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P i-induced muscle fatigue leads to near-hyperbolic power-duration dependence. Eur J Appl Physiol 2019; 119:2201-2213. [PMID: 31399839 DOI: 10.1007/s00421-019-04204-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Consequences of combining three ideas proposed previously by other authors: (1) that there exists a critical power (CP), above which no steady state in [Formula: see text]O2 (oxygen consumption) and metabolites can be achieved in voluntary constant-power exercise; (2) that muscle fatigue is related to decreased exercise efficiency (increased [Formula: see text]O2/power output ratio); and (3) that Pi (inorganic phosphate) is the main fatigue-related metabolite are investigated. METHODS A previously-developed computer model of the skeletal muscle bioenergetic system is used. It was assumed in computer simulations that skeletal muscle work terminates when cytosolic Pi (inorganic phosphate) exceeds a certain critical level. RESULTS Simulated changes in muscle [Formula: see text]O2, cytosolic ADP, pH, PCr and Pi as a function of time at various ATP usage activities (corresponding to power outputs) agreed well with experimental data. Computer simulations resulted in a fourth previously-published idea: (4) that the power-duration relationship describing the dependence of power output (PO) on the time to exhaustion of voluntary constant-power exercise at a given PO has a (near-)hyperbolic shape. CONCLUSIONS Pi is a major factor contributing to muscle fatigue, as such an assumption leads to a (near-)hyperbolic shape of the power-duration relationship, at least for exercise duration of ~ 1-10 min. Thus, a potential mechanism underlying the power-duration relationship shape is offered that was absent in the literature. Other factors/mechanisms, such as cytosol acidification, glycogen stores depletion and central fatigue can contribute to this relationship, especially in longer exercises.
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Korzeniewski B. Faster and stronger manifestation of mitochondrial diseases in skeletal muscle than in heart related to cytosolic inorganic phosphate (Pi) accumulation. J Appl Physiol (1985) 2016; 121:424-37. [PMID: 27283913 DOI: 10.1152/japplphysiol.00358.2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/08/2016] [Indexed: 01/04/2023] Open
Abstract
A model of the cell bioenergetic system was used to compare the effect of oxidative phosphorylation (OXPHOS) deficiencies in a broad range of moderate ATP demand in skeletal muscle and heart. Computer simulations revealed that kinetic properties of the system are similar in both cases despite the much higher mitochondria content and "basic" OXPHOS activity in heart than in skeletal muscle, because of a much higher each-step activation (ESA) of OXPHOS in skeletal muscle than in heart. Large OXPHOS deficiencies lead in both tissues to a significant decrease in oxygen consumption (V̇o2) and phosphocreatine (PCr) and increase in cytosolic ADP, Pi, and H(+) The main difference between skeletal muscle and heart is a much higher cytosolic Pi concentration in healthy tissue and much higher cytosolic Pi accumulation (level) at low OXPHOS activities in the former, caused by a higher PCr level in healthy tissue (and higher total phosphate pool) and smaller Pi redistribution between cytosol and mitochondria at OXPHOS deficiency. This difference does not depend on ATP demand in a broad range. A much greater Pi increase and PCr decrease during rest-to-moderate work transition in skeletal muscle at OXPHOS deficiencies than at normal OXPHOS activity significantly slows down the V̇o2 on-kinetics. Because high cytosolic Pi concentrations cause fatigue in skeletal muscle and can compromise force generation in skeletal muscle and heart, this system property can contribute to the faster and stronger manifestation of mitochondrial diseases in skeletal muscle than in heart. Shortly, skeletal muscle with large OXPHOS deficiencies becomes fatigued already during low/moderate exercise.
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Affiliation(s)
- Bernard Korzeniewski
- Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
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Torvinen S, Silvennoinen M, Piitulainen H, Närväinen J, Tuunanen P, Gröhn O, Koch LG, Britton SL, Kainulainen H. Rats bred for low aerobic capacity become promptly fatigued and have slow metabolic recovery after stimulated, maximal muscle contractions. PLoS One 2012. [PMID: 23185253 PMCID: PMC3502431 DOI: 10.1371/journal.pone.0048345] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM Muscular fatigue is a complex phenomenon affected by muscle fiber type and several metabolic and ionic changes within myocytes. Mitochondria are the main determinants of muscle oxidative capacity which is also one determinant of muscle fatigability. By measuring the concentrations of intracellular stores of high-energy phosphates it is possible to estimate the energy production efficiency and metabolic recovery of the muscle. Low intrinsic aerobic capacity is known to be associated with reduced mitochondrial function. Whether low intrinsic aerobic capacity also results in slower metabolic recovery of skeletal muscle is not known. Here we studied the influence of intrinsic aerobic capacity on in vivo muscle metabolism during maximal, fatiguing electrical stimulation. METHODS Animal subjects were genetically heterogeneous rats selectively bred to differ for non–trained treadmill running endurance, low capacity runners (LCRs) and high capacity runners (HCRs) (n = 15–19). We measured the concentrations of major phosphorus compounds and force parameters in a contracting triceps surae muscle complex using 31P-Magnetic resonance spectroscopy (31P-MRS) combined with muscle force measurement from repeated isometric twitches. RESULTS Our results demonstrated that phosphocreatine re-synthesis after maximal muscle stimulation was significantly slower in LCRs (p<0.05). LCR rats also became promptly fatigued and maintained the intramuscular pH poorly compared to HCRs. Half relaxation time (HRT) of the triceps surae was significantly longer in LCRs throughout the stimulation protocol (p≤0.05) and maximal rate of torque development (MRTD) was significantly lower in LCRs compared to HCRs from 2 min 30 s onwards (p≤0.05). CONCLUSION We observed that LCRs are more sensitive to fatigue and have slower metabolic recovery compared to HCRs after maximal muscle contractions. These new findings are associated with reduced running capacity and with previously found lower mitochondrial content, increased body mass and higher complex disease risk of LCRs.
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Affiliation(s)
- Sira Torvinen
- Department of Biology of Physical Activity, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Mika Silvennoinen
- Department of Biology of Physical Activity, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Harri Piitulainen
- Department of Biology of Physical Activity, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
- Brain Research Unit, Low Temperature Laboratory, School of Science, Aalto University, Espoo, Finland
| | - Johanna Närväinen
- Department of Neurobiology, AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Finland
| | - Pasi Tuunanen
- Department of Neurobiology, AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Finland
| | - Olli Gröhn
- Department of Neurobiology, AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Finland
| | - Lauren G. Koch
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Steven L. Britton
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Heikki Kainulainen
- Department of Biology of Physical Activity, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
- * E-mail:
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Giannesini B, Vilmen C, Le Fur Y, Dalmasso C, Cozzone PJ, Bendahan D. A strictly noninvasive MR setup dedicated to longitudinal studies of mechanical performance, bioenergetics, anatomy, and muscle recruitment in contracting mouse skeletal muscle. Magn Reson Med 2010; 64:262-70. [PMID: 20572140 DOI: 10.1002/mrm.22386] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
MR techniques have proven their ability to investigate skeletal muscle function in situ. Their benefit in terms of noninvasiveness is, however, lost in animal research, given that muscle stimulation and force output measurements are usually achieved using invasive surgical procedures, thereby excluding repeated investigations in the same animal. This study describes a new setup allowing strictly noninvasive investigations of mouse gastrocnemius muscle function using (1)H-MRI and (31)P-MR spectroscopy. Its originality is to integrate noninvasive systems for inducing muscle contraction through transcutaneous stimulation and for measuring mechanical performance with a dedicated ergometer. In order to test the setup, muscle function was investigated using a fatiguing stimulation protocol (6 min of repeated isometric contractions at 1.7 Hz). T(2)-weighted imaging demonstrated that transcutaneous stimulation mainly activated the gastrocnemius. Moreover, investigations repeated twice with a 7-day interval between bouts did show a high reproducibility in measurements with regard to changes in isometric force and energy metabolism. In conclusion, this setup enables us for the first time to access mechanical performance, energy metabolism, anatomy, and physiology strictly noninvasively in contracting mouse skeletal muscle. The possibility for implementing longitudinal studies opens up new perspectives in many research areas, including ageing, pharmaceutical research, and gene and cell therapy.
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Affiliation(s)
- Benoît Giannesini
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM) UMR 6612 CNRS - Université de la Méditerranée, Faculté de Médecine de Marseille, 27, bd Jean Moulin, 13385 Marseille Cedex 05, France.
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Keyser RE. Peripheral fatigue: high-energy phosphates and hydrogen ions. PM R 2010; 2:347-58. [PMID: 20656616 DOI: 10.1016/j.pmrj.2010.04.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
Abstract
Peripheral fatigue results from an overactivity-induced decline in muscle function that originates from non-central nervous system mechanisms. A common symptom of fatigue is a feeling of tiredness or weariness because of overexertion, such as that associated with intense or prolonged physical exercise. Fatigue is worsened by low physical fitness and chronic illnesses. These conditions may intensify fatigue to levels that limit physical and social functioning and severely diminish health-related quality of life. Although etiologic aspects of peripheral fatigue are often associated with regulatory system (neurologic, endocrine, immunologic, muscular) and support system (cardiovascular, pulmonary, metabolic, renal, digestive, skeletal) limitations, final mediation occurs in muscle cells as a result of altered crossbridge functioning. Specifically, the final product and ionic metabolite accumulation that result from adenosine triphosphate hydrolysis appear to inhibit crossbridge formation and activation. Thus, clinical manifestations of peripheral fatigue often can be observed as limitations placed upon muscle or cardiorespiratory endurance, here defined as fatigue resistance. An overview of the common pathways by which peripheral fatigue can be mediated is provided. Product inhibition of contractile chemistry is brought into focus as a common pathway through which the mechanisms of peripheral fatigue often act.
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Affiliation(s)
- Randall E Keyser
- Center for the Study of Chronic Illness and Disability, Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA.
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Abstract
Fatigue of skeletal muscle involves many systems beginning with the central nervous system and ending with the contractile machinery. This review concentrates on those factors that directly affect the actomyosin interaction: the build-up of metabolites; myosin phosphorylation; and oxidation of the myofibrillar proteins by free radicals. The decrease in [ATP] and increase in [ADP] appear to play little role in modulating function. The increase in phosphate inhibits tension. The decrease in pH, long thought to be a major factor, is now known to play a more minor role. Myosin phosphorylation potentiates the force achieved in a twitch, and a further role in inhibiting velocity is proposed. Protein oxidation can both potentiate and inhibit the actomyosin interaction. It is concluded that these factors, taken together, do not fully explain the inhibition of the actomyosin interaction observed in living fibers, and thus additional modulators of this interaction remain to be discovered.
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Affiliation(s)
- Roger Cooke
- Department of Biochemistry and Biophysics and Cardiovascular Research Institute, University of California, San Francisco, California 94158-2517, USA.
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Giannesini B, Izquierdo M, Dalmasso C, Le Fur Y, Cozzone PJ, Verleye M, Le Guern ME, Gillardin JM, Bendahan D. Endotoxemia causes a paradoxical intracellular pH recovery in exercising rat skeletal muscle. Muscle Nerve 2007; 36:505-14. [PMID: 17626288 DOI: 10.1002/mus.20843] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In resting skeletal muscle, endotoxemia causes disturbances in energy metabolism that could potentially disturb intracellular pH (pH(i)) during muscular activity. We tested this hypothesis using in situ (31)P-magnetic resonance spectroscopy in contracting rat gastrocnemius muscle. Endotoxemia was induced by injecting rats intraperitoneally at t(0) and t(0) + 24 h with Klebsiella pneumoniae endotoxin (lipopolysaccharides at 3 mg/kg) or saline vehicle. Muscle function was investigated strictly noninvasively at t(0) + 48 h through a transcutaneous electrical stimulation protocol consisting of 5.7 minutes of repeated isometric contraction at 3.3 HZ, and force production was measured with an ergometer. At rest, endotoxin treatment did not affect pH(i) and adenosine triphosphate concentration, but significantly reduced phosphocreatine and glycogen contents. Endotoxemia produced both a reduction of isometric force production and a marked linear recovery (0.08 +/- 0.01 pH unit/min) of pH(i) during the second part of the stimulation period. This recovery was not due to any phenomenon of fiber inactivation linked to development of muscle fatigue, and was not associated with any change in intracellular proton buffering, net proton efflux from the cell, or proton turnovers through creatine kinase reaction and oxidative phosphorylation. This paradoxical pH(i) recovery in exercising rat skeletal muscle under endotoxemia is likely due to slowing of glycolytic flux following the reduction in intramuscular glycogen content. These findings may be useful in the follow-up of septic patients and in the assessment of therapies.
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Affiliation(s)
- Benoît Giannesini
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Faculté de Médecine de Marseille, 27 Boulevard Jean Moulin, 13005, Marseille, France.
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Giannesini B, Izquierdo M, Le Fur Y, Cozzone PJ, Fingerle J, Himber J, Künnecke B, Von Kienlin M, Bendahan D. New experimental setup for studying strictly noninvasively skeletal muscle function in rat using 1H-magnetic resonance (MR) imaging and 31P-MR spectroscopy. Magn Reson Med 2006; 54:1058-64. [PMID: 16193467 DOI: 10.1002/mrm.20637] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traditional setups for in situ MR investigation of skeletal muscle function in animals use invasive systems for muscle stimulation and force measurement. These systems require surgical preparation and therefore exclude repetitive investigations on the same animal. This article describes a new experimental setup allowing strictly noninvasive MR investigations of muscle function in contracting rat gastrocnemius muscle using 1H-MR imaging and 31P-MR spectroscopy. The novelty of this setup is the integration of two noninvasive systems allowing muscle contraction by transcutaneous stimulation and force measurement with a dedicated ergometer. Muscle function was investigated in 20 rats (275-300 g) through a fatiguing stimulation protocol, either with this noninvasive setup (n = 10) or with a traditional MR setup (n = 10). T2-weighted images demonstrated that transcutaneous stimulation activated mainly the gastrocnemius muscle. Moreover, the changes in force development and in energy metabolism obtained with the noninvasive setup were qualitatively and quantitatively similar to those obtained with the traditional setup. This noninvasive setup is thus suitable for investigating skeletal muscle function in situ. It offers the possibility to repeat investigations in the same animal, avoiding individual variability and enabling longitudinal follow-up studies. This opens up new perspectives in various research areas including pharmaceutical research.
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Affiliation(s)
- Benoit Giannesini
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Faculté de Médecine de Marseille, Marseille, France
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Giannesini B, Cozzone PJ, Bendahan D. In vivo MR investigation of skeletal muscle function in small animals. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2004; 17:210-8. [PMID: 15592946 DOI: 10.1007/s10334-004-0080-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 10/26/2004] [Accepted: 10/26/2004] [Indexed: 11/30/2022]
Abstract
In vivo 31P-MRS investigations have been widely used in small animals to study skeletal muscle function under normal and pathological conditions. Paradoxically in these studies, the benefit provided by 31P-MRS in terms of non-invasiveness is lost because of the utilization of experimental setups that integrate invasive devices for inducing muscle contractions and for measuring mechanical performance. These traditional methodologies, which require surgical preparations, have obvious limitations regarding repeatability in the same animal. The purpose of this review is to highlight the technical aspects of the in vivo MR investigations of skeletal muscle function in small animal models. We will more particularly address the issue related to the invasiveness of different procedures used so far in order to show finally that a further step into non-invasiveness can be achieved, in particular with the support of muscle functional 1H-MRI.
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Affiliation(s)
- B Giannesini
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Faculté de Médecine de Marseille, 27 Boulevard Jean Moulin, 13005, Marseille, France
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Hwang I, Devine C, Hopkins D. The biochemical and physical effects of electrical stimulation on beef and sheep meat tenderness. Meat Sci 2003; 65:677-91. [DOI: 10.1016/s0309-1740(02)00271-1] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2002] [Revised: 09/16/2002] [Accepted: 09/16/2002] [Indexed: 01/09/2023]
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Darques JL, Bendahan D, Roussel M, Giannesini B, Tagliarini F, Le Fur Y, Cozzone PJ, Jammes Y. Combined in situ analysis of metabolic and myoelectrical changes associated with electrically induced fatigue. J Appl Physiol (1985) 2003; 95:1476-84. [PMID: 12819224 DOI: 10.1152/japplphysiol.00230.2003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Electrical muscle stimulation (Mstim) at a low or high frequency is associated with failure of force production, but the exact mechanisms leading to fatigue in this model are still poorly understood. Using 31P magnetic resonance spectroscopy (31PMRS), we investigated the metabolic changes in rabbit tibialis anterior muscle associated with the force decline during Mstim at low (10 Hz) and high (100 Hz) frequency. We also simultaneously recorded the compound muscle mass action potential (M-wave) evoked by direct muscle stimulation, and we analyzed its post-Mstim variations. The 100-Hz Mstim elicited marked M-wave alterations and induced mild metabolic changes at the onset of stimulation followed by a paradoxical recovery of phosphocreatine (PCr) and pH during the stimulation period. On the contrary, the 10-Hz Mstim produced significant PCr consumption and intracellular acidosis with no paradoxical recovery phenomenon and no significant changes in M-wave characteristics. In addition, the force depression was linearly linked to the stimulation-induced acidosis and PCr breakdown. These results led us to conclude that force failure during 100-Hz Mstim only results from an impaired propagation of muscle action potentials with no metabolic involvement. On the contrary, fatigue induced by 10-Hz Mstim is closely associated with metabolic changes with no alteration of the membrane excitability, thereby underlining the central role of muscle energetics in force depression when muscle is stimulated at low frequency. Finally, our results further indicate a reduction of energy cost of contraction when stimulation frequency is increased from 10 to 100 Hz.
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Affiliation(s)
- J L Darques
- Laboratoire de Physiopathologie Respiratoire, UPRES EA 2201, Institut Jean Roche, Faculté de Médecine, Université de la Méditerranée, Bd Pierre Dramard, 13916 Marseille Cedex 20, France.
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Rossiter HB, Ward SA, Howe FA, Kowalchuk JM, Griffiths JR, Whipp BJ. Dynamics of intramuscular 31P-MRS P(i) peak splitting and the slow components of PCr and O2 uptake during exercise. J Appl Physiol (1985) 2002; 93:2059-69. [PMID: 12391122 DOI: 10.1152/japplphysiol.00446.2002] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The dynamics of pulmonary O(2) uptake (Vo(2)) during the on-transient of high-intensity exercise depart from monoexponentiality as a result of a "slow component" whose mechanisms remain conjectural. Progressive recruitment of glycolytic muscle fibers, with slow O(2) utilization kinetics and low efficiency, has, however, been suggested as a mechanism. The demonstration of high- and low-pH components of the exercising skeletal muscle (31)P magnetic resonance (MR) spectrum [inorganic phosphate (P(i)) peak] at high work rates (thought to be reflective of differences between oxidative and glycolytic muscle fibers) is also consistent with this conjecture. We therefore investigated the dynamics of Vo(2) (using a turbine and mass spectrometry) and intramuscular ATP, phosphocreatine (PCr), and P(i) concentrations and pH, estimated from the (31)P MR spectrum. Eleven healthy men performed prone square-wave high-intensity knee extensor exercise in the bore of a whole body MR spectrometer. A Vo(2) slow component of magnitude 15.9 +/- 6.9% of the phase II amplitude was accompanied by a similar response (11.9 +/- 7.1%) in PCr concentration. Only five subjects demonstrated a discernable splitting of the P(i) peak, however, which began from between 35 and 235 s after exercise onset and continued until cessation. As such, the dynamics of the pH distribution in intramuscular compartments did not consistently reflect the temporal features of the Vo(2) slow component, suggesting that P(i) splitting does not uniquely reflect the activity of oxidative or glycolytic muscle fibers per se.
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Affiliation(s)
- H B Rossiter
- Department of Physiology, St. George's Hospital Medical School, Tooting, London SW17 0RE, United Kingdom
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Abstract
Prolonged or repeated contractions of skeletal muscles lead to impaired muscle function, fatigue develops. Fatigue may be caused by factors within the muscle cells (peripheral fatigue) and diminished activation from the central nervous system (central fatigue). The relative importance of peripheral central fatigue depends on the type of physical activity. Central fatigue may be more prominent in elderly subjects. Increased concentration of inorganic phosphate seems to be of major importance for acute peripheral fatigue. There is frequently a long-lasting depression of force production after fatiguing muscle activity, especially at low stimulation frequencies. This low-frequency fatigue seems to be due to "structural" changes in proteins involved in intracellular Ca handling. Contractions in which the muscle is stretched (eccentric contractions) cause muscle weakness and damage. The initial defect induced by eccentric contractions is overstretched sarcomeres, but these appear to cause localized membrane tears that subsequently contribute to muscle weakness and damage.
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Affiliation(s)
- Håkan Westerblad
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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