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Wang Q, Zeng A, Zhu M, Song L. Dual inhibition of EGFR‑VEGF: An effective approach to the treatment of advanced non‑small cell lung cancer with EGFR mutation (Review). Int J Oncol 2023; 62:26. [PMID: 36601768 PMCID: PMC9851127 DOI: 10.3892/ijo.2023.5474] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/01/2022] [Indexed: 01/04/2023] Open
Abstract
On a global scale, the incidence and mortality rates of lung cancer are gradually increasing year by year. A number of bad habits and environmental factors are associated with lung cancer, including smoking, second‑hand smoke exposure, occupational exposure, respiratory diseases and genetics. At present, low‑dose spiral computed tomography is routinely the first choice in the diagnosis of lung cancer. However, pathological examination is still the gold standard for the diagnosis of lung cancer. Based on the classification and stage of the cancer, treatment options such as surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy are available. The activation of the EGFR pathway can promote the survival and proliferation of tumor cells, and the VEGF pathway can promote the formation of blood vessels, thereby promoting tumor growth. In non‑small cell lung cancer (NSCLC) with EGFR mutation, EGFR activation can promote tumor growth by promoting VEGF upregulation through a hypoxia‑independent mechanism. The upregulation of VEGF can make tumor cells resistant to EGFR inhibitors. In addition, the expression of the VEGF signal is also affected by other factors. Therefore, the use of a single EGFR inhibitor cannot completely inhibit the expression of the VEGF signal. In order to overcome this problem, the combination of VEGF inhibitors and EGFR inhibitors has become the method of choice. Dual inhibition can not only overcome the resistance of tumor cells to EGFR inhibitors, but also significantly increase the progression‑free survival time of patients with NSCLC. The present review discusses the associations between the EGFR and VEGF pathways, and the characteristics of dual inhibition of the EGFR‑VEGF pathway.
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Affiliation(s)
- Qian Wang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, P.R. China
| | - Anqi Zeng
- Institute of Translational Pharmacology and Clinical Application, Sichuan Academy of Chinese Medical Science, Chengdu, Sichuan 610041, P.R. China
| | - Min Zhu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, P.R. China,Correspondence to: Dr Linjiang Song or Dr Min Zhu, School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Chengdu, Sichuan 611137, P.R. China, E-mail: , E-mail:
| | - Linjiang Song
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, P.R. China,Correspondence to: Dr Linjiang Song or Dr Min Zhu, School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Chengdu, Sichuan 611137, P.R. China, E-mail: , E-mail:
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Gregorc V, Lazzari C, Mandalá M, Ippati S, Bulotta A, Cangi MG, Khater A, Viganò MG, Mirabile A, Pecciarini L, Ogliari FR, Arrigoni G, Grassini G, Veronesi G, Doglioni C. Intratumoral Cellular Heterogeneity: Implications for Drug Resistance in Patients with Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13092023. [PMID: 33922215 PMCID: PMC8122731 DOI: 10.3390/cancers13092023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary The number of druggable tumor-specific molecular alterations in the treatment of non-small cell lung cancer (NSCLC) has grown significantly in the past decade. Emerging technologies such as liquid biopsy and single-cell methods allow for studying targetable drivers and develop personalized treatments. However, although new therapies confer prolonged disease control and high tumor response rates, most patients eventually progress on targeted treatments. Intratumoral heterogeneity is a frequent event in NSCLC, driving the tumor cells to develop adaptive or new resistance mechanisms within the drug environment. This review summarizes the current and upcoming research on the biological role of tumor heterogeneity, highlighting the link between early and acquired drug resistance and tumoral heterogeneity in targetable driver mutated NSCLC. Abstract Tailored therapies based on the identification of molecular targets currently represent a well-established therapeutic scenario in the treatment of non-small cell lung cancer (NSCLC) patients. However, while aiming to improve patients’ response to therapy, development of resistance is frequently observed in daily clinical practice. Intratumoral heterogeneity is a frequent event in NSCLC, responsible for several critical issues in patients’ diagnosis and treatment. Advances in single-cell sequencing technologies have allowed in-depth profiling of tumors and attributed intratumoral heterogeneity to genetic, epigenetic, and protein modification driven diversities within cancer cell populations. This review highlights current research on the biological role of tumor heterogeneity and its impact on the development of acquired resistance in NSCLC patients.
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Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
- Correspondence:
| | - Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Mario Mandalá
- Division of Pathological Anatomy, Papa Giovanni XXIII Hospital, 24100 Bergamo, Italy;
- Unit of Medical Oncology, University of Perugia, 06123 Perugia, Italy
| | - Stefania Ippati
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Maria Giulia Cangi
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Abdelrahman Khater
- San Raffaele Hospital, IRCCS, University Vita Salute, 20132 Milan, Italy;
| | - Maria Grazia Viganò
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Aurora Mirabile
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Lorenza Pecciarini
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Francesca Rita Ogliari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Gianluigi Arrigoni
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Greta Grassini
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Giulia Veronesi
- Division of Thoracic Surgery, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy;
| | - Claudio Doglioni
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
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Torres-Martinez Z, Delgado Y, Ferrer-Acosta Y, Suarez-Arroyo IJ, Joaquín-Ovalle FM, Delinois LJ, Griebenow K. Key genes and drug delivery systems to improve the efficiency of chemotherapy. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2021; 4:163-191. [PMID: 34142021 PMCID: PMC8208690 DOI: 10.20517/cdr.2020.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer cells can develop resistance to anticancer drugs, thereby becoming tolerant to treatment through different mechanisms. The biological mechanisms leading to the generation of anticancer treatment resistance include alterations in transmembrane proteins, DNA damage and repair mechanisms, alterations in target molecules, and genetic responses, among others. The most common anti-cancer drugs reported to develop resistance to cancer cells include cisplatin, doxorubicin, paclitaxel, and fluorouracil. These anticancer drugs have different mechanisms of action, and specific cancer types can be affected by different genes. The development of drug resistance is a cellular response which uses differential gene expression, to enable adaptation and survival of the cell to diverse threatening environmental agents. In this review, we briefly look at the key regulatory genes, their expression, as well as the responses and regulation of cancer cells when exposed to anticancer drugs, along with the incorporation of alternative nanocarriers as treatments to overcome anticancer drug resistance.
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Affiliation(s)
- Zally Torres-Martinez
- Chemistry Department, University of Puerto Rico- Rio Piedras campus, San Juan, PR 00936, USA
| | - Yamixa Delgado
- Biochemistry & Pharmacology Department, San Juan Bautista School of Medicine, Caguas, PR 00726, USA
| | - Yancy Ferrer-Acosta
- Neuroscience Department, Universidad Central del Caribe, Bayamon, PR 00956, USA
| | | | - Freisa M Joaquín-Ovalle
- Chemistry Department, University of Puerto Rico- Rio Piedras campus, San Juan, PR 00936, USA
| | - Louis J Delinois
- Chemistry Department, University of Puerto Rico- Rio Piedras campus, San Juan, PR 00936, USA
| | - Kai Griebenow
- Chemistry Department, University of Puerto Rico- Rio Piedras campus, San Juan, PR 00936, USA
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Laville D, Casteillo F, Yvorel V, Tiffet O, Vergnon JM, Péoc’h M, Forest F. Immune Escape Is an Early Event in Pre-Invasive Lesions of Lung Squamous Cell Carcinoma. Diagnostics (Basel) 2020; 10:diagnostics10070503. [PMID: 32708311 PMCID: PMC7399898 DOI: 10.3390/diagnostics10070503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022] Open
Abstract
Bronchial dysplasia is the pre-neoplastic lesion recognized for invasive squamous cell carcinoma. The mechanisms leading to invasive squamous cell carcinoma for this lesion are not fully known. Programmed Death-Ligand 1 (PD-L1) expression by the bronchial dysplasia neoplastic epithelium might suggest a response to immunotherapy. The objective of this work is to further characterize PD-L1 and CD8 expression in bronchial dysplasia and bronchial metaplasia compared to normal bronchial epithelium. Immunohistochemical analysis of PD-L1 and CD8 staining were characterized in bronchial dysplasia of 24 patients and correlated with clinical data. We also compared PD-L1 expression in dysplasia samples to 30 normal epithelium and 20 samples with squamous bronchial metaplasia. PD-L1 was never expressed in normal epithelium and in metaplastic epithelium whereas 37.5% of patients with bronchial dysplasia were stained by PD-L1 (p < 0.001). PD-L1 expression was not related to the degree of dysplasia or a medical history of invasive squamous cell carcinoma, while CD8 expression and its localization were related to medical history of squamous cell carcinoma (p = 0.044). Our results show that PD-L1 is expressed in roughly one third of patients with bronchial dysplasia and is not expressed in normal and metaplastic epithelium. This suggests that PD-L1 is expressed in preneoplastic lesions of squamous cell carcinoma.
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Affiliation(s)
- David Laville
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
| | - Francois Casteillo
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
| | - Violaine Yvorel
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
| | - Olivier Tiffet
- Thoracic Surgery Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France;
| | - Jean-Michel Vergnon
- Pneumology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France;
| | - Michel Péoc’h
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, 42000 Saint-Etienne, France
| | - Fabien Forest
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, 42000 Saint-Etienne, France
- Correspondence: ; Tel.: +33-(0)4-7712-7734; Fax: +33-(0)4-7782-8296
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Identification of relevant prognostic values of cytokeratin 20 and cytokeratin 7 expressions in lung cancer. Biosci Rep 2017; 37:BSR20171086. [PMID: 28827446 PMCID: PMC5672087 DOI: 10.1042/bsr20171086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 12/16/2022] Open
Abstract
Lung cancer is one of the most common malignant tumors harmful to human health. Cytokeratin (CK) is highly conserved and differentiated related to the proliferation and differentiation of epithelial cells. The aim of the study was to explore expressions of CK20 and CK7 and corresponding prognostic values in patients with lung cancer. Our study included 258 cases of patients confirmed with lung cancer. Expressions of CK20 and CK7 mRNA and protein were detected using real-time quantitative PCR (qRT-PCR) and Western blot, respectively, followed by the performance of immunohistochemistry staining. Associations of CK20 and CK7 with the clinical parameters and prognosis of lung cancer patients were further analyzed. There were obvious differences regarding the positive expression of CK20 in different T stage, lymph node metastasis, invasion, size, and clinical stage subgroups; besides, significant differences in the positive expression of CK7 were also observed in subgroups of different sex, age, lymph node metastasis, invasion, and differentiation. Furthermore, effects of age, smoking, T stage, lymph node metastasis and invasion, size, and CK7 expressions were significant on the survival of patients (all P<0.05). Multivariate analysis revealed that lymph node metastasis, T stage, and CK7 expression were independent risk factors for poor prognosis of involved patients (all P<0.05), while age, smoking, and invasion had no marked relation to the survival time of patients with lung cancer (all P>0.05). Positive CK20 and CK7 expressions are detected in patients with lung cancer; positive expression of CK7 associated with pathological features of lymph node metastasis and T stage may be independent clinical parameters for poor prognosis of patients with lung cancer.
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Sousa V, Rodrigues C, Silva M, Alarcão AM, Carvalho L. Lung adenocarcinoma: Sustained subtyping with immunohistochemistry and EGFR, HER2 and KRAS mutational status. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:113-25. [PMID: 25926253 DOI: 10.1016/j.rppnen.2014.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/01/2014] [Indexed: 10/23/2022] Open
Abstract
Pulmonary adenocarcinomas are still in the process of achieving morphological, immunohistochemical and genetic standardization. The ATS/ERS/IASLC proposed classification for lung adenocarcinomas supports the value of the identification of histological patterns, specifically in biopsies. Thirty pulmonary adenocarcinomas were subjected to immunohistochemical study (CK7, CK5, 6, 18, CK20, TTF1, CD56, HER2, EGFR and Ki-67), FISH and PCR followed by sequencing and fragment analysis for EGFR, HER2 and KRAS. Solid pattern showed lower TTF1 and higher Ki-67 expression. TTF1 expression was higher in non-mucinous lepidic and micropapillary patterns when compared to acinar and solid and acinar, solid and mucinous respectively. Higher Ki67 expression was present in lepidic and solid patterns compared to mucinous. EGFR membranous staining had increasing expression from non-mucinous lepidic/BA pattern to solid pattern and micropapillary until acinar pattern. EGFR mutations, mainly in exon 19, were more frequent in females, together with non-smoking status, while KRAS exon 2 mutations were statistically more frequent in males, especially in solid pattern. FISH EGFR copy was correlated gross, with mutations. HER2 copy number was raised in female tumours without mutations, in all cases. Although EGFR and KRAS mutations are generally considered mutually exclusive, in rare cases they can coexist as it happened in one of this series, and was represented in acinar pattern with rates of 42.9% and 17.9%, respectively. EGFR mutations were more frequent in lepidic/BA and acinar patterns. Some cases showed different EGFR mutations. The differences identified between the adenocarcinoma patterns reinforce the need to carefully identify the patterns present, with implications in diagnosis and in pathogenic understanding. EGFR and KRAS mutational status can be determined in biopsies representing bronchial pulmonary carcinomas because when a mutation is present it is generally present in all the histological patterns.
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Affiliation(s)
- Vitor Sousa
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pathology Institute, Coimbra University Hospital, Coimbra, Portugal.
| | - Carolina Rodrigues
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria Silva
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Maria Alarcão
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lina Carvalho
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pathology Institute, Coimbra University Hospital, Coimbra, Portugal
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Val MM, Mendes LA, Alarcão A, Carvalho L, Carreira I, Rodrigues CFD, Alpoim MC. Senescent bronchial fibroblasts induced to senescence by Cr(VI) promote epithelial-mesenchymal transition when co-cultured with bronchial epithelial cells in the presence of Cr(VI). Mutagenesis 2014; 30:277-86. [PMID: 25406472 DOI: 10.1093/mutage/geu070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cellular senescence is a physiological process that serves as a powerful barrier for tumorigenesis. However, senescent cells can be deleterious for the tissue microenvironment. Such is the case of senescent fibroblasts that release several pro-tumorigenic factors that promote malignant transformation in the nearby epithelial cells. Occupational exposure to hexavalent chromium [Cr(VI)] compounds is a cause of respiratory cancers. Although Cr(VI) is known to induce senescence in human foreskin fibroblasts, the role of senescent fibroblasts in the Cr(VI)-induced malignant transformation of human bronchial epithelial cells was never assessed. Thus, to study the evolutionary dynamics generated by the interaction between human bronchial epithelial cells and senescent bronchial fibroblasts, the non-tumorigenic human bronchial epithelial BEAS-2B cells were co-cultured with Cr(VI)-induced senescent human bronchial fibroblasts for 4 weeks. Under the pressure of 0.5 µM Cr(VI), senescent fibroblasts promoted the acquisition of mesenchymal features on BEAS-2B cells, e.g. the fusiform shape and increased Vimentin expression, consistent with the occurrence of an epithelial-mesenchymal transition-like process. Features of transformed cells including larger nuclei, as well as nuclei with heterogeneous size, were also observed. Altogether the results obtained demonstrate that besides acting over the epithelium, Cr(VI) also affects bronchial fibroblasts driving them senescent. As a consequence, a paracrine communication loop is established with the above-placed epithelium prompting the epithelial cells for malignant transformation and thus facilitating the initial steps of tumorigenesis.
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Affiliation(s)
- Mariana Monteiro Val
- Faculty of Sciences and Technology, University of Coimbra, Coimbra, Portugal, Center of Investigation in Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal, Center for Neuroscience and Cell Biology, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal and
| | - Luís André Mendes
- Faculty of Sciences and Technology, University of Coimbra, Coimbra, Portugal, Center of Investigation in Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal, Center for Neuroscience and Cell Biology, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal and
| | - Ana Alarcão
- Center of Investigation in Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lina Carvalho
- Center of Investigation in Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Carreira
- Center of Investigation in Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal, Center for Neuroscience and Cell Biology, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carlos Fernando D Rodrigues
- Center of Investigation in Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal, Center for Neuroscience and Cell Biology, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria Carmen Alpoim
- Faculty of Sciences and Technology, University of Coimbra, Coimbra, Portugal, Center of Investigation in Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal, Center for Neuroscience and Cell Biology, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal and
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