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Siniakova TS, Raikov AV, Kudryasheva NS. Water-Soluble Polymer Polyethylene Glycol: Effect on the Bioluminescent Reaction of the Marine Coelenterate Obelia and Coelenteramide-Containing Fluorescent Protein. Int J Mol Sci 2023; 24:ijms24076345. [PMID: 37047313 PMCID: PMC10094403 DOI: 10.3390/ijms24076345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
The current paper considers the effects of a water-soluble polymer (polyethylene glycol (PEG)) on the bioluminescent reaction of the photoprotein obelin from the marine coelenterate Obelia longissima and the product of this bioluminescent reaction: a coelenteramide-containing fluorescent protein (CCFP). We varied PEG concentrations (0–1.44 mg/mL) and molecular weights (1000, 8000, and 35,000 a.u.). The presence of PEG significantly increased the bioluminescent intensity of obelin but decreased the photoluminescence intensity of CCFP; the effects did not depend on the PEG concentration or the molecular weight. The photoluminescence spectra of CCFP did not change, while the bioluminescence spectra changed in the course of the bioluminescent reaction. The changes can be explained by different rigidity of the media in the polymer solutions affecting the stability of the photoprotein complex and the efficiency of the proton transfer in the bioluminescent reaction. The results predict and explain the change in the luminescence intensity and color of the marine coelenterates in the presence of water-soluble polymers. The CCFP appeared to be a proper tool for the toxicity monitoring of water-soluble polymers (e.g., PEGs).
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Affiliation(s)
| | - Alexander V. Raikov
- Biophysics Department, Siberian Federal University, 660041 Krasnoyarsk, Russia
| | - Nadezhda S. Kudryasheva
- Biophysics Department, Siberian Federal University, 660041 Krasnoyarsk, Russia
- Institute of Biophysics SB RAS, FRC KSC SB RAS, 660036 Krasnoyarsk, Russia
- Correspondence: n ; Tel.: +7-391-249-42-42
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Chen SF, Vysotski ES, Liu YJ. H 2O-Bridged Proton-Transfer Channel in Emitter Species Formation in Obelin Bioluminescence. J Phys Chem B 2021; 125:10452-10458. [PMID: 34520210 DOI: 10.1021/acs.jpcb.1c03985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bioluminescence of a number of marine organisms is conditioned by Ca2+-regulated photoprotein (CaRP) with coelenterazine as the reaction substrate. The reaction product, coelenteramide, at the first singlet excited state (S1) is the emitter of CaRP. The S1-state coelenteramide is produced via the decomposition of coelenterazine dioxetanone. Experiments suggested that the neutral S1-coelenteramide is the primary emitter species. This supposition contradicts with theoretical calculations showing that the anionic S1-coelenteramide is a primary product of the decomposition of coelenterazine dioxetanone. In this study, applying molecular dynamic (MD) simulations and the hybrid quantum mechanics/molecular mechanics (QM/MM) method, we investigated a proton-transfer (PT) process taking place in CaRP obelin from Obelia longissima for emitter formation. Our calculations demonstrate a concerted PT process with a water molecule as a bridge between anionic S1-coelenteramide and the nearest histidine residue. The low activation barrier as well as the strong hydrogen-bond network between the proton donor and the proton acceptor suggests a fast PT process comparable with that of the lifetime of excited anionic S1-coelenteramide. The existence of the PT process eliminates the discrepancy between experimental and theoretical studies. The fast PT process at emitter formation can also take place in other CaRPs.
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Affiliation(s)
- Shu-Feng Chen
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai 201418, People's Republic of China
| | - Eugene S Vysotski
- Photobiology Laboratory, Institute of Biophysics SB RAS, Federal Research Center "Krasnoyarsk Science Center SB RAS", Krasnoyarsk 660036, Russia
| | - Ya-Jun Liu
- Center for Advanced Materials Research, Advanced Institute of Natural Sciences, Beijing Normal University at Zhuhai, Zhuhai 519087, China.,Key Laboratory of Theoretical and Computational Photochemistry, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, People's Republic of China
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Liu C, Hirakawa H, Katsube T, Fang Y, Tanaka K, Nenoi M, Fujimori A, Wang B. Altered Induction of Reactive Oxygen Species by X-rays in Hematopoietic Cells of C57BL/6-Tg (CAG-EGFP) Mice. Int J Mol Sci 2021; 22:6929. [PMID: 34203224 PMCID: PMC8268547 DOI: 10.3390/ijms22136929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Previous work pointed to a critical role of excessive production of reactive oxygen species (ROS) in increased radiation hematopoietic death in GFP mice. Meanwhile, enhanced antioxidant capability was not demonstrated in the mouse model of radio-induced adaptive response (RAR) using rescue of radiation hematopoietic death as the endpoint. ROS induction by ex vivo X-irradiation at a dose ranging from 0.1 to 7.5 Gy in the nucleated bone marrow cells was comparatively studied using GFP and wild type (WT) mice. ROS induction was also investigated in the cells collected from mice receiving a priming dose (0.5 Gy) efficient for RAR induction in WT mice. Significantly elevated background and increased induction of ROS in the cells from GFP mice were observed compared to those from WT mice. Markedly lower background and decreased induction of ROS were observed in the cells collected from WT mice but not GFP mice, both receiving the priming dose. GFP overexpression could alter background and induction of ROS by X-irradiation in hematopoietic cells. The results provide a reasonable explanation to the previous study on the fate of cells and mice after X-irradiation and confirm enhanced antioxidant capability in RAR. Investigations involving GFP overexpression should be carefully interpreted.
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Affiliation(s)
- Cuihua Liu
- Molecular and Cellular Radiation Biology Group, Department of Charged Particle Therapy Research, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (C.L.); (H.H.); (Y.F.)
| | - Hirokazu Hirakawa
- Molecular and Cellular Radiation Biology Group, Department of Charged Particle Therapy Research, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (C.L.); (H.H.); (Y.F.)
| | - Takanori Katsube
- Dietary Effects Research Group, Department of Radiation Effects Research, National Institute of Radiological Sciences, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (T.K.); (K.T.)
| | - Yaqun Fang
- Molecular and Cellular Radiation Biology Group, Department of Charged Particle Therapy Research, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (C.L.); (H.H.); (Y.F.)
| | - Kaoru Tanaka
- Dietary Effects Research Group, Department of Radiation Effects Research, National Institute of Radiological Sciences, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (T.K.); (K.T.)
| | - Mitsuru Nenoi
- Human Resources Development Center, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan;
| | - Akira Fujimori
- Molecular and Cellular Radiation Biology Group, Department of Charged Particle Therapy Research, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (C.L.); (H.H.); (Y.F.)
| | - Bing Wang
- Dietary Effects Research Group, Department of Radiation Effects Research, National Institute of Radiological Sciences, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (T.K.); (K.T.)
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Rozhko TV, Nemtseva EV, Gardt MV, Raikov AV, Lisitsa AE, Badun GA, Kudryasheva NS. Enzymatic Responses to Low-Intensity Radiation of Tritium. Int J Mol Sci 2020; 21:E8464. [PMID: 33187108 PMCID: PMC7696592 DOI: 10.3390/ijms21228464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
The present study considers a possible role of enzymatic reactions in the adaptive response of cells to the beta-emitting radionuclide tritium under conditions of low-dose exposures. Effects of tritiated water (HTO) on the reactions of bacterial luciferase and NAD(P)H:FMN-oxidoreductase, as well as a coupled system of these two reactions, were studied at radioactivity concentrations ≤ 200 MBq/L. Additionally, one of the simplest enzymatic reactions, photobiochemical proton transfer in Coelenteramide-containing Fluorescent Protein (CLM-FP), was also investigated. We found that HTO increased the activity of NAD(P)H:FMN-oxidoreductase at the initial stage of its reaction (by up to 230%); however, a rise of luciferase activity was moderate (<20%). The CLM-FP samples did not show any increase in the rate of the photobiochemical proton transfer under the exposure to HTO. The responses of the enzyme systems were compared to the 'hormetic' response of luminous marine bacterial cells studied earlier. We conclude that (1) the oxidoreductase reaction contributes significantly to the activation of the coupled enzyme system and bacterial cells by tritium, and (2) an increase in the organization level of biological systems promotes the hormesis phenomenon.
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Affiliation(s)
- Tatiana V. Rozhko
- Department of Medical and Biological Physics, Krasnoyarsk State Medical Academy, 660022 Krasnoyarsk, Russia
| | - Elena V. Nemtseva
- Biophysics Department, Siberian Federal University, 660041 Krasnoyarsk, Russia; (E.V.N.); (M.V.G.); (A.V.R.); (A.E.L.); (N.S.K.)
- Institute of Biophysics SB RAS, FRC KSC SB RAS, 660036 Krasnoyarsk, Russia
| | - Maria V. Gardt
- Biophysics Department, Siberian Federal University, 660041 Krasnoyarsk, Russia; (E.V.N.); (M.V.G.); (A.V.R.); (A.E.L.); (N.S.K.)
| | - Alexander V. Raikov
- Biophysics Department, Siberian Federal University, 660041 Krasnoyarsk, Russia; (E.V.N.); (M.V.G.); (A.V.R.); (A.E.L.); (N.S.K.)
| | - Albert E. Lisitsa
- Biophysics Department, Siberian Federal University, 660041 Krasnoyarsk, Russia; (E.V.N.); (M.V.G.); (A.V.R.); (A.E.L.); (N.S.K.)
| | - Gennadii A. Badun
- Department of Chemistry, Moscow State University, 119991 Moscow, Russia;
| | - Nadezhda S. Kudryasheva
- Biophysics Department, Siberian Federal University, 660041 Krasnoyarsk, Russia; (E.V.N.); (M.V.G.); (A.V.R.); (A.E.L.); (N.S.K.)
- Institute of Biophysics SB RAS, FRC KSC SB RAS, 660036 Krasnoyarsk, Russia
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Liu C, Tanaka K, Katsube T, Varès G, Maruyama K, Ninomiya Y, Fardous Z, Sun C, Fujimori A, Moreno SG, Nenoi M, Wang B. Altered Response to Total Body Irradiation of C57BL/6-Tg (CAG-EGFP) Mice. Dose Response 2020; 18:1559325820951332. [PMID: 32922229 PMCID: PMC7453463 DOI: 10.1177/1559325820951332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Abstract
Application of green fluorescent protein (GFP) in a variety of biosystems as a unique bioindicator or biomarker has revolutionized biological research and made groundbreaking achievements, while increasing evidence has shown alterations in biological properties and physiological functions of the cells and animals overexpressing transgenic GFP. In this work, response to total body irradiation (TBI) was comparatively studied in GFP transgenic C57BL/6-Tg (CAG-EGFP) mice and C57BL/6 N wild type mice. It was demonstrated that GFP transgenic mice were more sensitive to radiation-induced bone marrow death, and no adaptive response could be induced. In the nucleated bone marrow cells of GFP transgenic mice exposed to a middle dose, there was a significant increase in both the percentage of cells expressing pro-apoptotic gene Bax and apoptotic cell death. While in wild type cells, lower expression of pro-apoptotic gene Bax and higher expression of anti-apoptotic gene Bcl-2, and significant lower induction of apoptosis were observed compared to GFP transgenic cells. Results suggest that presence of GFP could alter response to TBI at whole body, cellular and molecular levels in mice. These findings indicate that there could be a major influence on the interpretation of the results obtained in GFP transgenic mice.
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Affiliation(s)
- Cuihua Liu
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Kaoru Tanaka
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Takanori Katsube
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Guillaume Varès
- Cell Signal Unit, Okinawa Institute of Science and Technology, Okinawa, Japan
| | - Kouichi Maruyama
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yasuharu Ninomiya
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Zeenath Fardous
- Institute of Food and Radiation Biology, Atomic Energy Research Establishment, Bangladesh Atomic Energy Commission, People’s Republic of Bangladesh
| | - Chao Sun
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
| | - Akira Fujimori
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Stéphanie G. Moreno
- LRTS—François Jacob Institute of Biology, Fundamental Research Division, Atomic Energy and Alternative Energies Commission, Inserm, Fontenay-aux-Roses Cedex, France
| | - Mitsuru Nenoi
- Department of Safety Administration, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Bing Wang
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Kudryasheva NS, Kovel ES. Monitoring of Low-Intensity Exposures via Luminescent Bioassays of Different Complexity: Cells, Enzyme Reactions, and Fluorescent Proteins. Int J Mol Sci 2019; 20:E4451. [PMID: 31509958 PMCID: PMC6770735 DOI: 10.3390/ijms20184451] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
The current paper reviews the applications of luminescence bioassays for monitoring the results of low-intensity exposures which produce a stimulative effect. The impacts of radioactivity of different types (alpha, beta, and gamma) and bioactive compounds (humic substances and fullerenols) are under consideration. Bioassays based on luminous marine bacteria, their enzymes, and fluorescent coelenteramide-containing proteins were used to compare the results of the low-intensity exposures at the cellular, biochemical, and physicochemical levels, respectively. High rates of luminescence response can provide (1) a proper number of experimental results under comparable conditions and, therefore, proper statistical processing, with this being highly important for "noisy" low-intensity exposures; and (2) non-genetic, i.e., biochemical and physicochemical mechanisms of cellular response for short-term exposures. The results of cellular exposures were discussed in terms of the hormesis concept, which implies low-dose stimulation and high-dose inhibition of physiological functions. Dependencies of the luminescence response on the exposure time or intensity (radionuclide concentration/gamma radiation dose rate, concentration of the bioactive compounds) were analyzed and compared for bioassays of different organization levels.
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Affiliation(s)
- Nadezhda S Kudryasheva
- Institute of Biophysics, Federal Research Center "Krasnoyarsk Science Center, Russian Academy of Sciences, Siberian Branch", Krasnoyarsk 660036, Russia.
- Siberian Federal University, Krasnoyarsk 660041, Russia.
| | - Ekaterina S Kovel
- Institute of Biophysics, Federal Research Center "Krasnoyarsk Science Center, Russian Academy of Sciences, Siberian Branch", Krasnoyarsk 660036, Russia
- Institute of Physics, Federal Research Center "Krasnoyarsk Science Center, Russian Academy of Sciences, Siberian Branch", Krasnoyarsk 660036, Russia
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Petrova AS, Lukonina AA, Dementyev DV, Ya Bolsunovsky A, Popov AV, Kudryasheva NS. Protein-based fluorescent bioassay for low-dose gamma radiation exposures. Anal Bioanal Chem 2018; 410:6837-6844. [PMID: 30062510 DOI: 10.1007/s00216-018-1282-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 01/30/2023]
Abstract
The study suggests an application of a coelenteramide-containing fluorescent protein (CLM-CFP) as a simplest bioassay for gamma radiation exposures. "Discharged obelin," a product of the bioluminescence reaction of the marine coelenterate Obelia longissima, was used as a representative of the CLM-CFP group. The bioassay is based on a simple enzymatic reaction-photochemical proton transfer in the coelenteramide-apoprotein complex. Components of this reaction differ in fluorescence color, providing, by this, an evaluation of the proton transfer efficiency in the photochemical process. This efficiency depends on the microenvironment of the coelenteramide within the protein complex, and, hence, can evaluate a destructive ability of gamma radiation. The CLM-CFP samples were exposed to gamma radiation (137Cs, 2 mGy/h) for 7 and 16 days at 20 °C and 5 °C, respectively. As a result, two fluorescence characteristics (overall fluorescence intensity and contributions of color components to the fluorescence spectra) were identified as bioassay parameters. Both parameters demonstrated high sensitivity of the CLM-CFP-based bioassay to the low-dose gamma radiation exposure (up to 100 mGy). Higher temperature (20 °C) enhanced the response of CLM-CFP to gamma radiation. This new bioassay can provide fluorescent multicolor assessment of protein destruction in cells and physiological liquids under exposure to low doses of gamma radiation. Graphical abstract ᅟ.
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Affiliation(s)
- Alena S Petrova
- Krasnoyarsk State Agrarian University, Mira Avenue 90, Krasnoyarsk, 660049, Russia
| | - Anna A Lukonina
- Siberian Federal University, Svobodnyy Ave 79, Krasnoyarsk, 660041, Russia
| | - Dmitry V Dementyev
- Institute of Biophysics SB RAS, FRC KSC SB RAS, Krasnoyarsk, 660036, Russia
| | | | - Anatoliy V Popov
- Department of Radiology, University of Pennsylvania, 3401 N Broad St., Philadelphia, PA, 19140, USA
| | - Nadezhda S Kudryasheva
- Siberian Federal University, Svobodnyy Ave 79, Krasnoyarsk, 660041, Russia. .,Institute of Biophysics SB RAS, FRC KSC SB RAS, Krasnoyarsk, 660036, Russia.
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Mishra OP, Popov AV, Pietrofesa RA, Nakamaru-Ogiso E, Andrake M, Christofidou-Solomidou M. Synthetic secoisolariciresinol diglucoside (LGM2605) inhibits myeloperoxidase activity in inflammatory cells. Biochim Biophys Acta Gen Subj 2018; 1862:1364-1375. [PMID: 29524540 PMCID: PMC5970065 DOI: 10.1016/j.bbagen.2018.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Myeloperoxidase (MPO) generates hypochlorous acid (HOCl) during inflammation and infection. We showed that secoisolariciresinol diglucoside (SDG) scavenges radiation-induced HOCl in physiological solutions. However, the action of SDG and its synthetic version, LGM2605, on MPO-catalyzed generation of HOCl is unknown. The present study evaluated the effect of LGM2605 on human MPO, and murine MPO from macrophages and neutrophils. METHODS MPO activity was determined fluorometrically using hypochlorite-specific 3'-(p-aminophenyl) fluorescein (APF). The effect of LGM2605 on (a) the peroxidase cycle of MPO was determined using Amplex Red while the effect on (b) the chlorination cycle was determined using a taurine chloramine assay. Using electron paramagnetic resonance (EPR) spectroscopy we determined the effect of LGM2605 on the EPR signals of MPO. Finally, computational docking of SDG was used to identify energetically favorable docking poses to enzyme's active site. RESULTS LGM2605 inhibited human and murine MPO activity. MPO inhibition was observed in the absence and presence of Cl-. EPR confirmed that LGM2605 suppressed the formation of Compound I, an oxoiron (IV) intermediate [Fe(IV)O] containing a porphyrin π-radical of MPO's catalytic cycle. Computational docking revealed that SDG can act as an inhibitor by binding to the enzyme's active site. CONCLUSIONS We conclude that LGM2605 inhibits MPO activity by suppressing both the peroxidase and chlorination cycles. EPR analysis demonstrated that LGM2605 inhibits MPO by decreasing the formation of the highly oxidative Compound I. This study identifies a novel mechanism of LGM2605 action as an inhibitor of MPO and indicates that LGM2605 may be a promising attenuator of oxidant-dependent inflammatory tissue damage.
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Affiliation(s)
- Om P Mishra
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
| | - Anatoliy V Popov
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
| | - Ralph A Pietrofesa
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
| | - Eiko Nakamaru-Ogiso
- Department of Biochemistry and Biophysics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
| | - Mark Andrake
- Molecular Modeling Facility, Fox Chase Cancer Center, Philadelphia, PA 19111, United States.
| | - Melpo Christofidou-Solomidou
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
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