Skip to main content

Cystinosis

  • Reference work entry
Pediatric Nephrology

Abstract

Nephropathic cystinosis (13) deserves a special place in the annals of clinical medicine as the first treatable lysosomal storage disease. The pathophysiology itself, based upon the formation of cystine crystals within the lysosomes of cells, is remarkable. The presence of cystine crystals provides a clue to the basic defect in cystinosis, i.e., failure to transport of cystine out of lysosomes (46).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 369.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kleta R, Gahl W (updated October 2005). Cystinosis. In: GeneReviews at GeneTests: Medical Genetics Information Resource [database online]. Copyright, University of Washington, Seattle. 1997–2003. Available at www.genetests.org. (June, 2003).

  2. Gahl WA, Thoene JG, Schneider JA. Cystinosis. N Engl J Med 2002;347:111–121.

    Article  PubMed  Google Scholar 

  3. Gahl WA, Thoene JG, Schneider JA. Cystinosis: a disorder of lysosomal membrane transport. In The Metabolic and Molecular Bases of Inherited Disease, vol. 4, 8th edn., Scriver CR, Beaudet AL, Sly WS, Valle DL, Vogelstein B (eds.). New York, McGraw-Hill, 2001, pp. 5085–5108.

    Google Scholar 

  4. Gahl WA, Bashan N, Tietze F et al. Cystine transport is defective in isolated leukocyte lysosomes from patients with cystinosis. Science 1982;217:1263–1265.

    Article  PubMed  CAS  Google Scholar 

  5. Gahl WA, Tietze F, Bashan N et al. Defective cystine exodus from isolated lysosome-rich fractions of cystinotic leucocytes. J Biol Chem 1982;257:9570–9575.

    PubMed  CAS  Google Scholar 

  6. Jonas AJ, Smith ML, Schneider JA. ATP-dependent lysosomal cystine efflux is defective in cystinosis. J Biol Chem 1982;257:13185–13188.

    PubMed  CAS  Google Scholar 

  7. Thoene JG, Oshima RG, Crawhall JA et al. Cystinosis. Intracellular cystine depletion by aminothiols in vitro and in vivo. J Clin Invest 1976;58:180–189.

    Article  PubMed  CAS  Google Scholar 

  8. Gahl WA, Reed GF, Thoene JG et al. Cysteamine therapy for children with nephropathic cystinosis. N Engl J Med 1987;316:971–977.

    Article  PubMed  CAS  Google Scholar 

  9. Markello TC, Bernardini IM, Gahl WA. Improved renal function in children with cystinosis treated with cysteamine. N Engl J Med 1993;328:1157–1162.

    Article  PubMed  CAS  Google Scholar 

  10. Kaiser-Kupfer MI, Fujikawa L, Kuwabara T, Gahl WA. Removal of corneal crystals by topical cysteamine in nephropathic cystinosis. N Engl J Med 1987;316:775–779.

    Article  PubMed  CAS  Google Scholar 

  11. Kaiser-Kupfer MI, Gazzo MA, Datiles MB et al. A randomized placebo-controlled trial of cysteamine eyedrops in nephropathic cystinosis. Arch Ophthalmol 1990;108:689–693.

    Article  PubMed  CAS  Google Scholar 

  12. Gahl WA, Kuehl EM, Iwata F et al. Corneal crystals in nephropathic cystinosis: natural history and treatment with cysteamine eyedrops. Mol Genet Metab 2000;71:100–121.

    Article  PubMed  CAS  Google Scholar 

  13. Abderhalden E. Familiare cystindiathese. Z Physiol Chem 1903;38:557–561.

    Article  CAS  Google Scholar 

  14. Dent CE. The amino-aciduria in Fanconi syndrome. A study making extensive use of techniques based on paper partition chromatography. Biochem J 1947;41:240–253.

    PubMed  CAS  Google Scholar 

  15. Schulman JD, Bradley KH, Seegmiller JE. Cystine: compartmentalization within lysosomes in cystinotic leukocytes. Science 1969;166:1152–1154.

    Article  PubMed  CAS  Google Scholar 

  16. Theodoropoulos DS, Krasnewich D, Kaiser-Kupfer MI, Gahl WA. Classical nephropathic cystinosis as an adult disease. JAMA 1993;270:2200–2204.

    Article  PubMed  CAS  Google Scholar 

  17. Gahl WA, Balog JZ, Kleta R. Nephropathic cystinosis in adults: natural history and effects of oral cysteamine therapy. Annals Intern Med 2007;147:242–250.

    Google Scholar 

  18. Segal S, Their SO. Cystinuria. In The Metabolic Basis of Inherited Disease, 5th edn. Stanbury JB, Wyngaarden JB, Fredrickson DS et al. (eds.). New York, McGraw-Hill, 1983, pp. 1774–1791.

    Google Scholar 

  19. Patrick AD, Lake BD. Cystinosis: electron microscopic evidence of lysosomal storage of cystine in lymph node. J Clin Pathol 1968;21:571–575.

    Article  PubMed  CAS  Google Scholar 

  20. Tietze F, Bradley KH, Schulman JD. Enzymatic reduction of cystine by subcellular fractions of cultured and peripheral leukocytes from normal and cystinotic individuals. Pediatr Res 1972;6:649–658.

    Article  PubMed  CAS  Google Scholar 

  21. Steinherz R, Tietze F, Gahl WA et al. Cystine accumulation and clearance by normal and cystinotic leukocytes exposed to cystine dimethylester. Proc Natl Acad Sci USA 1982;79:4446–4450.

    Article  PubMed  CAS  Google Scholar 

  22. Gahl WA, Tietze F, Bashan N et al. Characteristics of cystine counter-transport in normal and cystinotic lysosome-rich leucocyte granular fraction. Biochem J 1983;216:393–400.

    PubMed  CAS  Google Scholar 

  23. Gahl WA, Bashan N, Tietze F, Schulman JD. Lysosomal cystine counter-transport in the detection of heterozygotes for cystinosis. Am J Hum Genet 1984;36:277–282.

    PubMed  CAS  Google Scholar 

  24. Town M, Jean G, Cherqui S et al. A novel gene encoding an integral membrane protein is mutated in nephropathic cystinosis. Nature Genet 1998;18:319–324.

    Article  PubMed  CAS  Google Scholar 

  25. Kalatzis V, Cherqui S, Antignac C, Gasnier B. Cystinosis, the protein defective in cystinosis, is a H+-driven lysosomal cystine transporter. EMBO J 2001;20:5940–5949.

    Article  PubMed  CAS  Google Scholar 

  26. Jonas AJ, Conley SB, Marshall R et al. Nephropathic cystinosis with central nervous system involvement. Am J Med 1987;83:966–970.

    Article  PubMed  CAS  Google Scholar 

  27. Mahoney CP, Striker GE. Early development of the renal lesions in infantile cystinosis. Pediatr Nephrol 2000;15:50–56.

    Article  PubMed  CAS  Google Scholar 

  28. Wong VG, Leitman PS, Seegmiller JE. Alterations of pigment epithelium in cystinosis. Arch Ophthalmol 1967;77:361–369.

    Article  PubMed  CAS  Google Scholar 

  29. Kaiser-Kupfer MI, Caruso RC, Minckler DS, Gahl WA. Long-term ocular manifestations in nephropathic cystinosis post-renal transplantation. Arch Ophthalmol 1986;104:706–711.

    Article  PubMed  CAS  Google Scholar 

  30. Gahl WA, Dalakas M, Charnas L et al. Myopathy and cystine storage in muscles in a patient with nephropathic cystinosis. N Engl J Med 1988;319:1461–1464.

    Article  PubMed  CAS  Google Scholar 

  31. Charnas L, Luciano C, Dalakas M et al. Distal vacuolar myopathy in nephropathic cystinosis. Annals Neurol 1994;35:181–188.

    Article  CAS  Google Scholar 

  32. O’Brien K, Hussain N, Warady B et al. Nodular regenerative hyperplasia and severe portal hypertension in cystinosis. Clin Gastroenterol & Hepatol 2006;4:387–394.

    Article  Google Scholar 

  33. Park M, Helip-Wooley A, Thoene J. Lysosomal cystine storage augments apoptosis in cultured human fibroblasts and renal tubular epithelial cells. J Am Soc Nephrol 2002;13:2878–2887.

    Article  PubMed  CAS  Google Scholar 

  34. Bois E, Feingold J, Frenay P, Briard ML. Infantile cystinosis in France: genetics, incidence, geographic distribution. J Med Genet 1976;13:434–438.

    Article  PubMed  CAS  Google Scholar 

  35. McDowell GA, Gahl WA, Stephenson L et al. Linkage of the gene for cystinosis to markers on the short arm of chromosome 17. Nature Genet 1995;10:246–248.

    Article  Google Scholar 

  36. Shotelersuk V, Larson D, Anikster Y et al. CTNS mutations in an American-based population of cystinosis patients. Am J Hum Genet 1998;63:1352–1362.

    Article  PubMed  CAS  Google Scholar 

  37. Attard M, Jean G, Forestier L et al. Severity of phenotype in cystinosis varies with mutations in the CTNS gene: predicted effect on the model of cystinosin. Hum Mol Genet 1999;8:2507–2514.

    Article  PubMed  CAS  Google Scholar 

  38. Phornphutkul C, Anikster Y, Huizing M et al. The promoter of a lysosomal membrane transporter gene, CTNS, binds Sp-1, shares sequences with the promoter of an adjacent gene (CARKL), and causes cystinosis if mutated in a critical region. Am J Hum Genet 2001;69:712–721.

    Article  PubMed  CAS  Google Scholar 

  39. Touchman JW, Anikster Y, Dietrich NL et al. The genomic region encompassing the nephropathic cystinosis gene (CTNS): complete sequencing of a 200-kb segment and discovery of a novel gene within the common cystinosis-causing deletion. Genome Res 2000;10:165–173.

    Article  PubMed  CAS  Google Scholar 

  40. Anikster Y, Lucero C, Touchman JW et al. Identification and detection of the common 65-kb deletion breakpoint in the nephropathic cystinosis gene (CTNS). Mol Genet Metab 1999;66:111–116.

    Article  PubMed  CAS  Google Scholar 

  41. McGowan-Jordan J, Stoddard K, Podolsky L et al. Molecular analysis of cystinosis: probable Irish origin of the most common French Canadian mutation. Eur J Hum Genet 1999;7:671–678.

    Article  PubMed  CAS  Google Scholar 

  42. Rupar CA, Matsell D, Surry S, Siu V. A G339R mutation in the CTNS gene is a common cause of nephropathic cystinosis in the south western Ontario Amish Mennonite population. J Med Genet 2001;38:615–616.

    Article  PubMed  CAS  Google Scholar 

  43. Thoene J, Lemons R, Anikster Y et al. Mutations of CTNS causing intermediate cystinosis. Mol Genet Metab 1999;67:283–293.

    Article  PubMed  CAS  Google Scholar 

  44. Gahl WA, Tietze F. Lysosomal cystine transport in cystinosis variants and their parents. Pediatr Res 1987;21:193–196.

    Article  PubMed  CAS  Google Scholar 

  45. Anikster Y, Lucero C, Guo J et al. Ocular, non-nephropathic cystinosis: clinical, biochemical and molecular correlations. Pediatr Res 2000;47:17–23.

    Article  PubMed  CAS  Google Scholar 

  46. Cherqui CS, Sevin C, Kalatzis V et al. Generation and characterization of a cystinosis murine model. J Am Soc Nephrol 2001;12:A2856.

    Google Scholar 

  47. Gahl WA. Cystinosis coming of age. Adv Pediatr 1986;33:95–126.

    PubMed  CAS  Google Scholar 

  48. Theodoropoulos DS, Shawker TH, Heinrichs C, Gahl WA. Medullary nephrocalcinosis in nephropathic cystinosis. Pediatr Nephrol 1995;9:412–418.

    Article  PubMed  CAS  Google Scholar 

  49. Gahl WA, Bernardini I, Dalakas M et al. Oral carnitine therapy in children with cystinosis and renal Fanconi syndrome. J Clin Invest 1988;81:549–560.

    Article  PubMed  CAS  Google Scholar 

  50. Charnas LR, Bernardini I, Rader D et al. Clinical and laboratory findings in the Oculocerebrorenal Syndrome of Lowe, with special reference to growth and renal function. N Engl J Med 1991;324:1318–1325.

    Article  PubMed  CAS  Google Scholar 

  51. Middleton R, Bradbury M, Webb N et al. Cystinosis. A clinicopathological conference. “From toddlers to twenties and beyond” Adult-Paediatric Nephrology Interface Meeting, Manchester 2001. Nephrol Dial Transplant 2003;18:2492–2495.

    Article  PubMed  Google Scholar 

  52. Gretz N, Manz F, Augustin R et al. Survival time in cystinosis. A collaborative study. Proc Eur Dial Transplant Assoc 1983;19:582–589.

    PubMed  CAS  Google Scholar 

  53. Lucky AW, Howley PM, Megyesi K et al. Endocrine studies in cystinosis: compensated primary hypothyroidism. J Pediatr 1977;91:204–210.

    Article  PubMed  CAS  Google Scholar 

  54. Wuhl E, Haffner D, Gretz N et al. Treatment with recombinant human growth hormone in short children with nephropathic cystinosis: no evidence for increased deterioration rate of renal function. Pediatr Res 1998;43:484–488.

    Article  PubMed  CAS  Google Scholar 

  55. Gahl WA, Schneider JA, Thoene JG, Chesney R. The course of nephropathic cystinosis after age 10 years. J Pediatr 1986;109:605–608.

    Article  PubMed  CAS  Google Scholar 

  56. Kimonis VE, Troendle J, Yang ML et al. Effects of early cysteamine therapy on thyroid function and growth in nephropathic cystinosis. J Clin Endocrinol Metab 1995;80:3257–3561.

    Article  PubMed  CAS  Google Scholar 

  57. Bercu BB, Orloff S, Schulman JD. Partial pituitary resistance to thyroid hormone in cystinosis. J Clin Endocrinol Metab 1980;51:1262–1268.

    Article  PubMed  CAS  Google Scholar 

  58. Spilkin AM, Ballantyne AO, Babchuck LR, Trauner DA. Non-verbal deficits in young children with a genetic metabolic disorder: WPPSI-III performance in cystinosis. Am J Med Genet B Neuropsychiatr Genet 2007;144:444–447.

    Google Scholar 

  59. Wolff G, Ehrich JH, Offner G, Brodehl J. Psychosocial and intellectual development in 12 patients with infantile nephropathic cystinosis. Acta Paediatr Scand 1982;71:1007–1011.

    Article  PubMed  CAS  Google Scholar 

  60. Colah S, Trauner DA. Tactile recognition in infantile nephropathic cystinosis. Dev Med Child Neurol 1997;39:409–413.

    Article  PubMed  CAS  Google Scholar 

  61. Ballantyne AO, Trauner DA. Neurobehavioral consequences of a genetic metabolic disorder: visual processing deficits in infantile nephropathic cystinosis. Neuropsychiatry Neuropsychol Behav Neurol 2000;13:254–263.

    PubMed  CAS  Google Scholar 

  62. Nichols SL, Press GA, Schneider JA, Trauner DA. Cortical atrophy and cognitive performance in infantile nephropathic cystinosis. Pediatr Neurol 1990;6:379–381.

    Article  PubMed  CAS  Google Scholar 

  63. Delgado G, Schatz A, Nichols S et al. Behavioral profiles of children with infantile nephropathic cystinosis. Dev Med Child Neurol 2005;47:403–407.

    Article  PubMed  Google Scholar 

  64. Avner ED, Ellis D, Jaffe R. Veno-occlusive disease of the liver associated with cysteamine treatment of nephropathic cystinosis. J Pediatr 1983;102:793–796.

    Article  PubMed  CAS  Google Scholar 

  65. Gahl WA, Hubbard VS, Orloff S. Decreased sweat production in cystinosis. J Pediatr 1984;104:904–905.

    Article  PubMed  CAS  Google Scholar 

  66. Dogulu CF, Tsilou E, Rubin B et al. Idiopathic intracranial hypertension in cystinosis. J Pediatr 2004;145:673–678.

    Article  PubMed  Google Scholar 

  67. Schneider JA, Bradley K, Seegmiller JE. Increased cystine in leukocytes from individuals homozygous and heterozygous for cystinosis. Science 1967;157:1321–1322.

    Article  PubMed  CAS  Google Scholar 

  68. Oshima RG, Willis RC, Furlong CE, Schneider JA. Binding assays for amino acids. The utilization of a cystine binding protein from Escherichia coli for the determination of acid-soluble cystine in small physiological samples. J Biol Chem 1974;249:6033–6039.

    PubMed  CAS  Google Scholar 

  69. Smith ML, Pellet OL, Cass MM et al. Prenatal diagnosis of cystinois utilizing chorionic villus sampling. Prenat Diagn 1987;7:23–26.

    Article  PubMed  CAS  Google Scholar 

  70. Schneider JA, Verroust FM, Kroll WA et al. Prenatal diagnosis of cystinosis. N Engl J Med 1974;290:878–882.

    Article  PubMed  CAS  Google Scholar 

  71. Smith ML, Clark KF, Davis SE et al. Diagnosis of cystinosis with use of placenta. N Engl J Med 1989;321:397–398.

    Article  PubMed  CAS  Google Scholar 

  72. Palacin M, Goodyer P, Nunes V, Gasparini P. Cystinuria. In The Metabolic and Molecular Bases of Inherited Disease, vol. 4, 8th edn., Scriver CR, Beaudet AL, Sly WS, Valle DL, Vogelstein B (eds.). New York, McGraw-Hill, 2001, pp. 4909–4932.

    Google Scholar 

  73. Pisoni RL, Thoene JG, Christensen HN. Detection and characterization of carrier-mediated cationic amino acid transport in lysosomes of normal and cystinotic human fibroblasts. J Biol Chem 1985;260:4791–4798.

    PubMed  CAS  Google Scholar 

  74. Schneider JA, Schlesselman JJ, Mendoza SA et al. Ineffectiveness of ascorbic acid therapy in nephropathic cystinosis. N Engl J Med 1979;300:756–759.

    Article  PubMed  CAS  Google Scholar 

  75. Gahl WA, Schneider JA, Aula PP. Lysosomal transport disorders: cystinosis and sialic acid storage disorders. In The metabolic and Molecular Bases of Inherited Disease, vol. 3, 7th edn., Scriver CR, Beaudet AL, Sly WS, Valle DL (eds.). New York, McGraw-Hill, 1995, pp. 3763–3797.

    Google Scholar 

  76. Gahl WA, Ingelfinger J, Mohan P et al. Intravenous cysteamine therapy for nephropathic cystinosis. Pediatr Res 1995;38:579–584.

    Article  PubMed  CAS  Google Scholar 

  77. Kleta R, Bernardini I, Ueda M et al. Long-term follow-up of well-treated nephropathic cystinosis patients. J Pediatr 2004;145:555–560.

    Article  PubMed  Google Scholar 

  78. Corden BJ, Schulman JD, Schneider JA, Thoene JG. Adverse reactions to oral cysteamine use in nephropathic cystinosis. Dev Pharmacol Therapeut 1981;3:25–30.

    CAS  Google Scholar 

  79. Gahl WA, Gregg RE, Hoeg JM, Fisher, EA. Cysteamine alteration of apolipoprotein E isoelectric focusing patterns in vivo. Am J Med Genet 1985;20:409–417.

    Article  PubMed  CAS  Google Scholar 

  80. Smolin LA, Clark KF, Thoene JG et al. A comparison of the effectiveness of cysteamine and phosphocysteamine in elevating plasma cysteamine concentration and decreasing leukocyte free cystine in nephropathic cystinosis. Pediatr Res 1988;23:616–620.

    Article  PubMed  CAS  Google Scholar 

  81. Fidler MC, Barshop BA, Gangoiti JA et al. Pharmacokinetics of cysteamine bitartrate following gastrointestinal infusion. Br J Clin Pharmacol 2007;63:36–40.

    Article  PubMed  CAS  Google Scholar 

  82. Gahl WA, Charnas L, Markello TC et al. Parenchymal organ cystine depletion with long term cysteamine therapy. Biochem Med Metab Biol 1992;48:275–285.

    Article  PubMed  CAS  Google Scholar 

  83. Tsilou ET, Thompson D, Lindblad AS et al. A multicenter randomised double-masked clinical trial of a new formulation of topical cysteamine for the treatment of corneal cystine crystals in cystinosis. Br J Ophthalmol 2003;87:28–31.

    Article  PubMed  CAS  Google Scholar 

  84. Müller-Felber W, Schröder M, Hirschmann M et al. Neurophysiological testing in long-standing cystinosis. Electromyogr Clin Neurophysiol 1999;39:67–70.

    PubMed  Google Scholar 

  85. Sonies B, Ekman EF, Andersson H et al. Swallowing dysfunction in nephropathic cystinosis. N Engl J Med 1990;323:565–570.

    Article  PubMed  CAS  Google Scholar 

  86. Anikster Y, Lacbawan F, Brantly M et al. Pulmonary dysfunction in adults with nephropathic cystinosis. CHEST 2001;119:394–401.

    Article  PubMed  CAS  Google Scholar 

  87. Fivush B, Green OC, Porter CC et al. Pancreatic endocrine insufficiency in post-transplant cystinosis. Am J Dis Child 1987;141:1087–1089.

    PubMed  CAS  Google Scholar 

  88. Fivush B, Flick JA, Gahl WA. Pancreatic exocrine insufficiency in a patient with nephropathic cystinosis. J Pediatr 1988;112:49–51.

    Article  PubMed  CAS  Google Scholar 

  89. Chik CL, Friedman A, Merriam GR, Gahl WA. Pituitary-testicular function in nephropathic cystinosis. Annals Intern Med 1993;119:568–575.

    CAS  Google Scholar 

  90. Reiss RE, Kuwabara T, Smith ML, Gahl WA. Successful pregnancy despite placental cystine crystals in a woman with nephropathic cystinosis. N Engl J Med 1988;319:223–226.

    Article  PubMed  CAS  Google Scholar 

  91. Fink JK, Brouwers P, Barton N et al. Neurologic complications in longstanding nephropathic cystinosis. Arch Neurol 1989;46:543–548.

    Article  PubMed  CAS  Google Scholar 

  92. Cochat P, Drachman R, Gagnadoux MF et al. Cerebral atrophy and nephropathic cystinosis. Arch Dis Child 1986;61:401–403.

    Article  PubMed  CAS  Google Scholar 

  93. Tsilou ET, Rubin B, Reed G et al. Nephropathic cystinosis: posterior segment manifestations and effects of cysteamine therapy. Ophthalmology 2006;113:1002–1009.

    Article  PubMed  Google Scholar 

  94. Ueda M, O’Brien K, Rosing DR et al. Coronary artery and other vascular calcifications in cystinosis patients after kidney transplantation. Clin J Am Soc Nephrol 2006;1:555–562.

    Article  PubMed  Google Scholar 

  95. Sonies BC, Almajid P, Kleta R et al. Swallowing dysfunction in 101 patients with nephropathic cystinosis: benefit of long-term cysteamine therapy. Medicine 2005;84:137–146.

    Article  PubMed  CAS  Google Scholar 

  96. Aula P, Gahl WA. Sialic acid storage diseases. In The Metabolic and Molecular Bases of Inherited Disease, vol. 4, 8th edn., Scriver CR, Beaudet AL, Sly WS, Valle DL, Vogelstein B. (eds.). New York, McGraw-Hill, 2001, pp. 5109–5120.

    Google Scholar 

  97. Fenton WA, Gravel RA, Rosenblatt DS. Disorders of propionate and methylmalonate metabolism. In The Metabolic and Molecular Bases of Inherited Disease, vol. 2, 8th edn., Scriver CR, Beaudet AL, Sly WS, Valle DL, Vogelstein B (eds.). New York, McGraw-Hill, 2001, pp. 2165–2193.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this entry

Cite this entry

Gahl, W.A. (2009). Cystinosis. In: Avner, E., Harmon, W., Niaudet, P., Yoshikawa, N. (eds) Pediatric Nephrology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-76341-3_41

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-76341-3_41

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-76327-7

  • Online ISBN: 978-3-540-76341-3

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics