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Xu J, Casella JF, Pollard TD. Effect of capping protein, CapZ, on the length of actin filaments and mechanical properties of actin filament networks. CELL MOTILITY AND THE CYTOSKELETON 2000; 42:73-81. [PMID: 9915586 DOI: 10.1002/(sici)1097-0169(1999)42:1<73::aid-cm7>3.0.co;2-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report on how physiological concentrations of capping protein shorten actin filaments and on the remarkably fluid nature of solutions of such short filaments even at the high concentrations that exist in cells. We measured the lengths of actin filaments formed by spontaneous polymerization of highly purified actin monomers by fluorescence microscopy after labeling with rhodamine-phalloidin. The length distributions are exponential with a mean of about 7 microm (2600 subunits). As observed previously with less quantitative assays, copolymerization with the actin capping protein, CapZ, reduces the length of the filaments. At cellular concentrations of capping protein, one filament forms for each molecule of capping protein and the population of filaments is uniformly short. Using CapZ to vary the length of actin filaments, we measured how their mechanical properties depend on length. The stiffness (elastic modulus) of actin filament networks depends steeply on the length, with long filaments contributing far out of proportion to their numbers to the stiffness. Even at physiological concentrations (300 microM), networks of filaments limited to lengths observed in cells with a 1 to 500 molar ratio of CapZ are more fluid and much less elastic than lower concentrations of longer actin filaments. Thus the high concentration of short actin filaments in cells must be crosslinked to produce the observed stiffness of the cortex.
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Affiliation(s)
- J Xu
- Department of Biophysics and Biophysical Chemistry, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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52
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Abstract
BACKGROUND Phagocytosis, the process by which cells internalize particles, is essential for the defense of multicellular organisms against invading pathogens and is the major means by which many unicellular organisms obtain nutrients. The actin cytoskeleton plays a critical role in phagocytosis and the observation that a significant amount of force (10-20 nN) is generated during internalization, suggests that a myosin participates in the process. Although more than 15 distinct classes of myosin have been identified, their roles in phagocytosis are unknown. RESULTS The identification of a class VII unconventional myosin (DdMVII) in the Dictyostelium discoideum amoeba, which is a model for phagocytosis, is reported here. Mutant cells lacking DdMVII exhibited an 80% decrease in the uptake of particles whereas all other actin-based behaviors that were tested, including pinocytosis, exocytosis, cytokinesis and morphogenesis, proceeded normally. The defect in phagocytosis was neither because of altered particle binding nor inability to form actin-filled phagocytic cups. CONCLUSIONS Molecular genetic analysis of Dictyostelium myosin VII reveals that this motor protein plays a specific and significant role in phagocytosis.
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Affiliation(s)
- M A Titus
- Department of Genetics, University of Minnesota, Minneapolis, 55455, USA.
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53
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Stamenović D, Coughlin MF. The role of prestress and architecture of the cytoskeleton and deformability of cytoskeletal filaments in mechanics of adherent cells: a quantitative analysis. J Theor Biol 1999; 201:63-74. [PMID: 10534436 DOI: 10.1006/jtbi.1999.1014] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mechanical properties of adherent cells were investigated using methods of engineering mechanics. The cytoskeleton (CSK) was modeled as a filamentous network and key mechanisms and corresponding molecular structures which determine cell elastic behavior were identified. Three models of the CSK were considered: open-cell foam networks, prestressed cable nets, and a tensegrity model as a special case of the latter. For each model, the modulus of elasticity (i.e. an index of resistance to small deformation) was given as a function of mechanical and geometrical properties of CSK filaments whose values were determined from the data in the literature. Quantitative predictions for the elastic modulus were compared with data obtained previously from mechanical tests on adherent cells. The open-cell foam model yielded the elastic modulus (10(3)-10(4)Pa) which was consistent with measurements which apply a large compressive stress to the cell. This suggests that bending of CSK filaments is the key mechanism for resisting large compression. The prestressed cable net and tensegrity model yielded much lower elastic moduli (10(1)-10(2)Pa) which were consistent with values determined from equilibrium measurements at low applied stress. This suggests that CSK prestress and architecture are the primary determinants of the cell elastic response. The tensegrity model revealed the possibility that buckling of microtubules of the CSK also contributed to cell elasticity.
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Affiliation(s)
- D Stamenović
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
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54
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Thimgan MS, Yee HF. Quantitation of rat hepatic stellate cell contraction: stellate cells' contribution to sinusoidal resistance. THE AMERICAN JOURNAL OF PHYSIOLOGY 1999; 277:G137-43. [PMID: 10409160 DOI: 10.1152/ajpgi.1999.277.1.g137] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Although it has been hypothesized that contraction of hepatic stellate cells (HSC) regulates blood flow by modulating sinusoidal resistance, neither HSC contraction nor relaxation has been directly quantitated. To test this hypothesis, a force transducer was employed to directly measure the magnitude and rate of contraction and relaxation by primary rat HSC (4.7 x 10(5) +/- 0.2 x 10(5) cells) cultured within a collagen gel. Serial exposures to 10% fetal bovine serum stimulated 81 +/- 14 and 82 +/- 10 dyn of contractile force, respectively. Subsequent stimulation with 2 nM endothelin-1 (ET-1) resulted in the development of 185 +/- 25 dyn of force. Contractions began within 10 s of ET-1 stimulation, and the half time of maximal force development was <5 min. Removal of agonist resulted in complete or nearly complete relaxation within 45 min. These results suggest that the magnitude and rate of HSC contraction and relaxation are capable of modulating blood flow via sinusoidal constriction.
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Affiliation(s)
- M S Thimgan
- Division of Digestive Diseases and CURE: Digestive Diseases Research Center, University of California School of Medicine, Los Angeles, California 90095, USA
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55
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Swanson JA, Johnson MT, Beningo K, Post P, Mooseker M, Araki N. A contractile activity that closes phagosomes in macrophages. J Cell Sci 1999; 112 ( Pt 3):307-16. [PMID: 9885284 DOI: 10.1242/jcs.112.3.307] [Citation(s) in RCA: 191] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Studies of Fc-mediated phagocytosis by mouse macrophages identified a contractile activity at the distal margins of forming phagosomes. Time-lapse video microscopic analysis of macrophages containing rhodamine-labeled actin and fluorescein dextran showed that actin was concentrated at the distal margins of closing phagosomes. Phagocytosis-related contractile activities were observed when one IgG-opsonized erythrocyte was engaged by two macrophages. Both cells extended pseudopodia until they met midway around the erythrocyte. It was then constricted and pulled into two phagosomes, which remained interconnected by a string of erythrocyte membrane. Butanedione monoxime, an uncompetitive inhibitor of class II and perhaps other myosins, and wortmannin and LY294002, inhibitors of phosphoinositide 3-kinase, prevented the constrictions without inhibiting the initial pseudopod extension. Immunofluorescence microscopy showed the presence of myosins IC, II, V and IXb in phagosomes. Of these, only myosin IC was concentrated around the strings connecting shared erythrocytes, suggesting that myosin IC mediates the purse-string-like contraction that closes phagosomes. The sequential processes of pseudopod extension and contraction can explain how macropinosomes and spacious phagosomes form without guidance from a particle surface.
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Affiliation(s)
- J A Swanson
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA.
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56
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Xu J, Schwarz WH, Käs JA, Stossel TP, Janmey PA, Pollard TD. Mechanical properties of actin filament networks depend on preparation, polymerization conditions, and storage of actin monomers. Biophys J 1998; 74:2731-40. [PMID: 9591697 PMCID: PMC1299613 DOI: 10.1016/s0006-3495(98)77979-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This study investigates possible sources for the variance of more than two orders of magnitude in the published values for the shear moduli of purified actin filaments. Two types of forced oscillatory rheometers used in some of our previous work agree within a factor of three for identical samples. Polymers assembled in EGTA and Mg2+ from fresh, gel-filtered ATP-actin at 1 mg/ml typically have an elastic storage modulus (G') of approximately 1 Pa at a deformation frequency of 0.1-1 Hz. G' is slightly higher when actin is polymerized in KCl with Ca2+ and Mg2+. Gel filtration removes minor contaminants from actin but has little effect on G' for most preparations of actin from acetone powder. Storage of actin monomers without frequent changes of buffer containing fresh ATP and dithiothreitol can result in changes that increase the G' of filaments by more than a factor of 10. Frozen storage can preserve the properties of monomeric actin, but care is necessary to prevent protein denaturation or aggregation due to freezing or thawing.
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Affiliation(s)
- J Xu
- Department of Biophysics and Biophysical Chemistry, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA
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57
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Lowry MB, Duchemin AM, Robinson JM, Anderson CL. Functional separation of pseudopod extension and particle internalization during Fc gamma receptor-mediated phagocytosis. J Exp Med 1998; 187:161-76. [PMID: 9432974 PMCID: PMC2212093 DOI: 10.1084/jem.187.2.161] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/1997] [Revised: 11/07/1997] [Indexed: 02/05/2023] Open
Abstract
Receptors for the Fc portion of immunoglobulin (Ig)G (Fc gamma R) mediate phagocytosis of IgG-opsonized particles by a process that can be divided into four major steps: receptor-ligand binding, pseudopod extension, internalization, and lysosomal fusion. We have expressed single classes of Fc gamma R in COS fibroblasts to examine the structural determinants necessary to complete the four steps of phagocytosis. Using phase contrast, fluorescence, confocal, and electron microscopy we have demonstrated that Fc gamma R-expressing COS cells can phagocytose in a manner similar to that of professional phagocytes. We have further analyzed the capacity of the three classes of Fc gamma R to phagocytose, placing special emphasis on the Fc gamma RIA-gamma chain complex, which allowed us to examine independently the roles of the ligand-binding unit (Fc gamma RIA) and the signaling unit (gamma chain). We found that receptor complexes containing a conserved tyrosine activation motif (ITAM), as found in the cytoplasmic domain of Fc gamma RIIA and in the gamma chain associated with Fc gamma RIA and Fc gamma RIIIA, readily internalized target particles. In contrast, Fc gamma RIA alone, having no ITAM, was unable to internalize target particles efficiently, but did mediate pseudopod extension. Cotransfection of gamma chain with Fc gamma RIA restored the ability of the receptor to internalize target particles. A mutant Fc gamma RIA in which the cytoplasmic domain had been deleted was also capable of mediating pseudopod extension, showing that neither the gamma chain nor the cytoplasmic domain of Fc gamma RIA were required for this step. Cytochalasin D, an inhibitor of actin polymerization, blocked particle internalization by all Fc gamma R, but did not block pseudopod extension. Staining the Fc gamma RIA COS cells for F-actin and for tyrosine phosphoproteins, we found that actin did not polymerize during Fc gamma RIA-mediated pseudopod extension, nor were tyrosine kinases activated. Our data suggest that pseudopod extension and internalization are functionally distinct steps mediated through different pathways.
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Affiliation(s)
- M B Lowry
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus 43210, USA
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58
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Ragsdale GK, Phelps J, Luby-Phelps K. Viscoelastic response of fibroblasts to tension transmitted through adherens junctions. Biophys J 1997; 73:2798-808. [PMID: 9370474 PMCID: PMC1181182 DOI: 10.1016/s0006-3495(97)78309-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cytoplasmic deformation was monitored by observing the displacements of 200-nm green fluorescent beads microinjected into the cytoplasm of Swiss 3T3 fibroblasts. We noted a novel protrusion of nonruffling cell margins that was accompanied by axial flow of beads and cytoplasmic vesicles as far as 50 microm behind the protruding plasma membrane. Fluorescent analog cytochemistry and immunofluorescence localization of F-actin, alpha-actinin, N-cadherin, and beta-catenin showed that the protruding margins of deforming cells were mechanically coupled to neighboring cells by adherens junctions. Observations suggested that protrusion resulted from passive linear deformation in response to tensile stress exerted by centripetal contraction of the neighboring cell. The time dependence of cytoplasmic strain calculated from the displacements of beads and vesicles was fit quantitatively by a Kelvin-Voight model for a viscoelastic solid with a mean limiting strain of 0.58 and a mean strain rate of 4.3 x 10(-3) s(-1). In rare instances, the deforming cell and its neighbor spontaneously became uncoupled, and recoil of the protruding margin was observed. The time dependence of strain during recoil also fit a Kelvin-Voight model with similar parameters, suggesting that the kinetics of deformation primarily reflect the mechanical properties of the deformed cell rather than the contractile properties of its neighbor. The existence of mechanical coupling between adjacent fibroblasts through adherens junctions and the viscoelastic responses of cells to tension transmitted directly from cell to cell are factors that must be taken into account to fully understand the role of fibroblasts in such biological processes as wound closure and extracellular matrix remodeling during tissue development.
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Affiliation(s)
- G K Ragsdale
- Department of Physiology, The University of Texas Southwestern Medical School, Dallas 75235-9040, USA
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59
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Luby-Phelps K, A. Weisiger R. Role of cytoarchitecture in cytoplasmic transport. Comp Biochem Physiol B Biochem Mol Biol 1996. [DOI: 10.1016/s0305-0491(96)00176-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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60
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Tempel M, Isenberg G, Sackmann E. Temperature-induced sol-gel transition and microgel formation in alpha -actinin cross-linked actin networks: A rheological study. PHYSICAL REVIEW. E, STATISTICAL PHYSICS, PLASMAS, FLUIDS, AND RELATED INTERDISCIPLINARY TOPICS 1996; 54:1802-1810. [PMID: 9965260 DOI: 10.1103/physreve.54.1802] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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61
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Affiliation(s)
- D A Lauffenburger
- Center for Biomedical Engineering, Massachusetts Institute of Technology Cambridge 02139, USA
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62
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Zhelev DV, Alteraifi AM, Hochmuth RM. F-actin network formation in tethers and in pseudopods stimulated by chemoattractant. CELL MOTILITY AND THE CYTOSKELETON 1996; 35:331-44. [PMID: 8956004 DOI: 10.1002/(sici)1097-0169(1996)35:4<331::aid-cm5>3.0.co;2-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Micropipets are used either to deliver a given concentration of the chemoattractant N-formyl-methionyl-leucyl-phenylalanine (fMLP) to a local region of a human neutrophil or to create a membrane tether. Pseudopods, which have a cylindrical shape and grow at a constant rate, are formed in either case. After reaching a maximum extension, they retract, even in the presence of chemoattractant. As a pseudopod grows, cell granules begin to penetrate the pseudopod region to a "boundary" that defines a distance to the pseudopod's leading edge that is almost constant. The exclusion of granules from this domain indicates that it is filled with a dense network. The formation of this network involves the plasma membrane because pseudopod growth ceases when a membrane tether is pulled away from the leading edge. The rate of pseudopod growth depends on fMLP concentration just as the number of occupied N-formyl peptide receptors depends on this concentration. The experimental data are explained by assuming that F-actin network is formed next to the plasma membrane. The newly formed network displaces the membrane and the dominant process in the network region then becomes F-actin depolymerization. The rate of pseudopod growth is determined by the rate of the process leading to network formation. This process is apparently an enzymatic type of reaction. It has a positive enthalpy change and, therefore, is endothermic.
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Affiliation(s)
- D V Zhelev
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina 27708-0300, USA
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63
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Nagarajan S, Chesla S, Cobern L, Anderson P, Zhu C, Selvaraj P. Ligand binding and phagocytosis by CD16 (Fc gamma receptor III) isoforms. Phagocytic signaling by associated zeta and gamma subunits in Chinese hamster ovary cells. J Biol Chem 1995; 270:25762-70. [PMID: 7592758 DOI: 10.1074/jbc.270.43.25762] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
CD16, the low affinity Fc gamma receptor III for IgG (Fc gamma RIII), exists as a polypeptide-anchored form (Fc gamma RIIIA or CD16A) in human natural killer cells and macrophages and as a glycosylphosphatidylinositol-anchored form (Fc gamma RIIIB or CD16B) in neutrophils. CD16A requires association of the gamma subunit of Fc epsilon RI or the zeta subunit of the TCR-CD3 complex for cell surface expression. The CD16B is polymorphic and the two alleles are termed NA1 and NA2. In this study, CD16A and the two alleles of CD16B have been expressed in Chinese hamster ovary (CHO) cells and their ligand binding and phagocytic properties analyzed. The two allelic forms of CD16B showed a similar affinity toward human IgG1. However, the NA1 allele showed approximately 2-fold higher affinity for the IgG3 than the NA2 allele. Although all three forms of CD16 efficiently bound rabbit IgG-coated erythrocytes (EA), only CD16A coexpressed with the gamma subunit phagocytosed EA. The phagocytosis mediated by CD16A expressed on CHO cells was independent of divalent cations but dependent on intact microfilaments. CHO cells expressing CD16A-gamma and CD16A-zeta chimeras also phagocytosed EA. The phagocytosis was specifically inhibited by tyrphostin-23, a tyrosine kinase inhibitor. In summary, our results demonstrate that glycosylphosphatidylinositol-anchored CD16B alleles differ from CD16A in their ability to mediate phagocytosis. Furthermore, since studies with other Fc gamma Rs have shown that CHO cells lack the phagocytic pathway mediated by the cytoplasmic domain of Fc gamma Rs, the phagocytosis of EA by CHO cells stably transfected with CD16A and CD16A-subunit chimera provides an ideal system to dissect the phagocytic signaling pathways mediated by these Fc gamma R-associated subunits.
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Affiliation(s)
- S Nagarajan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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64
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Zhelev DV, Hochmuth RM. Mechanically stimulated cytoskeleton rearrangement and cortical contraction in human neutrophils. Biophys J 1995; 68:2004-14. [PMID: 7612842 PMCID: PMC1282103 DOI: 10.1016/s0006-3495(95)80377-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A mechanical test with micropipets is used to characterize cytoskeleton rearrangement and contraction induced by mechanical stresses in human neutrophils. The yield shear resultant of the cell cortex is on the order of 0.06 to 0.09 mN.m-1. The measured yield shear resultant suggests that the neutrophil cortex is a weakly cross-linked structure. When a tether is pulled out from the cell surface, a polymer structure starts to fill it and spreads out from the cell body. The rate of advancement of the polymerization front is almost constant and, therefore, is not diffusion limited. The measured rate is much smaller than the one of spontaneous actin polymerization, suggesting that the limiting process is either the dissociation of actin monomers from their dimers with the capping proteins or the rate of formation of new nucleation sites or both. Polymerization is also observed after applying sufficient mechanical stresses on a small portion of the cell surface. The polymerization is followed by mass transfer from the cell into the prestressed region and later on by contraction of the main cell body. The pressure generating the flow is located in the prestressed region and most probably is a result of its "swelling" and contraction. The contraction of the main cell body is very similar (in its time dependence and magnitude) to the contraction during phagocytosis. The measured maximum cortical tension is on the order of 0.5 mN.m-1, which for a 3.5-microns diameter pipet corresponds to a maximum contraction force of 11 nN.
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Affiliation(s)
- D V Zhelev
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina 27708-0300, USA
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65
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Lee J, Leonard M, Oliver T, Ishihara A, Jacobson K. Traction forces generated by locomoting keratocytes. J Cell Biol 1994; 127:1957-64. [PMID: 7806573 PMCID: PMC2120302 DOI: 10.1083/jcb.127.6.1957] [Citation(s) in RCA: 265] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Traction forces produced by moving fibroblasts have been observed as distortions in flexible substrata including wrinkling of thin, silicone rubber films. Traction forces generated by fibroblast lamellae were thought to represent the forces required to move the cell forwards. However, traction forces could not be detected with faster moving cell types such as leukocytes and growth cones (Harris, A. K., D. Stopak, and P. Wild. 1981. Nature (Lond.). 290:249-251). We have developed a new assay in which traction forces produced by rapidly locomoting fish keratocytes can be detected by the two-dimensional displacements of small beads embedded in the plane of an elastic substratum. Traction forces were not detected at the rapidly extending front edge of the cell. Instead the largest traction forces were exerted perpendicular to the left and right cell margins. The maximum traction forces exerted by keratocytes were estimated to be approximately 2 x 10(-8) N. The pattern of traction forces can be related to the locomotion of a single keratocyte in terms of lamellar contractility and area of close cell-substratum contact.
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Affiliation(s)
- J Lee
- Department of Cell Biology and Anatomy, University of North Carolina at Chapel Hill 27599-7090
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66
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Janmey PA, Hvidt S, Käs J, Lerche D, Maggs A, Sackmann E, Schliwa M, Stossel TP. The mechanical properties of actin gels. Elastic modulus and filament motions. J Biol Chem 1994. [DOI: 10.1016/s0021-9258(18)31663-6] [Citation(s) in RCA: 218] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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67
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Abstract
The physical properties of cytoplasm differ considerably from dilute aqueous solutions. Recent research has improved our understanding of the properties of the fluid phase and provided a more detailed picture of cytoarchitecture and its relation to cytomechanics. Several recent holistic models indicate novel directions for future research.
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Affiliation(s)
- K Luby-Phelps
- Department of Physiology, University of Texas Southwestern Medical Center at Dallas 75235-9040
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