Journal of Animal Reproduction and Biotechnology 2022; 37(4): 218-225
Published online December 31, 2022
https://doi.org/10.12750/JARB.37.4.218
Copyright © The Korean Society of Animal Reproduction and Biotechnology.
Changwon Yang1,# , Garam An1,#
, Jisoo Song2
, Gwonhwa Song1,*
and Whasun Lim2,*
1Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Korea
2Department of Biological Sciences, Sungkyunkwan University, Suwon 16419, Korea
Correspondence to: Gwonhwa Song
E-mail: ghsong@korea.ac.kr
Whasun Lim
E-mail: wlim@skku.edu
#These authors contributed equally to this work.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
High levels of proinflammatory cytokines have been observed in obese pregnancies. Obesity during pregnancy may increase the risk of various pregnancyrelated complications, with pathogenesis resulting from excessive inflammation. Palmitic acid (PA) is a saturated fatty acid that circulates in high levels in obese women. In our previous study, we found that PA inhibited the proliferation of trophoblasts developing into the placenta, induced apoptosis, and regulated the number of cleaved halves derived from transfer RNAs (tRNAs). However, it is not known how the expression of tRNA-derived stress-induced RNAs (tiRNAs) changes in response to PA treatment at concentrations that induce inflammation in human trophoblasts. We selected concentrations that did not affect cell viability after dose-dependent treatment of HTR8/SVneo cells, a human trophoblast cell line. PA (200 μM) did not affect the expression of apoptotic proteins in HTR8/SVneo cells. PA significantly increased the expression of inflammatory cytokines including
Keywords: cytokine, inflammation, palmitic acid, tRNA-derived species, trophoblast
Inflammation is a hallmark of metabolic diseases such as obesity and diabetes, and is characterized by high levels of proinflammatory cytokines (Schenk et al., 2008). Obesity during pregnancy increases the risk of complications such as preeclampsia, gestational diabetes, and intrauterine growth retardation (Simko et al., 2019). Obesity is a chronic, low-grade inflammatory condition. Inflammatory cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, are positively correlated with obese pregnancy (Madan et al., 2009). Obesity is associated with an increase in fatty acids circulating in the bloodstream, and inflammation may be enhanced or alleviated depending on the type and levels of fatty acids in the placental environment. Increased saturated fatty acids during pregnancy induce lipotoxicity in the placenta, which is alleviated by monounsaturated fatty acids (Natarajan et al., 2021). Palmitic acid (PA) is the dominant saturated fatty acid in the diet and circulates in high amounts in obese women (Chen et al., 2010). Our previous studies and additional evidence have revealed that PA induces mitochondrial dysfunction and endoplasmic reticulum (ER) stress-mediated apoptosis in human trophoblasts (Colvin et al., 2017; Yang et al., 2018). Although PA has been reported to induce inflammation in a variety of cells, including macrophages and hepatocytes, its effect on human trophoblasts is unclear.
Noncoding RNAs are known to have diverse physiological and pathological functions, and play important roles in inflammatory regulation (Marques-Rocha et al., 2015). We previously determined that PA regulates the expression of microRNAs (miRNAs) that regulate stearoyl-CoA desaturase (
PA was purchased from Sigma-Aldrich (St. Louis, MO, USA) and the working solution was prepared as previously described (Yang et al., 2018). Antibodies against P53, poly (ADP-ribose) polymerase (PARP), Bcl-2, and LC3B were purchased from Cell Signaling Technology (Danvers, MA, USA).
HTR8/SVneo cells were purchased from the American Type Culture Collection and cultured as previously described (Yang et al., 2018). The cells were maintained in RPMI-1640 medium with 5% fetal bovine serum (FBS) at 37℃ in a CO2 incubator.
Cells treated with PA for 48 h were incubated with the MTT labeling reagent for 4 h and then incubated overnight with solubilization solution. The absorbance at 560 and 650 nm was measured using a microplate spectrophotometer.
Changes in protein expression in HTR8/SVneo cells in response to PA treatment for 24 h were measured by western blotting, as previously described (Yang et al., 2018). Bradford protein assay was performed to determine the total protein concentration in the cells.
Apoptosis was analyzed using the Annexin V Apoptosis Detection Kit I (BD Biosciences, San Jose, CA, USA) as previously described (Bae et al., 2020). Briefly, HTR8/SVneo cells were treated with PA for 48 h, harvested, and stained with equal amounts of annexin V and propidium iodide (PI). The fluorescence intensity was measured using a flow cytometer.
For the quantitative analysis of genes, quantitative PCR (qPCR) using SYBR Green dye was performed as previously described (Yang et al., 2020; Choi et al., 2022). For quantification of tiRNA expression, qPCR Master Mix (Agilent Technologies, Santa Clara, CA, USA) was used after cDNA synthesis based on polyadenylation, as previously described (Yang et al., 2022).
The SAS program (SAS Institute, Cary, NC, USA) was used for statistical analysis, as previously described (Yang et al., 2018). Differences with a probability value of
We first investigated changes in cell viability after dose-dependent treatment with PA in HTR8/SVneo cells. PA at < 200 μM did not significantly affect the viability of HTR8/SVneo cells, whereas 400 μM (23.5%,
We previously suggested that nuclear factor (NF)-κB activation by external factors and induction of inflammation, represented by increased inflammatory cytokines, can lead to gestational diseases, such as premature birth (Yang et al., 2019). Therefore, we investigated whether PA at concentrations that did not affect cell viability increased the mRNA levels of inflammatory cytokines in trophoblasts. PA (200 μM) significantly increased the mRNA expression levels of inflammatory pathway factors such as
We previously showed that 800 μM PA inhibited the expression of several types of tiRNAs, some of which are also associated with PA-induced trophoblast apoptosis regulation (Yang et al., 2022). However, we further analyzed the expression of tiRNAs in trophoblasts following dose-dependent treatment with PA and found that 200 μM PA significantly increased the expression of tiRNAs, including tiRNAGlyGCC, tiRNAValCAC, tiRNAHisGTG, and tiRNALysCTT (Fig. 3). In addition, 400 μM PA induced the expression of tiRNAGlyGCC, tiRNAValCAC, tiRNAHisGTG, and tiRNALysCTT in trophoblasts. These results suggest that the profile of tiRNAs may be different in response to a high concentration of PA, which induces apoptosis, and a low concentration of PA, which induces an inflammatory response. Considering that tiRNA production is regulated by external stress, further studies on the mechanism of tiRNA production by PA in trophoblasts are needed.
In the present study, we verified that PA increased the mRNA expression of inflammatory cytokines in human trophoblasts, even at low concentrations that did not affect their viability. Although saturated fatty acids are speculated to induce mitochondrial dysfunction and ER stress-mediated apoptosis in the placental environment, it is unclear whether PA regulates inflammatory pathway genes in human trophoblasts (Eastman et al., 2021). Several reports, including our previous study, have suggested that saturated and unsaturated fatty acids have opposing effects on the oxidative state and inflammatory response in the placenta (Yang et al., 2017; Manuel et al., 2018). High levels of saturated fatty acids in the blood have been observed in pregnant women who experience excessive weight gain during pregnancy. PA is the most abundant saturated fatty acid in the blood and promotes the production of NF-κB-dependent inflammatory cytokines (Wen et al., 2011). PA is one of the toll-like receptor (TLR) agonists and several studies have reported the inflammation-inducing effect of PA in a TLR4-dependent manner through the activation of NF-κB signaling (Korbecki and Bajdak-Rusinek, 2019). PA also had a synergistic effect when co-treated with lipopolysaccharide (LPS), an inflammation-inducing factor, as a TLR4 activator in macrophages and hepatocytes. In mice injected with PA, the NLRP3 inflammasome is activated within the placenta during pregnancy (Sano et al., 2020). In this context, it is unsurprising that even in human trophoblasts, PA regulates the expression of NF-κB and IRAK1, which play important roles in NF-κB signaling.
Evidence suggests that PA increases the expression of inflammatory cytokines in several cells, similar to the trophoblasts in the current study. The expression and activity of inflammatory cytokines must be tightly regulated in the placental environment during early pregnancy. Inflammatory cytokines produced by the placenta in obese women are associated with maternal macrophage infiltration into the placenta (Challier et al., 2008). In trophoblasts, inflammatory stimuli induce the secretion of inflammatory cytokines such as TNF-α and IL-6, which contributes to the development of inflammatory diseases during pregnancy due to trophoblast damage and placental dysfunction. IL-1β is secreted by NLRP3 inflammasome activation and is a potential proinflammatory cytokine that induces placental inflammatory responses (Abrahams, 2011). Moreover, placental IL-1β may affect fetal growth by activating NF-kB and JNK, which are associated with insulin resistance and functional impairment of insulin signaling. IL-8 levels in the blood of pregnant women remains high during the first trimester (Mor, 2008). Increased IL-8 levels are associated with the pathogenesis of metabolic diseases, including obesity and diabetes, and inflammatory diseases, such as hepatitis. PA increases
The current study and other evidence suggest that noncoding RNAs, including miRNAs, can regulate inflammation in trophoblasts. For instance, miR-138 increases TNF-α and IL-6 levels, which are associated with preeclampsia pathogenesis (Yin et al., 2021). We verified that the regulation of miR-146a-5p and miR-548e-5p can alleviate LPS-induced inflammation. Activation of the NF-κB inflammatory pathway following miRNA inhibition is speculated to contribute to the pathogenesis of preterm birth (Yang et al., 2019). However, little is known about whether noncoding RNAs cleaved from tRNAs can regulate inflammation in cells. Complement C3, known to contribute to the pathogenesis of alcoholic fatty liver disease, promotes the production of tRFGly, presenting tRNA-derived species as potential therapeutic targets for hepatosteatosis (Zhong et al., 2019). Recently, Su et al., (2020) found abundant expression of 5’ halves derived from tRNAGly, tRNAGlu, tRNAVal, and tRNALys in the placenta and decidua of mice (Su et al., 2020). In addition, the authors verified that the 5’ halves derived from tRNAs, including tRNAAsp, tRNAGly, tRNAGlu, and tRNAVal, decreased in response to maternal immune activation at the maternal-fetal interface, although the expression of the 5’ half derived from tRNAHis was not affected. In a previous study, we found that the expression of several tiRNAs in human trophoblasts was reduced by apoptosis-inducing concentrations of PA (Yang et al., 2022). In the present study, we analyzed the expression of tiRNAs after treating trophoblasts with PA at a low concentration that induced inflammation (but did not affect apoptosis) and a high concentration that previously confirmed the effect on apoptosis. Interestingly, 200 μM PA significantly increased tiRNA expression in trophoblasts. Differences in the expression of tiRNAs depending on the concentration of PA require further study; however, a recent study on angiogenin-mediated inflammation-induced metabolic disease suggests a new link between tiRNA generation and inflammation (Park et al., 2021; Zhang et al., 2021). Angiogenin expression is increased in the mouse caput epididymis by LPS, and inflammation is inhibited in mice lacking angiogenin, accompanied by a change in the tRNA-derived species profile. Therefore, it can be inferred that the expression of tiRNAs increased by PA in human trophoblasts in the current study was also associated with the induction of inflammatory responses. However, the expression and function of tiRNAs may be altered in response to the concentrations of PA that lead to apoptosis.
In conclusion, we analyzed the inflammatory response pattern induced by PA in human trophoblasts, independent of previous studies that have focused on the inhibition of proliferation and induction of apoptosis by PA. PA increased the mRNA levels of
None.
Conceptualization, G.S. and W.L.; methodology, C.Y., G.A., and J.S.; investigation, C.Y., G.A., and J.S.; data curation, C.Y. and G.A.; visualization, C.Y. and G.A.; writing-original draft, C.Y. and G.A.; writing-review and editing, G.S., and W.L.; funding acquisition, G.S. and W.L.; supervision, G.S. and W.L.; project administration, G.S. and W.L.
This study was supported by the Institute of Animal Molecular Biotechnology, Korea University. This work was also supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Science and ICT (grant number: 2018R1C1B6009048).
Not applicable.
Not applicable.
Not applicable.
Not applicable.
No potential conflict of interest relevant to this article was reported.
Journal of Animal Reproduction and Biotechnology 2022; 37(4): 218-225
Published online December 31, 2022 https://doi.org/10.12750/JARB.37.4.218
Copyright © The Korean Society of Animal Reproduction and Biotechnology.
Changwon Yang1,# , Garam An1,#
, Jisoo Song2
, Gwonhwa Song1,*
and Whasun Lim2,*
1Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Korea
2Department of Biological Sciences, Sungkyunkwan University, Suwon 16419, Korea
Correspondence to:Gwonhwa Song
E-mail: ghsong@korea.ac.kr
Whasun Lim
E-mail: wlim@skku.edu
#These authors contributed equally to this work.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
High levels of proinflammatory cytokines have been observed in obese pregnancies. Obesity during pregnancy may increase the risk of various pregnancyrelated complications, with pathogenesis resulting from excessive inflammation. Palmitic acid (PA) is a saturated fatty acid that circulates in high levels in obese women. In our previous study, we found that PA inhibited the proliferation of trophoblasts developing into the placenta, induced apoptosis, and regulated the number of cleaved halves derived from transfer RNAs (tRNAs). However, it is not known how the expression of tRNA-derived stress-induced RNAs (tiRNAs) changes in response to PA treatment at concentrations that induce inflammation in human trophoblasts. We selected concentrations that did not affect cell viability after dose-dependent treatment of HTR8/SVneo cells, a human trophoblast cell line. PA (200 μM) did not affect the expression of apoptotic proteins in HTR8/SVneo cells. PA significantly increased the expression of inflammatory cytokines including
Keywords: cytokine, inflammation, palmitic acid, tRNA-derived species, trophoblast
Inflammation is a hallmark of metabolic diseases such as obesity and diabetes, and is characterized by high levels of proinflammatory cytokines (Schenk et al., 2008). Obesity during pregnancy increases the risk of complications such as preeclampsia, gestational diabetes, and intrauterine growth retardation (Simko et al., 2019). Obesity is a chronic, low-grade inflammatory condition. Inflammatory cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, are positively correlated with obese pregnancy (Madan et al., 2009). Obesity is associated with an increase in fatty acids circulating in the bloodstream, and inflammation may be enhanced or alleviated depending on the type and levels of fatty acids in the placental environment. Increased saturated fatty acids during pregnancy induce lipotoxicity in the placenta, which is alleviated by monounsaturated fatty acids (Natarajan et al., 2021). Palmitic acid (PA) is the dominant saturated fatty acid in the diet and circulates in high amounts in obese women (Chen et al., 2010). Our previous studies and additional evidence have revealed that PA induces mitochondrial dysfunction and endoplasmic reticulum (ER) stress-mediated apoptosis in human trophoblasts (Colvin et al., 2017; Yang et al., 2018). Although PA has been reported to induce inflammation in a variety of cells, including macrophages and hepatocytes, its effect on human trophoblasts is unclear.
Noncoding RNAs are known to have diverse physiological and pathological functions, and play important roles in inflammatory regulation (Marques-Rocha et al., 2015). We previously determined that PA regulates the expression of microRNAs (miRNAs) that regulate stearoyl-CoA desaturase (
PA was purchased from Sigma-Aldrich (St. Louis, MO, USA) and the working solution was prepared as previously described (Yang et al., 2018). Antibodies against P53, poly (ADP-ribose) polymerase (PARP), Bcl-2, and LC3B were purchased from Cell Signaling Technology (Danvers, MA, USA).
HTR8/SVneo cells were purchased from the American Type Culture Collection and cultured as previously described (Yang et al., 2018). The cells were maintained in RPMI-1640 medium with 5% fetal bovine serum (FBS) at 37℃ in a CO2 incubator.
Cells treated with PA for 48 h were incubated with the MTT labeling reagent for 4 h and then incubated overnight with solubilization solution. The absorbance at 560 and 650 nm was measured using a microplate spectrophotometer.
Changes in protein expression in HTR8/SVneo cells in response to PA treatment for 24 h were measured by western blotting, as previously described (Yang et al., 2018). Bradford protein assay was performed to determine the total protein concentration in the cells.
Apoptosis was analyzed using the Annexin V Apoptosis Detection Kit I (BD Biosciences, San Jose, CA, USA) as previously described (Bae et al., 2020). Briefly, HTR8/SVneo cells were treated with PA for 48 h, harvested, and stained with equal amounts of annexin V and propidium iodide (PI). The fluorescence intensity was measured using a flow cytometer.
For the quantitative analysis of genes, quantitative PCR (qPCR) using SYBR Green dye was performed as previously described (Yang et al., 2020; Choi et al., 2022). For quantification of tiRNA expression, qPCR Master Mix (Agilent Technologies, Santa Clara, CA, USA) was used after cDNA synthesis based on polyadenylation, as previously described (Yang et al., 2022).
The SAS program (SAS Institute, Cary, NC, USA) was used for statistical analysis, as previously described (Yang et al., 2018). Differences with a probability value of
We first investigated changes in cell viability after dose-dependent treatment with PA in HTR8/SVneo cells. PA at < 200 μM did not significantly affect the viability of HTR8/SVneo cells, whereas 400 μM (23.5%,
We previously suggested that nuclear factor (NF)-κB activation by external factors and induction of inflammation, represented by increased inflammatory cytokines, can lead to gestational diseases, such as premature birth (Yang et al., 2019). Therefore, we investigated whether PA at concentrations that did not affect cell viability increased the mRNA levels of inflammatory cytokines in trophoblasts. PA (200 μM) significantly increased the mRNA expression levels of inflammatory pathway factors such as
We previously showed that 800 μM PA inhibited the expression of several types of tiRNAs, some of which are also associated with PA-induced trophoblast apoptosis regulation (Yang et al., 2022). However, we further analyzed the expression of tiRNAs in trophoblasts following dose-dependent treatment with PA and found that 200 μM PA significantly increased the expression of tiRNAs, including tiRNAGlyGCC, tiRNAValCAC, tiRNAHisGTG, and tiRNALysCTT (Fig. 3). In addition, 400 μM PA induced the expression of tiRNAGlyGCC, tiRNAValCAC, tiRNAHisGTG, and tiRNALysCTT in trophoblasts. These results suggest that the profile of tiRNAs may be different in response to a high concentration of PA, which induces apoptosis, and a low concentration of PA, which induces an inflammatory response. Considering that tiRNA production is regulated by external stress, further studies on the mechanism of tiRNA production by PA in trophoblasts are needed.
In the present study, we verified that PA increased the mRNA expression of inflammatory cytokines in human trophoblasts, even at low concentrations that did not affect their viability. Although saturated fatty acids are speculated to induce mitochondrial dysfunction and ER stress-mediated apoptosis in the placental environment, it is unclear whether PA regulates inflammatory pathway genes in human trophoblasts (Eastman et al., 2021). Several reports, including our previous study, have suggested that saturated and unsaturated fatty acids have opposing effects on the oxidative state and inflammatory response in the placenta (Yang et al., 2017; Manuel et al., 2018). High levels of saturated fatty acids in the blood have been observed in pregnant women who experience excessive weight gain during pregnancy. PA is the most abundant saturated fatty acid in the blood and promotes the production of NF-κB-dependent inflammatory cytokines (Wen et al., 2011). PA is one of the toll-like receptor (TLR) agonists and several studies have reported the inflammation-inducing effect of PA in a TLR4-dependent manner through the activation of NF-κB signaling (Korbecki and Bajdak-Rusinek, 2019). PA also had a synergistic effect when co-treated with lipopolysaccharide (LPS), an inflammation-inducing factor, as a TLR4 activator in macrophages and hepatocytes. In mice injected with PA, the NLRP3 inflammasome is activated within the placenta during pregnancy (Sano et al., 2020). In this context, it is unsurprising that even in human trophoblasts, PA regulates the expression of NF-κB and IRAK1, which play important roles in NF-κB signaling.
Evidence suggests that PA increases the expression of inflammatory cytokines in several cells, similar to the trophoblasts in the current study. The expression and activity of inflammatory cytokines must be tightly regulated in the placental environment during early pregnancy. Inflammatory cytokines produced by the placenta in obese women are associated with maternal macrophage infiltration into the placenta (Challier et al., 2008). In trophoblasts, inflammatory stimuli induce the secretion of inflammatory cytokines such as TNF-α and IL-6, which contributes to the development of inflammatory diseases during pregnancy due to trophoblast damage and placental dysfunction. IL-1β is secreted by NLRP3 inflammasome activation and is a potential proinflammatory cytokine that induces placental inflammatory responses (Abrahams, 2011). Moreover, placental IL-1β may affect fetal growth by activating NF-kB and JNK, which are associated with insulin resistance and functional impairment of insulin signaling. IL-8 levels in the blood of pregnant women remains high during the first trimester (Mor, 2008). Increased IL-8 levels are associated with the pathogenesis of metabolic diseases, including obesity and diabetes, and inflammatory diseases, such as hepatitis. PA increases
The current study and other evidence suggest that noncoding RNAs, including miRNAs, can regulate inflammation in trophoblasts. For instance, miR-138 increases TNF-α and IL-6 levels, which are associated with preeclampsia pathogenesis (Yin et al., 2021). We verified that the regulation of miR-146a-5p and miR-548e-5p can alleviate LPS-induced inflammation. Activation of the NF-κB inflammatory pathway following miRNA inhibition is speculated to contribute to the pathogenesis of preterm birth (Yang et al., 2019). However, little is known about whether noncoding RNAs cleaved from tRNAs can regulate inflammation in cells. Complement C3, known to contribute to the pathogenesis of alcoholic fatty liver disease, promotes the production of tRFGly, presenting tRNA-derived species as potential therapeutic targets for hepatosteatosis (Zhong et al., 2019). Recently, Su et al., (2020) found abundant expression of 5’ halves derived from tRNAGly, tRNAGlu, tRNAVal, and tRNALys in the placenta and decidua of mice (Su et al., 2020). In addition, the authors verified that the 5’ halves derived from tRNAs, including tRNAAsp, tRNAGly, tRNAGlu, and tRNAVal, decreased in response to maternal immune activation at the maternal-fetal interface, although the expression of the 5’ half derived from tRNAHis was not affected. In a previous study, we found that the expression of several tiRNAs in human trophoblasts was reduced by apoptosis-inducing concentrations of PA (Yang et al., 2022). In the present study, we analyzed the expression of tiRNAs after treating trophoblasts with PA at a low concentration that induced inflammation (but did not affect apoptosis) and a high concentration that previously confirmed the effect on apoptosis. Interestingly, 200 μM PA significantly increased tiRNA expression in trophoblasts. Differences in the expression of tiRNAs depending on the concentration of PA require further study; however, a recent study on angiogenin-mediated inflammation-induced metabolic disease suggests a new link between tiRNA generation and inflammation (Park et al., 2021; Zhang et al., 2021). Angiogenin expression is increased in the mouse caput epididymis by LPS, and inflammation is inhibited in mice lacking angiogenin, accompanied by a change in the tRNA-derived species profile. Therefore, it can be inferred that the expression of tiRNAs increased by PA in human trophoblasts in the current study was also associated with the induction of inflammatory responses. However, the expression and function of tiRNAs may be altered in response to the concentrations of PA that lead to apoptosis.
In conclusion, we analyzed the inflammatory response pattern induced by PA in human trophoblasts, independent of previous studies that have focused on the inhibition of proliferation and induction of apoptosis by PA. PA increased the mRNA levels of
None.
Conceptualization, G.S. and W.L.; methodology, C.Y., G.A., and J.S.; investigation, C.Y., G.A., and J.S.; data curation, C.Y. and G.A.; visualization, C.Y. and G.A.; writing-original draft, C.Y. and G.A.; writing-review and editing, G.S., and W.L.; funding acquisition, G.S. and W.L.; supervision, G.S. and W.L.; project administration, G.S. and W.L.
This study was supported by the Institute of Animal Molecular Biotechnology, Korea University. This work was also supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Science and ICT (grant number: 2018R1C1B6009048).
Not applicable.
Not applicable.
Not applicable.
Not applicable.
No potential conflict of interest relevant to this article was reported.
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pISSN: 2671-4639
eISSN: 2671-4663