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Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 272))

Abstract

Considerable progress has been made in recent years toward understanding the neurochemical events occurring in hepatic encephalopathy (HE). However, an integrated picture of all of the available facts and events regarding the pathogenesis of this condition has yet to emerge. Many studies to date have largely ignored certain fundamental cellular changes which occur in this condition. In this article, the involvement of astrocytes in HE will be reviewed in an attempt to bridge this gap in our knowledge. Studies carried out in our laboratory on astrocytes dealing with the effect of ammonia and other putative toxins will be presented, and an attempt will be made to integrate these findings with current pathogenetic views of HE. New concepts dealing with the role of second messengers and protein phosphorylation will be presented. Finally, we wish to leave the reader with the concept that HE represents a primary gliopathy, i.e., that the astrocyte is the prime CNS target in HE.

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References

  1. Norenberg MD: The astrocyte in liver disease. In, Advances in Cellular Neurobiology. Fedoroff S, and Hertz L (Eds), Academic Press, New York, 1981, Vol 2, 303–352.

    Google Scholar 

  2. Sobel RA, DeArmond SJ, Forno LS, and Eng LF: Glial fibrillary acidic protein in hepatic encephalopathy: an immunocytochemical study. J Neuropathol Exp Neurol 40: 625–632, 1981.

    Article  PubMed  CAS  Google Scholar 

  3. Kimura T, and Budka H: Glial fibrillary acidic protein and S-100 protein in human hepatic encephalopathy: immunocytochemical demonstration of dissociation of two glia-associated proteins. Acta Neuropathol (Berl) 70: 17–21, 1986.

    Article  CAS  Google Scholar 

  4. Diemer NH: Glial and neuronal changes in experimental hepatic encephalopathy. Acta Neurol Scand, 58 Suppl 71: 1978.

    Google Scholar 

  5. Brumback RA, and Lapham LW: DNA synthesis in Alzheimer type II astrocytosis: The question of astrocytic proliferation and mitosis in experimentally induced hepatic encephalopathy. Arch Neurol 46: 845–848, 1989.

    Article  PubMed  CAS  Google Scholar 

  6. Norenberg MD: A light and electron microscopic study of experimental portal-systemic (ammonia) encephalopathy. Progression and reversal of the disorder. Lab Invest 36: 618–627, 1977.

    PubMed  CAS  Google Scholar 

  7. Norenberg MD: Histochemical studies in experimental portal-systemic encephalopathy. I. Glutamic dehydrogenase. Arch Neurol 33: 265–269, 1976.

    Article  PubMed  CAS  Google Scholar 

  8. Norenberg MD, and Martinez-Hernandez A: Fine structural localization of glutamine synthetase in astrocytes of rat brain. Brain Res 161: 303–310, 1979.

    Article  PubMed  CAS  Google Scholar 

  9. Hertz L: Features of astrocytic function apparently involved in the response of central nervous tissue to ischemia-hypoxia. J Cereb Blood Flow Metabol 1: 143–153, 1981.

    Article  CAS  Google Scholar 

  10. Janzer RC, and Raff MC: Astrocytes induce blood-brain barrier properties in endothelial cells. Nature 325: 253–257, 1987.

    Article  PubMed  CAS  Google Scholar 

  11. Fedoroff S, and Vernadakis A, (Eds): Astrocytes. Academic Press, Orlando, 1986.

    Google Scholar 

  12. Norenberg MD, Hertz L, Schousboe A, and (Eds): The Biochemical Pathology of Astrocytes. Alan R Liss, Inc, New York, 1988.

    Google Scholar 

  13. Murphy S, and Pearce B: Functional receptors for neurotransmitters on astroglial cells. Neuroscience 22: 381–394, 1987.

    Article  PubMed  CAS  Google Scholar 

  14. Kimelberg HK: Glial Cell Receptors. Raven Press, New York, 1988.

    Google Scholar 

  15. Bevan S, Chiu SY, Gray PTA, and Ritchie JM: The presence of voltage-gated sodium, potassium and chloride channels in rat cultured astrocytes. Proc R Soc London 225: 299–313, 1985.

    Article  CAS  Google Scholar 

  16. Kimelberg HK, Rose JW, Barron KD, Waniewski RA, and Cragoe EJ: Astrocytic swelling in traumatic-hypoxic brain injury: Beneficial effects of an inhibitor of anion exchange transport and glutamate uptake in glial cells. Molec Chem Neuropathol 11: 1–32, 1989.

    Article  CAS  Google Scholar 

  17. Walz W, and Hertz L: Functional interactions between neurons and astrocytes. II. Potassium homeostasis at the cellular level. Prog Neurobiol 20: 133–183, 1983.

    Article  PubMed  CAS  Google Scholar 

  18. Hertz L: In, Astrocytes. Handbook of Neurochemistry. Lajtha A. (Ed) Plenum, New York, 1982, Vol 1, 319–355.

    Google Scholar 

  19. Norenberg MD, Mozes LW, Norenberg L-OB, and Gregorios JB: Effects of ammonia in primary astrocyte cultures: morphology and biochemical considerations. In, Dynamic Properties of Glia Cells. II. Cellular and Molecular Aspects. Grisar T, Franck G, Hertz L, Norton WT et al, (Eds) Pergamon, Oxford New York, 1986, 353–362.

    Google Scholar 

  20. Norenberg MD: Hepatic Encephalopathy: Studies with astrocyte cultures. In, The Biochemical Pathology of Astrocytes. Norenberg MD, Hertz L, and Schousboe A. (Eds), Alan R. Liss, Inc., New York, 1988, 451–464.

    Google Scholar 

  21. Norenberg MD: The use of cultured astrocytes in the study of hepatic encephalopathy. In, Hepatic Encephalopathy. Butterworth RF, and Layrargues GP (Eds), Humana Press, Clifton, NJ, 1989, 215–229.

    Chapter  Google Scholar 

  22. Kimelberg H: Primary astrocyte cultures — a key to astrocyte function. Molec Neurobiol 3: 1–16, 1983.

    Article  CAS  Google Scholar 

  23. Gregorios JB, Mozes LW, Norenberg LOB, and Norenberg MD: Morphologic effects of ammonia on primary astrocyte cultures. I. Light microscopic studies. J Neuropathol Exp Neurol 44: 397–403, 1985.

    Article  PubMed  CAS  Google Scholar 

  24. Gregorios JB, Mozes LW, and Norenberg MD: Morphologic effect of ammonia on primary astrocyte cultures. II. Electron microscopic studies. J Neuropath and Exp Neurol 44: 404–414, 1985.

    Article  CAS  Google Scholar 

  25. Gregorios JB, Mozes LW, Norenberg LOB, and Norenberg MD: Effect of cyclic AMP on ammonia-induced alterations in primary astrocyte cultures. J Neuropathol Exp Neurol 45: 396–407, 1986.

    Article  PubMed  CAS  Google Scholar 

  26. Zieve L: The mechanism of hepatic coma. Hepatology 1: 360–365, 1981.

    Article  PubMed  CAS  Google Scholar 

  27. Fischer JE: Amino acids in hepatic coma. Digest Dis Sci 27: 97–102, 1982.

    Article  PubMed  CAS  Google Scholar 

  28. Hawkins RA, Mans AM, and Biebuyck JF: Blood-brain barrier dysfunction in hepatic encephalopathy. In, Advances in Hepatic Encephalopathy and Urea Cycle Diseases. Kleinberger G, Ferenci P, Riederer P, and Thaler H. (Eds), Karger, Basle, 1984, 251–260.

    Google Scholar 

  29. Bernardini P, and Fischer JE: Amino acid imbalance and hepatic encephalopathy. Annu Rev Nutr 2: 419–454, 1982.

    Article  PubMed  CAS  Google Scholar 

  30. Jessy J, and Murthy CRK: Elevation of transamination of branched chain amino acids in brain in acute ammonia toxicity. Neurochem Int 7: 1027, 1985.

    Article  PubMed  CAS  Google Scholar 

  31. McGiven JD, Bradford NM, Crompton M, and Chappel JB: Effect of L-leucine on the nitrogen metabolism of isolated rat liver mitochondria. Biochem J 134: 209–215, 1973.

    Google Scholar 

  32. Ono J, Hutson DG, Dombro RS, Levi JU, Livingstone A, and Zeppa R: Tryptophan and hepatic coma. Gastroenterology 74: 196–200, 1978.

    PubMed  CAS  Google Scholar 

  33. Moroni F, Lombardi G, Moneti G, and Cortesini C: The release and the neosynthesis of glutamic acid are increased in experimental models of hepatic encephalopathy. J Neurochem 40: 850–854, 1983.

    Article  PubMed  CAS  Google Scholar 

  34. Kohler C., Ericksson LG, Okuno E, and Schwarcz R: Localization of quinolinic acid metabolizing enzymes in the rat brain. Immunohistochemical studies using antibodies to 3-hydroxyanthranilic acid oxygenase and quinolinic acid phosphoribosyltransferase. Neuroscience 27: 49–76, 1988.

    Article  PubMed  CAS  Google Scholar 

  35. Stone TW, and Perkins MN: Quinolinic acid: a potent endogenous excitant at amino acid receptors in CNS. Europ J Pharmacol 72: 411–412, 1981.

    Article  CAS  Google Scholar 

  36. Sontheimer H, Kettenmann H, Backus KH, and Schachner M: Glutamate opens Na+/K+ channels in cultured astrocytes. Glia 1: 328–336, 1988.

    Article  PubMed  CAS  Google Scholar 

  37. Norenberg MD, Forster EH, Norenberg L-OB, and Neary JT: Monoamine oxidase activity in cultured astrocytes treated with ammonia. Trans Amer Soc Neurochem 19: 237, 1988.

    Google Scholar 

  38. Levitt P, Pintar JE, and Breakfield XO: Immunocytochemical demonstration of monoamine oxidase B in brain astrocytes and serotonergic neurons. Proc Natl Acad Sci USA 79: 6385–6389, 1982.

    Article  PubMed  CAS  Google Scholar 

  39. O’Connor JE, Costell M, and Grisolia S: Prevention of ammonia toxicity by L-carnitine: metabolic changes in brain. Neurochem Res 9: 563–570, 1982.

    Article  Google Scholar 

  40. Fritz IB: Action of carnitine on long-chain fatty oxidation by liver. Am J Physiol 197: 297–304, 1959.

    PubMed  CAS  Google Scholar 

  41. Roe CR, Millington CS, Maltby DA, Bohan TP, and Hoppel CL: L-carnitine enhances excretion of propionyl coenzyme A as propionyl carnitine in propionic acidemia. J Clin Invest 73: 1785–1788, 1984.

    Article  PubMed  CAS  Google Scholar 

  42. Liskowsky DR, Norenberg LOB, and Norenberg MD: Effect of ammonia on cyclic AMP production in primary astrocyte cultures. Brain Res 386: 386–388, 1986.

    Article  PubMed  CAS  Google Scholar 

  43. Neary JT, Norenberg LOB, Gutierrez MP, and Norenberg MD: Hyperammonemia causes altered protein phosphorylation in astrocytes. Brain Res 437: 161–164, 1987.

    Article  PubMed  CAS  Google Scholar 

  44. Nestler E, and Greengard P: Protein phosphorylation in the nervous system. John Wiley, New York, 1984.

    Google Scholar 

  45. Norenberg MD, Neary JT, Norenberg LOB, and McCarthy M: Ammonia induced decrease in glial fibrillary acidic protein in cultured astrocytes. J Neuropathol Exp Neurol. 49: 399–405, 1990.

    Article  PubMed  CAS  Google Scholar 

  46. Schafer DF, and Jones EA: Hepatic encephalopathy and the gamma-aminobutyric acid neurotransmitter system. Lancet i: 18–20, 1982.

    Article  Google Scholar 

  47. Baraldi M, and Zeneroli ML: Experimental hepatic encephalopathy: changes in the binding of gamma-aminobutyric acid. Science 216: 427–429, 1982.

    Article  PubMed  CAS  Google Scholar 

  48. Rothstein J, McKhann G, Guarnerf P, Barbaccia M, Guidotti A, and Costa E: Diazepam binding inhibitor in hepatic encephalopathy. Soc Neurosci Abst 14: 346, 1988.

    Google Scholar 

  49. Mullen KD, Martin JV, Mendelson WB, Bassett ML, and Jones EA: Could an endogenous benzodiazepine ligand contribute to hepatic encephalopathy? Lancet i: 457–459, 1988.

    Article  Google Scholar 

  50. Olasmaa M, Guidotti A, Costa E, Rothstein JD, Goldman ME, Weber RJ, and Paul SM: Endogenous benzodiazepines in hepatic encephalopathy. Lancet i: 491–492, 1989.

    Article  Google Scholar 

  51. Alho H, Costa E, Ferrero P, Fujimoto M, Cosenza-Murphy D, and Guidotti A: Diazepam binding inhibitor: A neuropeptide located in selected neuronal populations of rat brain. Science 229: 179–182, 1985.

    Article  PubMed  CAS  Google Scholar 

  52. Bender AS, and Hertz L: Octadecaneuropeptide (ODN; anxiety peptide) displaces diazepam more potently from astrocytic than from neuronal binding sites. Eur J Pharmacol 132: 335–336, 1986.

    Article  PubMed  CAS  Google Scholar 

  53. McCarthy KD, and Harden TK: Identification of two benzodiazepine binding sites on cells cultured from rat cerebral cortex. J Pharm Exp Ther 216: 183–191, 1981.

    CAS  Google Scholar 

  54. Schoemaker H, Morelli M, Deshmukh P, and Yamamura HI: [3H] Ro5–4864 benzodiazepine binding in the kainate lesioned striatum and Huntington’s diseased basal ganglia. Brain Res 248: 396–401, 1982.

    Article  PubMed  CAS  Google Scholar 

  55. Sher PK, and Machen VL: Properties of [3H] diazepam binding sites on cultured murine glia and neurons. Brain Res 316: 1–6, 1984.

    PubMed  CAS  Google Scholar 

  56. Bender AS, and Hertz L: Flunitrazepam binding to intact and homogenized astrocytes and neurons in primary cultures. J Neurochem 43: 1319–1327, 1984.

    Article  PubMed  CAS  Google Scholar 

  57. Kuriyama K, Tomono S, Kishi M, Mukainaka T, and Ohkuma S: Development of gamma-aminobutyric acid (GABA)ergic neurons in cerebral cortical neurons in primary culture. Brain Res 416: 7–21, 1987.

    Article  PubMed  CAS  Google Scholar 

  58. Bender AS, and Hertz L: Pharmacological evidence that the non-neuronal diazepam binding site in primary cultures of glial cells is associated with a calcium channel. Eur. J Pharmacol 110: 287–288, 1985.

    Article  PubMed  CAS  Google Scholar 

  59. Anholt RRH, Pedersen PL, DeSouza EB, and Snyder SH: The peripheral-type benzodiazepine receptor: localization to the mitochondrial outer membrane. J Biol Chem 261: 576–583, 1986.

    PubMed  CAS  Google Scholar 

  60. Ducis I, Norenberg L-OB, and Norenberg MD: Effect of ammonium chloride on the astrocyte benzodiazepine receptor. Brain Res 493: 362–365, 1989.

    Article  PubMed  CAS  Google Scholar 

  61. Ducis I, Norenberg L-OB, and Norenberg MD: Effect of phenol on the astrocyte benzodiazepine receptor. Trans Amer Soc Neurochem 20: 132, 1989.

    Google Scholar 

  62. Giguere J-F, Hamel E, and Butterworth RF: Increased peripheral benzodiazepine binding sites following portacaval anastomosis in the rat. Neurosci Absts 15: 415, 1989.

    Google Scholar 

  63. Lavoie J, Layrargues GP, and Butterworth RF: Increased densities of peripheral-type benzodiazepine receptors in autopsied brain tissue from alcoholic patients with hepatic encephalopathy. Neurosci Absts 15: 415, 1989.

    Google Scholar 

  64. Neary JT, Woodson C, Blicharska J, Norenberg L-OB, and Norenberg MD: Chronic hyperammonemia decreases calcium uptake in primary astrocyte cultures. In, Differentiation and Functions of Glial Cells. Levi G. (Ed), Alan R. Liss, Inc, New York. 1989. In press.

    Google Scholar 

  65. Rasmussen H, and Barrett PQ: Calcium messenger system: an integrated view. Physiol Rev 64: 938–984, 1984.

    PubMed  CAS  Google Scholar 

  66. Neary JT, van Breemen C, Forster E, Norenberg L-OB, and Norenberg MD: ATP stimulates calcium influx in primary astrocyte cultures. Biochem Biophys Res Commun 157: 1410– 1416, 1989.

    Article  Google Scholar 

  67. Ede RJ, and Williams R: Hepatic encephalopathy and cerebral edema. Semin Liver Dis 6: 107–118, 1986.

    Article  PubMed  CAS  Google Scholar 

  68. Livingstone AS, Potrin M, Goresky CA, Finlayson MH, and Hinchey EJ: Changes in the blood-brain barrier in hepatic coma after hepatectomy in the rat. Gastroenterology 73: 697–704, 1977.

    PubMed  CAS  Google Scholar 

  69. Traber PG, Dal Canto M, Ganger D, and Blei AT: Electron microscopic evaluation of brain edema in rabbits with galactosamine-induced fulminant hepatic failure. Hepatology 7: 1257–1261, 1987.

    Article  Google Scholar 

  70. Ganz R, Swain M, Traber P, DalCanto M, Butterworth RF, and Blei AT: Ammonia-induced swelling of rat cerebral cortical slices: Implications for the pathogenesis of brain edema in acute hepatic failure. Metab Brain Dis 4: 213, 1989.

    Article  PubMed  CAS  Google Scholar 

  71. Canalese J, Gimson AES, Mellon PJ, Davis M, and Williams R: Controlled trial of dexamethasone and mannitol for the cerebral edema of fulminant hepatic failure. Gut 23: 625–629, 1982.

    Article  PubMed  CAS  Google Scholar 

  72. Dillon D, and Schenker S: Cerebrospinal fluid protein concentration in hepatic coma. JAMA 221: 507, 1972.

    Article  PubMed  CAS  Google Scholar 

  73. Goldstein GW: The role of brain capillaries in the pathogenesis of hepatic encephalopathy. Hepatology 4: 565–567, 1984.

    Article  PubMed  CAS  Google Scholar 

  74. Norenberg MD, Baker L, Norenberg LOB, and Neary JT: Ammonia-induced astrocyte swelling in primary culture. Trans Amer Soc Neurochem 20: 132, 1989.

    Google Scholar 

  75. Kletzien RF, Pariza MW, Becker JE, and Potter VR: A method using 3-0-methyl-D-glucose and phloretin for the determination of intracellular water space of cells in monolayer culture. Analyt Biochem 68: 537–544, 1975.

    Article  PubMed  CAS  Google Scholar 

  76. Pilbeam CM, Anderson RM, and Bhathal PS: The brain in experimental portal-systemic encephalopathy: II. Water and electrolyte changes. J Pathol 140: 347–355, 1983.

    Article  PubMed  CAS  Google Scholar 

  77. Aronson PS: Kinetic properties of the plasma membrane Na+−H+ exchanger. Annu Rev Physiol 47: 545–560, 1985.

    Article  PubMed  CAS  Google Scholar 

  78. Roos A, and Boron WF: Intracellular pH. Physiol Rev 61: 296–434, 1981.

    PubMed  CAS  Google Scholar 

  79. Kikeri D, Sun A. Zeidel ML, and Hebert SC: Cell membranes impermeable to NH3. Nature 339: 478–480, 1989.

    Article  PubMed  CAS  Google Scholar 

  80. Brooks KJ, Kauppinen RA, Williams SR, Bates TE, and Bachelard HS: Acute ammonia exposure causes a transient, heterogenous acidosis in metabolizing brain slices. A 31P and lH NMR study. J Neurochem 52: S209, 1989.

    Article  Google Scholar 

  81. Hoffmann EK, and Simonsen LO: Membrane mechanisms in volume and pH regulation in vertebrate cells. Physiol Rev 69: 315–383, 1989.

    PubMed  CAS  Google Scholar 

  82. Watson AJ, Karp JE, Walker WG, Chamber T, Risch VR, and Brusilow SW: Transient idiopathic hyperammonemia in adults. Lancet ii: 1271–1274, 1985.

    Article  Google Scholar 

  83. Christensen O: Mediation of cell volume regulation by Ca2+ influx through stretch-activated channels. Nature 330: 66, 1987.

    Article  PubMed  CAS  Google Scholar 

  84. Falke LC, and Misler S: Activity of ion channels during volume regulation by clonal NIE115 neuroblastoma cells. Proc Natl Acad Sci USA 86: 3919–3923, 1989.

    Article  PubMed  CAS  Google Scholar 

  85. Watson PA: Accumulation of cAMP and calcium in S40 mouse lymphoma cells following hypoosmotic swelling.J Biol Chem 264: 14735–14740, 1989.

    PubMed  CAS  Google Scholar 

  86. Emmer E, Rood RP, Wesolek JH, Cohen ME, Braithwaite RS, Sharp GWG, Murer H, and Donowitz M: Role of calcium and calmodulin in the regulation of the rabbit ileal brush-border membrane Na+/H+ antiporter. J Membrane Biol 108: 207–215, 1989.

    Article  CAS  Google Scholar 

  87. Alvarez J, Garcia-Sancho J, Mollinedo F, and Sanchez A: Intracellular Ca2+ potentiates Na+/H+ exchange and cell differentiation induced by phorbol ester in U937 cells. Eur J Biochem 183: 709–714, 1989.

    Article  PubMed  CAS  Google Scholar 

  88. Green J, and Muallem S: A common mechanism for activation of the Na+/H+ exchanger by different types of stimuli. FASEB J 3: 2408–2414, 1989.

    PubMed  CAS  Google Scholar 

  89. Neary JT, Norenberg LOB, and Norenberg MD: Calcium-activated, phospholipid-dependent protein kinase and protein substrates in primary cultures of astrocytes. Brain Res 385: 420–424, 1986.

    Article  PubMed  CAS  Google Scholar 

  90. Babcock-Atkinson E, Norenberg MD, Norenberg LOB, and Neary JT: Ca/calmodulin-dependent protein kinase activity in primary astrocyte cultures Glia 2: 112–119, 1989.

    Article  PubMed  CAS  Google Scholar 

  91. Sears ES, McCandless DW, and Chandler MD: Disruption of the blood-brain barrier in hyperammonemic coma and the pharmacologic effects of dexamethasone and difluoromethyl ornithine. J Neurosci Res 14: 255–261, 1985.

    Article  PubMed  CAS  Google Scholar 

  92. Solomon AK: Transport pathways: water movement across cell membranes. In, Membrane Transport: People and Ideas. Oxford Univ Press, New York, 1989.

    Google Scholar 

  93. Gard DL, and Lazarides E: Cyclic AMP-modulated phosphorylation of intermediate filament proteins in cultured avian myogenic cells. Molec Cell Biol 2: 1104–1114, 1982.

    PubMed  CAS  Google Scholar 

  94. Evans RM, and Fink LM: An alteration in the phosphorylation of vimentin-type intermediate filaments is associated with mitosis in cultured mammalian cells. Cell 29: 43–52, 1982.

    Article  PubMed  CAS  Google Scholar 

  95. Celis JE, Larsen PM, Fey SJ, and Celis A: Phosphorylation of keratin and vimentin polypeptides in normal and transformed mitotic human epithelial amnion cells: behavior of keratin and vimentin filaments during mitosis. J Cell Biol 97: 1429–1434, 1983.

    Article  PubMed  CAS  Google Scholar 

  96. Pollenz RS, and McCarthy KD: Analysis of cyclic AMP-dependent changes in intermediate filament protein phosphorylation and cell morphology in cultured astroglia. J Neurochem 47: 9–17, 1986.

    Article  PubMed  CAS  Google Scholar 

  97. Shafit-Zagardo B, Kume-Iwaki A, and Goldman JE: Astrocytes regulate GFAP mRNA levels by cyclic AMP and protein kinase C-dependent mechanisms. Glia 1: 346–354, 1988.

    Article  PubMed  CAS  Google Scholar 

  98. Breen J, and Schenker S: Hepatic coma: Present concepts of pathogenesis and therapy. Prog Liver Dis 4: 301–332, 1972.

    PubMed  CAS  Google Scholar 

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Norenberg, M.D. (1990). Astrocytes in Hepatic Encephalopathy. In: Grisolía, S., Felipo, V., Miñana, MD. (eds) Cirrhosis, Hepatic Encephalopathy, and Ammonium Toxicity. Advances in Experimental Medicine and Biology, vol 272. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-5826-8_5

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