The Bacterial Cytoskeleton based on Bacterial Translation Elongation Factor EF-Tu: Novel Insights

Review | DOI: https://doi.org/10.31579/2690-1919/224

The Bacterial Cytoskeleton based on Bacterial Translation Elongation Factor EF-Tu: Novel Insights

  • Frank Mayer *

* Retired from Georg-August University, Institute of Microbiology and Genetics, Goettingen/Germany.

*Corresponding Author: Frank Mayer, Am Hohen Tore 4a, 38118 Braunschweig/Germany.

Citation: Frank Mayer. (2022). The Bacterial Cytoskeleton based on Bacterial Translation Elongation Factor EF-Tu: Novel Insights. J Clinical Research and Reports, 10(2); DOI:10.31579/2690-1919/224

Copyright: © 2022, Frank Mayer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 19 December 2021 | Accepted: 30 December 2021 | Published: 10 January 2022

Keywords: bacterial cytoskeleton; elongation factor EF-Tu; occurrence; origin; formation; multi-resistance; pathogenic bacteria; target for antibiotics

Abstract

Bacteria possess an EF-Tu-based cytoskeleton.This article presents a short review. A number of questions which are not discussed in the former publications can be asked, such as: all bacteria possess a ribosomal protein synthesis system and, hence, also EF-Tu. EF-Tu is produced in an amount that is higher than the need for a function as translation elogation factor in ribsomal protein synthesis. This article tries to answer the question regarding the surplus of EF-Tu: formation of a "cell-wide web" by self-assembly as a feafure that stabilizes cell integrity.

An additional question can be asked: what is the origin of this bacterial cytoskeleton? This article contains a speculation on this topic. A third question regards the'ntteructjon of ribosomes in the process of protemsynthesis: does the EF-Tu protein move to the ribosome, or does the ribosome move to the EF-Tu intergated in a fibril of the bacterial cytoskeleton? The former publication depicts electron micrographs which show colocalizatton of botth entities. EF-Tu is an example for aprotein with two independent functions: participation in the ribosomal protein synthesis as a kanslation elongation factor, and component of a bacterial cytoskeleton. This situation can open up a discussion ofthe sequence of events and states of early cells during evolution.

Introduction

In former publications [1-6] and (Figure 1), the structural organization of the EF-Tu-based bacterial cytoskeleton is described. It is based on the surprising discovery of its existence [7,9]. 

Figure 1: The protein EF-Tu from [5] 

The protein exhibits three domains [5].                                                             

A bulge at domain 3 fits into a cleft in domain 2. This situation allows chain formation (fibrils, s. below) [6].

After all, the elongation factor EF-Tu is known for its important role in the bacterial ribosomal protein synthesis. In a former publication [10] it was stated that Ef-Tu in bacterial cells is produced in much higher numbers as compared to the need of its role in protein synthesis. No explanations were offered for the reason of this fact. In addition, in this former publication it was reported that EF-Tu can form fibrils consisting of many EF-Tu molecules bound to each other by non-covalent binding. Further implications of this observation were not discussed.

The idea that bacteria contain a cytoskeleton did come up by a surprising phenomenon: bacteria did maintain their typical shape and size even after removal of all layers of the cell wall and of its cytoplasmic membrane [11]. At this time publications such as [8] did report that bacteria possess a cytoskeleton consisting of proteins related to actin. Experiments with various kinds of antibodies, using immuno electron microscopic investigations, did not show binding of this labelling system to a layer close to the inner face of the cytoplasmic membrane when anti-actin antibodies were used. This layer close to the inner face of the cytoplasmic membrane mentioned above had to consist of other proteins. The properties of EF-Tu described above did lead to the conclusion that it may be EF-Tu that constitutes this layer. Immuno electron microscopy using anti-EF-Tu antibodies did give a convincing labelling result. In addition, positive labelling was also observed at other sites of the bacterial cells when thin-sectioning was applied for the labelling experiments.

Inspection of the results of an x-rax investigation of the EF-Tu protein [5] did give an explanation: EF-Tu is a 3-domain protein. The formation of fibrils by EF-Tu mentioned above could easily be explained by an interaction of an exposed distinct site (a bulge) on domain 3 with a distinct site (a cleft) exposed on domain 2 of the protein. In the meantime, the exact amino acid sequences of these sites are known [12].

This interpretation was supported by electron microscopic images obtained during investigations of fibrils isolated from artificially lysed bacteria, and of fibrils created, by polymerization, using isolated EF-Tu proteins (Figure 2).

Figure 2: Fibril formation a)  Chain (part of a fibril) (b,c) Chain model (fibril), depicted in two different modes.  d) Electron microscopic micrograph  of  such a chain (fibril) that was obtained from an artificially lysed bacterium   e) Electron microscopic micrograph of a fibril that was obtained in vitro by polymerization of  isolated EF-Tu protein moleculesNote the similarity with the model fibrils. Domain 1 is extending towards the cytosol. [6]

A further set of experiments was performed: isolated domain 3 protein was mixed with intact full-size EF-Tu. As soon as the domain 3 protein was located at the end of a fibril, the domain 3 had no binding partner (because domain 2 was missing) and, hence, fibril formation was hindered (Figures 3 and 4).

Figure 3: (a,b) Model: Isolated domain 3 protein („truncated“ protein) complexed with a full-size intact EF-Tu  protein in a fibril.  The added domain 3 protein, when  positioned at the end of a fibril, does not find a domain 2 site for binding. The result is the termination of the growth of  the fibril. [11].
Figure 4: Scetch illustrating prevention of fibril formation by inserion of domain 3 (shown in green) into the growing fibril [6].  a) Situation without addition of domain 3:  fibril formation b) Domain 3 protein  c)  Situation after addition of domain 3 copies to a sample containing intact full-size EF-Tu proteins; prevention of fibril formation by complex formation of  isolated domain 3 proteins with full-size EF-Tu proteins

This observation was the starting point for investigations related to the use of cytoskeleton damage by a new class of antibiotics [13]. (Figure 5) depicts the result of the application of domain 3 for destruction of the bacterial cytoskeleton.

Figure 5: Micrographs illustrating the effect of insertion of domain 3 proteins in the growing bacterial EF-Tu-based cytoskeleton a)  Two intact cells of the bacterium Escherichia coliF: Flagella, P: Pili  Magnification bar: 1 micrometer (b, c, d):  cells and cell remnants of Escherichia coli after the cells had taken up and started translation of  the genetic information coding for domain 3 of EF-Tu.

Note the increasing time-dependent damage to cell integrity .

Original electron micrographs by Frank Mayer

Novel insights

Existence of EF-Tu and EF-Tu-based cytoskeletons in all bacteria?

EF-Tu is a very old and conservative protein. Obviously, nature had no reason for selection of sequence variations in this very important protein.

As bacterial ribosomal protein synthesis is not missing in any bacterium, it is concluded that all bacteria possess EF-Tu protein molecules, probably synthesized in heigh numbers. This allows the conclusion that all bacteria possess an EF-Tu-related cytoskeleton. The surplus of EF-Tu in the bacterial cell (s.above) can allow that the cytoskeleton is formed by self-assembly: the individual EF-Tu proteins find their partners for the formation of fibrils by this process, with the energy needed for movement of the protein molcules and the binding process originating from Brownian movement. As EF-Tu protein is present in high numbers, a self-assembly would continuously take place during the entire growth phase of the bacteria. The consequence is an increase of fibrils in the bacterial cell (a “cell-wide web“, CWW). One could observe that, very often, a colocalization of ribosomes with cytoskeletal fibrils was evident. Hence, the question is: do the ribosomes their job (participation in protein synthesis) in close contact with EF-Tu proteins organized in fibrils? As the domain 1 of EF-Tu (Figure 1) extends towards the cytosol, and as the active center for elongation is located in domain 1, ribosomes close to an EF-Tu fibril might have easy access to domain 1. This would mean that EF-Tu protein is not moving to the ribosome to perform elongation, but that the ribosomes move to the EF-Tu proteins in the fibril. The observed colocalizaion of ribosomes and EF-Tu fibrils might support this view.

These described facts and conclusions indicate that bacterial cells, including multi-resistant pathogens, are targets for application of EF-Tu-based antibiotics [13].

By the way: development of resistance against EF-Tu or “truncated” EF-Tu may not be expected. After all, EF-Tu is an important component of ribosomal protein synthesis [9].  Resistance against EF-Tu would most probably damage the protein synthesis system, followed by death of the bacterial cell.

One more important aspect should be considered. Possession of a bacterial cytoskeleon is the common property of all bacteria. This is a feature that allows successful treatment of multi-resistant bacteria with the   EF-Tu-based antibiotic even when all other antibiotics fail.

Speculations on the origin of EF-Tu and on its role in bacteria for cell stability 

Protein synthesis is the key for living systems. In this context the overall stabilization of cell-like spheres by a cytoskeletal system may be of secondary importance. Hence, it might be reasonable to assume that precursors of modern EF-Tu systems active in ribosomal protein synthesis did not contain binding sites for fibril formation for cytoskeletons. Such a property might have evolved later. It should be kept in mind that the active center for the process of elongation of the growing protein is located in domain 1. The roles of domains 2 and 3 in this process (if present at all in early states of evolution) remain unknown (s.above, today’s functional role of these two domains).  It can be speculated that two domains, now with binding sites, were added later in evolutioa. The EF-Tu-based cytoskeleton might be the primordial cytoskeleton in bacteria.

This view is supported by the fact  that a different kind of bacterial cytoskeleton (MreB protein, related to actin of higher organisms)  was found, by labelling experiments,  to colocalize with the EF-Tu-based cytoskeleton   [14,15]. It was even shown that the EF-Tu-based cytoskeleton plays a steering role regarding the placement of MerB elements in an EF-Tu – MreB complex, and in the placing of these complexes in the bacterial cell.  It can be speculated - regarding evolution - that the EF-Tu-based cytoskeleton was first. The MreB cytoskeleton evolved later, and it then found its place in a complex of these two cytoskeletons by the assistance and steering role of the EF-Tu-based cytoskeleton components.  As mentioned above, EF-Tu is a very old and conservative kind of protein. This fact supports the view that EF-Tu was developed very early in evolution, prior to many other proteins in the evolving bacterial cells. The cells could now use the potential for protein synthesis and optimization of protein function.

This line of interpretation would imply that the EF-Tu-based bacterial cytoskeleton is, as mentioned above, the primordial cytoskeleon. This view would add a new aspect to the discussion on the origin of bacterial cytoskeletons and, in general, of cytoskeletons.

Conclusion

Former publications (references) describing the structural and functional features of a bacterial cytoskeleton based on the translation elongation factor EF-Tu did not consider some aspects that might need further explanation and discussion. The present article contains a short review of the earlier basic findings, but novel insights should be added. An example is the formation of the cytoskeleton. It appears reasonable to assume that it is the process of self-assembly that is the mode how structural elements (full-size EF-Tu protein molecules) are forming chains (fibrils) that are building up networks stabilizing the bacterial cell. Formation of a “cell-wide web” is caused by the fact that synthesis of EF-Tu produces more EF-Tu that is needed as an elongation factor. The surplus assembles to fibrils which contribute to cell stability. This stability can be reduced by insertion of “truncated” EF-Tu (only domain 3 of the EF-Tu protein) into the growing cytoskeleton.

This situation was used for the design of a novel kind of antibacterial agent. This agent is synthesized by the ribosomal protein synthesis system inside the pathogenic bacterial cell as soon as the genetic information coding for domain 3 of EF-Tu has been transferred into the cell, and translation is started. This approach can be described as a kind of induced suicide": the antibacterial agent that kills the cell is produced inside the cell that had produced it.

A further example of a novel insight may be the questions around the origin of the first bacterial cytoskeleton. It was shown that MreB, an action-related bacterial protein, also forms cytoskeletal elements. It was also described that it is the Ef-Tu-based cytoskeleton that organizes the sterical organization of complexes that contain MreB and EF-Tu.

EF-Tu is a very old and conservative protein that did not have substantial sequence alterations during evolution. Together with the colocalization of EF-Tu and MreB, this fact supports the view that an EF-Tu-based cytoskeleton might be the first cytoskeleton in the first cells formed during the early stages of evolution. This would mean that the EF-Tu-based bacterial cytoskeleton is the primordial cytoskeleton. The active center in EF-Tu for the function of elongation is located in domain I of the protein, supported by few features located in domain 2 of the protein. Are domain 2 and domain 3 younger than domain 1?

Discussion is open

An additional question could be the interaction of ribosomes in the process of protein synthesis with fibrils of the EF-Tu protein. In one of the earlier publications [11] a colocalization of both entities was observed. Is soluble EF-Tu in the cell moving to the ribosome, or fist the ribosome moving to the EF-Tu frbnl? Are there any steric hindrances?

To sum up: The existence of the Ef-Tu-based antibacterial agent is an example for new insights and ideas in a field of research that is important the fight against multi-resistant pathogenic bacteria.

Acknowledgement

This work was carried at the Institute of Microbiology and Genetics, Georg-August-University Goettingn/Germany. Supported by Volkswagenstiftung and Deutsche Forschungsgemeinschaft.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

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.

img

Delcio G Silva Junior

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.

img

Ziemlé Clément Méda

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.

img

Mina Sherif Soliman Georgy

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.

img

Layla Shojaie

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.

img

Sing-yung Wu

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.

img

Orlando Villarreal

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.

img

Katarzyna Byczkowska

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.

img

Anthony Kodzo-Grey Venyo

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.

img

Pedro Marques Gomes

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.

img

Bernard Terkimbi Utoo

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.

img

Prof Sherif W Mansour

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.

img

Hao Jiang

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.

img

Dr Shiming Tang

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.

img

Raed Mualem

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.

img

Andreas Filippaios

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.

img

Dr Suramya Dhamija

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.

img

Bruno Chauffert

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!

img

Baheci Selen

"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".

img

Jesus Simal-Gandara

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.

img

Douglas Miyazaki

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.

img

Dr Griffith

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.

img

Dr Tong Ming Liu

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.

img

Husain Taha Radhi

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.

img

S Munshi

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.

img

Tania Munoz

“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”.

img

George Varvatsoulias

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.

img

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.

img

Khurram Arshad

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.

img

Gomez Barriga Maria Dolores

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.

img

Lin Shaw Chin

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.

img

Maria Dolores Gomez Barriga