Mucosal administration of heat shock protein-65 decreases atherosclerosis and inflammation in aortic arch of low-density lipoprotein receptor-deficient mice
Increasing evidence supports the involvement of inflammation and immunity in atherogenesis as well as the role of autoimmunity to heat shock proteins (HSPs) in the progression of atherosclerosis. Mucosal administration of autoantigens decreases organ-specific inflammation and disease in several mode...
Gespeichert in:
Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2002-09, Vol.106 (13), p.1708-1715 |
---|---|
Hauptverfasser: | , , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 1715 |
---|---|
container_issue | 13 |
container_start_page | 1708 |
container_title | Circulation (New York, N.Y.) |
container_volume | 106 |
creator | MARON, Ruth SUKHOVA, Galina FARIA, Ana-Maria HOFFMANN, Ethan MACH, Francois LIBBY, Peter WEINER, Howard L |
description | Increasing evidence supports the involvement of inflammation and immunity in atherogenesis as well as the role of autoimmunity to heat shock proteins (HSPs) in the progression of atherosclerosis. Mucosal administration of autoantigens decreases organ-specific inflammation and disease in several models of autoimmunity (diabetes, arthritis, and encephalomyelitis) and is also being tested in human clinical trials.
We examined the effect of nasal or oral administration of mycobacterial HSP-65 on atherosclerotic lesion formation in mice lacking the receptor for LDL that were maintained on a high-cholesterol diet. Animals were nasally or orally treated for 1 week with HSP-65, and a high-cholesterol diet was started after the last treatment. The mice were mucosally treated once a week for 8 or 12 weeks, at which time pathological analysis was performed. We found a significant decrease in the size of atherosclerotic plaques, a reduction in macrophage-positive area in the aortic arch, increased interleukin-10 expression, and a reduced number of T cells in nasally treated animals compared with control animals. A similar trend was observed in orally treated mice, but it was not significant.
Our results demonstrate that nasal vaccination with HSP reduces the inflammatory process associated with atherosclerosis and provides a new immunologic approach for the treatment of atherosclerosis. |
doi_str_mv | 10.1161/01.CIR.0000029750.99462.30 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_72116513</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>208088241</sourcerecordid><originalsourceid>FETCH-LOGICAL-c590t-3ac654b942fe09e14417b052e58a88621289cdeb7e14df4d874d2fd02bed5bde3</originalsourceid><addsrcrecordid>eNpdkduKFDEQhhtR3HH1FSQs6F23OXY63sngYWFFEL0O6aSaydqdjEmaZd_FhzXjNAyYiwpFffVXUX_T3BDcEdKTd5h0-9vvHT49qqTAnVK8px3DT5odEZS3XDD1tNnVumolo_SqeZHzfU17JsXz5opQKvHQy13z5-tqYzYzMm7xweeSTPExoDihA5iC8iHaX-iYYgEf2l4gBzaByZCRKQdIMdv5FH3Ng0M-TLNZlrOGD8jEVLxFJtnDSXKOD62DkH15RLM_xk0XJbBwLDHV4uSth1DQ4i28bJ5NZs7wavuvm5-fPv7Yf2nvvn2-3X-4a61QuLTM2F7wUXE6AVZAOCdyxIKCGMww9JTQQVkHo6wlN3E3SO7o5DAdwYnRAbtu3p516z6_V8hFLz5bmGcTIK5ZS1rvLgir4M1_4H1cU6i76TpFciIUrdD7M2TrXXKCSR-TX0x61ATrk4EaE10N1BcD9T8DNcO1-fU2YR0XcJfWzbEKvNkAk62Zp2SC9fnCMSUwZT37C9MKp4c</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>212741592</pqid></control><display><type>article</type><title>Mucosal administration of heat shock protein-65 decreases atherosclerosis and inflammation in aortic arch of low-density lipoprotein receptor-deficient mice</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Journals@Ovid Complete</source><creator>MARON, Ruth ; SUKHOVA, Galina ; FARIA, Ana-Maria ; HOFFMANN, Ethan ; MACH, Francois ; LIBBY, Peter ; WEINER, Howard L</creator><creatorcontrib>MARON, Ruth ; SUKHOVA, Galina ; FARIA, Ana-Maria ; HOFFMANN, Ethan ; MACH, Francois ; LIBBY, Peter ; WEINER, Howard L</creatorcontrib><description>Increasing evidence supports the involvement of inflammation and immunity in atherogenesis as well as the role of autoimmunity to heat shock proteins (HSPs) in the progression of atherosclerosis. Mucosal administration of autoantigens decreases organ-specific inflammation and disease in several models of autoimmunity (diabetes, arthritis, and encephalomyelitis) and is also being tested in human clinical trials.
We examined the effect of nasal or oral administration of mycobacterial HSP-65 on atherosclerotic lesion formation in mice lacking the receptor for LDL that were maintained on a high-cholesterol diet. Animals were nasally or orally treated for 1 week with HSP-65, and a high-cholesterol diet was started after the last treatment. The mice were mucosally treated once a week for 8 or 12 weeks, at which time pathological analysis was performed. We found a significant decrease in the size of atherosclerotic plaques, a reduction in macrophage-positive area in the aortic arch, increased interleukin-10 expression, and a reduced number of T cells in nasally treated animals compared with control animals. A similar trend was observed in orally treated mice, but it was not significant.
Our results demonstrate that nasal vaccination with HSP reduces the inflammatory process associated with atherosclerosis and provides a new immunologic approach for the treatment of atherosclerosis.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.0000029750.99462.30</identifier><identifier>PMID: 12270867</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Administration, Intranasal ; Administration, Oral ; Animals ; Antibodies, Bacterial - blood ; Antigens, Bacterial - administration & dosage ; Antigens, Bacterial - adverse effects ; Aorta, Thoracic - drug effects ; Aorta, Thoracic - metabolism ; Aorta, Thoracic - pathology ; Arteriosclerosis - immunology ; Arteriosclerosis - pathology ; Arteriosclerosis - prevention & control ; Atherosclerosis (general aspects, experimental research) ; Bacterial Proteins ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cell Count ; Cell Division - drug effects ; Cell Division - immunology ; Chaperonin 60 ; Chaperonins - administration & dosage ; Chaperonins - adverse effects ; Chaperonins - immunology ; Cholesterol, Dietary ; Cytokines - metabolism ; Female ; Freund's Adjuvant - administration & dosage ; Inflammation - pathology ; Inflammation - prevention & control ; Lymph Nodes - metabolism ; Macrophages - drug effects ; Macrophages - pathology ; Medical sciences ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Mycobacterium - immunology ; Nasal Mucosa - cytology ; Nasal Mucosa - drug effects ; Nasal Mucosa - metabolism ; Receptors, LDL - deficiency ; Receptors, LDL - genetics ; Spleen - cytology ; Spleen - drug effects ; Spleen - immunology ; T-Lymphocytes - drug effects ; T-Lymphocytes - pathology</subject><ispartof>Circulation (New York, N.Y.), 2002-09, Vol.106 (13), p.1708-1715</ispartof><rights>2002 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Sep 24, 2002</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c590t-3ac654b942fe09e14417b052e58a88621289cdeb7e14df4d874d2fd02bed5bde3</citedby><cites>FETCH-LOGICAL-c590t-3ac654b942fe09e14417b052e58a88621289cdeb7e14df4d874d2fd02bed5bde3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13950236$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12270867$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MARON, Ruth</creatorcontrib><creatorcontrib>SUKHOVA, Galina</creatorcontrib><creatorcontrib>FARIA, Ana-Maria</creatorcontrib><creatorcontrib>HOFFMANN, Ethan</creatorcontrib><creatorcontrib>MACH, Francois</creatorcontrib><creatorcontrib>LIBBY, Peter</creatorcontrib><creatorcontrib>WEINER, Howard L</creatorcontrib><title>Mucosal administration of heat shock protein-65 decreases atherosclerosis and inflammation in aortic arch of low-density lipoprotein receptor-deficient mice</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Increasing evidence supports the involvement of inflammation and immunity in atherogenesis as well as the role of autoimmunity to heat shock proteins (HSPs) in the progression of atherosclerosis. Mucosal administration of autoantigens decreases organ-specific inflammation and disease in several models of autoimmunity (diabetes, arthritis, and encephalomyelitis) and is also being tested in human clinical trials.
We examined the effect of nasal or oral administration of mycobacterial HSP-65 on atherosclerotic lesion formation in mice lacking the receptor for LDL that were maintained on a high-cholesterol diet. Animals were nasally or orally treated for 1 week with HSP-65, and a high-cholesterol diet was started after the last treatment. The mice were mucosally treated once a week for 8 or 12 weeks, at which time pathological analysis was performed. We found a significant decrease in the size of atherosclerotic plaques, a reduction in macrophage-positive area in the aortic arch, increased interleukin-10 expression, and a reduced number of T cells in nasally treated animals compared with control animals. A similar trend was observed in orally treated mice, but it was not significant.
Our results demonstrate that nasal vaccination with HSP reduces the inflammatory process associated with atherosclerosis and provides a new immunologic approach for the treatment of atherosclerosis.</description><subject>Administration, Intranasal</subject><subject>Administration, Oral</subject><subject>Animals</subject><subject>Antibodies, Bacterial - blood</subject><subject>Antigens, Bacterial - administration & dosage</subject><subject>Antigens, Bacterial - adverse effects</subject><subject>Aorta, Thoracic - drug effects</subject><subject>Aorta, Thoracic - metabolism</subject><subject>Aorta, Thoracic - pathology</subject><subject>Arteriosclerosis - immunology</subject><subject>Arteriosclerosis - pathology</subject><subject>Arteriosclerosis - prevention & control</subject><subject>Atherosclerosis (general aspects, experimental research)</subject><subject>Bacterial Proteins</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Cell Count</subject><subject>Cell Division - drug effects</subject><subject>Cell Division - immunology</subject><subject>Chaperonin 60</subject><subject>Chaperonins - administration & dosage</subject><subject>Chaperonins - adverse effects</subject><subject>Chaperonins - immunology</subject><subject>Cholesterol, Dietary</subject><subject>Cytokines - metabolism</subject><subject>Female</subject><subject>Freund's Adjuvant - administration & dosage</subject><subject>Inflammation - pathology</subject><subject>Inflammation - prevention & control</subject><subject>Lymph Nodes - metabolism</subject><subject>Macrophages - drug effects</subject><subject>Macrophages - pathology</subject><subject>Medical sciences</subject><subject>Mice</subject><subject>Mice, Inbred C57BL</subject><subject>Mice, Knockout</subject><subject>Mycobacterium - immunology</subject><subject>Nasal Mucosa - cytology</subject><subject>Nasal Mucosa - drug effects</subject><subject>Nasal Mucosa - metabolism</subject><subject>Receptors, LDL - deficiency</subject><subject>Receptors, LDL - genetics</subject><subject>Spleen - cytology</subject><subject>Spleen - drug effects</subject><subject>Spleen - immunology</subject><subject>T-Lymphocytes - drug effects</subject><subject>T-Lymphocytes - pathology</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkduKFDEQhhtR3HH1FSQs6F23OXY63sngYWFFEL0O6aSaydqdjEmaZd_FhzXjNAyYiwpFffVXUX_T3BDcEdKTd5h0-9vvHT49qqTAnVK8px3DT5odEZS3XDD1tNnVumolo_SqeZHzfU17JsXz5opQKvHQy13z5-tqYzYzMm7xweeSTPExoDihA5iC8iHaX-iYYgEf2l4gBzaByZCRKQdIMdv5FH3Ng0M-TLNZlrOGD8jEVLxFJtnDSXKOD62DkH15RLM_xk0XJbBwLDHV4uSth1DQ4i28bJ5NZs7wavuvm5-fPv7Yf2nvvn2-3X-4a61QuLTM2F7wUXE6AVZAOCdyxIKCGMww9JTQQVkHo6wlN3E3SO7o5DAdwYnRAbtu3p516z6_V8hFLz5bmGcTIK5ZS1rvLgir4M1_4H1cU6i76TpFciIUrdD7M2TrXXKCSR-TX0x61ATrk4EaE10N1BcD9T8DNcO1-fU2YR0XcJfWzbEKvNkAk62Zp2SC9fnCMSUwZT37C9MKp4c</recordid><startdate>20020924</startdate><enddate>20020924</enddate><creator>MARON, Ruth</creator><creator>SUKHOVA, Galina</creator><creator>FARIA, Ana-Maria</creator><creator>HOFFMANN, Ethan</creator><creator>MACH, Francois</creator><creator>LIBBY, Peter</creator><creator>WEINER, Howard L</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20020924</creationdate><title>Mucosal administration of heat shock protein-65 decreases atherosclerosis and inflammation in aortic arch of low-density lipoprotein receptor-deficient mice</title><author>MARON, Ruth ; SUKHOVA, Galina ; FARIA, Ana-Maria ; HOFFMANN, Ethan ; MACH, Francois ; LIBBY, Peter ; WEINER, Howard L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c590t-3ac654b942fe09e14417b052e58a88621289cdeb7e14df4d874d2fd02bed5bde3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Administration, Intranasal</topic><topic>Administration, Oral</topic><topic>Animals</topic><topic>Antibodies, Bacterial - blood</topic><topic>Antigens, Bacterial - administration & dosage</topic><topic>Antigens, Bacterial - adverse effects</topic><topic>Aorta, Thoracic - drug effects</topic><topic>Aorta, Thoracic - metabolism</topic><topic>Aorta, Thoracic - pathology</topic><topic>Arteriosclerosis - immunology</topic><topic>Arteriosclerosis - pathology</topic><topic>Arteriosclerosis - prevention & control</topic><topic>Atherosclerosis (general aspects, experimental research)</topic><topic>Bacterial Proteins</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Cell Count</topic><topic>Cell Division - drug effects</topic><topic>Cell Division - immunology</topic><topic>Chaperonin 60</topic><topic>Chaperonins - administration & dosage</topic><topic>Chaperonins - adverse effects</topic><topic>Chaperonins - immunology</topic><topic>Cholesterol, Dietary</topic><topic>Cytokines - metabolism</topic><topic>Female</topic><topic>Freund's Adjuvant - administration & dosage</topic><topic>Inflammation - pathology</topic><topic>Inflammation - prevention & control</topic><topic>Lymph Nodes - metabolism</topic><topic>Macrophages - drug effects</topic><topic>Macrophages - pathology</topic><topic>Medical sciences</topic><topic>Mice</topic><topic>Mice, Inbred C57BL</topic><topic>Mice, Knockout</topic><topic>Mycobacterium - immunology</topic><topic>Nasal Mucosa - cytology</topic><topic>Nasal Mucosa - drug effects</topic><topic>Nasal Mucosa - metabolism</topic><topic>Receptors, LDL - deficiency</topic><topic>Receptors, LDL - genetics</topic><topic>Spleen - cytology</topic><topic>Spleen - drug effects</topic><topic>Spleen - immunology</topic><topic>T-Lymphocytes - drug effects</topic><topic>T-Lymphocytes - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MARON, Ruth</creatorcontrib><creatorcontrib>SUKHOVA, Galina</creatorcontrib><creatorcontrib>FARIA, Ana-Maria</creatorcontrib><creatorcontrib>HOFFMANN, Ethan</creatorcontrib><creatorcontrib>MACH, Francois</creatorcontrib><creatorcontrib>LIBBY, Peter</creatorcontrib><creatorcontrib>WEINER, Howard L</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>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MARON, Ruth</au><au>SUKHOVA, Galina</au><au>FARIA, Ana-Maria</au><au>HOFFMANN, Ethan</au><au>MACH, Francois</au><au>LIBBY, Peter</au><au>WEINER, Howard L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mucosal administration of heat shock protein-65 decreases atherosclerosis and inflammation in aortic arch of low-density lipoprotein receptor-deficient mice</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2002-09-24</date><risdate>2002</risdate><volume>106</volume><issue>13</issue><spage>1708</spage><epage>1715</epage><pages>1708-1715</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Increasing evidence supports the involvement of inflammation and immunity in atherogenesis as well as the role of autoimmunity to heat shock proteins (HSPs) in the progression of atherosclerosis. Mucosal administration of autoantigens decreases organ-specific inflammation and disease in several models of autoimmunity (diabetes, arthritis, and encephalomyelitis) and is also being tested in human clinical trials.
We examined the effect of nasal or oral administration of mycobacterial HSP-65 on atherosclerotic lesion formation in mice lacking the receptor for LDL that were maintained on a high-cholesterol diet. Animals were nasally or orally treated for 1 week with HSP-65, and a high-cholesterol diet was started after the last treatment. The mice were mucosally treated once a week for 8 or 12 weeks, at which time pathological analysis was performed. We found a significant decrease in the size of atherosclerotic plaques, a reduction in macrophage-positive area in the aortic arch, increased interleukin-10 expression, and a reduced number of T cells in nasally treated animals compared with control animals. A similar trend was observed in orally treated mice, but it was not significant.
Our results demonstrate that nasal vaccination with HSP reduces the inflammatory process associated with atherosclerosis and provides a new immunologic approach for the treatment of atherosclerosis.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>12270867</pmid><doi>10.1161/01.CIR.0000029750.99462.30</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0009-7322 |
ispartof | Circulation (New York, N.Y.), 2002-09, Vol.106 (13), p.1708-1715 |
issn | 0009-7322 1524-4539 |
language | eng |
recordid | cdi_proquest_miscellaneous_72116513 |
source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
subjects | Administration, Intranasal Administration, Oral Animals Antibodies, Bacterial - blood Antigens, Bacterial - administration & dosage Antigens, Bacterial - adverse effects Aorta, Thoracic - drug effects Aorta, Thoracic - metabolism Aorta, Thoracic - pathology Arteriosclerosis - immunology Arteriosclerosis - pathology Arteriosclerosis - prevention & control Atherosclerosis (general aspects, experimental research) Bacterial Proteins Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cell Count Cell Division - drug effects Cell Division - immunology Chaperonin 60 Chaperonins - administration & dosage Chaperonins - adverse effects Chaperonins - immunology Cholesterol, Dietary Cytokines - metabolism Female Freund's Adjuvant - administration & dosage Inflammation - pathology Inflammation - prevention & control Lymph Nodes - metabolism Macrophages - drug effects Macrophages - pathology Medical sciences Mice Mice, Inbred C57BL Mice, Knockout Mycobacterium - immunology Nasal Mucosa - cytology Nasal Mucosa - drug effects Nasal Mucosa - metabolism Receptors, LDL - deficiency Receptors, LDL - genetics Spleen - cytology Spleen - drug effects Spleen - immunology T-Lymphocytes - drug effects T-Lymphocytes - pathology |
title | Mucosal administration of heat shock protein-65 decreases atherosclerosis and inflammation in aortic arch of low-density lipoprotein receptor-deficient mice |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T20%3A20%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Mucosal%20administration%20of%20heat%20shock%20protein-65%20decreases%20atherosclerosis%20and%20inflammation%20in%20aortic%20arch%20of%20low-density%20lipoprotein%20receptor-deficient%20mice&rft.jtitle=Circulation%20(New%20York,%20N.Y.)&rft.au=MARON,%20Ruth&rft.date=2002-09-24&rft.volume=106&rft.issue=13&rft.spage=1708&rft.epage=1715&rft.pages=1708-1715&rft.issn=0009-7322&rft.eissn=1524-4539&rft.coden=CIRCAZ&rft_id=info:doi/10.1161/01.CIR.0000029750.99462.30&rft_dat=%3Cproquest_cross%3E208088241%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=212741592&rft_id=info:pmid/12270867&rfr_iscdi=true |