvants must be administered simultaneously with the vaccine in order to enhance vaccine-specific immune responses. Alum salts are the most commonly used adjuvant, but they are neither suitable for all vaccines nor always capable of eliciting the desired immune responses. Other types of adjuvants are being tested, such as liposomes, emulsions, and their combinations [6, 7]. The development of safe, effective, and suitable adjuvants is an important component in the future of mucosal vaccines.
\n
Several groups have examined the use of cytokines (proteinaceous bioactive substances) as a new type of vaccine adjuvant due to their potent effects on the immune system [8–10]. Although some encouraging results have been reported, cytokines are not yet in the practical use as adjuvants. One of the important points to consider is the type of drug delivery system (DDS). Recently, our group tried to generate a new type of vaccine adjuvant by combining cytokines and biocompatible saccharide materials. This chapter describes the creation of human tumor necrosis factor-α (TNF-α) encapsulated by cholesteryl pullulan (CHP) resulting in TNF/CHP nanoparticles. We investigated the potential of the nanoparticles as a nasal vaccine adjuvant by examining its ability to protect against lethal influenza infection in a mouse model and conducting further mechanistic analyses on innate and acquired immunity.
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\n
\n
2. Tumor necrosis factor-α (TNF-α)
\n
TNF-α is a major proinflammatory cytokine primarily produced by T cells and macrophages, and it is bioactive in a homotrimeric form [11]. It was first described as a potent anti-tumor factor, but it is now known to play an integral role in host defense. It activates innate and adaptive immunity by stimulating dendritic cell (DC) maturation and subsequent T cell activation as well as contributing to inflammatory responses [12, 13] (Figure 1).
\n
Figure 1.
Various actions of TNF-α.
\n
Interestingly, it was recently shown that TNF-α exerted adjuvant activities against pathogenic infections [14, 15]. Although there were some attempts to develop TNF-α (as well as other cytokines) as a vaccine adjuvant, successful practical results have not been reported. This is probably because TNF-α causes unfavorable biological reactions when administered systemically, and it is rapidly degraded when delivered at the mucosal surface. To overcome these obstacles, some investigators have attempted to generate protease-resistant mutant TNF-α molecules and have reported some potential as a vaccine adjuvant at the experimental level [16, 17].
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\n
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3. Pullulan and cholesteryl pullulan (CHP)
\n
One method of establishing a safer and more effective way to administer bioactive substances that is gaining popularity is a nanoparticle DDS. For nanoparticle materials, polysaccharides have been shown to possess several favorable characteristics in comparison with synthetic polymers currently used. Unlike synthetic polymers that could accumulate in the body to levels beyond the renal clearance, saccharides are biocompatible, meaning they are degraded by intrinsic enzymes inside the body [18, 19]. In this study, we used pullulan to create DDS nanoparticles.
\n
Pullulan is a natural and chemically neutral homopolysaccharide consisting of α-1, 6-linked maltotriose units (maltotriose is three glucose molecules linked with α-1, 4 glycosidic bonds). It is produced primarily by fermentation of starch by strains of the fungus Aureobasidium pullulans [20]. By introducing hydrophobic moieties onto the hydrophilic pullulan molecule, amphiphilic coploymers can be generated. A representative is cholesteryl pullulan (CHP) [21, 22] (Figure 2).
\n
Figure 2.
Chemical structure of CHP. m, n; integer values. In PUREBRIGHT CP-100T (NOF Co., Tokyo, Japan), 1–3% of glucose units are modified with cholesterol residues.
\n
CHP self-assembles into nanoparticles in aqueous solution and entraps various molecules in its internal space through hydrophobic interactions. The hydrophilic shell serves as a stabilizing interface between the hydrophobic core and the external aqueous environment. It also protects the entrapped molecule from mechanical, chemical, or enzymatic attacks from outside the particle, and it acts as a superior carrier for delivery. It also allows slow release of the encapsulated materials [23–25]. Furthermore, the CHP nanoparticles showed prolonged circulation and thermodynamic stability in animal models [26].
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Figure 3.
Schematic model of self-assembling of TNF/CHP nanoparticles. TNF-α is shown in the trimeric, bioactive form. The diameter of the particle is approximately 20–30 nm.
\n
Pullulan-based nanoparticles have been used for the delivery of proteins, anticancer drugs, imaging agents, and nucleotides. CHP nanoparticles are efficiently transferred to antigen-presenting cells such as macrophages and/or DCs, and they elicit strong immune responses [27, 28]. CHP is under vigorous investigation for establishing novel vaccine therapies against several types of cancers [29–31]. We created CHP nanoparticles containing TNF-α, which are described in the following sections (Figure 3).
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4. TNF/CHP nanoparticles
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4.1. Preparation of TNF/CHP nanoparticles
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In this study, we used TNF-α derived from a human lymphoblastoid cell line, BALL-1 [32], and CHP (PUREBRIGHT CP-100T) from NOF Corporation. CHP encapsulated active trimeric TNF-α to form stable nanoparticles as schematically shown in Figure 3. The encapsulating process was time- and temperature-dependent; at 37°C, more than 95% of the TNF-α was encapsulated into CHP complexes after 5 days of incubation; at 4°C, very few, if any, TNF/CHP nanoparticles were formed.
\n
The resulting nanoparticles were relatively uniform. The mode and average sizes of the particles were 27.2 and 42.4 nm based on dynamic light scattering (DLS) results. This was not very different from the size of the blank CHP particles with a mode of 27.6 nm and an average of 42.8 nm (Figure 4). Stoichiometric analyses showed that a TNF/CHP nanoparticle consisted of a TNF-α active trimer (ca. 50 kDa) in a CHP tetrameric complex (ca. 400 kDa).
\n
Figure 4.
Size distribution of TNF/CHP nanoparticles. Two hundred fifty μg/mL TNF-α and 12 mg/mL CHP were mixed, sterilized by filtration, and incubated at 37°C for 5 days. CHP self-assembled with TNF-α molecules to form nanoparticles. The particle size was determined by DLS with a Zetasizer Nano ZS (Malvern Instruments Ltd., Malvern, UK). (a) TNF/CHP nanoparticles, (b) blank CHP particles. Reproduced with permission from Nagatomo D. et al., [33].
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4.2. Storage stability of TNF/CHP nanoparticles
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Stability of the nanoparticles was evaluated after various treatments by measuring the level of TNF-α. To estimate the amount of encapsulated TNF-α, methyl-β-cyclodextrin (Me-β-CD) was used to disrupt the CHP complex and release the TNF-α as previously described [26]. The results showed that the nanoparticle retained its integrity and kept TNF-α molecules active inside the complex in aqueous solution at room temperature for at least 21 days (Figure 5a). Furthermore, even after five cycles of freezing and thawing, 80% of the particles remained intact (Figure 5b). These results show that the TNF/CHP nanoparticles have excellent storage stability. However, upon contact with high concentrations of dissolved proteins, such as serum albumin, the nanoparticles rapidly released the encapsulated TNF-α (data not shown), probably replaced by proteins from the external environment as reported [34]. This calls an attention to the usage of the nanoparticles, such as i.v. injection.
\n
Me-β-CD is known to interact with cholesteryl groups and disrupt CHP complexes to release the substance inside the particles [26]. The amount of Me-β-CD required to disrupt the TNF/CHP nanoparticles was approximately 100 mg/mL, much higher than the 0.3 mg/mL reported for Interleukin-12 (IL-12)/CHP nanoparticles [35], suggesting that the affinity between TNF-α and CHP was much stronger than that of IL-12 and CHP. The molecular interaction of TNF-α and CHP that creates this strength is an interesting area for further study.
\n
Many medical formulations, especially biologicals, require storage at low temperatures or freezing. On the contrary, the TNF/CHP nanoparticles could be stored in solution and without refrigeration. Our formulation offers improved convenience of handling and transportation.
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Figure 5.
Stability of TNF/CHP nanoparticles in vitro. TNF/CHP nanoparticles were incubated in Dulbecco’s phosphate buffer at 25°C or repeatedly freeze-thawed (−80°C/25°C). An aliquot was examined for the amount of active TNF-α. Samples were treated with 100 mg/mL Me-β-CD at 37°C for 2 h to release TNF-α from the particles. The amount of TNF-α was determined by an enzyme-linked immunosorbent assay (ELISA) system. (a) storage stability at 25°C; (b) stability through freeze-thaw cycles. Open circle, treated with Me-β-CD; closed circle, without Me-β-CD. (mean ± SD, n = 3).
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5. Immune responses induced by TNF/CHP nanoparticles administered nasally
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Although TNF-α is known to have immune-enhancing activity [14], severe and unfavorable effects have hampered its practical use. Based on the stability described in the previous section, we hypothesized that delayed release of TNF-α from TNF/CHP nanoparticles would promote the beneficial effects of TNF-α while avoiding harmful events. We examined the adjuvant activity of the TNF/CHP nanoparticles, for example, enhanced induction of antigen-specific antibodies in mice, particularly in the case of nasal administration. We used a commercial influenza virus hemagglutinin vaccine (IVV), which is a component-split and trivalent vaccine for seasonal influenza. It consists of the inactivated hemagglutinin (HA) antigens from A/Brisbane/59/2007 (H1N1), A/Uruguay/716/2007 (H3N2), and B/Brisbane/60/2008. The nasally administered TNF/CHP nanoparticles combined with the IVV induced significant levels of IgA in the nasal wash, as well as IgG1 in blood plasma (Figure 6a, b). These are comparable to those of the positive control cholera toxin B subunit (CTB), the most powerful adjuvant in experimental settings [35]. Furthermore, IVV with CHP alone (without TNF-α) or with free TNF-α failed to induce significant levels of antibodies when compared to IVV with no adjuvant. The TNF/CHP nanoparticles alone did not induce a measurable antibody response against IVV. To further examine antigen specificity, we performed hemagglutinin (HA)-specific hemagglutination inhibition (HI) assay for the different types of influenza virus included in the vaccine. The TNF/CHP nanoparticles with IVV induced significant HI activity against all types of HA used (A/H1N1, A/H3N2, and B) (Figure 6c).
\n
Figure 6.
Adjuvant effects of TNF/CHP nanoparticles administered nasally. BALB/c mice were nasally given IVV (SEIKEN, Denka Seiken Co., Ltd., Japan) (0.3 μg/mouse) and TNF/CHP nanoparticles (5 μg/mouse of TNF-α) or CTB (0.8 μg/mouse) once a week for 4 weeks. The nasal wash and blood plasma were prepared from the mice, and the levels of IVV-specific IgA and IgG1 were determined by ELISA. (a) IgA levels in nasal wash, (b) IgG1 levels in blood plasma, (c) HI titer in blood plasma against different HA types of influenza virus expressed in GMT (geometric mean titer). Blue column, type A/H1N1; red column, type A/H3N2; green column, type B. (mean ± SEM, n = 8). *, P < 0.05 vs. saline/IVV; #, P < 0.05 vs. free TNF/IVV. Adapted with permission from Nagatomo D. et al., [33].
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These data indicate that TNF/CHP nanoparticles administered nasally can induce not only mucosal but also systemic immunity significantly and efficiently, comparable to the effects of CTB. In addition, the nasal vaccination covers a broad range of antigenicity as previous reports suggested [1, 2]. Also, just for reference, the induction of specific antibodies was seen for other antigens, such as Hepatitis virus type A vaccine, diphtheria toxoid, and cedar pollen allergen (data not shown). Those suggest that TNF/CHP nanoparticles have the potential as a vaccine adjuvant with a broad range of applications, as well as influenza.
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Figure 7.
Proliferation and cytokine production by splenocytes from mice nasally administered TNF/CHP nanoparticles and IVV. BALB/c mice were given IVV (0.3 μg/mouse) and TNF/CHP nanoparticles (5 μg/mouse as TNF-α) or CTB (0.8 μg/mouse) by the nasal route as previously described. Splenocytes were prepared from the mice. Then, IVV-specific proliferation and IL-4/IFN-γ-producing cells were examined with alamarBlue and ELISpot, respectively. The results represent the difference (Δ) between data from experiments with and without IVV antigen stimulation. (a) proliferation response. (b) cytokine production. Blue column, IL-4 production; red column, IFN-γ production (mean ± SEM, n = 8). *, P < 0.05 vs. saline/IVV. Adapted with permission from Nagatomo D. et al. [33].
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The antigen-specific T cell responses of the vaccinated animals were examined by challenging their isolated splenocytes with IVV. IVV-specific proliferation in the TNF/CHP nanoparticle group was comparable to that of CTB (Figure 7a). We also measured cytokine production to understand what kind of T cell response occurred. IVV alone increased IFN-γ production, while the addition of either adjuvant (TNF/CHP nanoparticle or CTB) suppressed IVV-induced Interferon-γ(IFN-γ) production. The TNF/CHP nanoparticles combined with IVV also produced IL-4 cytokine to a higher level than IVV with CTB (Figure 7b). These experiments suggest that the nasally administered adjuvant shifted the Th1/Th2 balance to a Th2-dominant state, which confirms previous results obtained with a mutant TNF-α [17].
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6. Protective effect of TNF/CHP nanoparticles in lethal challenge of influenza virus on mice
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Figure 8.
Protective effect of TNF/CHP nanoparticles adjuvant against lethal influenza virus challenge in mice. BALB/c mice were nasally administered with IVV with or without an adjuvant once a week for 3 weeks. Seven days after the final immunization, mice were challenged nasally with influenza virus (Puerto Rico/8/34, 10 LD50) and then monitored daily. Mice that were moribund or that had lost more than 20% of their body weight were considered to have reached an experimental endpoint and were humanely euthanized by anesthetization. Blue diamond, saline only; red square, TNF/CHP nanoparticles only (5 μg/mouse of TNF-α); green triangle, IVV only (0.3 μg/mouse); purple cross, IVV with blank CHP nanoparticles (240 μg/mouse); blue square, IVV with TNF/CHP nanoparticles (5 μg/mouse of TNF-α); orange circle, IVV with free TNF (5 μg/mouse); purple dot, IVV with CTB (0.8 μg/mouse) (n = 10). Reproduced with permission from Nagatomo D. et al. [33].
\n
To directly address the stimulatory effect of the TNF/CHP nanoparticle adjuvant on protective immunity, we challenged immunized mice with a lethal dose of influenza virus. Mice were nasally immunized with IVV with or without TNF/CHP nanoparticles once a week for 3 weeks. Then, they were challenged with the antigenically distinct influenza virus A/Puerto Rico/8/34 strain at a lethal dose (Figure 8). The mice that received only IVV died by 8 days post challenge, which was comparable to mice without IVV immunization. The TNF/CHP nanoparticles without the IVV slightly delayed the time to death, but all of the animals eventually died. On the contrary, combined administration of IVV and TNF/CHP nanoparticles showed a highly protective effect with 90% of the mice surviving lethal challenge. The effect was comparable to that of the CTB adjuvant. Free TNF also showed a somewhat protective effect. Interestingly, CHP only (without TNF-α) provided a certain level of protection as an adjuvant, as we observed 50% survival. Importantly, the nasally administered TNF/CHP nanoparticles induced significant protective immunity in spite of the distinct antigenicities [36], suggesting that they have a potential for inducing broad cross-protection.
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Antibodies became detectable after the second or third vaccination and reached plateau levels thereafter in mice vaccinated with TNF/CHP nanoparticles. The surviving animals immunized with IVV and TNF/CHP nanoparticles had immunological memory, including IgG1 in plasma, and IgA in nasal/vaginal wash and feces. This memory was maintained at high levels for more than 90 days, and these mice responded to a boosting challenge of the IVV to further elevate the antibody levels (Table 1). These data indicate that the nanoparticles induced systemic immunity and long-lived memory, a critical feature for successful vaccine adjuvants. Overall, our data demonstrate that TNF/CHP nanoparticles are effective as a vaccine adjuvant for nasally delivered IVV.
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TNF/CHP nanoparticles enhanced an IgA response not only at the site of application (e.g., in the nasal wash) but also at distant mucosal sites, such as the intestine (feces), vaginal, and salivary glands (data not shown). IgA antibody elicited at the mucosa is of vital importance as the natural route of infection for influenza is via the respiratory mucosa. Hence, local mucosal protection against pharyngeal carriage is likely to be decisive for preventing disease [37]. Conventional parenteral vaccines are not able to stimulate mucosal immune responses, thus restricting their efficacy in infections of mucosal surfaces such as the respiratory tract [1]. Our nasal vaccine/adjuvant formulation consisting of the IVV and TNF/CHP nanoparticles effectively induced both systemic and mucosal protective immunity.
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IgG1 titer in plasma (U/mL)
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IgA titer in feces extract (U/mL)
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Adjuvant
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Unimmunized
\n
None
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TNF/CHP nanoparticles
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CTB
\n
Unimmunized
\n
None
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TNF/CHP nanoparticles
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CTB
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\n\n\n
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1 day before boost
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Day 90
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n.d.
\n
21,338 ± 2,438.9
\n
16,917 ± 9,392.0
\n
8,700 ± 5,510.3
\n
n.d.
\n
4.2 ± 3.5
\n
14.4 ± 16.7
\n
13.1 ± 10.8
\n
\n
\n
12 days after boost
\n
\n
\n
Day 112
\n
36.6 ± 43.2
\n
19,764 ± 13,601.2
\n
53,769 ± 29,893.7
\n
37,729 ± 29,281.3
\n
34.6 ± 33.3
\n
19.8 ± 8.3
\n
64.4 ± 63.4
\n
58.2 ± 37.1
\n
\n\n
Table 1.
Induction of immunological memory by TNF/CHP nanoparticles.
BALB/c mice were nasally administered with IVV (0.3 μg/mouse), with or without TNF/CHP nanoparticles (5 μg/mouse of TNF-α) or CTB (0.8 μg/mouse) once a week for 4 weeks. Ninety-one days after the immunization, the mice were boosted with IVV (0.9 μg/mouse). Twenty-one days after the boosting challenge, the blood plasma was prepared and the feces were extracted with 10 volumes of water. The IgG1 in blood plasma and IgA in feces extract were examined (mean ± SEM, n = 8).
n.d., not detected.
\n
Muraoka et al. proposed that CHP-based nanoparticles preferentially deliver antigen to antigen-presenting cells in the lymph nodes, which potentiates effective immune responses [38]. This might be the reason why the TNF/CHP nanoparticles induced excellent protective immunity. They, however, reported that CHP itself did not show an adjuvant effect in the context of a tumor vaccine [31]. Interestingly, CHP only (without TNF-α) showed a certain level of protective efficacy in our study. The reason for the discrepancy between their results and ours is not clear. It is unlikely, given the short time frame, that TNF-α was replaced in vivo by IVV antigens to form IVV/CHP nanoparticles that were then delivered to the lymph node. Another factor that is critical for adjuvant activity is particle size [39]; however, size is not an issue in our case since the DLS analyses showed no difference in particle size between the TNF/CHP nanoparticles and empty CHP particles (Figure 4). Most probably, the difference has to do with varying mechanisms to elicit protection against external pathogens, such as influenza virus, and internal antigens, such as tumor antigen.
\n
\n
\n
7. Mechanistic analyses of effects of TNF/CHP nanoparticles
\n
\n
7.1. Activation of immune cells in NALT
\n
Being focused on the nasal route of vaccination, we examined immune cells in nasal tissues after immunization. The mucosal surfaces contain abundant B cells, T cells, and plasma (or DC) cells. After repeated immunization of animals for 3 weeks, cells from the nasal-associated lymphoid tissues (NALT) were prepared from mice, and expression of a surface marker for DCs (CD11c) and activation markers for B cells (CD80 and CD86) were examined by flow cytometry. The ratios of CD80+/CD11c+ cells; CD86+/CD11c+ cells were 0.20; 0.33, 0.30; 0.44, and 0.33; 0.50% for saline, IVV, and IVV with TNF/CHP nanoparticles, respectively (data not shown). Even though the degree was small, IVV vaccination with or without TNF/CHP nanoparticles activated DCs and B cells. Also, TNF/CHP nanoparticles did not have a prominent effect on DC or B cell activation.
\n
\n
\n
7.2. Antigen uptake and activation of NALT and nasal passage cells
\n
We next focused on the early immune response of nasal mucosal tissues. Uptake of antigen by the mucosal tissues is essential for the induction of immune responses [40]. Therefore, we examined antigen uptake by NALT-resident and nasal passage DCs, the inductive sites of the common mucosal immune system [41]. In these experiments, we used ovalbumin (OVA) as a model antigen and assessed antigen uptake by DCs in the NALT and nasal passage cells by flow cytometry at 6 h after immunization. Immunization of mice with OVA combined with TNF/CHP nanoparticle activated antigen uptake by both NALT and nasal passage DCs. TNF/CHP nanoparticles stimulated DCs most in the nasal passage mucosal immune tissue (Figure 9). We also found that TNF/CHP nanoparticles enhanced expression of DC and B cell activation markers (CD40, 80, and 86) in a bone marrow-derived immature DC preparation in vitro (data not shown).
\n
Figure 9.
Antigen uptake of NALT and nasal passage DCs after TNF/CHP nanoparticles administration. BALB/c mice were nasally immunized with 10 μg of Alexa 647-labeled OVA antigen with or without TNF/CHP nanoparticles as an adjuvant. Six hours after the immunization the NALT and the nasal passage cells were prepared [42] and subjected to flow cytometric analysis. Antigen uptake was determined by detecting the Alexa 647 florescence intensity and the DC marker (CD11c+ cells) in parallel, for example, ratio of Alexa 647+/CD11c+. (a) NALT DCs, (b) nasal passage DCs. MFI, mean fluorescence intensity (mean ± SD, n = 4). Adapted with permission from Nagatomo D. et al. [33].
\n
\n
\n
7.3. Expression of inflammatory signals in NALT
\n
Vaccine adjuvants trigger the innate immune system allowing enhanced humoral and cellular responses against the co-administered vaccine antigens. To understand innate immune system activation caused by the TNF/CHP nanoparticles after immunization, we conducted gene expression profiling in NALT cells 2, 6, and 26 h after nasal administration of IVV antigen with or without the nanoparticles. By scattering analyses, the gene expression of inflammation- and immunity-related molecules was found to be significantly upregulated (data not shown). These included the triggering receptor expressed on myeloid cells 1, fibronectin 1, CD14, Toll-like receptor (TLR) 2, TLR3, IL-1β, IL-1 family 9, and IL-6. We confirmed the level of inflammation-related molecules in activated NALT cells by quantitative polymerase chain reaction (PCR) analysis. Expression of the inflammatory markers was enhanced when an adjuvant was included (TNF/CHP nanoparticles, free TNF, or CTB), while CHP itself did not show significant enhancing activity. Among the molecules tested, significant increases in expression occurred for IFN-γ, IL-1α, IL-1β, IL-6, CXCL2, IL-12β, CD14, and lipopolysaccharide (LPS)-binding protein (Figure 10). The degree of enhancement varied from gene to gene, but the greatest increase of expression was observed for IL-6 and IL-12β.
\n
Figure 10.
Gene expression in NALT after TNF/CHP nanoparticles administration. mRNA was prepared from NALT cells of BALB/c mice 2, 6, and 26 h after administration of TNF/CHP nanoparticles and IVV. Gene expression related to innate and adaptive immune responses was analyzed by quantitative PCR and normalized to glyceraldehyde 3-phosphate dehydrogenase (GAPDH) expression. Data are shown as relative level vs. control (means of quadruple experiments). Red column, 2 h; orange column, 6 h; yellow column, 26 h post treatment. *, P < 0.05; **, P < 0.01; ***, P < 0.001 vs. saline control. Adapted with permission from Nagatomo D. et al. [33].
\n
Overall, free exogenous TNF-α elicited the strongest increase in expression of inflammatory markers, and the enhancement tended to be highest at 2 h post-immunization. TNF/CHP nanoparticles elicited a moderate increase in gene expression by comparison, but the pattern over time was similar to that of free TNF-α. One reason for the discrepancy in gene expression between free TNF and the nanoparticles could be that the nanoparticles cause a slow release of TNF-α, prolonging the immune-stimulatory effect. The pattern of expression over time was very different for most genes when stimulated with CTB adjuvant. For example, although the expression of IL-12β was prominent at 6 h post-immunization when CTB was used as an adjuvant, the IL-12β response was much lower with TNF/CHP nanoparticles at the same time point.
\n
Taken together, TNF/CHP nanoparticles delayed activation of innate immunity. By prolonging and dampening the stimulatory effect of TNF-α CHP seemed to minimize the unfavorable effects of TNF-α while promoting its beneficial activities. One important safety issue related to the development of nasal vaccines is the potential dissemination of vaccine antigens to the central nervous system (CNS). Past reports suggested that nasal administration of CTB allowed it to reach the CNS and accumulate in olfactory tissues. It caused Bell’s Palsy in clinical studies, probably due to IL-12β production, and the use of CTB in humans was prohibited [43, 44]. In this context, the lower expression level of IL-12β seen in our experiments with TNF/CHP nanoparticles could be a beneficial safety feature.
\n
Regarding CHP itself, a shell of the nanoparticles did not show immune-enhancing activity, such as increasing IgG1 and IgA or the expression of inflammation-related genes (Figure 10). However, CHP did confer a certain level of protection in a lethal influenza virus challenge (Figure 8). We cannot easily account for these conflicting observations; there are other pathways and mechanisms likely involved and waiting to be clarified.
\n
\n
\n
\n
8. Safety study of TNF/CHP nanoparticles
\n
General safety was preliminarily examined according to the OECD guidelines for testing chemicals [45]. Mice nasally administered with a combination of TNF/CHP nanoparticles and IVV either once or four times were subjected to an acute or a repeated toxicity study, respectively.
\n
\n
8.1. General symptoms, ophthalmic examination, body weight, and body temperature
\n
No general symptoms or behavioral anomalies in either male or female animals were correlated with the IVV with TNF/CHP nanoparticles treatment during the study period. In ophthalmic examinations, there were no test material-related ocular findings observed. Body weight and body temperature were not statistically different among the treatment groups (data not shown).
\n
\n
\n
8.2. Hematology, blood biochemistry, and urinalysis
\n
Hematology evaluations were performed during and at the end of study. There were no differences in any of the tested parameters (white blood cell, red blood cell, hematocrit, lymphocyte, neutrophil, eosinophil, basophil, and monocyte) between controls and TNF/CHP nanoparticles with the IVV treatment. For blood biochemistry, we examined total protein, albumin, urea nitrogen, creatinine, Na+, K+, Cl−, Ca2+, inorganic phosphate, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), amylase (AMY), γ-glutamyl transpeptidase (γ-GT), total cholesterol, triglyceride, high density lipoprotein (HDL)-cholesterol, total bilirubin, and glucose. Urobilinogen, bilirubin, ketone body, glucose, protein, pH, specific gravity, nitrite salt, and leucocytes were examined during the study period. All differences found during the study fell within historical control value ranges and were not considered test material-related (data not shown).
\n
\n
\n
8.3. Pathology and major organ weights
\n
Gross pathology of all the animals was examined at the end of the study. The major organs (brain, heart, lung, kidney, liver, ovary, testis, spleen, adrenal, and thymus) were weighed at the end of the study in all of the animals. No change was noted as test material-related (data not shown).
\n
\n
\n
8.4. Histopathology
\n
The histopathology of tissues from animals in each group was examined. As discussed in Section 7.3, there were some concerns of possible harmful effects on the CNS. However, no abnormalities in the brain, especially olfactory bulb, were noted in any animals after histological examination. There were some effects observed at the administration site (nasal mucosal tissue). While single administration showed no effect, repeated administration with IVV alone showed a slight infusion and TNF/CHP nanoparticles combined with IVV induced slight-to-moderate infusion and infiltration of inflammatory cells (lymphocytes, neutrophils, eosinophils, and mast cells). However, the response was reversed with time since the infusion diminished to trace proportions after the 2-week cessation period. No excessive inflammatory symptoms, such as formation of edema or fibrosis, were noted (data not shown).
\n
Overall, no obvious immunotoxicity was detected. Although further evaluation is required, our results demonstrate that the toxicity of TNF/CHP nanoparticles is relatively low and safe as a nasal vaccine adjuvant against influenza.
\n
Very recently, Onishi et al. reported that hydroxypropyl-β-cyclodextrin (HP-β-CD), another type of saccharide-based material that can form nanoparticles, exhibited adjuvant activity and elicited a strong protective effect against influenza virus in mice and cynomolgus macaques [46]. They suggested the involvement of follicular helper T cells via myeloid differentiation primary gene 88 (MyD88)- and TANK-binding kinase (TBK)-dependent pathways. Their findings may shed some light on additional mechanisms at play with nanoparticles as vaccine adjuvants. However, they mentioned the cytotoxicity of HP-β-CD at more than 0.5% in vitro, probably because of β-CD’s ability to extract cholesterol out of cell membranes [47]. TNF/CHP nanoparticles might represent a preferable alternative.
\n
A probable precaution for the practical use of TNF/CHP nanoparticles is avoiding contact with high concentrations of dissolved proteins as mentioned in Section 4.2. Unless, encapsulated TNF-α would be released from the nanoparticles and the adjuvant activity would be diminished. This means that the nanoparticles is not suitable for i.v. administration and premixed formulation with vaccine antigen. For the best performance, we recommend to administer the TNF/CHP nanoparticles on mucosa, such as nasal surface, after mixing with the vaccine antigen just before use.
\n
\n
\n
\n
9. Conclusions
\n
The results of this study demonstrate that TNF/CHP nanoparticles are effective as a vaccine adjuvant against influenza when administered via the nasal mucosal route. Moreover, the ability of TNF/CHP nanoparticles to stimulate comparatively balanced systemic and mucosal immune responses makes them a potentially promising vaccine adjuvant for inducing immunity against infectious pathogens. In the short term, TNF/CHP nanoparticles may aid the development of new nasal influenza vaccines. Looking further ahead, we propose that combining TNF/CHP nanoparticles with next-generation vaccine platforms that do not rely on the cold chain will offer valuable alternatives for vaccination in a variety of settings.
\n
\n
Acknowledgments
\n
The author is very grateful to Dr. Ayato Takada of Research Center for Zoonosis Control, Hokkaido University for his expertise with influenza challenge of mice. The author is also thankful to the staff of R&D Center, Hayashibara Co., Ltd. for their excellent technical assistance, especially Mr. Daiki Nagatomo and Ms. Madoka Taniai for the mechanistic analyses of action, and Dr. Shigeyuki Arai for the histopathological examination.
\n
\n',keywords:"adjuvant, mucosal, nanoparticle, CHP, TNF-α",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/51507.pdf",chapterXML:"https://mts.intechopen.com/source/xml/51507.xml",downloadPdfUrl:"/chapter/pdf-download/51507",previewPdfUrl:"/chapter/pdf-preview/51507",totalDownloads:1419,totalViews:102,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,impactScore:0,impactScorePercentile:8,impactScoreQuartile:1,hasAltmetrics:0,dateSubmitted:"November 28th 2015",dateReviewed:"May 24th 2016",datePrePublished:null,datePublished:"October 26th 2016",dateFinished:"June 30th 2016",readingETA:"0",abstract:"We encapsulated tumor necrosis factor-α (TNF-α), a major proinflammatory cytokine, into cholesteryl pullulan (CHP) to prepare TNF/CHP nanoparticles. In this chapter, the immune response-enhancing capability of the nanoparticles to act as a vaccine adjuvant against influenza is described. TNF/CHP nanoparticles showed excellent storage stability, and they enhanced host immune responses to external immunogens. We applied the nanoparticles in a mouse model of influenza virus infection to investigate their adjuvant ability. Nasal administration of TNF/CHP nanoparticles combined with a conventional split vaccine was effective at inducing systemic IgG1 as well as mucosal IgA, and it protected mice against a lethal challenge of A/PR/8/34 (H1N1) influenza virus. Mechanistic studies showed that the nanoparticles enhanced antigen uptake by dendritic cells (DCs) and moderately induced the expression of inflammation-related genes in nasal-associated lymphoid tissue (NALT), leading to the activation of both B and T cells. A preliminary safety study revealed no severe toxicity to TNF/CHP nanoparticles. Slight-to-moderate influences in nasal mucosa were observed only after repeated administration and they were reversible. Our data show that TNF/CHP nanoparticles effectively enhance both humoral and cellular immunity via nasal administration and could be a potential adjuvant for vaccines against infectious diseases like influenza.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/51507",risUrl:"/chapter/ris/51507",book:{id:"5294",slug:"steps-forwards-in-diagnosing-and-controlling-influenza"},signatures:"Tsunetaka Ohta",authors:[{id:"129828",title:"Ph.D.",name:"Tsunetaka",middleName:null,surname:"Ohta",fullName:"Tsunetaka Ohta",slug:"tsunetaka-ohta",email:"tsunetaka.ota@hb.nagase.co.jp",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Hayashibara (Japan)",institutionURL:null,country:{name:"Japan"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Tumor necrosis factor-α (TNF-α)",level:"1"},{id:"sec_3",title:"3. Pullulan and cholesteryl pullulan (CHP)",level:"1"},{id:"sec_4",title:"4. TNF/CHP nanoparticles",level:"1"},{id:"sec_4_2",title:"4.1. Preparation of TNF/CHP nanoparticles",level:"2"},{id:"sec_5_2",title:"4.2. Storage stability of TNF/CHP nanoparticles",level:"2"},{id:"sec_7",title:"5. Immune responses induced by TNF/CHP nanoparticles administered nasally",level:"1"},{id:"sec_8",title:"6. Protective effect of TNF/CHP nanoparticles in lethal challenge of influenza virus on mice",level:"1"},{id:"sec_9",title:"7. Mechanistic analyses of effects of TNF/CHP nanoparticles",level:"1"},{id:"sec_9_2",title:"7.1. Activation of immune cells in NALT",level:"2"},{id:"sec_10_2",title:"7.2. Antigen uptake and activation of NALT and nasal passage cells",level:"2"},{id:"sec_11_2",title:"7.3. Expression of inflammatory signals in NALT",level:"2"},{id:"sec_13",title:"8. Safety study of TNF/CHP nanoparticles",level:"1"},{id:"sec_13_2",title:"8.1. General symptoms, ophthalmic examination, body weight, and body temperature",level:"2"},{id:"sec_14_2",title:"8.2. Hematology, blood biochemistry, and urinalysis",level:"2"},{id:"sec_15_2",title:"8.3. Pathology and major organ weights",level:"2"},{id:"sec_16_2",title:"8.4. Histopathology",level:"2"},{id:"sec_18",title:"9. Conclusions",level:"1"},{id:"sec_19",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'Kikuta K, Hirabayashi Y, Nagamine T, Aizawa C, Ueno Y, Oya A, Kurata T, and Tamura S. Cross-protection against influenza B type virus infection by intranasal inoculation of the HA vaccines combined with cholera toxin B subunit. Vaccine. 1990;8:595–599.'},{id:"B2",body:'Ichinohe T, Kawaguchi A, Tamura S, Takahashi H, Sawa H, Ninomiya A, Imai M, Itamura S, Odagiri T, Tashiro M, Chiba J, Sata T, Kurata T, and Hasegawa H. Intranasal immunization with H5N1 vaccine plus Poly I:Poly C12U, a Toll-like receptor agonist, protects mice against homologous and heterologous virus challenge. Microbes Infect. 2007;9:1333–1400.'},{id:"B3",body:'Holmgren J and Czerkinsky C. 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Immunol. 2000;165:4778–4782.'},{id:"B45",body:'OECD. OECD Guidelines for the testing of chemicals and related documents [Internet]. Available from: http://www.oecd.org/chemicalsafety/testing/oecdguidelinesforthetestingofchemicals.htm. [Accessed: 2016-03-18].'},{id:"B46",body:'Onishi M, Ozasa K, Kobiyama K, Ohata K, Kitano M, Taniguchi K, Homma T, Kobayashi M, Sato A, Katakai Y, Yasutomi Y, Wijaya E, Igarashi Y, Nakatsu N, Ise W, Inoue T, Yamada H, Vandenbon A, Standley DM, Kurosaki T, Coban C, Aoshi T, Kuroda E, and Ishii KJ. Hydroxypropyl-β-cyclodextrin spikes local inflammation that induces Th2 cell and T follicular helper cell responses to the coadministered antigen. J. Immunol. 2015;194:2673–2682. doi:10.4049/jimmunol.1402027.'},{id:"B47",body:'Atger VM, de la Llera Moya M, Stoudt GW, Rodrigueza WV, Phillips MC, and Rothblat GH. Cyclodextrins as catalysts for the removal of cholesterol from macrophage foam cells. J. Clin. 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1. Introduction
The external examination of the corpse is a procedure that can provide information on the examination of the body when the identity is unknown, provides guidance on cause of death, unnatural, or unexplained manner of death, and determines conditions, for example, time of death [1].
The external examination of the body must be accurate and must be performed by trained people with many years of experience in the field, as sometimes medical work is combined with the forensic work.
During the external examination, definitive signs of death (temperature, lividity, rigor, or advanced postmortem changes) should be considered. In the procedure, all areas of the naked body should be analyzed and photographed, and all visual evidence and findings, such as scars, traumatic changes, tattoos, deformities, syringe marks, should be reported [2].
Unnatural deaths are those with external influence, due to physical aggression, accident, homicide, poisoning, suicide, and in those death, the external examination is very important, because it can provide information about the cause, with indicators on the body such as conjunctival hemorrhages, livor mortis color, signs of injury, among others [1].
For these reasons, the external examination of the corpse is of great importance, as it allows to:
To provide the elements of identification.
Plan the steps to be followed in an autopsy, for which it is necessary to determine the autopsy technique to obtain results according to the needs of the case.
Document any pathological findings from the outset.
Support a medico-legal case if a full autopsy is not possible (which has happened due to health regulations in the context of the COVID-19 pandemic).
Provide evidence in cases of allegations of lack of timely and adequate obstetric care.
Document cases of neglected of elderly, disabled adults, and young children in the care of third parties.
2. External examination of the corpse
2.1 Identification elements
In addition to fingerprints, there are other elements accessible for external examination that can be valuable in determining or also confirming the identification of the deceased, such as dental features and tattoos [3]. In the case of dental features, age, sex, habits, cultural characteristics can be determined (Figure 1) in addition to the identification of the individual by comparison with dental records [4]. In the case of tattoos, it is important as a complement for identification (Figure 2), as it can provide information for relatives or a tour of tattoo shops which can narrow down the search field [5].
Figure 1.
Denture with missing pieces and poor care conditions.
Figure 2.
Oversized and eye-catching tattoo.
2.2 Autopsy step plan
Before performing an autopsy, it is ideal is to obtain as much information as possible, such as the place where the body or remains were discovered, the circumstances of death, the postmortem interval, the history of previous illnesses, and whether it was a witnessed death.
But if this is not possible, elements of external examination may be useful to:
Take extreme precautions in the use of personal protective equipment if infection is suspected.
Establish where the incisions will be placed, so as not to compromise internal structures (Figure 3).
Establish before starting the autopsy procedure, which complementary tests may be necessary, to have the appropriate containers (e.g., Petri dishes with culture media, fixatives for electron microscopy studies) or to establish coordination with other laboratories, in cases that require quickly processing.
The existence of entry points for skin infection, such as pressure ulcers (bed sores), suggests that sepsis may be present (Figure 4). Staining for microorganisms such as Gram stain and Lactophenol Blue needs to be considered [6, 7].
Figure 3.
Large umbilical hernia, with a median infra-umbilical laparotomy scar. The autopsy incision should be lateralised to visualize the underlying structures without interrupting them.
Figure 4.
Decubitus ulcer (pressure or bed sores). It is a starting point for skin sepsis.
2.3 Documenting any pathological findings from the outset
Many external signs in the ocular conjunctiva, mucosa of the lips, teeth, ears, or skin, among others, may suggest the underlying disease, or be a key in differential diagnoses.
Internal examination findings only have an impact on the clinicopathological picture, causing or contributed to death.
Alterations in skin color, focal such as petechiae or ecchymosis (Figures 5 and 6) or diffuse such as jaundice, the presence of edema (Figure 7), suggest from external examination of the body that it will be necessary to study certain organs and systems, both macroscopically and through complementary tests, like imaging, histopathology, forensic histopathology, or molecular biology.
Figure 5.
Petechiae on the chest and left flank. Thrombocytopenic purpura.
Figure 6.
Extensive ecchymoses on the abdomen, pubic and genital region. Coagulopathy by anticoagulants.
Figure 7.
Jaundice and generalized edema. Stillborn with Rh incompatibility and isoimmunization.
An example of this is how histology and forensic histopathology can be of great use in the diagnosis of skin alterations, which can give us an understanding of lesions or postmortem changes in the structure of the skin [8].
In congestive heart failure and myocardial infarction, vasodilation and congestion are observed, especially in the mucous membranes and conjunctivae, due to their transparency (Figure 8).
When pallor is severe, massive hemorrhage must be presumed. Occasionally, the source of bleeding is an external injury, as well as the gastrointestinal or respiratory tract (Figure 9).
Figure 9.
Conjunctival pallor. Cutting wound.
2.4 Support a medico-legal case if a full autopsy is not possible
In response to the COVID-19 pandemic, many countries have adapted their regulations on the examination of the deceased, reducing and eventually banning clinical autopsies [9, 10].
Forensic services, for their part, have restricted forensic autopsies, subjecting them to autopsy in case of a negative PCR for COVID-19, or even leaving the decision to prosecutors who do not usually handle technical criteria.
Therefore, forensic autopsies of potential cases and especially of confirmed cases, especially those without signs of violence, should be kept to a minimum and performed only when necessary, and internal examination of the body should be carried out only when necessary [11].
As it is necessary to have a cause of death to initiate a legal process and bring the case to justice, we can use the alternatives at our disposal to support the decision whether to do an autopsy and take certain samples.
In cases of sudden death, there is usually no history, so an autopsy and other complementary tests will be necessary, such as histopathology.
Deaths caused by trauma, asphyxia, and poisoning are classified as violent. A thorough external examination may be sufficient to document a case of violent death, for example:
In cases of traumatic death, where the offending element is often external to the body, it is essential to document the type, size, location, and relationship between external injuries. And non-invasive imaging tests may be useful.
If the presence of cyanosis suggests asphyxia, manual asphyxia and all lessons accompanied by constriction of the neck should be documented by photographs of the respective groove, fingerprints, nail stigmata, lividity studies, and lividity arrangement in cases of incomplete suspension.
Only if there are doubts about submersion asphyxia, it is necessary to prove the presence of a foreign body in the airway, which may require an internal examination.
In the case of poisoning, it should be borne in mind that for analysis and demonstration, it is necessary to isolate the toxic substance from the tissues or fluids of the corpse, for which it is essential to take a good sample. Although toxic substances produce what is called “asphyxia,” visible changes on external examination may be of value: Lividity of colors, other purplish spots, miosis, increased facial congestion are characteristic of some poisonings.
In cases of gunshot wounds, it is very important to determine the distance of the shot, the angle of the shot, the position in which the victim was when the projectile hit, and the entry and exit orifices (Figures 10 and 11).
Figure 10.
Close-range shot, with concentric equimotic-erosive halo and gunshot residue encrustation on its periphery.
Figure 11.
Long distance shot, no residue, with eccentric equimotic-erosive halo.
In cases of asphyxia due to aspiration of gastric contents, in addition to cyanosis, the cause of death may be evident on external examination (Figures 12 and 13).
Figure 12.
Patient found dead at home. Morbid obesity with complicated umbilical hernia, and intestinal volvulus.
Figure 13.
The same patient with severe cyanosis. Foamy hemorrhagic coming out of the mouth and nose.
2.5 Evidence in cases of allegations of lack of obstetric care
Autopsy of newborns can provide information to physicians and families about the cause of death and the accuracy of the antemortem clinical diagnosis [12].
Some women have given birth to a newborn. These deaths are attributed to excessive delay in obstetric care and lack of control of the fetoplacental unit. It is essential to record the external features of the stillbirth body to establish the approximate date of death in utero and the gestational age [13, 14].
Routine external examination includes body measurements (at least: body weight, crown-rump length, crown-heel length, foot length, occipitofrontal circumference).
Detailed external examination, including nutritional status/soft tissue and muscle volume; the presence of edema (localized/generalized), pallor, meconium staining, jaundice or the presence of trauma, location of thoracic drains and vascular cannulae, and other iatrogenic lesions (Figures 14 and 15) [15].
Figure 14.
Premature stillbirth. With skin. Sloughing.
Figure 15.
Term newborn. Fully developed pinna.
The report should include a description of the external morphology specifically mentioning fontanelles, eyes, ears, nose, choanal patency, palatal fusion, spine, extremities, fingers, palmar creases, external genitalia, anal patency, umbilical cord [15]. It is used to diagnose, why some fetuses die in the prenatal period due incompatible life malformations (Figures 16–18) [16].
Figure 16.
Premature and macerated fetus with large omphalocele.
Figure 17.
Term newborn, with multiple head and body malformations.
Figure 18.
Term newborn, with foot malformations.
Examination of the ovarian adnexa may also clarify the causes of death, such as large retroplacental clots (premature detachment of the placenta), opaque ovarian membranes (indicating ovarian infection), or true knots in the umbilical cord (Figure 19) [17, 18].
Figure 19.
Malformation of the foot secondary to oligohydramnios. This condition is associated with polycystic kidney or renal agenesis.
2.6 Document cases of neglected of elderly, disabled adults, and young children in the care of third parties
Malnutrition, soiling, bed sores and colonization by insects on living persons [19, 20] are located on the conjunctivae, ulcers, genitalia, or other wounds (Figure 20). These are the elements that in a judicial process that allow proving the crime of abandonment or neglect of vulnerable people by their relatives or caregivers. An example of poor care is best illustrated by the diagnosis of marasmus and cachexia. These diseases were frequently diagnosed. They were only rarely cited as a cause of death [21].
Figure 20.
Elderly adult male, living in a nursing home. Malnutrition, dirt, and dermatophytosis.
3. Conclusions
Despite the evolution of imaging techniques, the postmortem examination has maintained a key role in the clinical and forensic analysis. To obtain reliable information on the types of death and to allow a better understanding of the phenomenon, it is useful to study the results of clinical and forensic autopsies that start with the external examination of the corpse.
The search for and documentation of seemingly small details in the external examination of corpses help to resolve difficult situations surrounding medico-legal deaths, such as the identification of undocumented victims, the cause and manner of death, the postmortem interval, differential diagnoses of the cause of death, or the regulation of not performing complete autopsies during health crises.
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The main tasks of this analysis are firstly to establish death and then to determine the cause and manner of death.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/81090",risUrl:"/chapter/ris/81090",signatures:"William Aguilar-Navarro and Carmen Cerda-Aguilar",book:{id:"11041",type:"book",title:"Autopsy - What Do We Learn from Corpses?",subtitle:null,fullTitle:"Autopsy - What Do We Learn from Corpses?",slug:null,publishedDate:null,bookSignature:"Prof. Kamil Hakan Dogan",coverURL:"https://cdn.intechopen.com/books/images_new/11041.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-340-5",printIsbn:"978-1-80355-339-9",pdfIsbn:"978-1-80355-341-2",isAvailableForWebshopOrdering:!0,editors:[{id:"30612",title:"Prof.",name:"Kamil Hakan",middleName:null,surname:"Dogan",slug:"kamil-hakan-dogan",fullName:"Kamil Hakan Dogan"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. External examination of the corpse",level:"1"},{id:"sec_2_2",title:"2.1 Identification elements",level:"2"},{id:"sec_3_2",title:"2.2 Autopsy step plan",level:"2"},{id:"sec_4_2",title:"2.3 Documenting any pathological findings from the outset",level:"2"},{id:"sec_5_2",title:"2.4 Support a medico-legal case if a full autopsy is not possible",level:"2"},{id:"sec_6_2",title:"2.5 Evidence in cases of allegations of lack of obstetric care",level:"2"},{id:"sec_7_2",title:"2.6 Document cases of neglected of elderly, disabled adults, and young children in the care of third parties",level:"2"},{id:"sec_9",title:"3. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'Madea B. The postmortem external examination. Deutsches Ärzteblatt International. 2021;107(33):575-588. DOI: 10.3238/arztebl.2010.0575'},{id:"B2",body:'Arslan M. Handbook of Forensic Autopsy: Basic Algorithms and Technique. Independently published; 2021. p. 278. ISBN-13: 979-8759840022'},{id:"B3",body:'Marín L, Moreno F. Odontología Forense. Identificación odontológica de cadáveres quemados. Reporte de dos casos. Revista Estomatología; 2004;12(2):57-70'},{id:"B4",body:'Nambiar P. Identification from dental characteristics. The Medical Journal of Malaysia. 1995;49:406-408'},{id:"B5",body:'Birngruber CG, Martinez Peña EG, Corrales Blanco L, et al. The use of tattoos to identify unknown bodies. Rechtsmedizin. 2020;30:219-224. DOI: 10.1007/s00194-020-00396-y'},{id:"B6",body:'López-Jácome LE, Hernández-Durán M, Colín-Castro CA, Ortega-Peña S, et al. Las tinciones básicas en el laboratorio de microbiología. Investigación en Discapacidad. 2014;3(1)'},{id:"B7",body:'Araiza J, Hernández M. Procedimientos y técnicas de diagnóstico. In: Bonifaz Trujillo J, editor. Micología médica básica 5 ed. Ciudad de México: McGraw Hill Interamericana Editores. 2015. 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Revista Española de Medicina Legal. 2020;46:109-118. DOI: 10.1016/j.reml.2020.05.001'},{id:"B12",body:'de Sévaux JLH, Nikkels PGJ, Lequin MH, Groenendaal F. The value of autopsy in neonates in the 21st century. Neonatology. 2019;115:89-93. DOI: 10.1159/000493003'},{id:"B13",body:'Moore IE. Macerated stillbirth. In: Keeling JW, Khong TY, editors. Fetal and Neonatal Pathology. London: Springer; 2007. DOI: 10.1007/978-1-84628-743-5_10'},{id:"B14",body:'Gold KJ, Abdul-Mumin AR, Boggs ME, Opare-Addo HS, Lieberman RW. Assessment of “fresh” versus “macerated” as accurate markers of time since intrauterine fetal demise in low-income countries. International Journal of Gynecology & Obstetrics. 2014;125:223-227'},{id:"B15",body:'Osborn M. Guidelines on Autopsy Practice: Neonatal Death. London: The Royal College of Pathologists; 2019'},{id:"B16",body:'International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. 2014;125:223-227. DOI: 10.1016/j. ijgo.2013.12.006'},{id:"B17",body:'Aspillaga C, Las Heras J, Kakarieka E, Avila R, Henríquez C. Anomalías del cordón umbilical y su asociación con malformaciones fetales [anomalies of the umbilical cord and its association with fetal malformations]. Revista Chilena de Obstetricia y Ginecología. 1991;56(1):27-34 Spanish'},{id:"B18",body:'Hammad IA et al. Umbilical cord abnormalities and stillbirth. Obstetrics and Gynecology. 2020;135(3):644-652. DOI: 10.1097/AOG.0000000000003676'},{id:"B19",body:'Vanin S et al. A case of insect colonization before the death. Journal of Forensic Sciences. 2017;62:1665-1667. DOI: 10.1111/1556-4029.13481'},{id:"B20",body:'Kotzé Z et al. The forensic entomology case report—A global perspective. Insects. 2021;12:283. DOI: 10.3390/insects12040283'},{id:"B21",body:'Klima M et al. Causes of death in geriatric patients: A cross-cultural study. Journal of Gerontology. 1997;4:247-253'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"William Aguilar-Navarro",address:"waguilar@uchile.cl",affiliation:'
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Nanotechnology is widely considered to constitute the basis of the next technological revolution, following on from the first Industrial Revolution, which began around 1750 with the introduction of the steam engine and steelmaking. Nanotechnology is defined as the design, characterization, production, and application of materials, devices and systems by controlling shape and size of the nanoscale. The nanoscale itself is at present considered to cover the range from 1 to 100 nm. All samples prepared in thin film forms and the characterization revealed their nanostructure. The major exploitation of thin films has been in microelectronics, there are numerous and growing applications in communications, optical electronics, coatings of all kinds, and in energy generation. A great many sophisticated analytical instruments and techniques, largely developed to characterize thin films, have already become indispensable in virtually every scientific endeavor irrespective of discipline. Among all these techniques, electrodeposition is the most suitable technique for nanostructured thin films from aqueous solution served as samples under investigation. The electrodeposition of metallic layers from aqueous solution is based on the discharge of metal ions present in the electrolyte at a cathodic surface (the substrate or component.) The metal ions accept an electron from the electrically conducting material at the solid- electrolyte interface and then deposit as metal atoms onto the surface. The electrons necessary for this to occur are either supplied from an externally applied potential source or are surrendered by a reducing agent present in solution (electroless reduction). The metal ions themselves derive either from metal salts added to solution, or by the anodic dissolution of the so-called sacrificial anodes, made of the same metal that is to be deposited at the cathode.",book:{id:"4718",slug:"electroplating-of-nanostructures",title:"Electroplating of Nanostructures",fullTitle:"Electroplating of Nanostructures"},signatures:"Souad A. M. Al-Bat’hi",authors:[{id:"174793",title:"Dr.",name:"Mohamad",middleName:null,surname:"Souad",slug:"mohamad-souad",fullName:"Mohamad Souad"}]},{id:"54226",title:"Localized Surface Plasmon Resonance for Optical Fiber-Sensing Applications",slug:"localized-surface-plasmon-resonance-for-optical-fiber-sensing-applications",totalDownloads:2270,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"It is well known that optical fiber sensors have attracted the attention of scientific community due to its intrinsic advantages, such as lightweight, small size, portability, remote sensing, immunity to electromagnetic interferences and the possibility of multiplexing several signals. This field has shown a dramatic growth thanks to the creation of sensitive thin films onto diverse optical fiber configurations. In this sense, a wide range of optical fiber devices have been successfully fabricated for monitoring biological, chemical, medical or physical parameters. In addition, the use of nanoparticles into the sensitive thin films has resulted in an enhancement in the response time, robustness or sensitivity in the optical devices, which is associated to the inherent properties of nanoparticles (high surface area ratio or porosity). Among all of them, the metallic nanoparticles are of great interest for sensing applications due to the presence of strong absorption bands in the visible and near-infrared regions, due to their localized surface plasmon resonances (LSPR). These optical resonances are due to the coupling of certain modes of the incident light to the collective oscillation of the conduction electrons of the metallic nanoparticles. The LSPR extinction bands are very useful for sensing applications as far as they can be affected by refractive index variations of the surrounding medium of the nanoparticles, and therefore, it is possible to create optical sensors with outstanding properties such as high sensitivity and optical self-reference. In this chapter, the attractive optical properties of metal nanostructures and their implementation into different optical fiber configuration for sensing or biosensing applications will be studied.",book:{id:"5721",slug:"nanoplasmonics-fundamentals-and-applications",title:"Nanoplasmonics",fullTitle:"Nanoplasmonics - Fundamentals and Applications"},signatures:"Pedro J. Rivero, Javier Goicoechea and Francisco J. Arregui",authors:[{id:"69816",title:"Dr.",name:"Javier",middleName:null,surname:"Goicoechea",slug:"javier-goicoechea",fullName:"Javier Goicoechea"},{id:"188796",title:"Dr.",name:"Pedro J.",middleName:null,surname:"Rivero",slug:"pedro-j.-rivero",fullName:"Pedro J. Rivero"},{id:"197277",title:"Dr.",name:"Francisco",middleName:null,surname:"Arregui",slug:"francisco-arregui",fullName:"Francisco Arregui"}]},{id:"25297",title:"Nanofabrication of Metal Oxide Patterns Using Self-Assembled Monolayers",slug:"nanofabrication-of-metal-oxide-patterns-using-self-assembled-monolayers",totalDownloads:3448,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"860",slug:"nanofabrication",title:"Nanofabrication",fullTitle:"Nanofabrication"},signatures:"Yoshitake Masuda",authors:[{id:"12385",title:"Dr.",name:"Yoshitake",middleName:null,surname:"Masuda",slug:"yoshitake-masuda",fullName:"Yoshitake Masuda"}]},{id:"77225",title:"Piezoelectricity and Its Applications",slug:"piezoelectricity-and-its-applications",totalDownloads:524,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The piezoelectric effect is extensively encountered in nature and many synthetic materials. Piezoelectric materials are capable of transforming mechanical strain and vibration energy into electrical energy. This property allows opportunities for implementing renewable and sustainable energy through power harvesting and self-sustained smart sensing in buildings. As the most common construction material, plain cement paste lacks satisfactory piezoelectricity and is not efficient at harvesting the electrical energy from the ambient vibrations of a building system. In recent years, many techniques have been proposed and applied to improve the piezoelectric capacity of cement-based composite, namely admixture incorporation and physical. The successful application of piezoelectric materials for sustainable building development not only relies on understanding the mechanism of the piezoelectric properties of various building components, but also the latest developments and implementations in the building industry. Therefore, this review systematically illustrates research efforts to develop new construction materials with high piezoelectricity and energy storage capacity. In addition, this article discusses the latest techniques for utilizing the piezoelectric materials in energy harvesters, sensors and actuators for various building systems. With advanced methods for improving the cementations piezoelectricity and applying the material piezoelectricity for different building functions, more renewable and sustainable building systems are anticipated.",book:{id:"10511",slug:"multifunctional-ferroelectric-materials",title:"Multifunctional Ferroelectric Materials",fullTitle:"Multifunctional Ferroelectric Materials"},signatures:"B. Chandra Sekhar, B. Dhanalakshmi, B. Srinivasa Rao, S. Ramesh, K. Venkata Prasad, P.S.V. Subba Rao and B. Parvatheeswara Rao",authors:[{id:"335022",title:"Dr.",name:"B. Chandra",middleName:null,surname:"Sekhar",slug:"b.-chandra-sekhar",fullName:"B. Chandra Sekhar"},{id:"422021",title:"Dr.",name:"B.",middleName:null,surname:"Dhanalakshmi",slug:"b.-dhanalakshmi",fullName:"B. Dhanalakshmi"},{id:"422022",title:"Dr.",name:"B.Srinivasa",middleName:null,surname:"Rao",slug:"b.srinivasa-rao",fullName:"B.Srinivasa Rao"},{id:"422023",title:"Dr.",name:"S.",middleName:null,surname:"Ramesh",slug:"s.-ramesh",fullName:"S. Ramesh"},{id:"422024",title:"Dr.",name:"K.Venkata",middleName:null,surname:"Prasad",slug:"k.venkata-prasad",fullName:"K.Venkata Prasad"},{id:"422025",title:"Dr.",name:"P.S.V",middleName:null,surname:"Subba Rao",slug:"p.s.v-subba-rao",fullName:"P.S.V Subba Rao"},{id:"422026",title:"Dr.",name:"B.Parvatheeswara",middleName:null,surname:"Rao",slug:"b.parvatheeswara-rao",fullName:"B.Parvatheeswara Rao"}]}],onlineFirstChaptersFilter:{topicId:"1169",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81438",title:"Research Progress of Ionic Thermoelectric Materials for Energy Harvesting",slug:"research-progress-of-ionic-thermoelectric-materials-for-energy-harvesting",totalDownloads:25,totalDimensionsCites:0,doi:"10.5772/intechopen.101771",abstract:"Thermoelectric material is a kind of functional material that can mutually convert heat energy and electric energy. It can convert low-grade heat energy (less than 130°C) into electric energy. Compared with traditional electronic thermoelectric materials, ionic thermoelectric materials have higher performance. The Seebeck coefficient can generate 2–3 orders of magnitude higher ionic thermoelectric potential than electronic thermoelectric materials, so it has good application prospects in small thermoelectric generators and solar power generation. According to the thermoelectric conversion mechanism, ionic thermoelectric materials can be divided into ionic thermoelectric materials based on the Soret effect and thermocouple effect. They are widely used in pyrogen batteries and ionic thermoelectric capacitors. The latest two types of ionic thermoelectric materials are in this article. The research progress is explained, and the problems and challenges of ionic thermoelectric materials and the future development direction are also put forward.",book:{id:"10037",title:"Thermoelectricity - Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10037.jpg"},signatures:"Jianwei Zhang, Ying Xiao, Bowei Lei, Gengyuan Liang and Wenshu Zhao"},{id:"77670",title:"Thermoelectric Elements with Negative Temperature Factor of Resistance",slug:"thermoelectric-elements-with-negative-temperature-factor-of-resistance",totalDownloads:72,totalDimensionsCites:0,doi:"10.5772/intechopen.98860",abstract:"The method of manufacturing of ceramic materials on the basis of ferrites of nickel and cobalt by synthesis and sintering in controllable regenerative atmosphere is presented. As the generator of regenerative atmosphere the method of conversion of carbonic gas is offered. Calculation of regenerative atmosphere for simultaneous sintering of ceramic ferrites of nickel and cobalt is carried out. It is offered, methods of the dilated nonequilibrium thermodynamics to view process of distribution of a charge and heat along a thermoelement branch. The model of a thermoelement taking into account various relaxation times of a charge and warmth is constructed.",book:{id:"10037",title:"Thermoelectricity - Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10037.jpg"},signatures:"Yuri Bokhan"},{id:"79236",title:"Processing Techniques with Heating Conditions for Multiferroic Systems of BiFeO3, BaTiO3, PbTiO3, CaTiO3 Thin Films",slug:"processing-techniques-with-heating-conditions-for-multiferroic-systems-of-bifeo3-batio3-pbtio3-catio",totalDownloads:96,totalDimensionsCites:0,doi:"10.5772/intechopen.101122",abstract:"In this chapter, we have report a list of synthesis methods (including both synthesis steps & heating conditions) used for thin film fabrication of perovskite ABO3 (BiFeO3, BaTiO3, PbTiO3 and CaTiO3) based multiferroics (in both single-phase and composite materials). The processing of high quality multiferroic thin film have some features like epitaxial strain, physical phenomenon at atomic-level, interfacial coupling parameters to enhance device performance. Since these multiferroic thin films have ME properties such as electrical (dielectric, magnetoelectric coefficient & MC) and magnetic (ferromagnetic, magnetic susceptibility etc.) are heat sensitive, i.e. ME response at low as well as higher temperature might to enhance the device performance respect with long range ordering. The magnetoelectric coupling between ferromagnetism and ferroelectricity in multiferroic becomes suitable in the application of spintronics, memory and logic devices, and microelectronic memory or piezoelectric devices. In comparison with bulk multiferroic, the fabrication of multiferroic thin film with different structural geometries on substrate has reducible clamping effect. A brief procedure for multiferroic thin film fabrication in terms of their thermal conditions (temperature for film processing and annealing for crystallization) are described. Each synthesis methods have its own characteristic phenomenon in terms of film thickness, defects formation, crack free film, density, chip size, easier steps and availability etc. been described. A brief study towards phase structure and ME coupling for each multiferroic system of BiFeO3, BaTiO3, PbTiO3 and CaTiO3 is shown.",book:{id:"10037",title:"Thermoelectricity - Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10037.jpg"},signatures:"Kuldeep Chand Verma and Manpreet Singh"},{id:"78034",title:"Quantum Physical Interpretation of Thermoelectric Properties of Ruthenate Pyrochlores",slug:"quantum-physical-interpretation-of-thermoelectric-properties-of-ruthenate-pyrochlores",totalDownloads:78,totalDimensionsCites:0,doi:"10.5772/intechopen.99260",abstract:"Lead- and lead-yttrium ruthenate pyrochlores were synthesized and investigated for Seebeck coefficients, electrical- and thermal conductivity. Compounds A2B2O6.5+z with 0 ≤ z < 0.5 were defect pyrochlores and p-type conductors. The thermoelectric data were analyzed using quantum physical models to identify scattering mechanisms underlying electrical (σ) and thermal conductivity (κ) and to understand the temperature dependence of the Seebeck effect (S). In the metal-like lead ruthenates with different Pb:Ru ratios, σ (T) and the electronic thermal conductivity κe (T) were governed by ‘electron impurity scattering’, the lattice thermal conductivity κL (T) by the 3-phonon resistive process (Umklapp scattering). In the lead-yttrium ruthenate solid solutions (Pb(2-x)YxRu2O(6.5±z)), a metal–insulator transition occurred at 0.2 moles of yttrium. On the metallic side (<0.2 moles Y) ‘electron impurity scattering’ prevailed. On the semiconductor/insulator side between x = 0.2 and x = 1.0 several mechanisms were equally likely. At x > 1.5 the Mott Variable Range Hopping mechanism was active. S (T) was discussed for Pb-Y-Ru pyrochlores in terms of the effect of minority carrier excitation at lower- and a broadening of the Fermi distribution at higher temperatures. The figures of merit of all of these pyrochlores were still small (≤7.3 × 10−3).",book:{id:"10037",title:"Thermoelectricity - Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10037.jpg"},signatures:"Sepideh Akhbarifar"},{id:"77635",title:"Optimization of Thermoelectric Properties Based on Rashba Spin Splitting",slug:"optimization-of-thermoelectric-properties-based-on-rashba-spin-splitting",totalDownloads:125,totalDimensionsCites:0,doi:"10.5772/intechopen.98788",abstract:"In recent years, the application of thermoelectricity has become more and more widespread. Thermoelectric materials provide a simple and environmentally friendly solution for the direct conversion of heat to electricity. The development of higher performance thermoelectric materials and their performance optimization have become more important. Generally, to improve the ZT value, electrical conductivity, Seebeck coefficient and thermal conductivity must be globally optimized as a whole object. However, due to the strong coupling among ZT parameters in many cases, it is very challenging to break the bottleneck of ZT optimization currently. Beyond the traditional optimization methods (such as inducing defects, varying temperature), the Rashba effect is expected to effectively increase the S2σ and decrease the κ, thus enhancing thermoelectric performance, which provides a new strategy to develop new-generation thermoelectric materials. Although the Rashba effect has great potential in enhancing thermoelectric performance, the underlying mechanism of Rashba-type thermoelectric materials needs further research. In addition, how to introduce Rashba spin splitting into current thermoelectric materials is also of great significance to the optimization of thermoelectricity.",book:{id:"10037",title:"Thermoelectricity - Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10037.jpg"},signatures:"Zhenzhen Qin"},{id:"75364",title:"Challenges in Improving Performance of Oxide Thermoelectrics Using Defect Engineering",slug:"challenges-in-improving-performance-of-oxide-thermoelectrics-using-defect-engineering",totalDownloads:215,totalDimensionsCites:0,doi:"10.5772/intechopen.96278",abstract:"Oxide thermoelectric materials are considered promising for high-temperature thermoelectric applications in terms of low cost, temperature stability, reversible reaction, and so on. Oxide materials have been intensively studied to suppress the defects and electronic charge carriers for many electronic device applications, but the studies with a high concentration of defects are limited. It desires to improve thermoelectric performance by enhancing its charge transport and lowering its lattice thermal conductivity. For this purpose, here, we modified the stoichiometry of cation and anion vacancies in two different systems to regulate the carrier concentration and explored their thermoelectric properties. Both cation and anion vacancies act as a donor of charge carriers and act as phonon scattering centers, decoupling the electrical conductivity and thermal conductivity.",book:{id:"10037",title:"Thermoelectricity - Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10037.jpg"},signatures:"Jamil Ur Rahman, Gul Rahman and Soonil Lee"}],onlineFirstChaptersTotal:6},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:288,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,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:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"May 24th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:27,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"19",title:"Animal Science",coverUrl:"https://cdn.intechopen.com/series_topics/covers/19.jpg",isOpenForSubmission:!0,editor:{id:"259298",title:"Dr.",name:"Edward",middleName:null,surname:"Narayan",slug:"edward-narayan",fullName:"Edward Narayan",profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",biography:"Dr. Edward Narayan graduated with Ph.D. degree in Biology from the University of the South Pacific and pioneered non-invasive reproductive and stress endocrinology tools for amphibians - the novel development and validation of non-invasive enzyme immunoassays for the evaluation of reproductive hormonal cycle and stress hormone responses to environmental stressors. \nDr. Narayan leads the Stress Lab (Comparative Physiology and Endocrinology) at the University of Queensland. A dynamic career research platform which is based on the thematic areas of comparative vertebrate physiology, stress endocrinology, reproductive endocrinology, animal health and welfare, and conservation biology. \nEdward has supervised 40 research students and published over 60 peer reviewed research.",institutionString:null,institution:{name:"University of Queensland",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},{id:"20",title:"Animal Nutrition",coverUrl:"https://cdn.intechopen.com/series_topics/covers/20.jpg",isOpenForSubmission:!0,editor:{id:"175967",title:"Dr.",name:"Manuel",middleName:null,surname:"Gonzalez Ronquillo",slug:"manuel-gonzalez-ronquillo",fullName:"Manuel Gonzalez Ronquillo",profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",biography:"Dr. Manuel González Ronquillo obtained his doctorate degree from the University of Zaragoza, Spain, in 2001. He is a research professor at the Faculty of Veterinary Medicine and Animal Husbandry, Autonomous University of the State of Mexico. He is also a level-2 researcher. He received a Fulbright-Garcia Robles fellowship for a postdoctoral stay at the US Dairy Forage Research Center, Madison, Wisconsin, USA in 2008–2009. He received grants from Alianza del Pacifico for a stay at the University of Magallanes, Chile, in 2014, and from Consejo Nacional de Ciencia y Tecnología (CONACyT) to work in the Food and Agriculture Organization’s Animal Production and Health Division (AGA), Rome, Italy, in 2014–2015. He has collaborated with researchers from different countries and published ninety-eight journal articles. He teaches various degree courses in zootechnics, sheep production, and agricultural sciences and natural resources.\n\nDr. Ronquillo’s research focuses on the evaluation of sustainable animal diets (StAnD), using native resources of the region, decreasing carbon footprint, and applying meta-analysis and mathematical models for a better understanding of animal production.",institutionString:null,institution:{name:"Universidad Autónoma del Estado de México",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"28",title:"Animal Reproductive Biology and Technology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/28.jpg",isOpenForSubmission:!0,editor:{id:"177225",title:"Prof.",name:"Rosa Maria Lino Neto",middleName:null,surname:"Pereira",slug:"rosa-maria-lino-neto-pereira",fullName:"Rosa Maria Lino Neto Pereira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9wkQAC/Profile_Picture_1624519982291",biography:"Rosa Maria Lino Neto Pereira (DVM, MsC, PhD and) is currently a researcher at the Genetic Resources and Biotechnology Unit of the National Institute of Agrarian and Veterinarian Research (INIAV, Portugal). She is the head of the Reproduction and Embryology Laboratories and was lecturer of Reproduction and Reproductive Biotechnologies at Veterinary Medicine Faculty. She has over 25 years of experience working in reproductive biology and biotechnology areas with a special emphasis on embryo and gamete cryopreservation, for research and animal genetic resources conservation, leading research projects with several peer-reviewed papers. Rosa Pereira is member of the ERFP-FAO Ex situ Working Group and of the Management Commission of the Portuguese Animal Germplasm Bank.",institutionString:"The National Institute for Agricultural and Veterinary Research. 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