C/ebpα controls osteoclast terminal differentiation, activation, function, and postnatal bone homeostasis through direct regulation of Nfatc1

Osteoclast lineage commitment and differentiation have been studied extensively, although the mechanism by which transcription factor(s) control osteoclast terminal differentiation, activation, and function remains unclear. CCAAT/enhancer‐binding protein α (C/ebpα) has been reported to be a key regu...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The Journal of pathology 2018-03, Vol.244 (3), p.271-282
Hauptverfasser: Chen, Wei, Zhu, Guochun, Tang, Jun, Zhou, Hou‐De, Li, Yi‐Ping
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 282
container_issue 3
container_start_page 271
container_title The Journal of pathology
container_volume 244
creator Chen, Wei
Zhu, Guochun
Tang, Jun
Zhou, Hou‐De
Li, Yi‐Ping
description Osteoclast lineage commitment and differentiation have been studied extensively, although the mechanism by which transcription factor(s) control osteoclast terminal differentiation, activation, and function remains unclear. CCAAT/enhancer‐binding protein α (C/ebpα) has been reported to be a key regulator of osteoclast cell lineage commitment, yet C/ebpα's roles in osteoclast terminal differentiation, activation and function, and bone homeostasis, under physiological or pathological conditions, have not been studied because newborn C/ebpα‐null mice die within several hours after birth. Furthermore, the function of C/ebpα in osteoclast terminal differentiation, activation, and function is largely unknown. Herein, we generated and analyzed an osteoclast‐specific C/ebpα conditional knockout (CKO) mouse model via Ctsk‐Cre mice and found that C/ebpα‐deficient mice exhibited a severe osteopetrosis phenotype due to impaired osteoclast terminal differentiation, activation, and function, including mildly reduced osteoclast number, impaired osteoclast polarization, actin formation, and bone resorption, which demonstrated the novel function of C/ebpα in cell function and terminal differentiation. Interestingly, C/ebpα deficiency did not affect bone formation or monocyte/macrophage development. Our results further demonstrated that C/ebpα deficiency suppressed the expression of osteoclast functional genes, e.g. encoding cathepsin K (Ctsk), Atp6i (Tcirg1), and osteoclast regulator genes, e.g. encoding c‐fos (Fos), and nuclear factor of activated T‐cells 1 (Nfatc1), while having no effect on Pu.1 (Spi1) expression. Promoter activity mapping and ChIP assay defined the critical cis‐regulatory element (CCRE) in the promoter region of Nfatc1, and also showed that the CCREs were directly associated with C/ebpα, which enhanced the promoter's activity. The deficiency of C/ebpα in osteoclasts completely blocked ovariectomy‐induced bone loss, indicating that C/ebpα is a promising new target for the treatment of osteolytic diseases. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
doi_str_mv 10.1002/path.5001
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6240466</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1957768309</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4151-9d722fc2874a2dbc01187c5095974e3bbb63ef7cb39e5f3a6a2d4feaecf879263</originalsourceid><addsrcrecordid>eNp1kc9uFSEUh4nRtNfahS9gWGri9ALzl41Jc1OtSaMu6powzOEOhoERmJq-RN-lL9Jnktt7bXThCnLOd74D-SH0mpIzSghbzzKNZzUh9BlaUcKbgne8eY5WuceKsqLtMXoZ4w9CCOd1fYSOGSddWXXdCt1t1tDPD_dYeZeCtxH7mMArK2PCCcJknLR4MFpDAJeMTMa791iqZG4Od704dai6Ac953smUh3rvAI9-glyR0UScxuCX7ZhtAVTCAbaLfXRgr_EXLZOir9ALLW2E08N5gr5_vLjeXBZXXz993pxfFaqiNS340DKmFevaSrKhV4TSrlU14TVvKyj7vm9K0K3qSw61LmWTqUqDBKW7lrOmPEEf9t556ScYVP5akFbMwUwy3Aovjfi348wotv5GNKwiVbMTvD0Igv-5QExiMlGBtdKBX6KgvG7bpisJz-i7PaqCjzGAflpDidjlJ3b5iV1-mX3z97ueyD-BZWC9B34ZC7f_N4lv59eXj8rfdvmrSg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1957768309</pqid></control><display><type>article</type><title>C/ebpα controls osteoclast terminal differentiation, activation, function, and postnatal bone homeostasis through direct regulation of Nfatc1</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Chen, Wei ; Zhu, Guochun ; Tang, Jun ; Zhou, Hou‐De ; Li, Yi‐Ping</creator><creatorcontrib>Chen, Wei ; Zhu, Guochun ; Tang, Jun ; Zhou, Hou‐De ; Li, Yi‐Ping</creatorcontrib><description>Osteoclast lineage commitment and differentiation have been studied extensively, although the mechanism by which transcription factor(s) control osteoclast terminal differentiation, activation, and function remains unclear. CCAAT/enhancer‐binding protein α (C/ebpα) has been reported to be a key regulator of osteoclast cell lineage commitment, yet C/ebpα's roles in osteoclast terminal differentiation, activation and function, and bone homeostasis, under physiological or pathological conditions, have not been studied because newborn C/ebpα‐null mice die within several hours after birth. Furthermore, the function of C/ebpα in osteoclast terminal differentiation, activation, and function is largely unknown. Herein, we generated and analyzed an osteoclast‐specific C/ebpα conditional knockout (CKO) mouse model via Ctsk‐Cre mice and found that C/ebpα‐deficient mice exhibited a severe osteopetrosis phenotype due to impaired osteoclast terminal differentiation, activation, and function, including mildly reduced osteoclast number, impaired osteoclast polarization, actin formation, and bone resorption, which demonstrated the novel function of C/ebpα in cell function and terminal differentiation. Interestingly, C/ebpα deficiency did not affect bone formation or monocyte/macrophage development. Our results further demonstrated that C/ebpα deficiency suppressed the expression of osteoclast functional genes, e.g. encoding cathepsin K (Ctsk), Atp6i (Tcirg1), and osteoclast regulator genes, e.g. encoding c‐fos (Fos), and nuclear factor of activated T‐cells 1 (Nfatc1), while having no effect on Pu.1 (Spi1) expression. Promoter activity mapping and ChIP assay defined the critical cis‐regulatory element (CCRE) in the promoter region of Nfatc1, and also showed that the CCREs were directly associated with C/ebpα, which enhanced the promoter's activity. The deficiency of C/ebpα in osteoclasts completely blocked ovariectomy‐induced bone loss, indicating that C/ebpα is a promising new target for the treatment of osteolytic diseases. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley &amp; Sons, Ltd.</description><identifier>ISSN: 0022-3417</identifier><identifier>EISSN: 1096-9896</identifier><identifier>DOI: 10.1002/path.5001</identifier><identifier>PMID: 29083488</identifier><language>eng</language><publisher>Chichester, UK: John Wiley &amp; Sons, Ltd</publisher><subject>Animals ; Binding Sites ; C/ebpα ; cathepsin K ; CCAAT-Enhancer-Binding Proteins - deficiency ; CCAAT-Enhancer-Binding Proteins - genetics ; CCAAT-Enhancer-Binding Proteins - metabolism ; Cell Differentiation ; Cell Lineage ; Cells, Cultured ; Disease Models, Animal ; Female ; Gene Expression Regulation, Developmental ; Genetic Predisposition to Disease ; Homeostasis ; Humans ; Male ; Mice, Knockout ; NFATC Transcription Factors - genetics ; NFATC Transcription Factors - metabolism ; Nfatc1 ; osteoclast function ; Osteoclasts - metabolism ; Osteoclasts - pathology ; Osteogenesis ; Osteopetrosis - genetics ; Osteopetrosis - metabolism ; Osteopetrosis - pathology ; Osteoporosis, Postmenopausal - genetics ; Osteoporosis, Postmenopausal - metabolism ; Osteoporosis, Postmenopausal - pathology ; Ovariectomy ; Phenotype ; Promoter Regions, Genetic ; Signal Transduction ; terminal differentiation</subject><ispartof>The Journal of pathology, 2018-03, Vol.244 (3), p.271-282</ispartof><rights>Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley &amp; Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4151-9d722fc2874a2dbc01187c5095974e3bbb63ef7cb39e5f3a6a2d4feaecf879263</citedby><cites>FETCH-LOGICAL-c4151-9d722fc2874a2dbc01187c5095974e3bbb63ef7cb39e5f3a6a2d4feaecf879263</cites><orcidid>0000-0003-2188-6958</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpath.5001$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpath.5001$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29083488$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Wei</creatorcontrib><creatorcontrib>Zhu, Guochun</creatorcontrib><creatorcontrib>Tang, Jun</creatorcontrib><creatorcontrib>Zhou, Hou‐De</creatorcontrib><creatorcontrib>Li, Yi‐Ping</creatorcontrib><title>C/ebpα controls osteoclast terminal differentiation, activation, function, and postnatal bone homeostasis through direct regulation of Nfatc1</title><title>The Journal of pathology</title><addtitle>J Pathol</addtitle><description>Osteoclast lineage commitment and differentiation have been studied extensively, although the mechanism by which transcription factor(s) control osteoclast terminal differentiation, activation, and function remains unclear. CCAAT/enhancer‐binding protein α (C/ebpα) has been reported to be a key regulator of osteoclast cell lineage commitment, yet C/ebpα's roles in osteoclast terminal differentiation, activation and function, and bone homeostasis, under physiological or pathological conditions, have not been studied because newborn C/ebpα‐null mice die within several hours after birth. Furthermore, the function of C/ebpα in osteoclast terminal differentiation, activation, and function is largely unknown. Herein, we generated and analyzed an osteoclast‐specific C/ebpα conditional knockout (CKO) mouse model via Ctsk‐Cre mice and found that C/ebpα‐deficient mice exhibited a severe osteopetrosis phenotype due to impaired osteoclast terminal differentiation, activation, and function, including mildly reduced osteoclast number, impaired osteoclast polarization, actin formation, and bone resorption, which demonstrated the novel function of C/ebpα in cell function and terminal differentiation. Interestingly, C/ebpα deficiency did not affect bone formation or monocyte/macrophage development. Our results further demonstrated that C/ebpα deficiency suppressed the expression of osteoclast functional genes, e.g. encoding cathepsin K (Ctsk), Atp6i (Tcirg1), and osteoclast regulator genes, e.g. encoding c‐fos (Fos), and nuclear factor of activated T‐cells 1 (Nfatc1), while having no effect on Pu.1 (Spi1) expression. Promoter activity mapping and ChIP assay defined the critical cis‐regulatory element (CCRE) in the promoter region of Nfatc1, and also showed that the CCREs were directly associated with C/ebpα, which enhanced the promoter's activity. The deficiency of C/ebpα in osteoclasts completely blocked ovariectomy‐induced bone loss, indicating that C/ebpα is a promising new target for the treatment of osteolytic diseases. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley &amp; Sons, Ltd.</description><subject>Animals</subject><subject>Binding Sites</subject><subject>C/ebpα</subject><subject>cathepsin K</subject><subject>CCAAT-Enhancer-Binding Proteins - deficiency</subject><subject>CCAAT-Enhancer-Binding Proteins - genetics</subject><subject>CCAAT-Enhancer-Binding Proteins - metabolism</subject><subject>Cell Differentiation</subject><subject>Cell Lineage</subject><subject>Cells, Cultured</subject><subject>Disease Models, Animal</subject><subject>Female</subject><subject>Gene Expression Regulation, Developmental</subject><subject>Genetic Predisposition to Disease</subject><subject>Homeostasis</subject><subject>Humans</subject><subject>Male</subject><subject>Mice, Knockout</subject><subject>NFATC Transcription Factors - genetics</subject><subject>NFATC Transcription Factors - metabolism</subject><subject>Nfatc1</subject><subject>osteoclast function</subject><subject>Osteoclasts - metabolism</subject><subject>Osteoclasts - pathology</subject><subject>Osteogenesis</subject><subject>Osteopetrosis - genetics</subject><subject>Osteopetrosis - metabolism</subject><subject>Osteopetrosis - pathology</subject><subject>Osteoporosis, Postmenopausal - genetics</subject><subject>Osteoporosis, Postmenopausal - metabolism</subject><subject>Osteoporosis, Postmenopausal - pathology</subject><subject>Ovariectomy</subject><subject>Phenotype</subject><subject>Promoter Regions, Genetic</subject><subject>Signal Transduction</subject><subject>terminal differentiation</subject><issn>0022-3417</issn><issn>1096-9896</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9uFSEUh4nRtNfahS9gWGri9ALzl41Jc1OtSaMu6powzOEOhoERmJq-RN-lL9Jnktt7bXThCnLOd74D-SH0mpIzSghbzzKNZzUh9BlaUcKbgne8eY5WuceKsqLtMXoZ4w9CCOd1fYSOGSddWXXdCt1t1tDPD_dYeZeCtxH7mMArK2PCCcJknLR4MFpDAJeMTMa791iqZG4Od704dai6Ac953smUh3rvAI9-glyR0UScxuCX7ZhtAVTCAbaLfXRgr_EXLZOir9ALLW2E08N5gr5_vLjeXBZXXz993pxfFaqiNS340DKmFevaSrKhV4TSrlU14TVvKyj7vm9K0K3qSw61LmWTqUqDBKW7lrOmPEEf9t556ScYVP5akFbMwUwy3Aovjfi348wotv5GNKwiVbMTvD0Igv-5QExiMlGBtdKBX6KgvG7bpisJz-i7PaqCjzGAflpDidjlJ3b5iV1-mX3z97ueyD-BZWC9B34ZC7f_N4lv59eXj8rfdvmrSg</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Chen, Wei</creator><creator>Zhu, Guochun</creator><creator>Tang, Jun</creator><creator>Zhou, Hou‐De</creator><creator>Li, Yi‐Ping</creator><general>John Wiley &amp; Sons, Ltd</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>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2188-6958</orcidid></search><sort><creationdate>201803</creationdate><title>C/ebpα controls osteoclast terminal differentiation, activation, function, and postnatal bone homeostasis through direct regulation of Nfatc1</title><author>Chen, Wei ; Zhu, Guochun ; Tang, Jun ; Zhou, Hou‐De ; Li, Yi‐Ping</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4151-9d722fc2874a2dbc01187c5095974e3bbb63ef7cb39e5f3a6a2d4feaecf879263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Animals</topic><topic>Binding Sites</topic><topic>C/ebpα</topic><topic>cathepsin K</topic><topic>CCAAT-Enhancer-Binding Proteins - deficiency</topic><topic>CCAAT-Enhancer-Binding Proteins - genetics</topic><topic>CCAAT-Enhancer-Binding Proteins - metabolism</topic><topic>Cell Differentiation</topic><topic>Cell Lineage</topic><topic>Cells, Cultured</topic><topic>Disease Models, Animal</topic><topic>Female</topic><topic>Gene Expression Regulation, Developmental</topic><topic>Genetic Predisposition to Disease</topic><topic>Homeostasis</topic><topic>Humans</topic><topic>Male</topic><topic>Mice, Knockout</topic><topic>NFATC Transcription Factors - genetics</topic><topic>NFATC Transcription Factors - metabolism</topic><topic>Nfatc1</topic><topic>osteoclast function</topic><topic>Osteoclasts - metabolism</topic><topic>Osteoclasts - pathology</topic><topic>Osteogenesis</topic><topic>Osteopetrosis - genetics</topic><topic>Osteopetrosis - metabolism</topic><topic>Osteopetrosis - pathology</topic><topic>Osteoporosis, Postmenopausal - genetics</topic><topic>Osteoporosis, Postmenopausal - metabolism</topic><topic>Osteoporosis, Postmenopausal - pathology</topic><topic>Ovariectomy</topic><topic>Phenotype</topic><topic>Promoter Regions, Genetic</topic><topic>Signal Transduction</topic><topic>terminal differentiation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Wei</creatorcontrib><creatorcontrib>Zhu, Guochun</creatorcontrib><creatorcontrib>Tang, Jun</creatorcontrib><creatorcontrib>Zhou, Hou‐De</creatorcontrib><creatorcontrib>Li, Yi‐Ping</creatorcontrib><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>The Journal of pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Wei</au><au>Zhu, Guochun</au><au>Tang, Jun</au><au>Zhou, Hou‐De</au><au>Li, Yi‐Ping</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>C/ebpα controls osteoclast terminal differentiation, activation, function, and postnatal bone homeostasis through direct regulation of Nfatc1</atitle><jtitle>The Journal of pathology</jtitle><addtitle>J Pathol</addtitle><date>2018-03</date><risdate>2018</risdate><volume>244</volume><issue>3</issue><spage>271</spage><epage>282</epage><pages>271-282</pages><issn>0022-3417</issn><eissn>1096-9896</eissn><abstract>Osteoclast lineage commitment and differentiation have been studied extensively, although the mechanism by which transcription factor(s) control osteoclast terminal differentiation, activation, and function remains unclear. CCAAT/enhancer‐binding protein α (C/ebpα) has been reported to be a key regulator of osteoclast cell lineage commitment, yet C/ebpα's roles in osteoclast terminal differentiation, activation and function, and bone homeostasis, under physiological or pathological conditions, have not been studied because newborn C/ebpα‐null mice die within several hours after birth. Furthermore, the function of C/ebpα in osteoclast terminal differentiation, activation, and function is largely unknown. Herein, we generated and analyzed an osteoclast‐specific C/ebpα conditional knockout (CKO) mouse model via Ctsk‐Cre mice and found that C/ebpα‐deficient mice exhibited a severe osteopetrosis phenotype due to impaired osteoclast terminal differentiation, activation, and function, including mildly reduced osteoclast number, impaired osteoclast polarization, actin formation, and bone resorption, which demonstrated the novel function of C/ebpα in cell function and terminal differentiation. Interestingly, C/ebpα deficiency did not affect bone formation or monocyte/macrophage development. Our results further demonstrated that C/ebpα deficiency suppressed the expression of osteoclast functional genes, e.g. encoding cathepsin K (Ctsk), Atp6i (Tcirg1), and osteoclast regulator genes, e.g. encoding c‐fos (Fos), and nuclear factor of activated T‐cells 1 (Nfatc1), while having no effect on Pu.1 (Spi1) expression. Promoter activity mapping and ChIP assay defined the critical cis‐regulatory element (CCRE) in the promoter region of Nfatc1, and also showed that the CCREs were directly associated with C/ebpα, which enhanced the promoter's activity. The deficiency of C/ebpα in osteoclasts completely blocked ovariectomy‐induced bone loss, indicating that C/ebpα is a promising new target for the treatment of osteolytic diseases. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley &amp; Sons, Ltd.</abstract><cop>Chichester, UK</cop><pub>John Wiley &amp; Sons, Ltd</pub><pmid>29083488</pmid><doi>10.1002/path.5001</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-2188-6958</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0022-3417
ispartof The Journal of pathology, 2018-03, Vol.244 (3), p.271-282
issn 0022-3417
1096-9896
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6240466
source MEDLINE; Access via Wiley Online Library
subjects Animals
Binding Sites
C/ebpα
cathepsin K
CCAAT-Enhancer-Binding Proteins - deficiency
CCAAT-Enhancer-Binding Proteins - genetics
CCAAT-Enhancer-Binding Proteins - metabolism
Cell Differentiation
Cell Lineage
Cells, Cultured
Disease Models, Animal
Female
Gene Expression Regulation, Developmental
Genetic Predisposition to Disease
Homeostasis
Humans
Male
Mice, Knockout
NFATC Transcription Factors - genetics
NFATC Transcription Factors - metabolism
Nfatc1
osteoclast function
Osteoclasts - metabolism
Osteoclasts - pathology
Osteogenesis
Osteopetrosis - genetics
Osteopetrosis - metabolism
Osteopetrosis - pathology
Osteoporosis, Postmenopausal - genetics
Osteoporosis, Postmenopausal - metabolism
Osteoporosis, Postmenopausal - pathology
Ovariectomy
Phenotype
Promoter Regions, Genetic
Signal Transduction
terminal differentiation
title C/ebpα controls osteoclast terminal differentiation, activation, function, and postnatal bone homeostasis through direct regulation of Nfatc1
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-21T15%3A25%3A02IST&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=C/ebp%CE%B1%20controls%20osteoclast%20terminal%20differentiation,%20activation,%20function,%20and%20postnatal%20bone%20homeostasis%20through%20direct%20regulation%20of%20Nfatc1&rft.jtitle=The%20Journal%20of%20pathology&rft.au=Chen,%20Wei&rft.date=2018-03&rft.volume=244&rft.issue=3&rft.spage=271&rft.epage=282&rft.pages=271-282&rft.issn=0022-3417&rft.eissn=1096-9896&rft_id=info:doi/10.1002/path.5001&rft_dat=%3Cproquest_pubme%3E1957768309%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=1957768309&rft_id=info:pmid/29083488&rfr_iscdi=true