1
|
Song Q, Zhou X, Xu K, Liu S, Zhu X, Yang J. The Safety and Antiaging Effects of Nicotinamide Mononucleotide in Human Clinical Trials: an Update. Adv Nutr 2023; 14:1416-1435. [PMID: 37619764 PMCID: PMC10721522 DOI: 10.1016/j.advnut.2023.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
The importance of nicotinamide adenine dinucleotide (NAD+) in human physiology is well recognized. As the NAD+ concentration in human skin, blood, liver, muscle, and brain are thought to decrease with age, finding ways to increase NAD+ status could possibly influence the aging process and associated metabolic sequelae. Nicotinamide mononucleotide (NMN) is a precursor for NAD+ biosynthesis, and in vitro/in vivo studies have demonstrated that NMN supplementation increases NAD+ concentration and could mitigate aging-related disorders such as oxidative stress, DNA damage, neurodegeneration, and inflammatory responses. The promotion of NMN as an antiaging health supplement has gained popularity due to such findings; however, since most studies evaluating the effects of NMN have been conducted in cell or animal models, a concern remains regarding the safety and physiological effects of NMN supplementation in the human population. Nonetheless, a dozen human clinical trials with NMN supplementation are currently underway. This review summarizes the current progress of these trials and NMN/NAD+ biology to clarify the potential effects of NMN supplementation and to shed light on future study directions.
Collapse
Affiliation(s)
- Qin Song
- Department of Occupational and Environmental Health, Hangzhou Normal University School of Public Health, Hangzhou, China
| | - Xiaofeng Zhou
- Department of Radiotherapy, The 2(nd) Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kexin Xu
- Department of Nutritional and Toxicological Science, Hangzhou Normal University School of Public Health, Hangzhou, China
| | - Sishi Liu
- Department of Nutritional and Toxicological Science, Hangzhou Normal University School of Public Health, Hangzhou, China
| | - Xinqiang Zhu
- Core Facility, The 4(th) Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.
| | - Jun Yang
- Department of Nutritional and Toxicological Science, Hangzhou Normal University School of Public Health, Hangzhou, China; Zhejiang Provincial Center for Uterine Cancer Diagnosis and Therapy Research, The Affiliated Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| |
Collapse
|
2
|
Hao J, Zhang W, Huang Z. Bupivacaine modulates the apoptosis and ferroptosis in bladder cancer via phosphatidylinositol 3-kinase (PI3K)/AKT pathway. Bioengineered 2022; 13:6794-6806. [PMID: 35246010 PMCID: PMC9278971 DOI: 10.1080/21655979.2022.2036909] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The study aimed to explore the effects of local anesthetic bupivacaine on bladder cancer cells in vivo and in vitro. The cytotoxicity was detected by MTT assay. Apoptosis was measured by Hoechst 33342 staining and TUNEL. The contents of Fe2+, Malondialdehyde (MDA), Glutathione (GSH) and reactive oxygen species (ROS) were evaluated by the corresponding kit. Mitochondrial membrane potential was assessed by JC-1 kit. HE staining, TUNEL and immunohistochemistry were used to detect the xenografted tumors. Protein expression was estimated by Western blot. Bupivacaine significantly inhibited the activity of T24 cells and 5637 cells at 0.25-16 mM. Bupivacaine promoted cell apoptosis with increased concentration. bupivacaine inhibited the expression of Bcl-2 and increased the expression of Bax and cytochrome C. Moreover, bupivacaine amplified the level of Fe2+ and ROS, and restrained the expression of cystine/glutamic acid reverse transporter (xCT) and glutathione peroxidase 4 (GPX4). Further results showed that bupivacaine decreased mitochondrial membrane potential, reduced GSH, and increased MDA levels. Besides, bupivacaine attenuated the phosphorylation of PI3K, Akt, and mTOR. In addition, bupivacaine suppressed the growth of xenografted tumors, induced apoptosis and ferroptosis, and inhibited the activity of PI3K/AKT signaling pathway in xenografted tumors. Bupivacaine could induce apoptosis and ferroptosis by inhibiting PI3K/Akt signaling pathway in bladder cancer cells.
Collapse
Affiliation(s)
- Jianli Hao
- Department of Anesthesiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Weiqing Zhang
- Department of Anesthesiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Zeqing Huang
- Department of Anesthesiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| |
Collapse
|
3
|
Kulikova V, Shabalin K, Nerinovski K, Yakimov A, Svetlova M, Solovjeva L, Kropotov A, Khodorkovskiy M, Migaud ME, Ziegler M, Nikiforov A. Degradation of Extracellular NAD + Intermediates in Cultures of Human HEK293 Cells. Metabolites 2019; 9:E293. [PMID: 31795381 PMCID: PMC6950141 DOI: 10.3390/metabo9120293] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 01/06/2023] Open
Abstract
Nicotinamide adenine dinucleotide (NAD) is an essential redox carrier, whereas its degradation is a key element of important signaling pathways. Human cells replenish their NAD contents through NAD biosynthesis from extracellular precursors. These precursors encompass bases nicotinamide (Nam) and nicotinic acid and their corresponding nucleosides nicotinamide riboside (NR) and nicotinic acid riboside (NAR), now collectively referred to as vitamin B3. In addition, extracellular NAD+ and nicotinamide mononucleotide (NMN), and potentially their deamidated counterparts, nicotinic acid adenine dinucleotide (NAAD) and nicotinic acid mononucleotide (NAMN), may serve as precursors of intracellular NAD. However, it is still debated whether nucleotides enter cells directly or whether they are converted to nucleosides and bases prior to uptake into cells. Here, we studied the metabolism of extracellular NAD+ and its derivatives in human HEK293 cells using normal and serum-free culture medium. Using medium containing 10% fetal bovine serum (FBS), mono- and dinucleotides were degraded to the corresponding nucleosides. In turn, the nucleosides were cleaved to their corresponding bases. Degradation was also observed in culture medium alone, in the absence of cells, indicating that FBS contains enzymatic activities which degrade NAD+ intermediates. Surprisingly, NR was also rather efficiently hydrolyzed to Nam in the absence of FBS. When cultivated in serum-free medium, HEK293 cells efficiently cleaved NAD+ and NAAD to NMN and NAMN. NMN exhibited rather high stability in cell culture, but was partially metabolized to NR. Using pharmacological inhibitors of plasma membrane transporters, we also showed that extracellular cleavage of NAD+ and NMN to NR is a prerequisite for using these nucleotides to maintain intracellular NAD contents. We also present evidence that, besides spontaneous hydrolysis, NR is intensively metabolized in cell culture by intracellular conversion to Nam. Our results demonstrate that both the cultured cells and the culture medium mediate a rather active conversion of NAD+ intermediates. Consequently, in studies of precursor supplementation and uptake, the culture conditions need to be carefully defined.
Collapse
Affiliation(s)
- Veronika Kulikova
- Institute of Cytology, Russian Academy of Sciences, St. Petersburg 194064, Russia; (V.K.); (M.S.); (L.S.); (A.K.)
- Peter the Great St. Petersburg Polytechnic University, St. Petersburg 195251, Russia; (A.Y.); (M.K.)
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg 194223, Russia
| | - Konstantin Shabalin
- Petersburg Nuclear Physics Institute Named by B.P. Konstantinov of National Research Centre “Kurchatov Institute”, Gatchina 188300, Russia;
| | - Kirill Nerinovski
- Department of Nuclear Physics Research Methods, St. Petersburg State University, St. Petersburg 199034, Russia;
| | - Alexander Yakimov
- Peter the Great St. Petersburg Polytechnic University, St. Petersburg 195251, Russia; (A.Y.); (M.K.)
- Petersburg Nuclear Physics Institute Named by B.P. Konstantinov of National Research Centre “Kurchatov Institute”, Gatchina 188300, Russia;
| | - Maria Svetlova
- Institute of Cytology, Russian Academy of Sciences, St. Petersburg 194064, Russia; (V.K.); (M.S.); (L.S.); (A.K.)
| | - Ljudmila Solovjeva
- Institute of Cytology, Russian Academy of Sciences, St. Petersburg 194064, Russia; (V.K.); (M.S.); (L.S.); (A.K.)
| | - Andrey Kropotov
- Institute of Cytology, Russian Academy of Sciences, St. Petersburg 194064, Russia; (V.K.); (M.S.); (L.S.); (A.K.)
| | - Mikhail Khodorkovskiy
- Peter the Great St. Petersburg Polytechnic University, St. Petersburg 195251, Russia; (A.Y.); (M.K.)
| | - Marie E. Migaud
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA;
| | - Mathias Ziegler
- Department of Biomedicine, University of Bergen, 5020 Bergen, Norway;
| | - Andrey Nikiforov
- Institute of Cytology, Russian Academy of Sciences, St. Petersburg 194064, Russia; (V.K.); (M.S.); (L.S.); (A.K.)
| |
Collapse
|
4
|
Haslinger D, Waltes R, Yousaf A, Lindlar S, Schneider I, Lim CK, Tsai MM, Garvalov BK, Acker-Palmer A, Krezdorn N, Rotter B, Acker T, Guillemin GJ, Fulda S, Freitag CM, Chiocchetti AG. Loss of the Chr16p11.2 ASD candidate gene QPRT leads to aberrant neuronal differentiation in the SH-SY5Y neuronal cell model. Mol Autism 2018; 9:56. [PMID: 30443311 PMCID: PMC6220561 DOI: 10.1186/s13229-018-0239-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022] Open
Abstract
Background Altered neuronal development is discussed as the underlying pathogenic mechanism of autism spectrum disorders (ASD). Copy number variations of 16p11.2 have recurrently been identified in individuals with ASD. Of the 29 genes within this region, quinolinate phosphoribosyltransferase (QPRT) showed the strongest regulation during neuronal differentiation of SH-SY5Y neuroblastoma cells. We hypothesized a causal relation between this tryptophan metabolism-related enzyme and neuronal differentiation. We thus analyzed the effect of QPRT on the differentiation of SH-SY5Y and specifically focused on neuronal morphology, metabolites of the tryptophan pathway, and the neurodevelopmental transcriptome. Methods The gene dosage-dependent change of QPRT expression following Chr16p11.2 deletion was investigated in a lymphoblastoid cell line (LCL) of a deletion carrier and compared to his non-carrier parents. Expression of QPRT was tested for correlation with neuromorphology in SH-SY5Y cells. QPRT function was inhibited in SH-SY5Y neuroblastoma cells using (i) siRNA knockdown (KD), (ii) chemical mimicking of loss of QPRT, and (iii) complete CRISPR/Cas9-mediated knock out (KO). QPRT-KD cells underwent morphological analysis. Chemically inhibited and QPRT-KO cells were characterized using viability assays. Additionally, QPRT-KO cells underwent metabolite and whole transcriptome analyses. Genes differentially expressed upon KO of QPRT were tested for enrichment in biological processes and co-regulated gene-networks of the human brain. Results QPRT expression was reduced in the LCL of the deletion carrier and significantly correlated with the neuritic complexity of SH-SY5Y. The reduction of QPRT altered neuronal morphology of differentiated SH-SY5Y cells. Chemical inhibition as well as complete KO of the gene were lethal upon induction of neuronal differentiation, but not proliferation. The QPRT-associated tryptophan pathway was not affected by KO. At the transcriptome level, genes linked to neurodevelopmental processes and synaptic structures were affected. Differentially regulated genes were enriched for ASD candidates, and co-regulated gene networks were implicated in the development of the dorsolateral prefrontal cortex, the hippocampus, and the amygdala. Conclusions In this study, QPRT was causally related to in vitro neuronal differentiation of SH-SY5Y cells and affected the regulation of genes and gene networks previously implicated in ASD. Thus, our data suggest that QPRT may play an important role in the pathogenesis of ASD in Chr16p11.2 deletion carriers.
Collapse
Affiliation(s)
- Denise Haslinger
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, JW Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Regina Waltes
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, JW Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Afsheen Yousaf
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, JW Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Silvia Lindlar
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, JW Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ines Schneider
- Institute of Experimental Cancer Research in Pediatrics, Frankfurt am Main, Germany
| | - Chai K Lim
- 3Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales Australia
| | - Meng-Miao Tsai
- 4Neuropathology, University of Giessen, Giessen, Germany
| | - Boyan K Garvalov
- 4Neuropathology, University of Giessen, Giessen, Germany.,5Department of Microvascular Biology and Pathobiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Amparo Acker-Palmer
- 6Institute of Cell Biology and Neuroscience and Buchmann Institute for Molecular Life Sciences (BMLS), JW Goethe University of Frankfurt, Frankfurt am Main, Germany
| | | | | | - Till Acker
- 4Neuropathology, University of Giessen, Giessen, Germany
| | - Gilles J Guillemin
- 3Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales Australia
| | - Simone Fulda
- Institute of Experimental Cancer Research in Pediatrics, Frankfurt am Main, Germany
| | - Christine M Freitag
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, JW Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas G Chiocchetti
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, JW Goethe University Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
5
|
Zheng T, Zheng CY, Zheng XC, Zhao RG, Chen YQ. Effect of parthanatos on ropivacaine-induced damage in SH-SY5Y cells. Clin Exp Pharmacol Physiol 2017; 44:586-594. [PMID: 28079261 DOI: 10.1111/1440-1681.12730] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/04/2017] [Accepted: 01/08/2017] [Indexed: 11/29/2022]
Abstract
Ropivacaine is one of the most common but toxic local anaesthetics, and the mechanisms underlying its neurotoxicity are still largely unknown. This study was conducted to prepare a ropivacaine-induced neuronal injury model and research the effects of ropivacaine on PARP-1 activation and nicotinamide adenine dinucleotide (NAD)+ depletion. The cell death and apoptosis of ropivacaine-induced SH-SY5Y cells were detected with flow cytometry. The lactate dehydrogenase cycling reaction measured the NAD+ level, and western blots were used to analyze the expression levels of PARP-1 and apoptosis-inducing factor (AIF) after ropivacaine treatments with different concentrations and durations. A PARP-1 inhibitor (PJ-34) was used to confirm the relationship between PARP-1 activation and NAD+ depletion. Hoechst 33258 nuclear staining and a mitochondrial membrane potential (Δψm) assay were used to detect the role of exogenous NAD+ in ropivacaine-induced neuronal injury. Ropivacaine-induced SH-SY5Y cell death and apoptosis, PARP-1 activation, and AIF increase as well as intracellular NAD+ depletion occurred in a time- and concentration-dependent manner (P<.05). PARP-1 activation led to NAD+ depletion (P<.05). Exogenous NAD+ impaired ropivacaine-induced nuclear injury (P<.05). Ropivacaine treatment induced PARP-1 activation and NAD+ depletion (P<.05). Parthanatos (PARP-1-dependent cell death) was definitely involved in ropivacaine-induced neuronal injury, and exogenous NAD+ may be a novel therapeutic method for parthanatos-dependent neuronal injury.
Collapse
Affiliation(s)
- Ting Zheng
- Fujian Provincial Clinical College, Medical College, Fujian Medical University, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Chun-Ying Zheng
- Fujian Provincial Clinical College, Medical College, Fujian Medical University, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Chun Zheng
- Fujian Provincial Clinical College, Medical College, Fujian Medical University, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Ruo-Guang Zhao
- Fujian Provincial Clinical College, Medical College, Fujian Medical University, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Yan-Qing Chen
- Fujian Provincial Clinical College, Medical College, Fujian Medical University, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| |
Collapse
|
6
|
Xuan W, Hankin J, Zhao H, Yao S, Ma D. The potential benefits of the use of regional anesthesia in cancer patients. Int J Cancer 2014; 137:2774-84. [PMID: 25359704 DOI: 10.1002/ijc.29306] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/24/2014] [Indexed: 12/11/2022]
Abstract
Cancer is a leading cause of morbidity and mortality worldwide. In light of demographic changes among other factors, it is anticipated this trend will continue. Surgical resection is the primary method of treating solid tumours. Unfortunately, even with the use of adjunct therapies, metastatic disease is a leading cause of death in people with cancer. Recent evidence suggests choice of anesthetic technique may influence cancer outcome. This review considers the latest evidence regarding local and regional anesthesia in the context of cancer biology. There is a focus on the indirect and direct mechanisms involved. An integrated approach is used such that diverse areas of research are explored; ranging from epigenetics to cell death pathways. With a better understanding of how regional anesthesia and/or local anesthetics interact with cancer cells, these techniques can be trialed and evaluated to ascertain potential clinical benefits in cancer patients. Thus far, there is insufficient evidence to warrant a change in clinical practice.
Collapse
Affiliation(s)
- Wei Xuan
- Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - James Hankin
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Hailin Zhao
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Shanglong Yao
- Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daqing Ma
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| |
Collapse
|
7
|
Wang L, Ding D, Salvi R, Roth JA. Nicotinamide adenine dinucleotide prevents neuroaxonal degeneration induced by manganese in cochlear organotypic cultures. Neurotoxicology 2013; 40:65-74. [PMID: 24308914 DOI: 10.1016/j.neuro.2013.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/19/2013] [Accepted: 11/25/2013] [Indexed: 01/17/2023]
Abstract
Manganese (Mn) is an essential trace mineral for normal growth and development. Persistent exposures to high atmospheric levels of Mn have deleterious effects on CNS and peripheral nerves including those associated with the auditory system. Nicotinamide adenine dinucleotide (NAD) is a coenzyme which functions in the electron transfer system within the mitochondria. One of the most notable protective functions of NAD is to delay axonal degenerations caused by various neurodegenerative injuries. We hypothesized that NAD might also protect auditory nerve fibers (ANF) and SGN from Mn injury. To test this hypothesis, cochlear organotypic cultures were treated with different doses of Mn (0.5-3.0 mM) alone or combined with 20 mM NAD. Results demonstrate that the percentage of hair cells, ANF and SGN decreased with increasing Mn concentration. The addition of 20 mM NAD did not significantly reduce hair cells loss in the presence of Mn, whereas the density of ANF and SGN increased significantly in the presence of NAD. NAD suppressed Mn-induced TUNEL staining and caspase activation suggesting it prevents apoptotic cell death. These results suggest that excess Mn has ototoxic and neurotoxic effects on the auditory system and that NAD may prevent Mn-induced axonal degeneration and avoid or delay hearing loss caused by excess Mn exposure.
Collapse
Affiliation(s)
- Lu Wang
- Department of Otolaryngology, Head and Neck Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China; Center for Hearing and Deafness, University at Buffalo, Buffalo, NY 14214, United States
| | - Dalian Ding
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY 14214, United States; Department of Otolaryngology, Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Richard Salvi
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY 14214, United States
| | - Jerome A Roth
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, NY 14214, United States.
| |
Collapse
|