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Wallukat G, Botoni FA, Rocha MC, Louise V, Müller J, Talvani A. Functional antibodies against G-protein coupled receptors in Beagle dogs infected with two different strains of Trypanosoma cruzi. Front Immunol 2022; 13:926682. [PMID: 36389686 PMCID: PMC9641151 DOI: 10.3389/fimmu.2022.926682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/04/2022] [Indexed: 09/08/2024] Open
Abstract
The interaction of the anti-beta1-adrenergic receptor autoantibodies (β1ARAb) and the anti-muscarinic M2 receptor autoantibodies (M2RAb) with cardiac neurotransmitter receptors were identified in human chronic Chagas cardiomyopathy (CCC) related to the ECG and dysautonomia disturbances. Dogs are considered gold model to the study of Trypanosoma cruzi infection due the clinical similarities with CCC. This study aims to evaluate whether anti-β1ARAb, anti-β2ARAb, and anti-muscarinic M2RAb are generated in Beagle dogs infected by T. cruzi using Y and Berenice-78 strains of T. cruzi. Animals were infected with 4.0 x 103 bloodstream trypomastigotes/kg of body weight and, after 25 months of infection, blood sample was collected, and serum stored at -80°C. Dog serum was treated by ammonium sulphate precipitation and the IgG antibodies isolated and added to the beating neonatal rats' cardiomyocytes. All T. cruzi-infected dogs developed agonistic β1ARAb, β2ARAb, and M2RAb. Animals infected by Berenice strain presented less β2ARAb and M2RAb activities than dogs infected by Y strain of the parasite. In cardiomyocytes culture, the antibodies recognized an epitope on the second extracellular loop of the receptors which were similar to findings in human Chagas disease. There was no detection of antibody against G protein-coupled receptor in serum from uninfected dogs. In conclusion, both Y and Berenice-78 strains of T. cruzi induced dog antibodies, whose targets located in the second extracellular loop of the adrenergic and muscarinic receptors were similar to those observed in individuals with CCC. Therefore, our findings highlight dogs as a promisor model to investigate pathogenic roles of functional Ab against G-protein coupled receptors.
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Affiliation(s)
- Gerd Wallukat
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- Berlin Cures GmbH, Berlin, Germany
| | - Fernando Antônio Botoni
- Postgraduate Program in Infectiology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Manoel Otávio da Costa Rocha
- Postgraduate Program in Infectiology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vitória Louise
- Postgraduate Program in Infectiology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Department of Biological Sciences, Institute of Exact and Biological Sciences & Postgraduate Program of Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | | | - Andre Talvani
- Postgraduate Program in Infectiology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Department of Biological Sciences, Institute of Exact and Biological Sciences & Postgraduate Program of Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
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de Lana M, Giunchetti RC. Dogs as a Model for Chemotherapy of Chagas Disease and Leishmaniasis. Curr Pharm Des 2021; 27:1741-1756. [PMID: 33371843 DOI: 10.2174/1381612826666201228142703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/22/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dogs are natural reservoir of Chagas disease (CD) and leishmaniasis and have been used for studies of these infections as they develop different clinical forms of these diseases similar to humans. OBJECTIVE This article describes publications on the dog model relative to CD and leishmaniasis chemotherapy. METHODS The search of articles was based on PubMed, Scopus and MESH using the keywords: dog, Trypanosoma cruzi, treatment (T. cruzi chemotherapy analysis), Leishmania chagasi, Leishmania infantum, canine visceral leishmaniasis, treatment (Leishmania chemotherapy evaluation). RESULTS Benznidazole and nifurtimox were used as a reference in the treatment of CD and in combination with other compounds. Eleven out of the fifteen studies have authors from the same team, using similar protocols and post-treatment evaluations, which assured more reproducibility and credibility. Twenty leishmaniasis studies, especially on visceral leishmaniasis, presenting at least one parasitological analysis tested in distinct monochemotherapy and polychemotherapy approaches were accessed. Data demonstrated that polychemotherapy was more effective in improving the clinical signs and parasitism control. CONCLUSION The benefits of treatment in terms of reducing or eliminating lesions and/or cardiac dysfunctions were demonstrated at acute and/or chronic phases relative to parasite load and/or the T. cruzi strain resistance to treatment. BZ presented better therapeutic results than the two EBI compounds evaluated. Although treatment of the canine visceral leishmaniasis was not able to induce complete parasite clearance, it can improve clinical recovery. Thus, the dog is a good model for CD and leishmaniasis studies of chemotherapy and may be indicated for pre-clinical trials of new treatments.
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Affiliation(s)
- Marta de Lana
- Programa de Pos-Graduacao em Ciencias Farmaceuticas (CiPHARMA), Escola de Farmacia, Programa Pos-Graduacao em de Ciencias Biologicas, Nucleo de Pesquisas em Ciencias Biologicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Ouro Preto, MG, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Departamento de Morfologia, Instituto de Ciencias Biologicas (ICB), Universidade Federal de Minas Gerais, MG, Brazil
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Carvalho EB, Ramos IPR, Nascimento AFS, Brasil GV, Mello DB, Oti M, Sammeth M, Bahia MT, Campos de Carvalho AC, Carvalho AB. Echocardiographic Measurements in a Preclinical Model of Chronic Chagasic Cardiomyopathy in Dogs: Validation and Reproducibility. Front Cell Infect Microbiol 2019; 9:332. [PMID: 31616643 PMCID: PMC6768978 DOI: 10.3389/fcimb.2019.00332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
Background: The failure to translate preclinical results to the clinical setting is the rule, not the exception. One reason that is frequently overlooked is whether the animal model reproduces distinctive features of human disease. Another is the reproducibility of the method used to measure treatment effects in preclinical studies. Left ventricular (LV) function improvement is the most common endpoint in preclinical cardiovascular disease studies, while echocardiography is the most frequently used method to evaluate LV function. In this work, we conducted a robust echocardiographic evaluation of LV size and function in dogs chronically infected by Trypanosoma cruzi. Methods and Results: Echocardiography was performed blindly by two distinct observers in mongrel dogs before and between 6 and 9 months post infection. Parameters analyzed included end-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF), and fractional shortening (FS). We observed a significant LVEF and FS reduction in infected animals compared to controls, with no significant variation in volumes. However, the effect of chronic infection in systolic function was quite variable, with EF ranging from 17 to 66%. Using the cut-off value of EF ≤ 40%, established for dilated cardiomyopathy (DCM) in dogs, only 28% of the infected dogs were affected by the chronic infection. Conclusions: The canine model of CCC mimics human disease, reproducing the percentage of individuals that develop heart failure during the chronic infection. It is thus mandatory to establish inclusion criteria in the experimental design of canine preclinical studies to account for the variable effect that chronic infection has on systolic function.
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Affiliation(s)
- Eduardo B. Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isalira P. R. Ramos
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Guilherme V. Brasil
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Debora B. Mello
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Martin Oti
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michael Sammeth
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria T. Bahia
- School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Antonio C. Campos de Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute for Science and Technology in Regenerative Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana B. Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute for Science and Technology in Regenerative Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Penitente AR, Leite ALJ, de Paula Costa G, Shrestha D, Horta AL, Natali AJ, Neves CA, Talvani A. Enalapril in Combination with Benznidazole Reduces Cardiac Inflammation and Creatine Kinases in Mice Chronically Infected with Trypanosoma cruzi. Am J Trop Med Hyg 2015; 93:976-82. [PMID: 26350447 DOI: 10.4269/ajtmh.15-0237] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/03/2015] [Indexed: 12/31/2022] Open
Abstract
The protozoan Trypanosoma cruzi triggers an inflammatory process in mammalian heart causing events such as fibrosis, changes in the architecture and functionality in this organ. Enalapril, an angiotensin II-converting enzyme inhibitor, is a drug prescribed to ameliorate this heart dysfunction, and appears to exert a potential role in immune system regulation. Our aim was to evaluate the chronic cardiac inflammatory parameters after therapeutic treatment with enalapril and benznidazole in C57BL/6 mice infected with the VL-10 strain of T. cruzi. After infection, animals were treated with oral doses of enalapril (25 mg/kg), benznidazole (100 mg/kg), or both during 30 days. Morphometric parameters and levels of chemokines (CCL2, CCL5), IL-10, creatine kinases (CKs), and C-reactive protein were evaluated in the heart and serum at the 120th day of infection. Enalapril alone or in combination with benznidazole did not change the number of circulating parasites, but reduced cardiac leukocyte recruitment and total collagen in the cardiac tissue. Interestingly, the combination therapy (enalapril/benznidazole) also reduced the levels of chemokines, CK and CK-MB, and C-reactive proteins in chronic phase. In conclusion, during the chronic experimental T. cruzi infection, the combination therapy using enalapril plus benznidazole potentiated their immunomodulatory effects, resulting in a low production of biomarkers of cardiac lesions.
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Affiliation(s)
- Arlete Rita Penitente
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Ana Luísa Junqueira Leite
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Guilherme de Paula Costa
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Deena Shrestha
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Aline Luciano Horta
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Antônio J Natali
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Clóvis A Neves
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Andre Talvani
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
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5
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Regulator of G-protein signaling 6 (RGS6) in cardiology and oncology. Int J Cardiol 2015; 187:99-102. [PMID: 25828322 DOI: 10.1016/j.ijcard.2015.03.278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023]
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Campos de Carvalho AC, Bastos Carvalho A. Stem Cell-Based Therapies in Chagasic Cardiomyopathy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:436314. [PMID: 26161401 PMCID: PMC4486210 DOI: 10.1155/2015/436314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/27/2015] [Indexed: 02/08/2023]
Abstract
Chagas disease is caused by Trypanosoma cruzi and can lead to a dilated cardiomyopathy decades after the prime infection by the parasite. As with other dilated cardiomyopathies, conventional pharmacologic therapies are not always effective and as heart failure progresses patients need heart transplantation. Therefore alternative therapies are highly desirable and cell-based therapies have been investigated in preclinical and clinical studies. In this paper we review the main findings of such studies and discuss future directions for stem cell-based therapies in chronic chagasic cardiomyopathy.
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Affiliation(s)
- Antonio Carlos Campos de Carvalho
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rua Carlos Chagas Filho 373, 21949-900 Rio de Janeiro, RJ, Brazil
- *Antonio Carlos Campos de Carvalho:
| | - Adriana Bastos Carvalho
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rua Carlos Chagas Filho 373, 21949-900 Rio de Janeiro, RJ, Brazil
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Daliry A, Pereira IR, Pereira-Junior PP, Ramos IP, Vilar-Pereira G, Silvares RR, Lannes-Vieira J, Campos De Carvalho AC. Levels of circulating anti-muscarinic and anti-adrenergic antibodies and their effect on cardiac arrhythmias and dysautonomia in murine models of Chagas disease. Parasitology 2014; 141:1769-78. [PMID: 25093253 DOI: 10.1017/s0031182014001097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
SUMMARY Antibodies (Ab) recognizing G-protein coupled receptors, such as β 1 and β 2 adrenergic (anti-β 1-AR and anti-β 2-AR, respectively) and muscarinic cholinergic receptors (anti-M2-CR) may contribute to cardiac damage, however their role in chronic chagasic cardiomyopathy is still controversial. We describe that Trypanosoma cruzi-infected C3H/He mice show increased P and QRS wave duration, and PR and QTc intervals, while the most significant ECG alterations in C57BL/6 are prolonged P wave and PR interval. Echocardiogram analyses show right ventricle dilation in infected animals of both mouse lineages. Analyses of heart rate variability (HRV) in chronically infected C3H/He mice show no alteration of the evaluated parameters, while C57BL/6 infected mice display significantly lower values of HRV components, suggesting autonomic dysfunction. The time-course analysis of anti-β 1-AR, anti-β 2-AR and anti-M2-CR Ab titres in C3H/He infected mice indicate that anti-β 1-AR Ab are detected only in the chronic phase, while anti-β 2-AR and anti-M2-CR are observed in the acute phase, diminish at 60 dpi and increase again in the chronic phase. Chronically infected C57BL/6 mice presented a significant increase in only anti-M2-CR Ab titres. Furthermore, anti-β 1-AR, anti-β 2-AR and anti-M2-CR, exhibit significantly higher prevalence in chronically T. cruzi-infected C3H/He mice when compared with C57BL/6. These observations suggest that T. cruzi infection leads to host-specific cardiac electric alterations.
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Affiliation(s)
- Anissa Daliry
- Laboratório de Investigação Cardiovascular,Instituto Oswaldo Cruz,Fiocruz, Rio de Janeiro, RJ,Brazil
| | - Isabela Resende Pereira
- Laboratório de Biologia das Interações,Instituto Oswaldo Cruz,Fiocruz, Rio de Janeiro, RJ,Brazil
| | - Pedro Paulo Pereira-Junior
- Laboratório de Eletrofisiologia Cardíaca,Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, UFRJ,Rio de Janeiro,Brazil
| | - Isalira Peroba Ramos
- Laboratório de Cardiologia Celular e Molecular,Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, UFRJ,Rio de Janeiro,Brazil
| | - Glaucia Vilar-Pereira
- Laboratório de Biologia das Interações,Instituto Oswaldo Cruz,Fiocruz, Rio de Janeiro, RJ,Brazil
| | - Raquel Rangel Silvares
- Laboratório de Investigação Cardiovascular,Instituto Oswaldo Cruz,Fiocruz, Rio de Janeiro, RJ,Brazil
| | - Joseli Lannes-Vieira
- Laboratório de Biologia das Interações,Instituto Oswaldo Cruz,Fiocruz, Rio de Janeiro, RJ,Brazil
| | - Antônio Carlos Campos De Carvalho
- Laboratório de Cardiologia Celular e Molecular,Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, UFRJ,Rio de Janeiro,Brazil
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Patanè S. Regulator of G-protein signaling 2 (RGS2) in cardiology and oncology. Int J Cardiol 2014; 179:63-5. [PMID: 25464414 DOI: 10.1016/j.ijcard.2014.10.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy. patane-@libero.it
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Patanè S. M3 muscarinic acetylcholine receptor in cardiology and oncology. Int J Cardiol 2014; 177:646-9. [PMID: 25449471 DOI: 10.1016/j.ijcard.2014.09.178] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 09/27/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039 Taormina (Messina), Italy. patane-@libero.it
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