1.Construction and validation of machine learning predictive models for the risk of metabolic associated fatty liver disease
Linjie QIU ; Haiyan REN ; Yan REN ; Meijie LI ; Chacha ZOU ; Zijing WU ; Jin ZHANG
Journal of Clinical Hepatology 2026;42(4):848-855
ObjectiveTo investigate the value of predictive models established based on machine learning methods in predicting the risk of metabolic associated fatty liver disease (MAFLD), and to analyze its key risk factors. MethodsA retrospective analysis was performed for the 50 variables of 2 168 healthy individuals who underwent physical examination in Department of Health Assessment, Xiyuan Hospital, China Academy of Chinese Medical Sciences, from January 2021 to December 2024, including body composition, past history, and laboratory tests, and according to whether they were diagnosed with MAFLD or not, they were divided into MAFLD group with 265 individuals and non-MAFLD group with 1 903 individuals. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Randomly split the research data into a training set and a validation set in a 70% to 30% ratio. Predictive factors were screened from the training set data using univariate analysis, LASSO regression, and multivariate Logistic regression analysis. Predictive models were then constructed using seven machine learning methods: Logistic regression, decision tree, random forest (RF), eXtreme gradient boosting, light gradient boosting machine, support vector machine, and artificial neural network. Model performance was evaluated by plotting receiver operating characteristic curve for the validation set and calculating the area under the curve (AUC), sensitivity, specificity, and Youden index for each model. Furthermore, the SHapley Additive exPlanation (SHAP) method was used to analyze the contribution of variables in the optimal model. ResultsThe prevalence rate of MAFLD among the 2 168 subjects was 12.22% (265/2 168). Smoking, diastolic blood pressure, phase angle, visceral fat area, muscle fat ratio, waist-to-hip ratio, aspartate aminotransferase, non-HDL-C/HDL-C ratio, triglyceride-glucose index, and gallstones were independent risk factors for MAFLD (all P<0.05). The seven predictive models of support vector machine, eXtreme gradient boosting, decision tree, light gradient boosting machine, artificial neural network, RF, and Logistic regression had an AUC of 0.738, 0.754, 0.757, 0.786, 0.795, 0.796, and 0.815, respectively, in the validation set, among which the RF model had the best discriminatory ability (AUC=0.796, 95% confidence interval: 0.754 — 0.839), with a sensitivity of 81.01%, a specificity of 63.16%, and a Youden index of 44.17%. The SHAP analysis showed that visceral fat area, waist-to-hip ratio, and diastolic blood pressure were the top three predictive factors in terms of importance. ConclusionThe RF model, constructed based on body composition and clinical indicators, has a good performance in predicting the risk of MAFLD, and its interpretability can help to identify high-risk individuals in the early stage in clinical practice.
2.Traditional Chinese Medicine Regulates NF-κB Signaling Pathway for Treatment of Obesity: A Review
Zijing WU ; Jixin LI ; Linjie QIU ; Yan REN ; Chacha ZOU ; Meijie LI ; Wenjie LI ; Jin ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(5):310-318
Obesity is a chronic low-grade inflammation and a risk factor for diseases such as diabetes, hypertension, dyslipidemia, and malignant tumors, demonstrating an increasingly grim development situation. The nuclear factor-kappa B (NF-κB) signaling pathway is a key signaling pathway involved in the immune response and inflammatory response. In obese individuals, the expression of NF-κB is overactivated, which leads to abnormal inflammatory responses in the body. Therefore, it is expected to alleviate inflammation and treat obesity by regulating the NF-κB signaling pathway, which has been proven effective by a large number of studies. The available studies on the NF-κB signaling pathway mostly focus on tumors, and there is no systematic review of the mechanism of this pathway in mediating obesity and the traditional Chinese medicine (TCM) treatment. We reviewed the research progress in the pathological and physiological processes of obesity mediated by NF-κB signaling pathway and TCM treatment, aiming to give insights into the clinical treatment of obesity with TCM and provide reference targets and research directions for exploring the biological foundations and the development of new TCM preparations.
3.Comparison of the value of a body shape index and body roundness index in predicting non-alcoholic fatty liver disease among non-obese population
WU Zijing ; LI Jixin ; QIU Linjie ; REN Yan ; LI Meijie ; ZOU Chacha ; ZHANG Jin
Journal of Preventive Medicine 2025;37(12):1222-1227
Objective:
To compare the value of a body shape index (ABSI) and body roundness index (BRI) in predicting non-alcoholic fatty liver disease (NAFLD) among non-obese population, so as to provide a reference for the early identification of populations at high risk of NAFLD.
Methods:
Adults with a body mass index (BMI) of less than 28 kg/m2 who underwent health check-ups in Xiyuan Hospital of China Academy of Chinese Medical Sciences from 2022 to 2024 were selected as the study subjects. Demographic information, disease history, height, weight, waist circumference, blood pressure, and blood lipid indicators were collected, and ABSI and BRI were calculated. NAFLD was diagnosed using abdominal ultrasound. A multivariable logistic regression model was employed to analyze the relationships between ABSI, BRI and NAFLD among non-obese population. A generalized additive model combined with the penalized spline method was used to fit smooth curves to identify nonlinear relationships, and threshold effects were utilized to determine inflection points. The values of ABSI and BRI in predicting NAFLD among non-obese population were used the receiver operating characteristic (ROC) curve.
Results:
A total of 1 195 individuals were surveyed, including 345 males (28.87%) and 850 females (71.13%). A total of 348 cases of NAFLD were detected among the non-obese population, with a detection rate of 29.12%. The adjusted ABSI (sABSI) in the NAFLD group and non-NAFLD group were 7.95±0.33 and 8.08±0.34, while the BRI were 3.35±0.79 and 4.15±0.64, respectively, with statistically significant differences between the two groups (both P<0.05). Multivariable logistic regression analysis showed that, after adjusting for demographic information, disease history, blood pressure, and blood lipid indicators, both sABSI (OR=1.932, 95%CI: 1.184-3.158) and BRI (OR=1.594, 95%CI: 1.071-2.360) were significantly associated with NAFLD among non-obese population. Nonlinear positive correlations were observed between sABSI, BRI, and NAFLD among non-obese population. When sABSI≤8.46 and BRI≥2.72, both indices were positively associated with NAFLD. The area under the ROC curve for ABSI and BRI in predicting NAFLD risk among non-obese population were 0.619 and 0.782, respectively, with optimal cut-off values of 0.082 and 3.656, respectively.
Conclusions
ABSI and BRI show a non-linear relationship with NAFLD among non-obese population. BRI demonstrates relatively better performance in predicting NAFLD risk among this population and can serve as an auxiliary indicator for the early identification of NAFLD among non-obese population.
4.S1PR5 activation or overexpression enhances barrier function of mouse brain microvascular endothelial cells against OGD/R injury by modulating oxidative stress.
Jingxian WANG ; Zijing REN ; Peiyang ZHOU
Journal of Southern Medical University 2025;45(7):1451-1459
OBJECTIVES:
To investigate the role of sphingosine-1-phosphate receptor 5 (S1PR5) in modulating barrier function of mouse brain microvascular endothelial cells with oxygen-glucose deprivation and reoxygenation (OGD/R).
METHODS:
Mouse brain microvascular endothelial cells (bEnd.3) were exposed to OGD/R to induce barrier dysfunction following treatment with S1PR5-specific agonist A971432 or lentivirus-mediated transfection with a S1PR5-specific siRNA, a S1PR5-overexpressing plasmid, or their respective negative control sequences. The changes in viability and endothelial barrier permeability of the treated cells were evaluated with CCK-8 assay and FITC-dextran permeability assay; the levels of intracellular reactive oxygen species (ROS) and localization and expression levels of the proteins related with barrier function and oxidative stress were detected using immunofluorescence staining, DCFH-DA probe and Western blotting.
RESULTS:
S1PR5 activation obviously enhanced viability of bEnd.3 cells exposed to OGD/R (P<0.0001). Both activation and overexpression of S1PR5 reduced FITC-dextran leakage, while S1PR5 knockdown significantly increased FITC-dextran leakage in the exposed bEnd.3 cells. Activation and overexpression of S1PR5 both increased the cellular expressions of the barrier proteins ZO-1 and occludin, while S1PR5 knockdown produced the opposite effect. In cells exposed to OGD/R, ROS production was significantly reduced by S1PR5 activation and overexpression but increased following S1PR5 knockdown. Overexpression of S1PR5 obviously increased the expressions of the antioxidant proteins Nrf2, HO-1 and SOD2 in the exposed cells.
CONCLUSIONS
S1PR5 activation and overexpression significantly improve cell viability and reduce permeability of a mouse brain microvascular endothelial cell model of OGD/R, the mechanism of which may involve the reduction in ROS production and upregulation of the antioxidant proteins.
Animals
;
Mice
;
Oxidative Stress
;
Endothelial Cells/cytology*
;
Brain/blood supply*
;
Reactive Oxygen Species/metabolism*
;
Receptors, Lysosphingolipid/metabolism*
;
Sphingosine-1-Phosphate Receptors
;
Blood-Brain Barrier/metabolism*
;
Glucose
;
Cell Line
;
Oxygen/metabolism*
;
NF-E2-Related Factor 2/metabolism*
5.Plasma long noncoding RNA expression profiles in patients with Parkinson's disease and the role of lnc-CTSD-5:1 in a PD cell model:a ceRNA microarray-based study
Zijing REN ; Peiyang ZHOU ; Jing TIAN
Journal of Southern Medical University 2024;44(11):2146-2155
Objective To explore the key genes and long non-coding RNAs(lncRNAs)associated with Parkinson's disease(PD).Methods Peripheral blood plasma samples were collected from 6 PD patients and 6 healthy individuals.The mRNA and lncRNA expression profiles were detected using ceRNA microarray technology,and the differentially expressed genes were analyzed using bioinformatics methods.The differentially expressed mRNAs transcribed within 10 kb upstream or downstream of the differentially expressed lncRNAs were defined as potential cis-regulatable(Cis)target genes of the lncRNAs.A PD-specific protein-protein interaction network(PPI)was constructed.Competitive endogenous RNA(ceRNA)networks were also constructed using the differential lncRNAs with mRNAs and known microRNAs.Using MPP+-treated SH-SY5Y cells as a PD cell model,the expressions of the key lncRNAs and their functions were examined.Results We identified 316 genes and 986 lncRNAs showing significant differential expressions in PD patients(P<0.05).The differentially expressed mRNAs and the potential cis-regulatable target genes of these lncRNAs were functionally annotated using GO and KEGG enrichment analysis,and the targeting relationship of the differentially expressed mRNAs and lncRNAs with microRNAs were predicted.Analysis of the ceRNA networks constructed based on the differentially expressed lncRNAs suggested that lnc-MTG2-1:1,lnc-CTSD-5:1,lnc-PCCA-3:1,lnc-VTCN1-3:1,lnc-ZNF25-7:1,and lnc-DAZ3-1:1 might be the key lncRNAs in PD.In MPP+-treated SH-SY5Y cells,the expression of lnc-CTSD-5:1 showed the most significant changes,and silencing lnc-CTSD-5:1 obviously restored the expression level of tyrosine hydroxylase.Conclusion PD patients have significant changes in plasma lncRNA expression profile,and the differentially expressed genes and lncRNAs found in this study may provide new clues for exploring the pathogenesis and identifying potential biomarkers of PD.
6.Plasma long noncoding RNA expression profiles in patients with Parkinson's disease and the role of lnc-CTSD-5:1 in a PD cell model:a ceRNA microarray-based study
Zijing REN ; Peiyang ZHOU ; Jing TIAN
Journal of Southern Medical University 2024;44(11):2146-2155
Objective To explore the key genes and long non-coding RNAs(lncRNAs)associated with Parkinson's disease(PD).Methods Peripheral blood plasma samples were collected from 6 PD patients and 6 healthy individuals.The mRNA and lncRNA expression profiles were detected using ceRNA microarray technology,and the differentially expressed genes were analyzed using bioinformatics methods.The differentially expressed mRNAs transcribed within 10 kb upstream or downstream of the differentially expressed lncRNAs were defined as potential cis-regulatable(Cis)target genes of the lncRNAs.A PD-specific protein-protein interaction network(PPI)was constructed.Competitive endogenous RNA(ceRNA)networks were also constructed using the differential lncRNAs with mRNAs and known microRNAs.Using MPP+-treated SH-SY5Y cells as a PD cell model,the expressions of the key lncRNAs and their functions were examined.Results We identified 316 genes and 986 lncRNAs showing significant differential expressions in PD patients(P<0.05).The differentially expressed mRNAs and the potential cis-regulatable target genes of these lncRNAs were functionally annotated using GO and KEGG enrichment analysis,and the targeting relationship of the differentially expressed mRNAs and lncRNAs with microRNAs were predicted.Analysis of the ceRNA networks constructed based on the differentially expressed lncRNAs suggested that lnc-MTG2-1:1,lnc-CTSD-5:1,lnc-PCCA-3:1,lnc-VTCN1-3:1,lnc-ZNF25-7:1,and lnc-DAZ3-1:1 might be the key lncRNAs in PD.In MPP+-treated SH-SY5Y cells,the expression of lnc-CTSD-5:1 showed the most significant changes,and silencing lnc-CTSD-5:1 obviously restored the expression level of tyrosine hydroxylase.Conclusion PD patients have significant changes in plasma lncRNA expression profile,and the differentially expressed genes and lncRNAs found in this study may provide new clues for exploring the pathogenesis and identifying potential biomarkers of PD.
7.Effects of S1PR5 on cognitive behavior and inflammatory response in li-popolysaccharide-induced mice and its anti-inflammatory mechanism
Zijing REN ; Guojun WU ; Jingxian WANG ; Shengguang ZHANG ; Peiyang ZHOU
Chinese Journal of Pathophysiology 2024;40(10):1916-1925
AIM:To explore the impact of sphingosine 1-phosphate receptor 5(S1PR5)on lipopolysaccha-ride(LPS)-induced neuroinflammation and cognitive-behavioral impairments in mice,alongside the anti-inflammatory im-pacts on BV2 cells and associated mechanisms.METHODS:(1)C57BL/6 wild-type(WT)mice and homozygous S1PR5 knockout(KO)mice were utilized and categorized into WT control,WT-LPS,S1PR5 KO control,and S1PR5 KO-LPS groups using the random number method.Neuroinflammatory models in mice were induced by a single intraperitoneal injection of 5 mg/kg LPS in the WT-LPS and S1PR5 KO-LPS groups,while an equivalent volume of saline was injected in-to the WT control and S1PR5 KO control groups.Following 7 days of modeling,the Morris water maze test was conducted,followed by the collection of brain tissues from each group of mice.Hippocampal tissue sections were stained with Nissl.The mRNA expression levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and IL-6 in hippocampal tis-sues were determined using RT-qPCR.Western blot and tissue immunofluorescence techniques were employed to assess the expression of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)in hippocampal tissues.(2)The BV2 cells underwent LPS stimulation to induce an inflammatory response and were treated with either the S1PR5 ago-nist A971432 or lentiviral overexpression of S1PR5.The effects of S1PR5 agonism or overexpression on S1PR5,IL-1β,IL-6,TNF-α,and CD206 were assessed using RT-qPCR.Additionally,CD206 expression was examined via cellular im-munofluorescence.Western blot was employed to analyze the protein levels of microglia polarization markers CD206,in-ducible nitric oxide synthase(iNOS),cyclooxygenase 2(COX2),and NLRP3,as well as p-NF-κB,cleaved caspase-1,and IκBα.RESULTS:(1)Findings from in vivo experiments indicated that S1PR5 KO notably exacerbated LPS-induced memory impairments in mice,alongside increased mRNA levels of IL-1β and IL-6,and increased protein levels of NLRP3 in the hippocampus.(2)The presence of S1PR5 in BV2 cells remained unaffected by variations in A971432 concentration and exposure duration.(3)Activation of S1PR5 or its overexpression significantly mitigated LPS-induced expression of IL-1β,IL-6,and TNF-α,while concurrently enhancing CD206 expression in BV2 cells at the mRNA level.At the protein level,it led to a noteworthy increase in CD206 expression,indicative of M2-type macrophages,and a reduction in the ex-pression of iNOS and COX2,markers of M1-type macrophages.Furthermore,it downregulated NLRP3,p-NF-κB,and cleaved caspase-1 expression,while upregulating IκBα expression.CONCLUSION:S1PR5 deficiency exacerbates cog-nitive deficits in mice by promoting neuroinflammatory responses induced by LPS.
8.Artesunate reduces neuronal apoptosis and inflammatory response in model rats with ischemic stroke in vivo, and promotes microglia polarization in vitro
Zijing REN ; Xingyue LI ; Yue WANG ; Jiajia MA ; Ming SANG ; Peiyang ZHOU
Chinese Journal of Behavioral Medicine and Brain Science 2023;32(2):119-126
Objective:To investigate the effects of artesunate ( ART ) on neuronal apoptosis, inflammatory response after stroke in rats and microglia polarization.Methods:(1)Animal experiment: twenty-seven male SD rats of SPF grade were divided into sham operation group, model group and ART treatment group according to the random number table method, with 9 rats in each group.Rats in the model group and ART treatment group were used to establish a stroke model by middle cerebral artery occlusion (MCAO). And rats in the ART treatment group were intraperitoneally injected with ART (25 mg/kg) once a day for three days before modeling, while the rats in sham operation group and the model group were injected with the same amount of solvent.And 24 h after the modeling, TTC staining was used to evaluate the volume of cerebral infarction, Western blot was used to detect the expression of Bcl2 in the infarct area, penumbra and hippocampus, TUNEL method was used to detect neuronal apoptosis, and tissue immunofluorescence was used to observe the expression of tumor necrosis factor-α(TNF-α) in the penumbra region of cerebral cortex.(2)Cell experiments: microglia BV2 were cultured and divided into control group, oxygen-glucose deprivation/reoxygenation group, oxygen-glucose deprivation/reoxygenation + 0.05 μmol/L ART group, oxygen-glucose deprivation/reoxygenation + 0.1 μmol/L ART group and oxygen-glucose deprivation/reoxygenation + 0.5 μmol/L ART group.The levels of inflammatory factors interleukin-6(IL-6), interleukin-1β(IL-1β) and TNF-α were detected by qRT-PCR, the expressions of M2 type microglia marker protein CD206 and ARG1 were detected by Western blot, the BV2 cell medium after treatment in each of the above groups was collected as conditioned medium to culture HT22 hippocampal neuron cells and cell activity was measured by CCK8 method.GraphPad Prism 7 software was used for data analysis.One-way ANOVA was used for comparison of differences among multiple groups, and LSD was used for further two-by-two comparisons.Results:(1)Animal experiment results: TTC staining results showed that the percentage of cerebral infarction volume in the ART treatment group was smaller than that in the model group ((23.09±8.51)%, (39.63±5.71)%, t=33.93, P<0.01). The results of TUNEL staining showed that the number of apoptotic cells in the model group and ART treatment group was higher than that in the sham operation group ((638.90±177.82)cells/mm 2, (72.75±13.21) cells/mm 2, (16.16±2.73) cells/mm 2, both P<0.05), and the number of apoptotic cells in the ART treatment group was lower than that in the model group ( P<0.05). Western blot results showed that the levels of Bcl2 protein in penumbra and infarct area of the model group were both lower than those in sham group(both P<0.05). The levels of Bcl2 protein in penumbra, the hippocampus and infarcted area of the ART treatment group were significantly lower than those of the model group(all P<0.05). The results of tissue immunofluorescence showed that the fluorescence intensities of TNF-α in the model group and ART treatment group were higher than those in the sham group (all P<0.05), while the fluorescence intensity of TNF-α in the ART treatment group was lower than that in the model group ( P<0.05). (2)Cell experiment: qRT-PCR results showed that compared with the control group, the mRNA levels of IL-6, IL-1β and TNF-α (all P<0.05) in oxygen-glucose deprivation/reoxygenation group were significantly higher than those of the control group.And the mRNA levels of IL-1β, IL-6 and TNF-α in oxygen-glucose deprivation/reoxygenation + 0.05 μmol/L ART group, oxygen-glucose deprivation/reoxygenation + 0.1 μmol/L ART group and oxygen-glucose deprivation/reoxygenation + 0.5 μmol/L ART group were significantly lower than those of the oxygen-glucose deprivation/reoxygenation group (all P<0.05). Western blot results showed that compared with the control group, the expression of CD206 ((0.85±0.04), (1.07±0.07), P<0.05) was significantly down-regulated in the oxygen-glucose deprivation/reoxygenation group.The CD206 and ARG in oxygen-glucose deprivation/reoxygenation + 0.1 μmol/L ART group((1.22±0.06), (1.35±0.08)) and oxygen-glucose deprivation/reoxygenation + 0.5 μmol/L ART group((1.24±0.14), (1.14±0.07)) were significantly higer than those of oxygen-glucose deprivation/reoxygenation group((0.85±0.04), (0.85±0.05))(all P<0.05). The results of CCK8 showed that compared with the control group, the cell viability in the oxygen-glucose deprivation/reoxygenation group was significantly decreased( P<0.05). The cell viability of the oxygen-glucose deprivation/reoxygenation + 0.05 μmol/L ART group, the oxygen-glucose deprivation/reoxygenation + 0.1 μmol/L ART group, the oxygen-glucose deprivation/reoxygenation + 0.5 μmol/L ART group were all higher than those of oxygen-glucose deprivation/reoxygenation group(all P<0.05). Conclusion:ART reduces neuronal apoptosis after stroke, decreases the neuroinflammatory response after stroke, and promotes oxygen-glucose deprivation/reoxygenation-activated microglia BV2 polarization to the M2 type.
9.Clinical and mechanism research progress of chronic atrophic gastritis treated with TCM
Yang ZHANG ; Zijing QI ; Jing REN ; Sha LIU ; Qiyuan TIAN
International Journal of Traditional Chinese Medicine 2022;44(9):1069-1073
Traditional Chinese Medicine (TCM) alone or combined with western medicine has obvious clinical therapeutic effects on chronic atrophic gastritis, especially in improving symptoms and reversing lesions, based on the basic pathogenesis of chronic atrophic gastritis with deficiency in origin and excess in superficiality. The therapeutic methods include invigorating spleen, activating blood circulation and detoxification. The main mechanism is to inhibit cell proliferation, induce apoptosis, change the micro-environment, reduce the degree of inflammation, repair damaged mucosa and improve immune function.
10.N-acetylcysteine reduces artesunate-induced pancreatic carcinoma cell death by activating protective autophagy via the AMPK/mTOR pathway
Zijing REN ; Hongxia XU ; Xingyue LI ; Yue WANG ; Jiajia MA ; Peiyang ZHOU
Journal of Xi'an Jiaotong University(Medical Sciences) 2022;43(3):354-360
【Objective】 In this study, reactive oxygen species (ROS) scavenger N-acetyl-L-cysteine (NAC) was used to explore the inhibitory effect and mechanism of artesunate (ART) on pancreatic carcinoma (PC) cells. 【Methods】 Different concentrations of ART interfered with 3 PC cell lines CFPAC-1, Capan-2 and BxPC3. Cell viability was measured by CCK8; cell migration ability was measured by Transwell method, and the expressions of migration-related proteins E-cadherin, N-cadherin and Vimentin were measured by Western blotting. ROS probe DCFH-DA was used to measure intracellular ROS; LC3 cell immunofluorescence (IF) was used to detect the formation of intracellular autophagosomes. After adding NAC or autophagy inhibitor 3-MA, the cell viability was tested again by CCK8, and the expressions of p-AMPK/ AMPK, p-mTOR/mTOR, p62 and LC3Ⅱ/Ⅰ were detected by Western blotting. 【Results】 ART inhibited the growth of CFPAC-1 and Capan-2 in a time- and dose-dependent manner. After treatment of CFPAC-1 and Capan-2 cells with 200 μmol/L of ART for 48 h, the expression of E-cadherin was upregulated, while N-cadherin and Vimentin were downregulated, and the cell migration ability was significantly reduced. ART significantly upregulated intracellular ROS level and promoted the formation of autophagosomes. NAC could reduce the inhibitory effect of ART on CFPAC-1 and Capan-2 cells, upregulate p-AMPK/AMPK, P62 and LC3Ⅱ/Ⅰ, downregulate the expression of p-mTOR/mTOR, and intensify autophagy. 3-MA could not reverse the inhibitory effect of ART on PC cells. 【Conclusion】 ART is dependent on ROS, but not on autophagy, in exerting an anti-pancreatic carcinoma effect. NAC attenuates the inhibitory effect of ART on PC cells by activating protective autophagy through AMPK/mTOR signaling pathway.


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