List of some secondary plant product produced in suspension culture
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These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
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IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\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:"2232",leadTitle:null,fullTitle:"Chemical Biology",title:"Chemical Biology",subtitle:null,reviewType:"peer-reviewed",abstract:"Chemical biology utilizes chemical principles to modulate systems to either investigate the underlying biology or create new function. 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Tissue culture is the
Plant tissue culture technology is being widely used for large scale plant multiplication. Apart from their use as a tool of research, plant tissue culture techniques have in recent years, become of major industrial importance in the area of plant propagation, disease elimination, plant improvement and production of secondary metabolites.Small pieces of tissue (named explants) can be used to produce hundreds and thousands of plants in a continuous process. A single explant can be multiplied into several thousand plants in relatively short time period and space under controlled conditions, irrespective of the season and weather on a year round basis [2]. Endangered, threatened and rare species have successfully been grown and conserved by micropropagation because of high coefficient of multiplication and small demands on number of initial plants and space.
In addition, plant tissue culture is considered to be the most efficient technology for crop improvement by the production of somaclonal and gametoclonal variants. The micropropagation technology has a vast potential to produce plants of superior quality, isolation of useful variants in well-adapted high yielding genotypes with better disease resistance and stress tolerance capacities [3]. Certain type of callus cultures give rise to clones that have inheritable characteristics different from those of parent plants due to the possibility of occurrence of somaclonal variability [4], which leads to the development of commercially important improved varieties. Commercial production of plants through micropropagation techniques has several advantages over the traditional methods of propagation through seed, cutting, grafting and air-layering etc. It is rapid propagation processes that can lead to the production of plants virus free [5].
The science of plant tissue culture takes its roots from the discovery of cell followed by propounding of cell theory. In 1838, Schleiden and Schwann proposed that cell is the basic structural unit of all living organisms. They visualized that cell is capable of autonomy and therefore it should be possible for each cell if given an environment to regenerate into whole plant. Based on this premise, in 1902, a German physiologist, Gottlieb Haberlandt for the first time attempted to culture isolated single palisade cells from leaves in knop’s salt solution enriched with sucrose.The cells remained alive for up to one month, increased in size, accumulated starch but failed to divide. Though he was unsuccessful but laid down the foundation of tissue culture technology for which he is regarded as the father of plant tissue culture. After that some of the landmark discoveries took place in tissue culture which are summarized as under:
1902 - Haberlandt proposed concept of
1904 - Hannig cultured embryos from several cruciferous species
1922 - Kolte and Robbins successfully cultured root and stem tips respectively
1926 - Went discovered first plant growth hormone –Indole acetic acid
1934 - White introduced vitamin B as growth supplement in tissue culture media for tomato root tip
1939 - Gautheret, White and Nobecourt established endless proliferation of callus cultures
1941 - Overbeek was first to add coconut milk for cell division in
1946 - Ball raised whole plants of
1954 - Muir was first to break callus tissues into single cells
1955 - Skoog and Miller discovered kinetin as cell division hormone
1957 - Skoog and Miller gave concept of hormonal control (auxin: cytokinin) of organ formation
1959 - Reinert and Steward regenerated embryos from callus clumps and cell suspension of carrot (
1960 - Cocking was first to isolate protoplast by enzymatic degradation of cell wall
1960 - Bergmann filtered cell suspension and isolated single cells by plating
1960 - Kanta and Maheshwari developed test tube fertilization technique
1962 - Murashige and Skoog developed MS medium with higher salt concentration
1964 - Guha and Maheshwari produced first haploid plants from pollen grains of
1966 - Steward demonstrated totipotency by regenerating carrot plants from single cells of tomato
1970 - Power
1971 - Takebe
1972 - Carlson produced first interspecific hybrid of
1974 - Reinhardintroduced biotransformation in plant tissue cultures
1977 - Chilton
1978- Melchers
1981- Larkin and Scowcroft introduced the term somaclonal variation
1983 - Pelletier
1984 - Horsh
1987 - Klien
2005 - Rice genome sequenced under International Rice Genome Sequencing Project
In plant cell culture, plant tissues and organs are grown
Plant growth regulators (PGR’s) play an essential role in determining the development pathway of plant cells and tissues in culture medium. The auxins, cytokinins and gibberellins are most commonly used plant growth regulators. The type and the concentration of hormones used depend mainly on the species of the plant, the tissue or organ cultured and the objective of the experiment [11]. Auxins and cytokinins are most widely used plant growth regulators in plant tissue culture and their amount determined the type of culture established or regenerated. The high concentration of auxins generally favors root formation, whereas the high concentration of cytokinins promotes shoot regeneration. A balance of both auxin and cytokinin leads to the development of mass of undifferentiated cells known as callus.
Maximum root induction and proliferation was found in
As an emerging technology, the plant tissue culture has a great impact on both agriculture and industry, through providing plants needed to meet the ever increasing world demand. It has made significant contributions to the advancement of agricultural sciences in recent times and today they constitute an indispensable tool in modern agriculture [5].
Biotechnology has been introduced into agricultural practice at a rate without precedent. Tissue culture allows the production and propagation of genetically homogeneous, disease-free plant material [37]. Cell and tissue
Production of improved crop varieties
Production of disease-free plants (virus)
Genetic transformation
Production of secondary metabolites
Production of varieties tolerant to salinity, drought and heat stresses
Cryopreservation plays a vital role in the long-term
Embryo culture is a type of plant tissue culture that is used to grow embryos from seeds and ovules in a nutrient medium. In embryo culture, the plant develops directly from the embryo or indirectly through the formation of callus and then subsequent formation of shoots and roots. The technique has been developed to break seed dormancy, test the vitality of seeds, production of rare species and haploid plants [59, 119]. It is an effective technique that is employed to shorten the breeding cycle of plants by growing excised embryos and results in the reduction of long dormancy period of seeds. Intra-varietal hybrids of an economically important energy plant “Jatropha” have been produced successfully with the specific objective of mass multiplication [62]. Somatic embryogenesis and plant regeneration has been carried out in embryo cultures of Jucara Palm for rapid cloning and improvement of selected individuals [60]. In addition, conservation of endangered species can also be attained by practicing embryo culture technique. Recently a successful protocol has been developed for the
Genetic transformation is the most recent aspect of plant cell and tissue culture that provides the mean of transfer of genes with desirable trait into host plants and recovery of transgenic plants [63]. The technique has a great potential of genetic improvement of various crop plants by integrating in plant biotechnology and breeding programmes. It has a promising role for the introduction of agronomically important traits such as increased yield, better quality and enhanced resistance to pests and diseases [64].
Genetic transformation in plants can be achieved by either vector-mediated (indirect gene transfer) or vectorless (direct gene transfer) method [65]. Among vector dependant gene transfer methods,
Recently successful transgenic plants of Jatropha were obtained by direct DNA delivery to mature seed-derived shoot apices via particle bombardment method [68]. This technology has an important impact on the reduction of toxic substances in seeds [69] thus overcoming the obstacle of seed utilization in various industrial sector. Regeneration of disease or viral resistant plants is now achieved by employing genetic transformation technique. Researchers succeeded in developing transgenic plants of potato resistant to potato virus Y (PVY) which is a major threat to potato crop worldwide [70]. In addition, marker free transgenic plants of
Somatic hybridization is an important tool of plant breeding and crop improvement by the production of interspecific and intergeneric hybrids. The technique involves the fusion of protoplasts of two different genomes followed by the selection of desired somatic hybrid cells and regeneration of hybrid plants [48]. Protoplast fusion provides an efficient mean of gene transfer with desired trait from one species to another and has an increasing impact on crop improvement [3]. Somatic hybrids were produced by fusion of protoplasts from rice and ditch reed using electrofusion treatment for salt tolerance [49].
Schematic representation of production of hybrid plant via protoplast fusion
The tissue culture techniques enable to produce homozygous plants in relatively short time period through the protoplast, anther and microspore cultures instead of conventional breeding [53].
Haploids are sterile plants having single set of chromosomes which are converted into homozygous diploids by spontaneous or induced chromosome doubling. The doubling of chromosomes restores the fertility of plants resulting in production of double haploids with potential to become pure breeding new cultivars [54]. The term androgenesis refers to the production of haploid plants from young pollen cells without undergoing fertilization. Sudherson e
The past decades of plant cell biotechnology has evolved as a new era in the field of biotechnology, focusing on the production of a large number of secondary plant products. During the second half of the last century the development of genetic engineering and molecular biology techniques allowed the appearance of improved and new agricultural products which have occupied an increasing demand in the productive systems of several countries worldwide [31, 32, 33, 34]. Nevertheless, these would have been impossible without the development of tissue culture techniques, which provided the tools for the introduction of genetic information into plant cells [35]. Nowadays, one of the most promising methods of producing proteins and other medicinal substances, such as antibodies and vaccines, is the use of transgenic plants [36]. Transgenic plants represent an economical alternative to fermentation-based production systems. Plant-made vaccines or antibodies (plantibodies) are especially striking, as plants are free of human diseases, thus reducing screening costs for viruses and bacterial toxins. The number of farmers who have incorporated transgenic plants into their production systems in 2008 was 13.3 million, in comparison to 11 million in 2007 [34].
Micropropagation starts with the selection of plant tissues (explant) from a healthy, vigorous mother plant [15].Any part of the plant (leaf, apical meristem, bud and root) can be used as explant. The whole process can be summarized into the following stages as shown in Figure 2.
Any plant tissue can be introduced
In this stage an explant is surface sterilized and transferred into nutrient medium. Generally, the combined application of bactericide and fungicide products is suggested. The selection of products depends on the type of explant to be introduced. The surface sterilization of explant in chemical solutions is an important step to remove contaminants with minimal damage to plant cells [17]. The most commonly used disinfectants are sodium hypochlorite [18, 19], calcium hypochlorite [20], ethanol [21] and mercuric chloride (HgCl2) [17]. The cultures are incubated in growth chamber either under light or dark conditions according to the method of propagation.
The aim of this phase is to increase the number of propagules [22]. The number of propagules is multiplied by repeated subcultures until the desired (or planned) number of plants is attained.
The rooting stage may occur simultaneously in the same culture media used for multiplication of the explants. However, in some cases it is necessary to change media, including nutritional modification and growth regulator composition to induce rooting and the development of strong root growth.
At this stage, the
Plant regeneration via somatic embryogenesis occurs by the induction of embryogenic cultures from zygotic seed, leaf or stem segment and further multiplication of embryos.Mature embryos are then cultured for germination and plantlet development, and finally transferred to soil
Somatic embryogenesis has been reported in many plants including trees and ornamental plants of different families. The phenomenon has been observed in some cactus species [24]. There are various factors that affect the induction and development of somatic embryos in cultured cells. A highly efficient protocol has been reported for somatic embryogenesis on grapevine [25] that showed higher plant regeneration sufficiently when the tissues were cultured in liquid medium. Plant growth regulators play an important role in the regeneration and proliferation of somatic embryos. Highest efficiency of embryonic callus was induced by culturing nodal stem segments of rose hybrids on medium supplemented with various PGR’s alone or in combination [26]. This embryonic callus showed high germination rate of somatic embryos when grown on abscisic acid (ABA) alone. Somatic embryogenesis is not only a process of regenerating the plants for mass propagation but also regarded as a valuable tool for genetic manipulation. The process can also be used to develop the plants that are resistant to various kinds of stresses [27] and to introduce the genes by genetic transformation [28]. A successful protocol has been developed for regeneration of cotton cultivars with resistance to
Flow chart summarizing tissue culture experiments.
Plant cell and tissue cultures hold great promise for controlled production of myriad of useful secondary metabolites [72]. Plant cell cultures combine the merits of whole-plant systems with those of microbial and animal cell cultures for the production of valuable therapeutic secondary metabolites [73]. In the search for alternatives to production of medicinal compounds from plants, biotechnological approaches, specifically plant tissue cultures, are found to have potential as a supplement to traditional agriculture in the industrial production of bioactive plant metabolites [74]. Exploration of the biosynthetic capabilities of various cell cultures has been carried out by a group of plant scientists and microbiologists in several countries during the last decade [75].
A number of medicinally important alkaloids, anticancer drugs, recombinant proteins and food additives are produced in various cultures of plant cell and tissues. Advances in the area of cell cultures for the production of medicinal compounds has made possible the production of a wide variety of pharmaceuticals like alkaloids, terpenoids, steroids, saponins, phenolics, flavanoids and amino acids [72, 81]. Some of these are now available commercially in the market for example shikonin and paclitaxel (Taxol). Until now 20 different recombinant proteins have been produced in plant cell culture, including antibodies, enzymes, edible vaccines, growth factors and cytokines [73]. Advances in scale-up approaches and immobilization techniques contribute to a considerable increase in the number of applications of plant cell cultures for the production of compounds with a high added value. Some of the secondary plant products obtained from cell suspension culture of various plants are given in Table 1.
Vasine | [82] | |
Artemisinin | [83] | |
Azadirachtin | [84] | |
Cathin | [85] | |
Capsiacin | [86] | |
Sennosides | [87] | |
Ajmalicine Secologanin Indole alkaloids Vincristine | [88] [89] [90] [91] | |
Stilbenes | [92] | |
Berberin | [93] | |
Sterols | [94] | |
Shikonin | [95] | |
Ginseng saponin | [96] | |
Podophyllotoxin | [97] | |
Taxane Paclitaxel | [98] |
List of some secondary plant product produced in suspension culture
The hairy root system based on inoculation with Agrobacterium rhizogenes has become popular in the last two decades as a method of producing secondary metabolites synthesized in plant roots [99]. Organized cultures, and especially root cultures, can make a significant contribution in the production of secondary metabolites. Most of the research efforts that use differentiated cultures instead of cell suspension cultures have focused on transformed (hairy) roots. Agrobacterium rhizogenes causes hairy root disease in plants. The neoplastic (cancerous) roots produced by A. rhizogenes infection are characterized by high growth rate, genetic stability and growth in hormone free media [100]. High stability [101] and productivity features allow the exploitation of hairy roots as valuable biotechnological tool for the production of plant secondary metabolites [102]. These genetically transformed root cultures can produce levels of secondary metabolites comparable to that of intact plants [103]. Hairy root technology has been strongly improved by increased knowledge of molecular mechanisms underlying their development. Optimizing the composition of nutrients for hairy root cultures is critical to gain a high production of secondary metabolites [100]. Some of the secondary plant products obtained from hairy root culture of various plants are shown in Table 2.
Rosmarinic acid | [104] | |
Deoursin | [105] | |
Resveratol | [106] | |
Tropane | [107] | |
Asiaticoside | [108] | |
Rutin | [104] | |
Glucoside | [109] | |
Glycyrrhizin | [110] | |
Shikonin | [111] | |
Glycoside | [112] | |
Plumbagin | [113] | |
Anthraquinone | [114] | |
Silymarin | [115] | |
Flavonolignan | [116] | |
Vincamine | [117] | |
Withanoloid A | [118] |
Plant tissue culture Lab was established in 2004 with the objectives to raise endangered medicinal plant species and the plants difficult to raise through traditional methods for conservation and mass propagation. We have so far propagated 12 medicinal plant species (
Orchids are usually grown for the beauty, exoticism and fragrance of their flowers. They are cultivated since the times of Confucius (ca. 551 - 479 BC). Some orchids are commercialized not for their beauty, but for uses in food industry. They are also used medicinally as a treatment for diarrhea and as an aphrodisiac. The vegetative propagation of phalaenopsis is difficult and time consuming. In addition, the desired characteristics of seedlings and uniformity are not attained.
The regenerated shoots showed excess root development when transferred to medium added with 2.0 mg/l IBA. Further research work will focus on different potting medium compositions best suited for acclimatization of regenerated plants.As a high value crop, the mass production of orchids will provide a good opportunity of marketing locally as a good source of income.
Micropropagation of Orchids (a) callus culture (b) shoot regeneration (c) rooted plantlets
Tobacco is an important crop of Pakistan which covers a large area under cultivation. Being a cash crop grown all over the world, it has a good economic value. Fresh leaves of the plants are processed to obtain an agricultural product that is commercially available in dried, cured and natural forms. Clonal propagation of four important low nicotine content hybrid varieties of tobacco i.e. PGH-01, PGH-02, PGH-04 and PGH-09 was carried out with the special objective of commercialization of tissue cultured plants to the farmers and industry. The mother plants were provided by Pakistan Tobacco Board (PTB). Leaves and meristems were used as explants for the initiation of callus culture. Callus induction and proliferation was carried out on MS medium supplemented with different concentrations of 2,4-D. Excellent growth of callus was obtained at medium containing 1.0 mg/l 2,4-D. Callus was transferred to next medium for shoot regeneration. Efficient numbers of shoots were obtained when culture was shifted to MS medium supplemented with 0.5 mg/l BAP. For root induction different concentrations of IBA and NAA were tested and the result was found best on the same medium supplemented with 2.0 mg/l IBA as shown in Figure 4 a, b, c.
Tissue culture of
The disease free potato tubers were washed both with detergent and distilled water to remove impurities and allowed to sprouting. Five days old sprouts were used as explants for direct proliferation. The explants were surface sterilized in detergent for 10 minutes, later with 0.1 % mercuric chloride solution for 5 minutes followed by three times washing with sterilized-distilled water. The sprouts were aseptically cut into 10 mm sections containing one node and inoculated in medium. The Espinosa medium plus vitamin B5 supplemented with different concentrations of BAP and GA3 alone and in combinations was utilized. Highest shoot length of shoots was observed in presence of 0.5 mg/l BAP and 0.4 mg/l GA3 with the ability to produce maximum plantlets per explant. For root induction the same medium was used with different concentrations of NAA and IBA. NAA at2.0 mg/l induced the highestroot development. The rooted plantlets were successfully acclimatized and delivered to the company for cultivation.
Tissue culture of Potato (a) nodal segment (b) regenerated shoots and roots (c) tissue culturedpotato
The research studies on Tissue Culture of Jatropha (physic nut) had the objectives to develop protocol for mass propagation of elite trees selected on the bases of higher seed production and oil content.The experimental plant of
Leaf and apical meristem explants isolated from 7 days old seedling of
Murashige&Skoog (1962) medium supplemented with different growth regulator formulations including 2,4-D and IBA was used. Excellent growth of callus on leaf explants was obtained in medium supplemented with 1.0 mg/L 2, 4-D. Callus produced from leaf explants in all IBA concentrations grew faster during 7 to 30 days of culture and then stabilized at a slow growth rate. While 1.0 mg/L 2,4-D was proved to be most effective in inducing callus on a large scale in short period of time.Callus was soft, friable and white in color.
Apical meristem was used as explant for direct shoot regeneration. Rooting from meristem was effectively achieved on MS supplemented with 1.5, 2.0 and 2.5 mg/l IBA. Root induction with 2.0 mg/l IBA was most effective and the roots also developed secondary roots.
In near future somatic embryogenesis and shoot regeneration from callus will be tested in MS medium supplemented with various concentrations of BA. The regenerated plant will be acclimatized and released for field planting under various climatic and soil conditions for further studies.
Tissue culture of
Plant tissue culture represents the most promising areas of application at present time and giving an out look into the future. The areas ranges from micropropagation of ornamental and forest trees, production of pharmaceutically interesting compounds, and plant breeding for improved nutritional value of staple crop plants, including trees to cryopreservation of valuable germplasm. All biotechnological approaches like genetic engineering, haploid induction, or somaclonal variation to improve traits strongly depend on an efficient
The rapid production of high quality, disease free and uniform planting stock is only possible through micropropagation. New opportunities has been created for producers, farmers and nursery owners for high quality planting materials of fruits, ornamentals, forest tree species and vegetables. Plant production can be carried out throughout the year irrespective of season and weather. However micropropagation technology is expensive as compared to conventional methods of propagation by means of seed, cuttings and grafting etc. Therefore it is essential to adopt measures to reduce cost of production. Low cost production of plants requires cost effective practices and optimal use of equipment to reduce the unit cost of plant production. It can be achieved by improving the process efficiency and better utilization of resources. Bioreactor based plant propagation can increase the speed of multiplication and growth of cultures and reduce space, energy and labor requirements when commencing commercial propagation. However, the use of bioreactors needs special care and handling to avoid contamination of culture which may lead to heavy economic losses. The cost of production may also be reduced by selecting several plants that provide the option for around the year production and allow cost flow and optimal use of equipment and resources. It is also essential to have sufficient mother culture and reduce the number of subculture to avoid variation and plan the production of plants according to the demand.
Quality control is also very essential to assure high quality plant production and to obtain confidence of the consumers. The selection of explants source, diseases free material, authenticity of variety and elimination of somaclonal variants are some of the most critical parameters for ensuring the quality of the plants.
The
Since last two decades there have been considerable efforts made in the use of plant cell cultures in bioproduction, bioconversion or biotransformation and biosynthetic studies. The potential commercial production of pharmaceuticals by cell culture techniques depends upon detailed investigations into the biosynthetic sequence. There is great potential of cell culture to be use in the production of valuable secondary products. Plant tissue culture is a noble approach to obtain these substances in large scale.
Plant cell culture has made great advances. Perhaps the most significant role that plant cell culture has to play in the future will be in its association with transgenic plants. The ability to accelerate the conventional multiplication rate can be of great benefit to many countries where a disease or some climatic disaster wipes out crops. The loss of genetic resources is a common story when germplasm is held in field genebanks. Slow growth
The World Health Organization (WHO) estimates that there are more than one billion people in the world living with some form of impairment or disability, of whom nearly 200 million have considerable difficulties in functioning [1]. There is a growing proportion of
Currently, the National Organization on Disability (NOD), a private and nonprofit organization, estimates that 54 million children and adults in the United States have one or more disabilities, with 35 million Americans being severely disabled [2, 3, 4]. The proportion of children with disabilities is estimated to be 12.5 million or around 18% [3, 4, 5]. According to the estimated data by National Health and National Health and Nutrition Examination Survey (NHANES), 46% of adults in the United States have periodontitis, and 8.9% have severe periodontitis [6].
The geopolitical and social plurality of states and regions in Brazil have shown the emerging need for effective public policies to meet the specific needs of this diversity. According to the
Regarding children with developmental disorders, especially the autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (AD/HD), or specific learning disorder (LD), the field of “special care dentistry” is rapidly gaining recognition as a necessary service once they require oral health care needs at all times [8]. According to American Psychiatric Association (APA) [9], these disorders have relatively been growing due to the increase in birth rates and life expectancy of these individuals. Another relevant factor would be the ability or difficulty to perform their self-care, in particular, in the mouth, resulting in a negative impact of precarious oral conditions. The main oral signs and symptoms found in this target public include poor oral hygiene, dental caries, and severity of periodontal diseases (PD). High incidence of dental hypoplasia, traumatic lesion (factitious, iatrogenic, and accidental), drug-induced gingival overgrowth, dental malocclusion, and tooth missing are also evidenced [8, 10]. It is important to highlight that the large dental loss of intact teeth is caused by the destruction of the collagen fibers of the periodontal ligament (PDL) and severe resorption of alveolar bone tissue from the persistent supra and subgingival and periopathogenic microbiota, recognized as periodontal disease [11]. Therefore, this disease is one of the most common oral chronic infections in people with special health care needs (SHCN), becoming an important dental public health problem.
Based on combined data from the literature and our scientific experiences, we discussed the microbiological, histopathological, and clinical features of PD in each “special care needs” group. Furthermore, we reported some advances in “Omic” technologies which are molecular biology methods used to assess the genomics (genes), proteomics (proteins), transcriptomics (mRNA), and metabolomics (metabolites) aspects of PD. These methods promote a better
The field of “special care dentistry” is rapidly gaining recognition as a service that should be provided to persons with physical, mental, or intellectual disabilities by general physicians, pediatric physicians, geriatric physicians, dental practitioners, and dental hygienists. Considering the limited opening of the oral cavity and the great difficulty of clinical procedure handling, the special needs patients may be treated under applying of psychological, physical, or pharmacological techniques in order to control their behavior and the voluntary or involuntary body movements. These patients may be affected by several comorbid physical illnesses including diabetes mellitus, cardiovascular diseases, respiratory illnesses as aspiration pneumonia, sleep disturbance as obstructive sleep apnea, malignant neoplasms, and so on.
Extrinsic and intrinsic factors may corroborate to the installation and perpetuation of PD, as well as increase the susceptibility to supra and subgingival periopathogens in these individuals, even after oral hygiene promotion and/or intensive conventional mechanical treatment, combined or not with a supportive therapy. Concerning the main extrinsic factors, previous studies have considered oral mucositis-inducing chemotherapy drugs, saliva flow-reducing medications, respiratory disturbances as mouth breathing leading to oral hyperventilation and, as a consequence, dry mouth, motor deficit, cognitive impairment, learning difficulty and disability, crowded teeth, and inappropriate diet. The intrinsic factors include immune response deficiency, a high amount of periopathogens, sleep disorders such as obstructive sleep apnea, dysfunction of the oropharyngeal muscles resulting in severe dysphagia, and the risk of occurrence for aspiration pneumonia. Previous studies confirm the presence of respiratory pathogens in the oral cavity which may be aspirated into the lung alveoli due to severe dysphagia, developing aspiration pneumonia [12, 13]. This comorbidity may negatively influence the oral health homeostasis, aggravating the preexistent inflammatory processes, in particular, the PD.
Current researches confirm that the therapy applying neuromuscular electrical stimulation on the masticatory muscles was effective in adults with cerebral palsy. This
Regarding the oral health status of these populations, the main oral manifestations are dental caries, dental hypoplasia, dental agenesis, orofacial traumas, drug-induced gingival overgrowth, and, in particular, PD [8]. Recent studies have shown that the presence of periodontopathic microbiota at the oral biofilm and/or spread throughout the saliva may explain the higher susceptibility to PD in this target public [15, 16].
According to the Joint Advisory Committee for Special Care Dentistry (JACSD), “special care dentistry” provides oral services for people with an impairment or disability including physical, sensory, intellectual, mental, medical, social, or a combination of one or more of these [17]. Several conditions, disorders, and/or disabilities lead these patients to the need of specialized oral assistance. In Brazil, the Federal Council of Dentistry has recognized the specialty of Dentistry for Patients with Special Health Care Needs as a dental service which has been assisting people with simple or complex disabilities, of acute or chronic nature, and temporary or permanent conditions or disorders. This target public is inserted into the following categories: neuromotor disability (1), sensory disability (2), mental disorder (3), infecto-contagious diseases (4), chronic systemic diseases (5), and systemic conditions (6).
The neuromotor disorders (1) include people with physical and intellectual disabilities which are from an unknown, environmental, and a genetic origin. These disorders consist of cerebral palsy, cerebrovascular disturbances (e.g., ischemic and hemorrhagic cerebral strokes), spinal cord injury, myelomeningocele, infectious disease (e.g., poliomyelitis or infantile paralysis), autoimmune diseases (e.g., myasthenia gravis and multiple sclerosis), muscular dystrophy resulting in muscle weakness and cellular degeneration, metabolic bone diseases (e.g., rachitis or osteomalacia caused by genetic, nutritional and/or hormonal abnormalities affecting bone growth and remodeling), and bone genetic disorder (e.g., dysostosis, osteopetrosis and imperfect osteogenesis). The congenital and acquired abnormalities, resulting in craniomaxillofacial deformities, complex malformations, and syndromes are also included in the neuromotor disorders. It is important to emphasize that the intellectual disabilities may be associated with these conditions.
The sensory disorders (2) include the hearing and visual disabilities, generating immediate harmful effects as depression, isolation, dementia, and decrease of quality of life [18]. The severity of these impairments may result in the disruption of interpersonal relations and decrease of self-sufficiency in daily living activities, both of which are critical to the well-being of a person [19]. Hearing disability, with its resultant difficulties in communication function, pervades multiple domains of function in the individuals, decreasing activity, increasing depressive symptoms, and confounding assessment of cognitive ability. Although it is not curable, this impairment is often remediable with appropriate audiologic evaluation and the prescription of amplification devices. Visual disability also affects multiple domains of function, limiting the individuals’ ability and increasing the risk of falls, fractures, and morbidity. In order to attenuate the consequences of visual disability, the cause must be identified to obtain an effective treatment [20].
Conforming to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (APA) under coordination of the Division of Mental Health of the World Health Organization (WHO) and the National Institute of Mental Health (NIMH), a mental disorder (3) is a syndrome characterized by clinically significant disturbances in an individual’s cognition, emotion regulation, or behavior which reflects a dysfunction in psychological, biological, or developmental processes underlying mental functioning [9]. Thus, mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss (e.g., the death of a loved one) is not considered a mental disorder [9]. For a better elucidation, the new North American classification of mental disorders is briefly mentioned in Figure 1.
Different condition groups of mental disorders described in the fifth edition of the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association [
Among the different groups of psychopathologies, it is worth mentioning the neurodevelopmental disorders which include intellectual disabilities (mild, moderate, and severe levels), autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD), communication disorders (speech and language impairments), specific learning disorder, motor disorders (e.g., stereotyped movement disorder and tic disorders), and so on [9]. Children with neurodevelopmental disorders may experience difficulties with language and speech, motor skills, behavior, memory, learning, or other neurological functions [14]. While the symptoms and behaviors of neurodevelopmental disabilities often change or evolve as a child grows older, some disabilities are permanent. Diagnosis and treatment of these disorders may be difficult, frequently involving a combination of professional therapy, pharmaceuticals, and home- and school-based programs.
Considering the most common mental disorders including dementia, depression, generalized anxiety disorder, panic disorder, obsessive–compulsive disorder, posttraumatic stress, and phobias, the psychiatric patients have presented high susceptibility to PD. These illnesses have been caused by a set of processes such as the presence of oral microbial biofilm due to poor oral hygiene, psychotropic medication-induced dry mouth, and gingival hyperplasia [15, 21]. Mental health clinicians should also be aware of the oral consequences of prescribed medications, especially the antipsychotic drugs [15]. About this, the depression may dysregulate regulatory mechanisms within the brain involved in immune regulation, alter the immune system responses, and thereby influence the development and progression of infections and inflammatory diseases, including periodontitis [22]. As a support therapy, antidepressant drugs, such as fluoxetine, tianeptine (selective serotonin reuptake inhibitor), and venlafaxine (serotonin-norepinephrine reuptake inhibitor) are used; however, the side effects could affect the periodontal tissue health [23]. Current studies using animal models showed that the fluoxetine reduced the alveolar bone loss due to suppression of inflammatory response and protection against periodontal bone resorption and collagen fibers destruction of the periodontal ligament (PDL), while the tianeptine influenced the immune system, enhancing the plasma concentrations of pro-inflammatory and T regulatory cytokines and interleukins in response to the gram-negative bacterial lipopolysaccharide (LPS) antigen. As a consequence of these processes, there is an inhibition of the periodontal disease progression [24, 25]. On the other hand, the venlafaxine influenced the increase of alveolar bone loss, most likely due to its anti-inflammatory and immunoregulatory effects on the periodontitis once it is considered an inflammatory disorder and an immunologically compromised disease [22].
Therefore, an increased focus on the physical health of psychiatric patients should encompass oral health including closer collaboration between the dental practitioners and clinicians. Possible interventions must include the following approaches: to apply the best practices in health care focusing the transdisciplinary, to remove first the infectious foci as oral microbial biofilm and dental calculus through dental scaling and root planning for an appropriate teeth cleaning and reduction or inactivation of periodontal pockets, to guide the regular use of dental floss or interdental brushes and tooth brushing, to insert monitoring processes on oral self-care such as to create a strategic planning on interdental cleaning behaviors according to the difficulty levels of learning and the motor and cognitive dysfunction of each individual, and to perform periodic oral appraisals for necessary methodological adjustments in order to ensure the maintenance and the preservation of good oral health. Before introducing these procedures, the dental practitioner must comprehend the profile of each patient with SHCN, so as to know the physical and intellectual limitations, to identify the presence of comorbid diseases which may affect the overall health, and to assess the psychiatric behavior related to oral self-care. Surely, this systemic overview may favor the homeostasis of the stomatognathic system and improve the general health conditions, once these approaches can prevent the development of extensive and severe PD avoiding dental mobilities and/or loss.
The infecto-contagious diseases (4) is a subset category of highly dangerous transmissible diseases which include mainly infected patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS), patients with active tuberculosis disease, patients with viral hepatitis, and other such patients.
The chronic systemic diseases (5) are illnesses that spread throughout the body, affecting multiple organs and body systems, which may evolve into comorbidities, complicating the diagnosis and, consequently, influencing the prognosis. Considering this concept, the diseases imply juvenile rheumatoid arthritis, diabetes mellitus, congenital and acquired heart diseases, hematological diseases or disorders, chronic renal failure, autoimmune diseases (lichen planus, pemphigoid, pemphigus vulgar, erythema multiforme, lupus erythematosus, epidermolysis bullosa, etc.), vesiculobullous diseases, and so on.
The systemic conditions (6) are recognized as secondary factors that may modulate the disease initiation or progression rather than acting as primary etiological factors. These circumstances may affect the onset, progression, and treatment of such disease. Several patient types are included in these conditions, such as patients submitted to radiotherapy and chemotherapy in the head and neck regions, patients who received an organ transplant, patients with medication-induced immunosuppression, and similar others that may affect the general health conditions of the individual.
To better comprehend the relation among the environmental, genetic, and social effects and a person, a diagram was elaborated showing the occurrence of diseases, conditions, and/or disorders which may manifest during the life course of an individual. It is important to emphasize that these etiopathological factors may contribute to the development of one or more disabilities, leading to an acquired or congenital disability. On the other hand, an individual may be born with one or more disabilitiy and, concomitantly, develop diseases or disorders due to the high susceptibility to the environment and the different levels of disability complexity, characterizing the person with SHCN. It is noteworthy that the social impact resulting from precarious conditions of survival on the people with SHCN could explain the causes of health disparities or high occurrence of oral diseases (Figure 2). Socially disadvantaged groups have demonstrated poorer overall and oral health than the general population, becoming an aggravating factor, especially, in groups with SHCN. Therefore, a better attention to the public services in oral health for this population should be one of the main goals in government plans.
Diagram showing the life course of a susceptible individual to several extrinsic and intrinsic factors which may lead him/her to a disorder, disease, and/or a disability.
Some case reports of patients with SHCN were briefly described in relation to their clinical, radiographic, histopathological, and laboratorial characteristics together with the oral manifestations, clinical procedures, and transdisciplinary approaches; then, we correlate them with the findings found in the literature. Furthermore, we mainly discuss the clinical management related to the PD. The additional commentaries are aimed to reinforce the importance of the early diagnosis and an appropriate dental treatment for each complexity of disability. Types of PD that were correlated with some categories of people with SHCN are depicted in the following section.
A 14-year-old adolescent girl with Robinow syndrome had low stature, mild exophthalmos, hyperthyroidism, frequent thrombocytopenia, splenomegaly, and genital abnormality such as hypoplastic clitoris and small lips (a). Esophageal reflux was reported in the initial years of life. Using the Nicodemo et al. [26] and Grenlieh-Pyle [27] methods, dental and bone ages were 11.4 and 12, respectively. The intraoral examination showed mouth respiration, angular cheilitis, dental malocclusion, and ulcerated gingival surface (b and c) and accentuated alveolar bone loss (d), especially, at the region of mandibular incisors. Histologically, gingival tissues showed intense infiltration of mononuclear inflammatory cells diffusely spread throughout the connective tissue. Junctional epithelium hyperplasia with intense exocytosis (e) and extensive areas with no epithelium cover associated with infiltration of polymorphonuclear inflammatory cells into the lamina propria were also evidenced. In addition, presence of bacterial colonies (black arrows) and necrotic alveolar bone tissue fragments (blue arrows) was found (f and g). The diagnosis was chronic periodontitis with ulceration areas (Image 1).
Chronic periodontitis associated with genetic disorder (hematoxylin–eosin; original magnifications 100 and 50×).
A 19-year-old young man with Down syndrome associated with ectodermal anomalies. The extraoral features displayed dry skin and alopecia of eyelashes, eyebrows, and hair (a) while, the intraoral features showed dry mouth due to the severe reduction of saliva flow and mouth breathing, frequent angular cheilitis resulting from immune system deficiency, bilateral absence of the inner and upper third molars, presence of left upper and right lower deciduous canines, upper lateral incisors with microdontia, unerupted left upper permanent canine, generalized chronic gingivitis (a–d), and absence of caries. The recommended dental treatment was periodontal prophylaxis through the use of disclosing agents such as the scaling and root planning (e–g). It is important to point out that oral hygiene orientation and diet control must be continuously performed because of the neuromotor dysfunction of these patients, resulting in great understanding difficulties and difficulties in handling of cleaning devices and leading to a poor oral hygiene. Concerning dental education, we consider that the learning for repetition and use of ludic techniques or resources are effective strategies which must be implemented by dental practitioners. We also suggest the saliva analysis to assess their physicochemical properties, to determine the susceptibility to stress measuring the concentrations levels of salivary amylase or cortisol, and to identify the occurrence risk for aspiration pneumonia using as a biomarker the
Chronic gingivitis associated with genetic disorders plus ectodermal anomalies.
A 11-year-old female child with West syndrome had multiple epileptic spasms and, as a consequence, a severe neuropsychomotor impairment. The electroencephalography showed a hypsarrhythmia pattern confirming the diagnosis. The recommended treatment to this condition has been the use of phenobarbital and/or valproic acid since birth. The intraoral features were drug-induced generalized gingival proliferative lesion with partial covering of the posterior teeth and gingival bleeding. Some permanent teeth were still impacted due to the presence of gingival fibrosis (a–c). The recommended dental therapy was the prophylactic periodontal treatment and gingivectomy (Image 3).
Severe medications-induced gingival overgrowth.
To illustrate this case, histopathological features were depicted in order to show the medication effects on the oral mucosa, in particular, on the gingival tissues (epithelium and connective tissue) (Figure 3).
Medication-related gingival hyperplasia. Photomicrography showing gingival hyperplasia characterized by the epithelium hyperplasia and proliferation of dense connective tissue. Epithelial crest projections were thin and long (blue arrows), interconnecting them (black arrows) (a). A lamina propria exhibited infiltration of mononuclear inflammatory cells, especially lymphocytes, plasma cells, and macrophages. Furthermore, scattered eosinophilic globules of gamma globulin, known as Russell bodies (b; square), were also seen (hematoxylin–eosin; bars = 200 and 50 μm).
A 7-year-old male child with spastic quadriplegic cerebral palsy, caused by hypoxic–ischemic brain damage, exhibited poor cognitive function and has been feeding on semi-solid food since 3 years of age. Ranitidine hydrochloride was used to treat gastroesophageal reflux, and botulinum toxin was never used to decrease the severity of the sleep bruxism. As a consequence, severe upper and lower teeth wear reaching the region of the dental pulp were evidenced (a).
This child was in primary dentition phase and exhibited discreet chronic gingivitis, mouth-breathing pattern, severe dysphagia, and involuntary tongue movements. First, oral hygiene orientation and diet control under supervision were done due to his severe neuromotor dysfunction. Posteriorly, we used a masticatory device denominated “hyperbola” to attenuate the sleep bruxism and, consequently, to improve the quality of his life. After the proposed therapy, we obtained satisfactory results, including reduction of the sleep bruxism and improvements of sucking-swallowing movements at meals. (Source: Giannasi, et al. [14]) (Image 4).
Discreet chronic gingivitis associated with severe bruxism. (Source: Giannasi, et al. [
A 9-year-old male child with visual disability resulting from the intracranial hypertension and/or alterations in the vascularization of the optical nerves which were caused by the cystic craniopharyngioma. Diabetes insipidus was developed as a complication of this disease, whereas, the motor functions, learning ability, memory, and mental health were preserved. The intraoral features showed generalized chronic gingivitis and deep caries, in particular, in the molar regions, resulting from poor oral hygiene. Considering that the periodontal disease is one of the main oral complications of diabetes, the oral health balance must be a major goal of the dentists once hyperglycemic control in a diabetic child becomes is a great challenge for parents and doctor (Image 5).
Chronic gingivitis associated with visual disability and metabolic disease.
A 59-year-old man with diagnosis of active positive-HIV had squamous cell carcinoma in the vestibular fornix region. In the clinical history, the patient was a smoker since the age 13 and had arterial hypertension, saphenous bridge, and type 2 diabetes mellitus. The diagnosis of positive-HIV was confirmed when the patient was 36 years old. To treat the malignant neoplasm, chemotherapy and radiotherapy were indicated by the oncologists; however, no emergency dental treatment was done before the recommended therapies in order to first eliminate the dentoalveolar infection foci. We imply that the severe periodontitis combined with periapical lesion caused by the presence of residual root, quickly evolves into an abscess with spontaneous extraoral suppurative drainage. The neoplasm overgrowth and the indicated therapies with no support dental treatment surely influenced this infectious process (a and b). Severe candidiasis was spread on the hard palate and, in particular, superior alveolar ridge (c). The exfoliative cytology confirmed the diagnosis, showing a great amount of
Necrotizing periodontal disease in combination with AIDS and metabolic disorder (Papanicolaou stain, original magnification 400×).
A 61-year-old man had uncontrolled and insulin-dependent type 2-diabetes mellitus, arterial hypertension, ankylosing spondylitis, and hepatitis C. Regarding the diabetes control, the patient was treated with sinvastatina (10 mg), galvus (100 mg) and lantus (44 mL). The glycated hemoglobin (HbA1c) value was 9.1% (Reference values: normal: ≤5,6%,
Generalized chronic periodontitis associated with heart and metabolic diseases. (Courtesy: Doctor Professor Ana Cristina Solis).
Concerning the etiology of PD in patients with uncontrolled diabetes, the progressive attachment loss was detected due to the function and reduction of polymorphonuclear leukocyte chemotaxis leading to an increase in infection susceptibility, collagen synthesis and maturation reduction, increased collagenase activity, and the formation of advanced glycation end products (AGEs) that bind to the receptor for advanced glycation end products (RAGEs) in macrophages and monocytes. The effects of AGE accumulation increase tissue oxidant stress, alter the endothelial cell functions, elevate the activity of matrix metalloproteinases leading to the production of free radicals, and promote vascular dysfunction and cellular death. These factors may directly affect the migration and activity of inflammatory cells, impairing the mechanisms of defense against microorganisms and delaying the periodontal tissue repair processes, resulting in great losses of support structures [11].
To clarify these clinical findings, periodontal tissue alterations resulting from oral complications of diabetes were depicted, including intense alveolar bone resorption at the furcation region, proliferation of junctional epithelium (hyperplasia) toward the furcation, diffuse infiltration of mononuclear inflammatory cells which consisted of macrophages, lymphocytes, and especially plasma cells. Numerous blood vessels were congested and the diapedesis mechanism (leukocyte extravasation into connective tissue) were well evidenced, justifying the great amount of inflammatory cells at the lamina propria (Figure 4).
Photomicrography showing chronic periodontitis related to Case 7 (Masson’s trichrome; bars = 1000, 200, 100, and 50 μm).
A 33-year-old woman with chronic mucocutaneous inflammatory disorder of immunological background showing aggressive and extensive oral lesions with erythematous, erosive and extensive areas, especially in the marginal and attached gingivae (a and b). Histopathological features showing a band of infiltration of lymphocytic inflammatory cells under the surface epithelium extending throughout the gingiva (c), besides hydropic degeneration and sharpness loss of the basal layer (d) (hematoxylin and eosin, 50× and 100×). The diagnosis was lichen planus. (Source: Gomes et al. [29]) (Image 8).
Gingivitis associated with autoimmune disease (desquamative gingivitis) (Source: Gomes et al. [
A 23-year-old young woman with Fanconi’s anemia had severe pancytopenia and a prolonged, long-term immunosuppression which resulted in the development of an abscess on the infra-orbicular region. This process progressed to phlegmon causing tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbit region of the right side (a). The etiologic agent of the phlegmon was
Gingivitis associated with hematological disorders (Leishmann stain, 600×; Papanicolaou stain, 400×) (Source: Gomes et al. [
A 14-year-old adolescent boy with Acute Lymphoblastic Leukemia (ALL) underwent the chemotherapy and radiotherapy on the region of the central nervous system for relapse prophylaxis of the primary disease (a). The myelogram before the medical therapies displayed hypercellular bone marrow composed exclusively by lymphoblastic cells with numerous atypical mitoses (square) (b and c). Extra and intraoral features of the patient, before the recommended dental treatment, were acute necrotizing ulcerative gingivitis, severe oral mucositis with areas necrosis associated to pseudomembranes, and facial asymmetry with signs of phlogistic processes (d and e). The exfoliative cytology of the hard palate and attached and free gingivae shows a great number of inflammatory polymorphonuclear and mononuclear cells, besides a great amount of
Necrotizing ulcerative gingivitis associated with hematological disorder plus chemical and physical agents (Leishmann stain, 600×; Papanicolaou stain, 400×) (Source: Gomes et al. [
With advances in genomic (genes), transcriptomic (mRNA), proteomic (proteins), and metabolomic (metabolites) capabilities, an increased interest has emerged in the biologic system to define the complex regulatory networks that result in health or disease [32]. This implies a greater understanding of the data related to the etiopathogenesis of PD. These diseases are a multifactorial, highly complex disease involving some factors as host, environment, and microbiota. However, it is the host inflammatory response which may lead to the soft and hard tissue destruction. In severe diseases, this can lead to tooth loss [33].The host response to the infections draws upon the innate, inflammatory, and adaptive immune systems which provide an appropriate response to the aggressive microorganisms. In some individuals and with some bacteria, this phenomenon will be an innate-only response, others will need to invoke the inflammatory response, and yet others will require the adaptive immune response (cellular, humoral, or both) in order to reduce the microbial activities [33, 34].
Although much of what Page and Schroeder proposed in 1976 has stood the test of time, advances in the fields of basic and periodontal immunology need a reassessment of their work, as well as their integration with emerging new concepts [35]. Major advances have been made regarding the cellular and molecular mechanisms underlying the induction, regulation, and effector functions of immune and inflammatory responses. Likewise, Kornman [36] described a new look of the PD pathogenesis when he reported the specific bacteria and immunoinflammatory mechanisms related to innate differences among individuals and changes in environmental factors. This fact may accelerate or attenuate these biochemical changes [37].
With emerging genomic, proteomic, and metabolomic data and tools of biology systems for interpreting data, it is now possible to start describing the basic elements of a new model of pathogenesis [36]. Stunning new findings have begun to clarify several complexities of the host-pathogen interaction of PD, pointing to key roles for microbial dysboisis and immune imbalance in the pathogenesis of disease [34].
Regarding the genomic knowledge, inflammation, cellular infiltration, and expression of a complex array of cytokines, chemokines, and lipid mediators are key characteristics of PD. In PD, the presence of elevated inflammatory cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, interferon (IFN)-γ, and IL-12, is considered a central force when coupled with cell activation and RANKL (receptor activator of nuclear factor kappa-Β ligand) activation in driving pathogen elicited bone loss [38, 39]. In addition to pro-inflammatory cytokines, an array of chemokines including IL-8 and monocyte chemotactic protein (MCP)-1 and others are frequently elevated in PD [40]. Some examples of this type of interaction are described in the literature, for example, studies that reported a positive association between polymorphism of the IL-1 and PD [41, 42]. In addition, the presence of antiinflammatory and regulatory cytokines, such as transforming growth factor-beta (TGF-β), IL-10 and IL-4, has been reported [43, 44].
T lymphocyte cells (T cells) are well known as key regulating cells which orchestrate the host immune response. Considering the cells arise from the CD4+ population and are based on cytokine profiling, early studies showed that these cells were segregated into Th1 and Th2 populations. Modern cytokine profiling and transcription factor analysis have led to a much more detailed classification of Th cells and the emergence of the Th17, Treg, TFH, Th9, and Th22 subsets [45, 46]. More advances have been recognized in what concerns the Toll-like receptors (TLRs) and TLR signaling; TIR-domain-containing adapter-inducing interferon-β (TRIF), interferon regulatory factors and type 1 interferon, and other pattern recognition receptors and PD, including scavenger receptors (SRs) and
With a similar importance, the transcriptomics aspects are defined as gene expression profile and when altered may influence the microbiota composition of periodontal pocket, as observed by Papapanou et al. [47]. In the same way, recent studies started to use proteomic techniques, promoting high resolution in the evaluation of proteins and molecular pathways involved in gingival inflammation [48, 49].
The gingival fluid composition of inflamed sites of patients with generalized aggressive periodontitis was evaluated by Bostanci et al. [50], demonstrating the proportion of enzymes associated with neutrophils, metalloproteinase of matrix-8, catepsin G, mieloperoxidase in addition to bacterial, viral, and yeast proteins that were increased in aggressive periodontitis when compared to healthy sites of individuals without periodontitis. Cystatin B and defensins, defense proteins, were detected only in healthy individuals.
Proteins involved in immune response and antimicrobial function, such as α-amylases, calgranulin A, cystatin, C-lysozyme, and cathepsin G were regulated positively in the induction phase of gingivitis. In the resolution phase, several histones and neutrophilic proteins, including cathepsin G, myeloperoxidase, and defensin-1 had their production decreased [49].
Concerning metabolomic aspects, among the earliest host-response molecules found in response to infection are lipid mediators [51]. Resolution of inflammation involves the production of lipid mediators named immunoresolvents and includes the resolvins, protectins, lipoxins, and maresins [51, 52]. Functionally, resolvins limit inflammation in part through prevention of neutrophil penetration, limiting inflammation at the local level, and promote tissue regeneration. The reduction of inflammation, through the use of resolvin-based approaches, may represent a novel strategy to potentially augment PD treatment approaches [53].
New models in the next few years will be merely frameworks for integrating key knowledge as it becomes available from the “Omic” technologies for diagnosis, providing by identifying one or more biomarkers the detection of active disease, predict future progression, and evaluate the response to periodontal therapy, thereby improving clinical management through early diagnosis and intervention, especially in case of patients with SHCN.
As an alternative treatment to obtain the regeneration of the periodontium, the photobiomodulation (PBM) and some bioactive materials may be indicated, once they strongly stimulate the periodontal tissue response, attenuate the inflammatory processes, and/or promote the microstructural reconstruction of the periodontium. However, in the indication of these therapies, PBM must be carefully studied, since it depends exclusively on the general and oral health status of each patient.
Concerning the patients with SHCN associated to immune system deficiency, the PBM, also known as low-level laser therapy (LLLT), has been largely used to promote therapeutic and biostimulating effects, such as analgesia, antiinflammatory action, angiogenesis, and mitogenesis [11]. Gomes et al. [11] assessed the impact of the GaAlAs diode laser on the periodontal tissues and investigated its effects on the alveolar bone remodeling process during orthodontic tooth movement in normoglycemic and diabetic rats. The authors demonstrated that the PMB strongly stimulated the alveolar bone remodeling and favored the continuous reorganization of the soft periodontal tissues, leading to the maintenance and the integrity of periodontal microstructures under orthodontic force, especially in uncontrolled diabetic rats (Figure 5).
Low-level laser therapy applied on the periodontal tissues under orthodontic force (a) in a period of 21 days. Photomicrographs showing furcation region of the right mandibular first molar in diabetic rats: (b) diabetic rats with no laser irradiation displaying alveolar bone loss due to intense osteoclastic activity (square); and (c) diabetic rats with laser irradiation exhibiting suitable alveolar bone formation because of the intense osteoblastic activities (square) and the integrity of the periodontal ligament fibers (Source: Gomes et al. [
Several bioactive materials have been used in the regenerative medicine, especially in patients with complex metabolic and cellular disorders. Among them, we highlighted homogenous demineralized dentin matrix (HDDM), amniotic membrane (AM) used as a biological dressing, and different types of platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). These biomaterials were applied in the craniomaxillofacial complex resulting in tissue regeneration and microstructural reconstruction due to their effective inductive and conductive properties. The HDDM, PRP, and AM in implantation sites may initiate an inductive cascade as chemotaxis of progenitor cells, mitogenesis, angiogenesis, and differentiation into a wide variety of cells. The cell recruitment, division rate, and differentiation of cell lines are under the direct control of several growth factors and stem cells which are found in these biomaterials [54, 55, 56].
In particular, the AM is a huge source for multipotent mesenchymal stem cells (MSCs) with the ability to differentiate into a wide variety of cells, such as chondroblasts, osteoblasts, adipocytes and fibroblasts, myocytes, endothelial cells, neuronal cells, and hepatocytes, leading to formation of cartilage, bone, connective tissue, muscle, blood vessel, nerve, and liver tissue, respectively [56, 57, 58]. This membrane acts as a barrier, preventing the entry of pathogens and toxins, preserving the tissue structures, and, consequently, reducing the levels of local pro-inflammatory cytokines [58, 59]. Thus, it could be largely used to selectively guide the tissue regeneration in the periodontium following destructive PD.
Regarding the second-generation platelet concentrate, the PRF clot forms a strong and dense natural fibrin mesh full of growth factors that can stimulate proliferation of PDL cells and osteoblasts; besides, it favors various cytokine entrapment and preserves the growth factors from proteolysis [60]. This concentrate is characterized by a high content of platelets and leukocytes that release an array of growth factors such as platelet-derived growth factor (PDGF),
Although the use of autologous platelet concentrates is not new to periodontics, current researches are strongly encouraging the combination of platelet concentrates, such as PRP, PRF, and concentrated growth factors, with bone graft materials, membranes for guided tissue regeneration and MSCs to stimulate the periodontal regeneration. Most likely, this pool has synergistic effects, favoring the environment and the development of desirable periodontal tissues which were seriously compromised by the periodontal disease.
Considering the high susceptibility to PD in people with SHCN, it is important that the dental practitioners know the different levels of disability complexity and how the undesirable environment may impair the human and physical development, leading to temporary or permanent disorders and/or diseases. Among the most common oral diseases, periodontal disease is an inflammatory condition which has been identified as a potential risk factor for systemic diseases. Therefore, it must be continuously controlled by the dentists to maintain the general health status of this individual.
In addition, other treatments for oral rehabilitation may be indicated when the periodontium is healthy, such as orthodontics, dental implants and/or the use of dental prostheses, contributing to the balance of the stomatognathic system, the preservation of the general health, a better quality of life, and, consequently, social inclusion.
In search of alternative therapies for this target public, the photobiomodulation for periodontal tissue biostimulation and the reconstructive surgeries using bioactive materials may be recommended in order to favor the periodontal regeneration, to protect the periodontium under daily actions of physicochemical agents and psychic conditions, and to restore lost periodontal microstructures.
Despite the entire scientific and technological development for people with SHCN, we may presume that the major challenges for health multiprofessionals are to promote the best transdisciplinary practices in oral healthcare on dental services and hospitals due to the high complexity of disabilities, conditions, disorders and diseases of these individuals; to perform people management focusing on the good interpersonal relationship among the health multiprofessionals, patient, family and caregivers; and to combat the several environmental and social factors that may strongly affect the decision-making power of the patient to carry out a satisfactory self-care.
This book chapter was supported by the São Paulo State Secretariat for the Rights of the Person with Disability (SEDPcD) and State of São Paulo Research Foundation (FAPESP; grant number: 2017/06835-8), in Brazil. The authors would like to thank the Associate Professor Sergio Lúcio Pereira de Castro Lopes, the Associate Professor Maria Aparecida Neves Jardini, the Doctor Professor Ana Cristina Solis, and the dentist Mario Augusto Gomes by the technical support and radiographic and clinical assistances.
Authors have no conflict of interests.
ADHD | attention-deficit and hyperactivity disorder |
AGEs | advanced glycation end products |
AIDS | acquired immune deficiency syndrome |
AM | amniotic membrane |
ALL | Acute Lymphoblastic Leukemia |
APA | American Psychiatric Association |
ASD | autism spectrum disorder |
DSM | Diagnostic and Statistical Manual of Mental Disorders |
GaAlAs | gallium-aluminum-arsenide |
HbA1c | glycated hemoglobin |
HDDM | homogenous demineralized dentin matrix |
HIV | human immunodeficiency virus |
IFN | interferon |
IFN-γ | interferon-gamma |
IGF | insulin-like growth factor |
IL | interleukin |
IL-1 | interleukin-1 |
IL-10 | interleukin-10 |
IL-12 | interleukin-12 |
IL-4 | interleukin-4 |
IL-6 | interleukin-6 |
IL-8 | interleukin-8 |
JACSD | Joint Advisory Committee for Special Care Dentistry |
LLLT | low-level laser therapy |
LPS | bacterial lipopolysaccharide |
MCP-1 | monocyte chemotactic protein-1 |
mRNA | messenger ribonucleic acid |
MSCs | mesenchymal stem cells |
NHANES | National Health and Nutrition Examination Survey |
NIMH | National Institute of Mental Health |
NLRs | nucleotide-binding-oligomerization-domain (NOD)-like receptors |
PBM | photobiomodulation |
PD | periodontal diseases |
PDGF | platelet-derived growth factor |
PDL | periodontal ligament |
PRF | platelet-rich fibrin |
PRP | platelet-rich plasma |
RAGEs | receptor for advanced glycation end products |
RANKL | receptor activator of nuclear factor kappa-Β ligand |
SHCN | special health care needs |
SRs | scavenger receptors |
T cells | T lymphocyte |
TFH | T-follicular helper cell |
TGF | transforming growth factor |
Th cells | T helper cells |
Th1 | T helper cell 1 |
Th17 | T helper cell 17 |
Th2 | T helper cell 2 |
Th22 | T helper cell 22 |
Th9 | T helper cell 9 |
TLRs | Toll-like receptors |
TNF | tumor necrosis factor |
TNF-α | tumor necrosis factor-alpha |
Treg | regulatory T cell |
TRIF | TIR-domain-containing adapter-inducing interferon-β |
VEGF | vascular endothelial growth factor |
WHO | World Health Organization |
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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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During the ancient and medieval periods of education, students were trained by teachers in such a manner that they can survive and live in that era. After independence, there is a tremendous growth in the Indian education system providing teaching and training in all aspects, but it does not satisfy the global demands of the market. This chapter focuses on teaching methodology, curriculum, characteristics, methods of learning, aims of the Indian education system during the ancient and medieval period and how it differed in today’s modern education and what are the things that our today’s modern education need to learn and implement from ancient and medieval education. The mentioned points are used to differentiate ancient, medieval, and modern education with advantages and disadvantages. Through this chapter, students, teachers will get to know the difference in the education system and what else to be adapted in the future to overcome all the problems.",book:{id:"9536",slug:"education-at-the-intersection-of-globalization-and-technology",title:"Education at the Intersection of Globalization and Technology",fullTitle:"Education at the Intersection of Globalization and Technology"},signatures:"Mangesh M. 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In summary, entrepreneurship has been viewed from the standpoints of the psychologist (behaviourist), the economist, and sociologist. Furthermore, the objective of the chapter is to provide literature synthesis on the concept of entrepreneurship. The methodology was meta-synthesis of 15 relevant studies obtained from conference proceedings, text books, and online data bases. Scope of the study included higher and secondary education which are selected as the focus groups of the study in order to encourage assimilation and implementation of entrepreneurship education curricula and development. Data acquired were quantified using descriptive statistics (percentages on bar chart). The result of the study signifies definitions, characteristics, and importance of entrepreneurship needed for improvement of knowledge in enterprise curricula aside from skills and competencies. 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He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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