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Urdaci MC, Lefevre M, Lafforgue G, Cartier C, Rodriguez B, Fioramonti J. Antidiarrheal Action of Bacillus subtilis CU1 CNCM I-2745 and Lactobacillus plantarum CNCM I-4547 in Mice. Front Microbiol 2018; 9:1537. [PMID: 30042756 PMCID: PMC6048234 DOI: 10.3389/fmicb.2018.01537] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/20/2018] [Indexed: 12/29/2022] Open
Abstract
Preventive actions of probiotics as antidiarrheal agents are well documented, but their mechanisms are poorly understood. Two selected probiotics, Bacillus subtilis CU1 and Lactobacillus plantarum CNCM I-4547, were tested in mouse experimental models of diarrhea and the possible mechanisms of action were investigated. Diarrhea was induced in mice by oral castor oil administration or by i.v. injection of lipopolysaccharide (LPS) of Salmonella enteritis. The antidiarrheal drug loperamide was used as control. Fecal water excretion was quantified for 2 h and paracellular permeability and electrical parameters of the colon were assessed in Ussing chambers. The expression of colonic exchangers or channels and of Toll-like receptor 4 (TLR4) was assessed by immunohistochemistry. Prophylactic treatment with B. subtilis CU1 or with L. plantarum CNCM I-4547 reduced LPS-induced diarrhea. The reduction of water excretion was in the same range as those induced by loperamide. In the castor oil model, this effect was only observed with B. subtilis CU1. The two probiotic treatments abolished the increase in paracellular permeability induced by LPS, but not by castor oil. However, only L. plantarum CNCM I-4547 treatment decreased the colonic expression of TLR-4. After B. subtilis CU1, colonic expression of cystic fibrosis transmembrane conductance regulator (CFTR) was reduced and that of Na+/H+ exchanger 3 (NHE3) increased. B. subtilis CU1 may increase the capacity of the colon to absorb excess of water in diarrheic conditions by acting on CFTR and NHE3 expression. The two probiotics strains showed an impact on diarrhea through limitation of water excretion that may involve paracellular permeability or electrolyte transport for L. plantarum CNCM I-4547 and B. subtilis CU1 respectively.
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Affiliation(s)
- Maria C Urdaci
- Microbiology Laboratory, UMR 5248, Bordeaux Sciences Agro, University of Bordeaux, Gradignan, France
| | - Marie Lefevre
- Lesaffre Human Care, Lesaffre Group, Marcq-en-Baroeul, France
| | - Guylene Lafforgue
- Neuro-Gastroenterology and Nutrition Unit, INRA, Toulouse, France.,Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRA, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Christel Cartier
- Neuro-Gastroenterology and Nutrition Unit, INRA, Toulouse, France.,Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRA, ENVT, INP-Purpan, UPS, Toulouse, France
| | | | - Jean Fioramonti
- Neuro-Gastroenterology and Nutrition Unit, INRA, Toulouse, France.,Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRA, ENVT, INP-Purpan, UPS, Toulouse, France
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Moré MI, Swidsinski A. Saccharomyces boulardii CNCM I-745 supports regeneration of the intestinal microbiota after diarrheic dysbiosis - a review. Clin Exp Gastroenterol 2015; 8:237-55. [PMID: 26316791 PMCID: PMC4542552 DOI: 10.2147/ceg.s85574] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The probiotic medicinal yeast Saccharomyces cerevisiae HANSEN CBS 5926 (Saccharomyces boulardii CNCM I-745) is used for the prevention and treatment of diarrhea. Its action is based on multiple mechanisms, including immunological effects, pathogen-binding and antitoxinic effects, as well as effects on digestive enzymes. Correlated with these effects, but also due to its inherent properties, S. boulardii is able to create a favorable growth environment for the beneficial intestinal microbiota, while constituting extra protection to the host mucus layer and mucosa. This review focuses on the positive influence of S. boulardii on the composition of the intestinal microbiota. In a dysbiosis, as during diarrhea, the main microbial population (especially Lachnospiraceae, Ruminococcaceae, Bacteroidaceae, and Prevotellaceae) is known to collapse by at least one order of magnitude. This gap generally leads to transient increases in pioneer-type bacteria (Enterobacteriaceae, Bifidobacteriaceae, and Clostridiaceae). Several human studies as well as animal models demonstrate that treatment with S. boulardii in dysbiosis leads to the faster reestablishment of a healthy microbiome. The most relevant effects of S. boulardii on the fecal composition include an increase of short chain fatty acid-producing bacteria (along with a rise in short chain fatty acids), especially of Lachnospiraceae and Ruminococcaceae, as well as an increase in Bacteroidaceae and Prevotellaceae. At the same time, there is a suppression of pioneer bacteria. The previously observed preventive action of S. boulardii, eg, during antibiotic therapy or regarding traveler’s diarrhea, can be explained by several mechanisms, including a stabilizing effect on the healthy microbiota as well as possibly on the mucus layer. Several different dysbiotic situations could profit from the effects of S. boulardii CNCM I-745. Its additional potential lies in a general stabilization of the gut flora for at-risk populations. More studies are needed to explore the full potential of this versatile probiotic yeast.
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Affiliation(s)
| | - Alexander Swidsinski
- Laboratory for Molecular Genetics, Polymicrobial Infections and Bacterial Biofilms, Department of Medicine, Gastroenterology, Charité Hospital, CCM, Universitätsmedizin Berlin, Berlin, Germany
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Lactobacillus casei reduces susceptibility to type 2 diabetes via microbiota-mediated body chloride ion influx. Sci Rep 2014; 4:5654. [PMID: 25133590 PMCID: PMC4135721 DOI: 10.1038/srep05654] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/24/2014] [Indexed: 12/30/2022] Open
Abstract
Gut microbiota mediated low-grade inflammation is involved in the onset of type 2 diabetes (T2DM). In this study, we used a high fat sucrose (HFS) diet-induced pre-insulin resistance and a low dose-STZ HFS rat models to study the effect and mechanism of Lactobacillus casei Zhang in protecting against T2DM onset. Hyperglycemia was favorably suppressed by L. casei Zhang treatment. Moreover, the hyperglycemia was connected with type 1 immune response, high plasma bile acids and urine chloride ion loss. This chloride ion loss was significantly prevented by L. casei via upregulating of chloride ion-dependent genes (ClC1-7, GlyRα1, SLC26A3, SLC26A6, GABAAα1, Bestrophin-3 and CFTR). A shift in the caecal microflora, particularly the reduction of bile acid 7α-dehydroxylating bacteria, and fecal bile acid profiles also occurred. These change coincided with organ chloride influx. Thus, we postulate that the prevention of T2DM onset by L. casei Zhang may be via a microbiota-based bile acid-chloride exchange mechanism.
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Canonici A, Pellegrino E, Siret C, Terciolo C, Czerucka D, Bastonero S, Marvaldi J, Lombardo D, Rigot V, André F. Saccharomyces boulardii improves intestinal epithelial cell restitution by inhibiting αvβ5 integrin activation state. PLoS One 2012; 7:e45047. [PMID: 23028753 PMCID: PMC3447864 DOI: 10.1371/journal.pone.0045047] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/13/2012] [Indexed: 02/07/2023] Open
Abstract
Intestinal epithelial cell damage is frequently seen in the mucosal lesions of infectious or inflammatory bowel diseases such as ulcerative colitis or Crohn's disease. Complete remission of these diseases requires both the disappearance of inflammation and the repair of damaged epithelium. Saccharomyces boulardii (Sb, Biocodex) is a non-pathogenic yeast widely used as a preventive and therapeutic probiotic for the prevention and treatment of diarrhea and other gastrointestinal disorders. We recently showed that it enhances the repair of intestinal epithelium through activation of α2β1 integrin collagen receptors. In the present study, we demonstrated that α2β1 integrin is not the sole cell-extracellular matrix receptor involved during Sb-mediated intestinal restitution. Indeed, by using cell adhesion assays, we showed that Sb supernatant contains heat sensitive molecule(s), with a molecular weight higher than 9 kDa, which decreased αvβ5 integrin-mediated adhesion to vitronectin by competing with the integrin. Moreover, Sb-mediated changes in cell adhesion to vitronectin resulted in a reduction of the αvβ5signaling pathway. We used a monolayer wounding assay that mimics in vivo cell restitution to demonstrate that down-modulation of the αvβ5 integrin-vitronectin interaction is related to Sb-induced cell migration. We therefore postulated that Sb supernatant contains motogenic factors that enhance cell restitution through multiple pathways, including the dynamic fine regulation of αvβ5 integrin binding activity. This could be of major importance in diseases characterized by severe mucosal injury, such as inflammatory and infectious bowel diseases.
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Affiliation(s)
- Alexandra Canonici
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
| | - Emilie Pellegrino
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
| | - Carole Siret
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
| | - Chloé Terciolo
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
| | - Dorota Czerucka
- Team 4, Inflammation, Cancer, Cancer Stem Cells, INSERM U895, Centre Méditerranéen de Médecine Moléculaire, Nice, France
| | - Sonia Bastonero
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
| | - Jacques Marvaldi
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
| | - Dominique Lombardo
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
| | - Véronique Rigot
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
| | - Frédéric André
- Aix-Marseille Université, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Inserm UMR 9111, Marseille, France
- * E-mail:
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Thomas S, Metzke D, Schmitz J, Dörffel Y, Baumgart DC. Anti-inflammatory effects of Saccharomyces boulardii mediated by myeloid dendritic cells from patients with Crohn's disease and ulcerative colitis. Am J Physiol Gastrointest Liver Physiol 2011; 301:G1083-92. [PMID: 21903765 DOI: 10.1152/ajpgi.00217.2011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Saccharomyces boulardii (Sb) is a probiotic yeast that has demonstrated efficacy in pilot studies in patients with inflammatory bowel disease (IBD). Microbial antigen handling by dendritic cells (DC) is believed to be of critical importance for immunity and tolerance in IBD. The aim was to characterize the effects of Sb on DC from IBD patients. Highly purified (>95%), lipopolysaccharide-stimulated CD1c(+)CD11c(+)CD123(-) myeloid DC (mDC) from patients with ulcerative colitis (UC; n = 36), Crohn's disease (CD; n = 26), or infectious controls (IC; n = 4) were cultured in the presence or absence of fungal supernatant from Sb (SbS). Phenotype and cytokine production and/or secretion of IBD mDC were measured by flow cytometry and cytometric bead arrays, respectively. T cell phenotype and proliferation were assessed in a mixed lymphocyte reaction (MLR) with allogenic CD4(+)CD45RA(+) naïve T cells from healthy donors. Mucosal healing was investigated in epithelial wounding and migration assays with IEC-6 cells. SbS significantly decreased the frequency of CD40-, CD80-, and CD197 (CCR7; chemokine receptor-7)-expressing IBD mDC and reduced their secretion of tumor necrosis factor (TNF)-α and interleukin (IL)-6 while increasing IL-8. In the MLR, SbS significantly inhibited T cell proliferation induced by IBD mDC. Moreover, SbS inhibited T(H)1 (TNF-α and interferon-γ) polarization induced by UC mDC and promoted IL-8 and transforming growth factor-β-dependent mucosal healing. In summary, we provide novel evidence of synergistic mechanisms how Sb controls inflammation (inhibition of T cell costimulation and inflammation-associated migration and mobilization of DC) and promotes epithelial restitution relevant in IBD.
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Affiliation(s)
- Saskia Thomas
- Division of Gastroenterology and Hepatology, Department of Medicine, Charité Medical Center-Virchow Hospital, Medical School of the Humboldt-University of Berlin, Berlin, Germany
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Canonici A, Siret C, Pellegrino E, Pontier-Bres R, Pouyet L, Montero MP, Colin C, Czerucka D, Rigot V, André F. Saccharomyces boulardii improves intestinal cell restitution through activation of the α2β1 integrin collagen receptor. PLoS One 2011; 6:e18427. [PMID: 21483797 PMCID: PMC3069100 DOI: 10.1371/journal.pone.0018427] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/07/2011] [Indexed: 02/07/2023] Open
Abstract
Intestinal epithelial cell damage is frequently seen in the mucosal lesions of inflammatory bowel diseases such as ulcerative colitis or Crohn's disease. Complete remission of these diseases requires both the cessation of inflammation and the migration of enterocytes to repair the damaged epithelium. Lyophilized Saccharomyces boulardii (Sb, Biocodex) is a nonpathogenic yeast widely used as a therapeutic agent for the treatment and prevention of diarrhea and other gastrointestinal disorders. In this study, we determined whether Sb could accelerate enterocyte migration. Cell migration was determined in Sb force-fed C57BL6J mice and in an in vitro wound model. The impact on α2β1 integrin activity was assessed using adhesion assays and the analysis of α2β1 mediated signaling pathways both in vitro and in vivo. We demonstrated that Sb secretes compounds that enhance the migration of enterocytes independently of cell proliferation. This enhanced migration was associated with the ability of Sb to favor cell-extracellular matrix interaction. Indeed, the yeast activates α2β1 integrin collagen receptors. This leads to an increase in tyrosine phosphorylation of cytoplasmic molecules, including focal adhesion kinase and paxillin, involved in the integrin signaling pathway. These changes are associated with the reorganization of focal adhesion structures. In conclusion Sb secretes motogenic factors that enhance cell restitution through the dynamic regulation of α2β1 integrin activity. This could be of major importance in the development of novel therapies targeting diseases characterized by severe mucosal injury, such as inflammatory and infectious bowel diseases.
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Affiliation(s)
- Alexandra Canonici
- Inserm, UMR 911, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Aix-Marseille Université, UMR 911, Marseille, France
| | - Carole Siret
- Inserm, UMR 911, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Aix-Marseille Université, UMR 911, Marseille, France
| | - Emilie Pellegrino
- Inserm, UMR 911, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Aix-Marseille Université, UMR 911, Marseille, France
| | - Rodolphe Pontier-Bres
- Team 4: Inflammation, Cancer, Cancer stem cells, INSERM U895, Centre Méditerranéen de Médecine Moléculaire (C3M), Nice, France
| | | | - Marie Pierre Montero
- Inserm, UMR 911, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Aix-Marseille Université, UMR 911, Marseille, France
| | - Carole Colin
- Inserm, UMR 911, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Aix-Marseille Université, UMR 911, Marseille, France
| | - Dorota Czerucka
- Team 4: Inflammation, Cancer, Cancer stem cells, INSERM U895, Centre Méditerranéen de Médecine Moléculaire (C3M), Nice, France
| | - Véronique Rigot
- Inserm, UMR 911, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Aix-Marseille Université, UMR 911, Marseille, France
| | - Frédéric André
- Inserm, UMR 911, Centre de Recherche en Oncologie et Oncopharmacologie, Marseille, France
- Aix-Marseille Université, UMR 911, Marseille, France
- * E-mail:
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Bisson JF, Hidalgo S, Rozan P, Messaoudi M. Preventive effects of different probiotic formulations on travelers' diarrhea model in wistar rats : preventive effects of probiotics on TD. Dig Dis Sci 2010; 55:911-9. [PMID: 19437118 DOI: 10.1007/s10620-009-0822-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Accepted: 04/14/2009] [Indexed: 12/26/2022]
Abstract
A new animal model of travelers' diarrhea has been developed by infecting rats orally with a strain of enterotoxigenic Escherichia coli in order to assess the efficacy of three probiotic formulations for the prevention of travelers' diarrhea. Five groups of six rats were given daily (by oral gavage) either a placebo (negative and positive control groups), the suspension of bacterial probiotics called FF1, the yeast probiotic Saccharomyces boulardii, or a combination of both, called Protecflor(TM). After 14 days of treatment, all groups except the negative control one were infected by oral administration of E. coli. Body temperature, body weight, food and water consumption, stools consistency, behavior, and cytokines secretion were disturbed following E. coli infection. Probiotics-treated groups generally displayed less-pronounced symptoms, the combination of probiotics Protecflor(TM) being the most effective.
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Affiliation(s)
- Jean-François Bisson
- ETAP-Ethologie Appliquée, Département de Cancérologie et Pathologies Humaines, Centre de Recherche en Pharmacologie, Cancérologie-Pathologies Humaines et Nutrition-Santé, 13 rue du Bois de la Champelle, 54500, Vandoeuvre-lès-Nancy, France.
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Heuvelin E, Lebreton C, Bichara M, Cerf-Bensussan N, Heyman M. A Bifidobacterium probiotic strain and its soluble factors alleviate chloride secretion by human intestinal epithelial cells. J Nutr 2010; 140:7-11. [PMID: 19889806 DOI: 10.3945/jn.109.114553] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Previous studies indicate that certain probiotic bacterial strains or their soluble products can alleviate proinflammatory cytokine secretion by intestinal epithelial cells (IEC), but their impact on epithelial chloride (Cl(-)) secretion remains elusive. To further decipher the mechanisms of the cross-talk between bacteria/soluble factors and epithelial cells, we analyzed the capacity of the probiotic strain Bifidobacterium breve C50 (Bb C50), its conditioned medium, and other commensal Gram (+) bacteria to modulate epithelial Cl(-) secretion. The effect of Bb C50 on carbachol- (CCh) or forskolin (Fsk)-induced Cl(-) secretion was measured in an IEC line in Ussing chambers. The mechanisms involved in the regulation of Cl(-) secretion were assessed by measuring intracellular Ca(2+) concentration, phosphatase activity, protein kinase (PK) C and PKA activation, and cystic fibrosis transmembrane conductance regulator (CFTR) expression. CCh- or Fsk-induced Cl(-) secretion [short-circuit current (Isc): 151 +/- 28 and 98 +/- 14 microA/cm(2), respectively] was inhibited dose-dependently by Bb C50 (Isc 33 +/- 12 and 49 +/- 7 microA/cm(2) at multiplicity of infection 100; P < 0.02). Fsk-induced Cl(-) secretion was also inhibited by Lactobacillus rhamnosus 10893. No other inhibitory effect was recorded with the other Gram (+) bacteria tested. The inhibitory effect of Bb C50 on CCh-induced Cl(-) secretion targeted a step downstream of epithelial Ca(2+) mobilization and was associated with decreased PKC activity. Thus, Bb C50 and secreted soluble factors, by inhibiting phosphorylation processes, may promote intestinal homeostasis by controlling Cl(-) secretion.
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Thomas S, Przesdzing I, Metzke D, Schmitz J, Radbruch A, Baumgart DC. Saccharomyces boulardii inhibits lipopolysaccharide-induced activation of human dendritic cells and T cell proliferation. Clin Exp Immunol 2009; 156:78-87. [PMID: 19161443 DOI: 10.1111/j.1365-2249.2009.03878.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Saccharomyces boulardii (Sb) is a probiotic yeast preparation that has demonstrated efficacy in inflammatory and infectious disorders of the gastrointestinal tract in controlled clinical trials. Although patients clearly benefit from treatment with Sb, little is known on how Sb unfolds its anti-inflammatory properties in humans. Dendritic cells (DC) balance tolerance and immunity and are involved critically in the control of T cell activation. Thus, they are believed to have a pivotal role in the initiation and perpetuation of chronic inflammatory disorders, not only in the gut. We therefore decided to investigate if Sb modulates DC function. Culture of primary (native, non-monocyte-derived) human myeloid CD1c+CD11c+CD123(-) DC (mDC) in the presence of Sb culture supernatant (active component molecular weight < 3 kDa, as evaluated by membrane partition chromatography) reduced significantly expression of the co-stimulatory molecules CD40 and CD80 (P < 0.01) and the DC mobilization marker CC-chemokine receptor CCR7 (CD197) (P < 0.001) induced by the prototypical microbial antigen lipopolysaccharide (LPS). Moreover, secretion of key proinflammatory cytokines such as tumour necrosis factor-alpha and interleukin (IL)-6 were notably reduced, while the secretion of anti-inflammatory IL-10 increased. Finally, Sb supernatant inhibited the proliferation of naive T cells in a mixed lymphocyte reaction with mDC. In summary, our data suggest that Sb may exhibit part of its anti-inflammatory potential through modulation of DC phenotype, function and migration by inhibition of their immune response to bacterial microbial surrogate antigens such as LPS.
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Affiliation(s)
- S Thomas
- Department of Medicine, Division of Gastroenterology and Hepatology, Charité Medical Center-Virchow Hospital, Medical School of the Humboldt-University of Berlin, Berlin, Germany
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Graff S, Hussain S, Chaumeil JC, Charrueau C. Increased Intestinal Delivery of Viable Saccharomyces boulardii by Encapsulation in Microspheres. Pharm Res 2008; 25:1290-6. [DOI: 10.1007/s11095-007-9528-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 07/06/2007] [Indexed: 01/01/2023]
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