Reluctance machine parameters.
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"1830",leadTitle:null,fullTitle:"Hematology - Science and Practice",title:"Hematology",subtitle:"Science and Practice",reviewType:"peer-reviewed",abstract:"Hematology encompasses the physiology and pathology of blood and of the blood-forming organs. 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Dr. Lutsenko is the author of more than eighty published works.',institutionString:"Oleksandr Dovzhenko Hlukhiv National Pedagogical University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Oleksandr Dovzhenko Hlukhiv National Pedagogical University",institutionURL:null,country:{name:"Ukraine"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"265",title:"Education",slug:"social-sciences-education"}],chapters:[{id:"79315",title:"Features of Management of Research Activity in Higher Educational Institutions",slug:"features-of-management-of-research-activity-in-higher-educational-institutions",totalDownloads:155,totalCrossrefCites:0,authors:[{id:"225667",title:"Mrs.",name:"Olena",surname:"Lutsenko",slug:"olena-lutsenko",fullName:"Olena Lutsenko"}]},{id:"75350",title:"Active Learning: The Panacea to Miseducative Practices in Teacher Education",slug:"active-learning-the-panacea-to-miseducative-practices-in-teacher-education",totalDownloads:362,totalCrossrefCites:0,authors:[{id:"332250",title:"Dr.",name:"Davison",surname:"Zireva",slug:"davison-zireva",fullName:"Davison Zireva"}]},{id:"69557",title:"Usage-Based and Universal Grammar-Based Approaches to Second Language Acquisition",slug:"usage-based-and-universal-grammar-based-approaches-to-second-language-acquisition",totalDownloads:1156,totalCrossrefCites:0,authors:[{id:"284466",title:"Associate Prof.",name:"Kim Hua",surname:"Tan",slug:"kim-hua-tan",fullName:"Kim Hua Tan"},{id:"309067",title:"Dr.",name:"Vafa",surname:"Shojamanesh",slug:"vafa-shojamanesh",fullName:"Vafa Shojamanesh"}]},{id:"75088",title:"Non-Formal Education as a Foundation for Active Learning",slug:"non-formal-education-as-a-foundation-for-active-learning",totalDownloads:296,totalCrossrefCites:0,authors:[{id:"297298",title:"Dr.",name:"Roy",surname:"Alonso Terrazas Marín",slug:"roy-alonso-terrazas-marin",fullName:"Roy Alonso Terrazas Marín"},{id:"340946",title:"Dr.",name:"Brenda",surname:"Linda Alvarado Espinoza",slug:"brenda-linda-alvarado-espinoza",fullName:"Brenda Linda Alvarado Espinoza"}]},{id:"75959",title:"Activity-Based Online Learning: A Response to Dyslexia and COVID",slug:"activity-based-online-learning-a-response-to-dyslexia-and-covid",totalDownloads:215,totalCrossrefCites:1,authors:[{id:"93190",title:"Dr.",name:"Charles",surname:"Potter",slug:"charles-potter",fullName:"Charles Potter"}]},{id:"75444",title:"Artificial Intelligence in Education",slug:"artificial-intelligence-in-education",totalDownloads:1386,totalCrossrefCites:2,authors:[{id:"332017",title:"Dr.",name:"Andrej",surname:"Flogie",slug:"andrej-flogie",fullName:"Andrej Flogie"},{id:"332021",title:"Prof.",name:"Boris",surname:"Aberšek",slug:"boris-abersek",fullName:"Boris Aberšek"}]},{id:"75643",title:"Technology Enabled Active Learning in Electrical Engineering",slug:"technology-enabled-active-learning-in-electrical-engineering",totalDownloads:71,totalCrossrefCites:0,authors:[{id:"329692",title:"M.Sc.",name:"Syed Abdur Rauf",surname:"Magrabi",slug:"syed-abdur-rauf-magrabi",fullName:"Syed Abdur Rauf Magrabi"}]},{id:"76643",title:"University Mathematics-Laden Education, Competencies and the Fighting of Syllabusitis",slug:"university-mathematics-laden-education-competencies-and-the-fighting-of-syllabusitis",totalDownloads:205,totalCrossrefCites:0,authors:[{id:"341219",title:"Dr.",name:"Tomas",surname:"Højgaard",slug:"tomas-hojgaard",fullName:"Tomas Højgaard"}]},{id:"78086",title:"The Development Biology Authentic Learning of Mahasarakham University Demonstration School (Secondary), Thailand",slug:"the-development-biology-authentic-learning-of-mahasarakham-university-demonstration-school-secondary",totalDownloads:125,totalCrossrefCites:0,authors:[{id:"342787",title:"Dr.",name:"Wutthisak",surname:"Bunnaen",slug:"wutthisak-bunnaen",fullName:"Wutthisak Bunnaen"}]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"252211",firstName:"Sara",lastName:"Debeuc",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/252211/images/7239_n.png",email:"sara.d@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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by",editors:[{id:"187893",title:"Dr.",name:"Maria Jose",surname:"Hernández-Serrano",slug:"maria-jose-hernandez-serrano",fullName:"Maria Jose Hernández-Serrano"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"50778",title:"Wind‐Driven Self‐Excited Reluctance Generator for Rural Electrification",doi:"10.5772/62738",slug:"wind-driven-self-excited-reluctance-generator-for-rural-electrification",body:'\n
The age‐long exploitation of fossil fuel has resulted into attendant global warming, which has become the single largest environmental threat globally. An attempt to mitigate the effects of climate change due to the burning of fossil fuels and to meet the increasing energy demand has informed multi‐dimensional researches into the harnessing of renewable energy sources for power generation. Thus, exploration of renewable energy sources such as hydro, solar, wind, and geothermal energies has gained global attention [1, 2].
\nDistributed generation is also receiving a rapt attention over centralized generation due to cost of transmission, particularly to rural areas which are mostly remote and isolated from the urban regions. The underlying issues involved in such distributed generation includes energy conversion, control, and integration . A number of electrical machines can be used for the electromechanical energy conversion, each with its attendant merits and demerits [3, 4].
\nThe use of self‐excited induction generator (SEIG) in isolated wind turbine energy conversion has gained prominence in recent years. This is largely due to its inherent advantages over the conventional synchronous generator, which includes simple, brushless, rugged, and robust construction with squirrel cage rotor, relatively low initial and maintenance cost, self protection against excessive overload, and short‐circuit contingencies [5]. In addition, SEIGs require no external direct current (DC) supply for excitation and voltage regulation, and they have better transient performances [6]. On the other hand, the major drawbacks of SEIG are poor voltage and frequency regulations under varying prime mover speed and loading conditions. Its output frequency and generated voltage are dependent on the speed of the prime mover, hence a need for frequency and voltage stabilizing and control circuits, which invariably increases the installation cost [7, 8].
\nAnother self‐excited machine that can also provide a good and competitive potential for wind energy conversion for rural electrification is the self‐excited reluctance generator (SERG). Three‐phase SERG has almost all the advantages of SEIG. An additional advantage of SERG is the fact that it has constant output frequency in spite of varying loading conditions and excitation capacitances. Another desirable advantage of SERG is that of enhanced steady state performances and relatively high efficiency over a wide range of operation [9].
\nIn view of its shortcomings, SEIG suffers in terms of changes in both magnitude and frequency of the generated voltage under various loads. A salient‐pole or segmental pole rotor SERG without dc excitation has been proposed to decrease such problem [10].
\nThis chapter therefore focuses on the harnessing of wind energy for electric power generation in rural areas using SERG. A detailed mathematical model of energy conversion with SERG suitable for the dynamic and transient analysis of the machine is presented. The model is utilised to build an investigative simulation tool in the MATLAB‐Simulink environment. The advantages of SERG over SEIG are shown in the simulation results.
\nAlso, a typical model of a wind turbine is developed and integrated to that of the SERG to obtain a complete network for the wind‐driven self‐excited reluctance generator (WDSERG). The complete model was used to simulate the WDSERG. Different scenarios of wind speed and load conditions were investigated to determine the process of voltage build‐up and voltage collapse. Simulation results of the SERG driven by a wind turbine are presented in the concluding section of this chapter.
\nWind energy is one of the most prominent renewable energy sources on earth. In recent years, there has been a marked growth in the harnessing of this resource for electricity generation. The installed power increased from 7.5 GW in 1997 to more than 194 GW in 2010 globally [11]. This brought about a corresponding increase in the size and power ratings of turbines, with rotor diameters of more than 100 m and power ratings ranging from kilowatts to megawatts. The obvious need for off‐grid distributed generation is another reason for the increasing demand for the design, construction, and operation of wind energy conversion systems. The mechanical output power of the turbine (in Watts) is given by:
\nwhere
Where
The coefficients C1 to C6 are
where
The turbine power characteristics for different values of wind speeds and for the specified blade pitch angle (
Turbine Power Characteristics for different values of wind speed.
Although reluctance machine has been known as early as induction machine, it has received minimal attention due to its relatively poor overall performance. Its earliest operations were largely in the motor mode for special applications [12, 13]. These applications include electric clocks, textile drives, synchronous switches drives, and the more sophisticated applications in nuclear reactors to position control rods with exact precision and reliability [14, 15]. However, since early 1960s, [14] and others started to study the theory and performance of poly‐phase reluctance machines, and this paved way for an extensive study of the machine. Most of the studies carried out were however concentrated on the reluctance motor, until early 1980s when it was reported that the reluctance machine can also be operated as a SERG [16].
\nThe reluctance machine is made up of a stator similar to that of the induction machine, and the rotor is basically a squirrel‐cage induction machine rotor modified in order to have saliency in its magnetic circuit, which enhances the production of reluctance torque [14]. In order to ensure self‐starting, the machine is provided with squirrel‐cage rotor bars or damper cage windings. The principle of operation of the reluctance machine is based on the existence of varying air‐gap reluctance, such that the opposition to the passage of magnetic flux is a minimum along an axis called the direct axis, and a maximum along an electrically perpendicular axis, called the quadrature axis. The rotor is thus said to be magnetically anisotropic [15]. The tendency of the direct axis to align itself with the axis of the rotating magnetic field provided by the stator forms the basis for the operation of this machine.
\nUnlike induction machines, the motion of the rotor can be perfectly latched under the influence of the rotating magnetic field of the stator such that the rotor runs with the same speed of the stator\'s field. Thus, reluctance machine is a synchronous machine. This is a major advantage of the reluctance machine. Regardless of variations in the supply voltage and the load, the reluctance motor would run at synchronous speed. It is well‐known that the output power of a reluctance machine increases with the ratio of the direct‐axis inductance (or reactance) to the quadrature‐axis inductance (or reactance) (Ld/Lq or Xd/Xq). Therefore, several attempts have been made to increase the Ld/Lq ratio [13]. To improve the overall performance of the reluctance machine, there have been improvements in electromagnetic designs which have brought about different rotor geometrical configurations. Because of these improved designs, the reluctance machine can compete favourably with the well‐established induction machine [13]. Some of the rotor configurations include conventional salient pole rotor, segmented rotor, axially laminated anisotropic (ALA) rotor, flux‐guided or flux‐barrier rotor, and transversely laminated (TLA) rotor [13]. These have their different advantages and limitations.
\nThe growing interest to harness renewable energy sources has informed the use of self‐excited machines for energy conversion. Like the induction machine, the reluctance machine can also be used as a SERG driven by a prime mover. The self‐excitation is initiated when suitable capacitors are connected across its stator terminals. As the rotor rotates, the residual flux in the rotor induces a small amount of electromotive force in the stator windings. With suitable capacitors connected across the stator terminals, a small amount of current flows in the stator windings which then increases the magnetic flux in the machine. The voltage then builds up in this manner until the magnetic core becomes saturated. Thus, these two conditions must be satisfied for self excitation and voltage build‐up to occur [17]: (i) the rotor must have sufficient residual magnetism and (ii) the capacitance value must be adequate. The magnetizing inductance is a major factor for voltage buildup and stabilization of generated voltage for unloaded and loaded conditions.
\nIn this chapter, the following simplifying assumptions have been made.\n
Only the d‐axis magnetizing inductance is affected by magnetic saturation.
Core loss is negligible.
Negligible space harmonics in the air‐gap flux and time harmonics in the electromotive force and current waveforms.
The equations of a reluctance machine can be obtained from those of the wound field synchronous machine with the field winding terms omitted [18, 19]. In rotor reference frame, the voltage equation for a synchronous reluctance generator with no rotor conductor can thus be written as follows:
where:
The
Rotor reference frame equivalent circuit of a self‐excited reluctance generator. (a) q‐axis (b) d‐axis.
The electromagnetic torque developed by the generator may be written as:
If we substitute (8) and (9) into (12), we obtain:
Where
A system of gears contained in a gearbox system is required to convert the lower rotational speeds on the wind turbine side to a high rotor speed on the generator side, for electrical energy production. The gear ratio is the ratio of the generator speed to the tip speed of the turbine blade.
\nTherefore, the coupling equation, which represents the swing equation of the generator is given as:
where B is the friction constant of the system. The wind turbine is represented as a single lumped inertia, JT, in equation (14). This includes the inertial masses of the turbine blades, the gearbox, and the generator, referred to the generator side.
\nThe stator terminals are connected to a capacitance bank in parallel with the load. The equations that relate the terminal voltages with the stator currents and load currents are presented in the following equations. Looking into the equivalent circuit of Figure 2, the nodal equation at the stator‐capacitor‐load terminals is obtained using Kirchoff\'s Current Law as:
A general representation of the excitation capacitance in rotor reference frame is given in matrix form as:
whereupon, the voltages are expressed as:
Taking the load as a typical RLC, a general balanced RLC load model can be represented by:\n
The RL load model can be obtained from (20) and it is expressed in rotor reference frame as:
A 2 hp (1.5 KW), 4‐pole, 60 Hz machine with the parameters obtained from [20], and [21] is used for the simulation in this chapter. The parameters are given in Table 1.
\nMachine rating | \nTbase | \nIbase(abc) | \nJ | \n||||
---|---|---|---|---|---|---|---|
Horsepower | \nVolts | \nRpm | \nNm | \nAmps | \nOhms | \nH | \nKgm2 | \n
2 | \n120 | \n1800 | \n7.9577 | \n4.1667 | \n3.77 | \n0.081 | \n0.1 | \n
Reluctance machine parameters.
d‐axis magnetising characteristic.
The magnetising characteristics of the machine is given by the Ld‐Id curve shown in Figure 3. A 6th order curve fitting polynomial has been used to approximate the relationship. This enables the saturation effect to be taken into consideration.
\nThe polynomial is given as:
The equations derived in the previous sections are arranged in forms suitable for simulation. For the purpose of clarity, the voltage equations have been rearranged below. By substituting equations (8) and (9) into (6) and (7) respectively, the currents can be expressed as:
The detailed MATLAB‐Simulink model developed and utilised to simulate WDSERG is presented in the following Figures 4 to 12.
\nComplete WDSERG model in MATLAB‐Simulink.
The model is made up of the different subsystems (saturation, current, excitation capacitance, \nEM torque,
The inverse transformation (
Saturation Subsystem.
Current Subsystem.
Shunt Excitation Capacitance Subsystem.
RL Load Subsystem.
Electromagnetic Torque Subsystem.
Rotor Speed Subsystem.
Wind Turbine Model.
The simulation has been done using MATLAB‐Simulink to observe the performance of the system under the following conditions:\n
Constant wind speed
Wind Speed Variation
Load variations
The stator terminals are connected to a balanced star‐connected capacitance bank of
A no load condition can be simulated using a very large value of R and L (Figure 13). Under this condition, the terminal impedance is so high that it can be regarded as an open circuit. The result of the simulation under this condition is shown in Figure 13. The stator phase current is about 10.33 A, while the load current is practically equal to zero (0.000035 A). The electromagnetic torque developed, which is equal to the wind turbine torque rises to a steady value of 3.707 Nm.
\nThe performance of the WDSERG under a constant wind speed of 10 m/s and an RL load (R = 400 Ohms; L = 30 mH ) is shown in Figure 14. The wind turbine torque rose to a steady value of 0.7611 Nm. As the wind torque is applied, the generator speed quickly rises to the synchronous speed of 1800 rpm. The electromagnetic torque developed by the machine closely matches the wind torque, which invariably leads to a constant SERG speed.
\nWDSERG At Vwind = 10m/s at No load (R = 10Megaohms; L = 30H).
WDSERG At Vwind = 10m/s with R = 400ohms; L = 30mH.
It is observed that a WDSERG would perform smoothly with a constant wind speed profile.
\nThis scenario is analysed in two possible cases of decrease in wind speed and increase in wind speed as follows:
\nThe dynamic response of the wind‐driven SERG when the wind speed suddenly falls to 8 m/s for an RL load of 400 Ohms, 30 mH. The wind torque and the electromagnetic torque also falls suddenly from an initial value of 0.7611 Nm to a value of 0.3656 Nm. As the wind speed falls, the generator speed also falls from the synchronous value of 377 rad/s (1800 rpm) to 301.9 rad/s (1441.5 rpm).
\nDynamic response of the WDSERG when the wind speed suddenly falls to 8m/s.
Under this input condition, the generated voltage falls from a value of 118 V to a new value of about 100 V. The machine continues in this new values until 5 s when the wind speed was suddenly returned to 10 m/s. Thus, a decrease in the wind speed tends to reduce the generated voltage (Figure 15).
\nDynamic response of the WDSERG when the wind speed suddenly rises to 10.2m/s.
In Figure 16, with an RL load of 400 Ohms, 30 mH, and an excitation capacitance of
A scenario of an overloaded condition was simulated using an effective load impedance which reduced in steps from 400 Ohms to 200 Ohms at 2 s to 100 Ohms at 4s then to 80 Ohms at 6 s and finally back to 400 Ohms. The result of the simulation is illustrated in Figure 17. It is observed that at t = 2s, when the load suddenly changes to 200 Ohms, there is a remarkable fall in the voltage level. The generated voltage continues to fall at 4 s and at 6 s until it rapidly falls toward zero as a result of overload. This illustrates that at an overloaded condition, the generator will suffer voltage collapse. The voltage builds up again at 8 s when the load changes back to its initial impedance value.
\nVoltage Collapse of the WDSERG.
The performance of the WDSERG under varying loads is shown in Figure 18. When the RL load suddenly changes from 400 Ohms, 35 mH to 300 Ohms, 105 mH at 3 s, and then changes back to the initial RL values at 6 s, the following are observed:
\n\n(a) At 3 s, the drive torque and hence the electromagnetic torque falls from a value of 0.8216 Nm to a new steady state value of 0.6181 Nm. This consequently leads to a reduction in both the stator voltages and currents. The voltage dropped from about 123 V to a steady value of 101 V, and the stator current falls from about 4 A to about 3.2 A. However, during this period the load current increases slightly due to an increase in load inductance. When the RL value is suddenly increased again at 6 s, the voltage and current rises back to their initial values.
\nIn spite of the sudden increase and decrease in the load, the speed of the SERG remains constant at 1800 rpm, and hence the frequency. Thus, there is a constant output frequency regardless of the variations in load. This is unlike the SEIG, whose voltages and frequency are heavily affected by varying loading conditions [22]. It is obvious also that though the WDSERG voltage output varies with the load, this variation may not be as severe compared to the SEIG.
\nDynamic response of the WDSERG under sudden increase and decrease in the RL load at Vwind = 10m/s.
The dynamic performance of a wind‐driven SERG has been analysed and presented under conditions of constant wind speed, varying wind speed, and varying load. A step‐by‐step procedure for the MATLAB‐Simulink implementation has been clearly presented.The results show that the generated voltage slightly falls with increasing load, and requires an increase in excitation capacitance within the stable operating limits to maintain a constant generated voltage. A wind-driven SERG will however operate at constant output frequency regardless of the load variations at its output terminals. This makes the SERG a good candidate for wind power application in rural electrification.
\n“Almost all men die from their drugs and not from their diseases”
(Molière - 1622-1673, The Imaginary Invalid, Act III).
In his work devoted to analyzing the theme of health, Ivan Illich addressed the medicalization of society, the harms caused by the medical apparatus, the so-called iatrogenesis, including drug iatrogenesis, which he also listed as the cause of hospital admissions [1].
Revisited more than 40 years after its publication, the work ‘Medical Nemesis’ still proves to be thought provoking and current. More than stimulating reflection, it has the strength to motivate the investigation of several of the aspects it addresses, so that one can know, for example, whether iatrogeneses related to hospital admissions are still a public health problem, a topic that has been extensively discussed. Extensive investigation [2, 3, 4].
Although adverse drug events (ADE) often include errors that occurred before and during hospitalization, even the correct prescriptions can present iatrogenesis, a situation that occurs when they cause more harm than good. In addition to the direct losses to patients, ADEs influence to increase the already unsustainable costs of health systems.
Therefore, iatrogenesis is not just a result of an error in the prescription. It is relatively common to have a correct diagnosis and prescription, but undesirable results due to several aspects. One of them has the explanation for the adverse effect in genetics. The literature also refers to writing iatrogenesis, when difficult to read writing causes potential or real problems to patients [5].
On the other hand, the contribution of drugs towards the cure or control of various diseases is undisputed, with a direct impact on prolongation and quality of life.
The association between drugs and different responses to treatments explained by individuals’ genetic variants is an ancient discovery, confirmed by several scientists since the beginning of the last century [6]. The knowledge arising from the human genome project has led to advances in several fields of modern science, but it is in the field of Health, in particular, that its applicability has been growing in a promising way [7].
In Health, the discoveries of genomics have contributed to improve the assertiveness of diagnoses, prognoses and treatments, including those related to the ingestion of medications, which makes pharmacogenetics one of the main manifestations of the so-called precision medicine.
It may sound inconsistent to relate Ivan Illich - an iconoclast of health technologies and an opponent of everything that stimulates the medicalization of society - with pharmacogenetics, after all, one of the most advanced technologies. However, this new branch of science, which constitutes one of the most promising forms of the applicability of genomic findings, can respond to an important problem highlighted by the author (adverse drug reaction) that causes discomfort in people and increases the already unsustainable costs of the health system, especially when such effects result in hospital admissions [8].
The purpose of this article is to revisit Ivan Illich’s thinking and discuss the currentness of his complaints regarding the inconveniences arising from the use of drugs, especially in their impact on hospitalization, and also reflect on the potential of pharmacogenetics to mitigate adverse events related to drugs that victimize people.
In the text that follows, it begins with a brief presentation of Illich’s story. Thereafter, a digression is made on the association between the concepts of medicalization and iatrogenesis, to then make quick considerations about social iatrogenesis, considering the effects of this phenomenon on society. After presenting the consequences of iatrogenesis as proposed by Illich, from a fluent literature review, an update of the findings is made, providing evidence that the problem shows to be current and relevant nowadays. A quick conceptual presentation of pharmacogenetics is followed by examples of its clinical consequences in specific pharmacological groups.
Born in Austria in 1926, Ivan Illich is the owner of an extraordinary life trajectory. He resided in Florence, Italy, where he studied Natural Sciences with a specialization in inorganic chemistry and crystallography. In Rome, he graduated in Philosophy and Theology, and was ordained a priest. Subsequently, he completed a doctoral degree in Medieval History at the University of Salzburg [9], Austria, and a post-doctoral degree at the Princeton University, USA. At the Vatican, he would be used in diplomatic functions, but in 1951 he preferred to be a parish priest in New York, USA. The parish served the Puerto Rican community, which led him to occupy, in 1956, the vice-rectory at the Catholic University of Puerto Rico [10]. He traveled alone through South America and in 1961 created, in Cuernavaca, in Mexico, a center for studies and preparation of missionaries for Latin America. Finally, in Bremen, Germany, he was a visiting professor - as, indeed, at several world-renowned universities - and died on December 2, 2002 [11]. Due to the plurality of themes that he studied, explained in greater detail and which he published on, he was considered a polymath - “an individual who knows a lot, who studies or who knows many sciences”, in addition to polyglot, having mastered 10 different languages [9].
He was a controversial and polemical critic of the most diverse topics, such as education, transportation and health [12]. Due to disagreements with the Catholic Church, which also did not skimp on its critical approaches, he ended up leaving the priesthood in 1969 [11]. Most importantly, he wrote books and defended innovative and radical ideas in the field of education. In the health area, he used his restless and brilliant mind for a remarkable reflection, materialized in the publication, in 1974, of the work ‘
The term “medicalization” (which has not yet been included in the main Brazilian dictionaries) can be considered a polysemic word, if not with different meanings, but certainly with different connotations. Some authors even associate the term with a positive attribute, as in the case of AIDS, when the entire health production chain mobilized, in an unusual way until then, to understand the etiology of the disease, learn to diagnose and develop treatments, first to avoid deaths and then to prolong life and to provide greater well-being to people affected by the referred disease [13].
In his approach, Illich made no concessions to the eventual positive aspect of what he called the “medicalization of life”, which he called as unhealthy for producing a “morbid society”.
Continuing in his critique on “medicalization”, he found that epidemiologists were unable to prove, for example, that early intervention altered the survival rate of patients affected by breast cancer. Likewise, he questioned the treatments for lung cancer, whose medical interventions brought more expenses and more suffering, without changing the survival rate - constantly mentioning the studies and articles that supported his conclusions [1].
It was also worth using drug treatments as an example, stating that the evaluation of the advantages (benefits) and disadvantages (undesired effects) caused by the drugs could be null or even negative, an aspect that even today seems to remain unnoticed, if not neglected.
This preamble on “medicalization” was used by Illich in his book to make way towards the concept of iatrogenesis, formed by the Greek words iatros (doctor) and genesis (origin). He thus defined iatrogenic disease as one that characterizes all the clinical conditions of which physicians, drugs, laboratories or hospitals - any medical apparatus, anyways, are pathogenic agents.
In the chapter he called Social Iatrogenesis, Illich dealt with issues that are still disturbing today and that are frequently addressed in the field of public health.
He affirmed, for example, that “the level of health did not improve even when medical expenses increased”, and was supported by studies that showed that although the USA allocated a considerable percentage of its GDP in the health system (7.4%, in 1974), they were not able to obtain good indicators, because the life expectancy of adult men paradoxically declined in that country [1].
The percentage of GDP invested in health by the United States in health reached an incredible 17.1% in 2013 [14]. Although health expenditures in that country lead the world statistics by far, however, Americans, as Illich emphasized, are not able to obtain a counterpart in health indicators, as for example, the life expectancy at birth (79 years) where they appear in the 34th position [14].
It is worth mentioning, based on this evident American paradox,, a vernacular created by Illich, “counterproductivity” [15], which he defined as “the paradoxical effect of overproduction and overconsumption”, to verify and exemplify that the global volume of vehicles, designed to allow greater speed in travel, ends up stopping circulation on the roads public; the global volume of education prevents children from expanding their curiosity, intellectual courage and sensitivity; and that the global volume of “medicalization” reduces the level of health (ILLICH, 1975, p. 70).
No less interesting, still to characterize the “medicalization” of society, it was the record that the author already made at that time about the wonder that technology caused in people, impelling them to believe that health increased as they had access to prostheses, drugs, hospitalizations and examinations for preventive controls.
A similar finding was recorded, more than twenty years later, by the American cardiologist Bernard Lown, who was discouraged after investing a lot of time in the collection of a detailed medical history, which gave him exactly the diagnosis, to see that the patient appears to be incredulous. But when he took him to an examination room, where he had an old-fashioned fluoroscope with an image intensifier, with an instrument panel similar to that of an airplane, he saw the patient impressed and saying with his buttons: “Ah, how nice it is to be in such a well-equipped medical office.” Dr. Lown concludes, without hiding the nonconformity, that “the puerile faith in the magic of technology is one of the reasons why the public has been tolerating the dehumanization of medicine” [16].
In a recent publication, Atul Gawande, when dealing with aging and end-of-life care, also identifies the fetish that technology awakens in people, who are not encouraged to seek advice from a geriatrician, but who await with unquestionable expectation the invention of a device that doctors implant in them, for example, in the chest, hoping to reduce discomfort and prevent them from ending up, dependent on care, in a nursing home [17].
In general, it is common for people not to feel treated if the doctor does not request for an examination or does not prescribe a drug. On the contrary, they value the use of technologies, preferably the most up-to-date and sophisticated ones, without awareness of the iatrogenesis that tests and medications so often provoke.
“Medicalization” also reveals itself as a true outsourcing of care for one’s own health, when people renounce the possibility of taking preventive care, eliminating bad habits, to surrender to the medical arsenals, the side effects of medicines and imaging tests, in addition to choosing hospitals as a safe place to obtain health, forgetting the risk of exposure to nosocomial infection, iatrogenesis of the most harmful.
Illich was radical and rebellious in renouncing “medicalization”, so coherent and determined in his conviction, that he suffered for ten years from a brain tumor, the cause of his death, giving up the therapies available at the time, using only opiates to relieve the pain and accepting to live with a huge bulge on his right face that even startled his interlocutors [18].
Iatrogenesis caused by drugs is usually studied based on factors related to the prescription: whether it is foreign to the therapeutic relationship; if it is at odds with the clinical diagnosis; whether the doses or duration of treatment are inadequate; whether undesirable, harmful or unexpected effects occur; if there is morbidity or mortality and if interactions between drugs occur that are harmful to the patient [19]. In addition, iatrogenic episodes occur even when prescriptions follow clinical protocols and drug labels, for the simple reason that people do not react in the same way, even if they have the same diagnoses.
In addressing some causes of iatrogenesis caused by drugs, Illich highlighted some factors not directly linked to the doctor-patient relationship as described above, but to other external aspects, such as the role of the pharmaceutical industry, whether in spending on advertising and commercial promotion with doctors, but mainly in stimulating the overconsumption of medicines, which increases the potential for damage related to the intake of medicines.
These aspects are still a current phenomenon and have been echoed by several authors, who denounce even the manipulation of academic studies, the creation of diseases that no longer admit any healthy individual [20], treating as medical problems which are non-medical [13], inventing diseases to sell their drugs [21], even considering that “a healthy person is just an undiagnosed patient” [22].
The laboratories’ obsession with increasing the consumption of medications seems to have no limit, as can be seen in the encouragement of prescription classified as off label, when manufacturers convince doctors to prescribe drugs for indications other than those approved regulatory agencies at the time of their registration. The pharmaceutical industry does this by preparing articles and paying researchers to put their names in these “studies”, with the explicit aim of increasing sales, as Marcia Angell, a Harvard professor, reported in a hard-hitting publication [23].
In ‘Medical Nemesis’, Illich pointed out that 3 to 5% of all hospitalizations in the United States of America (USA) had as a main reason, bad drug reaction. And that, once hospitalized, 18 to 30% of patients experienced an adverse reaction caused by a drug substance, doubling the length of hospital stay (ILLICH, 1975, p. 25).
The consultation of more recent studies confirms the relevance of this relationship, as was verified in the assessment of patient admissions in the Department of Cardiology and Pulmonology, in a large hospital in the Netherlands [24]. The authors conclude, after evaluating 2,000 hospitalizations by pharmacists and epidemiologists, that 19% of hospital admissions were motivated by adverse drug reactions (using the World Health Organization definition for this type of occurrence) and this percentage may reach 29% if hospitalizations classified as possibly iatrogenic are also considered.
An observational study carried out at a University Hospital in Spain sought to estimate the prevalence of negative results associated with drugs as a cause of hospitalization, by means of a random choice carried out by lot, which resulted in the analysis of 163 patients [25]. In 16.6% of the studied cases (27 patients) admission to the hospital was caused mainly by an adverse reaction due to use of the drug, of which 88.9% were considered preventable. The study concluded that hospitalizations motivated by an adverse reaction to medications had a high prevalence and most would be preventable through pharmacotherapeutic follow-up.
Another cross-sectional study, also conducted in Spain, evaluated patients who were hospitalized from the emergency services of a hospital. We sought to assess the negative results associated with the use of drugs that motivated hospitalization, to know the drugs that appeared more frequently and to assess the economic impact of these occurrences [26]. The conclusion was that 19.4% of hospitalizations occurred as a direct consequence of negative clinical results associated with the use of drugs, 65% of which were considered preventable. In addition, it was observed that the antineoplastic and immunosuppressive therapy groups motivated 38% of these adverse reactions. It was also found that 20.4% of the patients needed to be treated in an intensive care unit. Finally, it was found that the expense incurred was 237,377 euros (estimated annualized cost of 15,568,952 euros).
In the case of illnesses caused by Adverse Drug Events (ADE), in a meta-analysis 39 studies were selected (out of a total of 153) that evaluated the incidence of severe or even fatal ADE in American hospitals [27]. The conclusion was that the incidence of serious (6.7%) and fatal events (0.32%) was considered expressively high. Although the authors of the study noted the caveat that the results should be viewed with caution, because of the heterogeneity between the studies and possible bias in the samples, they warn that these data suggest that the adverse reaction to drugs represents an important health problem public in the United States of America (USA).
In a review article on adverse events (AE) in medical and hospital care, it was noted that ADEs are the most frequently identified, in addition to being also the most underreported [28]. In another evaluation carried out in a teaching hospital, which sought to estimate the frequency of this occurrence, it was observed that 14.6% of the 240 hospitalizations evaluated were motivated by ADE [29].
In England, a prospective observational study conducted in two large general hospitals sought to assess the cause of hospitalization in 18,820 patients hospitalized over a six-month period, seeking to identify which of these admissions were due to ADE, in addition to other aspects related to them. The prevalence obtained was 6.5% (1,225 cases), with 80% of this total directly related to an adverse drug reaction. The study concludes that this is an important problem considering morbidity, mortality and extra costs attributed to the studied events [30].
In Brazil, an original study focused on hospital admissions related to intoxication and adverse effects of drugs in children under one year of age. The retrospective analysis of the Authorizations for Hospital Admissions (AHA) of the Unified Health System (SUS), from 2003 to 2005, identified that a total of 1,063 children under one year of age were hospitalized as a direct or indirect consequence of drug-related intoxications or adverse effects [31].
Elderly patients are more susceptible to this type of occurrence due to the overuse and concomitant use of various drugs, administration errors and changes in the organism that interfere with pharmacodynamics and pharmacokinetics [32]. Although more vulnerable, the occurrence of iatrogenic disease in the elderly has not been studied in the dimension that the problem represents, since the population considered elderly is characterized by having multiple chronic diseases, is usually treated by many doctors and ends up being more subject to hospitalization and medical or surgical procedures [33].
Studies that analyze the relationship between pharmacotherapy and hospitalization of the elderly population also confirm that the occurrence rates are significantly high and are largely preventable [34]. Many of these hospital admissions for elderly patients are attributed to known drugs and occur because of drug interactions, which can also be prevented [35].
In the analysis of emergency hospitalizations for ADE in older adults, it was also found that they resulted from commonly used drugs and relatively few occurred due to the use of drugs considered to be high risk or inappropriate, which allows us to infer that such occurrences would also be preventable [36].
There are numerous studies that list hospital admissions due ADE and invariably conclude that we are facing an important public health problem, which not only reduces the patient’s quality of life but generates unnecessary expenses for hospitals [37] and, consequently, for the health system. Although the hospitalizations that are attributed to ADE vary in relation to the percentage, the findings are always significant when studying the causes of hospitalizations [38].
Adverse reactions to medications, even in cases of diagnosis, prescriptions and correct administration, can be explained by the trial-and-error methodology, which is still decisive in medical practice.
It should be emphasized that the search for the definition of the most appropriate drug and dosage makes use of experimenting with people’s reactions, and while pursuing the patient’s benefit, it often produces harmful effects. In the next topic, the potential contributions of knowledge of genomics to mitigate the harmful effects of iatrogenesis caused by drugs and their possible repercussions on people and health systems will be discussed.
The sequencing of the human genome has revolutionized biology in several fields of study. Until 2012, 67% of global investments in genome sequencing technologies were directed to pure research and 11% to field of health. The projection for 2017 pointed out that investments in health would channel 39% of resources, mainly due to the reduction in the cost of exams and the applicability in medical practice, diagnosis and treatment [7]. That is, the field of health is the one that increasingly uses the potential of next generation sequencing.
The influence of genetics on how people react differently to drugs has been observed for at least five decades. Recent knowledge brought by genomics has an invaluable support potential to medicine, for doctors, geneticists and for the pharmaceutical industry, in the use of personalized treatments [39].
In the case of drugs, therapeutic inefficacy or pharmacological toxicity has frequently been observed due to the presence of some metabolizing enzymes in drugs, in which drugs can interfere as inhibitors or inducers of these enzymes, an activity that varies between individuals and that can be determined by DNA analysis [40]. Genetic variability, therefore, can affect how a drug can be absorbed, activated, metabolized or excreted from the organism [41].
The reaction to the same drug varies from person to person depending on weight, age, gender, liver and kidney function, interactions between drugs, type of disease and genetic factors. The drug goes through two major processes in the organism, called pharmacokinetics and pharmacodynamics. Pharmacogenetics seeks to study how the drug passes through these processes, establishing the link between metabolism and individual differences in people’s DNA [42].
This metabolization can occur in different ways. In addition to the normal metabolizers, which respond as expected to the dosage of the package insert leaflet, there are slow metabolizers, which, due to reduced enzyme activity, are at risk of accumulating toxic levels and are more exposed to adverse reactions. Ultra-rapid metabolizers tend to require higher doses and are subject to the inefficacy of pharmacological therapy [41]. In addition, there is the intermediate metabolizer, which can benefit from the dose of the package insert leaflet but which can also be subject to the inefficacy of drug therapy.
The inclusion of genetic tests in the routine of medical practice is one of the main objectives of the
CPIC defines the terms pharmacogenetics and pharmacogenomics, which are sometimes used interchangeably by some authors. Pharmacogenetics is the study of the genetic influence on the response to the drug, normally considering one or only a few genes involved. Pharmacogenomics is the study of the variation of how genomics influences the response to the drug, considering the sequencing of the entire human genome1.
Pharmacogenetics emerged as a diagnostic tool that uses genetic information to guide pharmacotherapy decisions, improving the clinical outcome, giving rise to personalized clinical decisions [45].
These terms also differ according to their origin. Pharmacogenetic expression was coined by Friedrich Vogel in 1959 [46]. The word pharmacogenomics appears logically after the Human Genome Project.
Pharmacogenetics associates variability to drug response to hereditary aspects after the identification of some pharmacogenes [47]. Pharmacogenomics is one of the first clinical applications of the post-genomic era and expands this dimension to even point to the development of personalized drugs [48].
The following are some examples of the applicability of the use of pharmacogenetics in drug treatments widely used in psychiatry, cardiology and oncology.
The main causes of individual variability in response to the same dose of a drug are: age, biological factors, immunological factors, interactions between drugs and genetic factors [49]. Pharmacogenetics studies the role of genetics in variability of drug response.
This response can vary from potentially lethal adverse reactions to the equally serious lack of therapeutic efficacy.
Genetic variability plays an important role in pharmacokinetics (absorption, distribution, metabolism and excretion) and in pharmacodynamics, that is, in the interaction of the drug with the target and in the relationship between its concentration and its effect [50].
Currently, many studies are published that relate drugs to individuals’ genetic variants. In psychiatry, in the case of initial treatment for depression, about 30 to 40% of patients do not respond adequately to the prescribed medication, and it can take up to six weeks to characterize that it is not effective [51], exposing the patient to a long period therapy based on trial and error, with a high chance of adverse reactions.
The use of knowledge of the presence of variants in the genes involved in the metabolism of antidepressants such as CYP2D6 can provide the physician with an important subsidy in the choice of medications and in the definition of the dosages used in the treatment of depression [52].
The genetic variability of the drug response, depending on the type of metabolizer, is very high, as shown in Figure 1, which shows the demonstration of the main marker genes (CYP2D6 and CYP2C19) for antidepressants and anxiolytics [53].
Genetic variability of enzymes that metabolize drugs. Source:
Considering the Extensive Metabolizer (MS) as one that obtains an adequate response with the dose of the package insert, the window of variability is very large in relation to the Ultra-Rapid Metabolizer (UM) and the Poor Metabolizer (PM), especially, as shown in Figure 1 in the cases of the psychotherapeutic drugs, Escitalopram and Desipramine.
Several important drugs used in the treatment of heart disease are already the subject of studies on pharmacogenetics, especially in anticoagulants, antihypertensive agents, antiarrhythmics and statins.
Warfarin is the most commonly used oral anticoagulant in the world and aims to prevent thromboembolism. Warfarin therapy is often associated with a high risk of increased bleeding, especially during the initial phase of treatment. The CYP2C9 gene is responsible for the metabolic degradation of the activity of this drug and the VKORC1 gene is responsible for the activation of vitamin K-dependent coagulation factors. When inhibiting VKORC1, Warfarin produces the anticoagulant effect [54].
Although the consequences of undue dosages are always serious, the dose of Warfarin is usually adjusted by the trial-and-error method, or by considering other clinical parameters obtained in conventional laboratory tests. The optimal dose of warfarin varies greatly between patients. If the dose is too strong, the risk of serious bleedings increases, and if it is too weak, the risk of stroke increases. It is estimated that two million Americans start treatment with warfarin annually [55].
A study that sought to describe the frequency and characteristics of ADEs, which led people to seek emergency care in the USA, concluded, among other findings, that the second drug that motivated the occurrence was warfarin, just behind the insulins [56].
Another study that evaluated the bleeding complications caused by the use of anticoagulants concluded that the drug has been used in an increasing proportion and that bleeding has been a predominant reaction, in addition to being an important cause of mortality [57].
From what we tried to describe, there is no doubt that we are dealing with a class of drugs (anticoagulants) of special relevance, which deserves all possible care in the prescription process, mainly due to the high potential for harm to patients and the cost it entails for the health system, as ADE almost always require hospital admissions.
In another case–control study in the USA, we sought to assess whether the genotyping test for patients starting warfarin treatment could reduce the incidence of hospitalizations due to bleeding or thromboembolism. Compared with the control group over a six-month period, one of the main conclusions was that genotyped patients had a 43% lower risk of hospitalization for bleeding or thromboembolism. The authors conclude that genotyping for the anticoagulant reduces the risk of hospitalization for hemorrhage or thromboembolism in patients who start outpatient treatment with warfarin, with great statistical and clinical significance. They further defend that doctors should seriously consider the use of pharmacogenetic tests for patients who are starting treatment with the referred drug [58].
It should also be noted that oral anticoagulants are among the most sensitive to drug interactions, especially when taken simultaneously with antidepressants [59]. In these cases, the influence of metabolization between drugs must be observed by clinicians and pharmacists, without obviously disregarding the adverse events arising from these interactions.
More recent studies seek to evaluate new algorithms that increase assertiveness in warfarin prescription. Such algorithms associate genetic variables with age, gender, body mass, vitamin K levels and thyroid function. At the current stage, studies should also be developed that also consider geographic areas and ethnic groups, in order to guarantee greater therapeutic efficacy, mitigate adverse reactions to the drug and reduce hospitalizations motivated by it [60].
In the case of statins, used in the control of cholesterol and in the prevention of cardiovascular diseases. Its use is widespread today, but the prescriptions ignore the effects of the presence of polymorphisms in the SLCO1B1 gene, in charge of synthesizing a family of proteins inside the cells for their metabolism and therapeutic action.
Several studies have been and are being carried out to verify how patients metabolize the different types of statins, some more or less indicated according to the phenotype of each individual, in order to avoid the side effects that in the case of statins are manifested mainly in myopathies that can worsen patients’ living conditions.
Currently, at least 7 types of statins can be prescribed: atorvastatin, fluvastatin, lovastatin, pravastatin, pitavastatin, rosuvastatin and simvastatin. Although these different types share the same mechanism of action, they have differences in their chemical structures and pharmacokinetic profiles. Chemical structures end their solubility in water and influence the way they are absorbed, distributed, metabolized and excreted [61]. The patient can metabolize each of these different types of statins differently, an aspect that can be revealed by the pharmacogenetic test.
As an area responsible for the main cause of death in the world, drug therapy for Cardiovascular Diseases is the focus of attention in pharmacogenetic studies also for other drugs related to it. In addition to those already mentioned, there are plenty of studies relating genetic variants to the way we process antiplatelet drugs such as Clopidogrel, aspirins and antihypertensive drug [62].
Minimizing toxicity while maximizing efficacy is a common goal for the treatment of any condition, but its importance is even more evident in the case of oncology, due to the severe nature of the disorders and the aggressive toxicity caused by chemotherapeutic agents, in addition to the risk of relapse cancer or disease progression. The challenge of achieving an optimal therapeutic index is especially relevant for the elderly population, due to age-related changes in metabolism and the interaction with concomitant medications [63].
Over the past decade, advances in pharmacogenetics and pharmacogenomics have revealed the relationship between genetic variables and individual differences in drug responses. A large part of these advances has been made in the field of antineoplastic therapy.
Periodically, the American agency U. S. Food and Drug Administration (FDA) updates drug labels and edits table with related pharmacogenomic biomarkers. In 2016, 166 drugs (55 of them for cancer treatments) made up the table in which the FDA defines it as mandatory or in which it at least recommends the pharmacogenetic test, before the first prescription [64]. The variable reaction to drugs in the forms of unresponsiveness and adverse effect, and the motivation to use them better are the basis for one of the main objectives of the so-called personalized medicine, more recently disseminated as precision medicine.
Currently, iatrogenesis classified as adverse events, including those caused by drugs, are still an important public health problem, as has been demonstrated.
In response to the effects of these events, which are almost always harmful to people and those who offend the cost of assistance, pharmacogenetics, which emerged to improve the assertiveness of treatments to the point of being able to personalize them, may also contribute to minimize iatrogenesis, including the most serious ones requiring hospital admissions.
Although this goal is promising, there are still many challenges in implementing pharmacogenetic tests in clinical practice. First, concomitant factors such as diet, age and drug interactions affect pharmacokinetics and pharmacodynamics, increasing the complexity of assessing biomarkers in each patient. Second, the nature of the heterogeneity of clinical conditions presents a considerable therapeutic challenge. For example, in the case of cancer, treatment choices based on a biomarker present in a single biopsy sample may not be sufficient. Third, the definition of gene panels for each case is another area that needs to be developed, in order to facilitate the interpretation of clinicians [65].
The adoption of pharmacogenetic tests in routine clinical practice has been very scarce, particularly in Brazil. The main barriers to its implementation in the medical clinic are the lack of doctors’ knowledge about the applicability in prescriptions, in addition to the provision of clear and accessible recommendations, based on proven evidence, as CPIC has been trying to do [66].
It is noteworthy that another difficulty of great relevance has been the lack of studies that demonstrate the positive cost-effectiveness of its application [67].
However, the continuous fall in the costs of sequencing allows us to project a not-too-distant future in which the realization of the exome (mapping the approximately 20,500 genes currently known), in early life, will allow a continuous revisit to the genetic results, which will be available and applicable in medical clinic for life [43], including the specificity of drug reaction.
The use of the findings of pharmacogenetics may not be a redeeming strategy in the solution of all drug iatrogeneses, reported more than forty years ago by Ivan Illich, because other factors, as mentioned here, interfere in the metabolism of drugs. But their adoption may significantly mitigate the deaths and suffering caused by them, in addition to replacing the practice of trial and error in prescriptions and dosimetry - a notable imperfection in medical practice and the health system.
Although the imperfections must all be credited to the author, I would like to put on record my utmost gratitude to Prof. Dr. Vera Lucia Luiza for the countless suggestions, tireless revisions and diligent guidance in the preparation of the article.
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\\n\\nAll scientific works are Peer Reviewed prior to publishing. Read more
\\n\\nOA Publishing Fees
\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\\n\\nDigital Archiving Policy
\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\\n\\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\\n\\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\\n\\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
\\n\\n\\n"}]'},components:[{type:"htmlEditorComponent",content:'
The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Stevenson",authors:[{id:"65554",title:"Dr.",name:"David",middleName:null,surname:"Stevenson",slug:"david-stevenson",fullName:"David Stevenson"}]},{id:"61858",doi:"10.5772/intechopen.78243",title:"Capsaicinoids and Vitamins in Hot Pepper and Their Role in Disease Therapy",slug:"capsaicinoids-and-vitamins-in-hot-pepper-and-their-role-in-disease-therapy",totalDownloads:1773,totalCrossrefCites:7,totalDimensionsCites:9,abstract:"Members of the genus Capsicum (Family: Solanaceae), which belongs to a dicotyledonous group of flowering plants, show fluctuating degrees of spiciness that mirror the relative concentrations of capsaicin, dihydrocapsaicin, and other analogs (nordihydrocapsaicin, homocapsaicin, and homodihydrocapsaicin) collectively known as capsaicinoids present in the fruit placenta. Pungent Chili varieties are grown for their food value, health-promoting properties and as a source of capsaicinoids that have a variety of medicinal uses. Accessions of the cultivated species (Capsicum annuum, C. baccatum, C. chinense, C. frutescens, and C. pubescens) have not all been analyzed for their capsaicinoids content. Identifying Capsicum species and accessions (genotypes) within species with high levels of antioxidants and bioactive compounds (capsaicin, dihydrocapsaicin, vitamin C, vitamin E, phenols, and β-carotene) that contribute to human disease therapy is the focus of this investigation. The main objectives of this chapter are to compile an overview of most recent achievements of the pharmacological properties of hot pepper compounds and provide a rationale for their use as analgesics and to present an evidence that supports the use of capsaicinoids in the treatment of neuropathic pain and other top leading death of worldwide human diseases.",book:{id:"6810",slug:"capsaicin-and-its-human-therapeutic-development",title:"Capsaicin and its Human Therapeutic Development",fullTitle:"Capsaicin and its Human Therapeutic Development"},signatures:"George F. Antonious",authors:[{id:"174916",title:"Dr.",name:"George",middleName:"Fouad",surname:"Antonious",slug:"george-antonious",fullName:"George Antonious"}]}],mostDownloadedChaptersLast30Days:[{id:"25790",title:"Zanthoxylum Genus as Potential Source of Bioactive Compounds",slug:"zanthoxylum-genus-as-potential-source-of-bioactive-compounds",totalDownloads:6981,totalCrossrefCites:9,totalDimensionsCites:29,abstract:null,book:{id:"1957",slug:"bioactive-compounds-in-phytomedicine",title:"Bioactive Compounds in Phytomedicine",fullTitle:"Bioactive Compounds in Phytomedicine"},signatures:"L. Oscar Javier Patiño, R. Juliet Angélica Prieto and S. Luis Enrique Cuca",authors:[{id:"65330",title:"Dr.",name:"Oscar",middleName:null,surname:"Patiño",slug:"oscar-patino",fullName:"Oscar Patiño"},{id:"76143",title:"Dr.",name:"Luis Enrique",middleName:null,surname:"Cuca Suárez",slug:"luis-enrique-cuca-suarez",fullName:"Luis Enrique Cuca Suárez"},{id:"76144",title:"Dr.",name:"Juliet",middleName:"Angélica",surname:"Prieto Rodríguez",slug:"juliet-prieto-rodriguez",fullName:"Juliet Prieto Rodríguez"}]},{id:"25789",title:"Erythrina, a Potential Source of Chemicals from the Neotropics",slug:"erythrina-a-potential-source-of-chemicals-from-the-neotropics",totalDownloads:5907,totalCrossrefCites:0,totalDimensionsCites:3,abstract:null,book:{id:"1957",slug:"bioactive-compounds-in-phytomedicine",title:"Bioactive Compounds in Phytomedicine",fullTitle:"Bioactive Compounds in Phytomedicine"},signatures:"R. Marcos Soto-Hernández, Rosario García-Mateos, Rubén San Miguel-Chávez, Geoffrey Kite, Mariano Martínez-Vázquez and Ana C. Ramos-Valdivia",authors:[{id:"65790",title:"Prof.",name:"Marcos",middleName:null,surname:"Soto-Hernández",slug:"marcos-soto-hernandez",fullName:"Marcos Soto-Hernández"}]},{id:"61858",title:"Capsaicinoids and Vitamins in Hot Pepper and Their Role in Disease Therapy",slug:"capsaicinoids-and-vitamins-in-hot-pepper-and-their-role-in-disease-therapy",totalDownloads:1773,totalCrossrefCites:7,totalDimensionsCites:9,abstract:"Members of the genus Capsicum (Family: Solanaceae), which belongs to a dicotyledonous group of flowering plants, show fluctuating degrees of spiciness that mirror the relative concentrations of capsaicin, dihydrocapsaicin, and other analogs (nordihydrocapsaicin, homocapsaicin, and homodihydrocapsaicin) collectively known as capsaicinoids present in the fruit placenta. Pungent Chili varieties are grown for their food value, health-promoting properties and as a source of capsaicinoids that have a variety of medicinal uses. Accessions of the cultivated species (Capsicum annuum, C. baccatum, C. chinense, C. frutescens, and C. pubescens) have not all been analyzed for their capsaicinoids content. Identifying Capsicum species and accessions (genotypes) within species with high levels of antioxidants and bioactive compounds (capsaicin, dihydrocapsaicin, vitamin C, vitamin E, phenols, and β-carotene) that contribute to human disease therapy is the focus of this investigation. The main objectives of this chapter are to compile an overview of most recent achievements of the pharmacological properties of hot pepper compounds and provide a rationale for their use as analgesics and to present an evidence that supports the use of capsaicinoids in the treatment of neuropathic pain and other top leading death of worldwide human diseases.",book:{id:"6810",slug:"capsaicin-and-its-human-therapeutic-development",title:"Capsaicin and its Human Therapeutic Development",fullTitle:"Capsaicin and its Human Therapeutic Development"},signatures:"George F. Antonious",authors:[{id:"174916",title:"Dr.",name:"George",middleName:"Fouad",surname:"Antonious",slug:"george-antonious",fullName:"George Antonious"}]},{id:"62311",title:"CAP and Metabolic Diseases: A Mini Review on Preclinical Mechanisms and Clinical Efficacy",slug:"cap-and-metabolic-diseases-a-mini-review-on-preclinical-mechanisms-and-clinical-efficacy",totalDownloads:1336,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Capsaicin (CAP) is the chief active ingredient of natural chili peppers. It has culinary and medicinal benefits. CAP activates its receptor, transient receptor potential vanilloid subfamily 1 (TRPV1), which is expressed in the sensory and motor neurons, adipocytes, liver, vascular smooth muscle cells, neuromuscular junction, skeletal muscle, heart and brain. The specificity of CAP to activate TRPV1 is the fundamental mechanism for its medicinal benefits to treat pain, obesity, hypertension, and other diseases. Preclinical data from rodent model of high fat diet-induced obesity collectively suggest that CAP exerts its effects by activating TRPV1 signaling pathway, which stimulates thermogenic mechanisms in the white and brown adipose tissues to induce browning of white adipose tissues and brown adipose tissue thermogenesis. This leads to enhancement of metabolic activity and thermogenesis to counter obesity. Although CAP and its pungent and non-pungent analogs are used in human clinical studies, their effects on satiety and energy expenditure have been the highlights of such studies. The precise mechanism of action of CAP has not been evaluated in humans. This article summarizes these data and suggests that long-term safety and tolerance studies are important for advancing CAP to treat human obesity.",book:{id:"6810",slug:"capsaicin-and-its-human-therapeutic-development",title:"Capsaicin and its Human Therapeutic Development",fullTitle:"Capsaicin and its Human Therapeutic Development"},signatures:"Baskaran Thyagarajan, Vivek Krishnan and Padmamalini Baskaran",authors:null},{id:"61453",title:"A Matter of Taste: Capsaicinoid Diversity in Chile Peppers and the Importance to Human Food Preference",slug:"a-matter-of-taste-capsaicinoid-diversity-in-chile-peppers-and-the-importance-to-human-food-preferenc",totalDownloads:1279,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Chile peppers are valued worldwide for their distinct capsaicinoid compounds that have been used traditionally in medicine and culinary practices. With 32 known species, five of them domesticated, they provide unique chemical profiles, when consumed by humans. Capsaicinoids, the spicy compounds, are alkaloids used to deter herbivory in the wild, offering protection to the chile pepper fruit seeds. Among the 22 known capsaicinoid structures, capsaicin and dihydrocapsaicin are normally the most abundant. In humans, capsaicin binds to nociceptor TRPV1 that generates a heat sensation. Capsaicin also mitigates inflammation responses in the digestive tract and has the potential to aid in nutrient absorption. Distinct heat profiles were recently described for the five domesticated Capsicum species showing a difference in heat sensations specific to species and pod type. Due to the many capsaicinoid structures, we explore the implications and opportunities of having a diverse array of heat profiles in genetically diverse Capsicum species.",book:{id:"6810",slug:"capsaicin-and-its-human-therapeutic-development",title:"Capsaicin and its Human Therapeutic Development",fullTitle:"Capsaicin and its Human Therapeutic Development"},signatures:"Ivette Guzmán and Paul W. 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Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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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. 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