1
|
Regular exposure to non-burning ultraviolet radiation reduces signs of non-alcoholic fatty liver disease in mature adult mice fed a high fat diet: results of a pilot study. BMC Res Notes 2019; 12:78. [PMID: 30744663 PMCID: PMC6371430 DOI: 10.1186/s13104-019-4112-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/06/2019] [Indexed: 02/08/2023] Open
Abstract
Objective Obesity often emerges in middle age, increasing risk for metabolic disorders. Our previous preclinical experiments identified that chronic exposure to non-burning ultraviolet radiation, like that achieved through sun exposure, prevented weight gain and signs of metabolic dysfunction in young adult mice fed a high fat diet. Our objective was to perform a pilot study to estimate the effect size of ongoing exposure to sub-erythemal (non-burning, low dose) UVB (1 kJ/m2) radiation on measures of adiposity, food intake and physical activity in ‘mature’ adult C57Bl/6J male mice fed a high fat diet for 12 weeks. Results The severity of liver steatosis, fibrosis and inflammation were reduced in older adult mice exposed twice a week to ultraviolet radiation (from 29 weeks of age), compared to mock-irradiated mice, with some evidence for reduced hepatic mRNAs for tnf and tgfß1 (not fatp2 nor fasN). Power analyses suggested that up to 24 mice per treatment would be required in future experiments to detect a significant effect on some markers of adiposity such as body weight gain. Our studies suggest frequent exposure to low levels of sunlight may reduce the severity of hepatic steatosis induced in older adults living in environments of high caloric intake. Electronic supplementary material The online version of this article (10.1186/s13104-019-4112-8) contains supplementary material, which is available to authorized users.
Collapse
|
2
|
Fleury N, Feelisch M, Hart PH, Weller RB, Smoothy J, Matthews VB, Gorman S. Sub-erythemal ultraviolet radiation reduces metabolic dysfunction in already overweight mice. J Endocrinol 2017; 233:81-92. [PMID: 28154004 DOI: 10.1530/joe-16-0616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/01/2017] [Indexed: 01/16/2023]
Abstract
Exposure to sunlight may limit cardiometabolic risk. In our previous studies, regular exposure to sub-erythemal (non-burning) ultraviolet radiation (UVR) reduced signs of adiposity and cardiometabolic dysfunction in mice fed a high-fat diet. Some of the observed effects were dependent on skin release of nitric oxide after UVR exposure. Here, we examine the effects of sub-erythemal UVR on signs of adiposity and metabolic dysfunction in already overweight mice, comparing the effects of two sunlamps with distinct emitted light spectra. Mice were fed a high-fat diet from 8 weeks of age, with UVR administered twice a week from 14 weeks of age until they were killed at 20 weeks of age. Mice were irradiated with the same dose of UVB radiation (1 kJ/m2) from either FS40 (65% UVB, 35% UVA) or CLEO (4% UVB, 96% UVA) sunlamps, but substantially more UVA from the latter. FS40 UVR (but not CLEO UVR) significantly reduced mouse weights and weight gain, compared to mice fed a high-fat diet (only). These effects were dependent on nitric oxide. Conversely, CLEO UVR (but not FS40 UVR) significantly reduced circulating LDL cholesterol. Both light sources reduced fasting insulin levels, and the extent of hepatic steatosis; the latter was reversed by topical application of cPTIO, suggesting an important role for skin release of nitric oxide in preventing hepatic lipid accumulation. These results suggest that there may be a number of benefits achieved by regular exposure to safe (non-burning) levels of sunlight or UV-containing phototherapy, with effects potentially dependent on the predominance of the wavelengths of UVR administered.
Collapse
Affiliation(s)
- Naomi Fleury
- Telethon Kids InstituteUniversity of Western Australia, Perth, Australia
| | - Martin Feelisch
- Clinical and Experimental SciencesFaculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Prue H Hart
- Telethon Kids InstituteUniversity of Western Australia, Perth, Australia
| | - Richard B Weller
- University of EdinburghMRC Centre for Inflammation Research, Edinburgh, Scotland
| | - Jordan Smoothy
- Telethon Kids InstituteUniversity of Western Australia, Perth, Australia
| | - Vance B Matthews
- School of Medicine and Pharmacology - Royal Perth Hospital UnitThe University of Western Australia, Perth, Australia
| | - Shelley Gorman
- Telethon Kids InstituteUniversity of Western Australia, Perth, Australia
| |
Collapse
|
3
|
Abstract
Living on a sun-drenched planet has necessitated adaption to and protection from the harmful effects of solar ultraviolet (UV) radiation, particularly skin cancer. However, convincing epidemiological and recent empirical evidence also supports a protective effect of UV against a range of diseases including multiple sclerosis, asthma and cardiovascular disease. Despite years of research attention into the biological effects of sunlight exposure, we are still far from being able to fully answer the question: How much sunlight is enough? This is probably because the answer is dependent on many complex and interacting variables. Many talented researchers are focused on exploring whether UV-induced vitamin D explains some of these effects. This perspectives article proposes an alternative hypothesis, namely that targeting UV-induced immune suppression by affecting the activation of regulatory cells and molecules will be of therapeutic benefit.
Collapse
Affiliation(s)
- Scott N Byrne
- Cellular Photoimmunology Group, Discipline of Infectious Diseases and Immunology, Sydney Medical School, University of Sydney, Australia.
| |
Collapse
|
4
|
Pharmacologically antagonizing the CXCR4-CXCL12 chemokine pathway with AMD3100 inhibits sunlight-induced skin cancer. J Invest Dermatol 2013; 134:1091-1100. [PMID: 24226205 DOI: 10.1038/jid.2013.424] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/28/2013] [Accepted: 09/06/2013] [Indexed: 11/08/2022]
Abstract
One way sunlight causes skin cancer is by suppressing anti-tumor immunity. A major mechanism involves altering mast cell migration via the C-X-C motif chemokine receptor 4-C-X-C motif chemokine ligand 12 (CXCR4-CXCL12) chemokine pathway. We have discovered that pharmacologically blocking this pathway with the CXCR4 antagonist AMD3100 prevents both UV radiation-induced immune suppression and skin cancer. The majority of control mice receiving UV-only developed histopathologically confirmed squamous cell carcinomas. In contrast, skin tumor incidence and burden was significantly lower in AMD3100-treated mice. Perhaps most striking was that AMD3100 completely prevented the outgrowth of latent tumors that occurred once UV irradiation ceased. AMD3100 protection from UV immunosuppression and skin cancer was associated with reduced mast cell infiltration into the skin, draining lymph nodes, and the tumor itself. Thus a major target of CXCR4 antagonism was the mast cell. Our results indicate that interfering with UV-induced CXCL12 by antagonizing CXCR4 significantly inhibits skin tumor development by blocking UV-induced effects on mast cells. Hence, the CXCR4-CXCL12 chemokine pathway is a novel therapeutic target in the prevention of UV-induced skin cancer.
Collapse
|
5
|
|
6
|
Gorman S, Scott NM, Tan DHW, Weeden CE, Tuckey RC, Bisley JL, Grimbaldeston MA, Hart PH. Acute erythemal ultraviolet radiation causes systemic immunosuppression in the absence of increased 25-hydroxyvitamin D3 levels in male mice. PLoS One 2012; 7:e46006. [PMID: 23049920 PMCID: PMC3458820 DOI: 10.1371/journal.pone.0046006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 08/27/2012] [Indexed: 12/17/2022] Open
Abstract
Vitamin D is synthesised by ultraviolet (UV) irradiation of skin and is hypothesized to be a direct mediator of the immunosuppression that occurs following UV radiation (UVR) exposure. Both UVR and vitamin D drive immune responses towards tolerance by ultimately increasing the suppressive activities of regulatory T cells. To examine a role for UVR-induced vitamin D, vitamin D3-deficient mice were established by dietary vitamin D3 restriction. In comparison to vitamin D3-replete mice, vitamin D3-deficient mice had significantly reduced serum levels of 25-hydroxyvitamin D3 (25(OH)D3, <20 nmol.L−1) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3, <20 pmol.L−1). Following either acute erythemal UVR, or chronic sub-erythemal UVR (8 exposures over 4 weeks) treatment, serum 25(OH)D3 levels significantly increased in vitamin D3-deficient female but not male mice. To determine if UVR-induced vitamin D was a mediator of UVR-induced systemic immunosuppression, responses were measured in mice that were able (female) or unable (male) to increase systemic levels of 25(OH)D3 after UVR. Erythemal UVR (≥4 kJ/m2) suppressed contact hypersensitivity responses (T helper type-1 or -17), aspects of allergic airway disease (T helper type-2) and also the in vivo priming capacity of bone marrow-derived dendritic cells to a similar degree in female and male vitamin D3-deficient mice. Thus, in male mice, UVR-induced 25(OH)D3 is not essential for mediating the immunosuppressive effects of erythemal UVR.
Collapse
Affiliation(s)
- Shelley Gorman
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Lipoteichoic acid from Lactobacillus rhamnosus GG as an oral photoprotective agent against UV-induced carcinogenesis. Br J Nutr 2012; 109:457-66. [DOI: 10.1017/s0007114512001225] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Probiotics are live micro-organisms that when administered in adequate amounts confer a health benefit on the host. Cell surface molecules of these micro-organisms are being studied in relation to their ability to interact with the host. The cell wall of lactobacilli possesses lipoteichoic acids (LTA) which are molecules with immunomodulatory properties. UV radiation (UVR) has been proposed as the main cause of skin cancer because of its mutagenic and immunosuppressive effects. Photoprotection with some nutrition interventions including probiotics has recently been shown. The aim of the present study was to investigate whether the oral administration of purified LTA from Lactobacillus rhamnosus GG can modulate the immune-suppressive effect of UVR and skin tumour development in female Crl:SKH-1-hrBR mice. For this purpose, two irradiation models were studied: (1) a chronic irradiation scheme consisting of daily irradiations during twenty consecutive days and (2) a long-term irradiation schedule, irradiating the animals three times per week, during 34 weeks for tumour development. The results showed that T-cells in the inguinal lymph node of LTA-treated mice produced higher levels of (1) interferon-γ and (2) a number of total, helper and cytotoxic T-cells compared with non-treated mice. Moreover, a significant delay in tumour appearance was found in LTA-treated mice. An increased IgA+ cell number was found in the small intestine together with a higher number of activated dendritic cells in the mesenteric lymph nodes. The latter results might be indicative of a direct effect of LTA in the gut, affecting the cutaneous immune system and restoring homeostasis through the gut–skin axis.
Collapse
|
8
|
Reversal of iC3b-inhibited dendritic cell differentiation via inhibition of the extracellular signal-regulated mitogen-activated protein kinase promotes CD4(+) T cell proliferation. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2012; 111:50-8. [PMID: 22513093 DOI: 10.1016/j.jphotobiol.2012.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 03/21/2012] [Accepted: 03/22/2012] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate the roles of ERK1/2 and p38 MAPK cascades in the differentiation of iC3b-combined CD14(+) monocyte into CD1a(+) MDDC, and to study how these cells influence CD4(+) T cell proliferation. METHODS CD14(+) monocyte was co-cultured with iC3b with or without inhibitors specific for ERK1/2 or p38 MAPK pathways for 2days, then the expressions of CD14, CD1a, phophso-ERK1/2, phophso-p38, IL-10 and IL-12 p70 were detected, and CD4(+) T cell proliferation was measured via (3)H-TdR as well. RESULTS Maturation of CD1a(+) DC was inhibited by iC3b along with downregulated expressions of CD1a, phophso-p38 and IL-12p70 and upregulated expressions of phophso-ERK1/2 and IL-10, and the CD4(+) T cell proliferation was restrained accordingly. When pretreated with inhibitor specific for ERK1/2 pathway, the inhibited maturation of imDC was reversed prominently with a higher level expression of CD1a and IL-12p70, whereas expressions of phophso-ERK1/2 and IL-10 were lowered, and accordingly the CD4(+) T cell proliferation restored significantly. CONCLUSIONS iC3b inhibited the differentiation of CD14(+) monocytes into CD1a(+) MDDCs via ERK1/2 pathway, and restoration of CD1a(+) MDDCs maturation occurred with the treatment of inhibitors specific for ERK1/2 pathway. Meanwhile, treatment of the inhibitor for the ERK1/2 cascade reversed the inhibited CD4(+) T cell proliferation, implying a potential possibility for clinical intervention.
Collapse
|
9
|
Ultraviolet exposure and non-Hodgkin's lymphoma: beneficial and adverse effects? Cancer Causes Control 2012; 23:653-5; author reply 657-8. [PMID: 22367726 DOI: 10.1007/s10552-012-9929-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
Abstract
Studies of risk of non-Hodgkin's lymphoma have found both direct and inverse correlations with respect to solar ultraviolet (UV) doses. Reduced risk is generally found in midlatitudes, while increased risk is generally found at higher latitudes. It is suggested that reduced risk arises from vitamin D production from UVB irradiance, while increased risk arises from immunosuppression associated with UVA irradiance. The ratio of UVA to UVB increases with increasing latitude.
Collapse
|
10
|
Halliday GM, Byrne SN, Damian DL. Ultraviolet A Radiation: Its Role in Immunosuppression and Carcinogenesis. ACTA ACUST UNITED AC 2011; 30:214-21. [DOI: 10.1016/j.sder.2011.08.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 08/07/2011] [Indexed: 11/29/2022]
|
11
|
Scott NM, Lambert MJM, Gorman S, McGlade JP, Hart PH. Differences in control by UV radiation of inflammatory airways disease in naïve and allergen pre-sensitised mice. Photochem Photobiol Sci 2011; 10:1894-901. [PMID: 22002339 DOI: 10.1039/c1pp05206c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Exposure of skin to UV radiation (UVR) prior to allergen exposure can inhibit inflammatory airways disease in mice by reducing effector CD4+ T cells in both the trachea and the airway draining lymph nodes. This study analysed the immunomodulatory properties of UVR delivered to naïve versus allergen pre-sensitised mice. In a model of inflammatory airways disease, BALB/c mice were sensitised by peritoneal injection of the allergen, ovalbumin (OVA) (20 μg/mouse), in the adjuvant, alum (4 mg/mouse), on days 0 and 14. On day 21, the mice were exposed to aerosolised OVA and 24 h later, proliferative responses by the cells in the airway draining lymph nodes were examined. UVR (8 kJ m(-2)) was administered 3 days prior to first OVA sensitisation (day -3), or OVA aerosol challenge (day 18). UVR before sensitisation reduced immune responses associated with expression of allergic airways disease; seven days after first OVA sensitisation, regulation of OVA-induced proliferation in vitro but not in vivo by CD4+CD25+ cells from UV-irradiated mice was detected. UVR administered to pre-sensitised mice regulated allergen responsiveness by cells from the airway draining lymph nodes only with a sensitisation protocol involving allergen and adjuvant at 5% strength of the original dose (1 μg OVA in 0.2 mg alum/mouse). These results suggest that UVR may modulate allergic airways disease by two mechanisms. The first, and more potent, is by reducing effector cells in respiratory tissues and requires UV delivery prior to sensitisation. The second, associated with administration to pre-sensitised mice, is weaker and is detected when the mice are sensitised with lower levels of allergen and adjuvant.
Collapse
Affiliation(s)
- Naomi M Scott
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, West Perth, Australia
| | | | | | | | | |
Collapse
|
12
|
Rana S, Rogers LJ, Halliday GM. Systemic low-dose UVB inhibits CD8 T cells and skin inflammation by alternative and novel mechanisms. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 178:2783-91. [PMID: 21641400 DOI: 10.1016/j.ajpath.2011.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/07/2011] [Accepted: 02/17/2011] [Indexed: 01/20/2023]
Abstract
Exposure to UVB radiation before antigen delivery at an unirradiated site inhibits functional immunological responses. Mice treated dorsally with suberythemal low-dose UVB and immunized with ova in abdominal skin generated ova-specific CD8 T cells with a significantly decreased activation, expansion, and cytotoxic activity compared with unirradiated mice. UVB also impaired the delayed-type hypersensitivity (DTH) reaction to ova. Transfer of CD4⁺CD25⁺cells from UVB-exposed mice did not suppress the ova-specific CD8 T-cell response or DTH reaction in unexposed mice, confirming that systemic low-dose UVB does not induce long-lived functional regulatory CD4⁺CD25⁺ T cells. Repairing cyclobutane pyrimidine dimer-type DNA damage and blocking aryl hydrocarbon receptor signaling also did not reverse the immunosuppressive effect of UVB on ova-specific CD8 T cells and DTH, suggesting that cyclobutane pyrimidine dimers and the aryl hydrocarbon receptor are not required in systemic low-dose UVB-induced immunosuppression. The known UVB chromophore, cis-urocanic acid, and reactive oxygen species triggered the inhibition of DTH caused by UVB, but they were not involved in the modulation of CD8 T cells. These findings indicate that systemic low-dose UVB impedes the primary response of antigen-specific CD8 T cells by a novel mechanism that is independent of pathways known to be involved in systemic suppression of DTH.
Collapse
Affiliation(s)
- Sabita Rana
- Discipline of Dermatology, Central Clinical School, Bosch Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | | |
Collapse
|
13
|
Linder N, Abudi Y, Abdalla W, Badir M, Amitai Y, Samuels J, Mendelson E, Levy I. Effect of season of inoculation on immune response to rubella vaccine in children. J Trop Pediatr 2011; 57:299-302. [PMID: 19889749 DOI: 10.1093/tropej/fmp104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The yearly seasons are marked by changes in the amount of sunlight. Ultraviolet radiation (UVR) is known to adversely affect the course of viral infections, immunologic memory and cellular and humoral immune responses. Our objectives were to investigate potential differences in the immune response of the rubella vaccine after 3-4 years by season of inoculation. Children aged 4-5 years attending four kindergartens in villages in northern Israel, all of whom had been vaccinated at 1 year of age, were enrolled in the study. Participants were divided into three groups by season of the year in which the inoculation was performed: summer (N = 63), winter (N = 36) and intermediate (N = 104). Main outcome measures were mean geometrical titer of rubella antibodies and complete, partial or no immunity to rubella by season of inoculation. Of the 203 children tested, 186 (91.6%) had adequate antibody levels, 7 (3.4%) had equivocal levels and 10 (4.9%) had inadequate levels. Significantly higher mean geometrical titers were found in the winter-inoculated compared with the summer-inoculated group (73.0 ± 2.6 vs 47.6 ± 2.8; p < 0.05). The same tendency was noted in the percent of infants properly immunized. This preliminary study shows a strong correlation between the immune response to rubella vaccine and the season of vaccination. Immunogenicity may be improved by inoculating children during seasons of less sunlight or by reducing the children's exposure to sunlight following inoculation. This practice is especially important in areas with extreme seasonal variability in solar radiation and tropical areas. Further studies are needed to corroborate and expand these findings.
Collapse
Affiliation(s)
- Nehama Linder
- Department of Neonatology, Rabin Medical Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Soontrapa K, Honda T, Sakata D, Yao C, Hirata T, Hori S, Matsuoka T, Kita Y, Shimizu T, Kabashima K, Narumiya S. Prostaglandin E2-prostaglandin E receptor subtype 4 (EP4) signaling mediates UV irradiation-induced systemic immunosuppression. Proc Natl Acad Sci U S A 2011; 108:6668-73. [PMID: 21460251 PMCID: PMC3081002 DOI: 10.1073/pnas.1018625108] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
UV radiation induces systemic immunosuppression. Because nonsteroidal anti-inflammatory drugs suppress UV-induced immunosuppression, prostanoids have been suspected as a crucial mediator of this UV effect. However, the identity of the prostanoid involved and its mechanism of action remain unclear. Here, we addressed this issue by subjecting mice deficient in each prostanoid receptor individually or mice treated with a subtype-specific antagonist to UV irradiation. Mice treated with an antagonist for prostaglandin E receptor subtype 4 (EP4), but not those deficient in other prostanoid receptors, show impaired UV-induced immunosuppression, whereas administration of an EP4 agonist rescues the impairment of the UV-induced immunosuppression in indomethacin-treated mice. The EP4 antagonist treatment suppresses an increase in the number of CD4(+)/forkhead box P3-positive (Foxp3(+)) regulatory T cells (Treg cells) in the peripheral lymph nodes (LNs) and dendritic cells expressing DEC205 in the LNs and the skin after UV irradiation. Furthermore, the EP4 antagonist treatment down-regulates UV-induced expression of receptor activator of NF-κB ligand (RANKL) in skin keratinocytes. Finally, administration of anti-RANKL antibody abolishes the restoration of UV-induced immunosuppression by EP4 agonism in indomethacin-treated mice. Thus, prostaglandin E(2) (PGE(2))-EP4 signaling mediates UV-induced immunosuppression by elevating the number of Treg cells through regulation of RANKL expression in the epidermis.
Collapse
MESH Headings
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Dendritic Cells/immunology
- Dendritic Cells/metabolism
- Dinoprostone/genetics
- Dinoprostone/immunology
- Dinoprostone/metabolism
- Female
- Gene Expression Regulation/drug effects
- Gene Expression Regulation/genetics
- Gene Expression Regulation/immunology
- Gene Expression Regulation/radiation effects
- Immune Tolerance/drug effects
- Immune Tolerance/genetics
- Immune Tolerance/immunology
- Immune Tolerance/radiation effects
- Indomethacin/pharmacology
- Lymph Nodes/immunology
- Lymph Nodes/metabolism
- Mice
- Mice, Transgenic
- RANK Ligand/biosynthesis
- RANK Ligand/genetics
- RANK Ligand/immunology
- Receptors, Prostaglandin E, EP4 Subtype/antagonists & inhibitors
- Receptors, Prostaglandin E, EP4 Subtype/genetics
- Receptors, Prostaglandin E, EP4 Subtype/immunology
- Receptors, Prostaglandin E, EP4 Subtype/metabolism
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Ultraviolet Rays/adverse effects
Collapse
Affiliation(s)
- Kitipong Soontrapa
- Department of Pharmacology
- Department of Pharmacology, Mahidol University Faculty of Medicine, Siriraj Hospital, Bangkok 10700, Thailand
| | - Tetsuya Honda
- Department of Pharmacology
- Department of Dermatology, and
| | | | | | | | - Shohei Hori
- Research Unit for Immune Homeostasis, RIKEN Research Center for Allergy and Immunology, Yokohama 230-0045, Japan; and
| | | | - Yoshihiro Kita
- Department of Biochemistry and Molecular Biology, University of Tokyo Faculty of Medicine, Tokyo 113-0033, Japan
| | - Takao Shimizu
- Department of Biochemistry and Molecular Biology, University of Tokyo Faculty of Medicine, Tokyo 113-0033, Japan
| | | | - Shuh Narumiya
- Department of Pharmacology
- Japan Science and Technology Agency, Core Research for Evolutional Science and Technology (CREST), Kyoto University Faculty of Medicine, Kyoto 606-8501, Japan
| |
Collapse
|
15
|
Gorman S, Judge MA, Hart PH. Topical 1,25-dihydroxyvitamin D3 subverts the priming ability of draining lymph node dendritic cells. Immunology 2011; 131:415-25. [PMID: 20561084 DOI: 10.1111/j.1365-2567.2010.03315.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The active form of vitamin D, 1,25-hydroxyvitamin D(3) [1,25(OH)(2)D(3)] is produced in skin following exposure to sunlight. It is also used topically to control inflammatory skin diseases by stimulating keratinocyte differentiation and suppressing immune responses. Administration of 1,25(OH)(2)D(3) to the skin of mice increases the capacity of CD4(+) CD25(+) (Foxp3(+) ) regulatory T cells residing in the skin-draining lymph nodes (SDLN) to suppress immune responses. We hypothesized that dendritic cells (DC) may migrate from the skin to the lymph nodes to regulate T-cell function. Increased proportions of skin-derived DC (CD11c(+) ClassII(+) DEC-205(hi) CD8(lo)) cells were detected in the SDLN 18 hr after topical 1,25(OH(2) D(3) treatment of mouse skin. The capacity of DC from the SDLN to take up, process and present antigen to co-cultured T cells was not modified following topical 1,25(OH)(2)D(3). However, CD11c(+) cells from the SDLN of 1,25(OH)(2)D(3)-treated mice induced a significantly smaller ear-swelling response in a T helper type 1/17-mediated model of contact hypersensitivity. CD4(+) CD25(+) cells isolated from the ear-draining lymph nodes (EDLN) of mice that received ear injections of CD11c(+) cells from donor mice topically treated with 1,25(OH)(2)D(3) more potently suppressed effector cell proliferation. In addition, EDLN cells from recipients of CD11c(+) cells from 1,25(OH)(2)D(3)-treated mice produced increased interleukin-4 levels. The CD11c(+) cells from the SDLN of mice treated with topical 1,25(OH)(2)D(3) expressed increased levels of indoleamine 2,3-dioxygenase messenger RNA, a molecule by which topical 1,25(OH)(2)D(3) may enhance the ability of DC to control the suppressive function of CD4(+) CD25(+) cells.
Collapse
Affiliation(s)
- Shelley Gorman
- Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
| | | | | |
Collapse
|
16
|
Weill FS, Cela EM, Ferrari A, Paz ML, Leoni J, Gonzalez Maglio DH. Skin exposure to chronic but not acute UV radiation affects peripheral T-cell function. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2011; 74:838-847. [PMID: 21598169 DOI: 10.1080/15287394.2011.570228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ultraviolet (UV) radiation (UVR) produces deleterious effects that may finally lead to carcinogenesis. These adverse effects include tissue inflammation, free radical formation with consequent oxidation of proteins and lipids, DNA damage, and immune function suppression. The aim of this study was to evaluate the effects of UVR at the local and systemic levels following acute (4 consecutive days with 0.5 minimal erythema dose [MED]) or chronic (20 consecutive days with 0.25 MED) exposure. Locally, histological alterations and epidermal T-cell populations were studied. Systemically, inguinal lymph-node and spleen T cells were analyzed with respect to proliferative response and cytokine production against a nonspecific mitogen. Lymph-node T-cell populations were also characterized. Our results indicated that while both acute and chronic UVR produced epidermal hyperplasia and a decrease in epidermal T-cell density, acute UVR increased T-cell proliferative response, while chronic UVR produced the opposite effect, shifting the cytokine production toward a Th2/Treg profile. Therefore, even though acute irradiation produced a direct effect on skin, it did not correlate with a marked modification of overall T-cell response, which is in contrast to marked effects in chronically irradiated animals. These findings may contribute to understanding the clinical relevance of occupational UVR exposure, typically related to outdoor activities, which is associated with nonmelanoma skin carcinogenesis.
Collapse
Affiliation(s)
- Federico S Weill
- Immunology Department, Pharmacy and Biochemistry School, University of Buenos Aires, Argentina.
| | | | | | | | | | | |
Collapse
|
17
|
Gorman S, Judge MA, Hart PH. Gene regulation by 1,25-dihydroxyvitamin D3 in CD4+CD25+ cells is enabled by IL-2. J Invest Dermatol 2010; 130:2368-76. [PMID: 20574434 DOI: 10.1038/jid.2010.167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Vitamin D may be responsible for reducing the development and severity of autoimmune and allergic diseases. Topically applied 1,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)) enhances the immunoregulatory ability of CD4+CD25+ T cells residing in the skin-draining lymph nodes (SDLNs) of mice. The mechanisms responsible were investigated by examining the expression of 84 cytokine and cytokine-related genes in a 96-well gene array. CD4+CD25+ cells isolated from the SDLNs of BALB/c mice, 24 and 96 hours after topical treatment with 1,25(OH)(2)D(3), consistently expressed increased IL-2 mRNA levels and also secreted enhanced quantities of IL-2 after ex vivo stimulation with phorbol 12-myristate 13-acetate and ionomycin. CD4+CD25+ cells from the lymph nodes of naive mice constitutively express the vitamin D receptor, allowing direct modulation by 1,25(OH)(2)D(3). However, in vitro treatment with 1,25(OH)(2)D(3) did not modify the expression of 84 tested cytokine and cytokine-related mRNAs. It was only in the presence of IL-2 that 1,25(OH)(2)D(3) increased the expression of genes including IL-2 and TLR4. Further, 1,25(OH)(2)D(3) enhanced the ability of IL-2 to stimulate CD4+CD25+ cells to proliferate in vitro and also regulate contact hypersensitivity responses on adoptive transfer into naive mice. Therefore, 1,25(OH)(2)D(3) enabled by IL-2 can directly enhance the regulatory potential of CD4+CD25+ T cells to control immune disease.
Collapse
Affiliation(s)
- Shelley Gorman
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
| | | | | |
Collapse
|
18
|
Gorman S, Judge MA, Burchell JT, Turner DJ, Hart PH. 1,25-dihydroxyvitamin D3 enhances the ability of transferred CD4+ CD25+ cells to modulate T helper type 2-driven asthmatic responses. Immunology 2010; 130:181-92. [PMID: 20059575 DOI: 10.1111/j.1365-2567.2009.03222.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The severity of allergic diseases may be modified by vitamin D. However, the immune pathways modulated by the active form of vitamin D, 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)], are yet to be fully elucidated. In this study, naturally occurring CD4(+) CD25(+) cells from the skin-draining lymph nodes (SDLN) of mice treated with topical 1,25(OH)(2)D(3) had an increased ability to suppress T helper type 2 (Th2) -skewed immune responses. CD4(+) CD25(+) cells transferred from mice treated with topical 1,25(OH)(2)D(3) into ovalbumin (OVA) -sensitized mice challenged intranasally with OVA 18 hr later, significantly suppressed the capacity of airway-draining lymph node (ADLN) cells to proliferate and secrete cytokines in response to further OVA stimulation ex vivo. The CD4(+) CD25(+) cells from 1,25(OH)(2)D(3)-treated mice also reduced airway hyperresponsiveness and the proportions of neutrophils and eosinophils in bronchoalveolar lavage fluid (BALF). To test the effect of 1,25(OH)(2)D(3) on cells able to respond to a specific antigen, CD4(+) CD25(+) cells were purified from the SDLN of OVA-T-cell receptor (TCR) transgenic mice treated 4 days earlier with topical 1,25(OH)(2)D(3). CD4(+) CD25(+) cells from OVA-TCR mice treated with 1,25(OH)(2)D(3) were able to alter BALF cell content and suppress ADLN responses to a similar degree to those cells from non-transgenic mice, suggesting that the effect of 1,25(OH)(2)D(3) was not related to TCR signalling. In summary, topical 1,25(OH)(2)D(3) increased the regulatory capacity of CD4(+) CD25(+) cells from the SDLN to suppress Th2-mediated allergic airway disease. This work highlights how local 1,25(OH)(2)D(3) production by lung epithelial cells may modulate the suppressive activity of local regulatory T cells.
Collapse
Affiliation(s)
- Shelley Gorman
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
| | | | | | | | | |
Collapse
|
19
|
Kerkvliet NI. AHR-mediated immunomodulation: the role of altered gene transcription. Biochem Pharmacol 2008; 77:746-60. [PMID: 19100241 DOI: 10.1016/j.bcp.2008.11.021] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 11/07/2008] [Accepted: 11/10/2008] [Indexed: 12/14/2022]
Abstract
The immune system is a sensitive target for aryl hydrocarbon receptor (AHR)-mediated transcriptional regulation. Most of the cells that participate in immune responses express AHR protein, and many genes involved in their responses contain multiple DRE sequences in their promoters. However, the potential involvement of many of these candidate genes in AHR-mediated immunomodulation has never been investigated. Many obstacles to understanding the transcriptional effects of AHR activation exist, owing to the complexities of pathogen-driven inflammatory and adaptive immune responses, and to the fact that activation of AHR often influences the expression of genes that are already being regulated by other transcriptional events in responding cells. Studies with TCDD as the most potent, non-metabolized AHR ligand indicate that AHR activation alters many inflammatory signals that shape the adaptive immune response, contributing to altered differentiation of antigen-specific CD4(+) T helper (TH) cells and altered adaptive immune responses. With TCDD, most adaptive immune responses are highly suppressed, which has been recently linked to the AHR-dependent induction of CD4(+)CD25(+) regulatory T cells. However activation of AHR by certain non-TCDD ligands may result in other immune outcomes, as a result of metabolism of the ligand to active metabolites or to unknown ligand-specific effects on AHR-mediated gene transcription. Based on studies using AHR(-/-) mice, evidence for a role of endogenous AHR ligands in regulation of the immune response is growing, with bilirubin and lipoxinA4 representing two promising candidates.
Collapse
Affiliation(s)
- Nancy I Kerkvliet
- Department of Environmental and Molecular Toxicology and Environmental Health Sciences Center, Oregon State University, Corvallis, OR 97331, USA.
| |
Collapse
|
20
|
Halliday GM, Rana S. Waveband and dose dependency of sunlight-induced immunomodulation and cellular changes. Photochem Photobiol 2008; 84:35-46. [PMID: 18173699 DOI: 10.1111/j.1751-1097.2007.00212.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Both the UVB and UVA wavebands within sunlight are immunosuppressive. This article reviews the relationship between wavebands and dose in UV-induced immunosuppression mainly concentrating on responses in humans. It also contrasts the effects of UVB and UVA on cellular changes involved in immunosuppression. Over physiological sunlight doses to which humans can be exposed during routine daily living or recreational pursuits, both UVA and UVB suppress immunity. While there is a linear dose relationship with UVB commencing at doses less than half of what is required to cause sunburn, UVA has a bell-shaped dose response over the range to which humans can be realistically exposed. At doses too low for either waveband to be suppressive, interactions between UVA and UVB augment each other, enabling immunosuppression to occur. At doses beyond where UVA is immunosuppressive, it still contributes to sunlight-induced immunosuppression via this interaction with UVB. While there is little research comparing the mechanisms by which UVB, UVA and their interactions can cause immunosuppression, it is likely that different chromophores and early molecular events are involved. There is evidence that both wavebands disrupt antigen presentation and effect T cell responses. Different individuals are likely to have different immunomodulatory responses to sunlight.
Collapse
Affiliation(s)
- Gary M Halliday
- Dermatology Research Laboratories, Melanoma and Skin Cancer Research Institute and Bosch Institute, University of Sydney, Sydney, NSW, Australia.
| | | |
Collapse
|
21
|
Rana S, Byrne SN, MacDonald LJ, Chan CYY, Halliday GM. Ultraviolet B suppresses immunity by inhibiting effector and memory T cells. THE AMERICAN JOURNAL OF PATHOLOGY 2008; 172:993-1004. [PMID: 18292235 DOI: 10.2353/ajpath.2008.070517] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Contact hypersensitivity is a T-cell-mediated response to a hapten. Exposing C57BL/6 mice to UV B radiation systemically suppresses both primary and secondary contact hypersensitivity responses. The effects of UVB on in vivo T-cell responses during UVB-induced immunosuppression are unknown. We show here that UVB exposure, before contact sensitization, inhibits the expansion of effector CD4+ and CD8+ T cells in skin-draining lymph nodes and reduces the number of CD4+ and IFN-gamma+ CD8+ T cells infiltrating challenged ear skin. In the absence of UVB, at 10 weeks after initial hapten exposure, the ear skin of sensitized mice was infiltrated by dermal effector memory CD8+ T cells at the site of challenge. However, if mice were previously exposed to UVB, this cell population was absent, suggesting an impaired development of peripheral memory T cells. This finding occurred in the absence of UVB-induced regulatory CD4+ T cells and did not involve prostaglandin E2, suggesting that the importance of these two factors in mediating or initiating UVB-induced immunosuppression is dependent on UVB dose. Together these data indicate that in vivo T-cell responses are prone to immunoregulation by UVB, including a novel effect on both the activated T-cell pool size and the development of memory T cells in peripheral compartments.
Collapse
Affiliation(s)
- Sabita Rana
- Department of Medicine, Melanoma and Skin Cancer Research Institute, Sydney Cancer Centre, The University of Sydney, NSW 2006, Australia
| | | | | | | | | |
Collapse
|
22
|
Hori T, Kuribayashi K, Uemoto S, Saito K, Wang L, Torii M, Shibutani S, Taniguchi K, Yagi S, Iida T, Yamamoto C, Kato T. Alloantigen-specific prolongation of allograft survival in recipient mice treated by alloantigen immunization following ultraviolet-B irradiation. Transpl Immunol 2007; 19:45-54. [PMID: 18346637 DOI: 10.1016/j.trim.2007.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 11/01/2007] [Accepted: 11/16/2007] [Indexed: 11/27/2022]
Abstract
It is well documented that ultraviolet (UV) radiation present in sunlight suppresses immune responses. However, the majority of studies documenting the immunosuppressive effects of UV irradiation have been carried out in animals exposed to UV irradiation before immunization. Here, we report that recipient mice exposed to UV irradiation 7 days after immunization with a donor alloantigen exhibited prolongation of allograft survival in an alloantigen-specific manner. Recipient mice (H-2(b)) intravenously immunized with 2 x 10(7) allogeneic spleen cells (H-2(b/d)) 7 days before UV irradiation (40 kJ/m(2)) showed prolonged survival of allografts presenting the alloantigen used for sensitization (H-2(b/d)), but not third-party allografts (H-2(b/k)). Adoptive transfer experiments revealed that CD4(+) T cells in UV-irradiated recipients were responsible for this prolongation. CD4(+) T cells that could transfer the suppression produced large amounts of interleukin (IL)-10, but not IL-4. The effect of UV irradiation on alloantigen-specific immunosuppression was cancelled by administration of an anti-IL-10 monoclonal antibody. These results indicate that UV irradiation given after alloantigen immunization induces alloantigen-specific type 1 regulatory T cell-like regulatory T cells that prolong allograft survival and imply that the difficulties associated with predicting donor-related organ availability in transplantation can be dealt with, given the effectiveness of UV irradiation after immunization.
Collapse
Affiliation(s)
- Tomohide Hori
- Department of Cellular and Molecular Immunology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Gorman S, Kuritzky LA, Judge MA, Dixon KM, McGlade JP, Mason RS, Finlay-Jones JJ, Hart PH. Topically applied 1,25-dihydroxyvitamin D3 enhances the suppressive activity of CD4+CD25+ cells in the draining lymph nodes. THE JOURNAL OF IMMUNOLOGY 2007; 179:6273-83. [PMID: 17947703 DOI: 10.4049/jimmunol.179.9.6273] [Citation(s) in RCA: 212] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The immunomodulatory effects of vitamin D have been described following chronic oral administration to mice or supplementation of cell cultures with 1,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)), the active form of vitamin D. In this study, topically applied 1,25(OH)(2)D(3), enhanced the suppressive capacity of CD4(+)CD25(+) cells from the draining lymph nodes. The effects of topical 1,25(OH)(2)D(3) were compared with those of UVB irradiation, which is the environmental factor required for 1,25(OH)(2)D(3) production in skin. CD4(+) cells from the skin-draining lymph nodes (SDLN) of either 1,25(OH)(2)D(3)-treated or UVB-irradiated mice had reduced capacity to proliferate to Ags presented in vitro, and could suppress Ag-specific immune responses upon adoptive transfer into naive mice. This regulation was lost upon removal of CD4(+)CD25(+) cells. Furthermore, purified CD4(+)CD25(+) cells from the SDLN of 1,25(OH)(2)D(3)-treated or UVB-irradiated mice compared with equal numbers of CD4(+)CD25(+) cells from control mice had increased capacity to suppress immune responses in both in vitro and in vivo assay systems. Following the sensitization of recipient mice with OVA, the proportion of CD4(+)Foxp3(+) cells of donor origin significantly increased in recipients of CD4(+)CD25(+) cells from the SDLN of 1,25(OH)(2)D(3)-treated mice, indicating that these regulatory T cells can expand in vivo with antigenic stimulation. These studies suggest that 1,25(OH)(2)D(3) may be an important mediator by which UVB-irradiation exerts some of its immunomodulatory effects.
Collapse
Affiliation(s)
- Shelley Gorman
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Australia
| | | | | | | | | | | | | | | |
Collapse
|
24
|
McGlade JP, Gorman S, Zosky GR, Larcombe AN, Sly PD, Finlay-Jones JJ, Turner DJ, Hart PH. Suppression of the asthmatic phenotype by ultraviolet B-induced, antigen-specific regulatory cells. Clin Exp Allergy 2007; 37:1267-76. [PMID: 17845406 DOI: 10.1111/j.1365-2222.2007.02750.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Over recent decades, there has been a significant global increase in the prevalence of asthma, an inflammatory disease of the respiratory system. While ultraviolet radiation (UV) has been used successfully in the treatment of inflammatory conditions such as psoriasis, studies of UV-induced regulation of allergic respiratory responses have been rare, and have not analysed in vivo measurements of airway hyperresponsiveness (AHR) or the antigen specificity of the UV-induced effects. OBJECTIVE To investigate the regulatory properties of erythemal ultraviolet B (UVB) irradiation of the skin and the induction of allergen-induced airway immunity in a murine asthma model, and to examine the mechanisms involved. METHODS BALB/c mice were exposed to a single erythemal dose of UV 3 days before intraperitonial sensitization (day 0) and boost (day 14) with the antigen, ovalbumin (OVA). Airway-associated, asthma-like responses to aerosolized OVA at day 21 were analysed including (a) AHR measured in vivo, (b) OVA-specific proliferative responses and cytokine production by cells from the lung-draining lymph nodes (LDLN), and (c) inflammatory cells and cytokines in the bronchoalveolar lavage fluid. To determine UVB-induced mechanisms of regulation, LDLN cells from UVB irradiated, OVA-sensitized mice were adoptively transferred into naïve BALB/c mice that were subsequently sensitized and challenged with OVA, or a non-specific antigen. RESULTS UVB irradiation of skin significantly suppressed AHR to methacholine and OVA-specific responses in the LDLN and in the lung compartment. Reduced OVA-specific responses by LDLN cells from both UVB irradiated mice and mice that received 5 x 10(6) LDLN cells from UVB irradiated, but not from non-irradiated, OVA-sensitized mice suggested that UVB-induced regulatory cells are responsible for many of the asthma-reducing effects of dorsal UVB exposure. CONCLUSION UVB irradiation of skin suppresses AHR and cellular responses of the airways to respiratory allergens. Further, this study implicates UVB or its downstream mediators as a potential approach to reducing the severity of asthma.
Collapse
Affiliation(s)
- J P McGlade
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | | | | | | | | | | | | | | |
Collapse
|