A Single-Chain Tetradomain Glycoprotein Hormone Analog Elicits Multiple Hormone Activities In Vivo
We previously demonstrated that genetically linking one or more of the glycoprotein hormone-specific β subunit genes to the common α subunit resulted in single-chain analogues that were bioactive in vitro. The ability of such large structures to bind their cognate receptors with high affinity supp...
Gespeichert in:
Veröffentlicht in: | Biology of reproduction 2005-02, Vol.72 (2), p.301-308 |
---|---|
Hauptverfasser: | , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 308 |
---|---|
container_issue | 2 |
container_start_page | 301 |
container_title | Biology of reproduction |
container_volume | 72 |
creator | Vicenta Garcia-Campayo Irving Boime Xiaoping Ma Dorit Daphna-Iken T. Rajendra Kumar |
description | We previously demonstrated that genetically linking one or more of the glycoprotein hormone-specific β subunit genes to the
common α subunit resulted in single-chain analogues that were bioactive in vitro. The ability of such large structures to
bind their cognate receptors with high affinity supported the hypothesis that extensive flexibility exists between the ligand
and receptor to establish a functional complex. To further characterize the extent of this conformational flexibility, we
engineered a single-chain analogue that consists of sequentially linked thyroid-stimulating hormone (TSH) β, follicle-stimulating
hormone (FSH) β, and chorionic gonadotropin (CG) β subunits to the α subunit and expressed this chimera in transfected CHO
(Chinese hamster ovary) cells. Because the four subunits are genetically linked and expressed as a single-chain, this analogue
presumably lacks significant native structural features of the individual heterodimers. However, it exhibited FSH, CG, and
TSH activities in vitro. Here, we test whether this nonnative structure would be stable in vivo and thus biologically active.
Using a variety of bioassay protocols, we demonstrate that the analogue elicits multihormone activities when injected in vivo.
First, treatment with the analogue caused increases in ovarian and uterine weights and resulted in elevated serum estradiol.
Second, the analogue-stimulated ovarian follicle growth and pharmacologically rescued in vivo FSH deficiency similar to recombinant
human FSH or equine CG (eCG) as confirmed by induction of aromatase in the ovaries of FSHβ knockout mice. Third, in a superovulation
protocol, when primed with eCG, the analogue elicited a dose-dependent ovulatory response comparable with that by native heterodimeric
human CG. Finally, the analogue-stimulated thyroxin production in hypothyroid mice similar to the pituitary-derived human
TSH standard. Based on these data, we conclude that a single-chain tetradomain glycoprotein hormone analogue, despite its
presumed altered conformation, is stable and biologically active in vivo. Our results establish the permissiveness and conformational
plasticity with which the glycoprotein hormones are recognized in vivo by their target cell receptors.
Abstract
Three disctinct glycoprotein hormone activities can be combined in a single chain analogue |
doi_str_mv | 10.1095/biolreprod.104.031732 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_67374431</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>67374431</sourcerecordid><originalsourceid>FETCH-LOGICAL-h269t-bf0586bbb96cc414498b9f8c0ec114555dc8b9a7fd04867fbc3beabc1a78c6293</originalsourceid><addsrcrecordid>eNpFkM1OwzAQhC0EoqXwCKBc4Jbi_yTHqiptpSIOFK6R7TiNkRMXO2nUtyeIop52Z_fTzGoBuEdwimDGnqVx1uu9d8Wg6RQSlBB8AcaI4SxOME8vwRhCyGNCOBmBmxC-IESUYHINRoiRlFGMxkDOonfT7KyO55UwTbTVrReFq3_7pT0qNyS0ehAr52vX6GjWCOt20cIaZdoQvXa2NXurz3vVmoNpjQ7Ruok-zcHdgqtS2KDvTnUCPl4W2_kq3rwt1_PZJq4wz9pYlpClXEqZcaUoojRLZVamCmqFEGWMFWoYiKQsIE15UkpFpBZSIZGkiuOMTMDTn-9w8nenQ5vXJihtrWi060LOE5JQStAAPpzATta6yPfe1MIf8_-vDMDjCRBBCVt60SgTzhynDMMUnrnK7KreeJ2HWlg72JK87_sE5zgnEJEfsK2B5Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67374431</pqid></control><display><type>article</type><title>A Single-Chain Tetradomain Glycoprotein Hormone Analog Elicits Multiple Hormone Activities In Vivo</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>BioOne Complete</source><creator>Vicenta Garcia-Campayo ; Irving Boime ; Xiaoping Ma ; Dorit Daphna-Iken ; T. Rajendra Kumar</creator><creatorcontrib>Vicenta Garcia-Campayo ; Irving Boime ; Xiaoping Ma ; Dorit Daphna-Iken ; T. Rajendra Kumar</creatorcontrib><description>We previously demonstrated that genetically linking one or more of the glycoprotein hormone-specific β subunit genes to the
common α subunit resulted in single-chain analogues that were bioactive in vitro. The ability of such large structures to
bind their cognate receptors with high affinity supported the hypothesis that extensive flexibility exists between the ligand
and receptor to establish a functional complex. To further characterize the extent of this conformational flexibility, we
engineered a single-chain analogue that consists of sequentially linked thyroid-stimulating hormone (TSH) β, follicle-stimulating
hormone (FSH) β, and chorionic gonadotropin (CG) β subunits to the α subunit and expressed this chimera in transfected CHO
(Chinese hamster ovary) cells. Because the four subunits are genetically linked and expressed as a single-chain, this analogue
presumably lacks significant native structural features of the individual heterodimers. However, it exhibited FSH, CG, and
TSH activities in vitro. Here, we test whether this nonnative structure would be stable in vivo and thus biologically active.
Using a variety of bioassay protocols, we demonstrate that the analogue elicits multihormone activities when injected in vivo.
First, treatment with the analogue caused increases in ovarian and uterine weights and resulted in elevated serum estradiol.
Second, the analogue-stimulated ovarian follicle growth and pharmacologically rescued in vivo FSH deficiency similar to recombinant
human FSH or equine CG (eCG) as confirmed by induction of aromatase in the ovaries of FSHβ knockout mice. Third, in a superovulation
protocol, when primed with eCG, the analogue elicited a dose-dependent ovulatory response comparable with that by native heterodimeric
human CG. Finally, the analogue-stimulated thyroxin production in hypothyroid mice similar to the pituitary-derived human
TSH standard. Based on these data, we conclude that a single-chain tetradomain glycoprotein hormone analogue, despite its
presumed altered conformation, is stable and biologically active in vivo. Our results establish the permissiveness and conformational
plasticity with which the glycoprotein hormones are recognized in vivo by their target cell receptors.
Abstract
Three disctinct glycoprotein hormone activities can be combined in a single chain analogue</description><identifier>ISSN: 0006-3363</identifier><identifier>EISSN: 1529-7268</identifier><identifier>DOI: 10.1095/biolreprod.104.031732</identifier><identifier>PMID: 15385421</identifier><identifier>CODEN: BIREBV</identifier><language>eng</language><publisher>Madison, WI: Society for the Study of Reproduction</publisher><subject>Animals ; Aromatase - biosynthesis ; Aromatase - genetics ; Biological and medical sciences ; Biological Assay ; CHO Cells ; Chorionic Gonadotropin - chemistry ; Chorionic Gonadotropin - pharmacology ; Cricetinae ; Female ; Follicle Stimulating Hormone - chemistry ; Follicle Stimulating Hormone - pharmacology ; Fundamental and applied biological sciences. Psychology ; Glycoproteins - chemistry ; Glycoproteins - pharmacology ; Hormones - chemistry ; Hormones - pharmacology ; Hormones and neuropeptides. Regulation ; Humans ; Hypothalamus. Hypophysis. Epiphysis. Urophysis ; Hypothyroidism - genetics ; Hypothyroidism - metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Ovary - drug effects ; Protein Conformation ; Radioimmunoassay ; Recombinant Proteins - chemistry ; Recombinant Proteins - pharmacology ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger - biosynthesis ; Superovulation - drug effects ; Superovulation - physiology ; Thyrotropin - chemistry ; Thyrotropin - pharmacology ; Uterus - drug effects ; Vertebrates: endocrinology ; Vertebrates: reproduction</subject><ispartof>Biology of reproduction, 2005-02, Vol.72 (2), p.301-308</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16452080$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15385421$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vicenta Garcia-Campayo</creatorcontrib><creatorcontrib>Irving Boime</creatorcontrib><creatorcontrib>Xiaoping Ma</creatorcontrib><creatorcontrib>Dorit Daphna-Iken</creatorcontrib><creatorcontrib>T. Rajendra Kumar</creatorcontrib><title>A Single-Chain Tetradomain Glycoprotein Hormone Analog Elicits Multiple Hormone Activities In Vivo</title><title>Biology of reproduction</title><addtitle>Biol Reprod</addtitle><description>We previously demonstrated that genetically linking one or more of the glycoprotein hormone-specific β subunit genes to the
common α subunit resulted in single-chain analogues that were bioactive in vitro. The ability of such large structures to
bind their cognate receptors with high affinity supported the hypothesis that extensive flexibility exists between the ligand
and receptor to establish a functional complex. To further characterize the extent of this conformational flexibility, we
engineered a single-chain analogue that consists of sequentially linked thyroid-stimulating hormone (TSH) β, follicle-stimulating
hormone (FSH) β, and chorionic gonadotropin (CG) β subunits to the α subunit and expressed this chimera in transfected CHO
(Chinese hamster ovary) cells. Because the four subunits are genetically linked and expressed as a single-chain, this analogue
presumably lacks significant native structural features of the individual heterodimers. However, it exhibited FSH, CG, and
TSH activities in vitro. Here, we test whether this nonnative structure would be stable in vivo and thus biologically active.
Using a variety of bioassay protocols, we demonstrate that the analogue elicits multihormone activities when injected in vivo.
First, treatment with the analogue caused increases in ovarian and uterine weights and resulted in elevated serum estradiol.
Second, the analogue-stimulated ovarian follicle growth and pharmacologically rescued in vivo FSH deficiency similar to recombinant
human FSH or equine CG (eCG) as confirmed by induction of aromatase in the ovaries of FSHβ knockout mice. Third, in a superovulation
protocol, when primed with eCG, the analogue elicited a dose-dependent ovulatory response comparable with that by native heterodimeric
human CG. Finally, the analogue-stimulated thyroxin production in hypothyroid mice similar to the pituitary-derived human
TSH standard. Based on these data, we conclude that a single-chain tetradomain glycoprotein hormone analogue, despite its
presumed altered conformation, is stable and biologically active in vivo. Our results establish the permissiveness and conformational
plasticity with which the glycoprotein hormones are recognized in vivo by their target cell receptors.
Abstract
Three disctinct glycoprotein hormone activities can be combined in a single chain analogue</description><subject>Animals</subject><subject>Aromatase - biosynthesis</subject><subject>Aromatase - genetics</subject><subject>Biological and medical sciences</subject><subject>Biological Assay</subject><subject>CHO Cells</subject><subject>Chorionic Gonadotropin - chemistry</subject><subject>Chorionic Gonadotropin - pharmacology</subject><subject>Cricetinae</subject><subject>Female</subject><subject>Follicle Stimulating Hormone - chemistry</subject><subject>Follicle Stimulating Hormone - pharmacology</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Glycoproteins - chemistry</subject><subject>Glycoproteins - pharmacology</subject><subject>Hormones - chemistry</subject><subject>Hormones - pharmacology</subject><subject>Hormones and neuropeptides. Regulation</subject><subject>Humans</subject><subject>Hypothalamus. Hypophysis. Epiphysis. Urophysis</subject><subject>Hypothyroidism - genetics</subject><subject>Hypothyroidism - metabolism</subject><subject>Male</subject><subject>Mice</subject><subject>Mice, Inbred C57BL</subject><subject>Mice, Knockout</subject><subject>Ovary - drug effects</subject><subject>Protein Conformation</subject><subject>Radioimmunoassay</subject><subject>Recombinant Proteins - chemistry</subject><subject>Recombinant Proteins - pharmacology</subject><subject>Reverse Transcriptase Polymerase Chain Reaction</subject><subject>RNA, Messenger - biosynthesis</subject><subject>Superovulation - drug effects</subject><subject>Superovulation - physiology</subject><subject>Thyrotropin - chemistry</subject><subject>Thyrotropin - pharmacology</subject><subject>Uterus - drug effects</subject><subject>Vertebrates: endocrinology</subject><subject>Vertebrates: reproduction</subject><issn>0006-3363</issn><issn>1529-7268</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkM1OwzAQhC0EoqXwCKBc4Jbi_yTHqiptpSIOFK6R7TiNkRMXO2nUtyeIop52Z_fTzGoBuEdwimDGnqVx1uu9d8Wg6RQSlBB8AcaI4SxOME8vwRhCyGNCOBmBmxC-IESUYHINRoiRlFGMxkDOonfT7KyO55UwTbTVrReFq3_7pT0qNyS0ehAr52vX6GjWCOt20cIaZdoQvXa2NXurz3vVmoNpjQ7Ruok-zcHdgqtS2KDvTnUCPl4W2_kq3rwt1_PZJq4wz9pYlpClXEqZcaUoojRLZVamCmqFEGWMFWoYiKQsIE15UkpFpBZSIZGkiuOMTMDTn-9w8nenQ5vXJihtrWi060LOE5JQStAAPpzATta6yPfe1MIf8_-vDMDjCRBBCVt60SgTzhynDMMUnrnK7KreeJ2HWlg72JK87_sE5zgnEJEfsK2B5Q</recordid><startdate>20050201</startdate><enddate>20050201</enddate><creator>Vicenta Garcia-Campayo</creator><creator>Irving Boime</creator><creator>Xiaoping Ma</creator><creator>Dorit Daphna-Iken</creator><creator>T. Rajendra Kumar</creator><general>Society for the Study of Reproduction</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20050201</creationdate><title>A Single-Chain Tetradomain Glycoprotein Hormone Analog Elicits Multiple Hormone Activities In Vivo</title><author>Vicenta Garcia-Campayo ; Irving Boime ; Xiaoping Ma ; Dorit Daphna-Iken ; T. Rajendra Kumar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h269t-bf0586bbb96cc414498b9f8c0ec114555dc8b9a7fd04867fbc3beabc1a78c6293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Animals</topic><topic>Aromatase - biosynthesis</topic><topic>Aromatase - genetics</topic><topic>Biological and medical sciences</topic><topic>Biological Assay</topic><topic>CHO Cells</topic><topic>Chorionic Gonadotropin - chemistry</topic><topic>Chorionic Gonadotropin - pharmacology</topic><topic>Cricetinae</topic><topic>Female</topic><topic>Follicle Stimulating Hormone - chemistry</topic><topic>Follicle Stimulating Hormone - pharmacology</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Glycoproteins - chemistry</topic><topic>Glycoproteins - pharmacology</topic><topic>Hormones - chemistry</topic><topic>Hormones - pharmacology</topic><topic>Hormones and neuropeptides. Regulation</topic><topic>Humans</topic><topic>Hypothalamus. Hypophysis. Epiphysis. Urophysis</topic><topic>Hypothyroidism - genetics</topic><topic>Hypothyroidism - metabolism</topic><topic>Male</topic><topic>Mice</topic><topic>Mice, Inbred C57BL</topic><topic>Mice, Knockout</topic><topic>Ovary - drug effects</topic><topic>Protein Conformation</topic><topic>Radioimmunoassay</topic><topic>Recombinant Proteins - chemistry</topic><topic>Recombinant Proteins - pharmacology</topic><topic>Reverse Transcriptase Polymerase Chain Reaction</topic><topic>RNA, Messenger - biosynthesis</topic><topic>Superovulation - drug effects</topic><topic>Superovulation - physiology</topic><topic>Thyrotropin - chemistry</topic><topic>Thyrotropin - pharmacology</topic><topic>Uterus - drug effects</topic><topic>Vertebrates: endocrinology</topic><topic>Vertebrates: reproduction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vicenta Garcia-Campayo</creatorcontrib><creatorcontrib>Irving Boime</creatorcontrib><creatorcontrib>Xiaoping Ma</creatorcontrib><creatorcontrib>Dorit Daphna-Iken</creatorcontrib><creatorcontrib>T. Rajendra Kumar</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Biology of reproduction</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vicenta Garcia-Campayo</au><au>Irving Boime</au><au>Xiaoping Ma</au><au>Dorit Daphna-Iken</au><au>T. Rajendra Kumar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Single-Chain Tetradomain Glycoprotein Hormone Analog Elicits Multiple Hormone Activities In Vivo</atitle><jtitle>Biology of reproduction</jtitle><addtitle>Biol Reprod</addtitle><date>2005-02-01</date><risdate>2005</risdate><volume>72</volume><issue>2</issue><spage>301</spage><epage>308</epage><pages>301-308</pages><issn>0006-3363</issn><eissn>1529-7268</eissn><coden>BIREBV</coden><abstract>We previously demonstrated that genetically linking one or more of the glycoprotein hormone-specific β subunit genes to the
common α subunit resulted in single-chain analogues that were bioactive in vitro. The ability of such large structures to
bind their cognate receptors with high affinity supported the hypothesis that extensive flexibility exists between the ligand
and receptor to establish a functional complex. To further characterize the extent of this conformational flexibility, we
engineered a single-chain analogue that consists of sequentially linked thyroid-stimulating hormone (TSH) β, follicle-stimulating
hormone (FSH) β, and chorionic gonadotropin (CG) β subunits to the α subunit and expressed this chimera in transfected CHO
(Chinese hamster ovary) cells. Because the four subunits are genetically linked and expressed as a single-chain, this analogue
presumably lacks significant native structural features of the individual heterodimers. However, it exhibited FSH, CG, and
TSH activities in vitro. Here, we test whether this nonnative structure would be stable in vivo and thus biologically active.
Using a variety of bioassay protocols, we demonstrate that the analogue elicits multihormone activities when injected in vivo.
First, treatment with the analogue caused increases in ovarian and uterine weights and resulted in elevated serum estradiol.
Second, the analogue-stimulated ovarian follicle growth and pharmacologically rescued in vivo FSH deficiency similar to recombinant
human FSH or equine CG (eCG) as confirmed by induction of aromatase in the ovaries of FSHβ knockout mice. Third, in a superovulation
protocol, when primed with eCG, the analogue elicited a dose-dependent ovulatory response comparable with that by native heterodimeric
human CG. Finally, the analogue-stimulated thyroxin production in hypothyroid mice similar to the pituitary-derived human
TSH standard. Based on these data, we conclude that a single-chain tetradomain glycoprotein hormone analogue, despite its
presumed altered conformation, is stable and biologically active in vivo. Our results establish the permissiveness and conformational
plasticity with which the glycoprotein hormones are recognized in vivo by their target cell receptors.
Abstract
Three disctinct glycoprotein hormone activities can be combined in a single chain analogue</abstract><cop>Madison, WI</cop><pub>Society for the Study of Reproduction</pub><pmid>15385421</pmid><doi>10.1095/biolreprod.104.031732</doi><tpages>8</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0006-3363 |
ispartof | Biology of reproduction, 2005-02, Vol.72 (2), p.301-308 |
issn | 0006-3363 1529-7268 |
language | eng |
recordid | cdi_proquest_miscellaneous_67374431 |
source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; BioOne Complete |
subjects | Animals Aromatase - biosynthesis Aromatase - genetics Biological and medical sciences Biological Assay CHO Cells Chorionic Gonadotropin - chemistry Chorionic Gonadotropin - pharmacology Cricetinae Female Follicle Stimulating Hormone - chemistry Follicle Stimulating Hormone - pharmacology Fundamental and applied biological sciences. Psychology Glycoproteins - chemistry Glycoproteins - pharmacology Hormones - chemistry Hormones - pharmacology Hormones and neuropeptides. Regulation Humans Hypothalamus. Hypophysis. Epiphysis. Urophysis Hypothyroidism - genetics Hypothyroidism - metabolism Male Mice Mice, Inbred C57BL Mice, Knockout Ovary - drug effects Protein Conformation Radioimmunoassay Recombinant Proteins - chemistry Recombinant Proteins - pharmacology Reverse Transcriptase Polymerase Chain Reaction RNA, Messenger - biosynthesis Superovulation - drug effects Superovulation - physiology Thyrotropin - chemistry Thyrotropin - pharmacology Uterus - drug effects Vertebrates: endocrinology Vertebrates: reproduction |
title | A Single-Chain Tetradomain Glycoprotein Hormone Analog Elicits Multiple Hormone Activities In Vivo |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T12%3A58%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20Single-Chain%20Tetradomain%20Glycoprotein%20Hormone%20Analog%20Elicits%20Multiple%20Hormone%20Activities%20In%20Vivo&rft.jtitle=Biology%20of%20reproduction&rft.au=Vicenta%20Garcia-Campayo&rft.date=2005-02-01&rft.volume=72&rft.issue=2&rft.spage=301&rft.epage=308&rft.pages=301-308&rft.issn=0006-3363&rft.eissn=1529-7268&rft.coden=BIREBV&rft_id=info:doi/10.1095/biolreprod.104.031732&rft_dat=%3Cproquest_pubme%3E67374431%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=67374431&rft_id=info:pmid/15385421&rfr_iscdi=true |