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Effects of a Calorie-Restricted Diet on the Content of Phospholipids in the Brain and Cognitive Functions in Rats. NEUROPHYSIOLOGY+ 2012. [DOI: 10.1007/s11062-012-9287-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mahesh R, Bhuvana S, Begum VMH. Effect of Terminalia chebula aqueous extract on oxidative stress and antioxidant status in the liver and kidney of young and aged rats. Cell Biochem Funct 2009; 27:358-63. [PMID: 19548245 DOI: 10.1002/cbf.1581] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We evaluated the preventive effects of Terminalia chebula (T. chebula) aqueous extract on oxidative and antioxidative status in liver and kidney of aged rats compared to young albino rats. The concentrations of malondialdehyde (MDA), lipofuscin (LF), protein carbonyls (PCO), activities of xantione oxidase (XO), manganese-superoxide dismutase (MnSOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), glutathione-S-transferase (GST), and glucose-6-phosphate dehydrogenase (G6PDH), levels of glutathione (GSH), vitamin C and vitamin E were used as biomarkers. In the liver and kidney of aged animals, enhanced oxidative stress was accompanied by compromised antioxidant defences. Administration of aqueous extract of T. cheubla effectively modulated oxidative stress and enhanced antioxidant status in the liver and kidney of aged rats. The results of the present study demonstrate that aqueous extract of T. cheubla inhibits the development of age-induced damages by protecting against oxidative stress.
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Affiliation(s)
- Ramalingam Mahesh
- Department of Siddha Medicine, Faculty of Science, Tamil University, Thanjavur, Tamilnadu, India.
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3
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Gomez-Pinilla F. The influences of diet and exercise on mental health through hormesis. Ageing Res Rev 2008; 7:49-62. [PMID: 17604236 PMCID: PMC3225189 DOI: 10.1016/j.arr.2007.04.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 04/17/2007] [Accepted: 04/20/2007] [Indexed: 12/23/2022]
Abstract
It is likely that the capacity of the brain to remain healthy during aging depends upon its ability to adapt and nurture in response to environmental challenges. In these terms, main principles involved in hormesis can be also applied to understand relationships at a higher level of complexity such as those existing between the CNS and the environment. This review emphasizes the ability of diet, exercise, and other lifestyle adaptations to modulate brain function. Exercise and diet are discussed in relationship to their aptitude to impact systems that sustain synaptic plasticity and mental health, and are therefore important for combating the effects of aging. Mechanisms that interface energy metabolism and synaptic plasticity are discussed, as these are the frameworks for the actions of cellular stress on cognitive function. In particular, neurotrophins are emerging as main factors in the equation that may connect lifestyle factors and mental health.
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Affiliation(s)
- Fernando Gomez-Pinilla
- Division of Neurosurgery, Brain Injury Research Center, UCLA Medical School, Los Angeles, CA 90095, USA.
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Prokai L, Simpkins JW. Structure-nongenomic neuroprotection relationship of estrogens and estrogen-derived compounds. Pharmacol Ther 2007; 114:1-12. [PMID: 17336390 PMCID: PMC1905848 DOI: 10.1016/j.pharmthera.2007.01.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 01/24/2007] [Indexed: 11/25/2022]
Abstract
Nongenomic estrogen signaling pathways involve extranuclear estrogen receptors or function independently from estrogen receptors. These pathways participate in neuroprotection elicited by the hormone. Additional nongenomic neuroprotective effects are attributable to antioxidant and antiinflammatory actions of estrogens. Numerous chemical modifications to afford neuroprotective compounds from estrogens while eliminating estrogenicity and maintaining or enhancing nongenomic neuroprotection have been described. This review highlights recent structure-activity studies that revealed the importance of antioxidant effects for neuroprotective estrogen analogues and derivatives.
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Affiliation(s)
- Laszlo Prokai
- Department of Molecular Biology & Immunology, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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5
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Effect of vitamin C on lipid hydroperoxides and carbonyl groups content of rat plasma depending on age and acute heat exposure. J Therm Biol 2006. [DOI: 10.1016/j.jtherbio.2006.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Prokai L, Prokai-Tatrai K, Perjési P, Simpkins JW. Mechanistic insights into the direct antioxidant effects of estrogens. Drug Dev Res 2006. [DOI: 10.1002/ddr.20050] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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7
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Skrzydlewska E, Sulkowska M, Koda M, Sulkowski S. Proteolytic-antiproteolytic balance and its regulation in carcinogenesis. World J Gastroenterol 2005; 11:1251-66. [PMID: 15761961 PMCID: PMC4250670 DOI: 10.3748/wjg.v11.i9.1251] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cancer development is essentially a tissue remodeling process in which normal tissue is substituted with cancer tissue. A crucial role in this process is attributed to proteolytic degradation of the extracellular matrix (ECM). Degradation of ECM is initiated by proteases, secreted by different cell types, participating in tumor cell invasion and increased expression or activity of every known class of proteases (metallo-, serine-, aspartyl-, and cysteine) has been linked to malignancy and invasion of tumor cells. Proteolytic enzymes can act directly by degrading ECM or indirectly by activating other proteases, which then degrade the ECM. They act in a determined order, resulting from the order of their activation. When proteases exert their action on other proteases, the end result is a cascade leading to proteolysis. Presumable order of events in this complicated cascade is that aspartyl protease (cathepsin D) activates cysteine proteases (e.g., cathepsin B) that can activate pro-uPA. Then active uPA can convert plasminogen into plasmin. Cathepsin B as well as plasmin are capable of degrading several components of tumor stroma and may activate zymogens of matrix metalloproteinases, the main family of ECM degrading proteases. The activities of these proteases are regulated by a complex array of activators, inhibitors and cellular receptors. In physiological conditions the balance exists between proteases and their inhibitors. Proteolytic-antiproteolytic balance may be of major significance in the cancer development. One of the reasons for such a situation is enhanced generation of free radicals observed in many pathological states. Free radicals react with main cellular components like proteins and lipids and in this way modify proteolytic-antiproteolytic balance and enable penetration damaging cellular membrane. All these lead to enhancement of proteolysis and destruction of ECM proteins and in consequence to invasion and metastasis.
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Affiliation(s)
- Elzbieta Skrzydlewska
- Department of Analytical Chemistry, Medical University of Bialystok, Mickiewicza 2, 15-230 Bialystok, Poland.
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van Haaften RIM, Haenen GRMM, Evelo CTA, Bast A. Effect of vitamin E on glutathione-dependent enzymes. Drug Metab Rev 2003; 35:215-53. [PMID: 12959415 DOI: 10.1081/dmr-120024086] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Reactive oxygen species and various electrophiles are involved in the etiology of diseases varying from cancer to cardiovascular and pulmonary disorders. The human body is protected against damaging effects of these compounds by a wide variety of systems. An important line of defense is formed by antioxidants. Vitamin E (consisting of various forms of tocopherols and tocotrienols) is an important fat-soluble, chain-breaking antioxidant. Besides working as an antioxidant, this compound possesses other functions with possible physiological relevance. The glutathione-dependent enzymes form another line of defense. Two important enzymes in this class are the free radical reductase and glutathione S-transferases (GSTs). The GSTs are a family of phase II detoxification enzymes. They can catalyze glutathione conjugation with various electrophiles. In most cases the electrophiles are detoxified by this conjugation, but in some cases the electrophiles are activated. Antioxidants do not act in isolation but form an intricate network. It is, for instance, known that vitamin E, together with glutathione (GSH) and a membrane-bound heat labile GSH-dependent factor, presumably an enzyme, can prevent damaging effects of reactive oxygen species on polyunsaturated fatty acids in biomembranes (lipid peroxidation). This manuscript reviews the interaction between the two defense systems, vitamin E and glutathione-dependent enzymes. On the simplest level, antioxidants such as vitamin E have protective effects on glutathione-dependent enzymes; however, we will see that reality is somewhat more complicated.
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Affiliation(s)
- Rachel I M van Haaften
- Department of Pharmacology and Toxicology, Faculty of Medicine, Universiteit Maastricht, Maastricht, The Netherlands.
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Boots AW, Haenen GRMM, den Hartog GJM, Bast A. Oxidative damage shifts from lipid peroxidation to thiol arylation by catechol-containing antioxidants. BIOCHIMICA ET BIOPHYSICA ACTA 2002; 1583:279-84. [PMID: 12176395 DOI: 10.1016/s1388-1981(02)00247-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Catechol-containing antioxidants are able to protect against lipid peroxidation by nonenzymatic scavenging of free radicals with their catechol moiety. During their antioxidant activity, catechol oxidation products such as semiquinone radicals and quinones are formed. These oxidation products of 4-methylcatechol inactivate the GSH-dependent protection against lipid peroxidation and the calcium sequestration in liver microsomes. This effect is probably due to arylation by oxidation products of 4-methylcatechol of free thiol groups of the enzymes responsible for the GSH-dependent protection and calcium sequestration, i.e. the free radical reductase and calcium ATPase. It is concluded that a catechol-containing antioxidant might shift radical damage from lipid peroxidation to sulfhydryl arylation.
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Affiliation(s)
- Agnes W Boots
- Department of Pharmacology and Toxicology, Faculty of Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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van Haaften RI, Evelo CT, Haenen GR, Bast A. No reduction of alpha-tocopherol quinone by glutathione in rat liver microsomes. Biochem Pharmacol 2001; 61:715-9. [PMID: 11266656 DOI: 10.1016/s0006-2952(01)00545-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The cell membrane is protected against lipid peroxidation by endogenous antioxidants such as vitamin E (alpha-tocopherol). The oxidised form of alpha-tocopherol (alpha-tocopherol quinone) does not have this antioxidant function. However, the literature indicates that alpha-tocopherol quinone can be reduced to alpha-tocopherol in vivo and thereby will add to the total antioxidant potential (Moore AN, Ingold KU. Free Radic Biol Med 1997;22:931-4). We found that GSH (reduced glutathione) did not mediate the reduction of alpha-tocopherol quinone, either directly in solution or in rat liver microsomes fortified with alpha-tocopherol quinone. This renders GSH a less likely candidate for alpha-tocopherol quinone reduction in vivo. In addition, alpha-tocopherol quinone did not enhance GSH-dependent protection against lipid peroxidation, either in control microsomes, or in vitamin E-extracted microsomes. Indeed, alpha-tocopherol quinone blocked GSH-dependent protection against lipid peroxidation in vitamin E-extracted microsomes. This indicates that alpha-tocopherol quinone can act as a pro-oxidant.
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Affiliation(s)
- R I van Haaften
- Department of Pharmacology and Toxicology, Faculty of Medicine, Universiteit Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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van Acker FA, Schouten O, Haenen GR, van der Vijgh WJ, Bast A. Flavonoids can replace alpha-tocopherol as an antioxidant. FEBS Lett 2000; 473:145-8. [PMID: 10812062 DOI: 10.1016/s0014-5793(00)01517-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Endogenous antioxidants such as the lipid-soluble vitamin E protect the cell membranes from oxidative damage. Glutathione seems to be able to regenerate alpha-tocopherol via a so-called free radical reductase. The transient protection by reduced glutathione (GSH) against lipid peroxidation in control liver microsomes is not observed in microsomes deficient in alpha-tocopherol. Introduction of antioxidant flavonoids, such as 7-monohydroxyethylrutoside, fisetin or naringenin, into the deficient microsomes restored the GSH-dependent protection, suggesting that flavonoids can take over the role of alpha-tocopherol as a chain-breaking antioxidant in liver microsomal membranes.
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Affiliation(s)
- F A van Acker
- Department of Medical Oncology, BR-232, University Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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12
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Arivazhagan P, Thilakavathy T, Panneerselvam C. Antioxidant lipoate and tissue antioxidants in aged rats. J Nutr Biochem 2000; 11:122-7. [PMID: 10742655 DOI: 10.1016/s0955-2863(99)00079-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Oxidative metabolism produces free radicals that must be removed from the cellular environment for the cell to survive. The levels of nonenzymic antioxidants involved in the elimination of free radicals were investigated in an attempt to correlate any changes in the levels of enzymic antioxidants during aging with changes in free radical mediated cellular damage. Antioxidants were measured in liver and kidney of young and aged rats with respect to DL-alpha-lipoic acid supplemented rats. In both organs lipid peroxidation damage (a marker of free radical mediated damage) increased with age, and a significant decrease in antioxidant systems was observed. Moreover, DL-alpha-lipoic acid treated aged rats showed a decrease in the level of lipid peroxides and an increase in the antioxidant status. The results of this study provide evidence that DL-alpha-lipoic acid treatment can improve antioxidants during aging and minimize the age-associated disorders in which free radicals are the major cause.
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Affiliation(s)
- P Arivazhagan
- Department of Medical Biochemistry, Dr. A.L. Mudaliar Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai, India
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Kelley EE, Wagner BA, Buettner GR, Burns CP. Nitric oxide inhibits iron-induced lipid peroxidation in HL-60 cells. Arch Biochem Biophys 1999; 370:97-104. [PMID: 10496982 DOI: 10.1006/abbi.1999.1386] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nitric oxide ((*)NO) can protect cells against the detrimental effects of reactive oxygen species. Using low-density lipoprotein as well as model systems, it has been demonstrated that (*)NO can serve as a chain-breaking antioxidant to blunt lipid peroxidation. To test the hypothesis that (*)NO can serve as a chain-breaking antioxidant in cell membranes, we examined the effect of (*)NO on iron-induced lipid peroxidation in human leukemia cells. We exposed HL-60 cells to an oxidative stress (20 microM Fe(2+)) and monitored the consumption of oxygen as a measure of lipid peroxidation. Oxygen consumption was arrested by the addition of (*)NO as a saturated aqueous solution. The duration of inhibition of oxygen consumption by (*)NO was concentration-dependent in the 0.4-1.8 microM range. The inhibition ended upon depletion of (*)NO. The addition of (*)NO prior to initiation of peroxidation delayed the onset of peroxidation; the nearer in time it was before Fe(2+) addition, the longer the inhibition. Depletion of cellular glutathione levels by d, l-buthionine-S,R-sulfoximine prior to Fe(2+) addition resulted in a more rapid initial rate of oxygen depletion and a shorter time for the (*)NO-induced inhibition of oxygen consumption. Complementary studies of this iron-induced lipid peroxidation, using thiobarbituric acid reactive substances as a marker, also demonstrated the protective effects of (*)NO. This protection of cells against lipid peroxidation also manifested itself as a reduction in trypan blue uptake, an observation demonstrating the protective effects of (*)NO on membrane integrity. We conclude that (*)NO protects HL-60 human leukemia cells from lipid peroxidation and that this protection ameliorates the toxicity of the oxidation processes initiated by Fe(2+) and dioxygen.
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Affiliation(s)
- E E Kelley
- Department of Medicine, The University of Iowa College of Medicine, Iowa City, Iowa, 52242, USA
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Lii CK, Ko YJ, Chiang MT, Sung WC, Chen HW. Effect of dietary vitamin E on antioxidant status and antioxidant enzyme activities in Sprague-Dawley rats. Nutr Cancer 1999; 32:95-100. [PMID: 9919618 DOI: 10.1080/01635589809514725] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The effect of dietary vitamin E on plasma, red blood cells (RBC), hepatic antioxidant status, and antioxidant enzyme activities was investigated. Three groups of six Sprague-Dawley rats were fed 0, 100, or 1,500 ppm vitamin E for eight weeks. Plasma alpha-tocopherol level was increased significantly by increasing dietary vitamin E (p < 0.05). Plasma lipid peroxidation (thiobarbituric acid-reactive substances) stimulation by 1 mM t-butyl hydroperoxide was correlated with dietary vitamin E level and was significantly greater in rats fed no vitamin E than in rats fed 100 or 1,500 ppm vitamin E (p < 0.05). RBC reduced glutathione (GSH) level was positively correlated with dietary vitamin E and was significantly greater in rats fed 1,500 ppm vitamin E than in rats fed 0 or 100 ppm vitamin E (p < 0.05). RBC oxidized glutathione was negatively correlated with dietary vitamin E. GSH redox status was expressed as the GSH-to-total GSH ratio; the ratio was also positively correlated with dietary vitamin E and was significantly greater in rats fed 1,500 ppm vitamin E than in rats fed no vitamin E (p < 0.05). For antioxidant enzymes, superoxide dismutase activity in hepatic cytosolic fraction was significantly greater in rats fed 1,500 ppm vitamin E than in rats fed 100 ppm vitamin E. Hepatic GSH reductase activity was significantly greater in rats fed 100 ppm vitamin E than in rats fed no vitamin E (p < 0.05). Dietary vitamin E had no effect on plasma vitamin C and protein thiol levels. In the systems studied, results indicated that dietary vitamin E selectively influences plasma vitamin E level, RBC GSH status, and hepatic cytosolic superoxide dismutase and GSH reductase activities.
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Affiliation(s)
- C K Lii
- Department of Nutrition, Chung Shan Medical College, Taichung, Taiwan
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15
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Mercury exacerbates cyclosporin nephrotoxicity in rats. Clin Exp Nephrol 1998. [DOI: 10.1007/bf02480562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tariq M, Morais C, Kishore PN, Biary N, Al Deeb S, Al Moutaery K. Neurological recovery in diabetic rats following spinal cord injury. J Neurotrauma 1998; 15:239-51. [PMID: 9555970 DOI: 10.1089/neu.1998.15.239] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This study was designed to assess the effect of spinal cord injury on neurobehavioral, electrophysiological, structural, and biochemical changes in normal and diabetic rats. Experimental diabetes was induced in Sprague-Dawley male rats (weighing 250-280 g) with streptozotocin (50 mg/kg i.p.). Eight weeks after the treatment with streptozotocin the animals were anaesthetized with chloral hydrate and laminectomy was performed at T 7-8 level leaving the dura intact. A compression plate (2.2 x 5.0 mm) loaded with a weight of 35 g was placed on the exposed spinal cord for 5 min. Postoperative neurological function was assessed using inclined plane test, modified Tarlov score, and vocal and sensory score daily for 10 days. Electrophysiological changes were assessed using somatosensory and corticomotor evoked-potentials. The animals were sacrificed at different time intervals and injured site of the spinal cord was analyzed for changes in vitamin E and glutathione levels (as markers of oxidative stress). Pathological changes in spinal cord were also studied using light microscopy. The data on neurobehavioral study clearly indicated that the compression of spinal cord produced highly significant neurological deficit and poor recovery in diabetic rats as compared to nondiabetic rats. Our histopathological and electrophysiological results also confirmed that diabetic animals are more susceptible to compressive spinal cord injury as compared to nondiabetic animals. A higher depletion of antioxidant defense markers (vitamin E and glutathione) was observed in diabetic rats as compared to nondiabetic rats. These results point toward the role of free radicals in poor recovery in diabetic rats following neurotrauma. Further studies are warranted to assess the neuroprotective potential of antioxidants to retard the secondary pathophysiological events following neurotrauma and to enhance the recovery.
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Affiliation(s)
- M Tariq
- Department of Neurosurgery and Research Center, Armed Forces Hospital, Riyadh, Saudi Arabia
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Scholz RW, Reddy PV, Wynn MK, Graham KS, Liken AD, Gumpricht E, Reddy CC. Glutathione-dependent factors and inhibition of rat liver microsomal lipid peroxidation. Free Radic Biol Med 1997; 23:815-28. [PMID: 9296460 DOI: 10.1016/s0891-5849(97)00067-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The effects of reduced glutathione (GSH) and glutathione disulfide (GSSG) on lipid peroxidation were investigated in rat liver microsomes containing deficient or adequate amounts of alpha-tocopherol (alpha-TH). Rates of formation of thiobarbituric acid reactive substances (TBARS) as well as rates of consumption of alpha-TH and O2 were decreased by GSH and were more pronounced in the NADPH-dependent assay system than in the ascorbate-dependent system. The GSH-dependent inhibition of lipid peroxidation was potentiated by GSSG in the NADPH-dependent assay system, but it had no effect in the nonenzymatic system. Diphenyliodonium chloride, an inhibitor of NADPH cytochrome P-450 reductase, completely prevented lipid peroxidation in the NADPH-dependent assay system whereas it had no effect on the ascorbate-dependent system. This is further evidenced by the fact that purified rat liver microsomal NADPH cytochrome P-450 reductase (EC 1.6.2.4) was inhibited approximately 24% and 52% by 5 mM GSH and 5 mM GSH + 2.5 mM GSSG, respectively. Glutathione disulfide alone had no effect on reductase activity. Similarly, other disulfides such as cystine, cystamine and lipoic acid were without effect on reductase activity. These results clearly delineate different mechanisms underlying the combined effects of GSH and GSSG on microsomal lipid peroxidation in rat liver. One mechanism involves recycling of microsomal alpha-TH by GSH during oxidative stress via a labile protein, ostensibly associated with "free radical reductase" activity. A second glutathione-dependent mechanism appears to be mediated through the inhibition of NADPH cytochrome P-450 reductase. The enhanced inhibition by GSH + GSSG of microsomal lipid peroxidation in the NADPH-dependent assay system suggests suppression of the initiation phase at the level of NADPH cytochrome P-450 reductase which is independent of microsomal alpha-TH.
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Affiliation(s)
- R W Scholz
- Environmental Resources Research Institute and Department of Veterinary Science, The Pennsylvania State University, University Park 16802, USA
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Suntres ZE, Shek PN. Alleviation of paraquat-induced lung injury by pretreatment with bifunctional liposomes containing alpha-tocopherol and glutathione. Biochem Pharmacol 1996; 52:1515-20. [PMID: 8937465 DOI: 10.1016/s0006-2952(96)89626-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Reactive oxygen species are known to play a key role in the development of acute lung injury, and such injury can be alleviated by pretreating the lung with a suitable antioxidant preparation. In this study, we evaluated and compared the antioxidant efficacy of two liposomal preparations: liposomes containing only alpha-tocopherol versus bifunctional liposomes containing both alpha-tocopherol and glutathione (GSH). alpha-Tocopherol liposomes (2 mg alpha-tocopherol/animal) or liposomes containing both alpha-tocopherol and GSH (2 mg alpha-tocopherol and 10 mumol GSH/animal) were intratracheally instilled into the lungs of rats 30 min prior to a challenge with paraquat dichloride (30 mg/kg, i.p.); animals were killed 24 hr post-paraquat challenge. Lungs of paraquat-challenged animals were damaged extensively as evidenced by increases in lung weight, indicative of edema, and decreases in lung activities of angiotensin converting enzyme (ACE) and alkaline phosphatase (AKP), indicative of endothelial and alveolar type II epithelial cell injuries, respectively. While the pretreatment of rats with alpha-tocopherol liposomes or liposomes containing both alpha-tocopherol and GSH significantly attenuated paraquat-induced changes in lung ACE activity to more or less the same extent, the bifunctional liposomal preparation conferred additional protection to alveolar type II epithelial cells, as evidenced by a significantly higher pulmonary AKP activity. Our results also showed that both liposomal preparations failed to ameliorate paraquat-induced lung edema despite a significant protection of pulmonary endothelial cells, suggesting that paraquat-induced edema formation may be independent of endothelial cell damage. In conclusion, liposome-associated antioxidants can protect the lung against an oxidant challenge, and the extent of protection appears to be related to the characteristics of each antioxidant formulation.
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Affiliation(s)
- Z E Suntres
- Operational Medicine Sector, Defence and Civil Institute of Environmental Medicine, North York, Ontario, Canada
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al Khader A, al Sulaiman M, Kishore PN, Morais C, Tariq M. Quinacrine attenuates cyclosporine-induced nephrotoxicity in rats. Transplantation 1996; 62:427-35. [PMID: 8781605 DOI: 10.1097/00007890-199608270-00001] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The biochemical mechanism underlying cyclosporine (CsA)* induced nephrotoxicity is far from clear. Increased generation of oxygen derived free radicals (ODFR) and enhanced activity of phospholipase A2 (PLA2) have been observed in experimental animals following treatment with CsA. Several recent reports have shown that quinacrine, besides being a potent inhibitor of PLA2, suppresses the generation of ODFR. The present study was designed to investigate the effect of quinacrine on CsA induced nephrotoxicity in rats. Male Wistar rats (weighing 280-300 g) were randomized into eight groups of eight animals each. Group 1 (control) received appropriate vehicles only, whereas the rats in groups 2, 3, 4, and 5 received subcutaneous injection of CsA (17.5 mg/kg dissolved in olive oil) daily for 8 weeks. The animals in groups 3, 4, and 5 were also given intraperitoneal injections of quinacrine in three different doses of 2.5 mg/kg, 5 mg/kg, and 10 mg/kg body weight, respectively, in addition to CsA. The animals in groups 6, 7, and 8 received intraperitoneal injection of quinacrine alone at doses of 2.5 mg/kg, 5 mg/kg, and 10 mg/kg respectively for eight weeks. After 8 weeks, animals were sacrificed under light ether anesthesia and blood and kidney samples were collected for various biochemical and histological studies. The biochemical parameters included blood urea nitrogen (BUN), serum creatinine (Scr), potassium, and sodium. The blood was also analyzed for the level of CsA. The kidney samples were analyzed for malondialdehyde (MDA), glutathione, and vitamin E (VE). Kidney sections were prepared for histopathological studies using hematoxylin-eosin staining. There was an increase in BUN, Scr, and potassium levels and decrease in sodium levels in cyclosporine alone treated group, suggesting a significant nephrotoxicity. Quinacrine treatment significantly protected animals against CsA induced biochemical changes. Our studies on free radical indices showed that quinacrine treatment protected animals against cyclosporine induced increase in MDA and depletion of glutathione and VE. The beneficial effect of quinacrine against CsA induced nephrotoxicity was also confirmed by histological studies.
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Affiliation(s)
- A al Khader
- Department of Nephrology, Armed Forces Hospital, Riyadh, Saudi Arabia
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Lambert N, Chambers SJ, Plumb GW, Williamson G. Human cytochrome P450's are pro-oxidants in iron/ascorbate-initiated microsomal lipid peroxidation. Free Radic Res 1996; 24:177-85. [PMID: 8728119 DOI: 10.3109/10715769609088015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We have examined the effect of human cytochrome P450's (1A1,1A2,3A4,2A6,2B6,2D6,2E1) on ascorbate/iron-induced lipid peroxidation. Using microsomes prepared from human lymphoblastic cells enriched in recombinant cytochrome P450 isoenzymes, we have shown that the degree of peroxidation is a function of the amount of P450 present rather than the presence of any specific isoenzyme. Incorporated P450 increased the amount of peroxidation products by up to 2.1-fold compared to the control microsomes with no P450. It is therefore concluded that cytochrome P450's play a significant role in ascorbate/iron peroxidation.
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Affiliation(s)
- N Lambert
- Department of Food Molecular Biochemistry, Norwich Research Park, Colney, UK
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21
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The effects of glutathione on protein thiols and α-tocopherol in rat liver microsomes following storage and during NADPH-dependent lipid peroxidation. Nutr Res 1995. [DOI: 10.1016/0271-5317(95)00075-t] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Powell SR, McCay PB. Inhibition of doxorubicin-induced membrane damage by thiol compounds: toxicologic implications of a glutathione-dependent microsomal factor. Free Radic Biol Med 1995; 18:159-68. [PMID: 7744298 DOI: 10.1016/0891-5849(94)00109-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The hypothesis was tested that glutathione exerts its protective actions against doxorubicin-induced oxidative stress through an enzyme-dependent mechanism. Glutathione at biological concentrations decreased doxorubicin-dependent rat hepatic microsomal lipid peroxidation, whereas N-acetylcysteine had no effect. Glutathione was utilized during this inhibition at a rate dependent on the concentration of both doxorubicin and the sulfhydryl. Increasing glutathione concentrations resulted in significant increases in utilization. N-acetylcysteine was also oxidized in the microsomal system; however, the rate of oxidation was not enhanced by doxorubicin. If bovine cardiac microsomes were substituted for the hepatic microsomes, no lipid peroxidation was detected in the presence of doxorubicin, yet significant utilization of glutathione was detected. Microsomes isolated from tocopherol-deficient rats utilized less glutathione in the presence of doxorubicin, and there was no inhibition of doxorubicin-dependent lipid peroxidation. These findings support the conclusion that glutathione inhibits hepatic microsomal lipid peroxidation initiated by the redox-cycling of doxorubicin. Inhibition of doxorubicin-dependent lipid peroxidation appears to be enzyme-mediated and to require tocopherol. A similar mechanism for protection against doxorubicin appears to be present in heart microsomal membranes.
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Affiliation(s)
- S R Powell
- Department of Surgery, North Shore University Hospital-Cornell University Medical School, Manhasset, NY, USA
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23
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24
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Suntres ZE, Shek PN. Incorporation of alpha-tocopherol in liposomes promotes the retention of liposome-encapsulated glutathione in the rat lung. J Pharm Pharmacol 1994; 46:23-8. [PMID: 8201524 DOI: 10.1111/j.2042-7158.1994.tb03714.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The present study was undertaken to investigate whether alpha-tocopherol incorporated in liposomes could improve the retention of entrapped glutathione (GSH) in the lung following intratracheal instillation in rats. Rats were treated with a single dose of [3H]GSH entrapped in liposomes with or without 30 mol% alpha-tocopherol and killed 0, 24 or 48 h later. The retention of GSH in the lung was assessed by measuring the recovery of either 3H-label or GSH in the lung. Animals instilled with free [3H]GSH were found to retain only 2% of the administered dose at 24 h after treatment and no detectable radioactivity at 48 h. Liposome encapsulation altered the pulmonary retention of GSH with 18 and 10% of radioactivity remaining in the lung at 24 and 48 h post-treatment, respectively. The instillation of GSH encapsulated in alpha-tocopherol-containing liposomes resulted in the highest level of GSH retention in the lung, namely 37 and 30% of the administered GSH dose at 24 and 48 h, respectively. Results from Sepharose 4B column chromatography revealed that lung homogenates, obtained from rats instilled with GSH entrapped in alpha-tocopherol-containing liposomes, 24 and 48 h earlier, contained 2 eluted GSH-related components--one associated with the liposomal lipid marker in the void volume and the other as free GSH tripeptide, suggesting a slow sustained release effect mediated by the liposomal formulation. The same liposome preparation containing both alpha-tocopherol and GSH also conferred better protection against FeADP-induced lipid peroxidation than liposomes containing either alpha-tocopherol or GSH alone, indicative of a potentially effective antioxidant formulation for treating oxidative lung injury.
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Affiliation(s)
- Z E Suntres
- Operational Medicine Section, Defence and Civil Institute of Environmental Medicine, North York, Ontario, Canada
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25
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Shek PN, Suntres ZE, Brooks JI. Liposomes in pulmonary applications: physicochemical considerations, pulmonary distribution and antioxidant delivery. J Drug Target 1994; 2:431-42. [PMID: 7704488 DOI: 10.3109/10611869408996819] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The application of liposomes for improved drug delivery to the lung is promising. Liposome-mediated pulmonary drug delivery promotes an increase in drug retention-time in the lung and more importantly, a reduction in extrapulmonary side-effects, invariably resulting in enhanced therapeutic efficacies. The engineering of an effective liposomal drug formulation for inhalation therapy must take into consideration the leakage problem associated with the nebulization process; vesicle stability and release kinetics within the pulmonary milieu; and, the altered pharmacokinetics of the entrapped drug. The delivery of liposome-entrapped antioxidants via the tracheobronchial route has been found to be very useful in increasing the half-times of the administered agents, thus providing a sustained release effect for prolonged drug action. The entrapment in liposomes of alpha-tocopherol, an extremely insoluble but highly effective antioxidant, has been shown to be very effective in ameliorating oxidant-induced injuries in the lung. The use of bifunctional liposomes containing two antioxidants have been determined to provide excellent resistance to an oxidative challenge and appears to hold promise for improved clinical applications in antioxidant therapy.
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Affiliation(s)
- P N Shek
- Operational Medicine Division, Defence and Civil Institute of Environmental Medicine, North York, Ontario, Canada
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26
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Zhang JR, Andrus PK, Hall ED. Age-related regional changes in hydroxyl radical stress and antioxidants in gerbil brain. J Neurochem 1993; 61:1640-7. [PMID: 8228983 DOI: 10.1111/j.1471-4159.1993.tb09798.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The levels of hydroxyl radicals and oxidized GSH have been examined as indices of oxidative stress in young (3 months), middle-aged (15 months), and old (20-24 months) gerbil brain hippocampus, cortex, and striatum. The hydroxyl radical stress was estimated by measuring the salicylate hydroxyl radical trapping products 2,5- and 2,3-dihydroxybenzoic acid. The stress was significantly higher in all three brain regions in middle-aged and old gerbils versus young animals (< or = 66.0%). Regional comparisons showed that the stress was significantly higher in cortex than in either the hippocampus or striatum of the middle-aged and old gerbils (< or = 32.0%). The ratio of oxidized to total GSH also increased progressively in middle-aged and old animals in all three brain regions (p < 0.05, < or = 41.1%), further indicating a general age-related increase in oxidative stress. Parallel to this age-related increase in oxidative stress, a significant, albeit slight (8%), decrease in neuronal number in hippocampal CA1 region was observed in both the middle-aged and old animals. Possible differences in antioxidant levels were also examined. Total GSH levels were similar across age groups (variance < 12%). However, the regional comparison showed that it was highest in striatum in all age groups. The levels of alpha-tocopherol (vitamin E) were significantly higher in the middle-aged and old animals in all three regions (< or = 70.4%). Vitamin E was highest in the hippocampus and the differences between the hippocampus and the cortex and striatum increased with age.(ABSTRACT TRUNCATED AT 250 WORDS)
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27
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Abstract
Vitamin E (alpha-tocopherol), the principal chain-breaking antioxidant in biological membranes, prevents toxicant- and carcinogen-induced oxidative damage by trapping reactive oxyradicals. Although alpha-tocopherol antioxidant reactions appear to be not under direct metabolic control, alpha-tocopherol may function through redox cycles, which deliver reducing equivalents for antioxidant reactions and link antioxidant function to cellular metabolism. This review describes the antioxidant chemistry of alpha-tocopherol and evaluates the experimental evidence for the linkage of alpha-tocopherol turnover to cellular metabolism through redox cycles. Numerous in vitro experiments demonstrate antioxidant synergism between alpha-tocopherol and ascorbate, reduced glutathione, NADPH, and cellular electron transport proteins. Nevertheless, evidence that a one-electron redox cycle regenerates alpha-tocopherol from the tocopheroxyl radical is inconclusive. The difficulty of separating tocopheroxyl recycling from direct antioxidant actions of other antioxidants has complicated interpretation of the available data. A two-electron redox cycle involving alpha-tocopherol oxidation to 8a-substituted tocopherones followed by tocopherone reduction to alpha-tocopherol may occur, but would require enzymatic catalysis in vivo. Metabolism of antioxidant-inactive alpha-tocopheryl esters releases alpha-tocopherol, whereas reductive metabolism of alpha-tocopherylquinone, an alpha-tocopherol oxidation product, yields alpha-tocopherylhydroquinone, which also may provide antioxidant protection.
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Affiliation(s)
- D C Liebler
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson 85721
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28
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Kagan VE, Shvedova A, Serbinova E, Khan S, Swanson C, Powell R, Packer L. Dihydrolipoic acid--a universal antioxidant both in the membrane and in the aqueous phase. Reduction of peroxyl, ascorbyl and chromanoxyl radicals. Biochem Pharmacol 1992; 44:1637-49. [PMID: 1417985 DOI: 10.1016/0006-2952(92)90482-x] [Citation(s) in RCA: 283] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Thioctic (lipoic) acid is used as a therapeutic agent in a variety of diseases in which enhanced free radical peroxidation of membrane phospholipids has been shown to be a characteristic feature. It was suggested that the antioxidant properties of thioctic acid and its reduced form, dihydrolipoic acid, are at least in part responsible for the therapeutic potential. The reported results on the antioxidant efficiency of thioctic and dihydrolipoic acids obtained in oxidation models with complex multicomponent initiation systems are controversial. In the present work we used relatively simple oxidation systems to study the antioxidant effects of dihydrolipoic and thioctic acids based on their interactions with: (1) peroxyl radicals which are essential for the initiation of lipid peroxidation, (2) chromanoxyl radicals of vitamin E, and (3) ascorbyl radicals of vitamin C, the two major lipid- and water-soluble antioxidants, respectively. We demonstrated that: (1) dihydrolipoic acid (but not thioctic acid) was an efficient direct scavenger of peroxyl radicals generated in the aqueous phase by the water-soluble azoinitiator 2,2'-azobis(2-amidinopropane)-dihydrochloride, and in liposomes or in microsomal membranes by the lipid-soluble azoinitiator 2,2'-azobis(2,4-dimethylvaleronitrile); (2) both dihydrolipoic acid and thioctic acid did not interact directly with chromanoxyl radicals of vitamin E (or its synthetic homologues) generated in liposomes or in the membranes by three different ways: UV-irradiation, peroxyl radicals of 2,2'-azobis(2,4-dimethylvaleronitrile), or peroxyl radicals of linolenic acid formed by the lipoxygenase-catalyzed oxidation; and (3) dihydrolipoic acid (but not thioctic acid) reduced ascorbyl radicals (and dehydroascorbate) generated in the course of ascorbate oxidation by chromanoxyl radicals. This interaction resulted in ascorbate-mediated dihydrolipoic acid-dependent reduction of the vitamin E chromanoxyl radicals, i.e. vitamin E recycling. We conclude that dihydrolipoic acid may act as a strong direct chain-breaking antioxidant and may enhance the antioxidant potency of other antioxidants (ascorbate and vitamin E) in both the aqueous and the hydrophobic membraneous phases.
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Affiliation(s)
- V E Kagan
- Department of Molecular and Cell Biology, University of California, Berkeley 94720
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29
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Abstract
The objectives of this study were to determine whether the recycling of tocopherol occurs in elicited rat polymorphonuclear leukocytes and if so, whether the recycling process is enzymic or chemical. When incubated with hemoglobin, tocopherol was oxidized in cell homogenates in a time- and concentration-dependent manner. The oxidized tocopherol could be regenerated by addition of ascorbate, glutathione or nordihydroguaiaretic acid. Time course studies showed a rapid regeneration of tocopherol which peaked at 1 min after the addition of reductants. Determination of the regeneration reaction in the presence of CHCl3 and MeOH indicated that under these enzyme-denaturing conditions, a considerable amount of tocopherol was still regenerated, suggesting that the regeneration reaction is predominantly a chemical reaction. This study provided direct evidence from mass analysis that oxidized vitamin E can be regenerated by cellular water-soluble reductants such as ascorbate and glutathione.
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Affiliation(s)
- C T Ho
- Department of Biochemistry, University of Ottawa, Ontario, Canada
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30
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Selvam R, Bijikurien T. Methionine feeding prevents kidney stone deposition by restoration of free radical mediated changes in experimental rat urolithiasis. J Nutr Biochem 1991. [DOI: 10.1016/0955-2863(91)90062-a] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Bisby RH, Parker AW. Reactions of the alpha-tocopheroxyl radical in micellar solutions studied by nanosecond laser flash photolysis. FEBS Lett 1991; 290:205-8. [PMID: 1915875 DOI: 10.1016/0014-5793(91)81260-f] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Laser flash photolysis of alpha-tocopherol in methanol and in aqueous micellar solutions has been shown to produce the alpha-tocopheroxyl radical. The reaction between the alpha-tocopheroxyl radical and ascorbate in positively charged hexadecyltrimethylammonium chloride (HTAC) micelles occurred with a second order rate constant of 7.2 x 10(7) M-1.s-1, whereas in negatively charged sodium dodecyl sulphate (SDS) micelles the rats constant was only 3.8 x 10(4) M-1.s-1. The alpha-tocopheroxyl radical was found to be relatively long-lived in HTAC micelles (t1/2 greater than or equal to 5 min), allowing the slow disappearance of the alpha-tocopheroxyl radical by reaction with glutathione to be observed.
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Affiliation(s)
- R H Bisby
- Department of Biological Sciences, University of Salford, UK
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32
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Adams JD, Klaidman LK, Odunze IN, Shen HC, Miller CA. Alzheimer's and Parkinson's disease. Brain levels of glutathione, glutathione disulfide, and vitamin E. MOLECULAR AND CHEMICAL NEUROPATHOLOGY 1991; 14:213-26. [PMID: 1958264 DOI: 10.1007/bf03159937] [Citation(s) in RCA: 122] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Human brain levels of glutathione (GSH), glutathione disulfide (GSSG), and vitamin E were measured in neurologically normal control patients and two groups of patients with neurodegeneration: those with Alzheimer's disease (AD), and AD with some features of Parkinson's disease (AD-PD). Control brain samples contained GSH levels more than 50 times higher than GSSG. The levels of GSH were highest in the caudate nucleus and lowest in the medulla. In patients with AD or AD-PD, hippocampal levels of GSH were significantly higher than controls. Patients with AD also demonstrated high GSH levels in the midbrain compared to normal. In contrast, patients with AD-PD did not have significantly elevated GSH levels in this site. GSSG levels were not significantly different in any brain region between controls and diseased patients. In control brains, the medulla had higher levels of vitamin E than any other brain region. The caudate nucleus had the lowest levels, which were about half the levels in the medulla. Control levels of vitamin E in the midbrain were about 18.8 micrograms/g. In AD patients the midbrain levels of vitamin E doubled to 42.3 micrograms/g. This doubling also occurred in AD-PD patients where midbrain vitamin E levels increased to 44.0 micrograms/g. These results may indicate that compensatory increases in GSH and vitamin E levels occur following damage to specific brain regions in patients with AD or AD-PD.
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Affiliation(s)
- J D Adams
- School of Pharmacy, University of Southern California, Los Angeles
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35
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Wells W, Xu D, Yang Y, Rocque P. Mammalian thioltransferase (glutaredoxin) and protein disulfide isomerase have dehydroascorbate reductase activity. J Biol Chem 1990. [DOI: 10.1016/s0021-9258(18)55401-6] [Citation(s) in RCA: 186] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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