The transcription factor MITF is a critical regulator of GPNMB expression in dendritic cells

Dendritic cells (DC) are the most potent antigen-presenting cells (APC) with the unique ability to activate naïve T cells and to initiate and maintain primary immune responses. Immunosuppressive and anti-inflammatory stimuli on DC such as the cytokine IL-10 suppress the activity of the transcription...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Cell communication and signaling 2015-03, Vol.13 (1), p.19, Article 19
Hauptverfasser: Gutknecht, Michael, Geiger, Julian, Joas, Simone, Dörfel, Daniela, Salih, Helmut R, Müller, Martin R, Grünebach, Frank, Rittig, Susanne M
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page
container_issue 1
container_start_page 19
container_title Cell communication and signaling
container_volume 13
creator Gutknecht, Michael
Geiger, Julian
Joas, Simone
Dörfel, Daniela
Salih, Helmut R
Müller, Martin R
Grünebach, Frank
Rittig, Susanne M
description Dendritic cells (DC) are the most potent antigen-presenting cells (APC) with the unique ability to activate naïve T cells and to initiate and maintain primary immune responses. Immunosuppressive and anti-inflammatory stimuli on DC such as the cytokine IL-10 suppress the activity of the transcription factor NF-κB what results in downregulation of costimulatory molecules, MHC and cytokine production. Glycoprotein NMB (GPNMB) is a transmembrane protein, which acts as a coinhibitory molecule strongly inhibiting T cell responses if present on APC. Interestingly, its expression on human monocyte-derived dendritic cells (moDC) is dramatically upregulated upon treatment with IL-10 but also by the BCR-ABL tyrosine kinase inhibitors (TKI) imatinib, nilotinib or dasatinib used for the treatment of chronic myeloid leukemia (CML). However, the molecular mechanisms responsible for GPNMB overexpression are yet unknown. The immunosuppressive cytokine IL-10 and the BCR-ABL TKI imatinib or nilotinib, that were examined here, concordantly inhibit the PI3K/Akt signaling pathway, thereby activating the downstream serine/threonine protein kinase GSK3ß, and subsequently the microphthalmia-associated transcription factor (MITF) that is phosphorylated and translocated into the nucleus. Treatment of moDC with a small molecule inhibitor of MITF activity reduced the expression of GPNMB at the level of mRNA and protein, indicating that GPNMB expression is in fact facilitated by MITF activation. In line with these findings, PI3K/Akt inhibition was found to result in GPNMB overexpression accompanied by reduced stimulatory capacity of moDC in mixed lymphocyte reactions (MLR) with allogeneic T cells that could be restored by addition of the GPNMB T cell ligand syndecan-4 (SD-4). In summary, imatinib, nilotinib or IL-10 congruently inhibit the PI3K/Akt signaling pathway thereby activating MITF in moDC, resulting in a tolerogenic phenotype. These findings extend current knowledge on the molecular mechanisms balancing activating and inhibitory signals in human DC and may facilitate the targeted manipulation of T cell responses in the context of DC-based immunotherapeutic interventions.
doi_str_mv 10.1186/s12964-015-0099-5
format Article
fullrecord <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4422548</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A542051044</galeid><sourcerecordid>A542051044</sourcerecordid><originalsourceid>FETCH-LOGICAL-c636t-457c0aa7a2707deb28dfdfc663e8855f7c26483c1972558caf7348fe8f146a8b3</originalsourceid><addsrcrecordid>eNptkUtLAzEUhYMoPqo_wI0EXLkYTTLJJLMRtPgo-EIruBBCmrmpkelMSaai_97UqliQLBJyvnO4l4PQLiWHlKriKFJWFjwjVGSElGUmVtAm5VJlitKn1T_vDbQV4yshjAsu19EGE0qVsmSb6Hn4ArgLpok2-Gnn2wY7Y7s24OvB8Bz7iA1OSuetqXGA8aw2c7F1-OLu5voUw_s0QIxzn29wBU31BWMLdR230ZozdYSd77uHHs_Phv3L7Or2YtA_ucpskRddxoW0xBhpmCSyghFTlaucLYoclBLCScsKrnJLS8mEUNY4mXPlQDnKC6NGeQ8dL3Kns9EEKgtN2qjW0-AnJnzo1ni9rDT-RY_bN805YyJF99D-ImBsatC-cW3C7MRHq08EZ0RQwnmiDv-h0qlg4m3bgPPpf8lwsGRITAfv3djMYtSDh_tlli5YG9oYA7jf8SnR87b1om2d2tbztrVInr2_e_86furNPwFdVaTm</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>The transcription factor MITF is a critical regulator of GPNMB expression in dendritic cells</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>SpringerLink Journals</source><source>PubMed Central Open Access</source><source>Springer Nature OA Free Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Gutknecht, Michael ; Geiger, Julian ; Joas, Simone ; Dörfel, Daniela ; Salih, Helmut R ; Müller, Martin R ; Grünebach, Frank ; Rittig, Susanne M</creator><creatorcontrib>Gutknecht, Michael ; Geiger, Julian ; Joas, Simone ; Dörfel, Daniela ; Salih, Helmut R ; Müller, Martin R ; Grünebach, Frank ; Rittig, Susanne M</creatorcontrib><description>Dendritic cells (DC) are the most potent antigen-presenting cells (APC) with the unique ability to activate naïve T cells and to initiate and maintain primary immune responses. Immunosuppressive and anti-inflammatory stimuli on DC such as the cytokine IL-10 suppress the activity of the transcription factor NF-κB what results in downregulation of costimulatory molecules, MHC and cytokine production. Glycoprotein NMB (GPNMB) is a transmembrane protein, which acts as a coinhibitory molecule strongly inhibiting T cell responses if present on APC. Interestingly, its expression on human monocyte-derived dendritic cells (moDC) is dramatically upregulated upon treatment with IL-10 but also by the BCR-ABL tyrosine kinase inhibitors (TKI) imatinib, nilotinib or dasatinib used for the treatment of chronic myeloid leukemia (CML). However, the molecular mechanisms responsible for GPNMB overexpression are yet unknown. The immunosuppressive cytokine IL-10 and the BCR-ABL TKI imatinib or nilotinib, that were examined here, concordantly inhibit the PI3K/Akt signaling pathway, thereby activating the downstream serine/threonine protein kinase GSK3ß, and subsequently the microphthalmia-associated transcription factor (MITF) that is phosphorylated and translocated into the nucleus. Treatment of moDC with a small molecule inhibitor of MITF activity reduced the expression of GPNMB at the level of mRNA and protein, indicating that GPNMB expression is in fact facilitated by MITF activation. In line with these findings, PI3K/Akt inhibition was found to result in GPNMB overexpression accompanied by reduced stimulatory capacity of moDC in mixed lymphocyte reactions (MLR) with allogeneic T cells that could be restored by addition of the GPNMB T cell ligand syndecan-4 (SD-4). In summary, imatinib, nilotinib or IL-10 congruently inhibit the PI3K/Akt signaling pathway thereby activating MITF in moDC, resulting in a tolerogenic phenotype. These findings extend current knowledge on the molecular mechanisms balancing activating and inhibitory signals in human DC and may facilitate the targeted manipulation of T cell responses in the context of DC-based immunotherapeutic interventions.</description><identifier>ISSN: 1478-811X</identifier><identifier>EISSN: 1478-811X</identifier><identifier>DOI: 10.1186/s12964-015-0099-5</identifier><identifier>PMID: 25889792</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Antigens ; Antineoplastic Agents - pharmacology ; Benzamides - pharmacology ; Cells, Cultured ; Computer software industry ; Cytokines ; Dendritic cells ; Dendritic Cells - cytology ; Dendritic Cells - metabolism ; Gene Expression Regulation - drug effects ; Gene Expression Regulation - physiology ; Humans ; Imatinib Mesylate ; Immune response ; Immunotherapy ; Interleukin-10 - pharmacology ; Leukemia ; Membrane Glycoproteins - biosynthesis ; Microphthalmia-Associated Transcription Factor - metabolism ; Phosphatidylinositol 3-Kinases - metabolism ; Physiological aspects ; Piperazines - pharmacology ; Protein kinases ; Proto-Oncogene Proteins c-akt - metabolism ; Pyrimidines - pharmacology ; RNA ; T cells ; Tyrosine</subject><ispartof>Cell communication and signaling, 2015-03, Vol.13 (1), p.19, Article 19</ispartof><rights>COPYRIGHT 2015 BioMed Central Ltd.</rights><rights>Gutknecht et al.; licensee BioMed Central. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c636t-457c0aa7a2707deb28dfdfc663e8855f7c26483c1972558caf7348fe8f146a8b3</citedby><cites>FETCH-LOGICAL-c636t-457c0aa7a2707deb28dfdfc663e8855f7c26483c1972558caf7348fe8f146a8b3</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/PMC4422548/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422548/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25889792$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gutknecht, Michael</creatorcontrib><creatorcontrib>Geiger, Julian</creatorcontrib><creatorcontrib>Joas, Simone</creatorcontrib><creatorcontrib>Dörfel, Daniela</creatorcontrib><creatorcontrib>Salih, Helmut R</creatorcontrib><creatorcontrib>Müller, Martin R</creatorcontrib><creatorcontrib>Grünebach, Frank</creatorcontrib><creatorcontrib>Rittig, Susanne M</creatorcontrib><title>The transcription factor MITF is a critical regulator of GPNMB expression in dendritic cells</title><title>Cell communication and signaling</title><addtitle>Cell Commun Signal</addtitle><description>Dendritic cells (DC) are the most potent antigen-presenting cells (APC) with the unique ability to activate naïve T cells and to initiate and maintain primary immune responses. Immunosuppressive and anti-inflammatory stimuli on DC such as the cytokine IL-10 suppress the activity of the transcription factor NF-κB what results in downregulation of costimulatory molecules, MHC and cytokine production. Glycoprotein NMB (GPNMB) is a transmembrane protein, which acts as a coinhibitory molecule strongly inhibiting T cell responses if present on APC. Interestingly, its expression on human monocyte-derived dendritic cells (moDC) is dramatically upregulated upon treatment with IL-10 but also by the BCR-ABL tyrosine kinase inhibitors (TKI) imatinib, nilotinib or dasatinib used for the treatment of chronic myeloid leukemia (CML). However, the molecular mechanisms responsible for GPNMB overexpression are yet unknown. The immunosuppressive cytokine IL-10 and the BCR-ABL TKI imatinib or nilotinib, that were examined here, concordantly inhibit the PI3K/Akt signaling pathway, thereby activating the downstream serine/threonine protein kinase GSK3ß, and subsequently the microphthalmia-associated transcription factor (MITF) that is phosphorylated and translocated into the nucleus. Treatment of moDC with a small molecule inhibitor of MITF activity reduced the expression of GPNMB at the level of mRNA and protein, indicating that GPNMB expression is in fact facilitated by MITF activation. In line with these findings, PI3K/Akt inhibition was found to result in GPNMB overexpression accompanied by reduced stimulatory capacity of moDC in mixed lymphocyte reactions (MLR) with allogeneic T cells that could be restored by addition of the GPNMB T cell ligand syndecan-4 (SD-4). In summary, imatinib, nilotinib or IL-10 congruently inhibit the PI3K/Akt signaling pathway thereby activating MITF in moDC, resulting in a tolerogenic phenotype. These findings extend current knowledge on the molecular mechanisms balancing activating and inhibitory signals in human DC and may facilitate the targeted manipulation of T cell responses in the context of DC-based immunotherapeutic interventions.</description><subject>Antigens</subject><subject>Antineoplastic Agents - pharmacology</subject><subject>Benzamides - pharmacology</subject><subject>Cells, Cultured</subject><subject>Computer software industry</subject><subject>Cytokines</subject><subject>Dendritic cells</subject><subject>Dendritic Cells - cytology</subject><subject>Dendritic Cells - metabolism</subject><subject>Gene Expression Regulation - drug effects</subject><subject>Gene Expression Regulation - physiology</subject><subject>Humans</subject><subject>Imatinib Mesylate</subject><subject>Immune response</subject><subject>Immunotherapy</subject><subject>Interleukin-10 - pharmacology</subject><subject>Leukemia</subject><subject>Membrane Glycoproteins - biosynthesis</subject><subject>Microphthalmia-Associated Transcription Factor - metabolism</subject><subject>Phosphatidylinositol 3-Kinases - metabolism</subject><subject>Physiological aspects</subject><subject>Piperazines - pharmacology</subject><subject>Protein kinases</subject><subject>Proto-Oncogene Proteins c-akt - metabolism</subject><subject>Pyrimidines - pharmacology</subject><subject>RNA</subject><subject>T cells</subject><subject>Tyrosine</subject><issn>1478-811X</issn><issn>1478-811X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkUtLAzEUhYMoPqo_wI0EXLkYTTLJJLMRtPgo-EIruBBCmrmpkelMSaai_97UqliQLBJyvnO4l4PQLiWHlKriKFJWFjwjVGSElGUmVtAm5VJlitKn1T_vDbQV4yshjAsu19EGE0qVsmSb6Hn4ArgLpok2-Gnn2wY7Y7s24OvB8Bz7iA1OSuetqXGA8aw2c7F1-OLu5voUw_s0QIxzn29wBU31BWMLdR230ZozdYSd77uHHs_Phv3L7Or2YtA_ucpskRddxoW0xBhpmCSyghFTlaucLYoclBLCScsKrnJLS8mEUNY4mXPlQDnKC6NGeQ8dL3Kns9EEKgtN2qjW0-AnJnzo1ni9rDT-RY_bN805YyJF99D-ImBsatC-cW3C7MRHq08EZ0RQwnmiDv-h0qlg4m3bgPPpf8lwsGRITAfv3djMYtSDh_tlli5YG9oYA7jf8SnR87b1om2d2tbztrVInr2_e_86furNPwFdVaTm</recordid><startdate>20150324</startdate><enddate>20150324</enddate><creator>Gutknecht, Michael</creator><creator>Geiger, Julian</creator><creator>Joas, Simone</creator><creator>Dörfel, Daniela</creator><creator>Salih, Helmut R</creator><creator>Müller, Martin R</creator><creator>Grünebach, Frank</creator><creator>Rittig, Susanne M</creator><general>BioMed Central Ltd</general><general>BioMed Central</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>ISR</scope><scope>5PM</scope></search><sort><creationdate>20150324</creationdate><title>The transcription factor MITF is a critical regulator of GPNMB expression in dendritic cells</title><author>Gutknecht, Michael ; Geiger, Julian ; Joas, Simone ; Dörfel, Daniela ; Salih, Helmut R ; Müller, Martin R ; Grünebach, Frank ; Rittig, Susanne M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c636t-457c0aa7a2707deb28dfdfc663e8855f7c26483c1972558caf7348fe8f146a8b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Antigens</topic><topic>Antineoplastic Agents - pharmacology</topic><topic>Benzamides - pharmacology</topic><topic>Cells, Cultured</topic><topic>Computer software industry</topic><topic>Cytokines</topic><topic>Dendritic cells</topic><topic>Dendritic Cells - cytology</topic><topic>Dendritic Cells - metabolism</topic><topic>Gene Expression Regulation - drug effects</topic><topic>Gene Expression Regulation - physiology</topic><topic>Humans</topic><topic>Imatinib Mesylate</topic><topic>Immune response</topic><topic>Immunotherapy</topic><topic>Interleukin-10 - pharmacology</topic><topic>Leukemia</topic><topic>Membrane Glycoproteins - biosynthesis</topic><topic>Microphthalmia-Associated Transcription Factor - metabolism</topic><topic>Phosphatidylinositol 3-Kinases - metabolism</topic><topic>Physiological aspects</topic><topic>Piperazines - pharmacology</topic><topic>Protein kinases</topic><topic>Proto-Oncogene Proteins c-akt - metabolism</topic><topic>Pyrimidines - pharmacology</topic><topic>RNA</topic><topic>T cells</topic><topic>Tyrosine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gutknecht, Michael</creatorcontrib><creatorcontrib>Geiger, Julian</creatorcontrib><creatorcontrib>Joas, Simone</creatorcontrib><creatorcontrib>Dörfel, Daniela</creatorcontrib><creatorcontrib>Salih, Helmut R</creatorcontrib><creatorcontrib>Müller, Martin R</creatorcontrib><creatorcontrib>Grünebach, Frank</creatorcontrib><creatorcontrib>Rittig, Susanne M</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: Science</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cell communication and signaling</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gutknecht, Michael</au><au>Geiger, Julian</au><au>Joas, Simone</au><au>Dörfel, Daniela</au><au>Salih, Helmut R</au><au>Müller, Martin R</au><au>Grünebach, Frank</au><au>Rittig, Susanne M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The transcription factor MITF is a critical regulator of GPNMB expression in dendritic cells</atitle><jtitle>Cell communication and signaling</jtitle><addtitle>Cell Commun Signal</addtitle><date>2015-03-24</date><risdate>2015</risdate><volume>13</volume><issue>1</issue><spage>19</spage><pages>19-</pages><artnum>19</artnum><issn>1478-811X</issn><eissn>1478-811X</eissn><abstract>Dendritic cells (DC) are the most potent antigen-presenting cells (APC) with the unique ability to activate naïve T cells and to initiate and maintain primary immune responses. Immunosuppressive and anti-inflammatory stimuli on DC such as the cytokine IL-10 suppress the activity of the transcription factor NF-κB what results in downregulation of costimulatory molecules, MHC and cytokine production. Glycoprotein NMB (GPNMB) is a transmembrane protein, which acts as a coinhibitory molecule strongly inhibiting T cell responses if present on APC. Interestingly, its expression on human monocyte-derived dendritic cells (moDC) is dramatically upregulated upon treatment with IL-10 but also by the BCR-ABL tyrosine kinase inhibitors (TKI) imatinib, nilotinib or dasatinib used for the treatment of chronic myeloid leukemia (CML). However, the molecular mechanisms responsible for GPNMB overexpression are yet unknown. The immunosuppressive cytokine IL-10 and the BCR-ABL TKI imatinib or nilotinib, that were examined here, concordantly inhibit the PI3K/Akt signaling pathway, thereby activating the downstream serine/threonine protein kinase GSK3ß, and subsequently the microphthalmia-associated transcription factor (MITF) that is phosphorylated and translocated into the nucleus. Treatment of moDC with a small molecule inhibitor of MITF activity reduced the expression of GPNMB at the level of mRNA and protein, indicating that GPNMB expression is in fact facilitated by MITF activation. In line with these findings, PI3K/Akt inhibition was found to result in GPNMB overexpression accompanied by reduced stimulatory capacity of moDC in mixed lymphocyte reactions (MLR) with allogeneic T cells that could be restored by addition of the GPNMB T cell ligand syndecan-4 (SD-4). In summary, imatinib, nilotinib or IL-10 congruently inhibit the PI3K/Akt signaling pathway thereby activating MITF in moDC, resulting in a tolerogenic phenotype. These findings extend current knowledge on the molecular mechanisms balancing activating and inhibitory signals in human DC and may facilitate the targeted manipulation of T cell responses in the context of DC-based immunotherapeutic interventions.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>25889792</pmid><doi>10.1186/s12964-015-0099-5</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1478-811X
ispartof Cell communication and signaling, 2015-03, Vol.13 (1), p.19, Article 19
issn 1478-811X
1478-811X
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4422548
source MEDLINE; DOAJ Directory of Open Access Journals; SpringerLink Journals; PubMed Central Open Access; Springer Nature OA Free Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central
subjects Antigens
Antineoplastic Agents - pharmacology
Benzamides - pharmacology
Cells, Cultured
Computer software industry
Cytokines
Dendritic cells
Dendritic Cells - cytology
Dendritic Cells - metabolism
Gene Expression Regulation - drug effects
Gene Expression Regulation - physiology
Humans
Imatinib Mesylate
Immune response
Immunotherapy
Interleukin-10 - pharmacology
Leukemia
Membrane Glycoproteins - biosynthesis
Microphthalmia-Associated Transcription Factor - metabolism
Phosphatidylinositol 3-Kinases - metabolism
Physiological aspects
Piperazines - pharmacology
Protein kinases
Proto-Oncogene Proteins c-akt - metabolism
Pyrimidines - pharmacology
RNA
T cells
Tyrosine
title The transcription factor MITF is a critical regulator of GPNMB expression in dendritic cells
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-26T05%3A38%3A58IST&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=The%20transcription%20factor%20MITF%20is%20a%20critical%20regulator%20of%20GPNMB%20expression%20in%20dendritic%20cells&rft.jtitle=Cell%20communication%20and%20signaling&rft.au=Gutknecht,%20Michael&rft.date=2015-03-24&rft.volume=13&rft.issue=1&rft.spage=19&rft.pages=19-&rft.artnum=19&rft.issn=1478-811X&rft.eissn=1478-811X&rft_id=info:doi/10.1186/s12964-015-0099-5&rft_dat=%3Cgale_pubme%3EA542051044%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/25889792&rft_galeid=A542051044&rfr_iscdi=true