An overview of the main uses of the WCD, therapy deliveries, and key findings [15, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44].
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The population at risk for SCD is heterogeneous and includes those whose risk is based on a transient arrhythmia-provoking electrical event, structural heart disease, a channelopathy, heart failure, cardiomyopathy, or other underlying conditions [1]. For patients at elevated risk for potentially life-threatening ventricular tachyarrhythmias but with a transient contraindication for an implantable cardioverter-defibrillator (ICD) therapy, the wearable cardioverter-defibrillator (WCD) is an important therapeutic option (LifeVest 4000®, Zoll, Pittsburgh, Pennsylvania, USA). The external vest delivers high-energy rescue therapy in the event a ventricular tachyarrhythmia is detected along with electrogram storage and remote monitoring [2]. First introduced to market in 2001, the WCD is intended for short-term use, typically for a few months [3].
Currently, there is only one WCD, the LifeVest 4000®, and no other similar products are on the market. The WCD weighs 800 g and is available in a range of sizes with adjustable straps and an elasticized belt to fit snugly next to the skin under clothing (Figure 1). The WCD has three pad-style electrodes for defibrillation and four more electrodes for arrhythmia detection (sensing). It is equipped with a battery-powered defibrillation unit capable of generating several high-energy shocks. When the WCD prepares to deliver a shock, it delivers a small amount of gel to the skin at each electrode, and a biphasic waveform of 75 or 150 J is delivered [4].
The WCD (LifeVest 4000® from Zoll) is worn like a vest and is powered by a rechargeable battery, capable of delivering high-energy shocks to convert a potentially life-threatening ventricular tachyarrhythmia. Art by Todd Cooper.
The WCD detects arrhythmias using an algorithm of heart rate (including rate stability and onset of arrhythmia) and waveform morphology. In the presence of noise or when a waveform template is not available, the detection function can work using rate alone. Once an arrhythmia is detected, the device signals the patient for about 30 s, allowing the wearer to abort the shock by manually depressing two response buttons. If the rate drops below the detection threshold during this 30-s waiting period, the detection is delayed or the shock prevented, depending on whether the slower rate was brief and temporary or persisted [5]. The WCD offers programmable parameters in that the ventricular fibrillation (VF) zone can be set between 120 and 250 beats per minute (bpm) and the ventricular tachycardia (VT) zone can be programmed from 120 bpm to the lower bound of the VF zone [6]. The clinician may also program the time from arrhythmia detection to therapy delivery from 60 to 180 s for the VT zone and 25 to 40 s for the VF zone [5].
The WCD is rechargeable and comes with two lithium-ion batteries. One battery is used at all times in the device, while the other may be charged in about 3.5 h using a proprietary charging station. Battery life is approximately 2 days, but even if the battery signals the patient that it is getting low, there is usually sufficient charge retained for 10 shocks of 150 J each. During an arrhythmic episode, the WCD will deliver up to five shocks. If the arrhythmia persists, the device detects again and repeats the cycle until the rhythm is converted or the battery is exhausted [5]. Once the WCD delivers therapy, it should be replaced.
Patients are given a transmitter which can transmit data from the WCD directly to the clinic via a secure server. Remote transmissions do not require any patient intervention. Like cardiac implantable electronic devices, the WCD can be programmed to send out alerts when specific triggering events occur. The remote monitoring system records the number of hours per day that the patient wears the WCD, and the patient can activate the device to record an electrogram in the event of symptoms. While the WCD will attempt to make a daily remote transmission, if this is not possible, data transmission should occur at least once a week, and monthly in-clinic visits are recommended for WCD patients [5]. Reports from the WCD are shown in Figures 2 and 3.
The wear time: report on the WCD.
Report from the WCD about a tachycardia that was detected but did not require therapy delivery.
The American College of Cardiology, American Heart Association, and European Society of Cardiology (ACC/AHA/ESC) 2006 guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death was the first society-based recommendation for the use of WCD in patients at transient high risk for VF, such as patients waiting for heart transplant; patients at high risk following an acute myocardial infarction or invasive cardiac procedure; and patients whose ICD had to be temporarily explanted, for example, because of an infection [7]. The International Society for Heart and Lung Transplantation guidance made the WCD a Class I indication for Status 18 patients awaiting transplant at home [8]. In 2009, the Heart Rhythm Society expert consensus recommended that the WCD be considered as an alternative treatment for patients who needed early ICD revision following device explant in the setting of suspected continuing infection [9]. In 2013, the ACC/AHA guideline stated that the utility of the WCD in high-risk patients in the first 4 to 6 weeks after myocardial infarction was being investigated [10]. The European Heart Rhythm Association, Heart Rhythm Society, and Asia Pacific Heart Rhythm Society (EHRA/HRS/APHRS) Expert Consensus on Ventricular Arrhythmias stated that patients with heart failure with reduced ejection fraction after a myocardial infarction (with or without revascularization) may benefit from WCD use in weeks to months until recovery [11]. Many patients who might be potential WCD candidates are not routinely included in clinical trials, and the HRS/ACC/AHA Expert Consensus Statement of 2014 suggested that the WCD may be considered as a “bridge to ICD” in certain patients [12]. The following year, in 2015, ESC guidelines suggested that the WCD might be used in patients with transiently impaired LV function, naming certain specific conditions such as myocardial infarction, peripartum cardiomyopathy, and myocarditis, and in patients awaiting heart transplantation or a left ventricular assist device [13].
In 2016, the AHA issued a science advisory about the WCD which was endorsed by the HRS [14]. Among their key concepts: they viewed the WCD as a temporary means for preventing arrhythmic death without the need of bystander response; despite limited evidence from randomized controlled trials, observational data support the notion that the WCD can detect and terminate ventricular tachyarrhythmias; and the use of a WCD is reasonable when there is a clear ICD indication and a current, transient contraindication to ICD implantation. According to this advisory, the role of a WCD is less clear when the risk of arrhythmias is transient, but a WCD still may be appropriate. The most controversial use of the WCD is in patients in the early recovery phase after myocardial infarction or with a newly diagnosed form of nonischemic cardiomyopathy. Many of these patients will not need a permanent ICD but will experience a period of time when they are at increased risk of SCD. Evidence for use of the WCD was C-level (expert opinion) and may be summarized as:
The use of WCD is reasonable when there is an indication for an ICD, but a transient contraindication or interruption in ICD care (such as infection) temporarily prevents implantation (Class IIa).
The use of WCD is reasonable as a bridge to more definitive therapy, such as heart transplant (Class IIa).
The use of WCD may be reasonable if there is concern about an elevated SCD risk that is expected to resolve over time or with treatment, for example, ischemic heart disease following revascularization or nonischemic cardiomyopathy being initiated on guideline-directed medical therapy (Class IIb).
The WCD may be appropriate as a bridge therapy when patients are at elevated risk for SCD in cases where an ICD would reduce the risk of SCD but not improve overall survival, such as within 40 days following acute myocardial infarction (Class IIb).
WCDs should not be used when the risk for potentially life-threatening non-arrhythmic causes is expected to exceed the risk of ventricular arrhythmias, especially in those situations where longevity is not expected to exceed 6 months (Class III).
There are many observational studies about the use of the WCD, but to date only one large randomized clinical trial has been published, the Vest Prevention of Early Sudden Death (VEST) study (n = 2302) [15]. All patients had had a recent myocardial infarction and a left ventricular ejection fraction ≤35%; some but not all patients had undergone revascularization. Patients were randomized into two arms: guideline-directed medical treatment (control) or a WCD. In the first 90 days after myocardial infarction, the WCD did not result in a lower rate of arrhythmic death, but total mortality was lower in the WCD group (3.1% vs. 4.9%, p = 0.04, uncorrected) [15]. Despite the fact that the VEST study did not result in a lower rate of arrhythmic death for WCD patients, there are important aspects of this study that deserve deeper scrutiny. Unwitnessed arrhythmic death is difficult to ascertain, and five of the nine VEST subjects deemed to have died due to an arrhythmia were wearing the WCD at the time, and the WCD showed no evidence of a tachyarrhythmia. Since arrhythmic death is rare, even a small number of misinterpretations in a study like this may skew results. Moreover, the study was designed assuming patients would wear the WCD at least 70% of the time, and compliance dropped as the study progressed. Since fewer patients wearing the WCD died, it has been argued that there was not a single active treatment group in the study (WCD group) but rather two: patients randomized to the WCD group broken down into those who wore the WCD and those who did not [16]. Of the patients in the WCD arm of the study who died, 75% were not wearing the WCD at the time [15].
Early after the WCD was first cleared to market, an observational study called the Wearable Defibrillator Investigative Trial (WEARIT) enrolled 177 ambulatory patients who had New York Heart Association (NYHA) functional Class III or IV heart failure and an ejection fraction <30%. It was subsequently combined with a similar observational study, the Bridge to ICD in patients at risk of sudden arrhythmic death (BIROAD), which enrolled patients who had an AMI and needed bridge therapy for up to 3 months (n = 112). In 901 patient-months, the mean duration of wear was 3.1 months. Among the WEARIT patients, there were two appropriate and successful therapy deliveries in the same patient several days apart, and there were four appropriate, successful therapies delivered in two of the BIROAD patients. Two unsuccessful therapy deliveries occurred, both of which involved the improper wear of the WCD. Altogether, 12 patients died over the course of the study, none of whom were wearing the WCD at the time. Over the 901 patient-months, there were 6 inappropriate therapy deliveries in 6 patients (0.7% per month) [17].
The WEARIT-II Registry enrolled 2000 patients, of whom 805 were diagnosed with ischemic cardiomyopathy, 927 with nonischemic cardiomyopathy, and 268 with congenital heart disease [18]. During the study, 41 patients experienced a total of 120 episodes of VT, of whom 54% received an appropriate shock. Inappropriate shocks occurred in 0.5% of patients. Many of the patients in WEARIT-II had improved their ejection fraction over the course of time they wore the WCD, and at the end of WCD treatment, only 42% got an ICD.
The Study of Wearable Cardioverter Defibrillator in Advanced Heart-Failure Patients (SWIFT) was a nonrandomized prospective study at two centers evaluating the use of the WCD in 75 patients hospitalized with advanced heart failure symptoms and LV dysfunction. Patients wore the WCD for 3 months after hospital discharge. Two-thirds of the patients (66%) had nonischemic cardiomyopathy. Eight arrhythmic events occurred in five patients, all successfully terminated by the WCD. No inappropriate therapies were delivered, and no patients died in the course of the study. When the study concluded, 28% were implanted with an ICD [19].
A summary of these trials appears in Table 1.
Study description | Appropriate therapy | Inappropriate therapy | Wear time | Comments |
---|---|---|---|---|
Acute myocardial infarction | ||||
Barraud et al. 24 consecutive patients with LVEF <30% and recent myocardial revascularization | Two VT occurred (8.3%); one terminated spontaneously, and one was successfully treated | None | Mean 3.0 ± 1.3 months duration Daily wear time 21.5 hours/day | The WCD offered life-saving intervention for one patient |
Kondo et al. 24 patients with myocardial infarction | Two patients (8.3%) received appropriate shock; both first shocks were successful | None | Median duration of WCD therapy was 33 days (range 20–67 days) Median daily wear time 23.1 h/day One patient excluded because of irregular use of WCD | In total, 58% went on to get ICD. Ejection fraction improved over baseline (p < 0.01) with 50% having an ejection fraction >35% Two patients (8.3%) died of fatal but non-arrhythmic events within 3 months |
Controlled studies | ||||
Olgin et al. VEST 2302 patients with myocardial infarction with ejection fraction ≤35% 1524 in WCD arm 778 controls | 20 patients (1.3% of WCD group) | Nine patients (0.6% of WCD group) | Mean follow-up was 84.3 ± 15.6 days Wear time for WCD patients was median 18.0 h/d (3.8–22.7) with decreasing wear time over course of study | Arrhythmic death occurred in 1.6% and 2.4% of WCD and controls, respectively (not significant) All-cause mortality rates were 3.1% and 4.9% for WCD and controls, respectively (p = 0.04) Of the 48 WCD patients who died, only 12 were wearing the WCD at time of death |
Heart failure | ||||
Barsheshet et al. 75 heart failure patients prescribed a WCD in an observational study at 2 centers, SWIFT | Eight arrhythmic events occurred in 6.6% of patients (n = 5), all successful | None | Median wearing duration was 59 days, 80% of patients wore the WCD more than 50% of the day | At the end of study, 28% received an ICD |
Duncker et al. PROLONG study 156 patients with ejection fraction ≤35% prescribed WCD for 3 months and then re-evaluated | Eleven patients received a total of 12 appropriate shocks | None | Cumulative 42.7 patient-years of wear time; mean time per patient was 101 ± 89 days Wear time 21.7 ± 4.0 h/day | 48/156 discontinued therapy before 3 months (noncompliance, early improvement of ejection fraction, ICD implanted, etc.) 33% of patients improved within 3 months to ejection fraction >35% |
Heart transplantation | ||||
Opreanu et al. 121 patients awaiting heart transplantation National registry based on convenience sample 55% NICM, 17% ICM, 27% mixed 32% were NYHA Class III and 34% Class IV | Seven patients (6%) | Two patients (1.7%) | Median wear time 39 days Median daily use 20 h/day | Eleven patients (9%) died in the study |
Hemodialysis | ||||
Wan et al. 75 hemodialysis patients with a history of SCA | 75 patients (100%) experienced at least 1 SCA event while wearing the WCD 84 total events 136 total shocks delivered | Not reported | Mean duration of wear 62.9 ± 73.1 day (2–308 days) Mean daily wear 18.9 ± 4.6 h/day | Among patients with shockable rhythms, 30-day survival rate was 63.0% |
Infected device | ||||
Ellenbogen et al. 8058 patients who had an ICD removed for infection and used WCD as bridge to reimplant | 334 patients (4%) experienced 406 VT/VF events, of which 348/406 (86%) were treated by WCD, all successfully 54 patients aborted shocks for arrhythmias that resolved spontaneously 12-month cumulative event rate 10% | 159 patients (2%), no associated deaths | Median wear duration 53 days (25–94) Daily wear time not reported | Risk of VT/VF was highest in initial weeks after ICD removal at 0.9%, 0.7%, and 0.7% for first, second, and third weeks, respectively 30-day post-event survival rate was 81% overall 80% of patients in this study got an ICD |
Observational studies from a single center | ||||
Bhaskaran et al. Eight WCD patients | None | None | Median duration 77 days Mean daily wear 23.4 ± 0.6 h/day | 1/8 patients in the study were noncompliant with WCD |
Erath et al. 102 WCD patients | Four patients (3.9%) | Two patients (2.0%), both due to SVT | Median duration 54 days Median daily wear 23 h/day | 55% received an ICD |
Naniwadekar et al. 140 WCD patients 32% ICM, 46% NICM 85.9% African-Americans | Two patients (1.4%) received a total of two appropriate shocks | Two patients (1.4%) received a total of four inappropriate shocks (two SVT, two artifacts) | Median duration 43 days (7–83 days) Mean daily wear time 17.3 ± 7.5 h/day | Seven patients died 32% received an ICD |
Roger et al. 105 consecutive patients with newly diagnosed ICM or NICM and ejection fraction ≤35% | Five patients (4.8%) | None | Mean duration of wear 68.8 ± 50.4 days Mean wear time 21.5 ± 3.5 h/day | At the end of WCD wear, 54.8% of ICM and 48.8% of NICM patients indicated for primary prevention ICD |
Sasaki et al. Nine patients at risk for SCD | One patient (11.1%) | None | Median duration of use 21 days [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31] Median wear time 23.7 h/day (23.6–23.9) | One patient died of worsening heart failure 67% received an ICD |
Pediatric | ||||
Spar et al. 455 patients (age 3–17 years) | Six patients (1.3%) received a total of 13 shocks | Two patients (0.4%) | Median duration of use 33 days (1–999) Median wear time 20.6 h/day (0.3–23.8) | Seven patients died, none of whom were wearing the WCD at time of death |
Psychological aspects | ||||
Weiss et al. 123 WCD patients from a multicenter registry administered several surveys | NA | NA | NA (study followed patients for 6 weeks) | Depressive symptoms decreased from 21% at baseline to 7% after 6 weeks of using the WCD Anxiety decreased from 52% at baseline to 25% at week 6 |
Registries | ||||
Chung et al. National postmarket registry Retrospective analysis 3569 WCD patients Compared against Social Security Death Index | First shock success was 100% (75/75) for unconscious VA and 99% (79/80) for all VA 89.5% survival of VA events | Inappropriate shocks occurred in 1.9% of patients in 4788 months of use, or 1.4% per month Multiple reasons for inappropriate shock. Some of these shocks could have been aborted by patients, but patients did respond | Mean duration of wear 52.6 ± 69.9 days (range 1–1590 days) Median daily wear time was 21.7 h/day 52% of patients wore WCD >90% of day | 14.2% of patients discontinued WCD Overall survival rate was 99.2% but no significant difference compared to first ICD implant patients |
Daimee et al. 1732 grouped as older (≥65, n = 722) and younger (<65 years, n = 1010) | Older patients had higher event rates per 100 patient-years for sustained VT and VF (32.0 vs. 9.8, (p = 0.027) Older patients, especially those with ICM were more likely to have VT/VF treated with shock (6.9 vs. 2.4, p = 0.034) | Not reported except as being “rare” | Older patients had significantly longer wear times (median 22.8 h/day vs. 22.3 h/day p < 0.001) | Younger patients with NICM had higher event rates per 100 patient-years for atrial arrhythmias (150.0 vs. 74.9, p = 0.055) Older patients were more likely to get an ICD after WCD (41.8% vs. 36.5%, p = 0.034) |
Kutyifa et al. 3195 (805 with ICM, 927 with NICM, 268 with congenital heart disease) WEARIT-II Registry | 41 patients had 120 episodes of sustained VT, of whom 54% received an appropriate shock | 0.5% of patients got an inappropriate shock | Median duration of wear was 90 days Median wear time 22.5 h/day | At the end of WCD use, 42% got an ICD; most frequent reason not to get an ICD was improved ejection fraction |
Lamichhane et al. 220 WCD patients in manufacturer’s postmarket registry of individuals who wore the WCD > 1 year 33.2% of the patients were African-Americans | 4.1% A total of 13 sustained VT episodes with 92.3% success rate (12/13 shocks) | 3.6% | Mean duration was 451 ± 290 days Median wear time 20.4 h/day (15.5–22.9) | Two patients died (one refractory VT and one bradycardia transitioning to asystole), and 59% of patients stopped using the WCD before the study ended, either because they got an ICD, their condition improved, they had another intervention (transplant), or other reasons |
Retrospective analyses | ||||
Bossory et al. 201 patients from 1 center prescribed a WCD with 1 year follow-up | Five patients (2.5%), nine shocks | One patient (0.5%), SVT | Mean duration was 63 ± 53.7 days Mean wear time 23.0 ± 0.62 h/day | 79% of WCDs were prescribed by clinicians who were not EPs |
Dillon et al. 2105 WCD patients in a retrospective analysis of arrhythmia detection | 1.58 appropriate shocks per 100 patient-months 54 total appropriate shocks | 0.99 inappropriate shocks per 100 patient-months 34 total inappropriate shocks, most due to interference (47.1%) | Data for 1 year were analyzed Median duration of use was 36 days (3–365) Median wear time 21.3 h/day (0–23.9) | Most frequent reason for wearing the WCD was myocardial infarction, but study included several indications |
Ellenbogen et al. population came from 234 consecutive in-hospital episodes of VT/VF in 173 in-hospital patients who had a WCD for primary prevention, history of VA, or other reasons, including device explant; 40% had a history of myocardial infarction | 100% had an appropriate shock 68% occurred during weekdays, and 55% of events happened in the daytime | Not reported | Median follow-up 6 days while patients were in the hospital | Most VA occurred in unmonitored units, the ICU, and the ED 24-h survival following therapy delivery was >90% |
Quast et al. 79 WCD patients | Two patients (2.6%) for annual rate of 13.6% | One patient (1.3%) for annual rate of 6.7% | Median duration 73 days (50.0–109.8) Median daily wear time 23.3 h/day (22.6–23.7) | In 52.2% ejection fraction improved enough that ICD implant was not necessary |
Salehi et al. 127 patients with CM and self-reported excessive alcohol use | Seven patients (5.5%) had nine sustained VT episodes, 100% successful conversion | Not reported | Median duration 51 days Median wear time 18.0 h/day | 11 patients (8.6%) died during the 100 days of follow-up, but no deaths were caused by WCD shock failure or undersense |
Singh et al. 639 WCD patients ICM and NICM | None for NICM patients Six ICM patients (2.2%), of whom five survived the shock and four survived to hospital discharge | Three NICM patients (1.2%) 0.7% of ICM | Mean duration 61 days (25–102) Mean daily wear 22 h/day | |
Uncontrolled studies | ||||
Beiert et al. 114 patients ICM (31.6%) NICM (45.6%) Congenital heart disease (5.3%) Infected device removal (11.4%) and others | 6.1% (no NICM patients were shocked) One patient had an appropriate but ineffective shock and was externally defibrillated | 64 patients (56.6%) were signaled inappropriately for a shock, almost all due to artifacts. All shocks were aborted by the patients, no inappropriate shocks delivered | Median duration 52.0 days (range 25–90) Daily wear time 23.1 h/day (19.0–23.8) | One patient in this study died of asystole |
Feldman et al. WEARIT (n = 177) and BIROAD (n = 112) studies WEARIT patients had symptomatic heart failure and ejection fraction <30% BIROAD patients had acute myocardial infarction and were in waiting period of 30–40 days before an ICD could be implanted | Eight appropriate shocks of which 75% were successful The two unsuccessful shocks were deemed related to improperly placed electrodes | Six inappropriate shocks (0.67% unnecessary shocks/month) | Mean duration of use was 3.1 months (2.6 for BIROAD and 3.4 for WEARIT groups, respectively) Daily wear time not reported | 12 patients died (5 of whom were not wearing WCD, and 1 wore it improperly) 68 patients dropped out of study for adverse events or discomfort wearing the WCD |
Wassnig et al. 6043 WCD patients | 94 patients (1.6%) were shocked Incidence rate 8.5% (95% CI, 6.7–10.7) per 100 patient-years for men and 7.9% (95% CI, 4.8–12.3) for women 94% success rate | 26 patients (0.4%), incidence 2.3 (95% CI, 1.5–3.4) per 100 patient-years In 10 cases, the reason was SVT | Median duration varied from 49 to 66 days Median daily wear varied from 22.7 to 23.5 h/day | Patients with explanted ICDs had higher average rates of shock (19.3 per 100 patient-years, 95% CI, 12.2–29.0) |
Zylla et al. 106 real-life cases taken from 2010 to 2016 | One patient (0.94%) shocked for VF, successful | Two patients (1.9%) 12.3% had an average of >1 inappropriate shock alarms per day (shocks aborted) | Median duration of wear 58.5 days Mean wear time 22.7 h/day Younger patients (≤ 50 years) less compliant | 17% discontinued therapy for various reasons: discomfort, frequent alarms, reimbursement problems, technical issues |
An overview of the main uses of the WCD, therapy deliveries, and key findings [15, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44].
AMI, acute myocardial infarction; CI, confidence interval; CM, cardiomyopathy; EP, electrophysiologist; ICD, implantable cardioverter-defibrillator; ICM, ischemic cardiomyopathy; NICM, nonischemic cardiomyopathy; NYHA, New York Heart Association; SCA, sudden cardiac arrest; SCD, sudden cardiac death; SVT, supraventricular tachycardia; VA, ventricular arrhythmia; VF, ventricular fibrillation; VT, ventricular tachycardia; WCD, wearable cardioverter-defibrillator.
One of the main reasons for WCD use is ICD system infection, which poses a clinical challenge in that the best course of action is to extract the device and lead(s), submit the patient to a course of antibiotic therapy, and then replace the ICD system with a new device [7, 9, 45]. The rate of infections associated with cardiac implantable electronic systems continues to increase, even at high-volume centers [46]. Antimicrobial therapy may last 10–14 days or longer, depending on the nature of the infection and the patient’s response. During this time, the patient is without an ICD. Leaving the ICD in place while treating an infection is associated with a high mortality rate (31–66%) [47, 48], but removing the device also increases the patient’s mortality rate, albeit from 8–27% [49, 50, 51]. Thus, the clinician faces three challenges: if the device is replaced too early, the patient risks re-infection; if the patient is deprived of the device too long, there is a risk for potentially life-threatening arrhythmias; and placing the patient under close monitoring in the hospital or a long-term care facility is cost prohibitive and deleterious to the patient’s quality of life. In such cases, the use of a WCD can be a valuable interim solution for arrhythmic rescue.
In a study of 97 ICD patients whose devices had to be explanted for infection, patients were prescribed a WCD for the mean antimicrobial treatment course of 21 days. As they recovered from infection, two patients experienced a total of four VT episodes, all of which could be successfully treated [52]. In a retrospective analysis of 8058 patients who received a WCD from 2002 to 2014 when an infected ICD was removed, 4% experienced ventricular tachyarrhythmias, and the rate of arrhythmic episodes was greatest in the first 3 weeks after device explantation (0.9, 0.7, and 0.7%, respectively), and the risk for ventricular tachyarrhythmias after device removal was 4% during the first 2 months and 10% at 1 year [25].
Heart transplantation or the use of a left ventricular assist device is the only potentially long-term therapeutic option for some patients, but during the waiting period, patients are at high risk for dangerous arrhythmias and may have other comorbid conditions as well. In a study of 121 patients prescribed with the WCD while waiting to receive a donor heart (mean 127 days), 7 patients (5.8%) were shocked appropriately, and all survived [23]. Two inappropriate therapy deliveries occurred deemed to be caused by rapid ventricular response to atrial fibrillation. In this study, two patients died of asystole during the waiting period; asystole is not treated by the WCD because it lacks a pacing capability [23].
In the USA and other parts of the world, patients with an ejection fraction ≤35% may be required by reimbursement authorities and guidelines to wait out a specific period of time before an ICD may be implanted; these time periods range from 30 to 90 days. This includes patients with cardiomyopathy.
This group of patients meets the requirements for Class IV heart failure but is not otherwise indicated or qualified to receive an ICD. Some of these patients may be waiting for cardiac transplantation, while others may be contraindicated for ICD implant for other reasons (frailty, comorbidities, patient refusal, and so on). The Study of Wearable Cardioverter Defibrillator in Advanced Heart-Failure Patients (SWIFT) was a prospective study of 75 advanced heart failure patients at 2 centers. All patients had low ejection fraction (21.5 ± 10.4% at baseline), were prescribed a WCD, and were followed up for 3 months. In the SWIFT study, 66% of patients had nonischemic cardiomyopathy. Over the course of the study, eight arrhythmic events occurred in five patients, including three episodes of nonsustained VT and one episode of polymorphic VT; all episodes were appropriately treated. No patient in the study received inappropriate therapy delivery. At the end of the study, 28% of patients went on to permanent device implantation, and the cumulative mortality rate at 3 years in this population was 21% for patients with nonischemic cardiomyopathy compared to 21% for those with ischemic cardiomyopathy [19].
Patients with ischemic cardiomyopathy may be indicated for a primary prevention ICD if they have an ejection fraction ≤35% and NYHA functional Class II or III or if they have an ejection fraction ≤30% with NYHA Class I [53]. Nonischemic cardiomyopathy covers a range of conditions that may include inflammatory, toxic, metabolic, genetic, or autoimmunological processes, and arrhythmic activity, including SCD, may be one of the first symptoms of nonischemic cardiomyopathy [5, 13]. Such patients typically fall into the reimbursement-mandated waiting period before a primary prevention ICD can be implanted, and many patients with recent-onset cardiomyopathy recover left ventricular ejection fraction and even experience reverse remodeling to the point that ICD implantation is unwarranted [5]. In cardiomyopathy patients, it is not clear if and how long patients should wait before ICD implantation is either deemed reasonable or unnecessary [5]. Ischemic cardiomyopathy patients may have higher rates of events than nonischemic cardiomyopathy patients [42]. Pharmacological therapy for cardiomyopathy may also improve the ejection fraction, and the WCD may be helpful as medical therapy is optimized [53].
In a retrospective single-center study of patients from June 2004 to May 2015, focus was placed on patients with newly diagnosed cardiomyopathy (254 nonischemic and 271 ischemic) [41]. Patients wore the WCD for a median of 61 days (interquartile range 25–102 days) and for a median of 22 h/day (17–23 h). The study produced 56.7 patient-years of data for nonischemic cardiomyopathy patients, during which no patients got appropriate shocks, but 1.2% (n = 3) were shocked inappropriately. There were 46.7 patient-years of data for ischemic cardiomyopathy, where 2.2% (n = 6) were shocked appropriately and two inappropriately (0.7%) [41].
The role of defibrillation has been controversial in acute myocardial infarction (AMI) patients since the defibrillator in acute myocardial infarction trial (DINAMIT) reported that early ICD implantation failed to confer a mortality benefit in this arrhythmia-rich population [54]. Current guidelines recommend that following myocardial infarction, patients with compromised left ventricular function do not receive an ICD for a 3-month to 40-day waiting period, whether or not they have been revascularized [53]. In the weeks immediately following a myocardial infarction, patients are vulnerable to a number of potentially lethal conditions, many unrelated to ventricular tachyarrhythmias, so that the mortality rate for myocardial infarction patients with or without an ICD is roughly the same (7.2% for both, assuming linear mortality rates in the first 3 months, based on DINAMIT study data) [54]. This imposes a “waiting period” on myocardial infarction patients before a device may be implanted and during which time they may be especially vulnerable to SCD. For many patients and clinicians, this creates a tension between abiding by evidence-based guidelines and meeting reimbursement requirements yet still providing reasonable means to rescue post-AMI patients from SCD [6]. The WCD has been proposed as an interim device for this population during this waiting period before a permanent ICD may be implanted. Further complicating this picture is the fact that some myocardial infarction patients will recover left ventricular function in the weeks following their heart attack to the point that they do not require an ICD at all. Thus, it may be argued that for these patients, the use of the WCD may be to provide possible rescue during recovery from the myocardial infarction and to avoid unnecessary ICD implantation [6].
It has been observed that myocardial infarction patients prescribed a WCD and shocked appropriately and successfully to convert a ventricular tachyarrhythmia nevertheless have high mortality rates. While this remains to be elucidated, it suggests that either ventricular tachyarrhythmias in the immediate aftermath of a heart attack are indicative of poor outcomes or the arrhythmia and/or the rescue shock has a destabilizing effect on the patient [55]. The Valsartan in acute myocardial infarction trial (VALIANT) evaluated 14,609 myocardial infarction patients with low ejection fraction for SCD. VALIANT reported myocardial infarction patients with an ejection fraction ≤30% had a mortality of 2.3% per month in the first 30 days after the myocardial infarction (and that 83% of all patients who died of sudden unexpected death died within the first 30 days of hospital discharge). Every decrease of 5% in the ejection fraction was associated with a 21% increase in SCD risk in the first 30 days after myocardial infarction [56].
The Vest Prevention of Early Sudden Death (VEST) trial found that in myocardial infarction patients with low ejection fractions (≤35%), the WCD did not significantly reduce arrhythmia-associated deaths compared to the control group who did not have a WCD [15]. The rates of arrhythmic death were 1.6% in the WCD and 2.4% in the control group (relative risk 0.67, 95% confidence interval, 0.37–1.21, p = 0.18) [15]. It must be noted in this connection that arrhythmic death can be challenging to adjudicate when the patient dies without a witness. However, even comparing all-cause mortality data did not provide a significant benefit for WCD patients over those who did not have a WCD [15].
Compared to one SCD death per 1000 patient-years in the general population, hemodialysis patients face a 50-fold greater risk of arrhythmic death at 43 deaths per 1000 patient-years [57, 58]. Patients on hemodialysis present clinical challenges in that they are often comorbid and frequently geriatric, may be frail, and are prone to infections. End-stage renal disease and hemodialysis expose these patients to a very considerable risk of arrhythmic death, but many hemodialysis patients are not appropriate candidates for ICD therapy. Compared to historical data, the WCD has been associated with improved survival in renal failure patients [24].
Takotsubo cardiomyopathy, sometimes called “broken-heart syndrome,” is a form of cardiomyopathy where the myocardium weakens and remodels. This condition is potentially reversible, but while patients experience the cardiomyopathy, they are at risk for potentially life-threatening ventricular tachyarrhythmias, and some develop concomitant QT interval prolongation, further increasing their risk for arrhythmia [5]. In a study based on all data from the USA involving WCD wear from 2007 through 2012, a total of 102 takotsubo patients were identified by the ICD-9 code 429.83. This population was overwhelmingly female (89%) with an initial ejection fraction of 27 ± 6% who wore the WCD for a mean duration of 44 ± 31 days with a mean follow-up of 440 ± 374 days. During the WCD wear time, 2% of patients (n = 2) received an appropriate shock, 1% (n = 1) received two inappropriate shocks, and 2% (n = 2) suffered bradyarrhythmias that required pacing. Two patients in the study died (one asystole and one from an arrhythmia while not wearing the WCD) [59].
Peripartum cardiomyopathy results in left ventricular dysfunction that can predispose the patient to SCD. About half of these patients will recover significantly or entirely over the course of about 6 months even without intervention; however, some will not, and all are at high risk for arrhythmias during the course of the condition [5]. In a study of 12 consecutive women with peripartum cardiomyopathy observed at a single center (of whom seven wore the WCD), four episodes of VF occurred in three of the patients wearing the WCD, all of which were successfully terminated. One patient experienced numerous alarms for inappropriate shocks but was able to abort them so that no inappropriate shocks occurred. No deaths occurred. During therapy for heart failure, over the course of the 12-month follow-up, ejection fractions improved significantly from 24.0 ± 11.8% at baseline to 46.6 ± 7.6%. Patients with a lower ejection fraction at baseline improved more than those with a higher ejection fraction at baseline [60].
Long QT syndrome (LQTS) is a heritable and potentially fatal cardiac channelopathy that exposes patients to the risk of SCD. LQTS patients are typically treated with beta blockade, left cardiac sympathetic denervation, and, in some cases, a permanent ICD. It is unclear what, if any, role the WCD might play for treating LQTS. A retrospective review of 1027 LQTS patients who were prescribed a WCD as a bridge to possible ICD implantation or other treatments found no inappropriate shocks that were administered by the WCD and only 1 patient received an appropriate shock to terminate VF [61]. Since LQTS is a lifelong condition, the WCD is not an optimal permanent solution in this population, but it may be helpful as newly diagnosed patients consider their therapeutic options or for LQTS patients on medical therapy who are entering high-risk periods of life, such as having to take a medication that might prolong their QT interval further or in postpartum women [61].
The WCD is available in different sizes and has an elasticized waistband and adjustable straps, making it suitable for use in a variety of patients, including children. The role of the WCD in certain special populations is being addressed, but there is limited evidence about these groups.
Guidance is available to schools and teachers for children prescribed the WCD. In particular, it is important that educators realize that unlike the automatic external defibrillator systems available in many schools, the WCD will detect arrhythmias and treat them without any bystander intervention [62, 63]. Children seem to adjust well to the WCD. In a study of 231 pediatric WCD patients between the ages of 8 and 17 years monitored a median of 39 days with daily wear time around 21 h/day, a step-counter accelerometer device reported that activity levels for these children increased significantly over baseline in the first 3 weeks after getting the WCD (p < 0.001) [64]. This suggests that the WCD does not inhibit or curtail the children’s activities and may help them achieve recommended levels of daily exercise.
Some patients with cancer may be at elevated risk for dangerous arrhythmias because of chemotherapy-induced cardiomyopathy or long QT syndrome caused by drugs but may be contraindicated for device implant because of their malignancy or other reasons [65].
The prevalence of cardiovascular disease is high in the geriatric population, but there may be reluctance to consider an older patient for WCD therapy, in particular because it may be uncomfortable or feel restricting to them. In a large study of 1732 patients with ischemic and nonischemic cardiomyopathy, patients were grouped by age into younger (<65 years) and older groups (≥65 years). The older group (n = 722) wore the WCD more hours per day (median 22.8 vs. 22.3, p < 0.001) and had higher rates of events (31.95 vs. 9.82, p = 0.027). Younger patients with nonischemic cardiomyopathy had a higher rate of atrial arrhythmias (150.1 vs. 74.9, p = 0.055), and more following WCD therapy, a greater number of older than younger patients got a permanent ICD (41.8% vs. 36.5%, p = 0.034). Patients in both age groups tolerated WCD therapy well [34].
The WCD has been shown to deliver appropriate high-energy therapy to convert dangerous ventricular tachyarrhythmias. In a postmarket registry of 3569 WCD patients (mean duration wear was 52.6 ± 69.9 days), first shock success occurred in 99% of cases (79/80) for all episodes of conscious VT/VF and in 100% of cases (n = 76) of unconscious VT/VF [33]. Because the WCD is an external device, it is far more exposed to sources of electromagnetic interference (noise) than implanted devices, which may result in oversensing, inappropriate arrhythmia detection, and inappropriate therapy delivery. Patients are signaled about 30 s prior to therapy delivery and may abort the shock by pressing two buttons [39, 40]. For this reason, the rate of inappropriate therapy delivery with the WCD is relatively low, occurring in approximately 0.4–3.0% of patients [6, 18, 33, 43]. See Table 1.
The WCD delivers rescue shock therapy only and has no pacing capability. Asystole, a recognized risk factor for dangerous ventricular tachyarrhythmias, may occur in patients with compromised cardiovascular function, such as low ejection fraction. While an ICD can detect and offer pacing support during an asystole episode, the WCD cannot pace such patients, and there is a risk that an untreated asystole may be fatal [66].
There are specific patient factors that warrant consideration when prescribing this novel therapeutic option. Many patients will have no concept of what a WCD is or how it works.
Manufacturer’s representatives may be available to help train patients in the proper function of the WCD, and, if they are not available, the clinical team should make sure the patient knows how to wear the vest, how to adjust it for proper fit, how to replace the battery, how to charge the battery, and how to transfer data from the WCD to the network. For this reason, the WCD requires the patient be able to understand and manage these tasks and be willing to do them. An initial training session should make sure the patient can put on the vest and insert batteries that may last an hour or more. It may be helpful for a second follow-up contact with the trainer over the course of the next few days to help with any questions or problems the patient may still have. The manufacturer has a 24-h technical support hotline for urgent questions [5].
Compliance is an issue in all areas of medicine but particularly in the case of the WCD which patients may find restrictive or uncomfortable. A postmarket registry study (n = 3569) found that patients who used the WCD for a longer duration of time (days of wear) were significantly more likely to wear in more hours per day (p < 0.001) [33]. Over time, the WCD has been redesigned to make it lighter in weight and more comfortable for extended wear. Remote monitoring can alert the clinic as to actual wear time for an individual patient [67]. Compliance may be encouraged by educating the patient as to the nature of ventricular tachyarrhythmias and how the device protects them.
It has been speculated that patients prescribed a WCD may experience emotional distress and view the device as a constant worrisome reminder of their own mortality. Patients may also feel isolated if they do not know anyone else who has ever worn such a device. Patients have sometimes reported that they find the device symbolic of their own vulnerability [33]. Of course, such adverse emotions may occur in all patients facing the sudden news that they have a serious cardiovascular condition regardless of whether they are prescribed a WCD or some other therapy. Psychological distress is an important clinical consideration because it is potentially modifiable. There may be ways to reduce depressive or anxious symptoms in clinically meaningful ways. Depression worsens outcomes and actually serves as a predictor for both mortality and shock therapy [68, 69]. Depression has been associated with a nearly doubled risk for all-cause mortality in ICD patients [69]. Furthermore, depression and anxiety may adversely affect patient compliance, adherence to pharmacological therapy, and lifestyle.
In another study of 123 patients considered WCD candidates, at baseline 21% showed signs of clinically depressive symptoms, and 52% had anxiety. Six weeks after WCD therapy commenced, rates of depression and anxiety dropped to 7 and 25%, respectively [32]. It is not clear if patients recovered their emotional equilibrium as a result of WCD therapy or as a matter of course as they got used to their new identities as cardiac patients.
When a patient has more than one electronic cardiac device, the potential of device-device interaction exists. The literature reports one case of a fatal device-device interaction between a permanent pacemaker and a WCD [70]. In this case, the patient received unipolar dual-chamber pacing, but when he developed VF, no therapy was delivered as the device inappropriately detected the large unipolar pacing spikes as cardiac signals [70].
A study sponsored by Zoll examined pacing in 60 patients testing the AAI, VVI, and DDD modes in both unipolar and bipolar device configurations to determine if the WCD would detect the pacing spikes; patients were signaled before shock delivery and could use the patient response buttons to avert the therapy delivery. Only unipolar DDD pacing was detected by the WCD’s algorithm and only in 10% of patients (6/60). This study suggests that pacing may occur concomitantly with WCD use if unipolar configurations are avoided [2]. If unipolar pacing must be used in a particular patient, then the WCD is contraindicated. Another study of the concomitant use of the WCD and a pacemaker showed that double-counting and waveform alterations might also occur in certain bipolar pacing modes and in single-chamber as well as dual-chamber pacing [44]. Caution is urged in using the WCD in patients with pacing support from an implanted pacemaker system.
The WCD is “rented” to patients for a monthly fee, and reimbursement provisions vary by country. Since costs can be substantial, there is a need to better stratify patients into those who truly need a WCD for arrhythmic rescue and those who might be unlikely to benefit from it [41]. Cost-effectiveness models show that the number needed to treat to save 1 life with a WCD falls in the range of 70–110 patients over a median of 53–57 days [26]. There are situations in which the WCD poses a decided cost advantage. For example, cardiomyopathy patients who might otherwise be considered a candidate for permanent primary prevention ICD implantation may benefit from using the WCD during a recovery period; data shows that ∼60% of such patients will recover to the point that an ICD implantation is not necessary [18, 33, 41]. Thus, the costs for the temporary use of the WCD may be offset by the decision not to implant an ICD. In patients whose ICD must be removed for infection, it is sometimes necessary to keep the patient in the hospital or discharge him or her to a skilled nursing facility for weeks during antimicrobial therapy and recovery. The patient is at risk for SCD throughout this time. A cost-effectiveness analysis found that the WCD was cost-effective in this situation in that it allowed the patient to be discharged home; the analysis is based on the assumption that there was a 2-week 5.6% risk of SCD in the population and the patient had to wait at least 2 weeks before ICD replacement [71].
The WCD technology effectively treats VT/VF, but bradycardia pacing support would likely prevent SCD to an even greater extent. Adding pacing capability to the WCD would be an important and life-saving step forward.
A major obstacle in WCD therapy remains patient adherence. Unfortunately, not all patients are motivated to comply with the prescription to use the WCD, and unnecessary deaths occur because of poor compliance. Therefore, motivating the patient to adhere to therapy is of utmost importance. A combined approach with technology reminders (e.g., text messages via smartphones) and close follow-up by device professionals is crucial.
Much has been accomplished in the past 30 years to better treat the risk of SCD, and the WCD is definitely an important milestone in our advancing knowledge. Nevertheless, much more needs to be done to reduce the rates of arrhythmic death even more.
A Class II recall of the WCD occurred in January 2018, covering 33,000 devices. This problem, in which certain vests displayed a warning message to the effect that they could not charge sufficiently to deliver therapy, has been addressed.
The WCD is an important advancement in the armamentarium for cardiovascular disease and demonstrates safe, effective therapy, but patient compliance remains a concern. The WCD is an interim therapeutic alternative to the ICD. In some cases, the WCD may help patients recover significant systolic function to the point that an ICD is no longer necessary. Patients who need the WCD should receive individual one-on-one instruction in how to use the device, and clinicians should be prepared that there may be a degree of psychological distress. Nevertheless, these devices are important advancement in cardiac care for people at risk of dangerous arrhythmias.
The authors gratefully acknowledge Todd Cooper of Coyote Studios in Green Valley, California, for the artwork in Figure 1.
Peter Magnusson has received speaker fees or grants from Abbott, Alnylam, Bayer, AstraZeneca, BMS, Boehringer Ingelheim, Lilly, Novo Nordisk, Internetmedicin, Octopus Medical, Pfizer, and Zoll.
Joseph Pergolizzi is a principal at Native Cardio, Inc.
Jo Ann LeQuang has no relevant disclosures.
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From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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In most of the cases, the structures of drugs or drug candidates and the interacting residues on the target proteins are also presented. In addition, a few successful examples of drug repurposing using molecular docking are mentioned in this chapter. It should provide us with confidence that the docking will be extensively employed in the industry and basic research. Moreover, we should actively apply molecular docking and related technology to create new therapies for diseases.",book:{id:"6365",slug:"molecular-docking",title:"Molecular Docking",fullTitle:"Molecular Docking"},signatures:"Mark Andrew Phillips, Marisa A. Stewart, Darby L. Woodling and\nZhong-Ru Xie",authors:[{id:"214567",title:"Prof.",name:"Zhong-Ru",middleName:null,surname:"Xie",slug:"zhong-ru-xie",fullName:"Zhong-Ru Xie"},{id:"223007",title:"Ms.",name:"Marisa A.",middleName:null,surname:"Stewart",slug:"marisa-a.-stewart",fullName:"Marisa A. 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Some plants contain in their reserve lipids unconventional fatty acids such as gamma linolenic acid in Borrago officinalis L., short-chain fatty acids C: 12 and C: 10, fatty acids with very long chains, and fatty acids that are cyclical. All of these fatty acids can have industrial and/or pharmaceutical applications.",book:{id:"7036",slug:"advances-in-lipid-metabolism",title:"Advances in Lipid Metabolism",fullTitle:"Advances in Lipid Metabolism"},signatures:"Fatiha AID",authors:[{id:"256576",title:"Prof.",name:"Fatiha",middleName:null,surname:"Aid",slug:"fatiha-aid",fullName:"Fatiha Aid"}]},{id:"66369",title:"General Perception of Liposomes: Formation, Manufacturing and Applications",slug:"general-perception-of-liposomes-formation-manufacturing-and-applications",totalDownloads:3320,totalCrossrefCites:17,totalDimensionsCites:40,abstract:"Liposomes are currently part of the most reputed carriers for various molecular species, from small and simple to large and complex molecules. 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This would enhance the understanding of the gaps in the field and, hence, provide directions for future research and developments.",book:{id:"8095",slug:"liposomes-advances-and-perspectives",title:"Liposomes",fullTitle:"Liposomes - Advances and Perspectives"},signatures:"Christian Isalomboto Nkanga, Alain Murhimalika Bapolisi, Nnamdi Ikemefuna Okafor and Rui Werner Maçedo Krause",authors:[{id:"284670",title:"Prof.",name:"Rui",middleName:null,surname:"Krause",slug:"rui-krause",fullName:"Rui Krause"},{id:"284672",title:"Mr.",name:"Alain",middleName:null,surname:"Bapolisi",slug:"alain-bapolisi",fullName:"Alain Bapolisi"},{id:"284673",title:"MSc.",name:"Christian",middleName:null,surname:"Nkanga",slug:"christian-nkanga",fullName:"Christian Nkanga"},{id:"284675",title:"Mr.",name:"Okafor",middleName:null,surname:"Nnamdi",slug:"okafor-nnamdi",fullName:"Okafor Nnamdi"}]},{id:"61865",title:"A Click Chemistry Approach to Tetrazoles: Recent Advances",slug:"a-click-chemistry-approach-to-tetrazoles-recent-advances",totalDownloads:2687,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"Introduction to tetrazole and click chemistry approaches was briefed in a concise way in order to help the readers have a basic understanding. Tetrazole and its derivatives play very important role in medicinal and pharmaceutical applications. The synthesis of tetrazole derivatives can be approached in ecofriendly approaches such as the use of water as solvent, moderate conditions, nontoxic, easy extractions, easy setup, low cost, etc. with good to excellent yields.",book:{id:"6365",slug:"molecular-docking",title:"Molecular Docking",fullTitle:"Molecular Docking"},signatures:"Ravi Varala and Bollikolla Hari Babu",authors:[{id:"212519",title:"Dr.",name:"Varala",middleName:null,surname:"Ravi",slug:"varala-ravi",fullName:"Varala Ravi"},{id:"221476",title:"Dr.",name:"Bollikolla",middleName:null,surname:"Hari Babu",slug:"bollikolla-hari-babu",fullName:"Bollikolla Hari Babu"}]},{id:"67034",title:"Biotransformation of Steroids Using Different Microorganisms",slug:"biotransformation-of-steroids-using-different-microorganisms",totalDownloads:1556,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"The introduction of a hydroxyl group “biohydroxylation” in the steroid skeleton is an important step in the synthesis of new steroids used physiologically as hormones and active drugs. There are currently about 300 known steroid drugs whose production constitutes the second category within the pharmaceutical market after antibiotics. Several biotransformations at industrial scale have been applied in the production of steroid hormones and drugs, which have functionalized different types of raw materials by means of chemo-, regio-, and stereoselective reactions (hydroxylation, Baeyer-Villiger oxidation, oxidation reactions, reduction of group carbonyl, isomerization, and Michael additions, condensation reactions, among others). In Green Chemistry, biotransformations are an important chemical methodology toward more sustainable industrial processes.",book:{id:"7588",slug:"chemistry-and-biological-activity-of-steroids",title:"Chemistry and Biological Activity of Steroids",fullTitle:"Chemistry and Biological Activity of Steroids"},signatures:"Arturo Cano-Flores, Javier Gómez and Rigoberto Ramos",authors:[{id:"269329",title:"Ph.D.",name:"Arturo",middleName:null,surname:"Cano-Flores",slug:"arturo-cano-flores",fullName:"Arturo Cano-Flores"},{id:"280765",title:"MSc.",name:"Rigoberto",middleName:null,surname:"Ramos",slug:"rigoberto-ramos",fullName:"Rigoberto Ramos"},{id:"280766",title:"Mr.",name:"Javier",middleName:null,surname:"Gomez",slug:"javier-gomez",fullName:"Javier Gomez"}]},{id:"38573",title:"Food Phenolic Compounds: Main Classes, Sources and Their Antioxidant Power",slug:"food-phenolic-compounds-main-classes-sources-and-their-antioxidant-power",totalDownloads:10268,totalCrossrefCites:42,totalDimensionsCites:115,abstract:null,book:{id:"3203",slug:"oxidative-stress-and-chronic-degenerative-diseases-a-role-for-antioxidants",title:"Oxidative Stress and Chronic Degenerative Diseases",fullTitle:"Oxidative Stress and Chronic Degenerative Diseases - A Role for Antioxidants"},signatures:"Maria de Lourdes Reis Giada",authors:[{id:"153687",title:"Associate Prof.",name:"Maria De Lourdes",middleName:"Reis",surname:"Giada",slug:"maria-de-lourdes-giada",fullName:"Maria De Lourdes Giada"}]}],onlineFirstChaptersFilter:{topicId:"380",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. Barderas",slug:"oxidative-stress-in-cardiovascular-diseases",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Importance of Oxidative Stress and Antioxidant System in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/11671.jpg",subseries:{id:"15",title:"Chemical Biology"}}}]},overviewPagePublishedBooks:{paginationCount:33,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. 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His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"11",type:"subseries",title:"Cell Physiology",keywords:"Neurodevelopment and Neurodevelopmental Disease, Free Radicals, Tumor Metastasis, Antioxidants, Essential Fatty Acids, Melatonin, Lipid Peroxidation Products and Aging Physiology",scope:"\r\n\tThe integration of tissues and organs throughout the mammalian body, as well as the expression, structure, and function of molecular and cellular components, is essential for modern physiology. The following concerns will be addressed in this Cell Physiology subject, which will consider all organ systems (e.g., brain, heart, lung, liver; gut, kidney, eye) and their interactions: (1) Neurodevelopment and Neurodevelopmental Disease (2) Free Radicals (3) Tumor Metastasis (4) Antioxidants (5) Essential Fatty Acids (6) Melatonin and (7) Lipid Peroxidation Products and Aging Physiology.
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He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. 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Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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