Eukaryotic elongation factor 2 controls TNF-α translation in LPS-induced hepatitis

Bacterial LPS (endotoxin) has been implicated in the pathogenesis of acute liver disease through its induction of the proinflammatory cytokine TNF-α. TNF-α is a key determinant of the outcome in a well-established mouse model of acute liver failure during septic shock. One possible mechanism for reg...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The Journal of clinical investigation 2013-01, Vol.123 (1), p.164-178
Hauptverfasser: González-Terán, Bárbara, Cortés, José R, Manieri, Elisa, Matesanz, Nuria, Verdugo, Ángeles, Rodríguez, María E, González-Rodríguez, Águeda, Valverde, Ángela M, Valverde, Ángela, Martín, Pilar, Davis, Roger J, Sabio, Guadalupe
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 178
container_issue 1
container_start_page 164
container_title The Journal of clinical investigation
container_volume 123
creator González-Terán, Bárbara
Cortés, José R
Manieri, Elisa
Matesanz, Nuria
Verdugo, Ángeles
Rodríguez, María E
González-Rodríguez, Águeda
Valverde, Ángela M
Valverde, Ángela
Martín, Pilar
Davis, Roger J
Sabio, Guadalupe
description Bacterial LPS (endotoxin) has been implicated in the pathogenesis of acute liver disease through its induction of the proinflammatory cytokine TNF-α. TNF-α is a key determinant of the outcome in a well-established mouse model of acute liver failure during septic shock. One possible mechanism for regulating TNF-α expression is through the control of protein elongation during translation, which would allow rapid cell adaptation to physiological changes. However, the regulation of translational elongation is poorly understood. We found that expression of p38γ/δ MAPK proteins is required for the elongation of nascent TNF-α protein in macrophages. The MKK3/6-p38γ/δ pathway mediated an inhibitory phosphorylation of eukaryotic elongation factor 2 (eEF2) kinase, which in turn promoted eEF2 activation (dephosphorylation) and subsequent TNF-α elongation. These results identify a new signaling pathway that regulates TNF-α production in LPS-induced liver damage and suggest potential cell-specific therapeutic targets for liver diseases in which TNF-α production is involved.
doi_str_mv 10.1172/JCI65124
format Article
fullrecord <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3533299</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A348997146</galeid><sourcerecordid>A348997146</sourcerecordid><originalsourceid>FETCH-LOGICAL-c615t-1a245bff852648e71e0cfef06b2dfc17de731d7c229046078b9859628e775a013</originalsourceid><addsrcrecordid>eNqN0t2KEzEUAOAgiltXwSeQAUH0Ytb8TjI3C0vZ1Upxxa7ehjRzMo1OkzKZEX0sX8RnMqXusgO9kFwETr5zSE4OQs8JPiNE0rcf5otKEMofoBkRQpWKMvUQzTCmpKwlUyfoSUrfMCacC_4YnVBGMZWMztDqcvxu-l9x8LaALobWDD6Gwhk7xL6ghY1h6GOXipuPV-Wf38XQm5C6A_KhWH5alT40o4Wm2MAuxwefnqJHznQJnv3bT9GXq8ub-ftyef1uMb9YlrYiYiiJoVysnVOCVlyBJICtA4erNW2cJbIByUgjLaU15hWWal0rUVc0UykMJuwUnR_q7sb1FhoL-aqm07veb_OTdDReT0-C3-g2_tBMMEbrOhd4eSjQmg60Dy5mZrc-WX3BuKprSXiVVXlEtRAg14wBnM_hiT874vNqYOvt0YQ3k4R9z-Hn0JoxJb1Yff5_e_11al_dsxsw3bBJsRv3n5em8PUB2j6m1IO76yHBej9g-nbAMn1xv-d38Hai2F_XzMfc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Eukaryotic elongation factor 2 controls TNF-α translation in LPS-induced hepatitis</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>González-Terán, Bárbara ; Cortés, José R ; Manieri, Elisa ; Matesanz, Nuria ; Verdugo, Ángeles ; Rodríguez, María E ; González-Rodríguez, Águeda ; Valverde, Ángela M ; Valverde, Ángela ; Martín, Pilar ; Davis, Roger J ; Sabio, Guadalupe</creator><creatorcontrib>González-Terán, Bárbara ; Cortés, José R ; Manieri, Elisa ; Matesanz, Nuria ; Verdugo, Ángeles ; Rodríguez, María E ; González-Rodríguez, Águeda ; Valverde, Ángela M ; Valverde, Ángela ; Martín, Pilar ; Davis, Roger J ; Sabio, Guadalupe</creatorcontrib><description>Bacterial LPS (endotoxin) has been implicated in the pathogenesis of acute liver disease through its induction of the proinflammatory cytokine TNF-α. TNF-α is a key determinant of the outcome in a well-established mouse model of acute liver failure during septic shock. One possible mechanism for regulating TNF-α expression is through the control of protein elongation during translation, which would allow rapid cell adaptation to physiological changes. However, the regulation of translational elongation is poorly understood. We found that expression of p38γ/δ MAPK proteins is required for the elongation of nascent TNF-α protein in macrophages. The MKK3/6-p38γ/δ pathway mediated an inhibitory phosphorylation of eukaryotic elongation factor 2 (eEF2) kinase, which in turn promoted eEF2 activation (dephosphorylation) and subsequent TNF-α elongation. These results identify a new signaling pathway that regulates TNF-α production in LPS-induced liver damage and suggest potential cell-specific therapeutic targets for liver diseases in which TNF-α production is involved.</description><identifier>ISSN: 0021-9738</identifier><identifier>EISSN: 1558-8238</identifier><identifier>DOI: 10.1172/JCI65124</identifier><identifier>PMID: 23202732</identifier><language>eng</language><publisher>United States: American Society for Clinical Investigation</publisher><subject>Animals ; Chemical and Drug Induced Liver Injury - genetics ; Chemical and Drug Induced Liver Injury - metabolism ; Chemical and Drug Induced Liver Injury - pathology ; Control ; Disease Models, Animal ; Endotoxins ; Gene Expression Regulation - drug effects ; Gene Expression Regulation - genetics ; Health aspects ; HEK293 Cells ; Hepatitis ; Humans ; Lipopolysaccharides - toxicity ; Macrophages - metabolism ; Macrophages - pathology ; MAP Kinase Kinase 3 - genetics ; MAP Kinase Kinase 3 - metabolism ; MAP Kinase Kinase 6 - genetics ; MAP Kinase Kinase 6 - metabolism ; MAP Kinase Signaling System - drug effects ; MAP Kinase Signaling System - genetics ; Mice ; Mice, Knockout ; Mitogen-Activated Protein Kinase 12 - genetics ; Mitogen-Activated Protein Kinase 12 - metabolism ; Mitogen-Activated Protein Kinase 13 - genetics ; Mitogen-Activated Protein Kinase 13 - metabolism ; Peptide Chain Elongation, Translational - drug effects ; Peptide Chain Elongation, Translational - genetics ; Peptide Elongation Factor 2 - genetics ; Peptide Elongation Factor 2 - metabolism ; Properties ; Translation elongation factors ; Tumor necrosis factor ; Tumor Necrosis Factor-alpha - biosynthesis ; Tumor Necrosis Factor-alpha - genetics</subject><ispartof>The Journal of clinical investigation, 2013-01, Vol.123 (1), p.164-178</ispartof><rights>COPYRIGHT 2013 American Society for Clinical Investigation</rights><rights>Copyright © 2013, American Society for Clinical Investigation 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c615t-1a245bff852648e71e0cfef06b2dfc17de731d7c229046078b9859628e775a013</citedby><cites>FETCH-LOGICAL-c615t-1a245bff852648e71e0cfef06b2dfc17de731d7c229046078b9859628e775a013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533299/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533299/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23202732$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>González-Terán, Bárbara</creatorcontrib><creatorcontrib>Cortés, José R</creatorcontrib><creatorcontrib>Manieri, Elisa</creatorcontrib><creatorcontrib>Matesanz, Nuria</creatorcontrib><creatorcontrib>Verdugo, Ángeles</creatorcontrib><creatorcontrib>Rodríguez, María E</creatorcontrib><creatorcontrib>González-Rodríguez, Águeda</creatorcontrib><creatorcontrib>Valverde, Ángela M</creatorcontrib><creatorcontrib>Valverde, Ángela</creatorcontrib><creatorcontrib>Martín, Pilar</creatorcontrib><creatorcontrib>Davis, Roger J</creatorcontrib><creatorcontrib>Sabio, Guadalupe</creatorcontrib><title>Eukaryotic elongation factor 2 controls TNF-α translation in LPS-induced hepatitis</title><title>The Journal of clinical investigation</title><addtitle>J Clin Invest</addtitle><description>Bacterial LPS (endotoxin) has been implicated in the pathogenesis of acute liver disease through its induction of the proinflammatory cytokine TNF-α. TNF-α is a key determinant of the outcome in a well-established mouse model of acute liver failure during septic shock. One possible mechanism for regulating TNF-α expression is through the control of protein elongation during translation, which would allow rapid cell adaptation to physiological changes. However, the regulation of translational elongation is poorly understood. We found that expression of p38γ/δ MAPK proteins is required for the elongation of nascent TNF-α protein in macrophages. The MKK3/6-p38γ/δ pathway mediated an inhibitory phosphorylation of eukaryotic elongation factor 2 (eEF2) kinase, which in turn promoted eEF2 activation (dephosphorylation) and subsequent TNF-α elongation. These results identify a new signaling pathway that regulates TNF-α production in LPS-induced liver damage and suggest potential cell-specific therapeutic targets for liver diseases in which TNF-α production is involved.</description><subject>Animals</subject><subject>Chemical and Drug Induced Liver Injury - genetics</subject><subject>Chemical and Drug Induced Liver Injury - metabolism</subject><subject>Chemical and Drug Induced Liver Injury - pathology</subject><subject>Control</subject><subject>Disease Models, Animal</subject><subject>Endotoxins</subject><subject>Gene Expression Regulation - drug effects</subject><subject>Gene Expression Regulation - genetics</subject><subject>Health aspects</subject><subject>HEK293 Cells</subject><subject>Hepatitis</subject><subject>Humans</subject><subject>Lipopolysaccharides - toxicity</subject><subject>Macrophages - metabolism</subject><subject>Macrophages - pathology</subject><subject>MAP Kinase Kinase 3 - genetics</subject><subject>MAP Kinase Kinase 3 - metabolism</subject><subject>MAP Kinase Kinase 6 - genetics</subject><subject>MAP Kinase Kinase 6 - metabolism</subject><subject>MAP Kinase Signaling System - drug effects</subject><subject>MAP Kinase Signaling System - genetics</subject><subject>Mice</subject><subject>Mice, Knockout</subject><subject>Mitogen-Activated Protein Kinase 12 - genetics</subject><subject>Mitogen-Activated Protein Kinase 12 - metabolism</subject><subject>Mitogen-Activated Protein Kinase 13 - genetics</subject><subject>Mitogen-Activated Protein Kinase 13 - metabolism</subject><subject>Peptide Chain Elongation, Translational - drug effects</subject><subject>Peptide Chain Elongation, Translational - genetics</subject><subject>Peptide Elongation Factor 2 - genetics</subject><subject>Peptide Elongation Factor 2 - metabolism</subject><subject>Properties</subject><subject>Translation elongation factors</subject><subject>Tumor necrosis factor</subject><subject>Tumor Necrosis Factor-alpha - biosynthesis</subject><subject>Tumor Necrosis Factor-alpha - genetics</subject><issn>0021-9738</issn><issn>1558-8238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0t2KEzEUAOAgiltXwSeQAUH0Ytb8TjI3C0vZ1Upxxa7ehjRzMo1OkzKZEX0sX8RnMqXusgO9kFwETr5zSE4OQs8JPiNE0rcf5otKEMofoBkRQpWKMvUQzTCmpKwlUyfoSUrfMCacC_4YnVBGMZWMztDqcvxu-l9x8LaALobWDD6Gwhk7xL6ghY1h6GOXipuPV-Wf38XQm5C6A_KhWH5alT40o4Wm2MAuxwefnqJHznQJnv3bT9GXq8ub-ftyef1uMb9YlrYiYiiJoVysnVOCVlyBJICtA4erNW2cJbIByUgjLaU15hWWal0rUVc0UykMJuwUnR_q7sb1FhoL-aqm07veb_OTdDReT0-C3-g2_tBMMEbrOhd4eSjQmg60Dy5mZrc-WX3BuKprSXiVVXlEtRAg14wBnM_hiT874vNqYOvt0YQ3k4R9z-Hn0JoxJb1Yff5_e_11al_dsxsw3bBJsRv3n5em8PUB2j6m1IO76yHBej9g-nbAMn1xv-d38Hai2F_XzMfc</recordid><startdate>20130101</startdate><enddate>20130101</enddate><creator>González-Terán, Bárbara</creator><creator>Cortés, José R</creator><creator>Manieri, Elisa</creator><creator>Matesanz, Nuria</creator><creator>Verdugo, Ángeles</creator><creator>Rodríguez, María E</creator><creator>González-Rodríguez, Águeda</creator><creator>Valverde, Ángela M</creator><creator>Valverde, Ángela</creator><creator>Martín, Pilar</creator><creator>Davis, Roger J</creator><creator>Sabio, Guadalupe</creator><general>American Society for Clinical Investigation</general><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>IOV</scope><scope>ISR</scope><scope>5PM</scope></search><sort><creationdate>20130101</creationdate><title>Eukaryotic elongation factor 2 controls TNF-α translation in LPS-induced hepatitis</title><author>González-Terán, Bárbara ; Cortés, José R ; Manieri, Elisa ; Matesanz, Nuria ; Verdugo, Ángeles ; Rodríguez, María E ; González-Rodríguez, Águeda ; Valverde, Ángela M ; Valverde, Ángela ; Martín, Pilar ; Davis, Roger J ; Sabio, Guadalupe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c615t-1a245bff852648e71e0cfef06b2dfc17de731d7c229046078b9859628e775a013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Animals</topic><topic>Chemical and Drug Induced Liver Injury - genetics</topic><topic>Chemical and Drug Induced Liver Injury - metabolism</topic><topic>Chemical and Drug Induced Liver Injury - pathology</topic><topic>Control</topic><topic>Disease Models, Animal</topic><topic>Endotoxins</topic><topic>Gene Expression Regulation - drug effects</topic><topic>Gene Expression Regulation - genetics</topic><topic>Health aspects</topic><topic>HEK293 Cells</topic><topic>Hepatitis</topic><topic>Humans</topic><topic>Lipopolysaccharides - toxicity</topic><topic>Macrophages - metabolism</topic><topic>Macrophages - pathology</topic><topic>MAP Kinase Kinase 3 - genetics</topic><topic>MAP Kinase Kinase 3 - metabolism</topic><topic>MAP Kinase Kinase 6 - genetics</topic><topic>MAP Kinase Kinase 6 - metabolism</topic><topic>MAP Kinase Signaling System - drug effects</topic><topic>MAP Kinase Signaling System - genetics</topic><topic>Mice</topic><topic>Mice, Knockout</topic><topic>Mitogen-Activated Protein Kinase 12 - genetics</topic><topic>Mitogen-Activated Protein Kinase 12 - metabolism</topic><topic>Mitogen-Activated Protein Kinase 13 - genetics</topic><topic>Mitogen-Activated Protein Kinase 13 - metabolism</topic><topic>Peptide Chain Elongation, Translational - drug effects</topic><topic>Peptide Chain Elongation, Translational - genetics</topic><topic>Peptide Elongation Factor 2 - genetics</topic><topic>Peptide Elongation Factor 2 - metabolism</topic><topic>Properties</topic><topic>Translation elongation factors</topic><topic>Tumor necrosis factor</topic><topic>Tumor Necrosis Factor-alpha - biosynthesis</topic><topic>Tumor Necrosis Factor-alpha - genetics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>González-Terán, Bárbara</creatorcontrib><creatorcontrib>Cortés, José R</creatorcontrib><creatorcontrib>Manieri, Elisa</creatorcontrib><creatorcontrib>Matesanz, Nuria</creatorcontrib><creatorcontrib>Verdugo, Ángeles</creatorcontrib><creatorcontrib>Rodríguez, María E</creatorcontrib><creatorcontrib>González-Rodríguez, Águeda</creatorcontrib><creatorcontrib>Valverde, Ángela M</creatorcontrib><creatorcontrib>Valverde, Ángela</creatorcontrib><creatorcontrib>Martín, Pilar</creatorcontrib><creatorcontrib>Davis, Roger J</creatorcontrib><creatorcontrib>Sabio, Guadalupe</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of clinical investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>González-Terán, Bárbara</au><au>Cortés, José R</au><au>Manieri, Elisa</au><au>Matesanz, Nuria</au><au>Verdugo, Ángeles</au><au>Rodríguez, María E</au><au>González-Rodríguez, Águeda</au><au>Valverde, Ángela M</au><au>Valverde, Ángela</au><au>Martín, Pilar</au><au>Davis, Roger J</au><au>Sabio, Guadalupe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Eukaryotic elongation factor 2 controls TNF-α translation in LPS-induced hepatitis</atitle><jtitle>The Journal of clinical investigation</jtitle><addtitle>J Clin Invest</addtitle><date>2013-01-01</date><risdate>2013</risdate><volume>123</volume><issue>1</issue><spage>164</spage><epage>178</epage><pages>164-178</pages><issn>0021-9738</issn><eissn>1558-8238</eissn><abstract>Bacterial LPS (endotoxin) has been implicated in the pathogenesis of acute liver disease through its induction of the proinflammatory cytokine TNF-α. TNF-α is a key determinant of the outcome in a well-established mouse model of acute liver failure during septic shock. One possible mechanism for regulating TNF-α expression is through the control of protein elongation during translation, which would allow rapid cell adaptation to physiological changes. However, the regulation of translational elongation is poorly understood. We found that expression of p38γ/δ MAPK proteins is required for the elongation of nascent TNF-α protein in macrophages. The MKK3/6-p38γ/δ pathway mediated an inhibitory phosphorylation of eukaryotic elongation factor 2 (eEF2) kinase, which in turn promoted eEF2 activation (dephosphorylation) and subsequent TNF-α elongation. These results identify a new signaling pathway that regulates TNF-α production in LPS-induced liver damage and suggest potential cell-specific therapeutic targets for liver diseases in which TNF-α production is involved.</abstract><cop>United States</cop><pub>American Society for Clinical Investigation</pub><pmid>23202732</pmid><doi>10.1172/JCI65124</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0021-9738
ispartof The Journal of clinical investigation, 2013-01, Vol.123 (1), p.164-178
issn 0021-9738
1558-8238
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3533299
source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection; Journals@Ovid Complete
subjects Animals
Chemical and Drug Induced Liver Injury - genetics
Chemical and Drug Induced Liver Injury - metabolism
Chemical and Drug Induced Liver Injury - pathology
Control
Disease Models, Animal
Endotoxins
Gene Expression Regulation - drug effects
Gene Expression Regulation - genetics
Health aspects
HEK293 Cells
Hepatitis
Humans
Lipopolysaccharides - toxicity
Macrophages - metabolism
Macrophages - pathology
MAP Kinase Kinase 3 - genetics
MAP Kinase Kinase 3 - metabolism
MAP Kinase Kinase 6 - genetics
MAP Kinase Kinase 6 - metabolism
MAP Kinase Signaling System - drug effects
MAP Kinase Signaling System - genetics
Mice
Mice, Knockout
Mitogen-Activated Protein Kinase 12 - genetics
Mitogen-Activated Protein Kinase 12 - metabolism
Mitogen-Activated Protein Kinase 13 - genetics
Mitogen-Activated Protein Kinase 13 - metabolism
Peptide Chain Elongation, Translational - drug effects
Peptide Chain Elongation, Translational - genetics
Peptide Elongation Factor 2 - genetics
Peptide Elongation Factor 2 - metabolism
Properties
Translation elongation factors
Tumor necrosis factor
Tumor Necrosis Factor-alpha - biosynthesis
Tumor Necrosis Factor-alpha - genetics
title Eukaryotic elongation factor 2 controls TNF-α translation in LPS-induced hepatitis
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T18%3A14%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Eukaryotic%20elongation%20factor%202%20controls%20TNF-%CE%B1%20translation%20in%20LPS-induced%20hepatitis&rft.jtitle=The%20Journal%20of%20clinical%20investigation&rft.au=Gonz%C3%A1lez-Ter%C3%A1n,%20B%C3%A1rbara&rft.date=2013-01-01&rft.volume=123&rft.issue=1&rft.spage=164&rft.epage=178&rft.pages=164-178&rft.issn=0021-9738&rft.eissn=1558-8238&rft_id=info:doi/10.1172/JCI65124&rft_dat=%3Cgale_pubme%3EA348997146%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/23202732&rft_galeid=A348997146&rfr_iscdi=true