Original Contributions |
From the Department of Biology, Tanabe Research Laboratories (T.M., K.A.F., R.R.C.), San Diego; and the Department of Immunology, The Scripps Research Institute (G.C.N.P.), La Jolla, Calif.
Correspondence to Dr Ronald R. Cobb, Department of Biology, Tanabe Research Laboratories, 4540 Towne Centre Ct, San Diego, CA 92121. E-mail rcobb{at}trlusa.com
| Abstract |
|---|
|
|
|---|
Bmediated reporter gene expression. The
effects of norLeu were due to its inhibition of the proteasome rather
than calpain, because other calpain inhibitors had no
effect on MCP-1 expression. In contrast to TPCK, which blocked NF-
B
translocation to the nucleus, norLeu had no effect on NF-
B nuclear
translocation or IL-1ßinduced phosphorylation of
p65. This study demonstrates that the proteasome pathway is involved in
IL-1ßinduced MCP-1 gene expression in human endothelial cells.
Key Words: monocyte chemoattractant protein-1 endothelial cells proteasome inhibitors
| Introduction |
|---|
|
|
|---|
The promoter region of the human MCP-1 gene has recently been cloned,
sequenced,13 14 and shown to contain two putative
consensus binding sites for the transcription factor NF-
B. Recently,
Martin et al15 demonstrated that the NF-
B and
activator protein-1 sites located 90 and 73 bp,
respectively, upstream of the transcriptional start site coordinately
regulate IL-1ßstimulated MCP-1 gene expression in ECs. In addition,
this NF-
B site is recognized by the p50/p65 heterodimer of the
NF-
B/Rel family of transcription factors.
ECs have been shown to express NF-
B/Rel proteins that mediate the
regulation of a variety of proinflammatory genes, including MCP-1,
ICAM-1, VCAM-1, and E-selectin.15 16 17 18 19 Treatment
of ECs with a variety of stimuli, including IL-1ß and tumor necrosis
factor-
, results in the rapid phosphorylation of
I
B
, its subsequent proteolytic degradation, and the nuclear
translocation of NF-
B.20 21 22 23 24 25 26 27 28 Previous studies
have shown that the proteasome system is involved in the proteolytic
degradation of I
B
and the precursor of
p50.25 27 The proteasome is a
calcium-independent, multicatalytic proteinase complex that is involved
in the turnover of abnormal and biologically active proteins. This
pathway has also been shown to play an important role in the
degradation of several short-lived
proteins.29 30 31
Given the importance of elevated levels of MCP-1 in the recruitment of
monocytes as well as T lymphocytes33 to sites of
inflammation, we investigated the role of the proteasome system in
cytokine-induced MCP-1 gene expression. We used specific
proteasome inhibitors to focus on the mechanism by which
these compounds interfere with MCP-1 induction. We present evidence
that the proteasome inhibitor norLeu and MG132 blocked
IL-1ß induction of MCP-1 protein expression as well as MCP-1 promoter
activity. The nonspecific protease inhibitor TPCK also
inhibited IL-1ßinduced MCP-1 protein expression and promoter
activity. In contrast to TPCK, norLeu did not block the
IL-1ßinduced nuclear translocation of NF-
B. In addition, norLeu
did not block cytokine-induced I
B
degradation or
phosphorylation of p65 in contrast to the results
obtained with TPCK.
| Methods |
|---|
|
|
|---|
Chemicals and Reagents
All chemicals were purchased from Sigma Chemical Co, with the
exception of E64, which was purchased from Boehringer Mannheim,
and MG132, which was from Calbiochem. Compounds were solubilized in
DMSO. IL-1ß was purchased from R&D Systems. All
oligonucleotides were synthesized on an ABI 381A DNA
synthesizer (Applied Biosystems).
ELISA
HUVECs (passage
6) were plated on gelatin-coated, 96-well
tissue culture dishes (CoStar) and incubated at 37°C until confluent.
The cells were then incubated with the test compound in EGM for 30
minutes. The medium was removed and replaced by medium containing the
test compound plus 0.5 ng/mL IL-1ß and incubated for another 6 hours.
The supernatants were then collected and analyzed for MCP-1
protein concentration with the MCP-1 Quantikine kit, following the
manufacturer's instructions (R&D Systems).
RT-PCR
HUVECs were treated in a manner analogous to that described for
the ELISA. Total RNA was isolated with RNAzol B by following the
procedures of the manufacturer (BioTecX). One microgram of total RNA
was used for the RT reaction with the GeneAmp RT-PCR kit (Perkin
Elmer). Human ß-actin primers were purchased from Clontech and
amplified a 838-bp product. The PCR primers for MCP-1 amplified a
500-bp product and contained the following sequences:
5'-AGCATGAAAGTCTCTGCCGCCCTTCTG-3' and 5'-ATTACTTAAGGCATAATGTTTCACA-3'.
The PCR parameters were as recommended by Clontech for
their amplimer sets. The amplified products were analyzed
by electrophoresis in a 3% agarose gel (wt/wt 3:1, GTG
NuSieve/Ultrapure agarose; FMC and Life Technologies,
respectively).
Plasmid Construction
Human DNA was isolated from HUVECs as
described.33 A 559-bp fragment of the human MCP-1
promoter region13 was amplified with the
following primers: 5'-GGTACCCCTACAGTTCTGCTAGGCTTCTAT-3' and
5'-GGTACCGAGCTTCAGTTTGAGAATTGGATG-3'. The amplified fragment was cloned
into the KpnI site of pGLneo33 34
(Promega) to create pGLneoMCP-1. Each plasmid was then purified by a
CsCl2 gradient, with standard
procedures.35 p(
B)4LUC
contains four copies of a murine Ig
-
B site cloned upstream of a
minimal SV40 promoter.
Luciferase Assays
pGLneoMCP-1 was transfected into ECV304 cells using lipofectin
and following the instructions of the manufacturer (Life Technologies).
Stably transfected cells were selected by resistance to geneticin at
300 µg/mL (Life Technologies). Transient transfections were performed
as described.36 pCMVß (Clontech) was used as a
transfection control. ß-Galactosidase levels were determined with the
Galacto-Light assay system (Tropix) and exhibited <20% variation
between samples.
The stably transfected cell line (ECV MCP-1) was plated in gelatin-coated, 96-well Microlite tissue culture dishes (Dynatech Laboratories) and incubated overnight at 37°C. Cells were treated in a manner analogous to that described for the ELISA. Each sample was assayed in triplicate. After the 6-hour incubation, the cells were washed with PBS, lysed by the addition of 20 µL of lysis buffer per well (Analytical Luminescence Laboratories), and stored at -20°C overnight. Samples were then brought to room temperature and analyzed for luciferase production with an ML9600 luminometer (Analytical Luminescence Laboratories).
Cell Viability
Percent viability of HUVECs treated with the test compound was
determined by using the alamarBlue Assay (BioSource International)
according to the manufacturer's instructions. Flourometer readings
were taken after a 6-hour incubation as well as a visual inspection of
the cells after treatment with the test compound. Test compound
concentrations with a cell viability of <80% were considered toxic.
EMSA
Nuclear extracts were prepared from HUVECs as previously
described.37 Protein concentrations in nuclear
extracts were 1 to 5 mg/mL, as determined by the bicinchoninic acid
protein assay (Pierce Chemical Co). The oligonucleotide
containing the prototypical
B binding site from the murine Ig
gene (italics), 5'-CAGAGGGACTTTCCGAGA-3', was radiolabeled
with [
-32P]dCTP (>3000 Ci/mmol, Amersham)
as described.36 This prototypical NF-
B binding
site has been shown to bind to p50/p65 heterodimers in human
ECs.37 Analysis of binding was performed
as described.36
To quantify the effect of norLeu on the nuclear translocation of
NF-
B, an oligonucleotide containing an Sp1 binding
site (italics), 5'-ATTCGATCGGGGCGGGGCGAGC-3', was used as an
internal control. The intensity of each protein/DNA complex was
determined by using a Molecular Dynamics PhosphorImager and ImageQuant
software (Molecular Dynamics Inc). The intensity of the NF-
B complex
was calculated relative to the intensity of the Sp1 complex. In all
determinations, the labeled oligonucleotide was in
excess, and measurements were made in the linear range of the
PhosphorImager screen.
Western Blot Analysis
HUVEC protein extracts were prepared according to the procedures
described in the Boehringer Mannheim immunoprecipitation kit.
Proteins were fractionated by electrophoresis on a 10%
SDSpolyacrylamide gel (Novex) and transferred to NitroBind
(Micron Separations, Inc). I
B
protein was detected with a 1:1000
dilution of an anti-I
B
antibody (Santa Cruz Biotechnology) and an
anti-rabbithorseradish peroxidase conjugate (Promega) according to
the ECL protocol (Amersham).
p65 Phosphorylation and
Immunoprecipitation
Confluent monolayers of HUVECs in a T25 flask were washed once
with PBS. The cells were then incubated in phosphate-free RPMI 1640
medium containing 100 mCi/mL of
[32P]PO4 (400 to 800
mCi/mL, ICN) for 2 hours. HUVEC monolayers were pretreated with the
inhibitors for 30 minutes. Cells were then stimulated with
IL-1ß (0.5 ng/mL) for 15 minutes. After incubation the cells were
washed with PBS, and p65 was recovered using an anti-p65 antibody
(Santa Cruz Biotechnology) and the immunoprecipitation kit containing
protein A beads and following the procedures of the manufacturer
(Boehringer Mannheim). Preclearing of the p65 antibody was
performed by a 2-hour incubation with the control peptide (Santa Cruz
Biotechnology) and the p65 antibody before immunoprecipitation. The
immunoprecipitated proteins were separated on a 10%
SDSpolyacrylamide gel (Novex) and visualized by
autoradiography.
| Results |
|---|
|
|
|---|
B
in HeLa and Jurkat cells. To address the role of the proteasome in the
IL-1ßinduced upregulation of MCP-1 in ECs, HUVEC monolayers were
treated with the proteasome inhibitor norLeu (also known as
a calpain I inhibitor).37 As shown in
Figure 1A
|
RT-PCR analysis was performed on total RNA from HUVECs to
elucidate whether the proteasome inhibitors had any effect
on MCP-1 mRNA accumulation. HUVECs were treated in a similar manner as
described for the ELISA. As shown in Figure 2
, a 100 µmol/L pretreatment with
norLeu or a 50 µmol/L pretreatment with TPCK almost completely
inhibited the IL-1ßinduced accumulation of MCP-1 mRNA. These
inhibitors had no effect on IL-1ßinduced
plasminogen activator inhibitor-1
expression,33 which is induced in HUVECs by
IL-1ß in an NF-
Bindependent manner.41
|
We next investigated the effects of norLeu on the transcriptional
regulation of MCP-1. For these studies a contiguous 559-bp fragment of
the human MCP-1 promoter including the transcriptional start
site13 was cloned into a luciferase reporter gene
plasmid. This plasmid, pGLneoMCP-1, was then used to stably transfect
ECV304 human ECs. The level of IL-1ßinduced luciferase
production from the pGLneoMCP-1 plasmid in the stably
transfected cell line was similar to that seen in HUVECs transiently
transfected with the same plasmid (data not shown). Therefore, the
stably transfected cell line was used in these experiments. The stably
transfected cell line was then treated with the test compounds, and
their effects on luciferase production were measured. As shown
in Figure 3
, norLeu significantly
inhibited MCP-1 promoter-driven luciferase production. MG132
also significantly inhibited MCP-1 promoter-driven luciferase
production. The effects of norLeu were due to its inhibition of
the proteasome rather than of calpain, because other calpain
inhibitors, eg,
(2S,3S)-trans-epoxysuccinyl-L-leucylamido-3-methylbutane
ethyl ester, did not block the IL-1ßinduced MCP-1 promoter activity
(Figure 3
).
|
Previous results have shown that NF-
B and activator
protein-1 coordinately regulate the cytokine-induced MCP-1
gene expression in ECs.15 Therefore, we
investigated the effects of norLeu on NF-
Bmediated promoter
activity. As shown in Figure 4
, norLeu
and TPCK inhibited cytokine-induced, NF-
Bdependent
promoter activity in a dose-dependent manner.
|
To investigate the effects of the proteasome inhibitor on
cytokine-induced nuclear translocation of NF-
B, EMSAs
were performed. Previous studies have shown that the p50/p65
heterodimer binds to the NF-
B binding site in the MCP-1
promoter.15 Therefore, we used the prototypical
B binding site from the murine Ig
gene as the target. This
prototypical site has been shown to bind to p50/p65 heterodimers in
human ECs.36 TPCK completely abolished
IL-1ßinduced nuclear translocation of NF-
B (Figure 5
). In contrast, norLeu had no effect on
nuclear translocation or the DNA binding ability of NF-
B at a
concentration that completely inhibited MCP-1 gene expression. To more
precisely characterize the effect of norLeu on the nuclear
translocation of NF-
B, an Sp1 oligonucleotide was
used as an internal control, and protein-DNA complexes were quantified
by using a PhosphorImager. In three independent experiments, the
intensity of the NF-
B complex in the norLeu-treated extracts was
120±14% (mean±SD) of that in the extracts treated with IL-1ß
alone. Thus, norLeu did not inhibit nuclear translocation of NF-
B in
IL-1ßstimulated ECs. Consistent with this observation,
norLeu did not block IL-1ßinduced degradation of I
B
, whereas
TPCK did block this degradation (Figure 6
), although a small amount of the
phosphorylated form of I
B
was observed in the
cells treated with norLeu in these experiments.
|
|
Recent evidence has shown that p65 is strongly
phosphorylated during the activation of
NF-
B.42 43 Further studies revealed that p65
contains two transactivation domains in the carboxy terminus,
TA1 and
TA2.43 Stimulation of cells
results in the phosphorylation of
TA2 and is correlated with increased
transcriptional activity, whereas TA1 is
constitutively phosphorylated.43
To determine whether norLeu treatment inhibited the activity of nuclear
p50/p65 complexes by blocking phosphorylation of p65,
we investigated the phosphorylation of p65 in
IL-1ßstimulated HUVECs. p65 was immunoprecipitated from
unstimulated and stimulated cells and detected by Western blotting with
an anti-p65 antibody (Santa Cruz Biotechnology) to confirm p65 recovery
from the extracts. IL-1ß induced significant
phosphorylation of p65 in HUVECs. This inducible
phosphorylation was not affected by norLeu treatment
but was inhibited by TPCK treatment (Figure 7
). Immunoprecipitation of p65 was
blocked by the addition of the peptide (Santa Cruz Biotechnology) that
was used to raise the antibody.
|
| Discussion |
|---|
|
|
|---|
BRel complexes and that the proteolytic degradation of
I
B
was not affected. However, the protease inhibitor
TPCK did block nuclear translocation of NF-
B, and I
B
proteolytic degradation was also inhibited. Furthermore, norLeu did not
block IL-1ßinduced phosphorylation of p65. However,
IL-1ßstimulated, NF-
Bmediated transcription was inhibited by
norLeu. Therefore, these studies suggest that norLeu blocks
NF-
Bmediated transcription either by affecting the functional
activity of the NF-
B/Rel proteins or by blocking the function of an
accessory protein necessary for NF-
B activation.
Previous studies have demonstrated that NF-
B/Rel proteins act in
concert with activator protein-1 in the
cytokine-mediated induction of MCP-1.15
The results presented in this study demonstrate that MCP-1 gene
expression can be blocked without interfering with nuclear
translocation of NF-
B. Similar effects of proteasome
inhibitors have been presented for VCAM-1 and
ICAM-1 gene expression.33 In addition,
phosphatidylcholine-specific phospholipase C inhibitors
have been shown to block cytokine-induced VCAM-1 and ICAM-1
gene expression in a similar manner.34 In this
study, we also present evidence that cytokine-induced
phosphorylation of p65 occurs even when the functional
activity of NF-
B is blocked. Our results indicate that the
proteasome inhibitors block transcription of the MCP-1
gene; however, we cannot exclude the possibility that MCP-1 mRNA may be
destabilized by this inhibitor. Furthermore, although
previous studies have shown that NF-
B activation is required for
maximal MCP-1 gene transcription,15 inhibition
may occur by effects on other, undescribed factors regulating the MCP-1
gene.
The effects of norLeu and TPCK on MCP-1 gene expression were specific
for IL-1ß induction of proinflammatory genes, which contain NF-
B
binding sites. Previous results have shown that norLeu and TPCK will
block ICAM-1 and VCAM-1 gene expression but not plasminogen
activator inhibitor-1 expression.
Plasminogen activator inhibitor-1
gene expression is induced in human ECs by IL-1ß via an
NF-
Bindependent mechanism.41 Other
inhibitors of calpain did not block IL-1ßinduced MCP-1
gene expression. Because these other inhibitors of calpain
did not block the cytokine induction of MCP-1, one can conclude
that inhibition of calpain cannot account for the
inhibitory effects of norLeu. Therefore, it appears that
the effects of norLeu on the proteasome complex account for the
inhibition of MCP-1 gene expression in response to cytokine
stimulation. In contrast to these observations, Read et
al40 suggested that inhibition of induced EC gene
expression by the proteasome inhibitor MG132 was due to
blocking of NF-
B nuclear translocation. However, only partial
inhibition of nuclear translocation was observed at doses of MG132 that
were significantly higher than those required to inhibit gene
expression. We did not observe any inhibition of NF-
B nuclear
translocation in norLeu-treated cells at doses that blocked MCP-1 gene
expression. This result suggests that inhibition of NF-
B activity
occurred by a novel mechanism.
Recent studies have shown that p65 is phosphorylated
upon activation of NF-
B.42 43 The
TA1 transactivation domain is constitutively
phosphorylated, whereas the TA2
transactivation domain is rapidly phosphorylated after
phorbol ester stimulation.43 This induced
phosphorylation of the TA2 domain
results in an enhancement of transactivation.43
The results presented here demonstrate that norLeu does not
inhibit IL-1ßinduced phosphorylation of p65.
However, it is possible that the changes in the
phosphorylation pattern of p65 are modified by
inhibition of the proteasome, which could not have been detected in our
experiments. In addition, norLeu did not completely block
NF-
Bmediated transcription in transiently transfected ECs. These
results are similar to those observed with inhibitors of
5-lipoxygenase, which inhibited NF-
Bmediated
transcription without interfering with nuclear translocation or p65
phosphorylation.44 Taken
together, these results imply that it is possible to inhibit the
transactivation by NF-
B without interfering with
phosphorylation or nuclear translocation.
This study identifies the importance of the proteasome complex in the
regulation of cytokine induction of MCP-1 in ECs. Our results
clearly demonstrate that phosphorylation of p65 and
nuclear translocation of NF-
B are not sufficient for the induction
of the MCP-1 gene. Because MCP-1 appears to play a significant role in
inflammation, the proteasome complex may represent a target for
therapeutic intervention in pathophysiological
states associated with high levels of MCP-1.
| Selected Abbreviations and Acronyms |
|---|
|
| Acknowledgments |
|---|
Received June 10, 1997; accepted January 5, 1998.
| References |
|---|
|
|
|---|
B and Sp1 regulate transcription of the human monocyte
chemoattractant protein-1 gene. J Immunol. 1994;153:20522063.[Abstract]
B and AP-1. Eur J
Immunol. 1997;27:10911097.[Medline]
[Order article via Infotrieve]
B subunits
in endothelial and epithelial cells. Mol Cell
Biol. 1993;13:62836289.
B sites that
specifically bind c-rel-p65 heterodimers. J Biol Chem. 1994;269:2082320825.
B and I
B
: an inducible regulatory system in
endothelial activation. J Exp Med. 1994;179:503512.
B is a specific
inhibitor of the NF-
B transcription factor.
Science. 1988;242:540546.
B
: a mechanism
for NF-
B activation. Mol Cell Biol. 1993;13:33013310.
B and its inhibitor, I
B
. Proc Natl
Acad Sci U S A. 1993;90:25322536.
B-
is necessary in the
activation of transcription factor NF-
B. Nature. 1993;365:182185.[Medline]
[Order article via Infotrieve]
B
controls the expression of inhibitor I
B
: evidence for
an inducible autoregulatory pathway. Science. 1993;259:19121915.
B and
stabilizes a newly phosphorylated form of I
B-
that is still bound to NF-
B. EMBO J. 1994;13:54335441.[Medline]
[Order article via Infotrieve]
B
is not sufficient for
its dissociation from NF-
B and is inhibited by protease
inhibitors. Proc Natl Acad Sci U S A. 1994;91:1188411888.
B1 precursor protein and the activation of NF-
B.
Cell. 1994;78:773785.[Medline]
[Order article via Infotrieve]
B by processing of the p105 through an ATP-dependent
pathway. Nature. 1991;354:395398.[Medline]
[Order article via Infotrieve]
B. Eur J
Immunol. 1996;26:839845.[Medline]
[Order article via Infotrieve]
B
in vivo is regulated by multiple
phosphorylations. EMBO J. 1994;13:45974604.[Medline]
[Order article via Infotrieve]
B:
similarity to TA1 and phorbol ester-stimulated
activity and phosphorylation in intact cells.
J Biol Chem. 1995;270:1557615582.This article has been cited by other articles:
![]() |
K. V. Reddy, G. Bhattacharjee, G. Schabbauer, A. Hollis, K. Kempf, M. Tencati, M. O'Connell, M. Guha, and N. Mackman Dexamethasone enhances LPS induction of tissue factor expression in human monocytic cells by increasing tissue factor mRNA stability J. Leukoc. Biol., July 1, 2004; 76(1): 145 - 151. [Abstract] [Full Text] [PDF] |
||||
![]() |
Y.-M. Chen, W.-C. Chiang, S.-L. Lin, K.-D. Wu, T.-J. Tsai, and B.-S. Hsieh Dual Regulation of Tumor Necrosis Factor-{alpha}-Induced CCL2/Monocyte Chemoattractant Protein-1 Expression in Vascular Smooth Muscle Cells by Nuclear Factor-{kappa}B and Activator Protein-1: Modulation by Type III Phosphodiesterase Inhibition J. Pharmacol. Exp. Ther., June 1, 2004; 309(3): 978 - 986. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. Zhao, S. A. Stavchansky, R. A. Bowden, and P. D. Bowman Effect of interleukin-1beta and tumor necrosis factor-alpha on gene expression in human endothelial cells Am J Physiol Cell Physiol, June 1, 2003; 284(6): C1577 - C1583. [Abstract] [Full Text] [PDF] |
||||
![]() |
N.-H. Cho, S.-Y. Seong, M.-S. Huh, N.-H. Kim, M.-s. Choi, and I.-s. Kim Induction of the Gene Encoding Macrophage Chemoattractant Protein 1 by Orientia tsutsugamushi in Human Endothelial Cells Involves Activation of Transcription Factor Activator Protein 1 Infect. Immun., September 1, 2002; 70(9): 4841 - 4850. [Abstract] [Full Text] [PDF] |
||||
![]() |
K. Nakayama, A. Furusu, Q. Xu, T. Konta, and M. Kitamura Unexpected Transcriptional Induction of Monocyte Chemoattractant Protein 1 by Proteasome Inhibition: Involvement of the c-Jun N-Terminal Kinase-Activator Protein 1 Pathway J. Immunol., August 1, 2001; 167(3): 1145 - 1150. [Abstract] [Full Text] [PDF] |
||||
![]() |
N.-H. Cho, S.-Y. Seong, M.-S. Choi, and I.-S. Kim Expression of Chemokine Genes in Human Dermal Microvascular Endothelial Cell Lines Infected with Orientia tsutsugamushi Infect. Immun., March 1, 2001; 69(3): 1265 - 1272. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Dickfeld, E. Lengyel, A. E May, S. Massberg, K. Brand, S. Page, C. Thielen, K. Langenbrink, and M. Gawaz Transient interaction of activated platelets with endothelial cells induces expression of monocyte-chemoattractant protein-1 via a p38 mitogen-activated protein kinase mediated pathway: Implications for atherogenesis Cardiovasc Res, January 1, 2001; 49(1): 189 - 199. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Alonso, Y. Bayon, M. Renedo, and M. S. Crespo Stimulation of Fc{gamma}R receptors induces monocyte chemoattractant protein-1 in the human monocytic cell line THP-1 by a mechanism involving I{kappa}B-{alpha} degradation and formation of p50/p65 NF-{kappa}B/Rel complexes Int. Immunol., April 1, 2000; 12(4): 547 - 554. [Abstract] [Full Text] [PDF] |
||||
![]() |
K. S.C. Weber, G. Draude, W. Erl, R. de Martin, and C. Weber Monocyte Arrest and Transmigration on Inflamed Endothelium in Shear Flow Is Inhibited by Adenovirus-Mediated Gene Transfer of Ikappa B-alpha Blood, June 1, 1999; 93(11): 3685 - 3693. [Abstract] [Full Text] [PDF] |
||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
ATVB Home | Subscriptions | Archives | Feedback | Authors | Help | AHA Journals Home | Search Copyright © 1998 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. |