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Akthar I, Kim Y, Umehara T, Kanno C, Sasaki M, Marey MA, Yousef MS, Haneda S, Shimada M, Miyamoto A. Activation of sperm Toll-like receptor 2 induces hyperactivation to enhance the penetration to mucus and uterine glands: a trigger for the uterine inflammatory cascade in cattle. Front Immunol 2023; 14:1319572. [PMID: 38179051 PMCID: PMC10766357 DOI: 10.3389/fimmu.2023.1319572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
It is known that sperm and seminal plasma (SP) affect uterine immunity. In cattle, artificial insemination enables breeding by depositing frozen and largely diluted sperm with a negligible amount of SP into the uterus. Thus, the present study focused on the impact of frozen-thawed sperm on bovine uterine immunity. We have previously shown that in the bovine uterus, sperm swim smoothly over the luminal epithelium and some sperm interact with uterine glands to induce a weak inflammatory response mainly via the endometrial Toll-like receptor 2 (TLR2) signaling. However, the process by which sperm is encountered in the uterine glands is not completely clear. The present study intended to evaluate the role of sperm-TLR2 in sperm-uterine mucus penetration for reaching the glandular epithelium to induce the uterine immune response. To activate and block sperm-TLR2, they were treated with TLR2 agonist and antagonist, respectively. TLR2 activation enhanced sperm hyperactivation and improved its capacity to penetrate the artificial viscoelastic fluid and estrous-uterine-mucus. In contrast, TLR2-blocked sperm showed completely opposite effects. It is noteworthy, that the TLR2-activated sperm that penetrated the uterine mucus exhibited increased motile activity with hyperactivation. In the sperm-endometrial ex-vivo model, a greater amount of TLR2-activated sperm entered the uterine glands with an immune response, which was seen as the upregulation of mRNA expression for TNFA, IL1B, IL8, PGES, and TLR2 similar to those in control sperm. On the other hand, a lesser amount of TLR2-blocked sperm entered the uterine glands and weakened the sperm-induced increase only in PGES, suggesting that penetration of a certain number of sperm in the uterine gland is necessary enough to trigger the inflammatory response. Altogether, the present findings indicate that activation of sperm-TLR2 promotes their hyperactivation and mucus penetration with greater motility, allowing them to enter into the uterine glands more. This further suggests that the hyperactivated sperm contributes to triggering the pro-inflammatory cascade partly via TLR2 in the uterus.
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Affiliation(s)
- Ihshan Akthar
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Yejin Kim
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Takashi Umehara
- Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima, Japan
| | - Chihiro Kanno
- School of Veterinary Medicine, Kitasato University, Towada, Japan
| | - Motoki Sasaki
- Department of Basic Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Mohamed Ali Marey
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
- Department of Theriogenology, Faculty of Veterinary Medicine, Damanhur University, Behera, Egypt
| | - Mohamed Samy Yousef
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
- Department of Theriogenology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Shingo Haneda
- Department of Clinical Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Masayuki Shimada
- Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima, Japan
| | - Akio Miyamoto
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
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Ma D, Marey MA, Shimada M, Miyamoto A. Toll-like Receptor 2 is Involved in Calcium Influx and Acrosome Reaction to Facilitate Sperm Penetration to Oocytes During in vitro Fertilization in Cattle. Front Cell Dev Biol 2022; 10:810961. [PMID: 35281105 PMCID: PMC8907135 DOI: 10.3389/fcell.2022.810961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Cumulus cells of ovulated cumulus-oocyte complexes (COCs) express Toll-like receptor 2 (TLR2), pathogen recognition receptors, to recognize and react to sperm signals during fertilization. Sperm also express TLR2, but its contribution to the sperm-oocytes crosstalk is still unclear. Here, we adapted the in vitro fertilization (IVF) model to characterize the potential relevance of sperm TLR2 in sperm-oocytes interactions during fertilization in bovine. The IVF results showed that the ligation of sperm TLR2 with its specific antagonist/agonist resulted in down/up-regulation of the cleavage and blastocyst rates either in COCs or cumulus-free oocytes, but not in zona pellucida (ZP)-free oocytes. The computer-assisted sperm analysis (CASA) system revealed that sperm motility parameters were not affected in TLR2 antagonist/agonist-treated sperm. However, fluorescence imaging of sperm-ZP interactions revealed that the blockage or activation of the TLR2 system in sperm reduced or enhanced both binding and penetration abilities of sperm to ZP compared to control, respectively. Flow cytometrical analysis of acrosome reaction (AR) demonstrated that the TLR2 system adjusted the occurrence of AR in ZP-attached sperm, suggesting that sperm TLR2 plays physiological impacts on the sperm-oocyte crosstalk via regulating ZP-triggered AR in sperm. Given that calcium (Ca2+) influx is a pre-requisite step for the induction of AR, we investigated the impact of the TLR2 system on the ionophore A23187-induced Ca2+ influx into sperm. Notably, the exposure of sperm to TLR2 antagonist/agonist reduced/increased the intracellular Ca2+ level in sperm. Together, these findings shed new light that the TLR2 system is involved in sperm AR induction which enables sperm to penetrate and fertilize oocytes during the fertilization, at least in vitro, in cows. This suggests that sperm possibly developed a quite flexible sensing mechanism simultaneously against pathogens as well as COCs toward fertilization with the same TLR2 of the innate immune system.
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Affiliation(s)
- Dongxue Ma
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Mohamed Ali Marey
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
- Department of Theriogenology, Faculty of Veterinary Medicine, Damanhur University, Behera, Egypt
| | - Masayuki Shimada
- Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima, Japan
| | - Akio Miyamoto
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
- *Correspondence: Akio Miyamoto,
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Kanno C, Sun-Sik K, Sakamoto KQ, Yanagawa Y, Katagiri S, Nagano M. Relationship between frame rates and subpopulation structure of bovine sperm divided by their motility analyzed by a computer-assisted sperm analysis system. Anim Sci J 2022; 93:e13796. [PMID: 36502272 DOI: 10.1111/asj.13796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
The authors investigated the relationship between frame rates and subpopulation structure of bovine sperm divided by their motility analyzed by a computer-assisted sperm analysis (CASA). Kinematic parameters of bovine sperm incubated in Brackett & Oliphant medium with and without calcium ionophore for 0, 1, 5, 10, 15, 20, 25, and 30 min were evaluated by a CASA at 150 frames per second (fps) and analyzed structure of sperm motility subpopulation by cluster analysis. Then, we converted CASA data at 150 fps to 75, 50, and 30 fps and evaluated the structures of sperm motility subpopulation at different fps in each sperm by a discriminant analysis. As the results, the structure of sperm motility subpopulation was affected by frame rate. Sperm were divided into six clusters at 150, 75, and 50 fps; on the other hand, there were five clusters at 30 fps. Straight-line velocity was similar at all frame rates. However, as the frame rate became higher, curvilinear velocity and beat cross frequency of sperm head increased significantly, whereas lateral sperm head displacement decreased significantly. In conclusion, higher frame rate at 150 fps is recommended to capture the trajectory of sperm accurately by CASA in the present study.
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Affiliation(s)
- Chihiro Kanno
- Laboratory of Clinical Veterinary Medicine for Large Animal, Division of Veterinary Medicine, School of Veterinary Medicine, Kitasato University, Towada, Japan
| | - Kang Sun-Sik
- Hanwoo Research Institute, National Institute of Animal Science of Korea, Pyeongchang, Korea
| | - Kentaro Q Sakamoto
- Department of Marine Bioscience, Atmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa, Japan
| | - Yojiro Yanagawa
- Laboratory of Theriogenology, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Seiji Katagiri
- Laboratory of Theriogenology, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Masashi Nagano
- Laboratory of Animal Reproduction, Department of Animal Science, School of Veterinary Medicine, Kitasato University, Towada, Japan
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Hashimoto M, Kimura S, Kanno C, Yanagawa Y, Watanabe T, Okabe J, Takahashi E, Nagano M, Kitamura H. Macrophage ubiquitin-specific protease 2 contributes to motility, hyperactivation, capacitation, and in vitro fertilization activity of mouse sperm. Cell Mol Life Sci 2021; 78:2929-2948. [PMID: 33104844 PMCID: PMC11073191 DOI: 10.1007/s00018-020-03683-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/15/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
Macrophages are innate immune cells that contribute to classical immune functions and tissue homeostasis. Ubiquitin-specific protease 2 (USP2) controls cytokine production in macrophages, but its organ-specific roles are still unknown. In this study, we generated myeloid-selective Usp2 knockout (msUsp2KO) mice and specifically explored the roles of testicular macrophage-derived USP2 in reproduction. The msUsp2KO mice exhibited normal macrophage characteristics in various tissues. In the testis, macrophage Usp2 deficiency negligibly affected testicular macrophage subpopulations, spermatogenesis, and testicular organogenesis. However, frozen-thawed sperm derived from msUsp2KO mice exhibited reduced motility, capacitation, and hyperactivation. In addition, macrophage Usp2 ablation led to a decrease in the sperm population exhibiting high intracellular pH, calcium influx, and mitochondrial membrane potential. Interrupted pronuclei formation in eggs was observed when using frozen-thawed sperm from msUsp2KO mice for in vitro fertilization. Administration of granulocyte macrophage-colony stimulating factor (GM-CSF), whose expression was decreased in testicular macrophages derived from msUsp2KO mice, restored mitochondrial membrane potential and total sperm motility. Our observations demonstrate a distinct role of the deubiquitinating enzyme in organ-specific macrophages that directly affect sperm function.
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Affiliation(s)
- Mayuko Hashimoto
- Laboratory of Veterinary Physiology, Department of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Shunsuke Kimura
- Division of Biochemistry, Faculty of Pharmacy and Graduate School of Pharmaceutical Science, Keio University, Tokyo, Japan
| | - Chihiro Kanno
- Laboratory of Theriogenology, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Yojiro Yanagawa
- Laboratory of Theriogenology, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Takafumi Watanabe
- Laboratory of Veterinary Anatomy, Department of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Jun Okabe
- Department of Diabetes, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Eiki Takahashi
- Research Resources Centre, RIKEN Brain Science Institute, Wako, Japan
| | - Masashi Nagano
- Laboratory of Animal Reproduction, Department of Animal Science, School of Veterinary Medicine, Kitasato University, Towada, Japan
| | - Hiroshi Kitamura
- Laboratory of Veterinary Physiology, Department of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan.
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Epidermal growth factor alleviates the negative impact of urea on frozen-thawed bovine sperm, but the subsequent developmental competence is compromised. Sci Rep 2021; 11:4687. [PMID: 33633199 PMCID: PMC7907109 DOI: 10.1038/s41598-021-83929-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/09/2021] [Indexed: 11/14/2022] Open
Abstract
Upon insemination, sperm cells are exposed to components of the female reproductive tract (FRT) fluids, such as urea and epidermal growth factor (EGF). It has been shown that both urea and EGF use EGF receptor signaling and produce reactive oxygen species (ROS) that are required at certain levels for sperm capacitation and acrosome reaction. We therefore hypothesized that during bovine sperm capacitation, a high level of urea and EGF could interfere with sperm function through overproduction of ROS. High-level urea (40 mg/dl urea is equal to 18.8 mg/dl of blood urea nitrogen) significantly increased ROS production and TUNEL-positive sperm (sperm DNA fragmentation, sDF) percentage, but decreased HOS test score, progressive motility, acrosome reaction and capacitation. The EGF reversed the negative effects of urea on all sperm parameters, with the exception of ROS production and DNA fragmentation, which were higher in urea-EGF-incubated sperm than in control-sperm. The developmental competence of oocytes inseminated with urea-EGF-incubated sperm was significantly reduced compared to the control. A close association of ROS production or sDF with 0-pronuclear and sperm non-capacitation rates was found in the network analysis. In conclusion, EGF enhanced urea-reduced sperm motility; however, it failed to reduce urea-increased sperm ROS or sDF levels and to enhance subsequent oocyte competence. The data suggests that any study to improve sperm quality should be followed by a follow-up assessment of the fertilization outcome.
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Peres Campanholi S, Garcia Neto S, Basso AC, de Agostini Losano JD, Perez Siqueira AF, Nichi M, Ortiz D'Avila Assumpção ME, Afonso de Freitas L, Paro de Paz CC, Ferraudo AS, Morato Monteiro F, Unno Gimenes L. Estimate of in vitro embryo production based on sperm subpopulations in Senepol bulls. Theriogenology 2020; 161:98-107. [PMID: 33302167 DOI: 10.1016/j.theriogenology.2020.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
In cattle, in vitro embryo production (IVEP) is an important reproductive biotechnology responsible for the rapid expansion of the Senepol breed in our country. This breed has shown important results when used in crossbreeding and estimate IVEP in Senepol based on seminal analysis would be valuable for the semen cryopreservation industry, research institutes and breeders. Combining the evaluation of sperm subpopulations with analysis of other sperm attributes may help to improve fertility predictions in cattle. Therefore, the objectives of the present study were to: 1) identify and characterize motile sperm subpopulations in cryopreserved Senepol semen following the washing process carried out before in vitro fertilization, and 2) to determine an model for estimate IVEP based on sperm subpopulations in conjunction with other sperm quality analyzes. Samples of 38 cryopreserved semen from 28 Senepol bulls, chosen based on retrospective data from 386 IVEP routines, underwent the semen washing and were evaluated by the computer-assisted sperm analysis system. Sperm morphology was evaluated by wet preparation technique, and plasma and acrosomal membranes integrity, mitochondrial potential, oxidative status and chromatin resistance were analyzed by flow cytometry. After multivariate analysis of principal components and grouping, three sperm subpopulations were identified: SBP1 (fast and progressive motility), SBP2 (hyperactivated motility) and SBP3 (slow non-progressive motility). After categorization of IVEP in high, medium and low embryo yield, logistic regression analysis was applied to associate the results of subpopulations and other sperm quality variables with IVEP. The SBP1 and SBP2 variables affected embryo production, and an IVEP estimation model was generated for Senepol bulls based on these two subpopulations: embryo yield = 0.1563 + 0.0328 (SBP1) + 0.0173 (SBP2). SBP1 and SBP2 represents the absolute value of the percentage of subpopulations in semen. If the calculated value (by this equation) is close to 1, the embryo yield will be low; if is close to 2, will be medium; if is close to 3, will be high. In conclusion, three subpopulations were found for Senepol semen and, despite all analyzed variables, only SBP1 and SBP2 were included in the model to estimate IVEP in this breed.
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Affiliation(s)
| | | | | | | | | | - Marcílio Nichi
- Universidade de São Paulo, FMVZ/USP, São Paulo, São Paulo, Brazil
| | | | | | | | | | - Fabio Morato Monteiro
- Centro Avançado de Pesquisa de Bovinos de Corte, APTA/IZ, Sertãozinho, São Paulo, Brazil
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Khaki A, Araghi A, Lotfi M, Nourian A. Differences between first and second ejaculations regarding seminal plasma calcium, magnesium and total antioxidant capacity in dual-purpose Fleckvieh bulls and their relationships with semen quality. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2019; 10:333-341. [PMID: 32206229 DOI: 10.30466/vrf.2018.89223.2159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/07/2019] [Indexed: 11/01/2022]
Abstract
Artificial insemination is a well-established and widely used method for genetic improvement in cattle breeding industry. Recently, researchers have shown an increased interest in the cryoprotective effects of minerals and antioxidants on semen. Previous studies on calcium (Ca) and magnesium (Mg), two main macro-minerals, have mainly investigated their roles in mammalian spermatogenesis and fertility. In addition, the experimental data examining the semen content regarding these minerals and antioxidants from different animal species are rather controversial and there is no general agreement about their associations with semen quality. Therefore, this study was conducted to assess the seminal plasma concentrations of Ca, Mg and total antioxidant capacity (TAC) in first and second ejaculations of dual-purpose Fleckvieh bulls and to link them to the sperm characteristics of fresh and frozen-thawed semen. Sperm progressive motility after thawing was used to classify the data into three groups: < 40.00%, 40.00 to 50.00% and > 50.00%. The measurements of two minerals and TAC were carried out using spectrophotometry and enzyme-linked immunosorbent assays, respectively. The results showed that there were significant differences in several parameters of semen quality between first and second ejaculations. No significant differences were also found on Ca and Mg concentrations and Ca/Mg ratio. The TAC level was significantly higher in the first ejaculation than the second one. The findings of this study suggest that TAC is a potential marker for bull semen quality assessment in the frozen semen production industry.
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Affiliation(s)
- Amir Khaki
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Amol University of Special Modern Technologies, Amol, Iran
| | - Atefeh Araghi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Amol University of Special Modern Technologies, Amol, Iran
| | - Mehdi Lotfi
- Iran Simmental Cattle Breeding Center, Amard-dam Company, Amol, Iran
| | - Alireza Nourian
- Iran Simmental Cattle Breeding Center, Amard-dam Company, Amol, Iran
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Holt WV, Satake N. Making the most of sperm activation responses: experiments with boar spermatozoa and bicarbonate. Reprod Fertil Dev 2019. [PMID: 29514735 DOI: 10.1071/rd17476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Attempting to extract useful and reliable information about semen quality and its fertility potential remains a difficult exercise, partly because the sperm heterogeneity within samples often renders simple statistical analyses rather meaningless. In fact, a mean and standard deviation may reflect neither the very fast swimming activities of the most active cells nor the slow and sluggish activities of others. Herein we propose that the information value within semen samples can be maximised if current knowledge about sperm activation mechanisms is exploited before undertaking the measurements. We explain, using boar semen as an example, that estimating and defining relative sperm subpopulation sizes, after activation by bicarbonate, provides a means of quantifying sperm quality. Although such estimates may indeed be related to in vivo fertility, the general approach also suggests potential new avenues that could be exploited for the elaboration of novel in vitro tests for the characterisation of toxic environmental chemicals and, indeed, to reduce the number of animals used in such testing programs.
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Affiliation(s)
- William V Holt
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Level 4, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| | - Nana Satake
- School of Veterinary Sciences, Faculty of Science, University of Queensland, Gatton Campus, Gatton, Qld 4343, Australia
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van der Horst G, Maree L, du Plessis SS. Current perspectives of CASA applications in diverse mammalian spermatozoa. Reprod Fertil Dev 2019; 30:875-888. [PMID: 29576045 DOI: 10.1071/rd17468] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/25/2017] [Indexed: 12/11/2022] Open
Abstract
Since the advent of computer-aided sperm analysis (CASA) some four decades ago, advances in computer technology and software algorithms have helped establish it as a research and diagnostic instrument for the analysis of spermatozoa. Despite mammalian spermatozoa being the most diverse cell type known, CASA is a great tool that has the capacity to provide rapid, reliable and objective quantitative assessment of sperm quality. This paper provides contemporary research findings illustrating the scientific and commercial applications of CASA and its ability to evaluate diverse mammalian spermatozoa (human, primates, rodents, domestic mammals, wildlife species) at both structural and functional levels. The potential of CASA to quantitatively measure essential aspects related to sperm subpopulations, hyperactivation, morphology and morphometry is also demonstrated. Furthermore, applications of CASA are provided for improved mammalian sperm quality assessment, evaluation of sperm functionality and the effect of different chemical substances or pathologies on sperm fertilising ability. It is clear that CASA has evolved significantly and is currently superior to many manual techniques in the research and clinical setting.
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Affiliation(s)
- Gerhard van der Horst
- Department of Medical Bioscience, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
| | - Liana Maree
- Department of Medical Bioscience, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
| | - Stefan S du Plessis
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Africa
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