AUCTORES
Globalize your Research
Review Article
*Corresponding Author: P D Gupta, Former Director Grade Scientist, Centre for Cellular and Molecular Biology, Hyderabad, India
Citation: P D Gupta., K Pushkala (2023), Faecal microbiota transplantation (FMT): An Effective Therapeutic Agent for Parkinson’s Disease, J New Medical Innovations and Research, 4(4); DOI:10.31579/2767-7370/052
Copyright: © 2023, P D Gupta. 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: 24 July 2023 | Accepted: 31 July 2023 | Published: 07 August 2023
Keywords: alpha-synuclein fibrils; pharmacotherapy; surgery; ayurvedic treatment; fmt
Parkinson’s disease is an autosomal-dominant neurodegenerative disease of the senior citizens worldwide. The slow progression of the disease affects motor and non-motor functions of the nervous system. Available pharmacotherapy, Surgery, Ayurvedic treatment and FMT only reduces the intensity of the symptoms but not completely wipe out the disease. Among them FMT proves to be the best since the side effects of the antibiotics could be avoided in elders. Few clinical trials as well as studies in animal models give a promising result using FMT. High-quality clinical trials with larger sample sizes demand to qualify FMT as widely recommended therapeutic measures.
Parkinson’s disease (PD) is a neurodegenerative disease which severely affects quality of life of the patient with a high rate of morbidity expressing four motor defects such as tremor, slowness of movements, stiffness and postural instability. The disease was comprehensively described by James Parkinson in 1817 (An Essay on the Shaking Palsy). But the review of much early literature of Ayurveda dating back as far as 5000 BC would show that syndrome strikingly similar to Parkinsonism mentioned as “Kampa vata”, was already known. The non motor defects observed are dysautonomia (constipation, vomiting, orthostatic hypotension, abnormal sweating and dysuria) as well as mental disorders (depression, anxiety disorder, visual hallucination and dementia). Loss of dopaminergic neurons in the substantia nigra leads to motor defects but the non-motor defects are due to loss of neurons in the brain regions affecting non dopaminergic neurotransmitter systems. The above said defects are the result of abnormally aggregated α-synuclein fibrils (Lewy bodies) as well as Lewy neurites in the neuronal cells. Alpha-synuclein “natively unfolded protein”is a small protein made up of 140 amino acids encoded by the SNCA gene found in 1997. A single miss-sense mutation in this gene gave rise to an autosomal-dominant form of PD [1]. α-Synuclein may be modified by phosphorylation, oxidation, nitrosylation, glycation, or glycosylation. This cascade of events, starting from the natively unfolded protein and culminating in the mature fibril formation is collectively termed α-synuclein aggregation [2]. In addition, oxidative stress, autophage dysfunction, proteostasis failure, vesicular trafficking defects and neuroinflammation also trigger loss of these neurons. The synapsis was observed to be the route for α-synuclein fibrils to other neuronal cells. This α-synuclein fibrils could be observed in cerebral cortex, the olfactory bulb, autonomic nervous system, salivary glands, skin and intestine [3]. Several processes have been implicated in PD, including mitochondrial dysfunction, defective protein clearance mechanisms, and neuroinflammation, but the way in which these factors interact remains incompletely understood [4]. In the course of Parkinson's disease (PD), the enteric nervous system (ENS) and parasympathetic nerves are amongst the structures earliest and most frequently affected by alpha-synuclein pathology [5]. Eight million people suffer with age related PD worldwide, but despite more than 200 years of research, its underlying causes are not fully understood [6]. Normally the disease develops after the age of 55, cases of getting the disease in their 30s and 40s is also observed, such as in the case of actor Michael J. Fox, who was diagnosed at age 30 [7]. Our review aims to consolidate the available information on clinical trials and study in animal models till today focussing to use FMT as a treatment modality for this disease and further explore the potential usage of FMT in treating constipation, motor, and non-motor symptoms in patients suffering with PD.
Secondary Parkinsonism
Secondary Parkinsonism is a disorder with symptoms similar to Parkinson's, but medication side effects are the causal factor for different neurodegenerative disorders, illness or brain damage. Quite similar to PD, in the expression of the disease, fortunately the risk of developing secondary Parkinsonism may be minimized by careful medication management, particularly limiting the usage of specific types of antipsychotic medications. At the same time, secondary Parkinsonism does not seem to respond as effectively to medical therapy as PD [7].
Treatments so far available:
Parkinson's patients are treated with medications to relieve the symptoms of the disease by stimulating the remaining cells in the substantia nigra to produce more dopamine (levodopa medications) or by inhibiting some of the acetylcholine that is produced (anticholinergic medications) to restore the balance between the chemicals in the brain. Devising an personalized treatment plan is indispensable and to work closely with the doctor due to vast variations linked with side effects of the class of medication as well as patient. Levodopa, developed more than 30 years ago, regarded as the gold standard for PD therapy though it does not stop or slow the progression of the disease. Side effects may include nausea, vomiting, dry mouth and dizziness. Dyskinesias (abnormal movements) may occur when the dose is increased. In some patients, levodopa may cause confusion, hallucinations or psychosis. Dopamine Agonists that mimic the role of chemical messengers in the brain, generally have more side effects than levodopa, so that is taken into consideration before doctors prescribe dopamine agonists to patients. Side effects may include drowsiness, nausea, vomiting, dry mouth, dizziness and feeling faint upon standing. These common symptoms usually resolve over several days, though some patients, dopamine agonists may cause confusion, hallucinations or psychosis like Levodopa. Entacapone and tolcapone are medications that are used to treat fluctuations in response to levodopa. COMT, an enzyme that metabolizes levodopa in the bloodstream when blocked more levodopa can penetrate the brain to effectiveness of treatment is practiced. Tolcapone is prescribed only for patients when symptoms are not adequately controlled by other medications due to potentially serious toxic effects on the liver. Side effects may include diarrhoea and dyskinesias. Selegiline slows down the activity of the enzyme monoamine oxidase B (MAO-B), the enzyme that metabolizes dopamine in the brain, delaying the breakdown of naturally occurring dopamine and dopamine formed from levodopa. It has been observed that, when taken in conjunction with levodopa, selegiline may enhance and prolong the effectiveness of levodopa. Side effects may include heartburn, nausea, dry mouth and dizziness. Confusion, nightmares, hallucinations and headache occur less often and should be reported to the doctor. Trihexyphenidyl, benztropine mesylate, biperiden HCL and procyclidine blocks acetylcholine whose effects become more pronounced when dopamine levels drop. These drugs are prescribed to solve tremor and muscle rigidity, as well as in reducing medication-induced Parkinsonism. Anticholinergic drugs are generally not recommended for extended use in older patients due to complications and serious side effects. Side effects may include dry mouth, blurred vision, sedation, delirium, hallucinations, constipation and urinary retention. Amantadine an antiviral medication that also helps reduce symptoms of PD (unrelated to its antiviral components) in the early stages of the disease along with an anticholinergic medication or levodopa, proved to be effective in treating the jerky motions associated with PD. Side effects may include difficulty in concentrating, confusion, insomnia, nightmares, agitation and hallucinations. Amantadine may cause leg swelling as well as mottled skin, often on the legs.
For many patients with PD, medications are effective for maintaining a good quality of life. Based upon the type and severity of symptoms and the deterioration of a patient's quality of life, surgery may be the next step. stereotactic surgery, pallidotomy, thalamotomy, Deep Brain Stimulation (DBS) are performed depending on the PD patients’ condition. Embryonic stem cell research is focussed to produce dopamine neurons from human stem cells in the laboratory for transplantation into humans with PD. The successful generation of an unlimited supply of dopamine neurons may offer hope for PD patients at some point in the future. With this technique researchers are anticipating an ability to prompt these cells, which can theoretically be manipulated into a building block of any of the body's tissues, to replace those lost during the disease’s progression. Adult stem cells from bone marrow may be utilized in a similar way to achieve the results. Human studies of so-called neurotrophic factors are also being explored. In animal studies, this family of proteins has revived dormant brain cells, caused them to produce dopamine, and prompted dramatic improvement of symptoms [7].
Ayurvedic treatment for Parkinson's disease
Ayurvedic treatment of PD was mentioned in the literature including its treatment. It includes the treatment with the seeds of a plant containing therapeutic levels of what is today known as levodopa apart from several other preparations. According to Ayurveda, most of the diseases of the Vata are essentially the conditions of degenerative diseases of the nervous system. The treatment of ‘kampa vata’ consists of both internal and external administration of drugs in different forms aimed to reverse the ‘vata’ imbalance [8;9].
Pathogenic role of Gut bacteria in PD
In the recent past the gut microbiota is found to be a key regulator [10] of many functions as well as disease conditions leading to the pathogenesis of several gastrointestinal, extraintestinal disorders and also linked to neurodegeneration through the gut microbiota brain axis, opening the possibility for new microbiota-based therapeutic options. A detailed analysis of the gut microbiota revealed the exact degree of gut dysbiosis in about 197 PD patients, and the data were compared to that from 130 healthy controls and the statistical analysis revealed there was significant dysbiosis in patients with PD [11]. Keshavarzian et al., (2015) observed that the microbiota of the faecal material as well as mucosa was significantly different from PD patients compared to controls. Putative, "anti-inflammatory" butyrate-producing bacteria from the genera Blautia, Coprococcus, and Roseburia and Faecalibacterium were significantly more abundant in faeces of controls than PD patients. On the other hand, "proinflammatory" Proteobacteria of the genus Ralstonia were significantly more abundant in mucosa of PD than controls. The authors also indicated that a large number of genes involved in metabolism were significantly lower in the PD faecal microbiome, whereas genes involved in lipopolysaccharide biosynthesis and type III bacterial secretion systems were significantly higher in PD patients [12]. A study by Sampson et al., (2016) tested the role of gut bacteria in the regulation motor symptoms and pathophysiology of PD, more specifically alpha-synuclein (α-synuclein) dysfunction, in a mouse model. In order to find out the link between PD and gut microbiota, FMT was performed from PD patients into mice. To their surprise significant motor impairment was observed in mice. In addition, they also demonstrated that the presence of specific microbes or even microbial metabolites is enough to promote α-synuclein pathology, neuroinflammatory changes, and characteristic motor and gastrointestinal dysfunction in the mouse model [13]. In another study Segal et al., (2021) increased abundance Akkermansia, Lactobacillus, Enterobacteriaceae, Bifidobacterium and decreased abundance of Prevotella Faecalibacterium, and Blautia was observed in PD patients. Inflammation-induced misfolding of α-Syn and development of PD pathology could be due to proinflammatory dysbiosis [14]. Scheperjans et al., (2015) compared the faecal microbiota of 72 PD patients and 72 control subjects by pyrosequencing the V1-V3 regions of the bacterial 16S ribosomal RNA gene. On average, the abundance of Prevotellaceae in faeces of PD patients was reduced by 77.6% as compared with controls. The relative abundance of Enterobacteriaceae was positively associated with the severity of postural instability and gait difficulty. These findings suggest that the intestinal microbiome is altered in PD and is related to motor phenotype [5].
Factors for the development of α-synuclein aggregation
Recently, the researchers at the University of Helsinki have demonstrated that certain strain of Desulfovibrio bacteria that absorbs toxic sulphate are responsible for the prognosis of the disease [15]. Roughly only 10% is contributed by individual gene mutation. Desulfovibrio, genus of gram-negative bacteria is commonly found in aquatic environments with high quantity of organic material as well as waterlogged soils species correlated with the severity of PD. Desulfovibrio bacteria produce hydrogen sulphide and lipopolysaccharide, and several strains synthesize magnetite, all of which likely induce the oligomerization and aggregation of α-synuclein protein. The substances originating from Desulfovibrio bacteria likely take part in Alpha-synuclein misfolding resulting in pathogenesis of PD [15]. Murros et al., (2021) found that worms Caenorhabditis elegans model fed Desulfovibrio from AD patients had significantly more and larger alpha-syn aggregates than worms fed bacteria from healthy subjects or worms fed Escherichia coli strains. The study group also suggested that by preventing the environmental exposure to the bacterial through a carrier, the disease burden could be reduced. They also anticipated that once the Desulfovibrio bacteria are eliminated from the gut, α-synuclein aggregates are no longer formed in intestinal cells, from which they travel towards the brain via the vagus nerve like prion proteins. Many people harbour this bacterial in the gut with or without AD. Scientific validation is wanting on the difference between the bacteria harbouring in healthy and PD patients [16; 17].
FMT in the management of PD
Currently, FMT is explored as a therapeutic option for a wide variety of gastrointestinal disorders as well as non-gastrointestinal disorders [18; 19; 20;21]. At present the treatment is limited to pharmacotherapy and surgery with the resurgence of most symptoms discussed earlier in this review. Out of these, FMT has been one of the most promising approaches since, strong evidence for the gut dysbiosis in the pathogenesis of PD is available and it is imperative to consider the various methods that bring about "eubiosis" or restore the normal microbiota of the gut. Jena R et al., (2021) summarised the details of the information on the clinical trials and studies in animal models performed to treat the disease with FMT [22]. Xiao-Yi Kuai et al., (2021) conducted a study with 11 PD patients were found to reduced constipation intensity with FMT treatment [23]. In another study Arik Segal et al., (2021) FMT infused via colonoscopy involving 6 PD patients, was observed to be safe and resulted in improvement of PD motor and non-motor symptoms, including constipation, at 6 months. Further research is needed to assess longer-term maintenance of efficacy and safety, including in large scale randomized controlled trials [14]. DuPont et al., (2023) performed a similar study found from their double-blind placebo-controlled pilot study in 12 PD patients suffering with constipation for 12 months with FMT, increased diversity of the intestinal microbiota that was associated with reduction in constipation and improved gut transit and intestinal motility. Faecal microbiota transplantation administration improved subjective motor and non-motor symptoms also. Significant increase in the selective families within the phylum Firmicutes but decrease in the proportion of microbiota belonging to Proteobacteria is an observation to focus in treatment of constipation. These conclusions suggests a therapeutic potential for reconstructing the gut microbiota of PD patients and improving their motor and non-motor symptoms [24]. In mouse model also FMT could protect mice against PD via suppressing α-syn expression [25].
With limited clinical trials it was shown that FMT is an effective treatment for PD however, further research is needed to assess longer-term maintenance of efficacy and safety in large scale randomized controlled trials, preferably in patients with moderate to severe PD patients. The outcome of the high-quality clinical trials with larger sample sizes required to qualify FMT as a widely recommended therapeutic measure. It is also needed to establish the routes of administration, standardized protocols and the adverse effect profile of FMT as well.
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.
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.
