The protective effect of parthenolide in an in vitro model of Parkinson's disease through its regulation of nuclear factor-kappa B and oxidative stress.


Journal

Molecular biology reports
ISSN: 1573-4978
Titre abrégé: Mol Biol Rep
Pays: Netherlands
ID NLM: 0403234

Informations de publication

Date de publication:
17 Jul 2024
Historique:
received: 20 05 2024
accepted: 04 07 2024
medline: 17 7 2024
pubmed: 17 7 2024
entrez: 17 7 2024
Statut: epublish

Résumé

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms, and is due to the degeneration of dopaminergic neurons. It is multifactorial, caused by genetic and environmental factors and currently has no definitive cure. We have investigated the protective effects of parthenolide (PTN), a compound with known anti-inflammatory and antioxidant properties, in an in vitro model of PD, that is induced by 6-OHDA, and that causes neurotoxicity in SH-SY5Y human neuroblastoma cells. SH-SY5Y cells were pretreated with PTN to assess its protective effects in 6-OHDA-induced cellular damage. Cell viability was measured using Alamar blue. Apoptosis was evaluated using an Annexin V-FITC/PI kit. Reactive oxygen species (ROS) levels were quantified, and expression levels of apoptotic markers (Bax, Bcl-2, p53) and NF-κB were analyzed via Western blotting and Quantitative real-time- (qRT-) PCR. We found that 6-OHDA reduced cell viability, that was inhibited significantly by pre-treatment with PTN (p < 0.05). Flow cytometry revealed that PTN reduced apoptosis induced by 6-OHDA. PTN also reduced the ROS levels raised by 6-OHDA (p < 0.05). Moreover, PTN decreased the expression of Bax, p53, NF-κB, and p-NF-κB that were increased by treatment with 6-OHDA. These findings indicate the potential beneficial effects of PTN in an in vitro model of PD via mitigating oxidative stress and inflammation, suggested PTN as a promising agent to be used for PD therapy, warranting further investigation in preclinical and clinical studies.

Sections du résumé

BACKGROUND BACKGROUND
Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms, and is due to the degeneration of dopaminergic neurons. It is multifactorial, caused by genetic and environmental factors and currently has no definitive cure. We have investigated the protective effects of parthenolide (PTN), a compound with known anti-inflammatory and antioxidant properties, in an in vitro model of PD, that is induced by 6-OHDA, and that causes neurotoxicity in SH-SY5Y human neuroblastoma cells.
METHODS AND RESULTS RESULTS
SH-SY5Y cells were pretreated with PTN to assess its protective effects in 6-OHDA-induced cellular damage. Cell viability was measured using Alamar blue. Apoptosis was evaluated using an Annexin V-FITC/PI kit. Reactive oxygen species (ROS) levels were quantified, and expression levels of apoptotic markers (Bax, Bcl-2, p53) and NF-κB were analyzed via Western blotting and Quantitative real-time- (qRT-) PCR. We found that 6-OHDA reduced cell viability, that was inhibited significantly by pre-treatment with PTN (p < 0.05). Flow cytometry revealed that PTN reduced apoptosis induced by 6-OHDA. PTN also reduced the ROS levels raised by 6-OHDA (p < 0.05). Moreover, PTN decreased the expression of Bax, p53, NF-κB, and p-NF-κB that were increased by treatment with 6-OHDA.
CONCLUSION CONCLUSIONS
These findings indicate the potential beneficial effects of PTN in an in vitro model of PD via mitigating oxidative stress and inflammation, suggested PTN as a promising agent to be used for PD therapy, warranting further investigation in preclinical and clinical studies.

Identifiants

pubmed: 39017801
doi: 10.1007/s11033-024-09779-w
pii: 10.1007/s11033-024-09779-w
doi:

Substances chimiques

parthenolide 2RDB26I5ZB
Sesquiterpenes 0
NF-kappa B 0
Reactive Oxygen Species 0
Oxidopamine 8HW4YBZ748
Neuroprotective Agents 0
Antioxidants 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

819

Subventions

Organisme : Mashhad University of M
ID : 4020025

Informations de copyright

© 2024. The Author(s), under exclusive licence to Springer Nature B.V.

Références

Hattori N, Funayama M, Imai Y, Hatano T (2024) Pathogenesis of Parkinson’s disease: from hints from monogenic familial PD to biomarkers. J Neural Transm. https://doi.org/10.1007/s00702-024-02747-5
doi: 10.1007/s00702-024-02747-5 pubmed: 38492012
Hamidpour SK, Amiri M, Ketabforoush AHME, Saeedi S, Angaji A, Tavakol S (2024) Unraveling dysregulated cell signaling pathways, genetic and epigenetic mysteries of Parkinson’s disease. Mol Neurobiol. https://doi.org/10.1007/s12035-024-04128-1
doi: 10.1007/s12035-024-04128-1 pubmed: 38573414
Bhusal CK, Uti DE, Mukherjee D, Alqahtani T, Alqahtani S, Bhattacharya A et al (2023) Unveiling nature’s potential: promising natural compounds in Parkinson’s disease management. Parkinsonism Relat Disord. https://doi.org/10.1016/j.parkreldis.2023.105799
doi: 10.1016/j.parkreldis.2023.105799 pubmed: 37633805
Mythri RB, Bharath MM (2012) Curcumin: a potential neuroprotective agent in Parkinson’s disease. Curr Pharm Des 18(1):91–99
pubmed: 22211691 doi: 10.2174/138161212798918995
Ikeda Y, Tsuji S, Satoh A, Ishikura M, Shirasawa T, Shimizu T (2008) Protective effects of astaxanthin on 6-hydroxydopamine-induced apoptosis in human neuroblastoma SH-SY5Y cells. J Neurochem 107(6):1730–1740
pubmed: 19014378 doi: 10.1111/j.1471-4159.2008.05743.x
Kesh S, Kannan RR, Balakrishnan A (2021) Naringenin alleviates 6-hydroxydopamine induced Parkinsonism in SHSY5Y cells and zebrafish model. Comp Biochem Physiol Toxicol Pharmacol: CBP 239:108893
doi: 10.1016/j.cbpc.2020.108893
Liu Z, Zhou T, Ziegler AC, Dimitrion P, Zuo L (2017) Oxidative stress in neurodegenerative diseases: from molecular mechanisms to clinical applications. Oxid Med Cell Longev 2017:2525967
pubmed: 28785371 pmcid: 5529664 doi: 10.1155/2017/2525967
Xicoy H, Brouwers JF, Kalnytska O, Wieringa B, Martens GJM (2020) Lipid analysis of the 6-hydroxydopamine-treated SH-SY5Y cell model for Parkinson’s disease. Mol Neurobiol 57(2):848–859
pubmed: 31493240 doi: 10.1007/s12035-019-01733-3
Marques NF, Massari CM, Tasca CI (2019) Guanosine protects striatal slices against 6-OHDA-induced oxidative damage, mitochondrial dysfunction, and ATP depletion. Neurotox Res 35(2):475–483
pubmed: 30417317 doi: 10.1007/s12640-018-9976-1
Singh NK, Singh A (2024) Nuclear factor kappa B: a nobel therapeutic target of flavonoids against Parkinson’s disease. Comb Chem High Throughput Screening 27(14):2062–2077
doi: 10.2174/0113862073295568240105025006
Park SH, Choi WS, Yoon SY, Ahn YS, Oh YJ (2004) Activation of NF-kappa B is involved in 6-hydroxydopamine-but not MPP+ -induced dopaminergic neuronal cell death: its potential role as a survival determinant. Biochem Biophys Res Commun 322(3):727–733
pubmed: 15336524 doi: 10.1016/j.bbrc.2004.07.193
Blum D, Torch S, Nissou MF, Verna JM (2001) 6-Hydroxydopamine-induced nuclear factor-kappa B activation in PC12 cells. Biochem Pharmacol 62(4):473–481
pubmed: 11448458 doi: 10.1016/S0006-2952(01)00680-3
Xiong C, Zhu Y, Luo Q, Phan CW, Huo Y, Li P et al (2023) Neuroprotective effects of a novel peptide from Lignosus rhinocerotis against 6-hydroxydopamine-induced apoptosis in PC12 cells by inhibiting NF-κB activation. Food Sci Nutr 11(5):2152–2165
pubmed: 37181320 doi: 10.1002/fsn3.3050
Lum PT, Sekar M, Gan SH, Bonam SR, Shaikh MF (2021) Protective effect of natural products against Huntington’s disease: an overview of scientific evidence and understanding their mechanism of action. ACS Chem Neurosci 12(3):391–418
pubmed: 33475334 doi: 10.1021/acschemneuro.0c00824
Li F, Gong Q, Dong H, Shi J (2012) Resveratrol, a neuroprotective supplement for Alzheimer’s disease. Curr Pharm Des 18(1):27–33
pubmed: 22211686 doi: 10.2174/138161212798919075
da Costa IM, Cavalcanti J, de Queiroz DB, de Azevedo EP, do Rêgo ACM, AraújoFilho I et al (2017) Supplementation with herbal extracts to promote behavioral and neuroprotective effects in experimental models of Parkinson’s disease: a systematic review. Phytother Res 31(7):959–970
pubmed: 28544038 doi: 10.1002/ptr.5813
Tiuman TS, Ueda-Nakamura T, GarciaCortez DA, DiasFilho BP, de Morgado-Díaz JA, Souza W, Nakamura CV (2005) Antileishmanial activity of parthenolide, a sesquiterpene lactone isolated from Tanacetum parthenium. Antimicrob Agents Chemother 49(1):176–182
pubmed: 15616293 pmcid: 538891 doi: 10.1128/AAC.49.11.176-182.2005
Darbahani M, Rahaie M, Ebrahimi A, Khosrowshahli M (2022) The effects of several abiotic elicitors on the expression of genes of key enzymes involved in the parthenolide biosynthetic pathway and its content in feverfew plant (Tanacetum parthenium L.). Nat Prod Res. https://doi.org/10.1080/14786419.2022.2055555
doi: 10.1080/14786419.2022.2055555 pubmed: 35356827
Katekunlaphan T, Chalermglin R, Rukachaisirikul T, Chalermglin P (2014) Sesquiterpene lactones from the leaves of Magnolia sirindhorniae. Biochem Syst Ecol 57:152–154
doi: 10.1016/j.bse.2014.08.011
Xianjin S, Sha S, Qi M, Zhang Z, Yang Y, Wu H et al (2018) Terpenoids from the barks of Magnolia maudiae (Dunn) Figlar. Nat Prod Res 32(13):1518–1524
pubmed: 29022760 doi: 10.1080/14786419.2017.1385012
Venditti A, Frezza C, Rossi G, Di Cecco M, Ciaschetti G, Serafini M et al (2016) Secondary metabolites with ecologic and medicinal implications in Anthemis cretica subsp. petraea from Majella National Park. AIMS Mol Sci. https://doi.org/10.3934/molsci.2016.4.648
doi: 10.3934/molsci.2016.4.648
Zhu S, Sun P, Bennett S, Charlesworth O, Tan R, Peng X et al (2023) The therapeutic effect and mechanism of parthenolide in skeletal disease, cancers, and cytokine storm. Front Pharmacol 14:1111218
pubmed: 37033622 pmcid: 10080395 doi: 10.3389/fphar.2023.1111218
Ding W, Cai C, Zhu X, Wang J, Jiang Q (2022) Parthenolide ameliorates neurological deficits and neuroinflammation in mice with traumatic brain injury by suppressing STAT3/NF-κB and inflammasome activation. Int Immunopharmacol 108:108913
pubmed: 35729839 doi: 10.1016/j.intimp.2022.108913
Gaojian T, Dingfei Q, Linwei L, Xiaowei W, Zheng Z, Wei L et al (2020) Parthenolide promotes the repair of spinal cord injury by modulating M1/M2 polarization via the NF-κB and STAT 1/3 signaling pathway. Cell Death Discov 6(1):97
pubmed: 33083018 pmcid: 7538575 doi: 10.1038/s41420-020-00333-8
Zhang Y, Miao L, Peng Q, Fan X, Song W, Yang B et al (2022) Parthenolide modulates cerebral ischemia-induced microglial polarization and alleviates neuroinflammatory injury via the RhoA/ROCK pathway. Phytomed: Int J Phytother Phytopharmacol 105:154373
doi: 10.1016/j.phymed.2022.154373
Sobota R, Szwed M, Kasza A, Bugno M, Kordula T (2000) Parthenolide inhibits activation of signal transducers and activators of transcription (STATs) induced by cytokines of the IL-6 family. Biochem Biophys Res Commun 267(1):329–333
doi: 10.1006/bbrc.1999.1948
Fan M, Wang C, Zhao X, Jiang Y, Wang C (2023) Parthenolide alleviates microglia-mediated neuroinflammation via MAPK/TRIM31/NLRP3 signaling to ameliorate cognitive disorder. Int Immunopharmacol 120:110287
doi: 10.1016/j.intimp.2023.110287
Arslan ME, Türkez H, Sevim Y, Selvitopi H, Kadi A, Öner S et al (2023) Costunolide and parthenolide ameliorate MPP+ induced apoptosis in the cellular Parkinson’s disease model. Cells 12(7):992
pubmed: 37048065 pmcid: 10093699 doi: 10.3390/cells12070992
Sun J, Li L, Xiong L, Chen F, She L, Tang H et al (2023) Parthenolide alleviates cognitive dysfunction and neurotoxicity via regulation of AMPK/GSK3β(Ser9)/Nrf2 signaling pathway. Biomed Pharmacother 169:115909
pubmed: 37992573 doi: 10.1016/j.biopha.2023.115909
Rahimmi A, Fathi F, Nikkhoo B, Soleimani F, Khademerfan M (2022) Over-expression of survivin could prevent the oxidative stress and toxicity of rotenone in SH-SY5Y cells. Iran J Basic Med Sci 25(7):842–849
pubmed: 36033958 pmcid: 9392565
Rampersad SN (2012) Multiple applications of alamar blue as an indicator of metabolic function and cellular health in cell viability bioassays. Sensors 12(9):12347–12360
pubmed: 23112716 pmcid: 3478843 doi: 10.3390/s120912347
Jalili-Nik M, Abbasinezhad-moud F, Sahab-Negah S, Maghrouni A, Etezad Razavi M, Khaleghi Ghadiri M et al (2021) Antitumor effects of 5-aminolevulinic acid on human malignant glioblastoma cells. Int J Mol Sci 22(11):5596
pubmed: 34070493 pmcid: 8199444 doi: 10.3390/ijms22115596
Jalili-Nik M, Sadeghi MM, Mohtashami E, Mollazadeh H, Afshari AR, Sahebkar A (2020) Zerumbone promotes cytotoxicity in human malignant glioblastoma cells through reactive oxygen species (ROS) generation. Oxid Med Cell Longev 2020:3237983
pubmed: 32454937 pmcid: 7225859 doi: 10.1155/2020/3237983
Iglesias-González J, Sánchez-Iglesias S, Méndez-Álvarez E, Rose S, Hikima A, Jenner P et al (2012) Differential toxicity of 6-hydroxydopamine in SH-SY5Y human neuroblastoma cells and rat brain mitochondria: protective role of catalase and superoxide dismutase. Neurochem Res 37(10):2150–2160
pubmed: 22821477 doi: 10.1007/s11064-012-0838-6
Zheng H, Youdim MBH, Weiner LM, Fridkin M (2005) Novel potential neuroprotective agents with both iron chelating and amino acid-based derivatives targeting central nervous system neurons. Biochem Pharmacol 70(11):1642–1652
pubmed: 16226724 doi: 10.1016/j.bcp.2005.09.003
Liu Q, Zhang S, Zhu D, Tang X, Che Y, Feng X (2020) The parthenolide derivative ACT001 synergizes with low doses of L-DOPA to improve MPTP-induced Parkinson’s disease in mice. Behav Brain Res 379:112337
pubmed: 31697983 doi: 10.1016/j.bbr.2019.112337
Ganapathy K, Datta I, Sowmithra S, Joshi P, Bhonde R (2016) Influence of 6-hydroxydopamine toxicity on α-Synuclein phosphorylation, resting vesicle expression, and vesicular dopamine release. J Cell Biochem 117(12):2719–2736
pubmed: 27064513 doi: 10.1002/jcb.25570
He X, Yuan W, Yang CQ, Zhu L, Liu F, Feng J et al (2022) Ghrelin alleviates 6-hydroxydopamine-induced neurotoxicity in SH-SY5Y cells. Neural Regen Res 17(1):170–177
pubmed: 34100453 doi: 10.4103/1673-5374.314314
Ferlazzo N, Cirmi S, Maugeri A, Russo C, Lombardo GE, Gangemi S et al (2020) Neuroprotective effect of bergamot juice in 6-OHDA-Induced SH-SY5Y cell death, an in vitro model of Parkinson’s disease. Pharmaceutics 12(4):326
pubmed: 32260543 pmcid: 7238189 doi: 10.3390/pharmaceutics12040326
Yao H, Tang X, Shao X, Feng L, Wu N, Yao K (2007) Parthenolide protects human lens epithelial cells from oxidative stress-induced apoptosis via inhibition of activation of caspase-3 and caspase-9. Cell Res 17(6):565–571
pubmed: 17339884 doi: 10.1038/cr.2007.6
Mao W, Zhu Z (2018) Parthenolide inhibits hydrogen peroxide-induced osteoblast apoptosis. Mol Med Rep 17(6):8369–8376
pubmed: 29693172
Jang J-H, Surh Y-J (2003) Potentiation of cellular antioxidant capacity by Bcl-2: implications for its antiapoptotic function. Biochem Pharmacol 66(8):1371–1379
pubmed: 14555211 doi: 10.1016/S0006-2952(03)00487-8
Ferlazzo N, Cirmi S, Maugeri A, Russo C, Lombardo GE, Gangemi S et al (2020) neuroprotective effect of bergamot juice in 6-OHDA-induced SH-SY5Y cell death, an in vitro model of Parkinson’s disease. Pharmaceutics. https://doi.org/10.3390/pharmaceutics12040326
doi: 10.3390/pharmaceutics12040326 pubmed: 32260543 pmcid: 7238189
Ren Y, Li Y, Lv J, Guo X, Zhang J, Zhou D et al (2019) Parthenolide regulates oxidative stress-induced mitophagy and suppresses apoptosis through p53 signaling pathway in C2C12 myoblasts. J Cell Biochem 120(9):15695–15708
pubmed: 31144365 doi: 10.1002/jcb.28839
Dehmer T, Heneka MT, Sastre M, Dichgans J, Schulz JB (2004) Protection by pioglitazone in the MPTP model of Parkinson’s disease correlates with I kappa B alpha induction and block of NF kappa B and iNOS activation. J Neurochem 88(2):494–501
pubmed: 14690537 doi: 10.1046/j.1471-4159.2003.02210.x
Levites Y, Youdim MB, Maor G, Mandel S (2002) Attenuation of 6-hydroxydopamine (6-OHDA)-induced nuclear factor-kappaB (NF-kappaB) activation and cell death by tea extracts in neuronal cultures. Biochem Pharmacol 63(1):21–29
pubmed: 11754870 doi: 10.1016/S0006-2952(01)00813-9
Youdim MB, Grünblatt E, Mandel S (1999) The pivotal role of iron in NF-kappa B activation and nigrostriatal dopaminergic neurodegeneration: prospects for neuroprotection in Parkinson’s disease with iron chelators. Ann NY Acad Sci 890:7–25
pubmed: 10668410 doi: 10.1111/j.1749-6632.1999.tb07977.x
García-Piñeres AJ, Castro V, Mora G, Schmidt TJ, Strunck E, Pahl HL et al (2001) Cysteine 38 in p65/NF-kappaB plays a crucial role in DNA binding inhibition by sesquiterpene lactones. J Biol Chem 276(43):39713–39720
pubmed: 11500489 doi: 10.1074/jbc.M101985200
Kwok BH, Koh B, Ndubuisi MI, Elofsson M, Crews CM (2001) The anti-inflammatory natural product parthenolide from the medicinal herb Feverfew directly binds to and inhibits IkappaB kinase. Chem Biol 8(8):759–766
pubmed: 11514225 doi: 10.1016/S1074-5521(01)00049-7
Liu Q, Zhang S, Zhu D, Tang X, Che Y, Feng X (2020) The parthenolide derivative ACT001 synergizes with low doses of L-DOPA to improve MPTP-induced Parkinson’s disease in mice. Behav Brain Res 379:112337
pubmed: 31697983 doi: 10.1016/j.bbr.2019.112337
Ham A, Kim DW, Kim KH, Lee SJ, Oh KB, Shin J et al (2013) Reynosin protects against neuronal toxicity in dopamine-induced SH-SY5Y cells and 6-hydroxydopamine-lesioned rats as models of Parkinson’s disease: reciprocal up-regulation of E6-AP and down-regulation of α-synuclein. Brain Res 1524:54–61
pubmed: 23751361 doi: 10.1016/j.brainres.2013.05.036
Liang ZQ, Li YL, Zhao XL, Han R, Wang XX, Wang Y et al (2007) NF-kappaB contributes to 6-hydroxydopamine-induced apoptosis of nigral dopaminergic neurons through p53. Brain Res 1145:190–203
pubmed: 17368433 doi: 10.1016/j.brainres.2007.01.130
Li LY, Zhao XL, Fei XF, Gu ZL, Qin ZH, Liang ZQ (2008) Bilobalide inhibits 6-OHDA-induced activation of NF-kappaB and loss of dopaminergic neurons in rat substantia nigra. Acta Pharmacol Sin 29(5):539–547
pubmed: 18430361 doi: 10.1111/j.1745-7254.2008.00787.x
Kaltschmidt C, Kaltschmidt B, Baeuerle PA (1993) Brain synapses contain inducible forms of the transcription factor NF-kappa B. Mech Dev 43(2–3):135–147
pubmed: 8297787 doi: 10.1016/0925-4773(93)90031-R
Block ML, Zecca L, Hong JS (2007) Microglia-mediated neurotoxicity: uncovering the molecular mechanisms. Nat Rev Neurosci 8(1):57–69
pubmed: 17180163 doi: 10.1038/nrn2038
Tarabin V, Schwaninger M (2004) The role of NF-κB in 6-hydroxydopamine-and TNFα-induced apoptosis of PC12 cells. Naunyn Schmiedebergs Arch 369(6):563–569
doi: 10.1007/s00210-004-0938-1

Auteurs

Seyed Ali Shariat Razavi (SA)

Neurosurgery Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Farzane Vafaei (F)

Department of Pharmacy, Shahreza Branch, Islamic Azad University, Shahreza, Isfahan, PO 311-86145, Iran.

Seyyed Moein Ebrahimi (SM)

Department of Biochemistry, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.

Farzaneh Abbasinezhad-Moud (F)

Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Ali Shahini (A)

Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Farid Qoorchi Moheb Seraj (F)

Endovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Mohaddeseh Sadat Alavi (MS)

Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Arghavan Fadavieslam (A)

Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Gordon A Ferns (GA)

Division of Medical Education, Brighton & Sussex Medical School, Falmer, Brighton, Sussex, BN1 9PH, UK.

Afsane Bahrami (A)

Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Afsbahramia931@gmail.com.
Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Afsbahramia931@gmail.com.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH