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Review Article | DOI: https://doi.org/10.31579/2690-1897/298
Grodno State Medical University
*Corresponding Author: Bon E.I., Maksimovich Grodno State Medical University, Gorkogo St, Grodno, Republic of Belarus.
Citation: Bon LI., Maksymovich NYe., Sitsko A., Otlivanchick A., Malenouskaya M, (2026), Smooth Muscle and Their Contractile Activity, J, Surgical Case Reports and Images, 9(2); DOI:10.31579/2690-1897/298
Copyright: © 2026, Bon E.I. 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: 27 January 2026 | Accepted: 02 February 2026 | Published: 05 February 2026
Keywords: smooth muscle; phasic contraction; myofibril; sarcoplasm; myosin; tropomyosin; ATPase activity; smooth muscle cell
Muscle tissue provides the body's motor activity, carrying out both voluntary movements and involuntary functions of internal organs. While striated muscle has been well studied, smooth muscle, which forms the walls of internal organs and blood vessels, is of particular interest due to its unique contractile activity. This tissue is responsible for fundamental processes—peristalsis, regulation of vascular tone, labor—demonstrating high plasticity, the ability for prolonged tonic contractions, and low energy expenditure in maintaining tone.
Muscle tissue provides the body's motor activity, carrying out both voluntary movements and involuntary functions of internal organs. While striated muscle has been well studied, smooth muscle, which forms the walls of internal organs and blood vessels, is of particular interest due to its unique contractile activity. This tissue is responsible for fundamental processes—peristalsis, regulation of vascular tone, labor—demonstrating high plasticity, the ability for prolonged tonic contractions, and low energy expenditure in maintaining tone [1].
The central question remains the molecular mechanism underlying the two types of contraction—fast phasic and slow tonic. There are two main viewpoints: one explains the differences by quantitative features of the contractile apparatus, the other suggests the existence of qualitatively different molecular substrates. An important argument in favor of the second hypothesis is data on the low content of classical actomyosin in smooth muscles specialized for tonic function.
This review systematizes current knowledge about the structural and functional organization of smooth muscle. It considers its embryological origin, morphological features, and unique physiological properties. The main focus is on the biochemical aspect: a comparative analysis of the protein composition of different muscle types and the identification of molecular determinants of tonic function. Analysis of experimental data shows a clear correlation between the functional profile of muscle tissue and the ratio of myofibrillar protein fractions—the actomyosin complex and the "T-fraction" (proteins soluble at low ionic strength). It is shown that a gradual decrease in the actomyosin/T-fraction ratio in the progression from skeletal to smooth muscle corresponds to an enhancement of its tonic capacity.
The totality of the presented data points to a complex multicomponent molecular mechanism of smooth muscle contractile activity. Its further study is of fundamental importance for physiology and may open new perspectives in understanding pathologies associated with impaired muscle tone.
In humans and vertebrates, the term smooth muscle refers to the muscular layers of internal organs (such as intestines, stomach, uterus, bladder, urogenital organs, and others) and blood vessels. This type of muscle tissue also includes contractile elements incorporated into the connective tissue of the skin and various organs. Vertebrate smooth muscle differs significantly from striated muscles in a number of characteristics and properties [1].
First of all, it must be noted that these two muscle types have different embryonic origins. Smooth muscle elements in vertebrates develop from mesenchyme. The embryonic basis for almost all highly differentiated somatic (skeletal) musculature in vertebrates is the myotomes, i.e., the part of the dorsal segments that remains after the segregation of all mesenchymal primordia. Thus, vertebrate smooth muscle cells are similar to fibroblasts, which also originate from undifferentiated mesenchyme. Therefore, the formation of new smooth muscle cells is possible even in the adult organism from poorly differentiated connective tissue elements. Such new formation of smooth muscle fibers is observed, for example, in the uterine muscle during pregnancy, during the transformation of capillaries into larger vessels due to changes in blood flow conditions, etc. This property, known as plasticity, is one of the key features of this tissue and distinguishes it from the strictly determined skeletal musculature [2].
At the same time, it is necessary to emphasize with certainty that the locomotor smooth muscle fibers of invertebrates, capable of rapid contractions and often combined based on the absence of transverse striations into a single smooth muscle tissue with the mesenchymal musculature of vertebrates, represent, in essence, a modification of somatic-type musculature. In terms of a number of properties—the ability for tetanic contraction, sensitivity to induction current, obedience to the "all or nothing" law, as well as high myosin and actomyosin content—these muscles are maximally close to striated muscle. This circumstance is especially important to consider when studying various muscle types from a biochemical point of view, as it indicates that the term "smooth muscle" unites functionally heterogeneous structures.
The morphological unit of smooth muscle of mesenchymal origin is a single-nucleated spindle-shaped cell, most often 60 to 100 µm long (often up to 200, less often up to 500 µm) and 4–5 µm in diameter. Smooth muscle cells, like striated muscle fibers, consist of sarcoplasm and myofibrils. However, the latter lack transverse striations and throughout consist of a substance exhibiting noticeable positive uniaxial birefringence. According to the latest data, myofibrils should be considered the contractile element of the smooth muscle cell, just as in the striated fiber. It is essential that smooth muscle cells lack an external membrane—the sarcolemma. However, according to some researchers, smooth muscle cells are still covered by a very thin membrane—the myolemma—formed by an intertwining of thin collagen fibrils and intercellular substance [3]. Such organization provides not only structural integrity but also effective mechanical and chemical integration of cells into a single functional syncytium.
Just as in the striated fiber, the sarcoplasm of the smooth muscle cell is a sufficiently complex system in which a number of microstructures can be identified. Significant is the presence in the sarcoplasm of minute particles—microsomes—possessing ATPase activity that differs in a number of properties, for example, resistance to high pressure, from myosin ATPase. The activity of this ATPase is especially high in the smooth muscle of the myometrium. With conventional methods of isolating myosin and actomyosin from smooth muscles, microsomes also pass into the extract, leading to an increase in the ATPase activity of KCl extracts not due to myosin ATPase. Therefore, to determine the true ATPase activity of myosin in these cases, it is necessary to separate microsomes from myosin by ultracentrifugation. This underscores the importance of methodological nuances in the biochemical analysis of smooth muscle tissue [4].
Smooth muscles also differ from skeletal musculature in the nature of their contractile activity. The excitability of smooth muscles is significantly lower than that of striated muscle; the conduction of excitation in typical smooth muscles proceeds very slowly; their latent period of contraction is much longer; their chronaxie is very high; plasticity, i.e., the ability to change length without changing tension, is expressed in smooth muscles to a much greater degree than in skeletal muscles, etc. Most importantly, a single contraction of smooth muscle and, especially, its relaxation following contraction, is extremely prolonged in time. This enables the possibility of prolonged maintenance of tone without signs of fatigue.
An interesting feature of some smooth muscles is also their ability to "freeze" or harden, or more precisely, to resist forces attempting to stretch the muscle at a given degree of contraction, without producing continuous energy expenditure. Such maintenance of the muscle in a state of tonic shortening (the locking function of the muscle) is usually not associated with significant change or increase in bioelectrical activity. Clearly expressed action currents from the closing muscle of mollusks are recorded only during rapid closing contractions or when the muscle transitions from one state of tonic shortening to another. During the maintenance of established tone or during very slow relaxation, bioelectrical activity is almost indistinguishable from the resting state. This indicates a fundamentally different, compared to phasic contraction, energetic and electrophysiological basis for tonic function [5].
The locking function of smooth muscle can apparently be viewed as an absence of relaxation or as delayed relaxation. Prolonged multi-hour tonic contraction likely represents nothing more than the superposition of individual contractions, increasingly stretched out in time due to viscous aftereffect. Interestingly, the tonic tension of smooth muscle is associated with an extremely insignificant expenditure of chemical energy, hundreds of times less than that of tetanic tension of corresponding force. Such high energy efficiency is a key adaptive advantage of smooth muscles performing continuous functions in the organism.
The debate about the existence of two substrates of muscle activity—the contraction substrate and the substrate of fatigue-resistant tone, transitioning in some cases into a locking action—was for a long time conducted almost exclusively by morphologists and physiologists. This debate revolved around the question of the existence of functionally and anatomically distinct substrates for tetanic contraction and tonic activity. Some authors believed that tonic activity and phasic muscle contraction are based on two different contractile mechanisms or even two different protein substrates; while others viewed the features of tonic and tetanic muscle activity solely as quantitative, not qualitative differences.
At present, it seems possible to present an accurate picture of the relationship between tetanic and tonic muscle activity. Here and below, the fatigue-resistant plastic tone of smooth muscle is implied. As already mentioned, tonic contraction can indeed be viewed as the summation of extremely slow contraction waves. However, at the same time, it is beyond doubt that the very ability of the muscle for viscous aftereffect, leading to extremely slow relaxation of the contracted muscle, transitioning in some cases into a locking function, is determined by the presence in muscle fibers of a special protein (or protein system) not identical to actomyosin. The very type of muscle organ, its adaptation either to rapid phasic movements or, conversely, to carrying out slowly progressing tonic contraction and prolonged stay in a state of fatigue-resistant tonic shortening, is undoubtedly determined by the fractional composition of myofibrillar proteins. This, of course, does not at all contradict the fact that the same muscle, if it contains both protein substrates, can, depending on stimulation conditions, respond either with a relatively fast twitch or with a slow "tonic" shortening. This kind of view has become possible to substantiate as a result of studying muscles of various types using the latest methods of investigating contractile muscle proteins [6].
Since it is now known that the contraction of the most diverse organs and organelles of movement is caused by a change in the physical state of the proteins of the actomyosin complex or proteins similar in their properties to actomyosin as a result of interaction with ATP, the question of the actomyosin content in muscles of various types was of great interest. Conducted research has established, on the one hand, a pronounced parallelism between the content of actomyosin complex proteins in muscle tissue and the muscle's ability for rapid and strong contractions, and on the other hand, the absence of any correlation between the muscle's ability to develop and maintain tonic resistance to stretching and the content of actomyosin in smooth muscles. Rather the opposite, the lower the content of actomyosin complex proteins in a muscle organ, the more reason to expect it to have a pronounced ability for tonic (locking) function and vice versa. These data indicate that phasic and tonic (locking) activity are based on changes in the physical state of different protein substrates. The development of tone by smooth locking muscle is accompanied by a change in electrical parameters different from that in phasic activity. Other biophysical data also testify to the existence of different mechanisms for phasic and tonic activity. There is a position according to which one can speak not of different mechanisms of fast and slow contraction, but of different mechanisms of contraction and fatigue-resistant resistance to stretching (viscous aftereffect, locking function). However, since the protein substrates of contraction and "viscous aftereffect" in myofibrils are most closely interconnected, contraction and tonic tension of smooth muscle are difficult to consider as independently proceeding processes; rather, they are two components of a single contractile cycle [2, 6].
The pronounced peculiarity of the fractional composition of smooth tonic muscle proteins compared to striated muscle, in particular, the smaller quantity of actomyosin complex proteins in smooth muscles, has been confirmed and demonstrated by a number of authors. These studies made it possible to link the weaker contractile ability of smooth muscle with its relatively low actomyosin content with full certainty. However, the question of the nature of the protein substrate of tonic tension or viscous aftereffect remained completely unclear. The study of this problem was particularly hindered by the circumstance that the development of muscle tone, unlike the act of contraction, cannot be reproduced in model systems, for example, on muscle fibers washed with 50% glycerol.
Nevertheless, a certain idea about the nature of proteins involved in the realization of tonic or locking function of muscles can still be formed on the basis of a detailed study and comparison of the fractional composition of proteins in muscles of different types, adapted, on the one hand, to rapid phasic movements, and on the other—to the development of fatigue-resistant tone. As was established, the fractional composition of proteins of various types of musculature—skeletal, cardiac, stomach and uterine muscle—has significant differences. To one degree or another, these differences concern all major protein groups—myofibrillar, sarcoplasmic, and stromal proteins [7].
From the point of view of the problem under consideration, data on the fractional composition of myofibrillar proteins, extracted from muscle tissue with saline solutions of high ionic strength after preliminary exhaustive extraction of easily soluble sarcoplasmic proteins, are of the greatest importance. The total content of myofibrillar proteins is highest in skeletal muscle, where the nitrogen of these proteins accounts for about 50% of total nitrogen or 57% of muscle protein nitrogen. In the heart and stomach muscles these values are two times lower, and in the uterine muscle the nitrogen of myofibrillar proteins accounts for only 16.7% of total tissue nitrogen or 18% of protein nitrogen, respectively. Upon dialysis against distilled water or upon strong dilution with water of an extract containing all extractable myofibrillar proteins, they can be separated into two groups: 1) proteins soluble in salt media with high ionic strength but precipitating under these conditions, and 2) proteins soluble at low ionic strength, remaining in the supernatant. The latter group of proteins is called the T-fraction. It has been suggested that tropomyosin may play an important role in the locking function of smooth muscle. The content of this protein in the locking muscle of mollusks indeed reaches 30% of the total amount of muscle proteins.
It is necessary to emphasize that in experiments, muscle tissue homogenates were completely freed from sarcoplasmic proteins, and only after that was the extraction of myofibrillar proteins carried out. Consequently, the T-fraction indeed represents myofibrillar proteins soluble at low ionic strength, apparently bound in the living muscle (in myofibrils) to proteins of the actomyosin group. This peculiar complex breaks down into its components during dialysis or upon strong dilution of the salt solution with distilled water. In terms of percentage content of actomyosin complex (AM) proteins, different muscle types differ greatly from each other. If in skeletal muscle the nitrogen of these proteins (AM) constitutes about 40% of total muscle tissue nitrogen or about 45% of protein nitrogen, then in the heart muscle it accounts for about 17.0 and 18.6% respectively (in stomach musculature 11.3 and 12.1% and in myometrium 4.2 and 4.6%). Consequently, the content of myofibrillar proteins insoluble at low ionic strength, i.e., actomyosin complex (AM) proteins, in the uterine muscle is almost 10 times lower than in skeletal muscle. Considering that smooth muscle actomyosin also includes nucleoproteins, which are extracted from muscle pulp and then precipitate during dialysis together with actomyosin, as well as, apparently, a water-insoluble form of tropomyosin, the true content of myosin and actomyosin in smooth muscle is likely even lower.
The percentage content of T-fraction proteins, calculated on total tissue nitrogen or protein, is approximately the same in all muscle types. However, the percentage content of T-fraction proteins, calculated on extractable myofibrillar nitrogen or protein, i.e., in other words, the ratio between the content of actomyosin complex proteins and myofibrillar proteins soluble in salt media with low ionic strength, is not the same for different muscles and represents a very characteristic value for each muscle type. Thus, for skeletal muscle this AM/T ratio is approximately 3.5/1, for cardiac muscle 1.5:1, for stomach musculature 1:1.5 and for uterine muscle 1:3.
Thus, a clear parallelism is revealed between the ability of a muscle for a particular type of physiological activity and the fractional composition of proteins that are integral components of the most functionally important muscle structures—myofibrils. This parallelism cannot be accidental and compels, when studying the nature of the protein substrate of muscle tone, to pay special attention to myofibrillar proteins soluble at low ionic strength, i.e., the T-fraction [8].
The proteins of this fraction were studied using the electrophoretic method. In agreement with literature data, it was established that the T-fraction of skeletal muscle is not homogeneous. It contains a small amount of some protein with high electrophoretic mobility, probably myoalbumin. The main mass of protein separates into two parts upon electrophoresis, of which one (the smaller) is tropomyosin, and the second appears to be another protein. In addition, the T-fraction contains a significant amount of some myofibrillar proteins extremely prone to spontaneous denaturation, apparently similar in their properties to globulins. The T-fraction of cardiac muscle, stomach musculature, and uterus also represents a heterogeneous system in which electrophoresis can establish the presence of at least two to three main subfractions: a water-soluble myofibrillar protein, tropomyosin, and one fast-moving component [9].
The obtained data are fully consistent with the assumption about the important role of tropomyosin and, possibly, other myofibrillar proteins soluble in salt media with low ionic strength, in imparting to smooth tonic muscle its peculiar properties and features in contractile activity. Indeed, tropomyosin solutions can under certain conditions exist in the form of either well-mobile sols or extremely viscous, low-mobility gels. Tropomyosin isolated from invertebrate muscles is almost insoluble in water at pH 7 or 8 and ionic strength 0.15, but its solubility sharply increases in the presence of 0.005 M ATP. ATP is adsorbed on protein particles but does not undergo cleavage, as tropomyosin does not possess ATPase activity. It can thus be thought that the increase in viscosity of muscle fiber proteins during the development of locking action is associated with the transformation of tropomyosin or some of its complexes with other proteins into a gel-like state as a result of desorption of ATP and salt ions from the particles of this protein.
Since the realization of tonic (locking) function is not accompanied by a substantial increase in energy metabolism and is obviously associated with a change in the physical state of proteins not identical to actomyosin, it can be expected that myofibrillar proteins of smooth tonic muscle should possess significantly lower ATPase activity than myosin of skeletal muscles. Especially low should be the ATPase activity of those muscle protein fractions whose change in physical state may be directly related to the development of fatigue-resistant tone, i.e., proteins of the T-fraction. It is known that proteins extracted from smooth tonic muscle indeed possess significantly (10–20 times) lower ATPase activity than myosin of skeletal muscles [2, 10]. It was established that proteins of the T-fraction of skeletal muscle are characterized by particularly low, practically zero, ATPase activity. Extremely low is also the ATPase activity of the T-fraction of stomach, heart, and uterine muscles. On the other hand, the cholinesterase activity of T-fraction proteins is quite pronounced. The highest cholinesterase activity is exhibited by T-fraction proteins of the uterus and, to a lesser degree, of the stomach. All these data are also fully consistent with the assumption about the important role of myofibrillar proteins soluble in salt media with low ionic strength (T-fraction) in the realization of tonic, in particular, locking function of muscles [11].
The proposition concerning the non-identity of the protein substrate of tonic (locking) muscle function to actomyosin has recently found confirmation in the works of a number of foreign authors. It is believed that the substrate of tonic tension in the smooth locking muscle of mollusks is water-insoluble tropomyosin, which is identical to paramyosin. It is particularly important that, according to available data, invertebrate smooth muscle contains two fiber types. Some of them are rich in water-insoluble tropomyosin and exhibit a sharply pronounced ability to resist stretching and a weakly pronounced contractile function. In tropomyosin-poor fibers, this difference between the ability for active contraction and resistance to stretching is expressed to a much lesser degree.
In experiments on frog striated muscles, as well as on mollusk locking muscles, the existence of a direct dependence was shown between the nature of contraction of a single muscle fiber upon stimulation by electric current and the degree of contraction of a washed fiber upon its interaction with ATP. Experiments were conducted on single muscle fibers isolated from tonic and non-tonic bundles. A single muscle fiber was stimulated by induction current in a special chamber, and the nature of contraction was recorded. After assessing the nature of contraction, the same fiber was washed in bidistilled water, after which the degree of its contraction in the presence of ATP was determined. With respect to ATP, muscle fibers could be divided into three groups. Fibers of the first group, contracting by more than 40% upon exposure to ATP and obviously containing a large amount of actomyosin, correspond in terms of physiological contraction type to tetanic fibers. The second group of fibers, reacting weaklier with ATP (contraction by 20–40%), corresponds to mixed or transitional fibers [12]. Finally, the third group comprises fibers contracting very weakly in the presence of ATP; these fibers exhibit a tonic type of contraction when stimulated by induction current.
It was established that in so-called tonic bundles of frog striated muscles and mollusk locking muscles, fibers of all three types are present. The content of transitional fibers in them is especially high. However, the percentage of so-called purely tonic fibers, contracting weakly upon interaction with ATP and obviously containing insignificant amounts of actomyosin, in these bundles is significantly higher than in tetanic areas. Tetanic areas of muscles are characterized, on the contrary, by a very large number of fibers giving a well-expressed contractile reaction with ATP, due to high actomyosin content. Thus, confirmation has been found for the position that the type of contractile response of a muscle fiber is determined primarily by the nature of the protein substrates of contraction and fatigue-resistant tone entering into their composition [2, 13, 14].
The present analysis allows formulating key conclusions regarding the structural and functional organization and molecular bases of the contractile activity of smooth muscle.
Smooth muscle, unlike striated muscle, is evolutionarily specialized for performing long-term tonic functions, which is ensured by its unique physiological properties: high plasticity, low conduction velocity, and exceptional energy efficiency in maintaining tone [15].
Accumulated biochemical and physiological data indicate that these properties cannot be explained solely by quantitative variations of the classical contractile apparatus. There is a convincing inverse correlation between the content of actomyosin complex proteins in the tissue and its tonic capacity, which points to the existence of a qualitatively distinct molecular substrate for tonic function.
Key evidence for this position is the revealed pattern in the change of myofibrillar protein composition. It is shown that in the progression of muscles with increasing tonic function, a systematic decrease occurs in the ratio of the actomyosin complex (AM) to proteins soluble at low ionic strength ("T-fraction"). In the smooth muscle of the uterus, possessing pronounced tonic properties, this ratio reaches 1:3. T-fraction proteins (primarily tropomyosin and related structures) are characterized by minimal ATPase activity, corresponding to low energy expenditure during tone, and are likely capable of reversible changes in aggregate state, forming the basis of "viscous aftereffect."
Thus, the contractile activity of smooth muscle is ensured by the synergy of two molecular systems: 1) the substrate of phasic contraction (actomyosin complex) and 2) the substrate of tonic tension (T-fraction proteins). The dominance of the latter in myofibrils determines the unique functional profile of this tissue.
Consequently, the fundamental determinant underlying the unique ability of smooth muscle for prolonged tonic contractions is the specific protein composition of its myofibrils with a predominance of the "T-fraction" over classical actomyosin [16]. An in-depth study of the interaction mechanisms of these components represents a crucial direction for further research, having both fundamental significance for physiology and applied significance—for developing new approaches to correcting pathologies associated with impaired smooth muscle tone [17].
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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.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
