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Erschienen in: Digestive Diseases and Sciences 4/2011

01.04.2011 | Original Article

A Role for Intestinal Alkaline Phosphatase in the Maintenance of Local Gut Immunity

verfasst von: Kathryn T. Chen, Madhu S. Malo, Laura Kline Beasley-Topliffe, Klaas Poelstra, Jose Luis Millan, Golam Mostafa, Sayeda N. Alam, Sundaram Ramasamy, H. Shaw Warren, Elizabeth L. Hohmann, Richard A. Hodin

Erschienen in: Digestive Diseases and Sciences | Ausgabe 4/2011

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Abstract

Background and Aims

Intestinal alkaline phosphatase (IAP) is a gut mucosal defense factor known to dephosphorylate lipopolysaccharide (LPS); however, the role of IAP in the gut response to luminal bacteria remains poorly defined. We investigated immune responses of wild-type (WT) and IAP-knockout (IAP-KO) mice to LPS and Salmonella typhimurium challenges.

Methods

Cryostat sectioning and standard indirect immunohistochemical staining for major histocompatibility complex (MHC) class II molecules were performed on liver tissue from WT and IAP-KO mice. WT and IAP-KO mice were orally gavaged with S. typhimurium; bacterial translocation to mesenteric nodes, liver, and spleen was determined by tissue homogenization and plating. In other experiments, WT and IAP-KO mice received intraperitoneal injections of LPS, with subsequent quantification of complete blood counts and serum interleukin (IL)-6 by enzyme-linked immunosorbent assay (ELISA). WT and IAP-KO whole blood were plated and stimulated with LPS and Pam-3-Cys, followed by cytokine assays.

Results

Immunohistologic liver examinations showed increased expression of MHC class II molecules in IAP-KO mice. Following S. typhimurium challenge, WT mice appeared moribund compared with IAP-KO mice, with increased bacterial translocation. WT mice had >50% decrease (P < .005) in platelets and 1.8-fold (P < .05) increased serum IL-6 compared with IAP-KO mice in response to LPS injections. IAP-KO whole-blood stimulation with LPS and Pam-3-Cys resulted in increased IL-6 and tumor necrosis factor (TNF)-alpha secretion compared with WT.

Conclusions

IAP-KO mice exhibit characteristics consistent with local LPS tolerance. Whole-blood response of IAP-KO mice did not reflect systemic tolerance. These data suggest that IAP is a local immunomodulating factor, perhaps regulating LPS–toll-like receptor 4 (TLR4) interaction between commensal microflora and intestinal epithelium.
Literatur
1.
Zurück zum Zitat Goldberg RF, Austen WG Jr, Zhang X, et al. Intestinal alkaline phosphatase is a gut mucosal defense factor maintained by enteral nutrition. Proc Natl Acad Sci U S A. 2008;105(9):3551–3556.PubMedCrossRef Goldberg RF, Austen WG Jr, Zhang X, et al. Intestinal alkaline phosphatase is a gut mucosal defense factor maintained by enteral nutrition. Proc Natl Acad Sci U S A. 2008;105(9):3551–3556.PubMedCrossRef
2.
Zurück zum Zitat Bates JM, Akerlund J, Mittge E, Guillemin K. Intestinal alkaline phosphatase detoxifies lipopolysaccharide and prevents inflammation in zebrafish in response to the gut microbiota. Cell Host Microbe. 2007;2(6):371–382.PubMedCrossRef Bates JM, Akerlund J, Mittge E, Guillemin K. Intestinal alkaline phosphatase detoxifies lipopolysaccharide and prevents inflammation in zebrafish in response to the gut microbiota. Cell Host Microbe. 2007;2(6):371–382.PubMedCrossRef
3.
Zurück zum Zitat Poelstra K, Bakker WW, Klok PA, Kamps JA, Hardonk MJ, Meijer DK. Dephosphorylation of endotoxin by alkaline phosphatase in vivo. Am J Pathol. 1997;151(4):1163–1169.PubMed Poelstra K, Bakker WW, Klok PA, Kamps JA, Hardonk MJ, Meijer DK. Dephosphorylation of endotoxin by alkaline phosphatase in vivo. Am J Pathol. 1997;151(4):1163–1169.PubMed
4.
Zurück zum Zitat Poelstra K, Bakker WW, Klok PA, Hardonk MJ, Meijer DK. A physiologic function for alkaline phosphatase: endotoxin detoxification. Lab Invest. 1997;76(3):319–327.PubMed Poelstra K, Bakker WW, Klok PA, Hardonk MJ, Meijer DK. A physiologic function for alkaline phosphatase: endotoxin detoxification. Lab Invest. 1997;76(3):319–327.PubMed
5.
Zurück zum Zitat Hodin RA, Graham JR, Meng S, Upton MP. Temporal pattern of rat small intestinal gene expression with refeeding. Am J Physiol. 1994;266(1 Pt 1):G83–G89.PubMed Hodin RA, Graham JR, Meng S, Upton MP. Temporal pattern of rat small intestinal gene expression with refeeding. Am J Physiol. 1994;266(1 Pt 1):G83–G89.PubMed
6.
Zurück zum Zitat McClure RJ, Newell SJ. Randomised controlled study of clinical outcome following trophic feeding. Arch Dis Child Fetal Neonatal Ed. 2000;82(1):F29–F33.PubMedCrossRef McClure RJ, Newell SJ. Randomised controlled study of clinical outcome following trophic feeding. Arch Dis Child Fetal Neonatal Ed. 2000;82(1):F29–F33.PubMedCrossRef
7.
Zurück zum Zitat Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma—a prospective, randomized study. J Trauma. 1986;26(10):874–881.PubMedCrossRef Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma—a prospective, randomized study. J Trauma. 1986;26(10):874–881.PubMedCrossRef
8.
Zurück zum Zitat Narisawa S, Huang L, Iwasaki A, Hasegawa H, Alpers DH, Millan JL. Accelerated fat absorption in intestinal alkaline phosphatase knockout mice. Mol Cell Biol. 2003;23(21):7525–7530.PubMedCrossRef Narisawa S, Huang L, Iwasaki A, Hasegawa H, Alpers DH, Millan JL. Accelerated fat absorption in intestinal alkaline phosphatase knockout mice. Mol Cell Biol. 2003;23(21):7525–7530.PubMedCrossRef
9.
Zurück zum Zitat Nakano T, Inoue I, Koyama I, et al. Disruption of the murine intestinal alkaline phosphatase gene Akp3 impairs lipid transcytosis and induces visceral fat accumulation and hepatic steatosis. Am J Physiol Gastrointest Liver Physiol. 2007;292(5):G1439–G1449.PubMedCrossRef Nakano T, Inoue I, Koyama I, et al. Disruption of the murine intestinal alkaline phosphatase gene Akp3 impairs lipid transcytosis and induces visceral fat accumulation and hepatic steatosis. Am J Physiol Gastrointest Liver Physiol. 2007;292(5):G1439–G1449.PubMedCrossRef
10.
Zurück zum Zitat Rath HC, Schultz M, Freitag R, et al. Different subsets of enteric bacteria induce and perpetuate experimental colitis in rats and mice. Infect Immun. 2001;69(4):2277–2285.PubMedCrossRef Rath HC, Schultz M, Freitag R, et al. Different subsets of enteric bacteria induce and perpetuate experimental colitis in rats and mice. Infect Immun. 2001;69(4):2277–2285.PubMedCrossRef
11.
Zurück zum Zitat Elson CO. Experimental models of intestinal inflammation: new insights into mechanisms of mucosal homeostasis. In: M.E.L. Ogro PL, Bienenstock J, Mestecky J, Strober W, McGhee JR, eds. Mucosal Immunology. San Diego: Academic Press; 1999:1007–1024. Elson CO. Experimental models of intestinal inflammation: new insights into mechanisms of mucosal homeostasis. In: M.E.L. Ogro PL, Bienenstock J, Mestecky J, Strober W, McGhee JR, eds. Mucosal Immunology. San Diego: Academic Press; 1999:1007–1024.
12.
Zurück zum Zitat Torres MI, Lorite P, Lopez-Casado MA, Rios A. A new approach using tissue alkaline phosphatase histochemistry to identify Crohn’s disease. Pathol Res Pract. 2007;203(6):485–487.PubMedCrossRef Torres MI, Lorite P, Lopez-Casado MA, Rios A. A new approach using tissue alkaline phosphatase histochemistry to identify Crohn’s disease. Pathol Res Pract. 2007;203(6):485–487.PubMedCrossRef
13.
Zurück zum Zitat Tuin A, Poelstra K, de Jager-Krikken A, et al. Role of alkaline phosphatase in colitis in man and rats. Gut. 2009;58(3):379–387.PubMedCrossRef Tuin A, Poelstra K, de Jager-Krikken A, et al. Role of alkaline phosphatase in colitis in man and rats. Gut. 2009;58(3):379–387.PubMedCrossRef
14.
Zurück zum Zitat Lehner MD, Ittner J, Bundschuh DS, van Rooijen N, Wendel A, Hartung T. Improved innate immunity of endotoxin-tolerant mice increases resistance to Salmonella enterica serovar typhimurium infection despite attenuated cytokine response. Infect Immun. 2001;69(1):463–471.PubMedCrossRef Lehner MD, Ittner J, Bundschuh DS, van Rooijen N, Wendel A, Hartung T. Improved innate immunity of endotoxin-tolerant mice increases resistance to Salmonella enterica serovar typhimurium infection despite attenuated cytokine response. Infect Immun. 2001;69(1):463–471.PubMedCrossRef
15.
Zurück zum Zitat Rayhane N, Fitting C, Lortholary O, Dromer F, Cavaillon JM. Administration of endotoxin associated with lipopolysaccharide tolerance protects mice against fungal infection. Infect Immun. 2000;68(6):3748–3753.PubMedCrossRef Rayhane N, Fitting C, Lortholary O, Dromer F, Cavaillon JM. Administration of endotoxin associated with lipopolysaccharide tolerance protects mice against fungal infection. Infect Immun. 2000;68(6):3748–3753.PubMedCrossRef
16.
Zurück zum Zitat Lu M, Varley AW, Ohta S, Hardwick J, Munford RS. Host inactivation of bacterial lipopolysaccharide prevents prolonged tolerance following gram-negative bacterial infection. Cell Host Microbe. 2008;4(3):293–302.PubMedCrossRef Lu M, Varley AW, Ohta S, Hardwick J, Munford RS. Host inactivation of bacterial lipopolysaccharide prevents prolonged tolerance following gram-negative bacterial infection. Cell Host Microbe. 2008;4(3):293–302.PubMedCrossRef
17.
Zurück zum Zitat Department of Health, E.a.H.S., Publication no. 85–23, N.I.o. Health, Editor. 1985. Department of Health, E.a.H.S., Publication no. 8523, N.I.o. Health, Editor. 1985.
18.
Zurück zum Zitat Enomoto N, Ikejima K, Bradford BU, et al. Role of Kupffer cells and gut-derived endotoxins in alcoholic liver injury. J Gastroenterol Hepatol. 2000;15(Suppl):20–25.CrossRef Enomoto N, Ikejima K, Bradford BU, et al. Role of Kupffer cells and gut-derived endotoxins in alcoholic liver injury. J Gastroenterol Hepatol. 2000;15(Suppl):20–25.CrossRef
19.
Zurück zum Zitat Thurman RG. II. Alcoholic liver injury involves activation of Kupffer cells by endotoxin. Am J Physiol. 1998;275(4 Pt 1):G605–G611.PubMed Thurman RG. II. Alcoholic liver injury involves activation of Kupffer cells by endotoxin. Am J Physiol. 1998;275(4 Pt 1):G605–G611.PubMed
20.
Zurück zum Zitat Jephthah-Ochola J, Urmson J, Farkas S, Halloran PF. Regulation of MHC expression in vivo. Bacterial lipopolysaccharide induces class I and II MHC products in mouse tissues by a T cell-independent, cyclosporine-sensitive mechanism. J Immunol. 1988;141(3):792–800.PubMed Jephthah-Ochola J, Urmson J, Farkas S, Halloran PF. Regulation of MHC expression in vivo. Bacterial lipopolysaccharide induces class I and II MHC products in mouse tissues by a T cell-independent, cyclosporine-sensitive mechanism. J Immunol. 1988;141(3):792–800.PubMed
21.
Zurück zum Zitat Kaufman JF, Auffray C, Korman AJ, Shackelford DA, Strominger J. The class II molecules of the human and murine major histocompatibility complex. Cell. 1984;36(1):1–13.PubMedCrossRef Kaufman JF, Auffray C, Korman AJ, Shackelford DA, Strominger J. The class II molecules of the human and murine major histocompatibility complex. Cell. 1984;36(1):1–13.PubMedCrossRef
22.
Zurück zum Zitat Takahashi M, Ogasawara K, Takeda K, et al. LPS induces NK1.1+ alpha beta T cells with potent cytotoxicity in the liver of mice via production of IL-12 from Kupffer cells. J Immunol. 1996;156(7):2436–2442.PubMed Takahashi M, Ogasawara K, Takeda K, et al. LPS induces NK1.1+ alpha beta T cells with potent cytotoxicity in the liver of mice via production of IL-12 from Kupffer cells. J Immunol. 1996;156(7):2436–2442.PubMed
23.
Zurück zum Zitat Franco A, Barnaba V, Natali P, Balsano C, Musca A, Balsano F. Expression of class I and class II major histocompatibility complex antigens on human hepatocytes. Hepatology. 1988;8(3):449–454.PubMedCrossRef Franco A, Barnaba V, Natali P, Balsano C, Musca A, Balsano F. Expression of class I and class II major histocompatibility complex antigens on human hepatocytes. Hepatology. 1988;8(3):449–454.PubMedCrossRef
24.
Zurück zum Zitat Wiegard C, Wolint P, Frenzel C, et al. Defective T helper response of hepatocyte-stimulated CD4 T cells impairs antiviral CD8 response and viral clearance. Gastroenterology. 2007;133(6):2010–2018.PubMedCrossRef Wiegard C, Wolint P, Frenzel C, et al. Defective T helper response of hepatocyte-stimulated CD4 T cells impairs antiviral CD8 response and viral clearance. Gastroenterology. 2007;133(6):2010–2018.PubMedCrossRef
25.
Zurück zum Zitat Coffee KA, Halushka PV, Wise WC, Tempel GE, Cook JA. Endotoxin tolerance differentially alters hemodynamic responses to a thromboxane A2 mimetic and phenylephrine. J Cardiovasc Pharmacol. 1991;17(1):20–26.PubMedCrossRef Coffee KA, Halushka PV, Wise WC, Tempel GE, Cook JA. Endotoxin tolerance differentially alters hemodynamic responses to a thromboxane A2 mimetic and phenylephrine. J Cardiovasc Pharmacol. 1991;17(1):20–26.PubMedCrossRef
26.
Zurück zum Zitat Beeson PB. Development of tolerance to typhoid bacterial pyrogen and its abolition by reticulo-endothelial blockade. Proc Soc Exp Biol Med. 1946;61:248–250.PubMed Beeson PB. Development of tolerance to typhoid bacterial pyrogen and its abolition by reticulo-endothelial blockade. Proc Soc Exp Biol Med. 1946;61:248–250.PubMed
27.
Zurück zum Zitat Garg S, Bal V, Rath S, George A. Effect of multiple antigenic exposures in the gut on oral tolerance and induction of antibacterial systemic immunity. Infect Immun. 1999;67(11):5917–5924.PubMed Garg S, Bal V, Rath S, George A. Effect of multiple antigenic exposures in the gut on oral tolerance and induction of antibacterial systemic immunity. Infect Immun. 1999;67(11):5917–5924.PubMed
28.
Zurück zum Zitat Favorite GO, Morgan HR. Effects produced by the intravenous injection in man of a toxic antigenic material derived from eberthella typhosa: clinical, hematological, chemical and serological studies. J Clin Invest. 1942;21(5):589–599.PubMedCrossRef Favorite GO, Morgan HR. Effects produced by the intravenous injection in man of a toxic antigenic material derived from eberthella typhosa: clinical, hematological, chemical and serological studies. J Clin Invest. 1942;21(5):589–599.PubMedCrossRef
29.
Zurück zum Zitat Greisman SE, Woodward WE. Mechanisms of endotoxin tolerance. 3. The refractory state during continuous intravenous infusions of endotoxin. J Exp Med. 1965;121:911–933.PubMedCrossRef Greisman SE, Woodward WE. Mechanisms of endotoxin tolerance. 3. The refractory state during continuous intravenous infusions of endotoxin. J Exp Med. 1965;121:911–933.PubMedCrossRef
30.
Zurück zum Zitat Madonna GS, Peterson JE, Ribi EE, Vogel SN. Early-phase endotoxin tolerance: induction by a detoxified lipid A derivative, monophosphoryl lipid A. Infect Immun. 1986;52(1):6–11.PubMed Madonna GS, Peterson JE, Ribi EE, Vogel SN. Early-phase endotoxin tolerance: induction by a detoxified lipid A derivative, monophosphoryl lipid A. Infect Immun. 1986;52(1):6–11.PubMed
31.
Zurück zum Zitat Henricson BE, Benjamin WR, Vogel SN. Differential cytokine induction by doses of lipopolysaccharide and monophosphoryl lipid A that result in equivalent early endotoxin tolerance. Infect Immun. 1990;58(8):2429–2437.PubMed Henricson BE, Benjamin WR, Vogel SN. Differential cytokine induction by doses of lipopolysaccharide and monophosphoryl lipid A that result in equivalent early endotoxin tolerance. Infect Immun. 1990;58(8):2429–2437.PubMed
32.
Zurück zum Zitat Mathison JC, Ulevitch RJ. The clearance, tissue distribution, and cellular localization of intravenously injected lipopolysaccharide in rabbits. J Immunol. 1979;123(5):2133–2143.PubMed Mathison JC, Ulevitch RJ. The clearance, tissue distribution, and cellular localization of intravenously injected lipopolysaccharide in rabbits. J Immunol. 1979;123(5):2133–2143.PubMed
33.
Zurück zum Zitat Munford RS, Hall CL, Lipton JM, Dietschy JM. Biological activity, lipoprotein-binding behavior, and in vivo disposition of extracted and native forms of Salmonella typhimurium lipopolysaccharides. J Clin Invest. 1982;70(4):877–888.PubMedCrossRef Munford RS, Hall CL, Lipton JM, Dietschy JM. Biological activity, lipoprotein-binding behavior, and in vivo disposition of extracted and native forms of Salmonella typhimurium lipopolysaccharides. J Clin Invest. 1982;70(4):877–888.PubMedCrossRef
34.
Zurück zum Zitat Munford RS, Hall CL, Dietschy JM. Binding of Salmonella typhimurium lipopolysaccharides to rat high-density lipoproteins. Infect Immun. 1981;34(3):835–843.PubMed Munford RS, Hall CL, Dietschy JM. Binding of Salmonella typhimurium lipopolysaccharides to rat high-density lipoproteins. Infect Immun. 1981;34(3):835–843.PubMed
35.
Zurück zum Zitat Vesy CJ, Kitchens RL, Wolfbauer G, Albers JJ, Munford RS. Lipopolysaccharide-binding protein and phospholipid transfer protein release lipopolysaccharides from gram-negative bacterial membranes. Infect Immun. 2000;68(5):2410–2417.PubMedCrossRef Vesy CJ, Kitchens RL, Wolfbauer G, Albers JJ, Munford RS. Lipopolysaccharide-binding protein and phospholipid transfer protein release lipopolysaccharides from gram-negative bacterial membranes. Infect Immun. 2000;68(5):2410–2417.PubMedCrossRef
36.
Zurück zum Zitat Wurfel MM, Kunitake ST, Lichenstein H, Kane JP, Wright SD. Lipopolysaccharide (LPS)-binding protein is carried on lipoproteins and acts as a cofactor in the neutralization of LPS. J Exp Med. 1994;180(3):1025–1035.PubMedCrossRef Wurfel MM, Kunitake ST, Lichenstein H, Kane JP, Wright SD. Lipopolysaccharide (LPS)-binding protein is carried on lipoproteins and acts as a cofactor in the neutralization of LPS. J Exp Med. 1994;180(3):1025–1035.PubMedCrossRef
37.
Zurück zum Zitat Kitchens RL, Thompson PA, Viriyakosol S, O’Keefe GE, Munford RS. Plasma CD14 decreases monocyte responses to LPS by transferring cell-bound LPS to plasma lipoproteins. J Clin Invest. 2001;108(3):485–493.PubMed Kitchens RL, Thompson PA, Viriyakosol S, O’Keefe GE, Munford RS. Plasma CD14 decreases monocyte responses to LPS by transferring cell-bound LPS to plasma lipoproteins. J Clin Invest. 2001;108(3):485–493.PubMed
38.
Zurück zum Zitat Asari Y, Majima M, Sugimoto K, Katori M, Ohwada T. Release site of TNF alpha after intravenous and intraperitoneal injection of LPS from Escherichia coli in rats. Shock. 1996;5(3):208–212.PubMedCrossRef Asari Y, Majima M, Sugimoto K, Katori M, Ohwada T. Release site of TNF alpha after intravenous and intraperitoneal injection of LPS from Escherichia coli in rats. Shock. 1996;5(3):208–212.PubMedCrossRef
39.
Zurück zum Zitat Sugimoto K, Kawamura M, Katori M, Shindo M, Ohwada T. Transmigration routes and a delayed systemic hypotension in rats after intraperitoneal injection of endotoxin from Escherichia coli. Circ Shock. 1993;41(3):185–196.PubMed Sugimoto K, Kawamura M, Katori M, Shindo M, Ohwada T. Transmigration routes and a delayed systemic hypotension in rats after intraperitoneal injection of endotoxin from Escherichia coli. Circ Shock. 1993;41(3):185–196.PubMed
40.
Zurück zum Zitat Ghezzi P, Sacco S, Agnello D, Marullo A, Caselli G, Bertini R. LPS induces IL-6 in the brain and in serum largely through TNF production. Cytokine. 2000;12(8):1205–1210.PubMedCrossRef Ghezzi P, Sacco S, Agnello D, Marullo A, Caselli G, Bertini R. LPS induces IL-6 in the brain and in serum largely through TNF production. Cytokine. 2000;12(8):1205–1210.PubMedCrossRef
41.
Zurück zum Zitat Fitting C, Dhawan S, Cavaillon JM. Compartmentalization of tolerance to endotoxin. J Infect Dis. 2004;189(7):1295–1303.PubMedCrossRef Fitting C, Dhawan S, Cavaillon JM. Compartmentalization of tolerance to endotoxin. J Infect Dis. 2004;189(7):1295–1303.PubMedCrossRef
42.
Zurück zum Zitat Rakoff-Nahoum S, Paglino J, Eslami-Varzaneh F, Edberg S, Medzhitov R. Recognition of commensal microflora by toll-like receptors is required for intestinal homeostasis. Cell. 2004;118(2):229–241.PubMedCrossRef Rakoff-Nahoum S, Paglino J, Eslami-Varzaneh F, Edberg S, Medzhitov R. Recognition of commensal microflora by toll-like receptors is required for intestinal homeostasis. Cell. 2004;118(2):229–241.PubMedCrossRef
43.
Zurück zum Zitat Madara J. Building an intestine—architectural contributions of commensal bacteria. N Engl J Med. 2004;351(16):1685–1686.PubMedCrossRef Madara J. Building an intestine—architectural contributions of commensal bacteria. N Engl J Med. 2004;351(16):1685–1686.PubMedCrossRef
44.
Zurück zum Zitat Ohno A, Isii Y, Tateda K, et al. Role of LPS length in clearance rate of bacteria from the bloodstream in mice. Microbiology. 1995;141(Pt 10):2749–2756.PubMedCrossRef Ohno A, Isii Y, Tateda K, et al. Role of LPS length in clearance rate of bacteria from the bloodstream in mice. Microbiology. 1995;141(Pt 10):2749–2756.PubMedCrossRef
Metadaten
Titel
A Role for Intestinal Alkaline Phosphatase in the Maintenance of Local Gut Immunity
verfasst von
Kathryn T. Chen
Madhu S. Malo
Laura Kline Beasley-Topliffe
Klaas Poelstra
Jose Luis Millan
Golam Mostafa
Sayeda N. Alam
Sundaram Ramasamy
H. Shaw Warren
Elizabeth L. Hohmann
Richard A. Hodin
Publikationsdatum
01.04.2011
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 4/2011
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-010-1396-x

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