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Ma J, Xue K, Jiang Y, Wang X, He D, Guo P. Down-regulation of SLC14A1 in prostate cancer activates CDK1/CCNB1 and mTOR pathways and promotes tumor progression. Sci Rep 2024; 14:14914. [PMID: 38942821 PMCID: PMC11213927 DOI: 10.1038/s41598-024-66020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/26/2024] [Indexed: 06/30/2024] Open
Abstract
Prostate cancer (PCa) is the most common cancer among men in the United States and the leading cause of cancer-related death. The Solute Carrier Family 14 Member 1 (SLC14A1) is a member of urea transporters which are important for the regulation of urine concentration. However, the physiological significance of SLC14A1 in PCa still remains unclear. In the present study, via bioinformatics analysis and experiments, we found that expression of SLC14A1 is significantly decreased in PCa progression, which could be attributed to hypermethylation on SLC14A1 promoter region. Moreover, its low expression and hypermethylation on SLC14A1 promoter are closely related to the poor prognosis of PCa patients. On the other hand, overexpression of SLC14A1 inhibited cell proliferation and metastasis while its overexpression also suppressed CDK1/CCNB1 pathway and mTOR/MMP-9 signaling pathway. Additionally, SLC14A1 expression is enriched in prostate basal-type cells. In summary, our study indicates that its low expression level and promoter hypermethylation of SLC14A1 may represent novel indicators for PCa progression and prognosis, and SLC14A1 could inhibit the progression of PCa.
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Affiliation(s)
- Jianbin Ma
- Department of Urology, Qujiang Hospital, Northwest Corner of Huang Qutou Road Number Two and Changming Road, Xi'an, 710061, Shaanxi, China
| | - Kaihua Xue
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yan-Ta West Road, Xi'an, 710061, Shaanxi, China
| | - Yifan Jiang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yan-Ta West Road, Xi'an, 710061, Shaanxi, China
| | - Xinyang Wang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yan-Ta West Road, Xi'an, 710061, Shaanxi, China
| | - Dalin He
- Department of Urology, Qujiang Hospital, Northwest Corner of Huang Qutou Road Number Two and Changming Road, Xi'an, 710061, Shaanxi, China.
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yan-Ta West Road, Xi'an, 710061, Shaanxi, China.
| | - Peng Guo
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yan-Ta West Road, Xi'an, 710061, Shaanxi, China.
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2
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Wan Z, Wang Y, Li C, Zheng D. SLC14A1 is a new biomarker in renal cancer. Clin Transl Oncol 2023:10.1007/s12094-023-03140-6. [PMID: 37004669 DOI: 10.1007/s12094-023-03140-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Renal cancer is one of the common malignant tumors of the urinary tract, prone to distant metastasis and drug resistance, with a poor clinical prognosis. SLC14A1 belongs to the solute transporter family, which plays a role in urinary concentration and urea nitrogen recycling in the renal, and is closely associated with the development of a variety of tumors. METHODS Transcription data for renal clear cell carcinoma (KIRC) were obtained from the public databases Gene Expression Omnibus database (GEO) and The Cancer Genome Atlas (TCGA), and we investigated the differences in SLC14A1 expression in cancerous and normal tissues of renal cancer, its correlation with the clinicopathological features of renal cancer patients. Then, we verified the expression levels of SLC14A1 in renal cancer tissues and their Paracancerous tissues using RT-PCR, Western-blotting and immunohistochemistry. Finally, we used renal endothelial cell line HEK-293 and renal cancer cell lines 786-O and ACHN to explore the effects of SLC14A1 on the biological behaviors of renal cancer cell proliferation, invasion and metastasis using EDU, MTT proliferation assay, Transwell invasion assay and scratch healing assay. RESULTS SLC14A1 was lowly expressed in renal cancer tissues and this was further validated by RT-PCR, Western blotting, and immunohistochemistry in our clinical samples. Analysis of KIRC single-cell data suggested that SLC14A1 was mainly expressed in endothelial cells. Survival analysis showed that low levels of SLC14A1 expression were associated with a better clinical prognosis. In biological behavioral studies, we found that upregulation of SLC14A1 expression levels inhibited the proliferation, invasion, and metastatic ability of renal cancer cells. CONCLUSION SLC14A1 plays an important role in the progression of renal cancer and has the potential to become a new biomarker for renal cancer.
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Affiliation(s)
| | - Yinglei Wang
- Yantai Affiliated Hospital of Binzhou Medical University, Shandong, China.
| | - Cheng Li
- Binzhou Medical University, Shandong, China
| | - Dongbing Zheng
- Yantai Affiliated Hospital of Binzhou Medical University, Shandong, China
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Shi J, Sha R, Yang X. Role of the human solute carrier family 14 member 1 gene in hypoxia-induced renal cell carcinoma occurrence and its enlightenment to cancer nursing. BMC Mol Cell Biol 2023; 24:10. [PMID: 36934247 PMCID: PMC10024409 DOI: 10.1186/s12860-023-00473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Hypoxia is considered a critical contributor to renal cell carcinoma progression, including invasion and metastasis. However, the potential mechanisms by which it promotes invasion and metastasis have not yet been clarified. The purpose of this study was to investigate the role and mechanism of hypoxia-induced renal cell carcinoma and provide evidence-based medical proof for improvements to postoperative nursing of renal cell carcinoma patients. A total of 64 patients with renal cell carcinoma were divided into the observation group (nursing based on oxygen administration) and the control group (conventional nursing). Renal function indexes, serum inflammatory factors, and tumor markers were evaluated. The human renal cell carcinoma cell line A498 under hypoxia/normoxia was used as an experimental model in vitro and the biological characteristics and mitochondrial function of the cells were assessed. RESULTS Nursing based on oxygen administration decreased the value of renal function indexes, serum inflammatory factors, and tumor markers in renal cell carcinoma patients. Hypoxia was found to induce A498 cell invasion, migration, and the release of inflammatory cytokines, while repressing human solute carrier family 14 member 1 gene expression. Elevated levels of solute carrier family 14 member 1 expression induced mitochondrial reactive oxygen species accumulation, diminished the intracellular adenosine triphosphate level, and destroyed both mitochondrial membrane potential integrity and mitochondrial morphology. Overexpression of the solute carrier family 14 member 1 gene could abolish hypoxia-induced invasion, reduce the migration of A498 cells, inhibit the hypoxia-induced release of inflammatory cytokines, and arrest the cell cycle at the G1/S checkpoint. CONCLUSIONS These data reveal that nursing based on oxygen administration can improve the clinical efficacy of renal cell carcinoma therapies, being safe and effective. The results elucidate a mechanism wherein the solute carrier family 14 member 1 gene participates in the occurrence and development of hypoxia-induced renal cell carcinoma in a mitochondria-dependent manner.
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Affiliation(s)
- Jing Shi
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Qinhuai District, 68 Changle Road, Nanjing, 210012, China
| | - Ruili Sha
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Qinhuai District, 68 Changle Road, Nanjing, 210012, China
| | - Xilan Yang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Qinhuai District, 68 Changle Road, Nanjing, 210012, China.
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4
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Li J, Sun Y, Yan R, Wu X, Zou H, Meng Y. Urea transporter B downregulates polyamines levels in melanoma B16 cells via p53 activation. BIOCHIMICA ET BIOPHYSICA ACTA. MOLECULAR CELL RESEARCH 2022; 1869:119236. [PMID: 35143901 DOI: 10.1016/j.bbamcr.2022.119236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
Urea transporter B (UT-B, encoded by the SLC14A1 gene) is a membrane channel protein involved in urea transmembrane transport. Compared with normal tissues, UT-B expression is significantly decreased in most tumours, especially melanoma. However, the UT-B role in tumorigenesis and development is still unclear. Herein, we investigated the effects of UT-B overexpression on polyamine metabolism and the urea cycle in murine melanoma B16 cells, to explore the roles of mitochondrial dysfunction and p53 activation in cell growth and polyamines metabolism. UT-B overexpression in B16 cells decreased cell growth, increased apoptosis, and significantly altered metabolic pathways related to the urea cycle, which were characterized by reduced production of urea and polyamines and increased production of nitric oxide. Subsequently, we observed that activation of the p53 pathway may be the main cause of the above phenomena. The p53 inhibitor pifithrin-α partially restored the production of polyamines, but the mitochondrial morphology and function were still impaired. Further treatment of UT-B-overexpressing B16 cells with reactive oxygen species scavenging agent N-acetyl-l-cysteine and coenzyme Q10 restored cell viability and mitochondrial function and increased polyamine production. In conclusion, UT-B overexpression caused mitochondrial dysfunction and increased oxidative stress in B16 cells, and then activated p53 expression, which may be one of the mechanisms leading to the decrease in intracellular polyamines.
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Affiliation(s)
- Jiajing Li
- Department of Pathophysiology, College of Basic Medical Science, Jilin University, Changchun, China
| | - Yuxin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Ruyu Yan
- Department of Pathophysiology, College of Basic Medical Science, Jilin University, Changchun, China
| | - Xiaolin Wu
- Department of Pathophysiology, College of Basic Medical Science, Jilin University, Changchun, China
| | - Hualong Zou
- Department of Pathophysiology, College of Basic Medical Science, Jilin University, Changchun, China
| | - Yan Meng
- Department of Pathophysiology, College of Basic Medical Science, Jilin University, Changchun, China.
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5
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Farrell A, Stewart G. Osmotic regulation of UT-B urea transporters in the RT4 human urothelial cell line. Physiol Rep 2019; 7:e14314. [PMID: 31872572 PMCID: PMC6928247 DOI: 10.14814/phy2.14314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 01/23/2023] Open
Abstract
Facilitative UT-B urea transporters play important physiological roles in numerous tissues, including the urino-genital tract. Previous studies have shown that urothelial UT-B transporters are crucial to bladder function in a variety of mammalian species. Using the RT4 bladder urothelial cell line, this study investigated the potential osmotic regulation of human UT-B transporters. Initial end-point PCR experiments confirmed expression of both UT-B1 and UT-B2 transcripts in RT4 cells. Western blotting analysis revealed glycosylated UT-B protein to be highly abundant and immunolocalization experiments showed it was predominantly located on the plasma membrane. Further PCR experiments suggested that a 48 hr, NaCl-induced raise in external osmolality increased expression of UT-B transcripts. Importantly, these NaCl-induced changes also significantly increased UT-B protein abundance (p < .01, n = 7, ANOVA), whereas mannitol-induced changes in external osmolality had no effect (NS, n = 4, ANOVA). Finally, similar increases in both UT-B RNA expression and protein abundance were observed with urea-induced changes to external osmolality (p < .05, n = 4, ANOVA). In conclusion, these findings strongly suggest that increases in external osmolality, via either NaCl or urea, can regulate human urothelial UT-B transporters.
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Affiliation(s)
- Alan Farrell
- School of Biology & Environmental ScienceScience Centre WestUniversity College DublinDublin 4Ireland
| | - Gavin Stewart
- School of Biology & Environmental ScienceScience Centre WestUniversity College DublinDublin 4Ireland
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6
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Liu L, Sun Y, Zhao Y, Wang Q, Guo H, Guo R, Liu Y, Fu S, Zhang L, Li Y, Meng Y. Urea transport B gene induces melanoma B16 cell death via activation of p53 and mitochondrial apoptosis. Cancer Sci 2018; 109:3762-3773. [PMID: 30290033 PMCID: PMC6272101 DOI: 10.1111/cas.13825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/17/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022] Open
Abstract
Urea Transporter B (UT-B) is a membrane channel protein that mediates the rapid transmembrane transport of urea and participates in urine concentration. Urea Transporter B is expressed in skin, but we found that there is little expression in human melanoma tissue. In this study, we examined the effects of UT-B overexpression in melanoma. The results indicated that there is no UT-B mRNA expression in B16 cells, and UT-B overexpression repressed B16 cell proliferation and induced apoptosis in vitro. We show that UT-B overexpression causes increased reactive oxygen species production, which may be caused by mitochondria dysfunction. The mitochondrial membrane potential (ΨΔm) was lower in UT-B-overexpressing B16 cells. The proteins involved in complexes I, III, IV and V of the respiratory chain were clearly downregulated in UT-B-overexpressing B16 cells, which would strongly reduce the activity of the electron transport chain. We found that mitochondrial release of cytochrome C into the cytoplasm also increased, indicating that apoptosis had been activated. In addition, UT-B overexpression reduced AKT phosphorylation and MDM2 expression and increased p53 expression; p53 activation may be involved in the anticancer effects of UT-B overexpression. Urea Transporter B overexpression also inhibited tumor growth in vivo. In conclusion, we demonstrated that UT-B may be related to the occurrence of melanoma and play a role in tumor development.
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Affiliation(s)
- Lianqin Liu
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
| | - Yuxin Sun
- Department of Otorhinolaryngology‐Head and Neck SurgeryChina‐Japan Union HospitalJilin UniversityChangchunChina
| | - Yunxia Zhao
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
| | - Qian Wang
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
| | - Hua Guo
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
| | - Rui Guo
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
| | - Yanan Liu
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
| | - Shuang Fu
- Department of Histology and EmbryologyChangchun University of Traditional Chinese MedicineChangchunChina
| | - Ling Zhang
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
| | - Yang Li
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
| | - Yan Meng
- Department of PathophysiologyProstate Diseases Prevention and Treatment Research CenterCollege of Basic Medical ScienceJilin UniversityChangchunChina
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7
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Walpole C, McGrane A, Al‐mousawi H, Winter D, Baird A, Stewart G. Investigation of facilitative urea transporters in the human gastrointestinal tract. Physiol Rep 2018; 6:e13826. [PMID: 30101448 PMCID: PMC6087735 DOI: 10.14814/phy2.13826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/12/2018] [Accepted: 07/16/2018] [Indexed: 01/10/2023] Open
Abstract
The symbiotic relationship between humans and their intestinal microbiome is supported by urea nitrogen salvaging. Previous studies have shown that colonic UT-B urea transporters play a significant role in this important physiological process. This current study investigated UT-A and UT-B urea transporter expression along the human gastrointestinal tract. Initial end-point PCR experiments determined that UT-A RNA was predominantly expressed in the small intestine, while UT-B RNA was expressed in stomach, small intestine, and colon. Using western blotting experiments, a strong 40-60 kDa UT-B signal was found to be abundant in both ileum and colon. Importantly, this signal was deglycosylated by PNGaseF enzyme treatment to a core protein of 30 kDa in both tissues. Further immunolocalization studies revealed UT-B transporter proteins were present at the apical membrane of the villi in the ileum, but predominantly at the basolateral membrane of the colonic surface epithelial cells. Finally, a blind scoring immunolocalization study suggested that there was no significant difference in UT-B abundance throughout the colon (NS, ANOVA, N = 5-21). In conclusion, this current study suggested UT-B to be the main human intestinal urea transporter. Intriguingly, these data suggested that the same UT-B isoform was present in all intestinal epithelial cells, but that the precise cellular location varied.
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Affiliation(s)
- Caragh Walpole
- School of Biology & Environmental ScienceUniversity College DublinDublinIreland
| | - Alison McGrane
- School of Biology & Environmental ScienceUniversity College DublinDublinIreland
| | | | - Desmond Winter
- Institute for Clinical Outcomes Research and EducationSt. Vincent's University HospitalDublinIreland
| | - Alan Baird
- College of Life SciencesConway Institute of Biomedical and Biomolecular ScienceDublinIreland
| | - Gavin Stewart
- School of Biology & Environmental ScienceUniversity College DublinDublinIreland
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8
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Hou R, Kong X, Yang B, Xie Y, Chen G. SLC14A1: a novel target for human urothelial cancer. Clin Transl Oncol 2017; 19:1438-1446. [PMID: 28589430 PMCID: PMC5700210 DOI: 10.1007/s12094-017-1693-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/26/2017] [Indexed: 12/23/2022]
Abstract
Urinary bladder cancer is the second commonly diagnosed genitourinary malignancy. Previously, bio-molecular alterations have been observed within certain locations such as chromosome 9, retinoblastoma gene and fibroblast growth factor receptor-3. Solute carrier family 14 member 1 (SLC14A1) gene encodes the type-B urea transporter (UT-B) which facilitates the passive movement of urea across cell membrane, and has recently been related with human malignancies, especially for bladder cancer. Herein, we discussed the SLC14A1 gene and UT-B protein properties, aiming to elucidate the expression behavior of SLC14A1 in human bladder cancer. Furthermore, by reviewing some well-established theories regarding the carcinogenesis of bladder cancer, including several genome wide association researches, we have bridged the mechanisms of cancer development with the aberrant expression of SLC14A1. In conclusion, the altered expression of SLC14A1 gene in human urothelial cancer may implicate its significance as a novel target for research.
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Affiliation(s)
- R Hou
- Department of Urology, China Japan Union Hospital, Jilin University, Changchun, 130033, Jilin, China
| | - X Kong
- Department of Urology, China Japan Union Hospital, Jilin University, Changchun, 130033, Jilin, China
| | - B Yang
- Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Y Xie
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Xiangya School of Medicine, Central South University, Changsha, 410008, Hunan, China
| | - G Chen
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Department of Physiology, Emory University School of Medicine, Whitehead Research Building Room 615, 615 Michael Street, Atlanta, GA, 30322, USA.
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9
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Hou R, Alemozaffar M, Yang B, Sands JM, Kong X, Chen G. Identification of a Novel UT-B Urea Transporter in Human Urothelial Cancer. Front Physiol 2017; 8:245. [PMID: 28503151 PMCID: PMC5409228 DOI: 10.3389/fphys.2017.00245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/07/2017] [Indexed: 02/01/2023] Open
Abstract
The urea transporter UT-B is widely expressed and has been studied in erythrocyte, kidney, brain and intestines. Interestingly, UT-B gene has been found more abundant in bladder than any other tissue. Recently, gene analyses demonstrate that SLC14A1 (UT-B) gene mutations are associated with bladder cancer, suggesting that urea transporter UT-B may play an important role in bladder carcinogenesis. In this study, we examined UT-B expression in bladder cancer with human primary bladder cancer tissues and cancer derived cell lines. Human UT-B has two isoforms. We found that normal bladder expresses long form of UT-B2 but was lost in 8 of 24 (33%) or significantly downregulated in 16 of 24 (67%) of primary bladder cancer patients. In contrast, the short form of UT-B1 lacking exon 3 was detected in 20 bladder cancer samples. Surprisingly, a 24-nt in-frame deletion in exon 4 in UT-B1 (UT-B1Δ24) was identified in 11 of 20 (55%) bladder tumors. This deletion caused a functional defect of UT-B1. Immunohistochemistry revealed that UT-B protein levels were significantly decreased in bladder cancers. Western blot analysis showed a weak UT-B band of 40 kDa in some tumors, consistent with UT-B1 gene expression detected by RT-PCR. Interestingly, bladder cancer associate UT-B1Δ24 was barely sialylated, reflecting impaired glycosylation of UT-B1 in bladder tumors. In conclusion, SLC14A1 gene and UT-B protein expression are significantly changed in bladder cancers. The aberrant UT-B expression may promote bladder cancer development or facilitate carcinogenesis induced by other carcinogens.
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Affiliation(s)
- Ruida Hou
- Department of Urology, China-Japan Union Hospital, Jilin UniversityChangchun, China.,Department of Physiology, Emory University School of MedicineAtlanta, GA, USA
| | | | - Baoxue Yang
- Department of Pharmacology, School of Basic Medical Sciences, Peking UniversityBeijing, China
| | - Jeff M Sands
- Department of Physiology, Emory University School of MedicineAtlanta, GA, USA.,Renal Division Department of Medicine, Emory University School of MedicineAtlanta, GA, USA
| | - Xiangbo Kong
- Department of Urology, China-Japan Union Hospital, Jilin UniversityChangchun, China
| | - Guangping Chen
- Department of Physiology, Emory University School of MedicineAtlanta, GA, USA.,Renal Division Department of Medicine, Emory University School of MedicineAtlanta, GA, USA
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