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Review Article | DOI: https://doi.org/10.31579/2578-8949/187
1 Professor, Clinical Director & Consultant Dermatologist, North Cumbria integrated care NHS Foundation Trust, University of Central Lancashire, UCLAN medical School. United Kingdom.
2,4 The Midlands Medical Academy, United Kingdom.
3 Medical School, Altinbas University, Medical Park Hospital, Istanbul, Turkey.
*Corresponding Author: Mohammed S Al Abadie, Professor, Clinical Director & Consultant Dermatologist, North Cumbria integrated care NHS Foundation Trust, University of Central Lancashire, UCLAN medical School. United Kingdom. Email: [email protected]
Citation: Mohammed S Al Abadie, Marwah Mahfoudh, Al-Hussain Al-Rawi, Nazik Abed, (2025), Exosomes: Pioneering the Future of Vitiligo Therapy, Dermatology and Dermatitis, 12(2); DOI:10.31579/2578-8949/187
Copyright: © 2025, Mohammed S Al Abadie. This is an open-access article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 27 February 2025 | Accepted: 26 April 2025 | Published: 23 May 2025
Keywords: exosome; vitiligo; melanogenesis; melanocyte; autoimmune disorder; stem cells
From disposal waste with no significant role in biology to a primary channel for long-distance communication between cells. Because of their precise function in microenvironments, exosomes are the future of regenerative therapy. Exosomes have a double-edged effect when it comes to regulating pathogenesis, whether in releasing inhibition or promotion factors, their effects influence the whole direction of the pathway. Exosomes are nanovesicles found in extracellular sites and body fluids. With their role in various pathological and physiological processes, studies have shown promising results, whether in a therapeutic or diagnostic approach. Vitiligo is an autoimmune disease with progressive loss of melanocytes and formation of white patches on the skin epidermis. Due to its challenging nature, continuous studies are conducted to further understand the pathogenesis and newest approach to enhance pigmentation with no recurrence loss of melanin. A total of 27 studies have been collected from PubMed, ScienceDirect, and Google Scholar databases between the years 1974 and 2024. The aim of this review is to deepen the understanding of vitiligo pathogenesis with the implication of exosomes from various sources of derivation that can be used in future approaches.
Skin is the largest organ of the human body, making up 16% of the total body’s weight [1]. Derived from ectoderm, this organ is composed of three layers: the outermost layer, called the epidermis, the middle layer, called the dermis, and the innermost layer, called the subcutaneous tissue. As a component of the integumentary system, the skin serves a variety of physiological functions, including controlling body temperature, forming a physical barrier to protect internal organs, and shielding the body from foreign objects. However, skin organs are exposed to various stressors internally and externally, where it challenges its epidermis to keep its integrity and normal function. Internal stressors such as genetics, diet, hormones, stress, and external stressors such as medications, UV light, chemicals, environmental irritants, and infections can lead to skin disorders over time. One of the skin disorders is vitiligo, a depigmenting skin disease characterized by selective loss of melanocytes and the formation of white patches [2]. Since vitiligo can cause devastating psychological implications and is often dismissed as a cosmetic issue, rather than an autoimmune disorder, careful diagnostic and therapeutic approach should be followed.
Skin development is important in maintaining survival against stressors. Researchers have found exosomes to be involved in both physiological and pathological processes. Exosomes or extracellular vesicles (EV) are small natural nanoparticles with a diameter of 30 to 1000 nm that are found in most body fluids [3]. Exosomes originate from endosomes and function in delivering various bioactive products to target cells [4]. The recognition of exosomes follows specific steps: 1) Surface receptor recognition, 2) direct fusion of exosome and target cell membrane; 3) endocytosis ingestion by the target cell [4]. With the emergence of studies, the application of exosomes in various medical conditions have led to their gradual use in clinical practices.
Understanding Vitiligo
Epidemiology: Where it All Started and Daily Challenges
The journey of discovering vitiligo started thousands of years ago by the Egyptian and Indian civilizations, where it was described in ancient texts as a depigmenting disorder and often confused with leprosy, a chronic infectious disease [5,6].
Since the earliest global epidemiology survey was conducted in Denmark in 1977, vitiligo prevalence was at 0.38% in the population [7]. Latest statistics show an increase in prevalence with 0.5%-1% globally despite the limited studies. The overall incidence was found to be 1.59 in every 10,000 patients per year, and the overall prevalence was 0.40 [8]. It was prevalent in West Asia and least prevalent in East Asia at a global scale. Both men and women are equally affected, and Jordan is considered the highest country in specific prevalence, while Sweden was considered the lowest [8][9]. Children populations are less prevalent in comparison to the adult population [9]. Additional ethnic background surveys are required to predict the prevalence of vitiligo and to conduct genetic research on these populations.
Vitiligo patients faced daily challenges, whether it’s psychological or social, in their everyday lives. Due to its unpredictable chronic nature, well-being and quality of life are affected, whether because of the sun exposure or social acceptance [10]. Studies have found psychiatric disorders associated with vitiligo patients such as depression, anxiety, and maniac disorders [11]. In addition, hospitalization for mental disorders has increased among the adult population [12]. While in the children population, attention deficit and hyperactivity disorder are more prominent [13].
Classification of Vitiligo
Clinical classification of vitiligo subtypes is based on the distribution and the shapes of the patches on the body. The following Table 1 demonstrates the subtypes of vitiligo.
Table 1: Classification of Vitiligo.
Etiopathogenesis of Vitiligo: A Glimpse of Possibilities
With the difficulty of biopsy being taken from patients to the complex theories of vitiligo pathogenesis, whether it was an autoimmune disease or a degenerative process of melanocytes [14]. Vitiligo is a multifactorial disorder, characterized by the loss of melanocyte function from the skin [2]. There have been theories upon discovering the precise pathophysiology and etiology of vitiligo, this includes genetics, autoimmunity disorder, oxidative stress, and inflammatory mediators’ dysregulation [15]. Different mechanisms of vitiligo subtypes can result in the same outcome. Thus, convergence theory was proposed to combine all theories into one to help us understand the pathogenesis of vitiligo skin condition [16].
Genetics of Vitiligo
Genetic factors have been a contributing factor for the onset of the disease, accounting for 80% of the estimated risk, with environmental factors accounting for 20%. The frequency in first degree relatives, contributed to the occurrence of vitiligo by 7%-9% termed as “multiplex”, 91% of
vitiligo cases are from distant relatives termed as “simplex”, and in monozygotic twins’ cases occurrence at 23%. [17, 18]. In family clustering phenomenon, polygenic inheritance can lead to partial vitiligo heritability [19]. Additional genetic risk factor of developing vitiligo is contributed to the presence of autoimmune diseases in family members or in vitiligo patient’s such as, autoimmune thyroiditis, type 1 diabetes mellitus, Addison disease, alopecia areata, inflammatory bowel disease, pernicious anemia, rheumatoid arthritis, systemic lupus erythematous, and autoimmune gastritis [19].
To further understand complex polygenic inheritance of vitiligo, DNA sequence is the best source, such as genome-wide association studies (GWAS), where conducted large-scale analysis of European and Asian populations and discovered 50 different loci that contributed to the risk of vitiligo [19]. From the genome wide linkage, five vitiligo loci have been alleged to be a causal gene: XBP1, NLRP1, HLA, PDGFRA, and FOXD3. Whereas two other vitiligo loci are still unclear in their pathogenesis: Th17 and IL17. Table 2 below lists other genomes that correlate to the risk of vitiligo.
Table 2: Other Risk Genes Involved in Vitiligo.
Overview of Vitiligo Pathogenesis
Oxidative Stress and ROS Overproduction in Vitiligo
One of the initial events in melanocyte destruction is oxidative stress, causing imbalance in redox homeostasis and excessive production of ROS, a by-product of melanin production. In contrast to healthy skin, vitiligo melanocytes proliferate slowly, dysregulated redox balance leads to elevated hydrogen peroxidase levels, increased ATP release from keratinocytes, and increased reactive oxygen species (ROS). Other prooxidants increase are xanthine oxidase, superoxide dismutase, and malondialdehyde, and a decrease in antioxidants such as superoxide dismutase, glutathione peroxidase, glutathione reductase, and catalase, as noted in both blood and skin [20]. In 1989, a study demonstrated melanocytes are not the main cause of vitiligo; after grafting onto the nude mice, the skin repigmented rapidly [21]. Both endogenous and exogenous stressors can result in the apoptosis of melanocytes and excessive production of ROS. Exogenous stressors are environmental stimuli such as: UV light, monobenzone, medications, vaccinations, infections, natural disasters, etc which are also known to produce oxidative by-products [22]. ROS accumulation and cumulative damage, disrupts the function of DNA, proteins and lipids. The power horse for the energy supply, i.e., the mitochondria, is considered the key inducer of the ROS production after mitochondria damage [23].
The Bridge Between Oxidative Stress and Adaptive Immunity: Innate Immunity
After endogenous or exogenous stress exposure, innate immunity activation begins early with the genetic change in NALP1, a regulator of innate immunity. After melanocyte stress and an increase in innate immunity, as commonly seen in vitiligo cases, an increase in natural killer cells infiltrates, as they are early responders to stress [24]. Furthermore, it’s normal to find type-1 innate lymphoid cells (ILC1) producing interferon-gamma (IFNγ) in blood and in vitiligo non-lesion skin [2].
Exosomes excretion is a way of communicating between innate system and stressed melanocytes. Nearby normal melanocytes secrete exosomes containing micro ribonucleic acid (miRNA), heat-shock proteins, melanocyte-specific antigens, and damage-associated molecular patterns (DAMPs). These exosomes deliver antigen specific to vitiligo cells and stimulate the maturation of dendritic cells into efficient antigen presenting cells [25]. One of the key roles of DAMPS, are heat-shock protein 70 (HSP70i) cells that act as cytoprotector preventing apoptosis [26]. A recent study has shown a mutation in Hsp70i that raises potential for discovering new treatments for vitiligo patients [27].
Adaptive Immunity in Vitiligo: From Progression to Reactivation
In the pathogenesis of vitiligo, both humoral and cell-mediated immune dysregulations are involved, where destructive melanocyte antibodies and cytoplasmic melanocyte antigens are found [2]. However, the autoantibodies are not the main driver for the vitiligo pathogenesis and there is no activity correlation.
CD8+ T Cells and The Destruction of Melanocytes. One of the main melanocyte damage mediators for vitiligo patients is the melanocyte-specific CD8+ T, due to the release of antigen proteins to dendritic cells and identified by T cells. CD8+ T cells present higher in the serum of vitiligo patients when compared to health controls, as through this parameter, severity of the disease can be measured [28]. Other cytokines involved are TNF-α as well as IFN-γ. After IFN-γ bind to their receptors, janus kinase (JAK) signal transduction and transcriptional activator stimulates and promotes chemokine ligands CXCL9 and CXCL10. CXCL10 represent as a biomarker in the serum of vitiligo patients to monitor their severity [29]. Regulatory T cells (Tregs) are relatively less in vitiligo skin, indicating a disadvantage in the ratio of Tregs/CD8+ T cells [30].
Resident memory T cells (TRM) and Reactivation. After the end of therapy, the possibility of depigmentation reappears at the same location due to the autoimmune memory, specifically Tissue-resident memory T (TRM) cells in chronic inflammatory skin conditions. Due to their long presence in the epithelial barrier tissues, this characteristic enables a swift immune response to the site [25].
Vitiligo Therapeutic Management
Vitiligo treatment is considered one of the most challenging to dermatologists due to its complex nature. Treatments range from systemic to topical applications based on the severity of the patient’s disease, patients’ preference, disease activity, and evaluation. Target results are stabilizing depigmented lesions from the destruction of melanocytes and avoid relapse after repigmentation [2]. Treatments range from phototherapy to systemic immunosuppressants, surgeries, and regenerative therapies. Clinical markers act as indicators such as the vitiligo signs of activity score (VSAS) is based on the presence of confetti-like depigmentation. Furthermore, the use of Koebner phenomenon in identifying hypochromic 15 body areas, is considered a reliable indicator to score visible clinical signs in segmental vitiligo. To determine efficiency, treatment should undergo 2-3 months to identify if any relapse occurs.
Management differs between phenotypes, for example SV is associated with poor responses to conventional treatments due to leukotrichia, while NSV responds. The earlier the diagnosis, the higher the success of treatment.
Medical Therapy
From topical immunosuppressant drugs (calcineurin inhibitors, corticosteroids, calcipotriol, cyclosporin) to UV lights whether the whole-body irradiation or targeted lesions. Topical corticosteroids are used for the treatment of localized vitiligo and systemic corticosteroids are given to stabilize the progression of the disease. When treating the lesions on the face or areas at high risk of atrophy, topical calcineurin inhibitors (tacrolimus and pimecrolimus) are used. Topical use of Pseudocatalase has been proven to stop the progression due to its mechanism in producing O2 and H2O from H2O2.
Phototherapy, including narrowband ultraviolet B (NBUVB) and psoralen plus ultraviolet A (PUVA) are considered one of the principal techniques in non-invasive treatments, because it stimulates resident melanocyte precursor and immunomodulates in generalized vitiligo [31]. The effectiveness of the treatment is noticed in early stages and used in medical and surgical treatment accelerative repigmentation [32]. Other medications used in vitiligo treatment mentioned in Table 3.
Table 3: Other Medical Treatments
Surgical Therapies in Vitiligo.
Surgical therapies are considered the last step when repigmentation has been assessed poorly. This can range from tissue grafts transplant to the whole epidermis or dermis such as epidermal sheet transplantation. Other graft techniques are mini punch graft, suction blistering, split-thickness skin graft, hair follicle graft, and cultured melanocytes graft. Cellular graft is the transplant of cell such as non-cultured epidermal cell and microneedling. Other non-grafting surgery techniques are tattoo pen for micropigmentation [32].
Regenerative Medicine in Vitiligo.
Various cell-based therapies in regenerative medicine focus on intrinsic regenerative capacity of the pathologic tissue or the replacement by a pluripotent stem precursor cells graft. Through melanocyte transplantation, melanocyte– keratinocyte cell transplantation (MKCT). It has been reported 90% of cases has been repigmented [33]. In contrast, cell free approaches have been seen in treating vitiligo lesions such as Platelet-rich plasma (PRP), stem cell secretome, and adipose tissue secretome [32].
Exosomes are composed of lipids such as: cholesterol, ceramide, glucosylceramides, glycerophospholipids, sphingolipids, and diglycerides, and by bioactive lipids such as leukotrienes and prostaglandins. Exosome composition is based on the origin of the cell type, and they typically carry nucleic acid including mRNAs, miRNA, lipids, cytokines (Figure.1). Transcription factors, and proteins. Two types of proteins are contained inside the exosome: exosome-specific proteins and conserved proteins. Conserved proteins serve as a marker for exosome detection, these are heat shock protein (Hsp)60, Hsp70, Hsp90, ALIX, cluster of differentiation (CD)63, CD9, CD81, CD82, and tumour susceptibility gene 101 (TSG101). However, exosome-antigen specific proteins appear on antigen cells and can be altered based on the cellular origin, physiological changes, and exposure to stimuli [36]. For example, major histocompatibility complex (MHC) class I and II proteins appear on exosomes, which are secreted by antigen presenting cells (APCs).
Figure 1.
Exosome Diagram.
Figure 1: Exosome are composed of phospholipid protein cell membrane with transmembrane proteins, integrins, receptors, and tetraspanins, and they contain genetic material such as miRNA, deoxyribonucleic acid DNA, mitochondrial DNA, amino acids and other proteins
The participation of exosomes in physiological or pathological processes, gained them function of predicting treatment and diagnostic approach. Some of the physiological involvement is angiogenesis, cutaneous wound healing, inflammatory response, coagulation, immune response, tissue homeostasis, bone fracture healing, transneuronal transport, skin immunity, melanogenesis. Exosomes are also involved in the pathogenesis of several diseases such as cancer, Parkinson disease, Alzheimer disease, multiple sclerosis, autoimmune disorders, atherosclerosis, and skin diseases [36].
Exosomes Uses in Skin Disorders
Exosomes use has been an eye opening to various medical specialties in its applications, whether used as diagnostic tool such as biomarker, drug delivery, therapeutic managements such as tissue repairing agent, as well as in the developing of vaccinations. In dermatology, exosomes gained attention in various applications whether cosmetically such as antiaging care or in skin disorders, i.e., vitiligo, psoriasis, atopic dermatitis, etc. Exosomes are extracted from extracellular spaces such as fluids, stem cells tissues, umbilical cord, blood, saliva, urine, breast milk from both animal and human sources [37]. The following sections will discuss the common use of exosomes in the skin.
Development of Skin through Exosomes.
The development of skin epidermis cells is crucial for the organism’s survival. An imbalance between self-renewal and differentiation can lead to skin disorders. Through progenitor stem cells, exosomes (EXOSC7, EXOSC9 and EXOSC10) are abundant in epidermal layer which helps in avoiding premature differentiation of progenitor cells. Homeostasis is also regulated through exosomes, as the hair is a predominant function for warmth in mammals. Androgenetic alopecia is a chronic skin condition that causes hair loss. A recent study has shown exosomes derived from mesenchymal stem cells promote hair growth into thicker and longer [38].
Wound Healing and Regeneration in Exosomes.
Studies have shown exosomes promote wound healing based on the source of the exosomes through paracrine mechanisms. For example, adipose tissue exosome derivative and amniotic human epithelial cells share common characteristics with MSCs. Exosomes can promote collagen synthesis and angiogenesis. Adipose stem cells derived exosomes (ASC-Exo) are found in fibroblasts that affect proliferation, cell migration of collagen, as well as enhancing fibroblasts properties. Further studies are needed in prolonging the wound healing period in cases like diabetic patients or post-operatives for wound repair [4].
Inflammatory Skin Diseases and Exosomes
From psoriasis to atopic dermatitis (AD), studies have found the use of exosomes derived from stem cells alleviate diseases through immune regulation and promote skin barrier respectively. A study has shown, topical application of epidermal stem cells derived exosomes (ESC- Exo) relieved pathogenesis of psoriasis through relieving imiquimod IMQ-induced psoriasis in mice [39]. While in atopic dermatitis, a study reported a subcutaneous injection of ADSC-Exo could decrease AD symptoms in mice by decreasing IgE levels, IL-4, IL-23, IL31, immune cell infiltration, and TNF-α expression [40].
Autoimmune Skin Disorders and Exosomes
Both systemic lupus erythematous (SLE) and systemic sclerosis (SSc) have their own distinct autoimmune nature despite their similarity in their pathophysiology, clinical features, and complications. Exosomes study has been found in SLE applications, where clinical symptoms are alleviated using bone marrow mesenchymal stem cells (BMSCs)-exos to promote M2 macrophages and decrease T cell infiltration [39]. Whereas in SSc, reduction of fibroblasts reduces dermal thickness through various uses of derived exosomes from mesenchymal stem cells [39,41]. Other use of exosomes includes immune response regulation, presenting antigen specific cells, induce innate immunity, regulation of redox balance from oxidative stress, present immunoregulatory molecules [42].
Pigmentation is the core process of the skin disorder vitiligo and is regulated by α-melanocyte-stimulating hormone/melanocortin 1 receptor, Wnt signaling pathway, and eosinophil-derived neurotoxin [4]. For skin pigmentation, communication between cells is vital for melanin production. For example, UVB light induces melanin production in melanoma cells. Abnormal skin pigmentation can either cause hyperpigmentation or hypopigmentation through keratinocyte-derived exosome carry specific miRNA (miRNA‑3196 and miRNA-203) to regulate pigmentation [43]. For example, circulating exosomal miR-493-3p are increased in segmental vitiligo (SV) [44].
Exosome Preparation: From Extraction to Packaging for Use
To use exosomes, controlled steps from extracting to purifying, as well as quality control to ensure its safety in clinical practice [45]. There are various techniques used to extract exosomes from fluids, such as differential ultracentrifugation (DC), which is a common method to separate samples, yet when exosomes were isolated, the purity and yield is relatively medium to low respectively [46]. Other techniques used are Density gradient centrifugation (DGC), which is used to isolate components in various sizes and molecular weight. The purity is highly yet the yield is low in terms of intensive preparation before operation [47]. In addition to various sizes isolation, ultrafiltration has a similar concept with no special equipment’s needed and high purity results yet clogging onto filters have been seen [48]. Size-Exclusion Chromatography (SEC) method is used on various particles sizes and molecular weight, its economical with high purity but special columns are used for lipoproteins [49]. Finally, Immunoaffinity method is used based on the interaction between specific membrane proteins of exosomes and antibodies, with high purity results yet yield is medium due the high expenses of the method [50].
The Role of Exosome in the Pathogenesis of Vitiligo
Exosomes have various roles in the pathogenesis of vitiligo, from regulating immune responses to influencing melanocytes apoptosis or synthesis. With the difference expression of exosomal-miRNA between vitiligo patients and healthy individuals, studies have found miRNA’s influence different steps in the pathogenic pathway, from immune responses, oxidative stress, to abnormal melanin production. For example, in CD8+ T cells in vitiligo are overexpressed in miR-370-3p, and miR-143-5p, and down regulated by miR-885-5p, miR-16-5p, miR-92a-3p, and miR-92b-3p [51]. Following details will demonstrate the roles of exosome-miRNA based on the source of origination.
Since its discovery 150 years ago, mesenchymal stem cells (MSCs) were identified in the bone marrow stromal stem cells (BMSCs) by Friedenstein in the 1970s. Ever since, MSCs have gained attention in the research world with their ability to self-renewal and differentiate from stromal cells in a variety of populations, including adults, fetal, and perinatal tissues [52]. This milestone laid the foundation of regenerative medicine and its future potential therapeutics, from bone marrow support to tissue repair. Mesenchymal stem cell-derived exosomes were identified 30 years ago, and they have been new in research trials in the last 14 years. Studies have proved its efficacy from preclinical models to clinical trials, such as in cerebrovascular disease treatment in cardiac repair against myocardial infarction to skin regeneration in alopecia. Its potent regulatory effects in various types of cells, whether its anti-inflammatory effects or survival effects in promoting and regenerative potentials [52]. Studies have shown the effect of mesenchymal stem cells-derived exosomes on vitiligo condition with its promotion of melanogenesis to its downregulation of PTEN pathway as future therapy with promising results for patients [52]. Mesenchymal cells derived exosome can improve keratinocyte antioxidant capacity against H2O2 damage and reduce oxidative stress [53].
Human Umbilical Cord Derived Exosomes (hUMSC-Exo)
Therapeutic efficacy has been proven of deriving mesenchymal stem cells from the human umbilical cord, as it’s been associated with the paracrine secretion of extracellular vesicles [54]. In a study conducted at Sun Yat-sen University, it was claimed that melanocyte treated with hUMSC-Exo at a lower dose of (1 µg/mL) than a higher dose before H2O2-induction, enhanced proliferation of melanocytes and the reduction of p21, p53 IL-1β, IL-8, and IL-6 expressions, as well as MITF and TRP1 expression, that were caused by H2O2 damage [55].
A preclinical study used a 3D hUMSC-Exo results showed efficacy against skin depigmentation with the expansion of Treg cells and less CD8+T cells infiltration that was caused by H2O2-induced melanocyte apoptosis. Targeting Sirt1 and Bak1 in vitiligo through the aggregation of miR-132-3p and miR-125b-5p helped in the suppression of oxidative stress [56]. It has been shown that mesenchymal stem cells in 3D biomaterial scaffolds have gained recognition as it is a cell free platform that serves in augmenting therapeutic potentials [57]. In contrast, a study has shown hUMSC-Exo of miR181a-5p and miR-199a inhibit melanogenesis and promote melanosome degradation in excessive skin pigmentation [58]. Future clinical studies are needed for vitiligo melanocytes from donors to understand the therapeutical management of the above studies.
Adipose Stem Cell Derived Exosome (ACS-Exo)
One of the main sources where mesenchymal stem cells can be obtained is adipose tissue. It has gained interest in various fields, from regenerative plastic surgeries to dermatological skin conditions. With its unique quality of sharing the same origin as the mesenchymal stem cell from mesoderm, it can replenish damaged skin tissues. In the purpose of regeneration, stromal vascular fraction (SVH) is obtained after the breakdown of adipose tissue, where adipose-derived stem cells carry multilineage [59]. New studies have favoured adipocytes among the other MSC derivatives with their complex molecules that can be beneficial in regeneration. For example, in fat grafting, adipocyte derivatives have biophysical integrity that support stem cells in accordance with the volume used in a specific area of the body [59].
Adipose stem cells have been proven to produce many exosomes compared to other cells, with their cutaneous regeneration and immune tolerance [60]. In terms of exosome derivatives from adipose stem cells, studies have shown ASC-Exo results have the same therapeutic effect compared to ASC.
ASC-Exo demonstrates an anti-inflammatory effect in suppression of the catabolic environment, such as NF-κB-dependent inflammatory [60]. In addition to anti-inflammatory effects, ACS-Exo contains Arg-1 that inhibits T cell proliferation while promoting macrophage polarization. With its original function, ACS-Exo transfers mitochondrial components by enhancing its integrity and oxidative phosphorylation [60]. ACS-Exo proves to have an advantage ahead of ACS due to its precise and simple structure that can facilitate its transportation. The size of the adipose tissue depends on the patient characteristics that can be chosen for selective treatment and desired effects. Studies have also shown ACS-Exo modulates tumor progression and promotes wound repair [61]. However, there aren’t studies that focus on ACS-Exo effects on vitiligo condition, although the current information we have does prove its efficacy.
Keratinocytes, the primary cells of the skin's outermost layer, make up approximately 90% of the epidermis. They contain direct progeny cells as they locate in the basal layer and can resist light due to their strong DNA single-strand break and thymine dimer repair ability [62]. With their critical role in the body, keratinocyte stem cells can provide support in different fields, from regenerative medicine to wound healing up to diagnostic uses for skin conditions like vitiligo. The use of keratinocytes has captured researchers’ attention ever since the mid-20th century due to their functionality and abundance in the human body. A recent study showed the use of dermal MSCs (DMSCs) in 23 vitiligo patients by the process of transplantation of autologous melanocytes. The results showed promising results for vitiligo patients by inhibiting CD8+ T lymphocyte activity that could improve therapeutic efficacy [63]. No studies have been found regarding Keratinocyte Stem Cells Derived Exosomes (KSC-Exo) when treating vitiligo. However, there are studies that spark interest in the use of KSC-Exo. In the following sections, various studies are presented that can help in developing KSC-Exo applications in vitiligo which will be discussed under therapeutics and diagnostics headlines.
Therapeutic Approach of Keratinocytes Stem Cell Derived Exosome (KSC-Exo) in Vitiligo
Keratinocytes Stem Cell Derived Exosome has a significant impact on the proliferation of melanogenesis by influencing melanocytes of the skin tissue with its abundancy and speed of regeneration. A study was conducted by irradiating keratinocytes with UVB light to derive exosomes and discover the potential regulators of melanogenesis by the upregulation of TRP1, TRP2, TYR expression, and MITF as well as inhibitory effects. The microRNAs (miRNAs) that upregulated melanogenesis are hsa-miR-365b-5p, hsa-miR-29c-3p, and hsa-miR-644a, while downregulated melanogenesis are hsa-miR-4281, hsa-miR-18a-5p, and hsa-miR-197-5p [64]. A study has shown that exosomal miR-675 inhibits melanin synthesis through the phosphorylation of CREB, AKT, and ERK and inhibiting the expression of TYR, TYRP1, and TYRP2 [65]. Figure 2 reviews two examples of melanogenesis regulation.
One of the regulation factors that are elevated in vitiligo disorder is PTEN expression as well as, decrease in AKT phosphorylation in vitiligo skin compared to normal skin. However, there is no difference between vitiligo and normal skin in AKT expression. An encouraging study showed cocultured melanocytes target regulation of cell proliferation and apoptosis through PI3K/AKT/PTEN pathway. It was also found in wound repairing by promoting axonal growth in targeting PTEN/mTOR pathway in vitiligo melanocytes [66].
Figure 2.
Keratinocyte Derived Exosome and Vitiligo Pathogenesis in Melanin Synthesis.
Figure 2: Keratinocyte derived exosomes contribute to the regulation of melanogenesis.
Exosomal miR-3196 promotes melanin production through the upregulation of TYR expression, while exosomal miR-675 inhibits melanin synthesis through phosphorylation of CREB, AKT, and ERK pathway and inhibits the TRY, TYRP1, and TYRP2 expression.
Diagnostic Approach of Keratinocytes Stem Cell Derived Exosome (KSC-Exo) in Vitiligo
The use of diagnostics can be as a mediator to treat autoimmune skin disorder whether in its ability to be reflected upon the pathological and physiological form of keratinocytes stem cells or KSC-Exo. One of the studies used circulating exosomes as potential biomarkers to identify the pathogenesis of segmental vitiligo. In terms of melanocyte survival and its function, the circulating exosomal miR-493-3p regulates epidermal dopamine concentration in SV. When miR-493-3p are over expressed in keratinocytes along with dopamine concentration in vivo led to increased reactive oxygen species (ROS). Therefore, melanocyte apoptosis increases and a decrease in melanin synthesis by targeting HNRNPU, which binds to the main degradative enzymes of dopamine [43].
A similar study was conducted, where two miRNAs found to contribute to melanocytes apoptosis and four miRNA enhanced proliferation through MITF axis [67]. Finally, another keratinocyte derived exosomes (miR-200c) that can be a future target for vitiligo treatment management. KSC- miR-200c exosome suppresses melanogenesis related genes such as SOX1 that activates β-catenin and down regulates melanogenesis [42]. In contrast, a study has shown the inhibition of MITF axis through miR-330-5p extracted from keratinocyte and inhibition of melanin production as well as the presence of protein biomarkers such as CD63, Alix, and TSG101 [68,43]. It was also shown miR-3196 exosome regulated melanin synthesis through regulating TYR expressions [68]. Exosome miR-211 from keratinocytes promote melanin production by altering p53 and MMP9 axis as well as acting as an oxidative stress relief after UVB induction [69]. Finally, miRNA-141-3p and miRNA-200a-3p stimulate amelanocyte-stimulating hormone to regulate melanogenesis [70].
There are various sources that are still under study from plant-based exosome derivation to drug induced exosomes such as chemotherapy drugs. One of the current sources that raise interest for stem cell exosome derivation is from plasma cells. Plasma exosomal microRNAs (miRNAs) are emerging as a biomarker that can help in tracking the pathogenesis stage of vitiligo. The study investigated miRNA exosomes from plasma patient of non-segmental vitiligo (NSV). The miR-1469 exosome is delivered to natural killer cells (NKC) to enhance proliferation in IFN-γ pathway, and down regulating CD122. The targeted therapy is to upregulate CD122 in NSV cases [71]. Further clinical trials are needed in targeting CD122 to understand further therapeutics management in NSV patients. Recently, a study has found circulating miR-21-5p, melanogenesis inhibition from vitiligo patient that target SATB1 [72]. Another study has found that vitiligo accelerates catabolism and hsa-miR-487b-3p exosomes in the serum of vitiligo patients serves as a biomarker for the progression of vitiligo [73]. A further insight into the proteomic profile for vitiligo patients by detecting ALDH1A1 and EEF1G exosomes as a potential biomarker for the vitiligo pathogenesis and process [74]. In contrast, milk-derived exosome regulates melanogenesis by inhibiting melanogenesis through the Akt-GSK3b pathway [75].
Knowledge of disease pathophysiology is a topic of interest for researchers to unlock key information in improving patient’s quality of life, whether in diagnostics or therapeutics. One of the main challenged skin disorders is vitiligo, which was discovered thousands of years ago. With its complex autoimmune nature, vitiligo is characterized as a selective loss of melanocytes and the formation of white patches on the surface of the skin. To this day, vitiligo patients face daily challenges psychologically and mentally when not kept aware or controlled. Recent studies have shown the possible use of exosomes, which are nanosized vehicles found in extracellular spaces and body fluids. They are paracrine mediators found in various tissues and help in communicating between cells in microenvironmental sites. Exosomes in clinical practice have been gradual in the past 10 years. Further studies are needed to ensure safety and bring out the potential uses of exosomes. Limited studies are available in the usage of exosomes in skin disorder diseases, whether in their pathogenesis level or applied therapeutics results. Innovation in regenerative medicine is on the rise when using pluripotent immature stem cells such as mesenchymal cells, adipose tissues, umbilical cord, and blood due to their pure properties and successful results in treatment. Exosome therapy can be a breakthrough in regenerative medicine as they contribute to regulating and promoting different pathways in immune modulations. However, further studies are needed, from the selection of donors for stem cells to the frequency of treatment to obtain the desired results and the best delivery. The production of large-scale exosome therapy should be carefully monitored as current methods produce low yields in high-purity exosomes as well as quality control. Furthermore, stability, standardized production, and safe and effective preparation are needed for treating vitiligo patients.
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Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
