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Erschienen in: Digestive Diseases and Sciences 6/2014

01.06.2014 | Original Article

Cholecystokinin Mediates Progression and Metastasis of Pancreatic Cancer Associated with Dietary Fat

verfasst von: Gail L. Matters, Timothy K. Cooper, Christopher O. McGovern, Evan L. Gilius, Jiangang Liao, Brian M. Barth, Mark Kester, Jill P. Smith

Erschienen in: Digestive Diseases and Sciences | Ausgabe 6/2014

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Abstract

Background

Obesity and dietary fat are associated with increased risk of several malignancies including pancreatic cancer. The incidence of pancreatic cancer is increased in countries that consume diets high in fat.

Aim

The purpose of this study was to assess the relationship and mechanism of action between dietary fat and endogenous cholecystokinin (CCK) on pancreatic tumor growth and metastasis in an immunocompetent animal model.

Methods

C57BL/6 mice were placed on regular, low-fat, or high-fat diets for 8 weeks before establishment of Panc-02 orthotopic pancreatic tumors. Mice were then treated with a CCK-A receptor antagonist, devazepide, or vehicle for an additional 2.5 weeks. Pancreas tumors were weighed and metastases counted. Blood CCK levels were measured by radioimmunoassay (RIA). Tissues were examined histologically and studied for genes associated with metastasis by RT-PCR array. Effects of the CCK antagonist on Panc-02 cells invasiveness was assessed in a Matrigel invasion assay.

Results

Mice that received the high-fat diet had larger tumors and tenfold higher serum CCK levels by RIA compared to normal diet controls (p < 0.01). Pancreatic tumors in high-fat diet mice treated with the antagonist had fewer intravascular tumor emboli and metastases compared to controls. The reduction in tumor emboli correlated with decreased vascular endothelial growth factor-A (VEGF-A) expression in tumors (p < 6 × 10−9). In vitro invasiveness of Panc-02 cells also was reduced by CCK-A receptor antagonist treatment (p = 1.33 × 10−6).

Conclusion

CCK is a mediator of dietary fat-associated pancreatic cancer. CCK is also involved in the invasiveness of pancreatic tumors through a mechanism involving VEGF-A.
Literatur
1.
2.
Zurück zum Zitat Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144:1252–1261.PubMedCrossRef Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144:1252–1261.PubMedCrossRef
4.
Zurück zum Zitat Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009;301:2553–2562.PubMedCentralPubMedCrossRef Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009;301:2553–2562.PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Roberts DL, Dive C, Renehan AG. Biological mechanisms linking obesity and cancer risk: new perspectives. Annu Rev Med. 2010;61:301–316.PubMedCrossRef Roberts DL, Dive C, Renehan AG. Biological mechanisms linking obesity and cancer risk: new perspectives. Annu Rev Med. 2010;61:301–316.PubMedCrossRef
6.
Zurück zum Zitat Aleman JO, Eusebi LH, Ricciardiello L, et al. Mechanisms of obesity-induced gastrointestinal neoplasia. Gastroenterology. 2014;146:357–373.PubMedCrossRef Aleman JO, Eusebi LH, Ricciardiello L, et al. Mechanisms of obesity-induced gastrointestinal neoplasia. Gastroenterology. 2014;146:357–373.PubMedCrossRef
7.
Zurück zum Zitat White PB, Ziegler KM, Swartz-Basile DA, et al. Obesity, but not high-fat diet, promotes murine pancreatic cancer growth. J Gastrointest Surg. 2012;16:1680–1685.PubMedCrossRef White PB, Ziegler KM, Swartz-Basile DA, et al. Obesity, but not high-fat diet, promotes murine pancreatic cancer growth. J Gastrointest Surg. 2012;16:1680–1685.PubMedCrossRef
8.
Zurück zum Zitat Wang F, Kumagai-Braesch M, Herrington MK, et al. Increased lipid metabolism and cell turnover of MiaPaCa2 cells induced by high-fat diet in an orthotopic system. Metabolism. 2009;58:1131–1136.PubMedCrossRef Wang F, Kumagai-Braesch M, Herrington MK, et al. Increased lipid metabolism and cell turnover of MiaPaCa2 cells induced by high-fat diet in an orthotopic system. Metabolism. 2009;58:1131–1136.PubMedCrossRef
9.
Zurück zum Zitat Dawson DW, Hertzer K, Moro A, et al. High-fat, high-calorie diet promotes early pancreatic neoplasia in the conditional KrasG12D mouse model. Cancer Prev Res (Phila). 2013;6:1064–1073.CrossRef Dawson DW, Hertzer K, Moro A, et al. High-fat, high-calorie diet promotes early pancreatic neoplasia in the conditional KrasG12D mouse model. Cancer Prev Res (Phila). 2013;6:1064–1073.CrossRef
10.
Zurück zum Zitat Lashinger LM, Harrison LM, Rasmussen AJ, et al. Dietary energy balance modulation of Kras- and Ink4a/Arf+/−-driven pancreatic cancer: the role of insulin-like growth factor-I. Cancer Prev Res (Phila). 2013;6:1046–1055.CrossRef Lashinger LM, Harrison LM, Rasmussen AJ, et al. Dietary energy balance modulation of Kras- and Ink4a/Arf+/−-driven pancreatic cancer: the role of insulin-like growth factor-I. Cancer Prev Res (Phila). 2013;6:1046–1055.CrossRef
11.
Zurück zum Zitat Pisani P. Hyper-insulinaemia and cancer, meta-analyses of epidemiological studies. Arch Physiol Biochem. 2008;114:63–70.PubMedCrossRef Pisani P. Hyper-insulinaemia and cancer, meta-analyses of epidemiological studies. Arch Physiol Biochem. 2008;114:63–70.PubMedCrossRef
12.
Zurück zum Zitat Stattin P, Bjor O, Ferrari P, et al. Prospective study of hyperglycemia and cancer risk. Diabetes Care. 2007;30:561–567.PubMedCrossRef Stattin P, Bjor O, Ferrari P, et al. Prospective study of hyperglycemia and cancer risk. Diabetes Care. 2007;30:561–567.PubMedCrossRef
13.
Zurück zum Zitat Stolzenberg-Solomon RZ, Limburg P, Pollak M, et al. Insulin-like growth factor (IGF)-1, IGF-binding protein-3, and pancreatic cancer in male smokers. Cancer Epidemiol Biomark Prev. 2004;13:438–444. Stolzenberg-Solomon RZ, Limburg P, Pollak M, et al. Insulin-like growth factor (IGF)-1, IGF-binding protein-3, and pancreatic cancer in male smokers. Cancer Epidemiol Biomark Prev. 2004;13:438–444.
14.
Zurück zum Zitat Philip B, Roland CL, Daniluk J, et al. A high-fat diet activates oncogenic Kras and COX2 to induce development of pancreatic ductal adenocarcinoma in mice. Gastroenterology. 2013;145:1449–1458.PubMedCrossRef Philip B, Roland CL, Daniluk J, et al. A high-fat diet activates oncogenic Kras and COX2 to induce development of pancreatic ductal adenocarcinoma in mice. Gastroenterology. 2013;145:1449–1458.PubMedCrossRef
16.
Zurück zum Zitat Solomon TE, Petersen H, Elashoff J, et al. Interaction of caerulein and secretin on pancreatic size and composition in rat. Am J Physiol. 1978;235:E714–E719.PubMed Solomon TE, Petersen H, Elashoff J, et al. Interaction of caerulein and secretin on pancreatic size and composition in rat. Am J Physiol. 1978;235:E714–E719.PubMed
17.
Zurück zum Zitat Solomon TE, Vanier M, Morisset J. Cell site and time course of DNA synthesis in pancreas after caerulein and secretin. Am J Physiol. 1983;245:G99–G105.PubMed Solomon TE, Vanier M, Morisset J. Cell site and time course of DNA synthesis in pancreas after caerulein and secretin. Am J Physiol. 1983;245:G99–G105.PubMed
18.
Zurück zum Zitat Lehv M, Fitzgerald PJ. Pancreatic acinar cell regeneration. IV. Regeneration after resection. Am J Pathol. 1968;53:513–535.PubMedCentralPubMed Lehv M, Fitzgerald PJ. Pancreatic acinar cell regeneration. IV. Regeneration after resection. Am J Pathol. 1968;53:513–535.PubMedCentralPubMed
19.
Zurück zum Zitat Elsasser HP, Adler G, Kern HF. Time course and cellular source of pancreatic regeneration following acute pancreatitis in the rat. Pancreas. 1986;1:421–429.PubMedCrossRef Elsasser HP, Adler G, Kern HF. Time course and cellular source of pancreatic regeneration following acute pancreatitis in the rat. Pancreas. 1986;1:421–429.PubMedCrossRef
21.
Zurück zum Zitat Howatson AG, Carter DC. Pancreatic carcinogenesis-enhancement by cholecystokinin in the hamster-nitrosamine model. Br J Cancer. 1985;51:107–114.PubMedCentralPubMedCrossRef Howatson AG, Carter DC. Pancreatic carcinogenesis-enhancement by cholecystokinin in the hamster-nitrosamine model. Br J Cancer. 1985;51:107–114.PubMedCentralPubMedCrossRef
22.
Zurück zum Zitat Carriere C, Young AL, Gunn JR, et al. Acute pancreatitis markedly accelerates pancreatic cancer progression in mice expressing oncogenic Kras. Biochem Biophys Res Commun. 2009;382:561–565.PubMedCentralPubMedCrossRef Carriere C, Young AL, Gunn JR, et al. Acute pancreatitis markedly accelerates pancreatic cancer progression in mice expressing oncogenic Kras. Biochem Biophys Res Commun. 2009;382:561–565.PubMedCentralPubMedCrossRef
23.
Zurück zum Zitat Guerra C, Schuhmacher AJ, Canamero M, et al. Chronic pancreatitis is essential for induction of pancreatic ductal adenocarcinoma by K-Ras oncogenes in adult mice. Cancer Cell. 2007;11:291–302.PubMedCrossRef Guerra C, Schuhmacher AJ, Canamero M, et al. Chronic pancreatitis is essential for induction of pancreatic ductal adenocarcinoma by K-Ras oncogenes in adult mice. Cancer Cell. 2007;11:291–302.PubMedCrossRef
24.
Zurück zum Zitat Smith JP, Rickabaugh CA, McLaughlin PJ, et al. Cholecystokinin receptors and PANC-1 human pancreatic cancer cells. Am J Physiol. 1993;265:G149–G155.PubMed Smith JP, Rickabaugh CA, McLaughlin PJ, et al. Cholecystokinin receptors and PANC-1 human pancreatic cancer cells. Am J Physiol. 1993;265:G149–G155.PubMed
25.
Zurück zum Zitat Smith JP, Liu G, Soundararajan V, et al. Identification and characterization of CCK-B/gastrin receptors in human pancreatic cancer cell lines. Am J Physiol. 1994;266:R277–R283.PubMed Smith JP, Liu G, Soundararajan V, et al. Identification and characterization of CCK-B/gastrin receptors in human pancreatic cancer cell lines. Am J Physiol. 1994;266:R277–R283.PubMed
26.
Zurück zum Zitat Weinberg DS, Ruggeri B, Barber MT, et al. Cholecystokinin A and B receptors are differentially expressed in normal pancreas and pancreatic adenocarcinoma. J Clin Invest. 1997;100:597–603.PubMedCentralPubMedCrossRef Weinberg DS, Ruggeri B, Barber MT, et al. Cholecystokinin A and B receptors are differentially expressed in normal pancreas and pancreatic adenocarcinoma. J Clin Invest. 1997;100:597–603.PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Smith JP, Solomon TE, Bagheri S, et al. Cholecystokinin stimulates growth of human pancreatic adenocarcinoma SW-1990. Dig Dis Sci. 1990;35:1377–1384.PubMedCrossRef Smith JP, Solomon TE, Bagheri S, et al. Cholecystokinin stimulates growth of human pancreatic adenocarcinoma SW-1990. Dig Dis Sci. 1990;35:1377–1384.PubMedCrossRef
28.
Zurück zum Zitat Smith JP, Kramer ST, Solomon TE. CCK stimulates growth of six human pancreatic cancer cell lines in serum-free medium. Regul Pept. 1991;32:341–349.PubMedCrossRef Smith JP, Kramer ST, Solomon TE. CCK stimulates growth of six human pancreatic cancer cell lines in serum-free medium. Regul Pept. 1991;32:341–349.PubMedCrossRef
29.
Zurück zum Zitat Smith JP, Kramer S, Bagheri S. Effects of a high-fat diet and L364,718 on growth of human pancreas cancer. Dig Dis Sci. 1990;35:726–732.PubMedCrossRef Smith JP, Kramer S, Bagheri S. Effects of a high-fat diet and L364,718 on growth of human pancreas cancer. Dig Dis Sci. 1990;35:726–732.PubMedCrossRef
30.
Zurück zum Zitat Corbett TH, Roberts BJ, Leopold WR, et al. Induction and chemotherapeutic response of two transplantable ductal adenocarcinomas of the pancreas in C57BL/6 mice. Cancer Res. 1984;44:717–726.PubMed Corbett TH, Roberts BJ, Leopold WR, et al. Induction and chemotherapeutic response of two transplantable ductal adenocarcinomas of the pancreas in C57BL/6 mice. Cancer Res. 1984;44:717–726.PubMed
31.
Zurück zum Zitat Nikfarjam M, Yeo D, He H, et al. Comparison of two syngeneic orthotopic murine models of pancreatic adenocarcinoma. J Invest Surg. 2013;26:352–359.PubMedCrossRef Nikfarjam M, Yeo D, He H, et al. Comparison of two syngeneic orthotopic murine models of pancreatic adenocarcinoma. J Invest Surg. 2013;26:352–359.PubMedCrossRef
32.
Zurück zum Zitat Matters GL, Harms JF, McGovern CO, et al. Growth of human pancreatic cancer is inhibited by down-regulation of gastrin gene expression. Pancreas. 2009;38:e151–e161.PubMedCentralPubMedCrossRef Matters GL, Harms JF, McGovern CO, et al. Growth of human pancreatic cancer is inhibited by down-regulation of gastrin gene expression. Pancreas. 2009;38:e151–e161.PubMedCentralPubMedCrossRef
33.
Zurück zum Zitat Barrachina MD, Martinez V, Wang L, et al. Synergistic interaction between leptin and cholecystokinin to reduce short-term food intake in lean mice. Proc Natl Acad Sci USA. 1997;94:10455–10460.PubMedCentralPubMedCrossRef Barrachina MD, Martinez V, Wang L, et al. Synergistic interaction between leptin and cholecystokinin to reduce short-term food intake in lean mice. Proc Natl Acad Sci USA. 1997;94:10455–10460.PubMedCentralPubMedCrossRef
34.
Zurück zum Zitat Carrillo J, Garcia-Aragoncillo E, Azorin D, et al. Cholecystokinin down-regulation by RNA interference impairs Ewing tumor growth. Clin Cancer Res. 2007;13:2429–2440.PubMedCrossRef Carrillo J, Garcia-Aragoncillo E, Azorin D, et al. Cholecystokinin down-regulation by RNA interference impairs Ewing tumor growth. Clin Cancer Res. 2007;13:2429–2440.PubMedCrossRef
36.
Zurück zum Zitat Surwit RS, Feinglos MN, Rodin J, et al. Differential effects of fat and sucrose on the development of obesity and diabetes in C57BL/6J and A/J mice. Metabolism. 1995;44:645–651.PubMedCrossRef Surwit RS, Feinglos MN, Rodin J, et al. Differential effects of fat and sucrose on the development of obesity and diabetes in C57BL/6J and A/J mice. Metabolism. 1995;44:645–651.PubMedCrossRef
37.
Zurück zum Zitat Grabowska AM, Watson SA. Role of gastrin peptides in carcinogenesis. Cancer Lett. 2007;257:1–15.PubMedCrossRef Grabowska AM, Watson SA. Role of gastrin peptides in carcinogenesis. Cancer Lett. 2007;257:1–15.PubMedCrossRef
38.
Zurück zum Zitat Lewis LD, Williams JA. Regulation of cholecystokinin secretion by food, hormones, and neural pathways in the rat. Am J Physiol. 1990;258:G512–G518.PubMed Lewis LD, Williams JA. Regulation of cholecystokinin secretion by food, hormones, and neural pathways in the rat. Am J Physiol. 1990;258:G512–G518.PubMed
39.
Zurück zum Zitat Smith JP, Solomon TE. Cholecystokinin and pancreatic cancer: the chicken or the egg? Am J Physiol Gastrointest Liver Physiol. 2014;306:G91–G101.PubMedCrossRef Smith JP, Solomon TE. Cholecystokinin and pancreatic cancer: the chicken or the egg? Am J Physiol Gastrointest Liver Physiol. 2014;306:G91–G101.PubMedCrossRef
40.
Zurück zum Zitat Shiratori K, Takeuchi T, Satake K, et al. Clinical evaluation of oral administration of a cholecystokinin-A receptor antagonist (loxiglumide) to patients with acute, painful attacks of chronic pancreatitis: a multicenter dose-response study in Japan. Pancreas. 2002;25:e1–e5.PubMedCrossRef Shiratori K, Takeuchi T, Satake K, et al. Clinical evaluation of oral administration of a cholecystokinin-A receptor antagonist (loxiglumide) to patients with acute, painful attacks of chronic pancreatitis: a multicenter dose-response study in Japan. Pancreas. 2002;25:e1–e5.PubMedCrossRef
41.
Zurück zum Zitat Lavine JA, Raess PW, Stapleton DS, et al. Cholecystokinin is up-regulated in obese mouse islets and expands beta-cell mass by increasing beta-cell survival. Endocrinology. 2010;151:3577–3588.PubMedCentralPubMedCrossRef Lavine JA, Raess PW, Stapleton DS, et al. Cholecystokinin is up-regulated in obese mouse islets and expands beta-cell mass by increasing beta-cell survival. Endocrinology. 2010;151:3577–3588.PubMedCentralPubMedCrossRef
42.
Zurück zum Zitat Zyromski NJ, Mathur A, Pitt HA, et al. Obesity potentiates the growth and dissemination of pancreatic cancer. Surgery. 2009;146:258–263.PubMedCrossRef Zyromski NJ, Mathur A, Pitt HA, et al. Obesity potentiates the growth and dissemination of pancreatic cancer. Surgery. 2009;146:258–263.PubMedCrossRef
43.
Zurück zum Zitat Weis S, Cui J, Barnes L, et al. Endothelial barrier disruption by VEGF-mediated Src activity potentiates tumor cell extravasation and metastasis. J Cell Biol. 2004;167:223–229.PubMedCentralPubMedCrossRef Weis S, Cui J, Barnes L, et al. Endothelial barrier disruption by VEGF-mediated Src activity potentiates tumor cell extravasation and metastasis. J Cell Biol. 2004;167:223–229.PubMedCentralPubMedCrossRef
44.
Zurück zum Zitat Silha JV, Krsek M, Sucharda P, et al. Angiogenic factors are elevated in overweight and obese individuals. Int J Obes (Lond). 2005;29:1308–1314.CrossRef Silha JV, Krsek M, Sucharda P, et al. Angiogenic factors are elevated in overweight and obese individuals. Int J Obes (Lond). 2005;29:1308–1314.CrossRef
45.
Zurück zum Zitat Wey JS, Fan F, Gray MJ, et al. Vascular endothelial growth factor receptor-1 promotes migration and invasion in pancreatic carcinoma cell lines. Cancer. 2005;104:427–438.PubMedCrossRef Wey JS, Fan F, Gray MJ, et al. Vascular endothelial growth factor receptor-1 promotes migration and invasion in pancreatic carcinoma cell lines. Cancer. 2005;104:427–438.PubMedCrossRef
47.
Zurück zum Zitat Takahashi H, Shibuya M. The vascular endothelial growth factor (VEGF)/VEGF receptor system and its role under physiological and pathological conditions. Clin Sci (Lond). 2005;109:227–241.CrossRef Takahashi H, Shibuya M. The vascular endothelial growth factor (VEGF)/VEGF receptor system and its role under physiological and pathological conditions. Clin Sci (Lond). 2005;109:227–241.CrossRef
48.
Zurück zum Zitat Yang AD, Camp ER, Fan F, et al. Vascular endothelial growth factor receptor-1 activation mediates epithelial to mesenchymal transition in human pancreatic carcinoma cells. Cancer Res. 2006;66:46–51.PubMedCrossRef Yang AD, Camp ER, Fan F, et al. Vascular endothelial growth factor receptor-1 activation mediates epithelial to mesenchymal transition in human pancreatic carcinoma cells. Cancer Res. 2006;66:46–51.PubMedCrossRef
49.
Zurück zum Zitat Seo Y, Baba H, Fukuda T, et al. High expression of vascular endothelial growth factor is associated with liver metastasis and a poor prognosis for patients with ductal pancreatic adenocarcinoma. Cancer. 2000;88:2239–2245.PubMedCrossRef Seo Y, Baba H, Fukuda T, et al. High expression of vascular endothelial growth factor is associated with liver metastasis and a poor prognosis for patients with ductal pancreatic adenocarcinoma. Cancer. 2000;88:2239–2245.PubMedCrossRef
50.
Zurück zum Zitat Berna MJ, Jensen RT. Role of CCK/gastrin receptors in gastrointestinal/metabolic diseases and results of human studies using gastrin/CCK receptor agonists/antagonists in these diseases. Curr Top Med Chem. 2007;7:1211–1231.PubMedCentralPubMedCrossRef Berna MJ, Jensen RT. Role of CCK/gastrin receptors in gastrointestinal/metabolic diseases and results of human studies using gastrin/CCK receptor agonists/antagonists in these diseases. Curr Top Med Chem. 2007;7:1211–1231.PubMedCentralPubMedCrossRef
Metadaten
Titel
Cholecystokinin Mediates Progression and Metastasis of Pancreatic Cancer Associated with Dietary Fat
verfasst von
Gail L. Matters
Timothy K. Cooper
Christopher O. McGovern
Evan L. Gilius
Jiangang Liao
Brian M. Barth
Mark Kester
Jill P. Smith
Publikationsdatum
01.06.2014
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 6/2014
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-014-3201-8

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