Pepsin-generated type VI collagen is a degradation product of GP140

Recombinant collagenase from Grimontia hollisae as a tissue dissociation enzyme for isolating primary cells

Collagenase products are crucial to isolate primary cells in basic research and clinical therapies, where their stability in collagenolytic activity is required. However, currently standard collagenase products from Clostridium histolyticum lack such stability. Previously, we produced a recombinant 74-kDa collagenase from Grimontia hollisae, which spontaneously became truncated to ~60 kDa and possessed no stability. In this study, to generate G. hollisae collagenase useful as a collagenase product, we designed recombinant 62-kDa collagenase consisting only of the catalytic domain, which exhibits high production efficiency. We demonstrated that this recombinant collagenase is stable and active under physiological conditions. Moreover, it possesses higher specific activity against collagen and cleaves a wider variety of collagens than a standard collagenase product from C. histolyticum. Furthermore, it dissociated murine pancreata by digesting the collagens within the pancreata in a dose-dependent manner, and this dissociation facilitated isolation of pancreatic islets with masses and numbers comparable to those isolated using the standard collagenase from C. histolyticum. Implantation of these isolated islets into five diabetic mice led to normalisation of the blood glucose concentrations of all the recipients. These findings suggest that recombinant 62-kDa collagenase from G. hollisae can be used as a collagenase product to isolate primary cells.

Transglutaminase 2 strongly binds to an extracellular matrix component other than fibronectin via its second C-terminal beta-barrel domain

Transglutaminase 2 (TG2) is a ubiquitous crosslinking enzyme present in both intra- and extracellular in many cell types and tissues. TG2 is upregulated upon cellular stress or injury, and extracellular TG2 is implicated in several human diseases, including celiac disease. However, incomplete knowledge about extracellular TG2 biology limits our understanding of how TG2 is involved in disease. Here, we demonstrate that binding of TG2 to the ECM of small intestinal tissue sections is the sum of binding to fibronectin (FN) via its N-terminal domain and binding to an abundant, novel extracellular matrix (ECM) interaction partner via its second C-terminal beta-barrel domain. The latter interaction dominates and gives rise to the characteristic reticular staining pattern of extracellular TG2. Of relevance for celiac disease, we show that self-multimerized TG2 does not efficiently deposit in the intestinal ECM, and TG2 complexes may thus become free-floating antigens in tissues in contrast to monomeric TG2 that would readily become sequestered by the ECM. Upon injection of monoclonal antibody targeting the FN-binding site, we observe antibody deposition on extracellular TG2 in cryosections, suggesting that the FN-binding site of TG2 is exposed in vivo. This would explain how and why celiac autoantibodies recognizing the FN-binding site of TG2 can bind TG2 in vitro, in situ as well as in vivo.

Using proteomics, immunohistology, and atomic force microscopy to characterize surface damage to lambskins observed after enzymatic dewooling

The effects of conventional lime sulfide depilation and enzymatic depilation on the enamel layer of pickled lamb pelts were examined using atomic force and optical microscopy, immunohistological, and proteomic techniques. Microscopy showed that the surface structure of enzymatically depilated material was visibly less organized than conventionally processed material, implying that the enzymes used for depilation were responsible for this difference. Proteomic analyses identified an absence of collagen VI in the enamel of skins that had been processed with enzymes, in contrast to the skins that had been processed using conventional methods, which was confirmed using immunolocalization studies. It is therefore possible that the destruction of collagen VI during enzymatic depilation may cause the changes to the enamel structure observed during enzyme processing and in turn affect the quality of the finished product.

Factors influencing the collagenase digestion phase of human islet isolation

Substantial advances in human islet isolation technology have occurred during the past decade. However, it is still difficult to recover the entire quantity of islets contained in a pancreas. A major obstacle to successful human islet isolation has been the variability of the collagenase digestion phase of islet isolation. Future advances in enzyme technology will make it possible to optimally liberate islets with enzyme blends "tailor-made" for each individual donor pancreas. Such innovative strategies will be advantageous in improving islet isolation efficiency, recovery, viability, and ultimately posttransplant function.

Characterisation of Collagen VI within the Islet-Exocrine Interface of the Human Pancreas: Implications for Clinical Islet Isolation?

BACKGROUND

To optimize the methods used for human islet isolation for transplantation, it is important to improve our understanding of the structure of the islet-exocrine interface. In this study, the composition of collagen subtypes in the interface have been characterized and quantified in human pancreas.

METHODS

Human adult pancreases were retrieved from older (mean age 55.7+/-3.0 yrs) and young donors (mean age 21.8+/-3.2 yrs). Tissue from the body of each pancreas was examined by quantitative immunohistochemistry. Collagen within the islet-exocrine interface was identified by immunolabeling for collagen I, IV, V or VI and islets identified either morphologically or by immunolabeling for insulin. Collagen subtypes were quantified and data expressed as collagen area at the interface relative to the islet area. Statistical analysis was by ANOVA or Mann Whitney U test.

RESULTS

In older pancreases, collagen IV, V and VI were present throughout the islet-exocrine interface, whereas collagen I was more variable. The mean peri-islet collagen VI proportion was significantly greater than that of collagen I or IV. Mean islet area and the proportional collagen VI content in specimens from younger subjects were not significantly different to those in older subjects.

CONCLUSIONS

Collagen VI is a major component of the islet-exocrine interface of the adult pancreas, the content being more than double that of collagen I or IV. However, the proportional collagen VI content was not dependent on the age of the donor. These data may facilitate the design of new collagenases, targeting major substrates such as collagen VI in order to improve clinical islet isolation.

Comparison of the Collagen VI Content Within the Islet-Exocrine Interface of the Head, Body, and Tail Regions of the Human Pancreas

Efficient islet isolation depends on the use of collagenase to digest the extracellular matrix within the islet-exocrine interface, the molecular structure of which is poorly understood. Recently it has been reported that transplantable yields of islets can be isolated from the tail segment of the pancreas alone. This study aimed to quantify and compare the amount of collagenase-resistant collagen VI within the islet-exocrine interface of the head, body, and tail of the human pancreas. Human adult pancreata (n = 5) were retrieved from heart-beating donors (age range, 40-62 years; cold ischemia times <10 hours). Tissue blocks from the head, body, and tail region of each pancreas were fixed in formalin and processed for immuno-labelling of collagen VI, which was quantified in the islet-exocrine interface using a Zeiss KS-400 image analysis system. Data were expressed as area of collagen at the interface relative to the islet area. Statistical analysis was done using paired t test. The mean islet areas in the head, body, and tail regions were not significantly different. Collagen VI was uniformly present within the islet-exocrine interface of all regions of the pancreas and was 0.326 +/- 0.064, 0.324 +/- 0.060, and 0.334 +/- 0.052 microm(2)/islet area (P = .441) in the head, body, and tail, respectively. The content of collagen VI within the islet-exocrine interface was uniform throughout all parts of the adult pancreas. Targeting this collagen subtype with novel collagenase blends may result in consistently improved islet yields and enable a wider number of available donor pancreata to be used.

Type VI collagen-specific messenger RNA is expressed constitutively by cultured human synovial fibroblasts and is suppressed by interleukin-1

OBJECTIVE

Type VI collagen is a prominent constituent of the synovial extracellular matrix. The cellular source of this matrix protein and the identity of local factor sin synovium that may regulate its expression have not been delineated, however. We examined the capacity of human fibroblast-like synovial cells to synthesize type VI collagen as well as the effect of interleukin-1 (IL-1) on this expression.

METHODS

RNA was extracted from cultured human synovial cells derived from patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Northern blots were analyzed using sequence-specific probes, and steady-state messenger RNA (mRNA) levels of the 3 alpha (VI) procollagen chains were measured. The effect of IL-1 treatment on these levels was determined.

RESULTS

Abundant expression of 3 characteristic mRNA transcripts, corresponding to the alpha 1 (4.2-kb), alpha 2 (3.5-kb), and alpha 3 (8.5-kb) chains of type VI procollagen, was observed in untreated cells derived from RA and OA patients. IL-1 treatment consistently suppressed steady-state mRNA levels for all 3 alpha (VI) procollagen chains in a time- and dose-dependent manner. Tumor necrosis factor alpha induced a response similar to that of IL-1, while IL-2 was ineffective in this regard. Indomethacin partially restored alpha (VI) mRNA expression in IL-1--treated cells.

CONCLUSION

These studies provide novel data demonstrating abundant steady-state levels of mRNA transcripts coding for all 3 type VI procollagen polypeptides in human synovial fibroblast-like cells, as well as coordinated down-regulation of these transcripts by IL-1. Local production of IL-1 may thus constitute an important means in vivo of regulating the production of type VI collagen.

Type VI collagen: high yields of a molecule with multiple forms of alpha 3 chain from avian and human tissues

A differential extraction procedure followed by molecular sieve column chromatography for the isolation of large quantities of the tissue form of type VI collagen is described. Recovery of the protein was more than 60% from both chick gizzard and human placenta. On reduced NaDodSO4-gels chick type VI collagen migrated as two major bands at Mr = 140,000 and 150,000 that were present in a 1:1 ratio and five less intense bands between Mr = 230,000 and 180,000. By immunoblotting with a polyclonal antibody against the pepsinized form of chick type VI collagen, all these bands were stained. Furthermore, the amino acid composition of the five higher Mr polypeptides indicated that they all contained hydroxyproline and hydroxylysine. In the chick type VI collagen molecule the five bands of higher Mr belong to the alpha 3 chain since they were recognized by monoclonal antibodies specific for the chick Mr = 260,000 alpha 3 chain. On examination of antigenic activity by solid-phase radioimmunobinding, densitometry of stained NaDodSO4 polyacrylamide gels, and protein content type VI was found to be an abundant collagen since it accounted for up to 0.1% of the tissue wet weight. The yields per tissue wet weight and the migration pattern of human type VI collagen polypeptides were similar to those of the chick. Agarose/polyacrylamide composite gels indicated that the molecular size of the tissue form of type VI collagen molecules under non-reduced conditions corresponded to a basic type of tetrameric molecule.

The bovine corneal SGP-complex is related to the tissue form of type VI collagen

A polyclonal antiserum was prepared in rabbits against the structural glycoprotein (SGP) complex previously isolated from a bacterial collagenase digest of bovine corneal stroma (R. Alper, Curr. Eye Res. 2:479, 1983). Direct and indirect enzyme-linked immunosorbent assays indicated that the antiserum was specific for the SGP-complex and did not react with Types I, III and IV collagen, fibronectin, laminin or actin. Immunoblot experiments indicated that the antiserum reacted with all of the components of the SGP-complex as well as with the cell matrix laid down by bovine keratocytes in culture. An attempt was made to isolate individual antibodies from the antiserum by selective elution from immunoblots of the components of the SGP-complex separated by SDS-PAGE. It was found that regardless of the protein band from which the antibody was eluted, every antibody isolated reacted with every protein component of the SGP-complex suggesting that the SGP-complex may have been derived from a single precursor protein and that the observed heterogeneity of the SGP-complex may have been the result of proteolytic breakdown of the protein held together by disulfide bonds. When the anti-SGP antiserum was used to immunoprecipitate 14C-proline labeled proteins from the media of bovine keratocytes in culture, the major protein observed had a Mr of about 140,000 daltons, similar to that of GP-140 also known as CL-glycoprotein. These proteins have been shown to represent the tissue form of Type VI collagen. To test the hypothesis that the SGP-complex may be related to the GP-140 (CL-glycoprotein), ELISA and immunoblotting studies were performed comparing the properties of the anti-SGP serum with those of a polyclonal antibody specific for Type VI collagen. The SGP-complex reacted positively by ELISA with the anti-human Type VI collagen antiserum and, conversely, human Type VI collagen gave a positive ELISA reaction with an antiserum against the SGP-complex. The anti-human Type VI collagen antiserum reacted with most of the major components of the SGP-complex on immunoblots of SDS-PAGE gels. These data indicate that the SGP-complex is related to and probably is derived from the tissue form of Type VI collagen.

Isolation of cDNA clones corresponding to the Mr = 150,000 subunit of chick type VI collagen

Type VI collagen is a disulfide-bonded protein with an unusual structure in that the molecule contains three short triple-helical domains and very extended non-collagenous regions. The molecule is a heterotrimer composed in the chick of two polypeptides of similar apparent size in SDS-PAGE (Mr = 140- and 150,000) but different structure, and a third component that is much larger (Mr = 260,000) than the other two chains. We report here on the isolation of several overlapping cDNA clones from a chicken aorta mRNA expression library in the plasmid vector pEX1. Antibodies affinity purified onto the fusion proteins recognized the chick type VI collagen Mr = 150,000 subunit. Northern blots using the cDNA inserts from the above clones revealed a single RNA species of about 4,600 nucleotides sufficient to code for a protein with the size of the Mr = 150,000 subunit.

Characterization of three constituent chains of collagen type VI by peptide sequences and cDNA clones

Pepsin-solubilized collagen VI was prepared from human placenta and used to separate three constituent chains for determining partial amino acid sequences. Antibodies raised against the chains assisted in the identification and purification of several cDNA clones from three expression lambda gt11 libraries. Most of the clones hybridized to either a 3.5-kb or 4.2-kb mRNA species which by matching peptide and nucleotide sequences could be identified as coding for the alpha 2(VI) or alpha 1(VI) chain, respectively. Other clones hybridized to either an 8.5-kb mRNA which very likely encoded the alpha 3(VI) chain or to an unknown 2.0-kb mRNA. Northern blots revealed a considerable variation in the mRNA levels for each collagen VI chain in both skin and cornea fibroblasts and in several tumor cell lines. Limited sequence data generated from peptides and cDNA clones demonstrated a characteristic cysteine pattern at the junction between N-terminal globular domain and triple helix in all three chains. In addition, the data showed occasional interruptions of triplet sequences within the triple-helical domain and the presence of two Arg-Gly-Asp sequences which are potential cell-binding structures.

The tissue form of chicken type VI collagen

We have purified intact type VI collagen from chicken gizzard. The protein was found to consist of a 130 kDa, a 140 kDa and a 180-200 kDa subunit. The 130 kDa and 140 kDa subunits were obtained in equimolar amounts and identified as the alpha 2 (VI) and the alpha 1 (VI) chains, respectively. The third subunit was usually obtained in the form of 3-4 closely related polypeptides, which may represent different processing or modification products of the alpha 3 (VI) chain.

Type VI collagen: immunohistochemical identification as a filamentous component of the extracellular matrix of the developing avian corneal stroma

Selected stages of the developing chicken cornea have been examined for type VI collagen, employing monoclonal antibodies specific for this molecule. By immunofluorescence, the molecule is not detectable in 5 1/2 day corneas, a time at which the epithelial-derived, acellular primary stroma is the only corneal matrix present. One day later, the presumptive stromal fibroblasts have invaded this stroma and have initiated synthesis of the secondary (mature) stroma. By that time, a strong fluorescent signal for the type VI collagen molecule is detectable throughout the stroma. It is present in all subsequent ages examined. The molecule is not restricted to the cornea, and is present in most stromal matrices examined, including those of the sclera, eyelid, and nictitating membrane. Immunoelectron microscopy was also performed, utilizing a colloidal gold-labeled secondary antibody. These data show that the type VI collagen is not a component of the striated collagen fibrils, but instead is assembled in the form of thin filaments. The monoclonal antibody bound to the filaments at periodic intervals of about 100 nm.

Avian type VI collagen. Monoclonal antibody production and immunohistochemical identification as a major connective tissue component of cornea and skeletal muscle

Two monoclonal antibodies have been characterized as being against avian type VI collagen. By competition ELISA, the antibodies bound to the native type VI collagen molecule but not to its separated chains or to any of the other native collagen types tested. By rotary shadowing analysis of complexes of antibody-type VI collagen monomers, one of the antibodies (VI-EC6) has been shown to bind to a site in the triple helical domain of the molecule. The site at which this antibody binds to the dimeric form of type VI collagen is consistent with the previously proposed model for a supramolecular organization of the molecule (Furthmayr et al., Biochem j 211 (1983) 303) in which the monomers are arranged in an antiparallel, slightly staggered overlap. Immunofluorescence analyses of sections of chicken eyes and skeletal muscle demonstrate that type VI collagen is a major component of most stromal matrices.

Exposure of binding sites for antibodies and concanavalin A on collagen by solubilization in hot urea. An immunoblot analysis

The presence of urea during solubilization of collagenous samples for SDS PAGE had a marked effect upon mobility of collagenous polypeptides and upon binding of antibodies from certain rabbit antisera, antibodies from several human sera and binding of concanavalin A. When samples were solubilized with urea by heating at 100 degrees C the mobility of collagenous polypeptides was retarded relative to samples that had been heated without urea or exposed to urea without heating. Antibodies from the rabbit sera only bound on immunoblots to collagen that had been urea/heat-treated. Periodate oxidation and deglycosylation with trifluoromethanesulfonic acid abolished binding of the rabbit antibodies. The results indicate the presence of carbohydrate epitopes buried within collagenous polypeptides that are exposed by harsh denaturing conditions. Heating with urea appears to cause an unfolding of collagenous molecules beyond that produced by SDS solubilization without urea. These results underscore the necessity to pay close attention to conditions used to solubilize for electrophoresis samples that are subsequently used as targets for antibodies or other ligands.

Collagen types in various layers of the human aorta and their changes with the atherosclerotic process

The types of collagen components extracted from human aortas by repeated pepsin digestion were investigated by SDS-polyacrylamide gel electrophoresis (SDS-PAGE), after differential salt precipitation, cyanogen bromide (CNBr) cleavage and beta-mercaptoethanol reduction. For further extraction of collagen components, repeated pepsin digestion was carried out, and two extracts, the former and latter, were obtained. The greatest increase was seen in type V collagen followed by type III in the former extract. Type I collagen was continually extracted, so the proportion of type I to other types became greater with the number of extractions. SDS-PAGE of the residue treated with CNBr revealed that it contained the greatest amount of type I, followed by the latter extract. Type I collagen comprised approximately two-thirds of the total collagen. It was the most predominant in the intima and adventitia but was also obviously abundant in the media. The proportion of type III collagen to total collagen fell slightly with advancing atherosclerosis, since the amounts of types I and V showed some increase. A band of the alpha 3(V) chain of type V collagen in the intima was occasionally detected between the bands of the alpha 1(V) and alpha 2(V) chains. Basement membrane collagen, type IV, which was extracted predominantly from the intima and subintima, showed a heterogenous distribution as to molecular size, ranging from 50 Kd to 140 Kd. The alpha 1(IV) and alpha 2(IV) collagens were found at positions corresponding to 100 Kd and 80 Kd, respectively. The content of collagen type IV also increased with the proliferative fibrotic process. Type VI collagen was found in the intima and subintima of the human aorta at a position corresponding to an approximate molecular weight of 150 Kd, and it was reduced to fragments of 40 Kd, 45 Kd and 52 Kd.

Type VI collagen is a major component of the human cornea

Collagen type VI is shown to be present in the human cornea. This finding is based on comparative peptide mapping relative to type VI collagen isolated from placenta and on immunoblotting using antibodies specific for human type VI collagen. Scanning of polyacrylamide gels indicates that type VI collagen comprises as much as one quarter of the dry weight of the cornea. Indirect immunofluorescence shows this collagen to be distributed throughout the corneal stroma. Thus, type VI collagen must be considered a major component of the extracellular matrix of the human cornea.

The platelet reactivity of collagen type VI

Collagen type VI in native (undenatured or triple-helical) form has been shown, like collagen types I-V, alpha 1(I) trimer and alpha 2(I) trimer, to possess platelet reactivity provided that essential quaternary structural needs are first satisfied. Thus platelet aggregation was induced by the collagenous domain of collagen type VI, isolated free of the non-collagenous elements, when this entity was presented to platelets in fibrillar form. This implies that platelet recognition sites in collagen type VI are located in the collagenous sequence of the molecule. Aggregation of platelets was also induced, although a higher concentration was required, by the intact, "parent" collagen following its polymerisation by random association of molecules with the aid of a cross-linking agent (glutaraldehyde) to yield an amorphous polymer. This permits the suggestion that the more ordered molecular assembly of collagen type VI thought to occur in vivo, to yield a microfibrillar form, is likely to be associated with significant platelet reactivity. Our results support the notion that any collagenous species may be reactive towards platelets provided that essential tertiary and quaternary structural requirements are met and in this sense, therefore, they favour more the idea of multiple platelet-reactive sites in collagen of relatively low structural specificity and low affinity.

Structure and macromolecular organization of type VI collagen

Collagen VI is a large, disulfide-bonded protein complex which is widely distributed in connective tissue. The constituent polypeptide chains (Mr = 110,000-140,000) consist of collagenous and noncollagenous segments, are degraded to chains of about half the size when collagen VI is solubilized by pepsin, and assemble to a unique pattern of oligomers. As revealed by electron microscopy, the triple-stranded protomer consists of a triple helix 105 nm in length flanked on each side by globular domains of similar size (diameter about 7 nm). Protomers are assembled to dimers by an antiparallel staggered alignment of triple-helical segments. This leads to inner regions, 75 nm in length, of two slightly supercoiled triple helices flanked by globular domains. At both sides 30-nm-long outer triple-helical segments emerge that are terminated by globules. Tetramers are formed from laterally aligned dimers that cross with their outer triple-helical segments in a scissors-like fashion. The same structures, except with much smaller globular domains, are found in pepsin-treated collagen VI. Disulfide-linked collagen VI produced by cultured fibroblasts has a size similar to that of genuine collagen VI found in tissue extracts. Larger forms of collagen VI are assembled from tetramers by end-to-end aggregation which because of an overlap of the outer segments brings all globular domains close together. This arrangement predicts microfibrillar structures in tissues with a periodicity of 100-110 nm and a diameter of 5-10 nm. Structures consistent with this proposal were indeed found by immunoelectron microscopy of placenta and aorta using the ferritin technique. Large, lateral aggregates of collagen VI microfibrils may in addition exist in cell cultures and tissues ("zebra collagen," "Luse bodies") and are presumably maintained by contacts between globular domains.

Radioimmunoassay for human type VI collagen and its application to tissue and body fluids

A liquid phase radioimmunoassay (RIA) was developed for pepsin-solubilized human type VI collagen, allowing quantitative analysis of this protein down to a concentration of 3 ng/ml. No cross-reactivity was observed with human collagens type I, III, IV (triple helical portion and 7-S domain), and V, nor with laminin fragment Pl and plasma fibronectin. Significant amounts of closely related antigenic material were detected in serum, bile, ascites, and mesenchymal cell culture media. Type VI collagen could be completely solubilized from several tissues by a repeated pepsin digest, and its content as determined by RIA was found to be less than 0.1% of total collagen (55-70 micrograms/g protein). In fibrotic liver tissue type VI collagen was elevated up to 10-fold (620 micrograms/g protein) when compared to normal liver. Sera of patients with fibrotic liver disease, however, revealed antigen levels usually below the narrow normal range of 22 +/- 7.8 ng/ml (mean +/- 2.5 SD). We conclude that, although type VI collagen represents a minor fraction of the interstitial collagens, its comparatively high serum levels point to a considerable turnover in the normal individual. Our data suggest that in fibrosis as exemplified in fibrotic liver disease, the metabolism of this collagen is down-regulated, while at the same time, it accumulates in the interstitial matrix.

The role of cell adhesion proteins--laminin and fibronectin--in the movement of malignant and metastatic cells

Metastasizing tumor cells must traverse diverse extracellular matrices during dissemination. Extracellular matrices consist of two basic types, interstitial stroma and basement membranes. Extracellular matrices are chemically complex structures that interact with cell surfaces by a number of mechanisms. There has been a great deal of effort in recent years to understand the molecular nature of extracellular matrices, especially as it relates to the adhesion of normal and malignant cell types. Adhesive noncollagenous glycoproteins, such as laminin and fibronectin, serve pivotal roles in basement membrane and stromal matrices, respectively. These proteins participate in establishing the architecture of extracellular matrices as well as in attaching to the surface of cells and affecting cellular phenotype. This phenotypic effect ranges from adhesion and motility to growth and differentiation. Changes in adhesive characteristics and motility of cells have long been suspected to play a role in mediating the spread of malignant neoplasms. This article is designed to review extracellular matrix constituents that are currently known that can mediate the adhesion and motility of malignant neoplasms. The adhesion of normal and malignant cells to matrices is a complex process mediated by several distinct mechanisms which are initially manifested by changes in cytoskeletal architecture. The topic of normal and malignant cell adhesion to matrices will also be discussed in this regard, since any explanation of tumor cell migration must account for the complex dynamic interactions of the cell surface with the substratum as well as with the cytoskeleton. Finally, current efforts designed to understand the molecular nature of tumor cell:matrix interactions that contribute to metastatic behavior will also be discussed. The rationale behind these studies is that selective inhibition of specific tumor:extracellular matrix interactions can provide an avenue for therapeutic intervention of metastatic cancer.