Role of the Lysine-Specific Demethylase 1 in the Proinflammatory Phenotype of Vascular Smooth Muscle Cells of Diabetic Mice

Insulin resistance and type 2 diabetes are major risk factors for vascular complications. Vascular smooth muscle cells (VSMCs) derived from db/db mice, an established mouse model of type 2 diabetes, displayed enhanced inflammatory gene expression and proatherogenic responses. We examined the hypothe...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Circulation research 2008-09, Vol.103 (6), p.615-623
Hauptverfasser: Reddy, Marpadga A, Villeneuve, Louisa M, Wang, Mei, Lanting, Linda, Natarajan, Rama
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 623
container_issue 6
container_start_page 615
container_title Circulation research
container_volume 103
creator Reddy, Marpadga A
Villeneuve, Louisa M
Wang, Mei
Lanting, Linda
Natarajan, Rama
description Insulin resistance and type 2 diabetes are major risk factors for vascular complications. Vascular smooth muscle cells (VSMCs) derived from db/db mice, an established mouse model of type 2 diabetes, displayed enhanced inflammatory gene expression and proatherogenic responses. We examined the hypothesis that aberrant epigenetic chromatin events may the underlying mechanism for this persistent dysfunctional behavior and “memory” of the diabetic cells. Chromatin immunoprecipitation assays showed that levels of histone H3 lysine 4 dimethylation (H3K4me2), a key chromatin mark associated with active gene expression, were significantly elevated at the promoters of the inflammatory genes monocyte chemoattractant protein-1 and interleukin-6 in db/db VSMCs relative to db/+ cells. Tumor necrosis factor-α-induced inflammatory gene expression, H3K4me2 levels, and recruitment of RNA polymerase II at the gene promoters were also enhanced in db/db VSMCs, demonstrating the formation of open chromatin poised for transcriptional activation in diabetes. On the other hand, protein levels of lysine-specific demethylase1 (LSD1), which negatively regulates H3K4 methylation and its occupancy at these gene promoters, were significantly reduced in db/db VSMCs. High glucose (25 mmol/L) treatment of human VSMCs also increased inflammatory genes with parallel increases in promoter H3K4me2 levels and reduced LSD1 recruitment. LSD1 gene silencing with small interfering RNAs significantly increased inflammatory gene expression and enhanced VSMC-monocyte binding in nondiabetic VSMCs. In contrast, overexpression of LSD1 in diabetic db/db VSMCs inhibited their enhanced inflammatory gene expression. These results demonstrate novel functional roles for LSD1 and H3K4 methylation in VSMCs and inflammation. Dysregulation of their actions may be a major mechanism for vascular inflammation and metabolic memory associated with diabetic complications.
doi_str_mv 10.1161/CIRCRESAHA.108.175190
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2693400</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69556778</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5212-eaf0e42443a85075d65c95b70c7a9ec91d13ebaf545ce12a7c0a99408cb43c33</originalsourceid><addsrcrecordid>eNpVkl1v0zAUhiMEYmXwE0C5gbuU468kvkGqssEmdWJqJ24t1z0hBicudsJU8efx1mofV5aOn_PYPq-z7D2BOSEl-dxcrprV-XpxsZgTqOekEkTCi2xGBOUFFxV5mc0AQBYVY3CSvYnxFwDhjMrX2Qmpy7oGzmfZv5V3mPs2HzvMl_toByzWOzS2tSY_wx7Hbu90xJzkdriHroO3Q-t03-vRh31-3eHgx_3u3vJDRzM5HfJ17_3Y5VdTNMnfoHPxbv_M6g2OSX1lDb7NXrXaRXx3XE-zm6_nN81Fsfz-7bJZLAsjKKEF6haQU86ZrgVUYlsKI8WmAlNpiUaSLWG40a3gwiChujKgpeRQmw1nhrHT7MtBu5s2PW4NDmPQTu2C7XXYK6-ter4z2E799H8VLSXjAEnw6SgI_s-EcVS9jSY9SQ_op6hKKURZVXUCxQE0wccYsH04hIC6S009ppZKtTqklvo-PL3hY9cxpgR8PAJpvtq1QQ_GxgeOQllJScvE8QN3692IIf520y0G1aF2Y6fSdwAGaaIUoAZJKBSpQij7D2BIsok</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69556778</pqid></control><display><type>article</type><title>Role of the Lysine-Specific Demethylase 1 in the Proinflammatory Phenotype of Vascular Smooth Muscle Cells of Diabetic Mice</title><source>MEDLINE</source><source>American Heart Association</source><source>Journals@Ovid Complete</source><source>EZB Electronic Journals Library</source><creator>Reddy, Marpadga A ; Villeneuve, Louisa M ; Wang, Mei ; Lanting, Linda ; Natarajan, Rama</creator><creatorcontrib>Reddy, Marpadga A ; Villeneuve, Louisa M ; Wang, Mei ; Lanting, Linda ; Natarajan, Rama</creatorcontrib><description>Insulin resistance and type 2 diabetes are major risk factors for vascular complications. Vascular smooth muscle cells (VSMCs) derived from db/db mice, an established mouse model of type 2 diabetes, displayed enhanced inflammatory gene expression and proatherogenic responses. We examined the hypothesis that aberrant epigenetic chromatin events may the underlying mechanism for this persistent dysfunctional behavior and “memory” of the diabetic cells. Chromatin immunoprecipitation assays showed that levels of histone H3 lysine 4 dimethylation (H3K4me2), a key chromatin mark associated with active gene expression, were significantly elevated at the promoters of the inflammatory genes monocyte chemoattractant protein-1 and interleukin-6 in db/db VSMCs relative to db/+ cells. Tumor necrosis factor-α-induced inflammatory gene expression, H3K4me2 levels, and recruitment of RNA polymerase II at the gene promoters were also enhanced in db/db VSMCs, demonstrating the formation of open chromatin poised for transcriptional activation in diabetes. On the other hand, protein levels of lysine-specific demethylase1 (LSD1), which negatively regulates H3K4 methylation and its occupancy at these gene promoters, were significantly reduced in db/db VSMCs. High glucose (25 mmol/L) treatment of human VSMCs also increased inflammatory genes with parallel increases in promoter H3K4me2 levels and reduced LSD1 recruitment. LSD1 gene silencing with small interfering RNAs significantly increased inflammatory gene expression and enhanced VSMC-monocyte binding in nondiabetic VSMCs. In contrast, overexpression of LSD1 in diabetic db/db VSMCs inhibited their enhanced inflammatory gene expression. These results demonstrate novel functional roles for LSD1 and H3K4 methylation in VSMCs and inflammation. Dysregulation of their actions may be a major mechanism for vascular inflammation and metabolic memory associated with diabetic complications.</description><identifier>ISSN: 0009-7330</identifier><identifier>EISSN: 1524-4571</identifier><identifier>DOI: 10.1161/CIRCRESAHA.108.175190</identifier><identifier>PMID: 18688044</identifier><identifier>CODEN: CIRUAL</identifier><language>eng</language><publisher>Hagerstown, MD: American Heart Association, Inc</publisher><subject>Animals ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Diabetes Mellitus, Type 2 - enzymology ; Diabetes Mellitus, Type 2 - genetics ; Diabetes Mellitus, Type 2 - pathology ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Fundamental and applied biological sciences. Psychology ; Histone Demethylases ; Histones - metabolism ; Humans ; Inflammation Mediators - physiology ; Lysine - metabolism ; Male ; Medical sciences ; Methylation ; Mice ; Mice, Knockout ; Mice, Mutant Strains ; Muscle, Smooth, Vascular - enzymology ; Muscle, Smooth, Vascular - pathology ; Myocytes, Smooth Muscle - enzymology ; Myocytes, Smooth Muscle - pathology ; Oxidoreductases, N-Demethylating - metabolism ; Oxidoreductases, N-Demethylating - physiology ; Phenotype ; Vertebrates: cardiovascular system</subject><ispartof>Circulation research, 2008-09, Vol.103 (6), p.615-623</ispartof><rights>2008 American Heart Association, Inc.</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5212-eaf0e42443a85075d65c95b70c7a9ec91d13ebaf545ce12a7c0a99408cb43c33</citedby><cites>FETCH-LOGICAL-c5212-eaf0e42443a85075d65c95b70c7a9ec91d13ebaf545ce12a7c0a99408cb43c33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3673,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=20679926$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18688044$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reddy, Marpadga A</creatorcontrib><creatorcontrib>Villeneuve, Louisa M</creatorcontrib><creatorcontrib>Wang, Mei</creatorcontrib><creatorcontrib>Lanting, Linda</creatorcontrib><creatorcontrib>Natarajan, Rama</creatorcontrib><title>Role of the Lysine-Specific Demethylase 1 in the Proinflammatory Phenotype of Vascular Smooth Muscle Cells of Diabetic Mice</title><title>Circulation research</title><addtitle>Circ Res</addtitle><description>Insulin resistance and type 2 diabetes are major risk factors for vascular complications. Vascular smooth muscle cells (VSMCs) derived from db/db mice, an established mouse model of type 2 diabetes, displayed enhanced inflammatory gene expression and proatherogenic responses. We examined the hypothesis that aberrant epigenetic chromatin events may the underlying mechanism for this persistent dysfunctional behavior and “memory” of the diabetic cells. Chromatin immunoprecipitation assays showed that levels of histone H3 lysine 4 dimethylation (H3K4me2), a key chromatin mark associated with active gene expression, were significantly elevated at the promoters of the inflammatory genes monocyte chemoattractant protein-1 and interleukin-6 in db/db VSMCs relative to db/+ cells. Tumor necrosis factor-α-induced inflammatory gene expression, H3K4me2 levels, and recruitment of RNA polymerase II at the gene promoters were also enhanced in db/db VSMCs, demonstrating the formation of open chromatin poised for transcriptional activation in diabetes. On the other hand, protein levels of lysine-specific demethylase1 (LSD1), which negatively regulates H3K4 methylation and its occupancy at these gene promoters, were significantly reduced in db/db VSMCs. High glucose (25 mmol/L) treatment of human VSMCs also increased inflammatory genes with parallel increases in promoter H3K4me2 levels and reduced LSD1 recruitment. LSD1 gene silencing with small interfering RNAs significantly increased inflammatory gene expression and enhanced VSMC-monocyte binding in nondiabetic VSMCs. In contrast, overexpression of LSD1 in diabetic db/db VSMCs inhibited their enhanced inflammatory gene expression. These results demonstrate novel functional roles for LSD1 and H3K4 methylation in VSMCs and inflammation. Dysregulation of their actions may be a major mechanism for vascular inflammation and metabolic memory associated with diabetic complications.</description><subject>Animals</subject><subject>Atherosclerosis (general aspects, experimental research)</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Diabetes Mellitus, Type 2 - enzymology</subject><subject>Diabetes Mellitus, Type 2 - genetics</subject><subject>Diabetes Mellitus, Type 2 - pathology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Histone Demethylases</subject><subject>Histones - metabolism</subject><subject>Humans</subject><subject>Inflammation Mediators - physiology</subject><subject>Lysine - metabolism</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Methylation</subject><subject>Mice</subject><subject>Mice, Knockout</subject><subject>Mice, Mutant Strains</subject><subject>Muscle, Smooth, Vascular - enzymology</subject><subject>Muscle, Smooth, Vascular - pathology</subject><subject>Myocytes, Smooth Muscle - enzymology</subject><subject>Myocytes, Smooth Muscle - pathology</subject><subject>Oxidoreductases, N-Demethylating - metabolism</subject><subject>Oxidoreductases, N-Demethylating - physiology</subject><subject>Phenotype</subject><subject>Vertebrates: cardiovascular system</subject><issn>0009-7330</issn><issn>1524-4571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkl1v0zAUhiMEYmXwE0C5gbuU468kvkGqssEmdWJqJ24t1z0hBicudsJU8efx1mofV5aOn_PYPq-z7D2BOSEl-dxcrprV-XpxsZgTqOekEkTCi2xGBOUFFxV5mc0AQBYVY3CSvYnxFwDhjMrX2Qmpy7oGzmfZv5V3mPs2HzvMl_toByzWOzS2tSY_wx7Hbu90xJzkdriHroO3Q-t03-vRh31-3eHgx_3u3vJDRzM5HfJ17_3Y5VdTNMnfoHPxbv_M6g2OSX1lDb7NXrXaRXx3XE-zm6_nN81Fsfz-7bJZLAsjKKEF6haQU86ZrgVUYlsKI8WmAlNpiUaSLWG40a3gwiChujKgpeRQmw1nhrHT7MtBu5s2PW4NDmPQTu2C7XXYK6-ter4z2E799H8VLSXjAEnw6SgI_s-EcVS9jSY9SQ_op6hKKURZVXUCxQE0wccYsH04hIC6S009ppZKtTqklvo-PL3hY9cxpgR8PAJpvtq1QQ_GxgeOQllJScvE8QN3692IIf520y0G1aF2Y6fSdwAGaaIUoAZJKBSpQij7D2BIsok</recordid><startdate>20080912</startdate><enddate>20080912</enddate><creator>Reddy, Marpadga A</creator><creator>Villeneuve, Louisa M</creator><creator>Wang, Mei</creator><creator>Lanting, Linda</creator><creator>Natarajan, Rama</creator><general>American Heart Association, Inc</general><general>Lippincott</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>7X8</scope><scope>5PM</scope></search><sort><creationdate>20080912</creationdate><title>Role of the Lysine-Specific Demethylase 1 in the Proinflammatory Phenotype of Vascular Smooth Muscle Cells of Diabetic Mice</title><author>Reddy, Marpadga A ; Villeneuve, Louisa M ; Wang, Mei ; Lanting, Linda ; Natarajan, Rama</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5212-eaf0e42443a85075d65c95b70c7a9ec91d13ebaf545ce12a7c0a99408cb43c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Animals</topic><topic>Atherosclerosis (general aspects, experimental research)</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Diabetes Mellitus, Type 2 - enzymology</topic><topic>Diabetes Mellitus, Type 2 - genetics</topic><topic>Diabetes Mellitus, Type 2 - pathology</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Histone Demethylases</topic><topic>Histones - metabolism</topic><topic>Humans</topic><topic>Inflammation Mediators - physiology</topic><topic>Lysine - metabolism</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Methylation</topic><topic>Mice</topic><topic>Mice, Knockout</topic><topic>Mice, Mutant Strains</topic><topic>Muscle, Smooth, Vascular - enzymology</topic><topic>Muscle, Smooth, Vascular - pathology</topic><topic>Myocytes, Smooth Muscle - enzymology</topic><topic>Myocytes, Smooth Muscle - pathology</topic><topic>Oxidoreductases, N-Demethylating - metabolism</topic><topic>Oxidoreductases, N-Demethylating - physiology</topic><topic>Phenotype</topic><topic>Vertebrates: cardiovascular system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reddy, Marpadga A</creatorcontrib><creatorcontrib>Villeneuve, Louisa M</creatorcontrib><creatorcontrib>Wang, Mei</creatorcontrib><creatorcontrib>Lanting, Linda</creatorcontrib><creatorcontrib>Natarajan, Rama</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>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reddy, Marpadga A</au><au>Villeneuve, Louisa M</au><au>Wang, Mei</au><au>Lanting, Linda</au><au>Natarajan, Rama</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of the Lysine-Specific Demethylase 1 in the Proinflammatory Phenotype of Vascular Smooth Muscle Cells of Diabetic Mice</atitle><jtitle>Circulation research</jtitle><addtitle>Circ Res</addtitle><date>2008-09-12</date><risdate>2008</risdate><volume>103</volume><issue>6</issue><spage>615</spage><epage>623</epage><pages>615-623</pages><issn>0009-7330</issn><eissn>1524-4571</eissn><coden>CIRUAL</coden><abstract>Insulin resistance and type 2 diabetes are major risk factors for vascular complications. Vascular smooth muscle cells (VSMCs) derived from db/db mice, an established mouse model of type 2 diabetes, displayed enhanced inflammatory gene expression and proatherogenic responses. We examined the hypothesis that aberrant epigenetic chromatin events may the underlying mechanism for this persistent dysfunctional behavior and “memory” of the diabetic cells. Chromatin immunoprecipitation assays showed that levels of histone H3 lysine 4 dimethylation (H3K4me2), a key chromatin mark associated with active gene expression, were significantly elevated at the promoters of the inflammatory genes monocyte chemoattractant protein-1 and interleukin-6 in db/db VSMCs relative to db/+ cells. Tumor necrosis factor-α-induced inflammatory gene expression, H3K4me2 levels, and recruitment of RNA polymerase II at the gene promoters were also enhanced in db/db VSMCs, demonstrating the formation of open chromatin poised for transcriptional activation in diabetes. On the other hand, protein levels of lysine-specific demethylase1 (LSD1), which negatively regulates H3K4 methylation and its occupancy at these gene promoters, were significantly reduced in db/db VSMCs. High glucose (25 mmol/L) treatment of human VSMCs also increased inflammatory genes with parallel increases in promoter H3K4me2 levels and reduced LSD1 recruitment. LSD1 gene silencing with small interfering RNAs significantly increased inflammatory gene expression and enhanced VSMC-monocyte binding in nondiabetic VSMCs. In contrast, overexpression of LSD1 in diabetic db/db VSMCs inhibited their enhanced inflammatory gene expression. These results demonstrate novel functional roles for LSD1 and H3K4 methylation in VSMCs and inflammation. Dysregulation of their actions may be a major mechanism for vascular inflammation and metabolic memory associated with diabetic complications.</abstract><cop>Hagerstown, MD</cop><pub>American Heart Association, Inc</pub><pmid>18688044</pmid><doi>10.1161/CIRCRESAHA.108.175190</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0009-7330
ispartof Circulation research, 2008-09, Vol.103 (6), p.615-623
issn 0009-7330
1524-4571
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2693400
source MEDLINE; American Heart Association; Journals@Ovid Complete; EZB Electronic Journals Library
subjects Animals
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Diabetes Mellitus, Type 2 - enzymology
Diabetes Mellitus, Type 2 - genetics
Diabetes Mellitus, Type 2 - pathology
Diabetes. Impaired glucose tolerance
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Fundamental and applied biological sciences. Psychology
Histone Demethylases
Histones - metabolism
Humans
Inflammation Mediators - physiology
Lysine - metabolism
Male
Medical sciences
Methylation
Mice
Mice, Knockout
Mice, Mutant Strains
Muscle, Smooth, Vascular - enzymology
Muscle, Smooth, Vascular - pathology
Myocytes, Smooth Muscle - enzymology
Myocytes, Smooth Muscle - pathology
Oxidoreductases, N-Demethylating - metabolism
Oxidoreductases, N-Demethylating - physiology
Phenotype
Vertebrates: cardiovascular system
title Role of the Lysine-Specific Demethylase 1 in the Proinflammatory Phenotype of Vascular Smooth Muscle Cells of Diabetic Mice
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T16%3A42%3A19IST&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=Role%20of%20the%20Lysine-Specific%20Demethylase%201%20in%20the%20Proinflammatory%20Phenotype%20of%20Vascular%20Smooth%20Muscle%20Cells%20of%20Diabetic%20Mice&rft.jtitle=Circulation%20research&rft.au=Reddy,%20Marpadga%20A&rft.date=2008-09-12&rft.volume=103&rft.issue=6&rft.spage=615&rft.epage=623&rft.pages=615-623&rft.issn=0009-7330&rft.eissn=1524-4571&rft.coden=CIRUAL&rft_id=info:doi/10.1161/CIRCRESAHA.108.175190&rft_dat=%3Cproquest_pubme%3E69556778%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=69556778&rft_id=info:pmid/18688044&rfr_iscdi=true