Microglia-Derived NLRP3 Activation Mediates the Pressor Effect of Prorenin in the Rostral Ventrolateral Medulla of Stress-Induced Hypertensive Rats

Increased microglial activation and neuroinflammation within autonomic brain regions such as the rostral ventrolateral medulla (RVLM) have been implicated in stress-induced hypertension (SIH). Prorenin, a member of the brain renin-angiotensin system (RAS), can directly activate microglia. The presen...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Neuroscience bulletin 2020-05, Vol.36 (5), p.475-492
Hauptverfasser: Hu, Li, Zhang, Shutian, Ooi, Kokwin, Wu, Xuehai, Wu, Jiaxiang, Cai, Jian, Sun, Yinggang, Wang, Jijiang, Zhu, Danian, Chen, Fuxue, Xia, Chunmei
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 492
container_issue 5
container_start_page 475
container_title Neuroscience bulletin
container_volume 36
creator Hu, Li
Zhang, Shutian
Ooi, Kokwin
Wu, Xuehai
Wu, Jiaxiang
Cai, Jian
Sun, Yinggang
Wang, Jijiang
Zhu, Danian
Chen, Fuxue
Xia, Chunmei
description Increased microglial activation and neuroinflammation within autonomic brain regions such as the rostral ventrolateral medulla (RVLM) have been implicated in stress-induced hypertension (SIH). Prorenin, a member of the brain renin-angiotensin system (RAS), can directly activate microglia. The present study aimed to investigate the effects of prorenin on microglial activation in the RVLM of SIH rats. Rats were subjected to intermittent electric foot-shocks plus noise, this stress was administered for 2 h twice daily for 15 consecutive days, and mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA) were monitored. The results showed that MAP and RSNA were augmented, and this paralleled increased pro-inflammatory phenotype (M1) switching. Prorenin and its receptor (PRR) expression and the NLR family pyrin domain containing 3 (NLRP3) activation were increased in RVLM of SIH rats. In addition, PLX5622 (a microglial depletion agent), MCC950 (a NLRP3 inhibitor), and/or PRO20 (a (Pro)renin receptor antagonist) had antihypertensive effects in the rats. The NLRP3 expression in the RVLM was decreased in SIH rats treated with PLX5622. Mito-tracker staining showed translocation of NLRP3 from mitochondria to the cytoplasm in prorenin-stimulated microglia. Prorenin increased the ROS-triggering M1 phenotype-switching and NLRP3 activation, while MCC950 decreased the M1 polarization. In conclusion, upregulated prorenin in the RVLM may be involved in the pathogenesis of SIH, mediated by activation of the microglia-derived NLRP3 inflammasome. The link between prorenin and NLRP3 in microglia provides insights for the treatment of stress-related hypertension.
doi_str_mv 10.1007/s12264-020-00484-9
format Article
fullrecord <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7186257</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A717926624</galeid><sourcerecordid>A717926624</sourcerecordid><originalsourceid>FETCH-LOGICAL-c579t-937b1919996ec62badd27cfad9a7f247af68afb392bbf97bfa5ebc00abe6654e3</originalsourceid><addsrcrecordid>eNp9UV1rFDEUHUSxtfoHfJCAz6mZzGwyeRGWttrCVsv68RoymZttymyyJNmF_g7_sHccLRZEEkhy7znn3ptTVa9rdlozJt_lmnPRUsYZZaztWqqeVMe1Ugva8bp7inchGyqZkEfVi5zvGBNMNu3z6qjhvOW8a4-rH9feprgZvaHnkPwBBvJptb5pyNIWfzDFx0CuYfCmQCblFshNgpxjIhfOgS0kOozEBMEHgntCrGMuyYzkO4SS4ojM6YUi-3E0E-FLmTToVRj2Futd3u8gFQgZq5O1Kfll9cyZMcOr3-dJ9e3DxdezS7r6_PHqbLmidiFVoaqRfa1wXiXACt6bYeDSOjMoIx1vpXGiM65vFO97p2TvzAJ6y5jpQYhFC81J9X7W3e37LQx26teMepf81qR7HY3XjzPB3-pNPGhZd4IvJAq8nQU2ZgTtg4sIs1ufrV7KWiouBG8RdfoPFK4Btt7GAM5j_BGBzwR0JucE7qGlmunJeT07r9F5_ct5rZD05u9hHih_rEZAMwMypsIGkr6L-xTwg_8n-xPU-bz-</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Microglia-Derived NLRP3 Activation Mediates the Pressor Effect of Prorenin in the Rostral Ventrolateral Medulla of Stress-Induced Hypertensive Rats</title><source>MEDLINE</source><source>SpringerLink Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Hu, Li ; Zhang, Shutian ; Ooi, Kokwin ; Wu, Xuehai ; Wu, Jiaxiang ; Cai, Jian ; Sun, Yinggang ; Wang, Jijiang ; Zhu, Danian ; Chen, Fuxue ; Xia, Chunmei</creator><creatorcontrib>Hu, Li ; Zhang, Shutian ; Ooi, Kokwin ; Wu, Xuehai ; Wu, Jiaxiang ; Cai, Jian ; Sun, Yinggang ; Wang, Jijiang ; Zhu, Danian ; Chen, Fuxue ; Xia, Chunmei</creatorcontrib><description>Increased microglial activation and neuroinflammation within autonomic brain regions such as the rostral ventrolateral medulla (RVLM) have been implicated in stress-induced hypertension (SIH). Prorenin, a member of the brain renin-angiotensin system (RAS), can directly activate microglia. The present study aimed to investigate the effects of prorenin on microglial activation in the RVLM of SIH rats. Rats were subjected to intermittent electric foot-shocks plus noise, this stress was administered for 2 h twice daily for 15 consecutive days, and mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA) were monitored. The results showed that MAP and RSNA were augmented, and this paralleled increased pro-inflammatory phenotype (M1) switching. Prorenin and its receptor (PRR) expression and the NLR family pyrin domain containing 3 (NLRP3) activation were increased in RVLM of SIH rats. In addition, PLX5622 (a microglial depletion agent), MCC950 (a NLRP3 inhibitor), and/or PRO20 (a (Pro)renin receptor antagonist) had antihypertensive effects in the rats. The NLRP3 expression in the RVLM was decreased in SIH rats treated with PLX5622. Mito-tracker staining showed translocation of NLRP3 from mitochondria to the cytoplasm in prorenin-stimulated microglia. Prorenin increased the ROS-triggering M1 phenotype-switching and NLRP3 activation, while MCC950 decreased the M1 polarization. In conclusion, upregulated prorenin in the RVLM may be involved in the pathogenesis of SIH, mediated by activation of the microglia-derived NLRP3 inflammasome. The link between prorenin and NLRP3 in microglia provides insights for the treatment of stress-related hypertension.</description><identifier>ISSN: 1673-7067</identifier><identifier>EISSN: 1995-8218</identifier><identifier>DOI: 10.1007/s12264-020-00484-9</identifier><identifier>PMID: 32242284</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Anatomy ; Anesthesiology ; Animals ; Biomedical and Life Sciences ; Biomedicine ; Blood Pressure - drug effects ; Heterocyclic Compounds, 4 or More Rings - pharmacology ; Human Physiology ; Hypertension ; Hypertension - metabolism ; Hypertension - physiopathology ; Male ; Medulla Oblongata - metabolism ; Microglia - metabolism ; Neurology ; Neurophysiology ; Neurosciences ; NLR Family, Pyrin Domain-Containing 3 Protein - metabolism ; Original ; Original Article ; Pain Medicine ; Rats ; Rats, Sprague-Dawley ; Receptors, Cell Surface - metabolism ; Renin - metabolism ; Stress, Physiological ; Sulfones - pharmacology ; Sympathetic Nervous System - drug effects</subject><ispartof>Neuroscience bulletin, 2020-05, Vol.36 (5), p.475-492</ispartof><rights>The Author(s) 2020</rights><rights>COPYRIGHT 2020 Springer</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c579t-937b1919996ec62badd27cfad9a7f247af68afb392bbf97bfa5ebc00abe6654e3</citedby><cites>FETCH-LOGICAL-c579t-937b1919996ec62badd27cfad9a7f247af68afb392bbf97bfa5ebc00abe6654e3</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/PMC7186257/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186257/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32242284$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hu, Li</creatorcontrib><creatorcontrib>Zhang, Shutian</creatorcontrib><creatorcontrib>Ooi, Kokwin</creatorcontrib><creatorcontrib>Wu, Xuehai</creatorcontrib><creatorcontrib>Wu, Jiaxiang</creatorcontrib><creatorcontrib>Cai, Jian</creatorcontrib><creatorcontrib>Sun, Yinggang</creatorcontrib><creatorcontrib>Wang, Jijiang</creatorcontrib><creatorcontrib>Zhu, Danian</creatorcontrib><creatorcontrib>Chen, Fuxue</creatorcontrib><creatorcontrib>Xia, Chunmei</creatorcontrib><title>Microglia-Derived NLRP3 Activation Mediates the Pressor Effect of Prorenin in the Rostral Ventrolateral Medulla of Stress-Induced Hypertensive Rats</title><title>Neuroscience bulletin</title><addtitle>Neurosci. Bull</addtitle><addtitle>Neurosci Bull</addtitle><description>Increased microglial activation and neuroinflammation within autonomic brain regions such as the rostral ventrolateral medulla (RVLM) have been implicated in stress-induced hypertension (SIH). Prorenin, a member of the brain renin-angiotensin system (RAS), can directly activate microglia. The present study aimed to investigate the effects of prorenin on microglial activation in the RVLM of SIH rats. Rats were subjected to intermittent electric foot-shocks plus noise, this stress was administered for 2 h twice daily for 15 consecutive days, and mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA) were monitored. The results showed that MAP and RSNA were augmented, and this paralleled increased pro-inflammatory phenotype (M1) switching. Prorenin and its receptor (PRR) expression and the NLR family pyrin domain containing 3 (NLRP3) activation were increased in RVLM of SIH rats. In addition, PLX5622 (a microglial depletion agent), MCC950 (a NLRP3 inhibitor), and/or PRO20 (a (Pro)renin receptor antagonist) had antihypertensive effects in the rats. The NLRP3 expression in the RVLM was decreased in SIH rats treated with PLX5622. Mito-tracker staining showed translocation of NLRP3 from mitochondria to the cytoplasm in prorenin-stimulated microglia. Prorenin increased the ROS-triggering M1 phenotype-switching and NLRP3 activation, while MCC950 decreased the M1 polarization. In conclusion, upregulated prorenin in the RVLM may be involved in the pathogenesis of SIH, mediated by activation of the microglia-derived NLRP3 inflammasome. The link between prorenin and NLRP3 in microglia provides insights for the treatment of stress-related hypertension.</description><subject>Anatomy</subject><subject>Anesthesiology</subject><subject>Animals</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Blood Pressure - drug effects</subject><subject>Heterocyclic Compounds, 4 or More Rings - pharmacology</subject><subject>Human Physiology</subject><subject>Hypertension</subject><subject>Hypertension - metabolism</subject><subject>Hypertension - physiopathology</subject><subject>Male</subject><subject>Medulla Oblongata - metabolism</subject><subject>Microglia - metabolism</subject><subject>Neurology</subject><subject>Neurophysiology</subject><subject>Neurosciences</subject><subject>NLR Family, Pyrin Domain-Containing 3 Protein - metabolism</subject><subject>Original</subject><subject>Original Article</subject><subject>Pain Medicine</subject><subject>Rats</subject><subject>Rats, Sprague-Dawley</subject><subject>Receptors, Cell Surface - metabolism</subject><subject>Renin - metabolism</subject><subject>Stress, Physiological</subject><subject>Sulfones - pharmacology</subject><subject>Sympathetic Nervous System - drug effects</subject><issn>1673-7067</issn><issn>1995-8218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9UV1rFDEUHUSxtfoHfJCAz6mZzGwyeRGWttrCVsv68RoymZttymyyJNmF_g7_sHccLRZEEkhy7znn3ptTVa9rdlozJt_lmnPRUsYZZaztWqqeVMe1Ugva8bp7inchGyqZkEfVi5zvGBNMNu3z6qjhvOW8a4-rH9feprgZvaHnkPwBBvJptb5pyNIWfzDFx0CuYfCmQCblFshNgpxjIhfOgS0kOozEBMEHgntCrGMuyYzkO4SS4ojM6YUi-3E0E-FLmTToVRj2Futd3u8gFQgZq5O1Kfll9cyZMcOr3-dJ9e3DxdezS7r6_PHqbLmidiFVoaqRfa1wXiXACt6bYeDSOjMoIx1vpXGiM65vFO97p2TvzAJ6y5jpQYhFC81J9X7W3e37LQx26teMepf81qR7HY3XjzPB3-pNPGhZd4IvJAq8nQU2ZgTtg4sIs1ufrV7KWiouBG8RdfoPFK4Btt7GAM5j_BGBzwR0JucE7qGlmunJeT07r9F5_ct5rZD05u9hHih_rEZAMwMypsIGkr6L-xTwg_8n-xPU-bz-</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Hu, Li</creator><creator>Zhang, Shutian</creator><creator>Ooi, Kokwin</creator><creator>Wu, Xuehai</creator><creator>Wu, Jiaxiang</creator><creator>Cai, Jian</creator><creator>Sun, Yinggang</creator><creator>Wang, Jijiang</creator><creator>Zhu, Danian</creator><creator>Chen, Fuxue</creator><creator>Xia, Chunmei</creator><general>Springer Singapore</general><general>Springer</general><scope>C6C</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>5PM</scope></search><sort><creationdate>20200501</creationdate><title>Microglia-Derived NLRP3 Activation Mediates the Pressor Effect of Prorenin in the Rostral Ventrolateral Medulla of Stress-Induced Hypertensive Rats</title><author>Hu, Li ; Zhang, Shutian ; Ooi, Kokwin ; Wu, Xuehai ; Wu, Jiaxiang ; Cai, Jian ; Sun, Yinggang ; Wang, Jijiang ; Zhu, Danian ; Chen, Fuxue ; Xia, Chunmei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c579t-937b1919996ec62badd27cfad9a7f247af68afb392bbf97bfa5ebc00abe6654e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anatomy</topic><topic>Anesthesiology</topic><topic>Animals</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Blood Pressure - drug effects</topic><topic>Heterocyclic Compounds, 4 or More Rings - pharmacology</topic><topic>Human Physiology</topic><topic>Hypertension</topic><topic>Hypertension - metabolism</topic><topic>Hypertension - physiopathology</topic><topic>Male</topic><topic>Medulla Oblongata - metabolism</topic><topic>Microglia - metabolism</topic><topic>Neurology</topic><topic>Neurophysiology</topic><topic>Neurosciences</topic><topic>NLR Family, Pyrin Domain-Containing 3 Protein - metabolism</topic><topic>Original</topic><topic>Original Article</topic><topic>Pain Medicine</topic><topic>Rats</topic><topic>Rats, Sprague-Dawley</topic><topic>Receptors, Cell Surface - metabolism</topic><topic>Renin - metabolism</topic><topic>Stress, Physiological</topic><topic>Sulfones - pharmacology</topic><topic>Sympathetic Nervous System - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hu, Li</creatorcontrib><creatorcontrib>Zhang, Shutian</creatorcontrib><creatorcontrib>Ooi, Kokwin</creatorcontrib><creatorcontrib>Wu, Xuehai</creatorcontrib><creatorcontrib>Wu, Jiaxiang</creatorcontrib><creatorcontrib>Cai, Jian</creatorcontrib><creatorcontrib>Sun, Yinggang</creatorcontrib><creatorcontrib>Wang, Jijiang</creatorcontrib><creatorcontrib>Zhu, Danian</creatorcontrib><creatorcontrib>Chen, Fuxue</creatorcontrib><creatorcontrib>Xia, Chunmei</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neuroscience bulletin</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hu, Li</au><au>Zhang, Shutian</au><au>Ooi, Kokwin</au><au>Wu, Xuehai</au><au>Wu, Jiaxiang</au><au>Cai, Jian</au><au>Sun, Yinggang</au><au>Wang, Jijiang</au><au>Zhu, Danian</au><au>Chen, Fuxue</au><au>Xia, Chunmei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Microglia-Derived NLRP3 Activation Mediates the Pressor Effect of Prorenin in the Rostral Ventrolateral Medulla of Stress-Induced Hypertensive Rats</atitle><jtitle>Neuroscience bulletin</jtitle><stitle>Neurosci. Bull</stitle><addtitle>Neurosci Bull</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>36</volume><issue>5</issue><spage>475</spage><epage>492</epage><pages>475-492</pages><issn>1673-7067</issn><eissn>1995-8218</eissn><abstract>Increased microglial activation and neuroinflammation within autonomic brain regions such as the rostral ventrolateral medulla (RVLM) have been implicated in stress-induced hypertension (SIH). Prorenin, a member of the brain renin-angiotensin system (RAS), can directly activate microglia. The present study aimed to investigate the effects of prorenin on microglial activation in the RVLM of SIH rats. Rats were subjected to intermittent electric foot-shocks plus noise, this stress was administered for 2 h twice daily for 15 consecutive days, and mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA) were monitored. The results showed that MAP and RSNA were augmented, and this paralleled increased pro-inflammatory phenotype (M1) switching. Prorenin and its receptor (PRR) expression and the NLR family pyrin domain containing 3 (NLRP3) activation were increased in RVLM of SIH rats. In addition, PLX5622 (a microglial depletion agent), MCC950 (a NLRP3 inhibitor), and/or PRO20 (a (Pro)renin receptor antagonist) had antihypertensive effects in the rats. The NLRP3 expression in the RVLM was decreased in SIH rats treated with PLX5622. Mito-tracker staining showed translocation of NLRP3 from mitochondria to the cytoplasm in prorenin-stimulated microglia. Prorenin increased the ROS-triggering M1 phenotype-switching and NLRP3 activation, while MCC950 decreased the M1 polarization. In conclusion, upregulated prorenin in the RVLM may be involved in the pathogenesis of SIH, mediated by activation of the microglia-derived NLRP3 inflammasome. The link between prorenin and NLRP3 in microglia provides insights for the treatment of stress-related hypertension.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>32242284</pmid><doi>10.1007/s12264-020-00484-9</doi><tpages>18</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1673-7067
ispartof Neuroscience bulletin, 2020-05, Vol.36 (5), p.475-492
issn 1673-7067
1995-8218
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7186257
source MEDLINE; SpringerLink Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection
subjects Anatomy
Anesthesiology
Animals
Biomedical and Life Sciences
Biomedicine
Blood Pressure - drug effects
Heterocyclic Compounds, 4 or More Rings - pharmacology
Human Physiology
Hypertension
Hypertension - metabolism
Hypertension - physiopathology
Male
Medulla Oblongata - metabolism
Microglia - metabolism
Neurology
Neurophysiology
Neurosciences
NLR Family, Pyrin Domain-Containing 3 Protein - metabolism
Original
Original Article
Pain Medicine
Rats
Rats, Sprague-Dawley
Receptors, Cell Surface - metabolism
Renin - metabolism
Stress, Physiological
Sulfones - pharmacology
Sympathetic Nervous System - drug effects
title Microglia-Derived NLRP3 Activation Mediates the Pressor Effect of Prorenin in the Rostral Ventrolateral Medulla of Stress-Induced Hypertensive Rats
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T05%3A44%3A46IST&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=Microglia-Derived%20NLRP3%20Activation%20Mediates%20the%20Pressor%20Effect%20of%20Prorenin%20in%20the%20Rostral%20Ventrolateral%20Medulla%20of%20Stress-Induced%20Hypertensive%20Rats&rft.jtitle=Neuroscience%20bulletin&rft.au=Hu,%20Li&rft.date=2020-05-01&rft.volume=36&rft.issue=5&rft.spage=475&rft.epage=492&rft.pages=475-492&rft.issn=1673-7067&rft.eissn=1995-8218&rft_id=info:doi/10.1007/s12264-020-00484-9&rft_dat=%3Cgale_pubme%3EA717926624%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/32242284&rft_galeid=A717926624&rfr_iscdi=true