Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
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We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
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Throughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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In this way we find a review of multi-agents, different techniques applied to the navigation systems, artificial intelligence algorithms, which include deep learning applications, systems where a Kalman filter estimator is extended for visual odometry, and finally the design of an on-chip system for the execution of cognitive agents. Additionally, the development of different ideas in mobile robot applications are included and hopefully will be useful and enriching for readers.",isbn:"978-1-78985-756-6",printIsbn:"978-1-78985-755-9",pdfIsbn:"978-1-83962-086-7",doi:"10.5772/intechopen.74181",price:119,priceEur:129,priceUsd:155,slug:"applications-of-mobile-robots",numberOfPages:228,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"b4993517c29aed9abd474e362370e28a",bookSignature:"Efren Gorrostieta Hurtado",publishedDate:"March 20th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/7227.jpg",numberOfDownloads:14509,numberOfWosCitations:1,numberOfCrossrefCitations:16,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:46,numberOfDimensionsCitationsByBook:1,hasAltmetrics:0,numberOfTotalCitations:63,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"January 25th 2018",dateEndSecondStepPublish:"February 15th 2018",dateEndThirdStepPublish:"April 16th 2018",dateEndFourthStepPublish:"July 5th 2018",dateEndFifthStepPublish:"September 3rd 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"38850",title:"Dr.",name:"Efren",middleName:null,surname:"Gorrostieta Hurtado",slug:"efren-gorrostieta-hurtado",fullName:"Efren Gorrostieta Hurtado",profilePictureURL:"https://mts.intechopen.com/storage/users/38850/images/system/38850.jpg",biography:"Dr. Eng Efren Gorrostieta is a Professor at the Engineering Faculty of the Autonomous University of Queretaro, Mexico. He studied Electronics Engineering, received a master of Science in Control and Automation and a PhD in Mechatronics. He was a co-founder of the Mechatronics Mexican Association, President of the IEEE Querétaro Section and the Chair of the IEEE Queretaro Computational Intelligence Chapter; he has given lectures in Control Systems and Robotics at different universities and has been a chair, reviewer and editor in several national/international congresses related to robotics, automation, and artificial intelligence. He has several publications in conferences and journals in the field.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1262",title:"Mobile Robot",slug:"psychology-artificial-intelligence-mobile-robot"}],chapters:[{id:"63854",title:"A Survey and Analysis of Cooperative Multi-Agent Robot Systems: Challenges and Directions",doi:"10.5772/intechopen.79337",slug:"a-survey-and-analysis-of-cooperative-multi-agent-robot-systems-challenges-and-directions",totalDownloads:2439,totalCrossrefCites:8,totalDimensionsCites:20,hasAltmetrics:0,abstract:"Research in the area of cooperative multi-agent robot systems has received wide attention among researchers in recent years. The main concern is to find the effective coordination among autonomous agents to perform the task in order to achieve a high quality of overall performance. Therefore, this paper reviewed various selected literatures primarily from recent conference proceedings and journals related to cooperation and coordination of multi-agent robot systems (MARS). The problems, issues, and directions of MARS research have been investigated in the literature reviews. Three main elements of MARS which are the type of agents, control architectures, and communications were discussed thoroughly in the beginning of this paper. A series of problems together with the issues were analyzed and reviewed, which included centralized and decentralized control, consensus, containment, formation, task allocation, intelligences, optimization and communications of multi-agent robots. Since the research in the field of multi-agent robot research is expanding, some issues and future challenges in MARS are recalled, discussed and clarified with future directions. Finally, the paper is concluded with some recommendations with respect to multi-agent systems.",signatures:"Zool Hilmi Ismail and Nohaidda Sariff",downloadPdfUrl:"/chapter/pdf-download/63854",previewPdfUrl:"/chapter/pdf-preview/63854",authors:[{id:"91546",title:"MSc.",name:"Nohaidda Binti",surname:"Sariff",slug:"nohaidda-binti-sariff",fullName:"Nohaidda Binti Sariff"},{id:"135439",title:"Dr.",name:"Zool",surname:"Ismail",slug:"zool-ismail",fullName:"Zool Ismail"}],corrections:null},{id:"62533",title:"Motion Control and Velocity-Based Dynamic Compensation for Mobile Robots",doi:"10.5772/intechopen.79397",slug:"motion-control-and-velocity-based-dynamic-compensation-for-mobile-robots",totalDownloads:1534,totalCrossrefCites:0,totalDimensionsCites:5,hasAltmetrics:1,abstract:"The design of motion controllers for wheeled mobile robots is often based only on the robot’s kinematics. However, to reduce tracking error it is important to also consider the robot dynamics, especially when high-speed movements and/or heavy load transportation are required. Commercial mobile robots usually have internal controllers that accept velocity commands, but the control signals generated by most dynamic controllers in the literature are torques or voltages. In this chapter, we present a velocity-based dynamic model for differential-drive mobile robots that also includes the dynamics of the robot actuators. Such model can be used to design controllers that generate velocity commands, while compensating for the robot dynamics. We present an explanation on how to obtain the parameters of the dynamic model and show that motion controllers designed for the robot’s kinematics can be easily integrated with the velocity-based dynamic compensation controller. We conclude the chapter with experimental results of a trajectory tracking controller that show a reduction of up to 50% in tracking error index IAE due to the application of the dynamic compensation controller.",signatures:"Felipe Nascimento Martins and Alexandre Santos Brandão",downloadPdfUrl:"/chapter/pdf-download/62533",previewPdfUrl:"/chapter/pdf-preview/62533",authors:[{id:"164609",title:"Dr.",name:"Alexandre",surname:"Brandão",slug:"alexandre-brandao",fullName:"Alexandre Brandão"},{id:"246107",title:"Dr.",name:"Felipe",surname:"Martins",slug:"felipe-martins",fullName:"Felipe Martins"}],corrections:null},{id:"62906",title:"Theoretical and Experimental Collaborative Area Coverage Schemes Using Mobile Agents",doi:"10.5772/intechopen.78940",slug:"theoretical-and-experimental-collaborative-area-coverage-schemes-using-mobile-agents",totalDownloads:943,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter is concerned with the development of collaborative control schemes for mobile ground robots for area coverage purposes. The simplest scheme assumes point omnidirectional robots with heterogeneous circular sensing patterns. Using information from their spatial neighbors, each robot (agent) computes its cell relying on the power diagram partitioning. If there is uncertainty in inferring the locations of these robots, the Additively Weighted Guaranteed Voronoi scheme is employed resulting in a rather conservative performance. The aforementioned schemes are enhanced by using a Voronoi-free coverage scheme that relies on the knowledge of any arbitrary sensing pattern employed by the agents. Experimental results are offered to highlight the efficiency of the suggested control laws.",signatures:"Sotiris Papatheodorou and Anthony Tzes",downloadPdfUrl:"/chapter/pdf-download/62906",previewPdfUrl:"/chapter/pdf-preview/62906",authors:[{id:"242670",title:"Dr.",name:"Anthony",surname:"Tzes",slug:"anthony-tzes",fullName:"Anthony Tzes"},{id:"244840",title:"Mr.",name:"Sotiris",surname:"Papatheodorou",slug:"sotiris-papatheodorou",fullName:"Sotiris Papatheodorou"}],corrections:null},{id:"64100",title:"Mobile Robot Feature-Based SLAM Behavior Learning, and Navigation in Complex Spaces",doi:"10.5772/intechopen.81195",slug:"mobile-robot-feature-based-slam-behavior-learning-and-navigation-in-complex-spaces",totalDownloads:975,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Learning mobile robot space and navigation behavior, are essential requirements for improved navigation, in addition to gain much understanding about the navigation maps. This chapter presents mobile robots feature-based SLAM behavior learning, and navigation in complex spaces. Mobile intelligence has been based on blending a number of functionaries related to navigation, including learning SLAM map main features. To achieve this, the mobile system was built on diverse levels of intelligence, this includes principle component analysis (PCA), neuro-fuzzy (NF) learning system as a classifier, and fuzzy rule based decision system (FRD).",signatures:"Ebrahim A. Mattar",downloadPdfUrl:"/chapter/pdf-download/64100",previewPdfUrl:"/chapter/pdf-preview/64100",authors:[{id:"216016",title:"Prof.",name:"Ebrahim",surname:"Mattar",slug:"ebrahim-mattar",fullName:"Ebrahim Mattar"}],corrections:null},{id:"63790",title:"Mobile Robot Navigation in Indoor Environments: Geometric, Topological, and Semantic Navigation",doi:"10.5772/intechopen.79842",slug:"mobile-robot-navigation-in-indoor-environments-geometric-topological-and-semantic-navigation",totalDownloads:1547,totalCrossrefCites:2,totalDimensionsCites:8,hasAltmetrics:0,abstract:"The objective of the chapter is to show current trends in robot navigation systems related to indoor environments. Navigation systems depend on the level of abstraction of the environment representation. The three main techniques for representing the environment will be described: geometric, topological, and semantic. The geometric representation of the environment is closer to the sensor and actuator world and it is the best one to perform local navigation. Topological representation of the environment uses graphs to model the environment and it is used in large navigation tasks. The semantic representation is the most abstract representation model and adds concepts such as utilities or meanings of the environment elements in the map representation. In addition, regardless of the representation used for navigation, perception plays a significant role in terms of understanding and moving through the environment.",signatures:"Ramón Barber, Jonathan Crespo, Clara Gómez, Alejandra C.\nHernámdez and Marina Galli",downloadPdfUrl:"/chapter/pdf-download/63790",previewPdfUrl:"/chapter/pdf-preview/63790",authors:[{id:"158703",title:"Dr.",name:"Ramon",surname:"Barber",slug:"ramon-barber",fullName:"Ramon Barber"},{id:"260264",title:"Dr.",name:"Jonathan",surname:"Crespo",slug:"jonathan-crespo",fullName:"Jonathan Crespo"},{id:"260265",title:"Ms.",name:"Clara",surname:"Gomez",slug:"clara-gomez",fullName:"Clara Gomez"},{id:"260266",title:"Ms.",name:"Alejandra C.",surname:"Hernandez",slug:"alejandra-c.-hernandez",fullName:"Alejandra C. Hernandez"},{id:"260267",title:"Ms.",name:"Marina",surname:"Galli",slug:"marina-galli",fullName:"Marina Galli"}],corrections:null},{id:"62978",title:"Intelligent Robotic Perception Systems",doi:"10.5772/intechopen.79742",slug:"intelligent-robotic-perception-systems",totalDownloads:2412,totalCrossrefCites:5,totalDimensionsCites:11,hasAltmetrics:0,abstract:"Robotic perception is related to many applications in robotics where sensory data and artificial intelligence/machine learning (AI/ML) techniques are involved. Examples of such applications are object detection, environment representation, scene understanding, human/pedestrian detection, activity recognition, semantic place classification, object modeling, among others. Robotic perception, in the scope of this chapter, encompasses the ML algorithms and techniques that empower robots to learn from sensory data and, based on learned models, to react and take decisions accordingly. The recent developments in machine learning, namely deep-learning approaches, are evident and, consequently, robotic perception systems are evolving in a way that new applications and tasks are becoming a reality. Recent advances in human-robot interaction, complex robotic tasks, intelligent reasoning, and decision-making are, at some extent, the results of the notorious evolution and success of ML algorithms. This chapter will cover recent and emerging topics and use-cases related to intelligent perception systems in robotics.",signatures:"Cristiano Premebida, Rares Ambrus and Zoltan-Csaba Marton",downloadPdfUrl:"/chapter/pdf-download/62978",previewPdfUrl:"/chapter/pdf-preview/62978",authors:[{id:"203409",title:"Ph.D.",name:"Cristiano",surname:"Premebida",slug:"cristiano-premebida",fullName:"Cristiano Premebida"},{id:"254880",title:"Dr.",name:"Rares",surname:"Ambrus",slug:"rares-ambrus",fullName:"Rares Ambrus"},{id:"254881",title:"Dr.",name:"Zoltan-Csaba",surname:"Marton",slug:"zoltan-csaba-marton",fullName:"Zoltan-Csaba Marton"}],corrections:null},{id:"62563",title:"Online Mapping-Based Navigation System for Wheeled Mobile Robot in Road Following and Roundabout",doi:"10.5772/intechopen.79412",slug:"online-mapping-based-navigation-system-for-wheeled-mobile-robot-in-road-following-and-roundabout",totalDownloads:1468,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"A road mapping and feature extraction for mobile robot navigation in road roundabout and road following environments is presented in this chapter. In this work, the online mapping of mobile robot employing the utilization of sensor fusion technique is used to extract the road characteristics that will be used with path planning algorithm to enable the robot to move from a certain start position to predetermined goal, such as road curbs, road borders, and roundabout. The sensor fusion is performed using many sensors, namely, laser range finder, camera, and odometry, which are combined on a new wheeled mobile robot prototype to determine the best optimum path of the robot and localize it within its environments. The local maps are developed using an image’s preprocessing and processing algorithms and an artificial threshold of LRF signal processing to recognize the road environment parameters such as road curbs, width, and roundabout. The path planning in the road environments is accomplished using a novel approach so called Laser Simulator to find the trajectory in the local maps developed by sensor fusion. Results show the capability of the wheeled mobile robot to effectively recognize the road environments, build a local mapping, and find the path in both road following and roundabout.",signatures:"Mohammed A. H. Ali and Musa Mailah",downloadPdfUrl:"/chapter/pdf-download/62563",previewPdfUrl:"/chapter/pdf-preview/62563",authors:[{id:"32016",title:"Prof.",name:"Musa",surname:"Mailah",slug:"musa-mailah",fullName:"Musa Mailah"},{id:"243606",title:"Dr.",name:"Mohammed A. H",surname:"Ali",slug:"mohammed-a.-h-ali",fullName:"Mohammed A. H Ali"}],corrections:null},{id:"62939",title:"Path Tracking of a Wheeled Mobile Manipulator through Improved Localization and Calibration",doi:"10.5772/intechopen.79598",slug:"path-tracking-of-a-wheeled-mobile-manipulator-through-improved-localization-and-calibration",totalDownloads:1279,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"This chapter focuses on path tracking of a wheeled mobile manipulator designed for manufacturing processes such as drilling, riveting, or line drawing, which demand high accuracy. This problem can be solved by combining two approaches: improved localization and improved calibration. In the first approach, a full-scale kinematic equation is derived for calibration of each individual wheel’s geometrical parameters, as opposed to traditionally treating them identical for all wheels. To avoid the singularity problem in computation, a predefined square path is used to quantify the errors used for calibration considering the movement in different directions. Both statistical method and interval analysis method are adopted and compared for estimation of the calibration parameters. In the second approach, a vision-based deviation rectification solution is presented to localize the system in the global frame through a number of artificial reflectors that are identified by an onboard laser scanner. An improved tracking and localization algorithm is developed to meet the high positional accuracy requirement, improve the system’s repeatability in the traditional trilateral algorithm, and solve the problem of pose loss in path following. The developed methods have been verified and implemented on the mobile manipulators developed by Shanghai University.",signatures:"Tao Song, Fengfeng (Jeff) Xi and Shuai Guo",downloadPdfUrl:"/chapter/pdf-download/62939",previewPdfUrl:"/chapter/pdf-preview/62939",authors:[{id:"65530",title:"Prof.",name:"Guo",surname:"Shuai",slug:"guo-shuai",fullName:"Guo Shuai"},{id:"133537",title:"Prof.",name:"Fengfeng",surname:"Xi",slug:"fengfeng-xi",fullName:"Fengfeng Xi"},{id:"244038",title:"Dr.",name:"Tao",surname:"Song",slug:"tao-song",fullName:"Tao Song"}],corrections:null},{id:"63491",title:"4WD Robot Posture Estimation by Radial Multi-View Visual Odometry",doi:"10.5772/intechopen.79130",slug:"4wd-robot-posture-estimation-by-radial-multi-view-visual-odometry",totalDownloads:948,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter presents a four-wheel robot’s trajectory tracking model by an extended Kalman filter (EKF) estimator for visual odometry using a divergent trinocular visual sensor. The trinocular sensor is homemade and a specific observer model was developed to measure 3D key-points by combining multi-view cameras. The observer approaches a geometric model and the key-points are used as references for estimating the robot’s displacement. The robot’s displacement is estimated by triangulation of multiple pairs of environmental 3D key-points. The four-wheel drive (4WD) robot’s inverse/direct kinematic control law is combined with the visual observer, the visual odometry model, and the EKF. The robot’s control law is used to produce experimental locomotion statistical variances and is used as a prediction model in the EKF. The proposed dead-reckoning approach models the four asynchronous drives and the four damping suspensions. This chapter presents the deductions of models, formulations and their validation, as well as the experimental results on posture state estimation comparing the four-wheel dead-reckoning model, the visual observer, and the EKF with an external global positioning reference.",signatures:"Edgar Alonso Martínez-García and Luz Abril Torres-Méndez",downloadPdfUrl:"/chapter/pdf-download/63491",previewPdfUrl:"/chapter/pdf-preview/63491",authors:[{id:"9751",title:"Dr.",name:"Luz Abril",surname:"Torres-Méndez",slug:"luz-abril-torres-mendez",fullName:"Luz Abril Torres-Méndez"},{id:"84958",title:"Dr.",name:"Edgar A.",surname:"Martínez García",slug:"edgar-a.-martinez-garcia",fullName:"Edgar A. Martínez García"}],corrections:null},{id:"62387",title:"IntelliSoC: A System Level Design and Conception of a System- on-a-Chip (SoC) to Cognitive Agents Architecture",doi:"10.5772/intechopen.79265",slug:"intellisoc-a-system-level-design-and-conception-of-a-system-on-a-chip-soc-to-cognitive-agents-archit",totalDownloads:970,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"This chapter presents a system level design and conception of a System-on-a-Chip (SoC) for the execution of cognitive agents. The computational architecture of this SoC will be presented using the cognitive model of the concurrent autonomous agent (CAA) as a reference. This cognitive model comprises three levels that run concurrently, namely the reactive level, the instinctive level and the cognitive level. The reactive level executes a fast perception-action cycle. The instinctive level receives perceptions from and sends the active behavior to the reactive level, and using a Knowledge Based System (KBS) executes plans by selecting reactive behaviors. The cognitive level receives symbolic information from the instinctive level to update its logical world model, used for planning and sends new local goals to instinctive level. Thus, this work proposes a novel SoC whose architecture fits the computational demands of the aforementioned cognitive model, allowing for fast, energy-efficient, embedded intelligent applications.",signatures:"Diego Ferreira, Augusto Loureiro da Costa and Wagner Luiz Alves\nDe Oliveira",downloadPdfUrl:"/chapter/pdf-download/62387",previewPdfUrl:"/chapter/pdf-preview/62387",authors:[{id:"246122",title:"Prof.",name:"Augusto",surname:"Loureiro Da Costa",slug:"augusto-loureiro-da-costa",fullName:"Augusto Loureiro Da Costa"},{id:"247158",title:"M.Sc.",name:"Diego",surname:"Fonseca Ferreira",slug:"diego-fonseca-ferreira",fullName:"Diego Fonseca Ferreira"},{id:"247159",title:"Prof.",name:"Wagner Luiz",surname:"Alves De Oliveira",slug:"wagner-luiz-alves-de-oliveira",fullName:"Wagner Luiz Alves De Oliveira"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited 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\n
1. Introduction
\n
The intracellular matrix is physically separated from the dynamic extracellular environment; however, their functions are intimately coordinated in order to ensure cell adaptation and survival. Mitogen-activated protein kinase (MAPK) cascades sense and integrate extracellular cues through sequential activation of protein kinases. These highly conserved transduction pathways are involved in a myriad of fundamental cellular processes and determine cell fate. Misregulation of these signaling cascades has major consequences for numerous diseases such as cancer, diabetes, inflammatory, and immune response diseases.
\n
About 300 genes encode signaling proteins directly involved in signal transduction, including their positive and negative regulators as well [1]. Upon cell stimulation, in order to adapt to an extracellular insult, these seemingly simple linear signaling pathways harbor the potential to target a large number of substrates of which many are involved in gene expression. In fact, MAPKs control every step studied to date of the highly dynamic process of gene expression. The overall picture of MAPK pathway substrates and interactors is still far from complete; however, the knowledge generated over the last 20 years has allowed a more holistic understanding of the underlying mechanisms of MAPK-regulated transcription. Due to the growing interest in MAPK-biology and the sheer volume of literature available, in this chapter, we not only mainly focus on the main mammalian MAPK cascades in humans (ERK1/2, JNK, p38, and ERK5), but we also discuss the main findings regarding MAPK cascades in the model organism Saccharomyces cerevisiae.
\n
\n
\n
2. MAP kinase pathways
\n
MAPKs mediate the transmission of extracellular information through a series of consecutive chemical reactions that lead to the activation of a terminal MAPK to orchestrate the appropriate gene expression pattern. To date, four major MAPK signaling cascades have been characterized in mammals, which are named according to their MAPK components: extracellular signal-regulated kinase 1 and 2 (ERK1/2), c-Jun N-terminal kinase 1 to 3 (JNK), p38 α/β/γ/δ (p38), and ERK5. Apart from these main MAPKs, several atypical MAPKs have also been described (ERK 3/4, ERK 7/8, and NLK, among others) with less well-defined functions and distinct modes of activation [2].
\n
\n
2.1. MAPK activators
\n
MAPKs can be activated in two different ways: (1) ligand-dependent that requires the physical interaction of a ligand (e.g., growth factors, hormones, or cytokines) with a receptor or (2) ligand-independent that mediates the signaling of physical stressors (e.g., radiation, injury, and osmotic pressure). In general, ERK1/2 responds to proliferative and survival stimuli such as growth factors, serum, and phorbol esters and, to a lesser extent, to ligands of G protein-coupled receptors (GPCRs) or cytokines, or to osmotic stress and microtubule disorganization. ERK5 is activated by growth factors [e.g., EGF, NGF, FGF-2, and brain-derived neurotrophic factor (BDNF)] and cytokines (e.g., Leukemia inhibitory factor—LIF) as well as by some stresses such as osmotic stress and hydrogen peroxide [3]. JNKs and p38 MAPKs are functionally related and are collectively named stress-activated protein kinases (SAPKs). The JNK pathway strongly responds to cytokines, growth factor deprivation, intracellular stimuli (e.g., DNA damage, cytoskeletal changes, oxidative, and ER stress), and extracellular stresses (e.g., UV radiation and osmotic stress) and less efficiently responds to stimulation by some GPCRs, serum, and growth factors [4]. Finally, p38 signaling has been shown to be consistently activated by a wide variety of environmental stresses and inflammation but to be inconsistently activated by insulin and growth factors in certain cell types [1].
\n
\n
\n
2.2. Modular architecture of the MAPK signaling cascades
\n
MAPK signaling is triggered by the stimulation of different membrane receptor families (e.g., receptor tyrosine kinases (RTKs), GPCRs, cytokine receptors, Ser/Thr kinase receptors, and membrane-bound stress sensors) that are coupled to the MAPK signaling cascades. Depending on the stimulus, the signal is transmitted downstream through small G proteins, kinases, or adaptor proteins that are the immediate upstream activators of the conventional MAPK signaling cascades.
\n
A major and highly conserved feature of MAPK pathways is their central three-tiered core signaling module of sequentially activating kinases (Figure 1). In the first tier, a Ser/Thr kinase MAPKKK (MAP3K) is activated by the effectors mentioned above. This MAPKKK then phosphorylates and activates a MAPKK (MAP2K) in the second tier; the MAPKK is a dual specificity kinase that phosphorylates both threonine and tyrosine within a conserved Thr-Xaa-Tyr motif in its substrate. Finally, there is a terminal Ser/Thr MAPK in the third tier, which, upon activation, phosphorylates a huge number of cytoplasmic and nuclear substrates on consensus Ser/Thr-Pro sites. Although not always present, other kinases are involved in MAPK signal transduction. One such kinase is the MAP4K that phosphorylates and activates the MAP3K; downstream MAPK-activated protein kinases (MAPKAPKs) contribute to the spread of the signal transduction.
\n
Figure 1.
Conceptual representation of the three core components of a MAPK signaling cascade. A typical MAPK cascade is composed of three consecutively activated tiers of kinases: MAP3Ks, MAP2Ks, and MAPKs. Kinases are grouped by layers according to their position in the signaling cascade. Arrows link components of different layers representing activation pathways. The core modules of mammalian (left) and yeast (right) signaling pathways are shown. Output responses resulting from MAPK activation through substrate phosphorylation and control of gene expression are indicated.
\n
The first MAPK pathway identified was ERK1 whose activation depends on the dimerization and autophosphorylation of the ligand-activated tyrosine kinase receptors (RTKs and GPCRs). These ligand-induced chemical and conformational receptor changes trigger recruitment of the adaptor proteins Shc and Grb2, a guanine exchange factor (SOS), and the small GTPase (Ras) to the plasma membrane. The interaction of these four elements leads to the homo- and hetero-dimerization of the Raf family of kinases (B- or C-Raf) that activate the MAP3K module. The MAP3K then phosphorylates MEKK1/2 (MAP2K) at two serine within their activation loop (Ser-Met-Ala-Asn-Ser). Activated MEKK1/2 in turn phosphorylates ERK1/2 (MAPK) on the tyrosine and threonine residues of the Thr-Glu-Tyr motif in their activating loop. Additionally, MAPKAPKs have been identified that propagate ERK signaling (RSKs, MSKs, MNKs, and in some cases MK3/5) [1, 5].
\n
The least studied of the four MAPK cascades is ERK5, whose mechanisms of upstream activation may include activation of tyrosine kinase receptors, the protein tyrosine kinase c-Src, the small GTPase Ras, the adaptor protein Lad1, and the protein Ser/Thr kinase WNK1, which acts as a MAP4K [1, 3]. Activation of these signaling molecules leads to activation of the MAP3Ks (not only MEKK2/3 but also TPL2 and MLTK) to phosphorylate the two alternatively spliced MEK5 isoforms (MEK5a and MEK5b, MAP2K) at the Ser-Xaa-Ala-Xaa-Thr activation motif, leading to ERK5 activation at the Thr-Glu-Tyr motif. The ERK5 pathway also involves downstream MAPKAPKs such as the serum and glucocorticoid-activated kinase (SGK) and p90 ribosomal S6 kinases (RSKs) [2].
\n
The signal through the JNK cascade is transmitted through adaptor proteins (TRAFs), small GTPases (Rac1, Cdc42), or Ste20-like kinases that act as MAP4Ks [6]. A large number of MAP3Ks convey the signal to the main MAP2Ks (MKK4/7) by phosphorylating the sequence Ser-Xaa-Ala-Xaa-Ser/Thr in their activation loop [4]. Ultimately, the three components of the MAPK level (JNK1–3) are activated by dual Thr/Tyr phosphorylation at the Thr-Pro-Tyr motif. As for other kinases in the JNK cascade, MAPKAPKs such as MST1 are well-defined JNK substrates that can act as both upstream and downstream of JNK [7].
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Finally, p38 operates through different receptors from apoptosis-related receptors to physical sensors. The initial signal is transferred using Cdc42, Rac1, and Ste20-like kinases (shared with JNK) and results in phosphorylation of the activation loop (Ser-Xaa-Ala-Xaa-Ser/Thr) of the MAP2Ks MKK3/6 that uniquely target p38. The differences between the p38 and JNK pathways lie within the specific scaffold proteins and substrates. All p38 isoforms, either the major isoforms (p38α,β,γ,δ) or the minor isoforms generated through alternative splicing, are activated through dual phosphorylation at the Thr-Gly-Tyr motif [1]. The main p38 isoform (p38α) is constitutively expressed, while the remaining isoforms are tissue-restricted. Uniquely for a MAP kinase, p38 can be activated through MAP2K-independent mechanisms that involve adaptors that promote p38 autophosphorylation [6]. Finally, the downstream MAPKAPK layer is partially shared with ERK and includes MAPKAPK2,3,5, MNKs, and MSKs [1].
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2.2.1. Specificity of signaling cascades
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The signaling proteome is composed of a limited number of genes that specifically integrate a virtually endless number of extracellular stimuli. Several strategies have evolved in order to maintain the signaling fidelity. For instance, this is achieved by the interaction of MAPKs with other components of the pathway and with substrates through docking sites composed of specific consensus motifs. Two types of docking motifs have been reported: D-motif and docking site for ERK (FXF)-motif, which ensure fidelity of signaling. D-motifs contain at least two basic residues flanking hydrophobic residues and are located opposite to the catalytic pocket in MAPKs [8]. The FXF-motif is composed of two Phe residues separated by one residue [9]. Another mechanism to gain specificity of signaling is the use of MAPK-scaffold proteins, which were first described in yeast (Ste5 and Pbs2) [10, 11]. Scaffolds are crucial for maintenance of signaling specificity as they sequester multiprotein interactions to prevent crosstalk by controlling stability and subcellular localization.
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2.2.2. Regulators of signaling cascades
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The amplitude, frequency, and localization of activated MAPK-activity is tightly controlled, not only through positive and negative feedback mechanisms at the post-translational level mediated by regulatory proteins (e.g., phosphatases and kinases) but also through post-transcriptional control mediated by RNA-binding proteins and microRNAs (miRNAs).
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The fastest mechanism of ablating MAPK activity is to remove one of the two activating phosphates through the activity of specific phosphatases. Their role in regulating the terminal MAPK has been extensively studied, but little is known about their effect on upstream signaling components. Phosphatase activity is mainly derived from Ser/Thr phosphatases, Tyr phosphatases, and the dual specificity phosphatases (DUSP) known as MAPK phosphatases (MKP) [1]. Based on sequence homology, substrate specificity, and subcellular localization, DUSPs can be divided into three groups: nuclear inducible (DUSP1/2/4/5), cytoplasmic and ERK-specific (DUSP6/7/9), and DUSPs with no specific cellular localization that targets JNK and p38 SAPKs (DUSP8/10/16) [4, 12]. MAPKs also exert a transcriptional control of regulatory elements such as these phosphatases and thereby generate a negative feedback loop. Another relevant type of negative feedback regulation is driven by the direct phosphorylation of different upstream components of the MAPK cascade by the MAPK itself to modulate basal [13] and stimuli-dependent signaling dynamics [5]. Additionally, scaffold proteins and other enzymatic activities either positively or negatively regulate different levels of MAPK signal transduction such as, for example, the formation of the ligand-receptor signaling complex, the intracellular modular interactions, and the degradation of the components [14]. Post-transcriptional regulation of MAPKs can also be achieved at the RNA level. RNA-binding proteins and miRNA negatively regulate MAPK gene expression by directly cleaving their mRNAs or through complementary pairing [15].
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2.3. Yeast MAPK cascades
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Five MAPK pathways have been well characterized in the budding yeast, S. cerevisiae. In vegetative cells, the four MAPKs Fus3, Kss1, Hog1, and Slt2/Mpk1 are involved in the mating-pheromone response, the filamentous-invasion pathway, the high osmolarity growth, and the cell integrity pathway, respectively. The fifth MAPK, Smk1, is believed to play a role in spore wall assembly [16, 17].
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Haploid yeast cells sense the reciprocal mating pheromones (α-factor or a-factor) through Ste2 and Ste3 GPCRs. The signal is then transmitted by GTPases to the p21-activated kinase (PAK)-like kinase Ste20, the MAPK scaffold Ste5, Cdc42, a guanine-nucleotide exchange factor (GEF), and Far1. Ste5 signals and serves as a scaffold that links the MAP4K and the MAPK signalosome (Ste11 → Ste7 → Fus3; the latter is the ERK1 homolog) [18].
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The high osmolarity glycerol (Hog1) MAPK, the yeast homolog of p38, is activated in response to osmotic stress as a consequence of signaling elicited from two upstream-independent mechanisms (Sln1/Sho1). The Sln1 sensor is the primary osmosensor and is a complex variation of the well-known bacterial two-component system. Upon osmostress, inactivation of the transmembrane histidine kinase Sln1 leads to the derepression and activation of the MAP3K (Ssk2/22) via Ypd1/Skk1. The Sho1 osmosensing branch is mediated by mucin-like proteins (Hkr1 and Msb2) and ultimately activates the MAP3K Ste11 through the integral transmembrane protein Opy2, the GTPase Cdc42 and the MAP4K Ste20. These two osmosensing branches converge at the MAP2K (Pbs2) that acts as a scaffold protein for phosphorylation of the MAPK Hog1 [19].
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The filamentous/invasive growth pathway leads to the activation of Kss1 (an ortholog of mammalian Erk2) under nutrient limiting conditions and, to a much lesser extent, to pheromone stimulation. Remarkably, it relies on proteins involved in the HOG pathway and the pheromone pathway (Mep2, Gpr1, Msb2, Sho1, Ste20, Ste11, and Ste7). In this case, specific activation of Kss1 is achieved by the absence of the Ste5 scaffold that liberates Ste7 allowing its interaction with Kss1 [20].
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Cell wall instability is sensed through the cell wall integrity pathway (CWI) (Mpk1 MAPK) and is detected by five mechanosensors (Wsc1–3, Mid2, and Mtl1) that interact with the guanine nucleotide exchange factor (GED) Rom2 to activate Rho1 GTPase leading to protein kinase C (Pkc1) phosphorylation. Yeast Pkc1 serves as a MAP4K that phosphorylates the MAP3K Bck1, which leads to activation of Mpk1 through activation of the redundant MAP2K (Mkk1/2). Despite the absence of a cell wall in higher eukaryotes, mammalian ERK5 has been characterized as a functional ortholog of the CWI pathway [21].
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Finally, the meiosis-specific MAPK Smk1 controls the postmeiotic program in diploid cells subjected to nutrient starvation. Activation of Smk1 differs from activation of MAPKs in the classical three-tiered MAPK cascade in which a CDK-activating kinase (CAK1) phosphorylates Smk1 and induces its auto-phosphorylation [22].
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2.4. Dynamics of signal transduction
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According to the nature of its input signal, MAPK activation can range from minutes (transient) to hours (sustained). The dynamics of MAPK activation results from the interplay between the extracellular environment and a myriad of intracellular feedforward/feedback regulators that give rise to cell fate decisions during cancer progression or development. For example, pulses of or continuous high EGF administration induce transient ERK activation and cell proliferation in rat adrenal cells, whereas repeated pulses of low EGF induce ERK-mediated differentiation into sympathetic-like neurons [23]. Similarly, different dynamics of JNK can generate opposing behaviors as persistent JNK activation has been shown to trigger apoptosis while its transient activation promotes cell survival [24]. Despite different signaling dynamics can determine cell fate, the underlying molecular mechanisms are not well understood.
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2.5. Output responses to MAPK activation
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The first response to extracellular insults is the immediate arrest of cell growth and hence a blockage of or a delay in cell cycle progression. Once activated, the different MAPKs phosphorylate a large number of substrates that distribute over many cellular compartments. In general terms, the ERK1/2 pathway is mainly associated with the promotion of growth in most cell types and is often linked with differentiation processes, although it can occasionally suppress cell survival [25]. Similarly, ERK5 also promotes proliferation during normal cell growth and differentiation [3]. On the other hand, JNK and p38 pathways have a well-established role in apoptosis, although they have also been shown to contribute to survival, immunity, development, and differentiation [4, 26, 27, 28, 29]. One of the main mechanisms by which MAPKs modulate the abovementioned cellular processes is by controlling gene expression, mainly through regulation of the transcriptional machinery, chromatin structure, and post-transcriptional modifications.
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3. Nuclear localization and function of MAPKs
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In resting cells, MAPK components are usually located in the cytoplasm through their interaction with different anchor proteins, scaffolds, or phosphatases. Upon stimulation, MAPK signaling cascades rapidly transmit information into the nucleus to ensure the appropriate transcriptional response (Figure 2A). Across eukaryotes, this process is often initiated by transient accumulation of the MAPKs within the nucleus. The duration and the type of stimuli affect the nuclear localization of MAPK signaling proteins and play an important role in determination of the transcriptional output. Translocation of MAPK molecules requires specialized transport elements to travel through the nuclear pore complex (NPC). Nucleoplasmic shuttling of active MAPK can be mediated mainly by three strategies: (1) active regulation of import-export through the NPC; (2) escape from cytoplasmic anchors and/or sequestration by nuclear components; and (3) passive diffusion.
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Figure 2.
MAPK regulatory roles on gene expression: From transcription initiation to translation. (A) Activated MAPK is released from its cytoplasmic anchor and translocated to the nucleus. (B) From top and clockwise, MAPK regulation on different targets is represented by a black arrow; MAPKs are known to activate transcription factors (TFs) through phosphorylation and to recruit PolII to initiate transcription. Moreover, MAPKs also target several chromatin remodelers (Ch Rem) and histone modifiers (Hist mod) to regulate chromatin structure and histone eviction. MAPK interacts with transcription elongating (TEF) and termination factors to enhance transcription rate. mRNA is shown as a green line with a 5′ cap (green dot) and the polyA at the 3′ end. MAPKs also regulate several stabilizing RNA-binding proteins (RBPs), target miRNA processing through the microprocessor complex (MC), nuclear exporters, and splicing factors. Finally, MAPKs are also known to regulate translation elongation initiation factors (eIFs) to stimulate rapid mRNA translation. Overall, all these mechanisms aim to promote a rapid and efficient response for maximal cell adaptation.
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Canonical nuclear localization is an active process during which nuclear α/β importin complexes deliver cargo containing mono- or bi-partite stretches of basic residues (nuclear localization signals—NLSs) to the nucleus. Once in the nucleus, targeted proteins dissociate from importins by interacting with RanGTP. For example, in its inactive state, a nuclear export signal (NES) is exposed in ERK2, which confines it to the cytoplasm. Upon activation of ERK2, a conformational change disrupts its N- and C-terminal interactions, thereby exposing a NLS that sends the kinase into the nucleus. Similarly, activation of ERK1/2 allows their interaction with importin-7 and their nuclear accumulation [30]. Not only ERK1/2 nuclear accumulation is mediated through Ran as direct interaction, but also phosphorylation of nucleoporins (NUP50) facilitates translocation through importin-β [31]. The mechanisms by which p38 and JNK translocate into the nucleus are far less well understood. Recently, the motifs for interaction of both p38 and JNK with importins 3, 7, and 9 have been mapped at their N-terminal region. Ablated interaction of p38/JNK with their importins selectively impairs their nuclear accumulation and phosphorylation of their nuclear but not their cytosolic targets [32]. Nuclear translocation of the budding yeast Hog1 requires both Ran (GSP1) and importin-β (NMD5). Phosphorylation of Hog1 by its MAP2K Pbs2 is essential for its translocation, while MAPK activity is dispensable for its import. Similar to mammalian MAPKs, transcription factors such as Msn2/4, Hot1, Sko1, and the nuclear phosphatase Ptp2 contribute to the nuclear retention of Hog1. Dephosphorylated Hog1 is exported out of the nucleus through an importin-β homolog, XPO1. Blocking its nuclear export traps Hog1 in the nucleus but does not prevent its dephosphorylation [33].
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An increasing body of knowledge supports the presence of other upstream kinases: MEK1/2, MEK5, MEKK2/3, and MKK6 in the nucleus [3, 6, 34, 35]. The role of upstream signaling components in transcriptional regulation has not received much attention and requires deeper understanding.
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4. MAPK-regulated gene expression
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Nuclear localized MAPKs have the capacity to rewire the transcriptional architecture by controlling several layers of mRNA biogenesis (Figure 2B). Nuclear localized MAPKs are competent to govern the transcription cycle by acting on several layers of the process. Temporal integration of MAPK signaling into transcription is generally mediated by the phosphorylation of hundreds of transcription-related targets. How this transcriptional control is achieved will be discussed in this section.
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4.1. Genes regulated by MAPK activation: global induction/repression patterns
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MAPK activation overrides the homeostatic transcriptional program by transiently governing the simultaneous upregulation and downregulation of gene expression. Activation of different MAPK cascades leads to a pathway-specific transcriptional landscape. This stimuli-specific response is required to redefine the demands of each condition and involves the regulation of all RNA species. Unbiased approaches such as tiling arrays and RNA-seq have further extended the type of MAPK-regulated transcripts to noncoding RNA (ncRNA), long noncoding RNA (lncRNA), and, specifically in higher eukaryotes, the expression of miRNA.
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The MAPK-induced transcriptional response encompasses not only stimuli-specific genes but also a set of well-defined genes that respond to multiple signals, providing coping mechanisms for adaptation. The transcriptional program induced by MAPK activation is classically described in two stages: A primary response is independent of protein synthesis and triggers the expression of immediate and delayed early genes (IEG and DEG, respectively). Then, the secondary response follows in a protein synthesis-dependent manner to induce the expression of secondary response genes [36]. Here, we will focus our attention on the mechanisms that promote gene induction.
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During this early or primary response, cells have to be able to repress cell cycle and growth genes while upregulating several transcription factor genes, which, once translated, will amplify the signal to generate a secondary or late response [37]. Thus, while a selected group of genes are upregulated, the rest of the transcriptome is transiently downregulated. Understanding of the mechanisms of MAPK-mediated gene repression has lagged behind when compared to the activating mechanisms, but some well understood prominent targets of repression are cell cycle- and growth-related genes (cyclins, tRNAs, and rRNAs).
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4.2. MAPK as components of the transcriptional machinery
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MAPKs localize and interact with all of the regulatory regions of their target genes to control gene expression through similar principles but through distinct molecular mechanisms. These mechanisms include the coordinated control of transcription initiation, elongation, and termination together with modulation of chromatin architecture to ensure proper transcription through its target genes. MAPK phosphorylation of chromatin-related factors alters their activity by regulating their nuclear localization, protein stability, or affinity to DNA [38].
Transcription initiation is the first step in governing gene expression and can be either directly or indirectly regulated by MAPKs. The most common regulatory mechanism involves the control of promoters by the regulation of an intricate network of transcription factors usually through direct phosphorylation and/or by induction of their expression [39]. Transcription factors serve as anchoring platforms for the recruitment of MAPKs to chromatin. Chromatin-tethered MAPK nucleates the key signaling components to promoters and other regulatory elements to form a competent pre-initiation complex (PIC). Examples of “hubs” in the transcription factor network that facilitate the recruitment of active MAPK to chromatin are Elk-1, c-Jun and c-Fos for p38, ERKs, and JNKs. ERK5 is a rare MAPK that contains a transcriptional coactivator domain and has the capability of stimulating transcription through transcription factors or by direct binding to DNA through its noncatalytic region [3].
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One of the best characterized transcription factors is c-Jun upon which stimulation is phosphorylated by JNK in its transactivator domain, which is required for induction of its maximal transcriptional activity and increased protein stability [39]. A single-transcription factor can serve to integrate signals from different MAPKs, or several MAPKs can cooperate in regulation of the same target. In response to UV light, both p38 and ERK contribute to the activation of c-Fos. On the other hand, efficient Elk1 phosphorylation is achieved by its differential interaction with ERK1/2, p38, and JNK. Activated Elk1 induces the expression of c-Fos and c-Jun transcription factors that will subsequently regulate a second transcriptional wave that includes other transcription factors and phosphatases [38]. Alternatively, a more indirect method to promote transcription is to activate downstream kinases that will themselves activate other transcription factors. For example, p38 activates two downstream kinases, mitogen- and stress-activated kinase 1/2 (MSK1–2), that activate another set of transcription factors STAT1/3, CREB, ATF1, and NF-ĸB [40].
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In yeast, Fus3 and Kss1 MAPKs activate the transcription factor Ste12 that induces the expression of over 200 genes, including its own gene [41]. For example, in yeast, the combination of deletions of transcription factors and genome-wide analyses has been especially useful in providing a detailed view of the circuitry activated by the Hog1 or Fus3 MAPKs [42, 43].
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The interrelationship between transcription factors and MAPKs is conserved throughout evolution, although the number of players and their functions has increased over time. MEF2 family transcription factors are substrates for several ERKs and in particular for p38 [44]. In yeast, it has been widely reported that the different transcription factors relevant for osmoresponsive gene expression are phosphorylated and recruited to target genes in a Hog1-dependent manner [45, 46]. Targeted recruitment of the MAPK activation machinery can also include recruitment of upstream MAPK-regulatory kinases. Examples of such in mammals are the recruitment of MEK1/2 to ERK-dependent genes [47] and the recruitment of MKK6 to p38 targeted regions in a MAPK-dependent manner [35]. Yeast upstream MAPK components have received far less attention than those of mammals, although Ste5 also associates with chromatin upon pheromone stimulation [48].
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Besides controlling transcription factors, MAPKs control several other enzymatic activities, protein complexes, and targets that contribute to the formation of a transcriptionally competent Pre-Initiation Complex (PIC) (SAGA, Mediator, Ubp3) [49, 50]. A critical downstream node for MEK1/2 and ERK1/2 signaling upon the induction of EGF responsive genes is the integrator complex, a transcriptional coactivator. The binding of integrator to chromatin depends on catalytically active ERK1/2. Indeed, inhibition of the MAPK resulted in diminished association of integrator and RNA Pol II to chromatin [51].
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4.2.2. Transcription elongation
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Our knowledge of MAPK-regulated transcriptional control extends far beyond its control of transcription initiation and mainly originates from analysis of yeast MAPKs. The detection of MAPKs at the coding regions of their target genes suggested a far more extensive role for MAPKs as crucial components of the transcription regulatory complex. Seminal work regarding this phenomenon has been done in S. cerevisiae in which the association of Hog1, Fus3, and Mpk1 MAPKs with the coding regions of their target genes has been reported. Mpk1 elicits elongation of stress-responsive genes in a catalytic-independent manner by its interaction with the Paf1 elongation complex. Mpk1 is tethered to its target genes through binding to Paf1 that serves as a scaffold to escort Mpk1 into the elongating RNA Pol II. This binding requires the presence of the cell cycle transcriptional regulator SBF. The loss of this interaction restricts Mpk1 to the promoter region, which impairs both transcription and cell viability upon stress [52]. In response to osmotic stress, Hog1 and Paf1 interact through an unknown region, but the function and outcome of the Paf1 complex are kinase-specific.
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The majority of genes targeted by Hog1 display an enrichment of the MAPK throughout the coding region [53, 54] that is mediated by the 3’UTR and is independent of promoter association. ORF-bound Hog1 behaves as a selective elongation factor by traveling and interacting with phosphorylated RNA Pol II (Rpb1). As RNA Pol II moves across the gene, it regulates chromatin structure through the recruitment of chromatin remodelers and chromatin-modifying enzymes (Section 4.3). Moreover, Hog1 phosphorylates the Spt4 elongation factor to regulate RNA Pol II processivity to stimulate elongation efficiency at stress-responsive genes [55]. As happens during initiation, Hog1 recruits other protein complexes with specific enzymatic activities such as deubiquitinase (Ubp3) to ensure the proper production of stress-responsive genes [50]. Further studies in mammalian cells also corroborated p38 binding to coding regions of genes not only in response to osmotic stress but also during skeletal muscle differentiation, suggesting that the mechanism and purposes of Hog1/p38 transcriptional regulation are conserved throughout evolution.
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Transcription elongation rates for many genes depend on the entangled interplay of factors and complexes that regulate RNA Pol II. During elongation, a number of positive and negative elongation factors (P-TEFs and N-TEFs, respectively) have been shown to accelerate or attenuate Pol II, and, not surprisingly, these factors are targeted by MAPKs at stress-responsive genes. In response to hormone stimulation, MEK1 and ERK1/2 promote elongation and abolish pausing of RNA Pol II [56].
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4.2.3. Termination
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Unlike initiation and elongation, transcription termination can be carried out through different pathways depending on the coding or noncoding nature of the transcript. The two best defined termination pathways that are also highly conserved are the polyA-dependent pathway for protein coding and the Sen1-dependent pathway for noncoding transcripts.
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One of the best studied examples of the involvement of MAPKs in the control of transcription termination is that of the role of Mpk1 in transcription termination during heat stress in yeast. As mentioned before, Paf1 and Mpk1 interact at heat responsive genes; this association prevents the recruitment of the Sen1-Nrd1-Nab3 termination machinery (NNS). Interestingly, the same study showed that human ERK5 and human Paf1 complex expressed in yeast also regulated termination in response to cell wall stress [52]. Mpk1 has recently been shown to directly phosphorylate Tyr1 in the RNA Pol II CTD as it traverses the coding region with the elongating machinery. This phosphorylation occurs in a stress-dependent manner and prevents early termination through the NNS pathway [57]. Deep sequencing of osmotically stressed neuronal cell lines identified a new set of transcripts termed downstream of gene-containing transcripts (DoGs). These noncoding transcripts span large region downstream of annotated gene features (>45 Kb) and are actively regulated through IP3 signaling [58].
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4.3. MAP kinases and their effects on chromatin
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MAPKs facilitate the abovementioned transcription activity by also regulating several chromatin remodelers to generate the proper chromatin environment for the transcription machinery. For induction of gene expression, chromatin must be accessible to allow the assembly of transcription factors, RNA Pol II and other factors, during initiation, elongation, and termination. These chromatin remodelers have been studied in both yeast and mammalian models as has been extensively reviewed in [38].
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There are numerous examples of MAPKs interacting with chromatin remodelers. For instance, both Hog1 and p38 govern the recruitment of the remodeling complex SWI/SNF to target genes [38]. On the other hand, MAPK regulation goes beyond the substrate phosphorylation. As described in previous sections, MAPKs can also regulate chromatin remodeling through direct protein-protein interactions. This is the case with ERK2, which contacts PolyADP-ribose polymerase (PARP1), thereby increasing its activating activity on chromatin remodelers [59]. Apart from chromatin remodelers, MAPKs govern a cohort of histone modifiers that not only destabilize nucleosomes but also, in a more complex manner, generate selective marks that dictate nucleosome dynamics. An example of this type of regulation is the Hog1-dependent gene recruitment of Rpd3, a histone deacetylase, that induces gene expression by promoting the eviction of histones at osmoresponsive genes [60] and the regulation of H3K4 monomethylation to dictate specificity of chromatin remodelers [61]. During elongation, as Hog1 travels with the elongating RNA polymerase, it recruits the RSC remodeling complex, thereby facilitating transcription along the gene body [62]. In mammals, ERKs, p38, and JNK promote the phosphorylation of H3S10 either directly or through their downstream kinases [38, 63]. p38 also phosphorylates the transcription factor MEF2D, which, in turn, leads to recruitment of the Ash2L-containing methyltransferase complex that generates an increase in the activating mark H3K4me3 [64]. These examples highlight the relevance of MAPK-mediated histone modification to generate an efficient chromatin remodeling robustly achieved through different mechanisms.
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MAPKs also regulate gene silencing through chromatin remodelers. ERK1/2 directly interacts with the histone deacetylase 4 (HDAC4) that removes acetyl groups leading to chromatin condensation [6]. Similarly, Hog1 promotes the transcription of PNC1, which encodes an activator of Sir2, a histone acetyltransferase that protects sensible rRNA-coding regions from DNA damage [65]. In these two cases, MAPKs act as repressing elements of chromatin remodeling.
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5. Role of MAPK signaling in post-transcriptional regulation
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The ultimate goal of MAPK-mediated transcriptional reprogramming is to change the proteome composition. This change becomes especially important upon extracellular challenge when a massive pool of previously low-abundant RNAs needs to be expressed. Activated MAPKs target mRNA-binding proteins to downregulate unnecessary mRNAs and favor expression of the required genes in order to adapt to the new conditions [31, 45].
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5.1. Transcript/RNA stability
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Genomic run-on (GRO) experiments that have revealed global changes of gene expression in response to stress are also achieved through the regulation of mRNA stability and decay [66]. In yeast, upon osmotic stress, there is a broad mRNA destabilization, while Hog1 plays a role on the stabilization of osmo-induced mRNAs [67]. The p38 MAPK pathway is also a key regulator of the mRNA stability of both TTP (tristetraprolin), a protein that shortens the half-lives of adenine-uracil rich element (ARE)-containing mRNA, and HuR (human antigen R), a protein that stabilizes such mRNA. The role of p38 turns out to be opposed depending on the cell type [68]. Like p38, ERK and possibly JNK are thought to target HuR, changing its localization to the cytosol, where it stabilizes ARE-containing mRNA [69]. As a further example of the role of p38 in regulating mRNA stability, p38-mediated phosphorylation of ADAR1p110, another mRNA-binding protein, suppresses apoptosis in stressed cells by protecting many antiapoptotic gene transcripts from mRNA decay [70].
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Another layer of transcriptional regulation coordinated by MAPKs, which has gained importance over the years, is the regulation of miRNA biogenesis. A relevant example of the coordination of the regulation of miRNA by different MAPK cascades is the regulation that takes place in the early stages of the inflammatory response. JNK and p38 trigger transcription of the miRNA let-7f, which downregulates the expression of Blimp1 and PRDM1, two transcriptional repressors of inflammatory genes. Since a sustained expression of inflammatory genes is detrimental, later activation of ERK promotes the transcription of Lin28, an inhibitor of let-7f biogenesis, thereby increasing the expression of the Blimp1 and PRDM1 repressors [71]. Here, the same stimuli generate a time-dependent regulated activation of multiple signaling pathways to achieve a finely tuned transcriptional response.
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5.2. mRNA export
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There are numerous examples of interactions between MAPK pathways and different components of the mRNA exporting machinery in biological systems ranging from yeast to mammalian cells. In yeast, it has been reported that, in response to osmotic or heat stress, Hog1 and Mpk1, respectively, phosphorylate components of the nuclear pore complex to increase the export efficiency of stress-responsive mRNAs [72, 73]. Similarly, in mammals, both p38 and ERK pathways regulate RNA-binding proteins such as eIF4E or hDl1 that facilitate mRNA export [74, 75]. In the event of stress, the export of the newly transcribed mRNAs is prioritized to maximize the transcriptional response.
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5.3. mRNA splicing
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The transcriptional response to external stimuli generates an outburst of mRNAs that have to be spliced. The associations between splicing events that modulate MAPK genes are becoming increasingly relevant in human disease [76]. One strategy to regulate splicing under stress is phosphorylation of the splicing factor TDP-43 by MEK1/2, which prevents TDP-43 aggregation [77]. Another mechanism of regulating splicing is by interfering with the localization of splicing factors such as RNM4, hn-RNPA1, or hSlut7 [78, 79, 80].
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5.4. Translation
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Translation plays a pivotal role in the control of gene expression and is tightly regulated by MAPK pathways that modulate the activity of several components within the translational machinery [81]. In yeast, Hog1 promotes Rck2-mediated attenuation of protein synthesis in response to osmotic stress by phosphorylation of the translation elongation factor 2 (EF-2) [82]. ERK- and p38-activated MNKs phosphorylate the elongation initiation factor eIF4E to enhance translation initiation [83]. Another example is the activation of RSK, a downstream kinase of ERK. RSK phosphorylates S6, a component of the 40S ribosomal subunit, as well as the elongation initiation factor eIF4B, which facilitates their binding to eIF3 to promote mRNA translation [84, 85]. Besides the targeting of newly transcribed mRNAs, translation regulation can also target mRNAs that have not been transcriptionally induced, a type of regulation found in yeast and mammals [86].
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6. Future perspectives and challenges
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Due to their master regulatory role, MAPKs have sparked a lot of interest and have been the main focus of multiple researchers worldwide over the last 30 years. As MAPK knowledge advances, it has become obvious that the external control of MAPK activity has the potential to modulate cellular behavior and survival. Moreover, MAPK signaling has been found to be altered or defective in many human diseases such as cancer; therefore, achievement of the control of MAPK activity could provide an attractive intervention point for new therapeutic approaches. However, despite the tremendous amount of knowledge generated, there are fundamental questions that remain to be elucidated in order to transform the biomedical potential of MAPKs into a reality.
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While the central core of MAPK signaling cascades has been extensively described, branches of the networks have not yet been completely identified. This is especially true in terms of the upstream sensors, where the picture is not well defined, especially in higher eukaryotes. In the immediate future, we therefore foresee that more sophisticated approaches using CRISPR/Cas9 and RNAi-based libraries will provide a means to perform systematic genome-wide genetic screens to reveal missing components of these pathways.
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Additionally, there are other features of MAPK signaling that might have been overlooked. An example of such a feature is the peptide-mediated blockage of p38/JNK interaction with importins, which reduces their nuclear export. The presence of this peptide impaired MAPK nuclear localization and decreased cell proliferation and tumor growth to a larger extent than the presence of commercial p38 inhibitors. These data open up a new perspective on MAPK regulation and need to be further examined as they could provide a new therapeutic intervention strategy to regulate MAPK activity [32]. It is clear that nuclear localization stimulates the encounter of MAPKs with defined chromatin loci, where their targets are located to provide specificity for gene induction; however, how the kinases are directed to these regions is not clear. Similarly, the molecular mechanisms of transcriptional termination have only recently been uncovered, and there are few reports regarding the targets and the control of MAPKs in termination, as many noncoding RNAs have been shown to be regulated by MAPKs such as Hog1/p38 and ERK2 [87, 88].
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Remarkably, upstream MAPK pathway components as transcriptional regulators are also unclear, although the recruitment of several MAP2Ks (MEK1/2, MKK6) to chromatin has been detected. Furthermore, an extreme case has been reported in which, upon insulin stimulation, the entire signaling pathway from the insulin receptor to the ERK signaling cascades is recruited to insulin inducible loci [89]. The functions and consequences of such recruitment require further investigation. Due to their master regulatory role, MAPKs have generated a lot of interest. It is clear that controlling MAPK activity could provide a means of controlling cell behavior. Additionally, understanding the consequences of heterogeneity for MAPK-regulated events will be crucial for understanding differential responses to extracellular stimuli and therapeutic treatments. In conclusion, it is of utmost importance that MAPK-mediated mechanisms of controlling gene expression are fully characterized in order to further identify druggable targets/processes that are relevant to human diseases.
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Acknowledgments
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MNR is a recipient of a Maria de Maeztu Postdoctoral Fellowship (Doctores Banco de Santander-María de Maeztu at Universitat Pompeu Fabra). GMC is a recipient of an FPI Predoctoral Fellowship (Spanish Ministry of Economyv Industry and Competitiveness (MINECO). The FP and EdN’s laboratory is supported by grants from the Spanish Ministry of Economy and Competitiveness (BFU2015-64437-P to FP and BFU2017-85152-P and FEDER to EN), the Catalan Government (2017 SGR 799), the Fundación Botín, and the Banco Santander through its Santander Universities Global Division to FP and the Unidad de Excelencia Maria de Maeztu, MDM-2014-0370. FP is a recipient of an ICREA Acadèmia (Generalitat de Catalunya). We gratefully acknowledge funding from the Spanish Ministry of Economy, Industry, and Competitiveness (MINECO) through the Centers of Excellence Severo Ochoa award and from the CERCA Program of the Catalan Government.
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Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"MAP kinases, signal transduction, transcription, gene expression, chromatin",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/63916.pdf",chapterXML:"https://mts.intechopen.com/source/xml/63916.xml",downloadPdfUrl:"/chapter/pdf-download/63916",previewPdfUrl:"/chapter/pdf-preview/63916",totalDownloads:1107,totalViews:113,totalCrossrefCites:1,totalDimensionsCites:5,totalAltmetricsMentions:0,impactScore:3,impactScorePercentile:85,impactScoreQuartile:4,hasAltmetrics:0,dateSubmitted:"April 30th 2018",dateReviewed:"July 31st 2018",datePrePublished:"November 5th 2018",datePublished:"April 17th 2019",dateFinished:"October 4th 2018",readingETA:"0",abstract:"A change in the transcriptional landscape is an equilibrium-breaking event important for many biological processes. Mitogen-activated protein kinase (MAPK) signaling pathways are dedicated to sensing extracellular cues and are highly conserved across eukaryotes. Modulation of gene expression in response to the extracellular environment is one of the main mechanisms by which MAPK regulates proteome homeostasis to orchestrate adaptive responses that determine cell fate. A massive body of knowledge generated from population and single-cell analyses has led to an understanding of how MAPK pathways operate. MAPKs have thus emerged as fundamental transcriptome regulators that function through a multi-layered control of gene expression, a process often deregulated in disease, which therefore provides an attractive target for therapeutic strategies. Here, we summarize the current understanding of the mechanisms underlying MAPK-mediated gene expression in organisms ranging from yeast to mammals.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/63916",risUrl:"/chapter/ris/63916",book:{id:"7566",slug:"gene-expression-and-control"},signatures:"Mariona Nadal-Ribelles, Carme Solé, Gerard Martínez-Cebrián,\nFrancesc Posas and Eulàlia de Nadal",authors:[{id:"256797",title:"Prof.",name:"Francesc",middleName:null,surname:"Posas",fullName:"Francesc Posas",slug:"francesc-posas",email:"francesc.posas@upf.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"256799",title:"Dr.",name:"Mariona",middleName:null,surname:"Nadal",fullName:"Mariona Nadal",slug:"mariona-nadal",email:"mariona.nadal@upf.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"256800",title:"Dr.",name:"Carme",middleName:null,surname:"Sole",fullName:"Carme Sole",slug:"carme-sole",email:"carme.sole@upf.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"256801",title:"Mr.",name:"Gerard",middleName:null,surname:"Martinez-Cebrian",fullName:"Gerard Martinez-Cebrian",slug:"gerard-martinez-cebrian",email:"gerard.martinez-cebrian@upf.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"256802",title:"Prof.",name:"Eulàlia",middleName:null,surname:"De Nadal",fullName:"Eulàlia De Nadal",slug:"eulalia-de-nadal",email:"eulalia.nadal@upf.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. MAP kinase pathways",level:"1"},{id:"sec_2_2",title:"2.1. MAPK activators",level:"2"},{id:"sec_3_2",title:"2.2. Modular architecture of the MAPK signaling cascades",level:"2"},{id:"sec_3_3",title:"2.2.1. Specificity of signaling cascades",level:"3"},{id:"sec_4_3",title:"2.2.2. Regulators of signaling cascades",level:"3"},{id:"sec_6_2",title:"2.3. Yeast MAPK cascades",level:"2"},{id:"sec_7_2",title:"2.4. Dynamics of signal transduction",level:"2"},{id:"sec_8_2",title:"2.5. Output responses to MAPK activation",level:"2"},{id:"sec_10",title:"3. Nuclear localization and function of MAPKs",level:"1"},{id:"sec_11",title:"4. MAPK-regulated gene expression",level:"1"},{id:"sec_11_2",title:"4.1. Genes regulated by MAPK activation: global induction/repression patterns",level:"2"},{id:"sec_12_2",title:"4.2. MAPK as components of the transcriptional machinery",level:"2"},{id:"sec_12_3",title:"4.2.1. Transcription initiation: transcription factor modification",level:"3"},{id:"sec_13_3",title:"4.2.2. Transcription elongation",level:"3"},{id:"sec_14_3",title:"4.2.3. Termination",level:"3"},{id:"sec_16_2",title:"4.3. MAP kinases and their effects on chromatin",level:"2"},{id:"sec_18",title:"5. Role of MAPK signaling in post-transcriptional regulation",level:"1"},{id:"sec_18_2",title:"5.1. Transcript/RNA stability",level:"2"},{id:"sec_19_2",title:"5.2. mRNA export",level:"2"},{id:"sec_20_2",title:"5.3. mRNA splicing",level:"2"},{id:"sec_21_2",title:"5.4. Translation",level:"2"},{id:"sec_23",title:"6. Future perspectives and challenges",level:"1"},{id:"sec_24",title:"Acknowledgments",level:"1"},{id:"sec_27",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Seger R, Wexler S. The MAPK signaling cascades. In: Bradshaw RA, Stahl PD, editors. Encyclopedia of Cell Biology. Academic Press. Elsevier Inc; 2015. pp. 122-127. 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DOI: 10.1101/cshperspect.a012252\n'},{id:"B82",body:'Teige M, Scheikl E, Reiser V, Ruis H, Ammerer G. Rck2, a member of the calmodulin-protein kinase family, links protein synthesis to high osmolarity MAP kinase signaling in budding yeast. Proceedings of the National Academy of Sciences. 2001;98:5625-5630. DOI: 10.1073/pnas.091610798\n'},{id:"B83",body:'Waskiewicz AJ, Flynn A, Proud CG, Cooper JA. Mitogen-activated protein kinases activate the serine/threonine kinases Mnk1 and Mnk2. The EMBO Journal. 1997;16:1909-1920. DOI: 10.1093/emboj/16.8.1909\n'},{id:"B84",body:'Roux PP, Shahbazian D, Vu H, Holz MK, Cohen MS, Taunton J, et al. RAS/ERK Signaling promotes site-specific ribosomal protein S6 phosphorylation via RSK and stimulates cap-dependent translation. Journal of Biological Chemistry. 2007;282:14056-14064. DOI: 10.1074/jbc.M700906200\n'},{id:"B85",body:'Shahbazian D, Roux PP, Mieulet V, Cohen MS, Raught B, Taunton J, et al. The mTOR/PI3K and MAPK pathways converge on eIF4B to control its phosphorylation and activity. The EMBO Journal. 2006;25:2781-2791. DOI: 10.1038/sj.emboj.7601166\n'},{id:"B86",body:'Warringer J, Hult M, Regot S, Posas F, Sunnerhagen P. The HOG pathway dictates the short-term translational response after hyperosmotic shock. Molecular Biology of the Cell. 2010;21:3080-3092. DOI: 10.1091/mbc.E10-01-0006\n'},{id:"B87",body:'Göke J, Chan Y-S, Yan J, Vingron M, Ng H-H. Genome-wide kinase-chromatin interactions reveal the regulatory network of ERK Signaling in human embryonic stem cells. Molecular Cell. 2013;50:844-855. DOI: 10.1016/J.MOLCEL.2013.04.030\n'},{id:"B88",body:'Nadal-Ribelles M, Solé C, Xu Z, Steinmetz LM, de Nadal E, Posas F. Control of Cdc28 CDK1 by a stress-induced lncRNA. Molecular Cell. 2014;53:549-561. DOI: 10.1016/j.molcel.2014.01.006\n'},{id:"B89",body:'Nelson JD, LeBoeuf RC, Bomsztyk K. Direct recruitment of insulin receptor and ERK signaling cascade to insulin-inducible gene loci. Diabetes. 2011;60:127-137. DOI: 10.2337/db09-1806\n'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Mariona Nadal-Ribelles",address:null,affiliation:'
Departament de Ciències Experimentals i de la Salut, Cell Signaling Research Group, Universitat Pompeu Fabra (UPF), Spain
Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Spain
Departament de Ciències Experimentals i de la Salut, Cell Signaling Research Group, Universitat Pompeu Fabra (UPF), Spain
Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Spain
'},{corresp:"yes",contributorFullName:"Eulàlia de Nadal",address:"francesc.posas@upf.edu",affiliation:'
Departament de Ciències Experimentals i de la Salut, Cell Signaling Research Group, Universitat Pompeu Fabra (UPF), Spain
Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Spain
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1. Introduction
Stent is an artificial tube graft defined as “a short narrow metal or plastic tube often in the form of a mesh that is inserted into the lumen of an anatomical vessel (such as an artery or a bile duct) especially to keep a previously blocked passageway open” [1]. Stenting is a medical procedure for placing a stent. It should be differentiated from shunting, when a tube conduit is used for allowing flow between two previous unconnected structures. Splint refers to a rod- or a cast-like shell device placed outside any desired organ to make it stable. An endoprosthesis refers to a stent inserted into the lumen (endoluminal), which can be inside the gastrointestinal (GI) visceral tract (esophagus, stomach, duodenum, intestinal, colorectal), or into a blood or biliary vessel (endovascular or endobiliary, respectively).
The term stent is an eponym of a British dentist, Charles T. Stent (1807–1885), who developed a compound originally used for dental impressions [2]. He developed a formula made of gutta-percha, a natural latex produced from tropical trees native to Southeast Asia and Northern Australia. The etymological origin of “stent” as a term in surgery started with Dr. Johannes F. Esser in 1917, which used Stent’s dental compound as a mold for bridging skin grafts [2]. The term stent became popular among surgeons for such applications and was then later used to define any surgical mold for bridging tissues until a healing process has taken place, as in 1954, when a polyethylene tube was described by Drs. Remine and Grindlay as “to act as a stent for the anastomosis” in experimental biliary surgery [2].
In gastroenterology, gastrointestinal stents have been originally used to treat obstructed cancer in the GI tract. From early modern medicine in the nineteenth century until nowadays, GI tract cancer or luminal palliation has always been a huge challenge for surgeons and physicians. In esophageal cancer, for example, nonsurgical attempts to relieve dysphagia and starvation from the early to mid-1800s were esophageal dilatation or placement of an esophageal gumlike, rubber-made tube. The esophageal tube was passed through the mouth or nose across the tumor, acting as a feeding tube, with no effect on dysphagia [3]. These early esophageal tubes ultimately gave place to flexible polyethylene or silicone nasogastric feeding tubes used today. It was a matter of time for physicians to come out with a solution involving an artificial tube that could fit across the tumor and relieve dysphagia. The first successful esophageal stenting procedure has been credited to Sir Charters James Symonds in 1885 [4], who developed an esophageal semirigid tube with a funnel attached to a silk suture to treat malignant esophageal tumors. This tube was orally and blindly inserted, and the suture was brought out from the mouth and attached to the patient’s ear. Later in the 1920s–1930s, a stent introducer over a guide-wire technique was developed to increase safety and facilitate stent insertion. After further technical developments with the aid of a flexible endoscope, several materials were used to increase softness. Gumlike or black rubber tubes gave place to tubes made of latex or silicone (the Celestin or Atkinson esophageal tube) or also polyvinyl, which all became popular in the 1960s–1980s [5]. Although being the best palliation measure at that time, avoiding surgery, these tubes were associated to high-risk complications, such as esophageal perforation. As they were semirigid, their passage through a narrow friable lumen required prior dilatation. To overcome this problem, a self-expandable tube would be the solution. The first self-expandable metal stent (SEMS) models were stainless steel coil springs [5]. Their design was similar to endovascular stent models produced in the 1980s. For being developed for gastrointestinal (GI) tract use, they were inserted orally using an introducer and a fixation thread to tie them down into a compressed shape around an introducer or a gastroscope. Once positioned across the tumor, the stent was released to expand to its original shape using a novel feature that is producing significantly more radial force expansion instead of mostly axial. These stents became popular compared to their rigid plastic stent counterparts, especially after a first randomized study favoring SEMS over semirigid plastic stents for esophageal cancer [6]. Although being more expensive, they resulted in a higher cost-effectiveness due to their lower complication rates, lower hospitalization rate, and lower mortality. These stents gained significant improvement in design over time: a mesh-like stent to increase flexibility, while retaining a good radial expansion, a longer body, and a proximal flare at its end to prevent migration, and a synthetic covering film to prevent tumor ingrowth.
The third-generation SEMS were made of nitinol (an acronym for nickel titanium Naval Ordnance Laboratories) [5], a so-called memory-shape alloy; once deformed it returns to its pre-deformed shape when heated. This results in a more flexible stent that can fit into a reduced caliber introducer/delivery system. Their first models had a higher foreshortening (25–40%) and a lower radial expansion compared to prior stainless steel models. As they gained later refinements in stent design and metal alloy, these stents are capable of being passed through a working channel of an endoscope to reach deeper parts of the gastrointestinal tract, reaching, for example, the proximal biliary tree, pancreatic duct, and proximal colon. Apart from other models made of self-expandable plastic or biodegradable material, nowadays SEMS remains the standard of care in most gastrointestinal stent applications.
2. Stent types
There are several different gastrointestinal stent shapes and materials (Figure 1), and there is no ideal stent type to date to fit all expectations.
Figure 1.
A typical self-expandable metal stent. One is an uncovered colonic enteral stent (a) and another is a partially covered (silicone covering) esophageal stent (b). Its proximal flange has a larger caliber than its body, to ensure anchoring and prevent migration. Also, a curved wire flange instead of sharp struts is designed to prevent stent piercing into tissue. Picture from Eduardo A. Bonin.
Each distinguished shape and material have several physical properties, which enable a distinct function, ultimately influencing clinical outcome and stent choice (Figure 2) [7].
Figure 2.
Self-expandable stents, one totally made of plastic (silicone) (a), no longer commercially available for the gastrointestinal tract. The other is a multi-wire braided-type metal (nitinol), uncovered stent (b). Note the “kinking effect” of the plastic stent when compressed (a), where the metal stent remains patent, with some foreshortening. Picture from Eduardo A. Bonin.
A laser-cut stent is a seamless metal tube (i.e., nitinol) being cut into several mesh stent patterns, which differs from a handmade woven, wire-braided or knitted stent configuration (Figure 2). A laser-cut stent has higher radial force and a lower foreshortening property, thus being more predictable when deployed. This can be useful in a straight narrow short lumen such as the biliary tree, a coronary vessel, or the bronchial tree [8]. They also have a higher radial force and higher longitudinal force. For some laser-cut stents with pointed struts at its distal end, longitudinal force might induce tissue reaction from direct piercing [8]. Wire-braided or knitted stents are more flexible and have a greater conformability (less “kinking effect”) when deployed (Figure 2). They also allow placing another stent across its mesh, as required in some specific anatomic structures such as the biliary tree.
The most common stent types used in gastroenterology are made of semirigid, plastic tubes (polyethylene) or SEMS (nitinol or stainless steel mesh). Semirigid plastic tube stents are currently being used exclusively in the biliary tree and the pancreas [9]. They are commonly made of polyethylene, a softer plastic with a better molding capability compared to polyurethane. They remain a first-line and cost-effective method compared to fully covered SEMS in most biliopancreatic benign conditions (biliary stricture, fistula) with a lower migration rate, however having higher occlusion rates. Fully covered SEMS are currently being investigated for refractory benign biliary strictures (Table 5). Semirigid, plastic tubes are no longer used in the gastrointestinal tract (esophagus, stomach, or colorectal).
A typical SEMS design has a cylinder-shape body part, which is used to cover or seal the desired area, and a flare (funnel-like shape) at one or both extremities (Figure 1). Self-expandable plastic stents (SEPS) are another version of SEMS in terms of material used. SEMS can be found as uncovered or partially and totally covered using a synthetic covering film such as polyethylene or silicone (Figure 1).
Biodegradable stents and drug-eluting stents are other models under investigation. Biodegradable stents are made of biodegradable material (i.e., polyesters, polycarbonates, bacterial-derived polymers, and corrodible metals), mostly used in coronary artery disease. In gastroenterology, these stents are particularly useful in benign conditions, where a metallic stent would be incorporated to tissue over time, becoming very difficult to remove once achieving a stable luminal patency. Several models have been tested in clinical trials, and none has proved a consistent clinical result in terms of luminal patency. Drug-eluting stents are capable of maintaining patency not only from radial expansion but also from drug delivery directly to tissue, reducing its occlusion rates. These stents are very popular in cardiology, where they are superior to traditional bare stents to prevent coronary artery re-occlusion from endothelial intimal proliferation. In gastroenterology, they have been used in malignant disease to prevent tumor ingrowth and overgrowth. Despite the use of covered SEMS, its synthetic covering membrane is destroyed over time by hydrolysis and oxidation from gastrointestinal contents. Chemotherapeutic antitumoral agents, such as paclitaxel, have been initially tested with no proven benefit over the standard fully covered SEMS. For hydrophilic agents such as gemcitabine, a slow-release surface-stabilizing substance pullulan acetate has been added to increase optimal local drug release. Five-fluorouracil (5-FU) has also being tested as an antiproliferative agent for local tumor control in esophageal and biliopancreatic cancer [10]. Although promising, most of these stents are still in the experimental field, with scarce clinical experience. One major concern about these stents is local drug delivery causing injury to adjacent tissue and distant organ toxicity due to systemic exposure. Setting an appropriate drug concentration and release will enable an optimal local drug distribution to reach the desired effect.
3. A typical SEMS placement procedure in the gastrointestinal tract
A gastrointestinal stenting procedure usually requires the aid of an endoscope under radiological (fluoroscopy) guidance or at least one of these techniques. The procedure can be performed even in high-risk patients, with or without general anesthesia. Stent placement requires a special training and is reserved for interventional radiologists or interventional endoscopy gastroenterologists or surgeons. For SEMS placement there is an introducer system, in which the stent is compressed against a guiding catheter using an outer catheter sheath (Figure 3) or a thread suture (older models).
Figure 3.
A typical catheter-based self-expandable metal stent (SEMS) delivery system. The outer catheter has been pulled back to open the stent (white arrow). This can be done under radiological or endoscopic guidance. Note the SEMS being partially deployed (yellow arrow). The blue arrow depicts the proximal part of the delivery system, which is facing the distal flange of the SEMS (for duodenal and esophageal models). Note some foreshortening of the SEMS while being deployed (distance between the yellow and blue arrows). For biliary and colonic stents, the proximal flange is facing the proximal part of the catheter delivery system. Picture from Eduardo A. Bonin.
The procedure always requires a guide wire, with stiffness enough to avoid kinking, especially for passing a bulky fully covered large SEMS. For such stents a dilation procedure may be required using the smallest caliber dilation possible to avoid perforation. Fortunately, introducer systems are becoming thinner over time to facilitate insertion. Those are commonly used for intestinal and biliary stents. The stent and introducer system (Figure 3) is advanced over the guide wire and placed across the desired area. The stent is then deployed pulling back the outer catheter sheath (or advancing the outer catheter sheath, for a few models), under endoscopic or radiological guidance. The over-the-wire (OTW) technique refers to placing a stent over a guide wire having an endoscope alongside to ensure proper placement, with or without radiological guidance. The through-the-scope (TTS) technique refers to placing the stent over a guide wire using the working channel of an endoscope (Figure 3). Alternatively, one may compress the stent over an endoscope using sutures and release it at difficult-to-reach proximal portions of the gastrointestinal tract (over-the-scope technique) [11]. Technical issues can be related to a poor preclinical evaluation, lack of patient information consent, wrong stent choice, and lack of accessories/logistics [12].
4. Stent-related issues
Nowadays, a huge effort in stent design is to overcome the most common stent-related issues: migration, stent-related perforation, and stent occlusion.
Anchoring measures to prevent stent migration: the most popular anchoring measure is having a flange at its proximal end to anchor it against a more elastic, healthy GI tract wall proximal to the tumor. Using a barbed proximal end, similar as found in plastic tube stents, has the same principle. An uncovered stent (Figure 1) has a lower migration rate compared to a covered stent because it becomes fixed and embedded to tissue over time due to pressure necrosis. However, this poses a special problem for removing it, which is required in benign conditions. Partially covered stents (Figure 1) are stents covered only at the body of the stent, leaving its proximal end to embed into tissue. They are very popular for malignant esophageal and biliopancreatic cancer, but again, there is a problem in removing the stent when used in benign conditions. Other measures are stent fixation using an endoscopic clip (Figure 5) or using an endoscopic suturing device [13] or passing a temporary suture thread at its proximal end, coming out from a nostril and fixated at the ear (Figure 4). A double-layer stent (a fully covered stent with an outer uncovered mesh layer) has also been proposed (Figure 4). Lumen-apposing stents are fully covered SEMS with a larger flange that allows transluminal drainage procedures (Figure 8).
Figure 4.
Anchoring methods for stenting. A suture thread passed at the proximal flange can be used to anchor the stent at the level of the nostril (a, b, c, red arrows). Using a near-fully covered stent with a short uncovered line at the proximal flange allows ingrowth of granulating tissue to prevent migration (c, green arrows). A double-layer stent is a fully covered stent with an outer mesh layer to prevent migration (picture modified from www.stent.net.com).
Figure 5.
A 65-year-old male with advanced mid-distal esophageal cancer treated with chemoradiation. He developed a liver metastasis and an extensive esophageal stenosis (a–c), refractory to dilatation. Because of dysphagia and an ongoing, non-curable disease, it was decided for esophageal stenting. Picture from Eduardo A. Bonin.
Stent-related perforation occurs due to gastrointestinal wall pressure necrosis due to stent compression, usually occurring at the stent’s distal end. Perforation can be devastating and is more likely to occur when there is more angulation (surgically altered anatomy or the colon). More flexible and longer stents are less likely to have this issue, having in mind to avoid placing a short and/or more rigid or self-expandable plastic stent at any sharp angulation.
Stent occlusion may occur from tumor ingrowth or overgrowth and/or accumulation of debris and bacterial biofilm deposit. Tumor overgrowth corresponds to tumor growth at any of both ends of a stent. This is avoided by covering the tumor at least 2 cm away from any of both ends. Tumor ingrowth corresponds to tumor growing within the stent mesh. This has been largely supervened using a covering film (silicone, polyethylene, polyvinyl). Larger caliber stents and stents with a good radius force expansion are associated to a larger fluid flow, thus a lower risk of occlusion.
5. Stents in gastrointestinal diseases
In clinical practice, stents are being used for gastrointestinal tract tumor palliation (luminal patency maintenance, luminal recanalization, tunneling), gastrointestinal bleeding (luminal vessel compression), gastrointestinal perforation or leak sealing (gastrointestinal fistula sealing), and gastrointestinal bypass or anastomosis (gastrointestinal transluminal drainage).
For each stent application, there are several technical and clinical issues to be assessed. Technical success refers to a successful stent deployment across the GI tract for a specific function (tumor palliation, compression, or anastomosis). Generally speaking, a successfully deployed stent should remain in the desired position and ideally expanded to its full radial force until up to 48 hours after deployment. Clinical success refers to achieving a desired clinical endpoint (i.e., relief of dysphagia, biliary decompression, fistula sealing) from the first 3–30 days (early) or 3 months and beyond (later) after stent deployment. A bridging stent refers to a stent used as a temporary measure for GI tract decompression, as in obstructed colon cancer patients to avoid colostomy. Since stents are commonly used for palliation of end-of-life cancer patients, quality of life is also a major concern. Cost-effectiveness refers to evaluation of cost of the device and procedure, complication, hospitalization, and mortality rates compared to other available techniques in terms of clinical success and quality of life. SEMS are often more cost-effective than traditional or laparoscopic surgery for palliation of cancer in high-risk patients.
GI stenting is one of many nonsurgical methods to achieve palliation of gastrointestinal cancer. Stents are more popular compared to other technologies for upper GI luminal recanalization/tunneling-ablation such as Nd:YAG laser ablation, argon plasma coagulation, or brachytherapy because it is the first-line recommended method [14] and it is an affordable single device with high technical success rates (approaching 90%) and no need for specific or expensive, dedicated equipment. For its widespread use, it is the most common nonsurgical palliation technique used for GI tract cancer worldwide. There are several recommendation guidelines for GI stenting from Western and Eastern surgical and gastrointestinal endoscopy societies based on evidence medicine (Table 1) [14]. For this present chapter, we have selected the most recently published guidelines.
Level of evidence
A. High-quality evidence
Further research is unlikely to change our confidence in the estimate of effect. Consistent evidence from RCTs without important limitations or exceptionally strong evidence from observational studies
B. Moderate-quality evidence
Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Evidence from RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or very strong evidence from observational studies
C. Low-quality evidence
Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Evidence for at least one critical outcome from observational studies, case series, or RCTs with serious flaws, indirect evidence, or expert consensus
Strength of recommendation
1. Strong recommendation
Recommendation can apply to most patients in most circumstances.
2. Weak recommendation
The best action may differ depending on the circumstances or patient or society values. Other alternatives may be equally reasonable
Table 1.
Level of evidence and strength of recommendation (extracted from [14]).
RCT, randomized controlled trial.
6. Indications
6.1 Gastrointestinal cancer
Stenting is a first-line approach to esophageal cancer palliation [15] (Table 2, Figures 5 and 6).
Placement of partially or fully covered self-expandable metal stents (SEMS) is recommended for palliative treatment of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass (strong recommendation, high-quality evidence)
For patients with longer life expectancy, brachytherapy is recommended as a valid alternative or in addition to stenting in esophageal cancer patients with malignant dysphagia. Brachytherapy may provide a survival advantage and possibly a better quality of life compared to SEMS placement alone (strong recommendation, high-quality evidence)
SEMS placement is recommended as the preferred treatment for sealing malignant tracheoesophageal or bronchoesophageal fistula (strong recommendation, low-quality evidence)
The use of concurrent external radiotherapy and esophageal stent treatment is not recommended. SEMS placement is also not recommended as a bridge to surgery or prior to preoperative chemoradiotherapy. It is associated with a high incidence of adverse events, and alternative satisfactory options such as placement of a feeding tube are available (strong recommendation, low-quality evidence)
Table 2.
Recommendations for stenting in esophageal cancer (modified from [15]).
Figure 6.
The same patient as in Figure 5. A 23 mm/12 cm partially covered self-expandable metal stent was placed covering the stenosis. The stent migrated distally 2 days after the procedure, which required repositioning. The stent was then fixed with clips at its proximal end (a, b, blue arrows). The patient resumed oral diet, and the stent remained in place, with its distal end at the level of the cardia (b, c, green arrows). Picture from Eduardo A. Bonin.
Initial historical attempts to relieve dysphagia and alleviate starvation were esophageal dilatation and the use of an esophageal catheter-like tube. This first measure is temporary, unsuccessful over time due to tumor growth and associated to high risk of perforation. It can be still used as an initial approach in areas with no access to more advanced resources. The main, absolute indication for esophageal stenting is tracheoesophageal cancer fistula. Esophageal dysphagia is another major indication; however, it has been balanced with esophageal brachytherapy, when available. Esophageal stenting leads to a better quality of life mainly because of relief of dysphagia. It also helps in patient’s nutritional condition, but this should not be highly expected. The clinical success rates for dysphagia are 80–95%, with a median duration of esophageal stent patency being reported as 94% at 4 weeks, 78% at 3 months, and 67% at 6 months [16]. Recurrent obstruction occurs in 30% of patients, and migration rate is more common for covered stents (10–25%) than uncovered stents (2–5%). Stent placement can be considered as a temporary/bridge measure for those who have severe dysphagia before radio- or chemotherapy (neoadjuvant therapy). However, the stent has to be removed after a few weeks, and a high migration risk is expected once the tumor responds and reduces its size from treatment. Thus, the cost-benefit of a bridging stent for esophageal cancer remains controversial. Several anti-reflux in-stent valve mechanisms have been used for preventing gastroesophageal reflux in distal esophageal tumors; however, it seems not to add any advantage over standard esophageal SEMS [17].
Chemotherapy and radiotherapy have evolved over the years into better quality of life scores in palliation of esophageal cancer patients, since many of them are spared from dysphagia for several months on the course of disease. The correct timing for esophageal stent insertion is crucial for a better clinical outcome. It is usually considered when there is an ongoing disease and dysphagia despite optimal previous chemotherapy and radiotherapy treatment. Esophageal stenting with SEMS is superior to any other surgical palliation method for any given patient. It is also superior to gastrostomy for nutritional therapy in advanced cancer patients. Combinations of brachytherapy with SEMS are an interesting approach due to a reduced requirement for re-interventions [18].
Gastroduodenal outlet obstruction (GOO) may rise from a locally advanced gastric, duodenal, or pancreatic cancer. It occurs in up to 20% of pancreatic cancer patients and is associated to recurrent vomiting, severe weight loss, and malnutrition. This condition is associated to a poor prognosis, with a 3–4 month average life expectancy. Stent placement should be considered for palliation of such patients, especially those who are not fit for surgery or have metastatic cancer (Figure 7).
Figure 7.
A 90-year-old male with gastric outlet obstruction due to advanced gastric (antral) cancer. He was not clinically fit for a surgical intervention. A duodenal stent was inserted endoscopically. He was able to eat per mouth until he deceased 6 months later because of advanced cancer and pneumonia. The red arrow depicts the proximal flange, located at the antrum (a, b). The distal flange is at the duodenum (c, d, yellow arrow). Picture from Eduardo A. Bonin.
Patients with pancreatic cancer and a larger life expectancy have always the option for a surgical bypass, which nowadays is achieved using minimally invasive laparoscopic techniques. Surgical bypass appears to offer a longer luminal patency compared to stents for patients with GOO with a life expectation of more than 2 months [19]. Patients with locally advanced gastric cancer who are fit for surgery can be considered for gastric resection (partial gastrectomy) as a palliation method [20], since it treats the obstruction and also reduces the chance of tumor bleeding. Although peritoneal disease (carcinomatosis) is considered a relative contraindication to SEMS placement for GOO given the risk of multifocal obstruction, this procedure seems reasonable in such advanced gastric cancer patients [21].
For malignant biliopancreatic diseases, SEMS are preferred over traditional plastic tube stents due to its better cost-effectiveness (lower occlusion rates) [22]. This applies to biliary obstruction in pancreatic cancer and biliary tract cancer. Apart from some evidence-based recommendations [23] (Table 3), there are several other clinical aspects in biliary and pancreatic stenting that are beyond the scope of this book chapter.
Routine preoperative biliary drainage is not recommended in patients with malignant extrahepatic biliary obstruction; preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice (e. g., intense pruritus), or delayed surgery or before neoadjuvant chemotherapy in jaundiced patients (strong recommendation, moderate-quality evidence)
Endoscopic placement of a 10 mm diameter self-expandable metal stent (SEMS) is recommended for preoperative biliary drainage of malignant extrahepatic biliary obstruction (strong recommendation, moderate-quality evidence)
SEMS insertion is recommended for palliative drainage of extrahepatic malignant biliary obstruction (strong recommendation, high-quality evidence)
Insertion of uncovered SEMS is not recommended for the drainage of extrahepatic biliary obstruction of unconfirmed etiology (strong recommendation, low-quality evidence)
Routine preoperative biliary drainage is not recommended in patients with malignant hilar obstruction (weak recommendation, low-quality evidence)
Uncovered SEMS is recommended for palliative drainage of malignant hilar obstruction (strong recommendation, moderate-quality evidence)
Temporary insertion of multiple plastic stents or of a fully covered SEMS is recommended for treatment of benign biliary strictures (strong recommendation, moderate-quality evidence)
Endoscopic placement of plastic stent(s) is recommended to treat bile duct leaks that are not due to transection of the common bile duct or common hepatic duct (strong recommendation, moderate-quality evidence)
Table 3.
Recommendations for stenting in biliopancreatic diseases (modified from [23]).
In colorectal cancer, acute colonic obstruction represents a major complication, since it requires prompt intervention because of the risk of colonic necrosis and perforation. It is the primary symptom for 10–30% of patients with colorectal cancer. Others may develop colonic obstruction under their course of any nonsurgical adjuvant therapy. Emergency surgery for an acute obstructed colonic cancer is associated with a morbidity rate of 32–64% and mortality rate of 15–34% [24].
Stenting of obstructed colon cancer is mainly used for palliation in advanced left-sided high-risk colonic cancer patients (Table 4) [25, 26], since it avoids a definitive stoma, with a potential increase in quality of life. It can also be used as an alternative temporary decompression measure as a bridge before surgical resection, as it may prevent the need of a stoma (colostomy) in 30–40% of cases. However, there are some concerns regarding its safety and long-term oncological issues [27]. Colonic stenting is associated to technical and clinical success rate approaching 90%. It has an overall adverse event rate of up to 25% (perforation, migration, colonic decompression failure as major events, pain as minor event). Patients at higher risk of major events have strictures longer than 4 cm and complete obstruction. A colonic decompression failure may require urgent surgery. Perforation is another feared complication, with an estimated rate of 9.5%. Stent migration usually occurs within a week after placement at a rate of 10% of patients when used as a bridge to surgery, whereas stent occlusion occurs in 10% of palliative patients [27], usually 3–6 months after placement (tumor growth). Covered stents are solely used in benign conditions, with a migration rate reaching up to 90% within 1–3 weeks after placement [25].
Prophylactic colonic stent placement is not recommended. Colonic stenting should be reserved for patients with clinical symptoms and imaging evidence of malignant large-bowel obstruction, without signs of perforation (strong recommendation, low-quality evidence)
Colonic SEMS placement as a bridge to elective surgery is not recommended as a standard treatment of symptomatic left-sided malignant colonic obstruction (strong recommendation, high-quality evidence)
For patients with potentially curable but obstructing left-sided colonic cancer, stent placement may be considered as an alternative to emergency surgery in those who have an increased risk of postoperative mortality, i.e., American Society of Anesthesiologists (ASA) physical status ≥ III and/or age > 70 years (weak recommendation, low-quality evidence)
SEMS placement is recommended as the preferred treatment for palliation of malignant colonic obstruction (strong recommendation, high-quality evidence), except in patients treated or considered for treatment with antiangiogenic drugs (e.g., bevacizumab) (strong recommendation, low-quality evidence)
Table 4.
Recommendations for stenting in colorectal cancer (modified from [26]).
7. Benign gastrointestinal tract conditions
7.1 Gastrointestinal strictures, fistulas, and bleeding tamponade
Benign GI tract strictures usually occur from previous surgery (anastomotic) or post-radiotherapy. Caustic chemically induced esophageal strictures are fortunately becoming more rare due to chemical commercial restrictions. Recalcitrant gastrointestinal strictures remain a huge clinical challenge, since results are not consistent and no single therapy has been proven uniformly efficacious. Gastrointestinal stenting has emerged as an alternative therapy for benign stricture treatment, and a fully covered SEMS has been regarded the stent of choice, preferably using a fixation method (Table 5) [28].
SEMS is not recommended as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and costs (strong recommendation, low-quality evidence)
Temporary placement of SEMS should be considered as therapy for refractory benign esophageal strictures (weak recommendation, moderate-quality evidence). Stents should usually be removed at a maximum of 3 months (strong recommendation, low-quality evidence)
Fully covered SEMS are preferred over partially covered SEMS for the treatment of refractory benign esophageal strictures, because of their lack of embedment and ease of removability (weak recommendation, low-quality evidence)
For the removal of partially covered esophageal SEMS that are embedded, the stent-in-stent technique is recommended (strong recommendation, low-quality evidence)
Temporary stent placement can be considered for treating esophageal leaks, fistulas, and perforations. The optimal stenting duration remains unclear and should be individualized (strong recommendation, low-quality evidence)
Placement of a SEMS is recommended for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy or as initial therapy for patients with massive esophageal variceal bleeding (strong recommendation, moderate-quality evidence)
Table 5.
Recommendations for stenting for benign disease (modified from [15]).
Gastrointestinal perforation and fistula management have evolved dramatically over the last 15 years toward a noninvasive endoscopic treatment. Gastrointestinal perforation or laceration usually refers to any gastrointestinal full-thickness wall opening that can occur during a therapeutic endoscopic procedure [29] or spontaneously from intense vomiting (Boerhaave syndrome) or gut wall necrosis following an intense inflammatory process [30]. Gastrointestinal leakage may also occur postoperatively after a given gastrointestinal anastomosis. Any of these situations may lead to gastrointestinal fluid leak/extravasation and consequent abdominal cavity contamination, leading to an established communication (fistula) of the afflicted organ to the abdominal cavity or to other GI tract compartments or the skin. Gastrointestinal stenting may aid as a sealing procedure to avoid gastrointestinal content leakage and also to maintain luminal patency, reducing any pressure from an unexpected gastrointestinal anastomotic stricture (Table 5).
Gastroesophageal varices are mostly found in cirrhotic patients. Other causes include Schistosoma infection and portal vein thrombosis from other causes excluding cirrhosis. They may lead to massive bleeding with a high-rate mortality. Variceal band ligation and endoscopic injection therapy are the treatment of choice for ongoing acute variceal bleeding despite medical management. However, patients with massive refractory bleeding and coagulation impairment (usually due to cirrhosis) may require a life-saving tamponade measure, usually done using an esophagogastric balloon device (Sengstaken-Blakemore tube). This device requires a highly compromised team to take care of the balloon device tube and is very uncomfortable for an awaken patient. It also leads to complications such as mucosal ischemic injury. Stenting has emerged as an alternative effective temporary tamponade measure for such bleeding cases until a definitive treatment can be applied (Table 5).
8. Other indications
8.1 Gastrointestinal bypass/drainage/anastomosis
Transgastric pancreatic fluid collection drainage (cystogastrostomy drainage) has been for at least 20 years the most popular representative of a typical transmural endoscopic drainage procedure (Figure 8). Until 5 years ago, no one would assume a gastrointestinal anastomosis being performed totally under endoscopic technique in the clinical setting, until a novel lumen-apposing self-expandable metal stent (LAMS) has been developed.
Figure 8.
Lumen-apposing self-expandable metal stent used for transgastric drainage of a walled of pancreatic necrosis. (a) Four weeks after transgastric endoscopic necrosectomy, the resulting cavity has been replaced by granulating tissue. The stent was then removed. The stent has large flanges to avoid migration (b) and a 14 mm lumen to allow endoscope insertion (c). Picture from Eduardo A. Bonin.
This totally covered, dumbbell-shape self-expandable metal stent has been used for gastroenteral (gastrojejunal) and bilioenteric (cholecysto-gastric, choledoco-duodenal) anastomosis in clinical practice with promising results [31]. A recent case control retrospective trial has demonstrated its role compared to traditional endoscopic stenting in managing gastric outlet obstruction from malignant and benign conditions [32].
9. Summary
Gastrointestinal stenting is a procedure associated to a high safety and technical success profile, and its clinical indications have surpassed its original use, esophageal cancer. Self-expandable metal stent placement is the preferred nonsurgical method for biliopancreatic and upper and lower gastrointestinal tract cancer palliation. Stenting is also being used for several other indications, such as benign gastrointestinal stricture treatment, gastrointestinal fistula management, variceal bleeding arrest, and gastrointestinal bypass or drainage. Several efforts have been made to overcome its three remaining clinical major issues: stent occlusion, stent migration, and stent-related perforation.
\n',keywords:"stent, gastroenterology, endoscopy",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/68554.pdf",chapterXML:"https://mts.intechopen.com/source/xml/68554.xml",downloadPdfUrl:"/chapter/pdf-download/68554",previewPdfUrl:"/chapter/pdf-preview/68554",totalDownloads:1179,totalViews:0,totalCrossrefCites:0,dateSubmitted:"April 8th 2019",dateReviewed:"June 18th 2019",datePrePublished:"August 31st 2019",datePublished:"March 11th 2020",dateFinished:"August 9th 2019",readingETA:"0",abstract:"Stent is a medical device originally designed for recanalization and/or sealing of any obstructing or leaking lesion. In gastroenterology, it has a major role in recanalization of gastrointestinal (GI) tumors and postoperative leak sealing. Among several materials and models used in stent manufacturing, self-expandable metallic stents (SEMS) are the most common used stents. Over the years, SEMS has evolved into a standard of care medical device in several oncological conditions, such as advanced esophageal cancer. Other potential applications are drug-eluting devices, scar tissue modeling for benign conditions, and GI tract drainage/anastomosis. The aim of this chapter is to review the most common GI stent models and its indications in gastrointestinal diseases.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/68554",risUrl:"/chapter/ris/68554",signatures:"Eduardo Aimore Bonin, Bruno Verschoor, Fernanda Hoffmann Silva, Kelly Cristina Vieira and Susan Kakitani Takata",book:{id:"7869",type:"book",title:"Advanced Endoscopy",subtitle:null,fullTitle:"Advanced Endoscopy",slug:"advanced-endoscopy",publishedDate:"March 11th 2020",bookSignature:"Qiang Yan and Xu Sun",coverURL:"https://cdn.intechopen.com/books/images_new/7869.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-78985-070-3",printIsbn:"978-1-78985-069-7",pdfIsbn:"978-1-78985-175-5",isAvailableForWebshopOrdering:!0,editors:[{id:"247970",title:"Prof.",name:"Qiang",middleName:null,surname:"Yan",slug:"qiang-yan",fullName:"Qiang Yan"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"301234",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Aimore Bonin",fullName:"Eduardo Aimore Bonin",slug:"eduardo-aimore-bonin",email:"eabonin@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"301241",title:"Ms.",name:"Susan Louise",middleName:null,surname:"Kakitani Takata",fullName:"Susan Louise Kakitani Takata",slug:"susan-louise-kakitani-takata",email:"xulouise@yahoo.com.br",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"301242",title:"Mr.",name:"Bruno",middleName:null,surname:"Verschoor",fullName:"Bruno Verschoor",slug:"bruno-verschoor",email:"bruno_verschoor@yahoo.com.br",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"301243",title:"Mrs.",name:"Kelly Cristina",middleName:null,surname:"Vieira",fullName:"Kelly Cristina Vieira",slug:"kelly-cristina-vieira",email:"kellycvieira@yahoo.com.br",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"306494",title:"Mrs.",name:"Fernanda",middleName:null,surname:"Hoffmann Silva",fullName:"Fernanda Hoffmann Silva",slug:"fernanda-hoffmann-silva",email:"fhoffmann@erastogaertner.com.br",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Hospital Erasto Gaertner",institutionURL:null,country:{name:"Brazil"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Stent types",level:"1"},{id:"sec_3",title:"3. A typical SEMS placement procedure in the gastrointestinal tract",level:"1"},{id:"sec_4",title:"4. Stent-related issues",level:"1"},{id:"sec_5",title:"5. Stents in gastrointestinal diseases",level:"1"},{id:"sec_6",title:"6. Indications",level:"1"},{id:"sec_6_2",title:"6.1 Gastrointestinal cancer",level:"2"},{id:"sec_8",title:"7. Benign gastrointestinal tract conditions",level:"1"},{id:"sec_8_2",title:"7.1 Gastrointestinal strictures, fistulas, and bleeding tamponade",level:"2"},{id:"sec_10",title:"8. Other indications",level:"1"},{id:"sec_10_2",title:"8.1 Gastrointestinal bypass/drainage/anastomosis",level:"2"},{id:"sec_12",title:"9. Summary",level:"1"}],chapterReferences:[{id:"B1",body:'Available from: https://www.merriam-webster.com/dictionary/stent#h1m [Accessed: April 30, 2019]'},{id:"B2",body:'Roguin A. Stent: The man and word behind the coronary metal prosthesis. Circulation Cardiovascular Interventions. 2011;4(2):206-209'},{id:"B3",body:'Girardet RE, Ransdell HT Jr, Wheat MW Jr. Palliative intubation in the management of esophageal carcinoma. The Annals of Thoracic Surgery. 1974;18(4):417-430'},{id:"B4",body:'Symonds CJ. The treatment of malignant stricture of the oesophagus by tubage or permanent catheterism. British Medical Journal. 1887;1(1373):870-873'},{id:"B5",body:'Irani S, Kozarek RA. History of GI stenting: Rigid prostheses in the esophagus. In: Kozarek RA, Baron TH, Song HY, editors. Self-Expandable Stents in the GI Tract. New York, USA: Springer; 2013. pp. 3-15. ISBN 978-1-4614-3745-1'},{id:"B6",body:'Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. The New England Journal of Medicine. 1993;329(18):1302-1307'},{id:"B7",body:'Thiebes AL, McGrath DJ, Kelly N, Sweeney CA, Kurtenbach K, Gesché VN, et al. Comparison of covered laser-cut and braided respiratory stents: From bench to pre-clinical testing. Annals of Biomedical Engineering. 2019;47(8):1738-1747'},{id:"B8",body:'Domingo S, Puértolas S, Gracia-Villa L, Puértolas JA. Mechanical comparative analysis of stents for colorectal obstruction. Minimally Invasive Therapy & Allied Technologies. 2007;16(2):126-136'},{id:"B9",body:'Mangiavillano B, Pagano N, Baron TH, Arena M, Iabichino G, Consolo P, et al. Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. World Journal of Gastrointestinal Endoscopy. 2016;8(3):143-156'},{id:"B10",body:'Shatzel J, Kim J, Sampath K, Syed S, Saad J, Hussain ZH, et al. Drug eluting biliary stents to decrease stent failure rates: A review of the literature. World Journal of Gastrointestinal Endoscopy. 2016;8(2):77-85. DOI: 10.4253/wjge.v8.i2.77'},{id:"B11",body:'Samadder NJ, Bonin EA, Buttar NS, Baron TH, Gostout CJ, Topazian MD, et al. Placement of a covered stent for palliation of a cavitated colon cancer by using a novel over-the-scope technique (with video). Gastrointestinal Endoscopy. 2012;76(6):1275-1277'},{id:"B12",body:'Veld JV, Fockens P, van Hooft JE. Mistakes in enteral stenting and how to avoid them. UEG Education. 2019;19:5-8'},{id:"B13",body:'Fujii LL, Bonin EA, Baron TH, Gostout CJ, Wong Kee Song LM. Utility of an endoscopic suturing system for prevention of covered luminal stent migration in the upper GI tract. Gastrointestinal Endoscopy. 2013;78(5):787-793'},{id:"B14",body:'Jee SR, Cho JY, Kim KH, Kim SG, Cho JH, The Stent Study Group of the Korean Society of Gastrointestinal Endoscopy. Evidence-based recommendations on upper gastrointestinal tract stenting: A report from the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy. Clinical Endoscopy. 2013;46(4):342-354'},{id:"B15",body:'Spaander MC, Baron TH, Siersema PD, Fuccio L, Schumacher B, Escorsell À, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2016;48(10):939-948'},{id:"B16",body:'Kang HW, Kim SG. Upper gastrointestinal stent insertion in malignant and benign disorders. Clinical Endoscopy. 2015;48(3):187-193'},{id:"B17",body:'Pandit S, Samant H, Morris J, Alexander SJ. Efficacy and safety of standard and anti-reflux self-expanding metal stent: A systematic review and meta-analysis of randomized controlled trials. World Journal of Gastrointestinal Endoscopy. 2019;11(4):271-280'},{id:"B18",body:'Dai Y, Li C, Xie Y, Liu X, Zhang J, Zhou J, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database of Systematic Reviews. 2014;10:CD005048'},{id:"B19",body:'Jeurnink SM, Steyerberg EW, van Hooft JE, van Eijck CH, Schwartz MP, Vleggaar FP, et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): A multicenter randomized trial. Gastrointestinal Endoscopy. 2010;71(3):490-499'},{id:"B20",body:'No JH, Kim SW, Lim CH, Kim JS, Cho YK, Park JM, et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: Endoscopic stenting versus surgery. Gastrointestinal Endoscopy. 2013;78(1):55-62'},{id:"B21",body:'Mendelsohn RB, Gerdes H, Markowitz AJ, DiMaio CJ, Schattner MA. Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction. Gastrointestinal Endoscopy. 2011;73(6):1135-1140'},{id:"B22",body:'Bonin EA, Baron TH. Preoperative biliary stents in pancreatic cancer. Journal of Hepato-Biliary-Pancreatic Sciences. 2011;18(5):621-629'},{id:"B23",body:'Dumonceau JM, Tringali A, Papanikolaou IS, Blero D, Mangiavillano B, Schmidt A, et al. Endoscopic biliary stenting: Indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline—Updated October 2017. Endoscopy. 2018;50(9):910-930'},{id:"B24",body:'Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: Results of a systematic review and meta-analysis of randomized controlled trials. Gastrointestinal Endoscopy. 2017;86:416-426'},{id:"B25",body:'Bonin EA, Baron TH. Update on the indications and use of colonic stents. Current Gastroenterology Reports. 2010;12(5):374-382'},{id:"B26",body:'van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RG, DeWitt JM, Donnellan F, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: Clinical guideline. Endoscopy. 2014;46(11):990-1053'},{id:"B27",body:'Ribeiro IB, de Moura DTH, Thompson CC, de Moura EGH. Acute abdominal obstruction: Colon stent or emergency surgery? An evidence-based review. World Journal of Gastrointestinal Endoscopy. 2019;11(3):193-208'},{id:"B28",body:'Ngamruengphong S, Sharaiha R, Sethi A, Siddiqui A, DiMaio CJ, Gonzalez S, et al. Fully-covered metal stents with endoscopic suturing vs. partially-covered metal stents for benign upper gastrointestinal diseases: A comparative study. Endoscopy International Open. 2018;6(2):E217-E223'},{id:"B29",body:'Rao AS, LeRoy AJ, Bonin EA, Sweetser SR, Baron TH. Novel technique for placement of overlapping self-expandable metal stents to close a massive pancreatitis-induced duodenal fistula. Endoscopy. 2012;44(Suppl 2 UCTN):E163-E164'},{id:"B30",body:'Hadj Amor WB, Bonin EA, Vitton V, Desjeux A, Grimaud JC, Barthet M. Successful endoscopic management of large upper gastrointestinal perforations following EMR using over-the-scope clipping combined with stenting. Endoscopy. 2012;44(Suppl 2 UCTN):E277'},{id:"B31",body:'Lee HS, Chung MJ. Past, present, and future of gastrointestinal stents: New endoscopic ultrasonography-guided metal stents and future developments. Clinical Endoscopy. 2016;49(2):131-138'},{id:"B32",body:'Chen YI, Itoi T, Baron TH, Nieto J, Haito-Chavez Y, Grimm IS, et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surgical Endoscopy. 2017;31(7):2946-2952'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Eduardo Aimore Bonin",address:"eabonin@gmail.com",affiliation:'
Hospital Erasto Gaertner, Curitiba, Paraná, Brazil
Hospital Erasto Gaertner, Curitiba, Paraná, Brazil
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They also pay attention to the 3D interrogation zone (IZ) that is the main parameter in which multitude technical aspects of the RFID systems are gathered simultaneously, as regards the theoretical synthesis as well as market needs.",book:{id:"5368",slug:"radio-frequency-identification",title:"Radio Frequency Identification",fullTitle:"Radio Frequency Identification"},signatures:"Piotr Jankowski-Mihułowicz and Mariusz Węglarski",authors:[{id:"5982",title:"Associate Prof.",name:"Piotr",middleName:null,surname:"Jankowski-Mihułowicz",slug:"piotr-jankowski-mihulowicz",fullName:"Piotr Jankowski-Mihułowicz"}]},{id:"66114",doi:"10.5772/intechopen.85075",title:"Combined Deep Learning and Traditional NLP Approaches for Fire Burst Detection Based on Twitter Posts",slug:"combined-deep-learning-and-traditional-nlp-approaches-for-fire-burst-detection-based-on-twitter-post",totalDownloads:828,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"The current chapter introduces a procedure that aims at determining regions that are on fire, based on Twitter posts, as soon as possible. The proposed scheme utilizes a deep learning approach for analyzing the text of Twitter posts announcing fire bursts. Deep learning is becoming very popular within different text applications involving text generalization, text summarization, and extracting text information. A deep learning network is to be trained so as to distinguish valid Twitter fire-announcing posts from junk posts. Next, the posts labeled as valid by the network have undergone traditional NLP-based information extraction where the initial unstructured text is converted into a structured one, from which potential location and timestamp of the incident for further exploitation are derived. Analytic processing is then implemented in order to output aggregated reports which are used to finally detect potential geographical areas that are probably threatened by fire. So far, the part that has been implemented is the traditional NLP-based and has already derived promising results under real-world conditions’ testing. The deep learning enrichment is to be implemented and expected to build upon the performance of the existing architecture and further improve it.",book:{id:"8511",slug:"cyberspace",title:"Cyberspace",fullTitle:"Cyberspace"},signatures:"Konstantinos-George Thanos, Andrianna Polydouri, Antonios Danelakis, Dimitris Kyriazanos and Stelios C.A. Thomopoulos",authors:null},{id:"66610",doi:"10.5772/intechopen.85362",title:"Text Mining to Facilitate Domain Knowledge Discovery",slug:"text-mining-to-facilitate-domain-knowledge-discovery",totalDownloads:1080,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The high-precision observation and measurement techniques have accelerated the rapid development of geoscience research in the past decades and have produced large amounts of research outputs. Many findings and discoveries were recorded in the geological literature, which is regarded as unstructured data. For these data, traditional research methods have limited functions for integrating and mining them to make knowledge discovery. Text mining based on natural language processing (NLP) provides the necessary method and technology to analyze unstructured geological literature. In this book chapter, we will review the latest researches of text mining in the domain of geoscience and present results from a few case studies. The research includes three major parts: (1) structuralization of geological literature, (2) information extraction and visualization for geological literature, and (3) geological text mining to assist database construction and knowledge discovery.",book:{id:"8511",slug:"cyberspace",title:"Cyberspace",fullTitle:"Cyberspace"},signatures:"Chengbin Wang and Xiaogang Ma",authors:null}],mostDownloadedChaptersLast30Days:[{id:"68505",title:"Research Design and Methodology",slug:"research-design-and-methodology",totalDownloads:24839,totalCrossrefCites:7,totalDimensionsCites:16,abstract:"There are a number of approaches used in this research method design. The purpose of this chapter is to design the methodology of the research approach through mixed types of research techniques. The research approach also supports the researcher on how to come across the research result findings. In this chapter, the general design of the research and the methods used for data collection are explained in detail. It includes three main parts. The first part gives a highlight about the dissertation design. The second part discusses about qualitative and quantitative data collection methods. The last part illustrates the general research framework. The purpose of this section is to indicate how the research was conducted throughout the study periods.",book:{id:"8511",slug:"cyberspace",title:"Cyberspace",fullTitle:"Cyberspace"},signatures:"Kassu Jilcha Sileyew",authors:[{id:"292841",title:"Ph.D.",name:"Kassu",middleName:null,surname:"Jilcha Sileyew",slug:"kassu-jilcha-sileyew",fullName:"Kassu Jilcha Sileyew"}]},{id:"72160",title:"5G Road Map to Communication Revolution",slug:"5g-road-map-to-communication-revolution",totalDownloads:862,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The goal of this chapter is to give researchers, practitioners, and students a pedestal to get a comprehensive look at the new technology of communication named 5G. The chapter will present an introduction that shows the importance of 5G to the different uses of the Internet. Then, the chapter will present two essential aspects: (1) 5G research in academia and real world and (2) timeline of Gs. Then, the chapter will discuss three aspects of 5G which are, namely, (1) Regulations, (2) security, and (3) the 5 enabling Technologies. Then, the chapter will discuss the real-life case of South Korea mobile carrier.",book:{id:"8511",slug:"cyberspace",title:"Cyberspace",fullTitle:"Cyberspace"},signatures:"Evon Abu-Taieh, Issam H. Al Hadid and Ali Zolait",authors:null},{id:"68561",title:"Cyberspace and Artificial Intelligence: The New Face of Cyber-Enhanced Hybrid Threats",slug:"cyberspace-and-artificial-intelligence-the-new-face-of-cyber-enhanced-hybrid-threats",totalDownloads:1236,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"While, until recently, cyber operations have constituted a specific subset of defense and security concerns, the synergization of cyberspace and artificial intelligence (AI), which are driving the Fourth Industrial Revolution, has raised the threat level of cyber operations, making them a centerpiece of what are called hybrid threats. The concept of hybrid threat is presently a key concern for the defense and security community; cyber-enabled and cyber-enhanced hybrid operations have been amplified in scope, frequency, speed, and threat level due to the synergies that come from the use of cyberspace and machine learning (ML)-based solutions. In the present work, we address the relevance of cyberspace-based operations and artificial intelligence for the implementation of hybrid operations and reflect on what this cyber dimension of hybrid operations implies for the concept of what constitutes a cyberweapon, the concept of hybrid human intelligence (hybrid HUMINT) and possible responses to the hybrid threat patterns.",book:{id:"8511",slug:"cyberspace",title:"Cyberspace",fullTitle:"Cyberspace"},signatures:"Carlos Pedro Gonçalves",authors:[{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves"}]},{id:"52156",title:"Case Study: Installing RFID Systems in Supermarkets",slug:"case-study-installing-rfid-systems-in-supermarkets",totalDownloads:2471,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Radio frequency identification technology (RFID) is considered as the reference technology for wireless identification and item traceability. Supermarkets are one of those scenarios where the RFID potential can be harnessed. In theory, RFID in supermarkets shows several advantages compared with traditional barcode systems, offering real‐time inventory, stock control, cash queues, among others. In practice, its massive and global implementation is still being delayed due to the high quantity of factors that degrade the RFID system performance in these scenarios, causing uncontrolled items and identification losses and, at the end, economical losses. Some works in the scientific literature studied a single or a set of problems related to RFID performance, mostly focused on a specific communication layer: antennas and hardware design, interferences at physical layer, medium access control (MAC) protocols, security issues, or middleware challenges. However, there are no works describing in depth the set of factors affecting RFID performance in a specific scenario and contemplating the entire communication layer stack. The first challenge of this chapter is to provide a complete analysis of those physical and environmental factors, hardware and software limitations, and standard and regulation restrictions that have a direct impact on the RFID system performance in supermarkets. This analysis is addressed by communication layers, paying attention to the point of view of providers, supermarket companies, and final customers. Some of the most feasible and influential research works that address individual problems are also enumerated. Finally, taking the results extracted from this study, this chapter provides a Guide of Good Practices (GGPs), giving a global vision for addressing a successful RFID implementation project, useful for researchers, developers, and installers.",book:{id:"5368",slug:"radio-frequency-identification",title:"Radio Frequency Identification",fullTitle:"Radio Frequency Identification"},signatures:"María-Victoria Bueno‐Delgado, Francesc Burrull and Pablo Pavón‐\nMariño",authors:[{id:"186584",title:"Dr.",name:"M.V.",middleName:null,surname:"Bueno-Delgado",slug:"m.v.-bueno-delgado",fullName:"M.V. Bueno-Delgado"},{id:"194375",title:"Dr.",name:"Francesc",middleName:null,surname:"Burrull",slug:"francesc-burrull",fullName:"Francesc Burrull"},{id:"194376",title:"Prof.",name:"Pablo",middleName:null,surname:"Pavón-Mariño",slug:"pablo-pavon-marino",fullName:"Pablo Pavón-Mariño"}]},{id:"52083",title:"A Methodology for Evaluating Security in Commercial RFID Systems",slug:"a-methodology-for-evaluating-security-in-commercial-rfid-systems",totalDownloads:1711,totalCrossrefCites:15,totalDimensionsCites:29,abstract:"Although RFID has become a widespread technology, the developers of numerous commercial systems have not taken care of security properly. This chapter presents a methodology for detecting common security flaws. The methodology is put in practice using an open-source RFID platform (Proxmark 3), and it is tested in different fields, such as public transportation or animal identification. The results obtained show that the consistent application of the methodology allows researchers to perform security audits easily and detect, mitigate, or avoid risks and possible attacks.",book:{id:"5368",slug:"radio-frequency-identification",title:"Radio Frequency Identification",fullTitle:"Radio Frequency Identification"},signatures:"Tiago M. Fernández-Caramés, Paula Fraga-Lamas, Manuel Suárez-\nAlbela and Luis Castedo",authors:[{id:"186818",title:"Dr.",name:"Tiago M.",middleName:null,surname:"Fernández-Caramés",slug:"tiago-m.-fernandez-carames",fullName:"Tiago M. 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He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. 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Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. 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He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. 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His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:58,paginationItems:[{id:"81961",title:"Antioxidants as an Adjuncts to Periodontal Therapy",doi:"10.5772/intechopen.105016",signatures:"Sura Dakhil Jassim and Ali Abbas Abdulkareem",slug:"antioxidants-as-an-adjuncts-to-periodontal-therapy",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}},{id:"82357",title:"Caries Management Aided by Fluorescence-Based Devices",doi:"10.5772/intechopen.105567",signatures:"Atena Galuscan, Daniela Jumanca and Aurora Doris Fratila",slug:"caries-management-aided-by-fluorescence-based-devices",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Caries - The Selection of Restoration Methods and Restorative Materials",coverURL:"https://cdn.intechopen.com/books/images_new/11565.jpg",subseries:{id:"1",title:"Oral Health"}}},{id:"81894",title:"Diet and Nutrition and Their Relationship with Early Childhood Dental Caries",doi:"10.5772/intechopen.105123",signatures:"Luanna Gonçalves Ferreira, Giuliana de Campos Chaves Lamarque and Francisco Wanderley Garcia Paula-Silva",slug:"diet-and-nutrition-and-their-relationship-with-early-childhood-dental-caries",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Caries - The Selection of Restoration Methods and Restorative Materials",coverURL:"https://cdn.intechopen.com/books/images_new/11565.jpg",subseries:{id:"1",title:"Oral Health"}}},{id:"81595",title:"Prosthetic Concepts in Dental Implantology",doi:"10.5772/intechopen.104725",signatures:"Ivica Pelivan",slug:"prosthetic-concepts-in-dental-implantology",totalDownloads:27,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}}]},overviewPagePublishedBooks:{paginationCount:8,paginationItems:[{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}]},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",publishedDate:"October 23rd 2019",editedByType:"Edited by",bookSignature:"Alaa Eddin Omar Al Ostwani",hash:"b81d39988cba3a3cf746c1616912cf41",volumeInSeries:4,fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention",editors:[{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",institutionURL:null,country:{name:"India"}}}]}]},openForSubmissionBooks:{paginationCount:3,paginationItems:[{id:"11570",title:"Influenza - New Approaches",coverURL:"https://cdn.intechopen.com/books/images_new/11570.jpg",hash:"157b379b9d7a4bf5e2cc7a742f155a44",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 10th 2022",isOpenForSubmission:!0,editors:[{id:"139889",title:"Dr.",name:"Seyyed Shamsadin",surname:"Athari",slug:"seyyed-shamsadin-athari",fullName:"Seyyed Shamsadin Athari"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11569",title:"Bacterial Sexually Transmitted Infections - New Findings, Diagnosis, Treatment, and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/11569.jpg",hash:"069d6142ecb0d46d14920102d48c0e9d",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 31st 2022",isOpenForSubmission:!0,editors:[{id:"189561",title:"Dr.",name:"Mihaela Laura",surname:"Vica",slug:"mihaela-laura-vica",fullName:"Mihaela Laura Vica"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11568",title:"Staphylococcal Infections - Recent Advances and Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11568.jpg",hash:"92c881664d1921c7f2d0fee34b78cd08",secondStepPassed:!1,currentStepOfPublishingProcess:2,submissionDeadline:"July 8th 2022",isOpenForSubmission:!0,editors:[{id:"59719",title:"Dr.",name:"Jaime",surname:"Bustos-Martínez",slug:"jaime-bustos-martinez",fullName:"Jaime Bustos-Martínez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{paginationCount:10,paginationItems:[{id:"82380",title:"Evolution of Parasitism and Pathogenic Adaptations in Certain Medically Important Fungi",doi:"10.5772/intechopen.105206",signatures:"Gokul Shankar Sabesan, Ranjit Singh AJA, Ranjith Mehenderkar and Basanta Kumar Mohanty",slug:"evolution-of-parasitism-and-pathogenic-adaptations-in-certain-medically-important-fungi",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fungal Infectious Diseases - Annual Volume 2022",coverURL:"https://cdn.intechopen.com/books/images_new/11400.jpg",subseries:{id:"4",title:"Fungal Infectious Diseases"}}},{id:"82367",title:"Spatial Variation and Factors Associated with Unsuppressed HIV Viral Load among Women in an HIV Hyperendemic Area of KwaZulu-Natal, South Africa",doi:"10.5772/intechopen.105547",signatures:"Adenike O. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. Voyich",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Montana State University",country:{name:"United States of America"}}},{id:"330412",title:"Dr.",name:"Muhammad",middleName:null,surname:"Farhab",slug:"muhammad-farhab",fullName:"Muhammad Farhab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"349495",title:"Dr.",name:"Muhammad",middleName:null,surname:"Ijaz",slug:"muhammad-ijaz",fullName:"Muhammad Ijaz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}}]}},subseries:{item:{id:"95",type:"subseries",title:"Urban Planning and Environmental Management",keywords:"Circular economy, Contingency planning and response to disasters, Ecosystem services, Integrated urban water management, Nature-based solutions, Sustainable urban development, Urban green spaces",scope:"
\r\n\tIf we aim to prosper as a society and as a species, there is no alternative to sustainability-oriented development and growth. Sustainable development is no longer a choice but a necessity for us all. Ecosystems and preserving ecosystem services and inclusive urban development present promising solutions to environmental problems. Contextually, the emphasis on studying these fields will enable us to identify and define the critical factors for territorial success in the upcoming decades to be considered by the main-actors, decision and policy makers, technicians, and public in general.
\r\n
\r\n\tHolistic urban planning and environmental management are therefore crucial spheres that will define sustainable trajectories for our urbanizing planet. This urban and environmental planning topic aims to attract contributions that address sustainable urban development challenges and solutions, including integrated urban water management, planning for the urban circular economy, monitoring of risks, contingency planning and response to disasters, among several other challenges and solutions.
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Since 2015 he heads the research department Sanitation, Water and Solid Waste for Development (Sandec) at the Swiss Federal Institute of Aquatic Research and Technology (Eawag).",institutionString:"Swiss Federal Institute of Aquatic Science and Technology, Switzerland",institution:null},editorTwo:{id:"290571",title:"Dr.",name:"Rui Alexandre",middleName:null,surname:"Castanho",slug:"rui-alexandre-castanho",fullName:"Rui Alexandre Castanho",profilePictureURL:"https://mts.intechopen.com/storage/users/290571/images/system/290571.jpg",biography:"Rui Alexandre Castanho has a master\\'s degree in Planning, Audit, and Control in Urban Green Spaces and an international Ph.D. in Sustainable Planning in Borderlands. Currently, he is a professor at WSB University, Poland, and a visiting professor at the University of Johannesburg, South Africa. Dr. Castanho is a post-doc researcher on the GREAT Project, University of Azores, Ponta Delgada, Portugal. He collaborates with the Environmental Resources Analysis Research Group (ARAM), University of Extremadura (UEx), Spain; VALORIZA - Research Center for the Enhancement of Endogenous Resources, Polytechnic Institute of Portalegre (IPP), Portugal; Centre for Tourism Research, Development and Innovation (CITUR), Madeira, Portugal; and AQUAGEO Research Group, University of Campinas (UNICAMP), Brazil.",institutionString:"University of Johannesburg, South Africa and WSB University, Poland",institution:{name:"University of Johannesburg",institutionURL:null,country:{name:"South Africa"}}},editorThree:null,series:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null},editorialBoard:[{id:"181486",title:"Dr.",name:"Claudia",middleName:null,surname:"Trillo",slug:"claudia-trillo",fullName:"Claudia Trillo",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSAZHQA4/Profile_Picture_2022-03-14T08:26:43.jpg",institutionString:null,institution:{name:"University of Salford",institutionURL:null,country:{name:"United Kingdom"}}},{id:"308328",title:"Dr.",name:"Dávid",middleName:null,surname:"Földes",slug:"david-foldes",fullName:"Dávid Földes",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002nXXGKQA4/Profile_Picture_2022-03-11T08:25:45.jpg",institutionString:null,institution:{name:"Budapest University of Technology and Economics",institutionURL:null,country:{name:"Hungary"}}},{id:"282172",title:"Dr.",name:"Ivan",middleName:null,surname:"Oropeza-Perez",slug:"ivan-oropeza-perez",fullName:"Ivan Oropeza-Perez",profilePictureURL:"https://mts.intechopen.com/storage/users/282172/images/system/282172.jpg",institutionString:"Universidad de las Américas Puebla",institution:{name:"Universidad de las Américas Puebla",institutionURL:null,country:{name:"Mexico"}}}]},onlineFirstChapters:{paginationCount:14,paginationItems:[{id:"82457",title:"Canine Hearing Management",doi:"10.5772/intechopen.105515",signatures:"Peter M. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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