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Soeiro MNC, De Souza EM, Stephens CE, Boykin DW. Aromatic diamidines as antiparasitic agents. Expert Opin Investig Drugs 2006; 14:957-72. [PMID: 16050790 DOI: 10.1517/13543784.14.8.957] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Parasitic infections are widespread in developing countries and frequently associated with immunocompromised patients in developed countries. Consequently, such infections are responsible for a significant amount of human mortality, morbidity and economic hardship. A growing consensus has identified the urgent need for the development of new antiparasitic compounds, mostly due to the large number of drug-resistant parasites and the fact that currently available drugs are expensive, highly toxic, require long treatment regimens and frequently exhibit significantly reduced activity towards certain parasite strains and evolutive stages. In this context, the activity of aromatic diamidines has been explored against a widespread range of micro-organisms, and the authors' present aim is to review the current status of chemotherapy with these compounds against human parasitic infections.
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Affiliation(s)
- M N C Soeiro
- Lab. Biologia Celular, DUBC, Instituto Oswaldo Cruz, FIOCRUZ, Avenida Brasil 4365, Manguinhos, 21045-900, Rio de Janeiro, RJ, Brazil.
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Affiliation(s)
- Souria M. Donya
- Department of Genetics and Cytology, National Research Center, Egypt
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Barber L, Prince HM, Rossi R, Bertoncello I. Fluoro-Gold: An alternative viability stain for multicolor flow cytometric analysis. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/(sici)1097-0320(19990801)36:4<349::aid-cyto10>3.0.co;2-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Miyahira Y, Dvorak JA. Kinetoplastidae display naturally occurring ancillary DNA-containing structures. Mol Biochem Parasitol 1994; 65:339-49. [PMID: 7969274 DOI: 10.1016/0166-6851(94)90084-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Kinetoplast-derived, DNA-containing structures were found in several members of the order Kinetoplastida. The structures, for which we propose the name ancillary DNA-containing structures (aDNA), were discovered during the course of low-light-level video fluorescence microscopy studies using several nucleic acid-specific fluorescent reagents. DNase treatment and supravital stain with Höechst 33342 confirmed that aDNA is not an artifact of specimen preparation. Fluorescent in situ hybridization using either a 122-bp kinetoplast DNA-specific probe derived from a conserved region of minicircle DNA or a 188-bp nuclear DNA-specific probe derived from highly repetitive nuclear DNA demonstrated that aDNA is derived from the kinetoplast and not the nucleus. However, the structures do not contain minicircle DNA replication intermediates. Immunofluorescence assays using an anti-mitochondrial protein antibody, anti-mtp70, demonstrated that the structures contain mitochondrial protein and confirmed their kinetoplast origin. The frequency of occurrence of aDNA varies markedly between members of the Kinetoplastida. In the case of Trypanosoma cruzi stocks, the percentage of cells with aDNA was positively correlated to the population doubling time of the stock. However, there is no statistically significant relationship between the developmental or replicative stage of the parasite and the frequency of aDNA. An inhibitor of DNA topoisomerase I had no effect upon the frequency of aDNA. An inhibitor of DNA topoisomerase II gave equivocal results depending upon the parasite stock used. We speculate that aDNA may be the morphological consequence of a yet-to-be-determined biological process intrinsic to but variable within the Kinetoplastida.
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Affiliation(s)
- Y Miyahira
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852-1727
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LaVail JH, Carter SR, Topp KS. The retrograde tracer Fluoro-Gold interferes with the infectivity of herpes simplex virus. Brain Res 1993; 625:57-62. [PMID: 8242400 DOI: 10.1016/0006-8993(93)90137-c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fluoro-Gold has been used previously to identify those trigeminal ganglion cells that innervate the central cornea. To examine the effects of Fluoro-Gold treatment on infection and spread of HSV in vivo, we measured the number of plaque forming units recovered from trigeminal ganglia 3 or 5 days after corneal scratch and inoculation with Fluoro-Gold and HSV. Treatment with Fluoro-Gold reduced the amount of virus recovered after retrograde transport 63% at 3 days and 28% at 5 days after inoculation. When we examined trigeminal ganglion sections from animals treated with HSV and Fluoro-Gold, we found the number of neurons double labeled with antibodies that recognize HSV and Fluoro-Gold was only 13% of all Fluoro-Gold labeled neurons. This was significantly fewer cells that we had anticipated, on the basis of double labeling experiments with wheat germ agglutinin combined with Fluoro-Gold. The effects of varying doses of the retrograde tracer, Fluoro-Gold on Herpes simplex virus (type 1) (HSV) infectivity were also assayed in vitro using a standard viral plaque assay. At 1 x 10(-3) mg/ml Fluoro-Gold there was no effect on the number of plaque forming units. At 5 x 10(-1) mg/ml the number of plaques was reduced about 67%. We conclude that Fluoro-Gold interferes with productive HSV infection in vivo and in vitro after retrograde transport of HSV by neurons.
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Affiliation(s)
- J H LaVail
- Department of Anatomy and Neuroscience Program, University of California at San Francisco 94143
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Abstract
African trypanosomiasis continues to pose a challenge for the development of new chemotherapy. Type II topoisomerases, essential enzymes in nucleic acid metabolism, have proven highly suitable as targets for antibacterial and antitumor therapy. Well-characterized topoisomerase II inhibitors affect the cognate nuclear and mitochondrial enzymes in Trypanosoma equiperdum. Inhibition is accompanied by extensive fragmentation and structural alteration in nuclear and mitochondrial DNA. Some clinically important antitrypanosomal drugs bind to DNA (i.e., pentamidine, isometamidium, diminazene). These agents inhibit the mitochondrial, but not nuclear, topoisomerase II of trypanosomes. These studies suggest that type II topoisomerase inhibitors may prove to be effective and safe new antitrypanosomal drugs.
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Affiliation(s)
- T A Shapiro
- Johns Hopkins University School of Medicine, Baltimore, MD 21205
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Chitambo H, Arakawa A, Ono T. In vivo assessment of drug sensitivity of African trypanosomes using the akinetoplastic induction test. Res Vet Sci 1992; 52:243-9. [PMID: 1374928 DOI: 10.1016/0034-5288(92)90017-v] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Following treatment of mice infected with Trypanosoma congolense or T brucei brucei with various doses of isometamidium chloride or diminazene aceturate, the induction of akinetoplastic (AK) forms was observed in the trypomastigotes of both species within 10 hours of drug administration. The levels of AK-induction were closely correlated with the levels of resistance to each compound found using a standard in vivo drug assay in mice. In general, ineffective doses of either compound conferred AK-induction rates of less than 30 per cent; relapsing cases had between 30 and 50 per cent while curative doses had AK-induction rates of 50 per cent or more. In vivo determination of AK-induction rates using ordinary light microscopy is thus a potentially feasible alternative indicator to the conventional use of mice infection and treatment methods for assessing drug sensitivity in African trypanosomes.
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Affiliation(s)
- H Chitambo
- Department of Veterinary Science, College of Agriculture, University of Osaka Prefecture, Japan
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Abstract
Determining the mechanism by which fluorescent retrograde neuronal tracers are taken up requires knowledge of their composition. It has been claimed that Fluoro-Gold, a retrogradely transported fluorescent neuronal tracer, is 2-hydroxy-4,4'-diamidinostilbene (hydroxystilbamidine), an amidine antibiotic. However, this appears questionable, since the fluorescence spectrograms reported for Fluoro-Gold differ markedly from the spectrograms previously reported for purified hydroxystilbamidine. To help clarify the mechanism by which Fluoro-Gold might be taken up, it was decided to examine its composition and determine whether hydroxystilbamidine was its active agent. Fluoro-Gold was found by mass spectrometry to contain a component with a molecular weight of 280 Da (identical to that of hydroxystilbamidine), and fluorescence spectroscopy demonstrated the existence of a substance with a fluorescence spectrum similar to that of purified hydroxystilbamidine. Although a major fluorescent impurity was also observed, chromatographic separation of different fluorescent components of Fluoro-Gold suggested that the fraction resembling hydroxystilbamidine was responsible for its retrograde labeling of cells. It is concluded that hydroxystilbamidine is the active constituent of Fluoro-Gold. Chemically, hydroxystilbamidine is a weak base. In this respect it resembles True blue, DAPI, Granular blue, bis-benzimide, Nuclear yellow, and several other retrogradely transported molecules. It is suggested that these agents cross cell membranes in their uncharged form and are trapped in lysosomes and endosomes by a favorable pH gradient. Thus, the uptake of this type of retrograde tracer may be an example of a well-understood process occurring widely throughout biological systems: the trapping of weak bases in acidic cellular compartments.
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Affiliation(s)
- M W Wessendorf
- Department of Cell Biology and Neuroanatomy, University of Minnesota, Minneapolis 55455
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Shapiro TA, Englund PT. Selective cleavage of kinetoplast DNA minicircles promoted by antitrypanosomal drugs. Proc Natl Acad Sci U S A 1990; 87:950-4. [PMID: 2153980 PMCID: PMC53387 DOI: 10.1073/pnas.87.3.950] [Citation(s) in RCA: 145] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Pentamidine, diminazene aceturate (Berenil), isometamidium chloride (Samorin), and ethidium bromide, which are important antitrypanosomal drugs, promote linearization of Trypanosoma equiperdum minicircle DNA (the principal component of kinetoplast DNA, the mitochondrial DNA in these parasites). This effect occurs at therapeutically relevant concentrations. The linearized minicircles are protease sensitive and are not digested by lambda exonuclease (a 5' to 3' exonuclease), indicating that the break is double stranded and that protein is bound to both 5' ends of the molecule. The cleavage sites map to discrete positions in the minicircle sequence, and the cleavage pattern varies with different drugs. These findings are characteristic for type II topoisomerase inhibitors, and they mimic the effects of the antitumor drug etoposide (VP16-213, a semisynthetic podophyllotoxin analog) on T. equiperdum minicircles. However, the antitrypanosomal drugs differ dramatically from etoposide in that they do not promote detectable formation of nuclear DNA-protein complexes or of strand breaks in nuclear DNA. Selective inhibition of a mitochondrial type II topoisomerase may explain why these antitrypanosomal drugs preferentially disrupt mitochondrial DNA structure and generate dyskinetoplastic trypanosomes (which lack mitochondrial DNA).
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Affiliation(s)
- T A Shapiro
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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Kerschmann RL, Wolfson JS, McHugh GL, Dickersin GR, Hooper DC, Swartz MN. Novobiocin-induced ultrastructural changes and antagonism of DNA synthesis in Trypanosoma cruzi amastigotes growing in cell-free medium. THE JOURNAL OF PROTOZOOLOGY 1989; 36:14-20. [PMID: 2651651 DOI: 10.1111/j.1550-7408.1989.tb02669.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The antimicrobial agent novobiocin, an inhibitor of the bacterial enzyme topoisomerase II (DNA gyrase), is known to antagonize Trypanosoma cruzi amastigotes growing in cell-free medium. To determine sites of antagonism of novobiocin, the effects of drug on parasite ultrastructure and incorporation of radiolabeled precursors of DNA, RNA and protein into macromolecules were determined. The predominant ultrastructural abnormality seen after exposure to 0.40 mM novobiocin for 24 h was the presence of electron-dense clumps in the mitochondrion-kinetoplast organelle in 95 of 257 (37%) of cells, in comparison to no clumps seen in 110 drug-free cells. In addition, in the nucleus, the karyosome was less distinct than in control cells and appeared to merge with the chromatin. In the radiolabeling studies, incorporation of thymidine was inhibited in a dose-dependent fashion by novobiocin (0.16-0.80 mM) in a range of drug concentrations that also inhibited parasite growth. For 0.16 and 0.24 mM novobiocin, incorporation of thymidine was inhibited up to 65% relative to drug-free control cells while uptake of uridine and leucine was unaltered. We interpret these ultrastructure and precursor-incorporation studies as suggesting that (i) the mitochondrion-kinetoplast and possibly the nucleus are sites of novobiocin antagonism of T. cruzi amastigotes and (ii) that novobiocin appears to antagonize DNA synthesis within these organisms. Whether the drug target is topoisomerase II, however, is as yet unknown.
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Affiliation(s)
- R L Kerschmann
- Department of Pathology, Massachusetts General Hospital, Boston 02114
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Affiliation(s)
- V B Braide
- Department of Pharmacology, College of Medical Sciences, University of Calabar, Nigeria
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Mercado TI, Butany JW, Ferrans VJ. Trypanosoma cruzi: ultrastructural changes produced by an anti-trypanosomal factor from Pseudomonas fluorescens. Exp Parasitol 1986; 61:65-75. [PMID: 3080328 DOI: 10.1016/0014-4894(86)90136-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Trypomastigotes and amastigotes of Trypanosoma cruzi exhibited distinct ultrastructural alterations when treated with an extracellular lytic substance (anti-trypanosomal factor) produced by Pseudomonas fluorescens. Marked swelling of the parasites and detachment of the plasma membrane from the subjacent cytoplasm were observed after 15 min of treatment. After 3 hr, the nucleus was extensively damaged, the kinetoplast was indistinguishable, the mitochondrion was markedly swollen, the cytoplasm was disrupted, and the plasma membrane showed extensive blebbing and focal loss of subpellicular microtubules. These changes were progressive, as shown by the occurrence of parasite ghosts after 10 hr. Amastigotes exhibited an extremely swollen mitochondrion with disrupted internal structure, widening of the perinuclear space, and blebbing of the external nuclear membrane. The kinetoplast, however, remained clearly discernible. The drugs used today in controlling Chagas' disease are toxic. Therefore, there is a need for new anti-trypanosomal agents such as the Pseudomonas fluorescens antibiotics. The observations described in this study indicate the potential chemotherapeutic usefulness of these compounds for this disease.
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Zaar K, Wunderlich F, Belehu A. Electron microscopical studies on cutaneous leishmaniasis in Ethiopia. I. The diffuse form and its treatment with pentamidine. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1982; 76:595-605. [PMID: 7171248 DOI: 10.1080/00034983.1982.11687589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Croft SL, Brazil RP. Effect of pentamidine isethionate on the ultrastructure and morphology of Leishmania mexicana amazonensis in vitro. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1982; 76:37-43. [PMID: 7082077 DOI: 10.1080/00034983.1982.11687502] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Riou G, Baltz T, Gabillot M, Pautrizel R. Absence of kinetoplast DNA in a late antigenic variant of Trypanosoma equiperdum. Mol Biochem Parasitol 1980; 1:97-105. [PMID: 7442712 DOI: 10.1016/0166-6851(80)90004-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We have analysed by several biochemical techniques the DNA components of two antigenic variants isolated from Trypanosoma equiperdum. We did not observe any kinetoplast DNA (kDNA) structures or networks in the late antigen variant BoTat 28. Furthermore, the results of reassociation kinetics of in vitro labelled kDNA show that neither kDNA minicircle sequences nor kDNA maxicircle sequences of BoTat 1, the basic antigen type, can be detected in the total DNA of BoTat 28.
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Williamson J, McLaren DJ. Effects of DAPI a new diamidine trypanocide, on the ultrastructure of Trypanosoma rhodesiense. Trans R Soc Trop Med Hyg 1978; 72:660-1. [PMID: 734728 DOI: 10.1016/0035-9203(78)90029-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Bénard J, Riou G. Effects of 9-hydroxy ellipticine on in vitro transcription of Trypanosoma cruzi DNAs. Biochem Biophys Res Commun 1977; 77:1189-95. [PMID: 332175 DOI: 10.1016/s0006-291x(77)80105-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hentzer B, Kobayasi T. The ultrastructural changes of Leishmania tropica after treatment with pentamidine. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1977; 71:157-66. [PMID: 869606 DOI: 10.1080/00034983.1977.11687174] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effect of the antiprotozoal drug pentamidine on the ultrastructure of the amastigote stage of Leishmania tropica was studied. The most remarkable change introduced by the treatment occurred in the kinetoplast-mitochondrion complex. All mitochondria were extremely enlarged and most kinetoplasts disintegrated into a network of fine filaments. The flagellar pocket was frequently dilated and filled with various quantities of double-membrane bounded bodies ejected from the pocket wall. The multivesicular bodies and lipid droplets were enlarged. The number of ribosomal granules decreased. Many protozoa had an irregular shape and damaged internal structure. The drug-induced changes of L. tropica are discussed in relation to similar effects previously observed in trypanosomes.
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Damper D, Patton CL. Pentamidine transport and sensitivity in brucei-group trypanosomes. THE JOURNAL OF PROTOZOOLOGY 1976; 23:349-56. [PMID: 6797 DOI: 10.1111/j.1550-7408.1976.tb03787.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sensitivity to pentamidine of bloodstream forms and culture forms of Trypanosoma brucei brucei, strains of this subspecies, and strains of T. brucei rhodesiense characteristically differs in vitro. Analyses of transport parameters for pentamidine uptake in these organisms show differences that correspond with drug sensitivity. Long slender bloodstream forms of T. b. brucei have a high affinity for the drug and high rates of uptake at indicated by Km and Vmax values for [3H]pentamidine transport. Although pentamidine and stilbamidine resistance is associated with dyskinetoplasty, this condition does not itself confer resistance to pentamidine nor does it affect pentamidine transport. However, drug-resistant strains show lower rates for pentamidine transport as does T. b. rhodesiense, which is characteristically less sensitive to the drug. Of all the forms and strains studied, procyclic trypomastigotes were least sensitive to pentamidine and had a remarkable ability to exclude the drug.
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Folds JD, Orlando G, Spitznagel JK. Immunosuppression by hydroxystilbamidine isethionate, a lysosome-stabilizing, anti-proteolytic, antifungal drug. Infect Immun 1975; 11:441-4. [PMID: 1090530 PMCID: PMC415083 DOI: 10.1128/iai.11.3.441-444.1975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hydroxystilbamidine (HSB) is a potent suppressor of the plaque-forming cell response of mice injected with heterologous erythrocytes. HSB, given in varying doses and injection schedules, suppressed both the primary and secondary immune responses to bovine serum albumin. Apparently the effect is not simply a toxic effect on spleen cells, because there was no appreciable difference in cell numbers between control and HSB-treated mice. The effect of HSB was most apparent in the early phase of the immune respone.
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Macadam RF, Williamson J. Drug effects on the fine structure of Trypanosoma rhodesiense: acriflavine, ethidium and antrycide. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1974; 68:291-9. [PMID: 4447388 DOI: 10.1080/00034983.1974.11686951] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Simpson L, Berliner J. Isolation of the kinetoplast DNA of Leishmania tarentolae in the form of a network. THE JOURNAL OF PROTOZOOLOGY 1974; 21:382-93. [PMID: 4838484 DOI: 10.1111/j.1550-7408.1974.tb03675.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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De Souza W, Meyer H. On the fine structure of the nucleus in Trypanosoma cruzi in tissue culture forms. Spindle fibers in the dividing nucleus. THE JOURNAL OF PROTOZOOLOGY 1974; 21:48-52. [PMID: 4594241 DOI: 10.1111/j.1550-7408.1974.tb03615.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Brack C, Delain E, Riou G, Festy B. Molecular organization of the kinetoplast DNA of Trypanosoma cruzi treated with berenil, a DNA interacting drug. JOURNAL OF ULTRASTRUCTURE RESEARCH 1972; 39:568-79. [PMID: 4556327 DOI: 10.1016/s0022-5320(72)90122-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Macadam RF, Williamson J. Drug effects on the fine structure of Trypanosoma rhodesiense: diamidines. Trans R Soc Trop Med Hyg 1972; 66:897-904. [PMID: 4678907 DOI: 10.1016/0035-9203(72)90125-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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