Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 56
Filter
1.
Nat Commun ; 14(1): 4174, 2023 07 13.
Article in English | MEDLINE | ID: mdl-37443074

ABSTRACT

Since the emergence of SARS-CoV-2, vaccines targeting COVID-19 have been developed with unprecedented speed and efficiency. CoronaVac, utilising an inactivated form of the COVID-19 virus and the mRNA26 based Pfizer/BNT162b2 vaccines are widely distributed. Beyond the ability of vaccines to induce production of neutralizing antibodies, they might lead to the generation of antibodies attenuating the disease by recruiting cytotoxic and opsonophagocytic functions. However, the Fc-effector functions of vaccine induced antibodies are much less studied than virus neutralization. Here, using systems serology, we follow the longitudinal Fc-effector profiles induced by CoronaVac and BNT162b2 up until five months following the two-dose vaccine regimen. Compared to BNT162b2, CoronaVac responses wane more slowly, albeit the levels remain lower than that of BNT162b2 recipients throughout the entire observation period. However, mRNA vaccine boosting of CoronaVac responses, including response to the Omicron variant, induce significantly higher peak of antibody functional responses with increased humoral breadth. In summary, we show that vaccine platform-induced humoral responses are not limited to virus neutralization but rather utilise antibody dependent effector functions. We demonstrate that this functionality wanes with different kinetics and can be rescued and expanded via boosting with subsequent homologous and heterologous vaccination.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , BNT162 Vaccine , SARS-CoV-2 , COVID-19/prevention & control , Vaccination , Immunoglobulin Fc Fragments , Antibodies, Neutralizing , Antibodies, Viral
2.
bioRxiv ; 2022 Jul 25.
Article in English | MEDLINE | ID: mdl-35923313

ABSTRACT

Since the emergence of the SARS-CoV-2 virus, we have witnessed a revolution in vaccine development with the rapid emergence and deployment of both traditional and novel vaccine platforms. The inactivated CoronaVac vaccine and the mRNA-based Pfizer/BNT162b2 vaccine are among the most widely distributed vaccines, both demonstrating high, albeit variable, vaccine effectiveness against severe COVID-19 over time. Beyond the ability of the vaccines to generate neutralizing antibodies, antibodies can attenuate disease via their ability to recruit the cytotoxic and opsinophagocytic functions of the immune response. However, whether Fc-effector functions are induced differentially, wane with different kinetics, and are boostable, remains unknown. Here, using systems serology, we profiled the Fc-effector profiles induced by the CoronaVac and BNT162b2 vaccines, over time. Despite the significantly higher antibody functional responses induced by the BNT162b2 vaccine, CoronaVac responses waned more slowly, albeit still found at levels below those present in the systemic circulation of BNT162b2 immunized individuals. However, mRNA boosting of the CoronaVac vaccine responses resulted in the induction of significantly higher peak antibody functional responses with increased humoral breadth, including to Omicron. Collectively, the data presented here point to striking differences in vaccine platform-induced functional humoral immune responses, that wane with different kinetics, and can be functionally rescued and expanded with boosting.

4.
Mucosal Immunol ; 9(6): 1528-1536, 2016 11.
Article in English | MEDLINE | ID: mdl-26838048

ABSTRACT

Understanding vaginal and rectal HIV transmission and protective cellular and molecular mechanisms is critical for designing new prevention strategies, including those required for an effective vaccine. The determinants of protection against HIV infection are, however, poorly understood. Increasing evidence suggest that innate immune defenses may help protect mucosal surfaces from HIV transmission in highly exposed, uninfected subjects. More recent studies suggest that systemically administered type 1 interferon protects against simian immunodeficiency virus infection of macaques. Here we hypothesized that topically applied type 1 interferons might stimulate vaginal innate responses that could protect against HIV transmission. We therefore applied a recombinant human type 1 interferon (IFN-ß) to the vagina of rhesus macaques and vaginally challenged them with pathogenic simian/human immunodeficiency virus (SHIV). Vaginal administration of IFN-ß resulted in marked local changes in immune cell phenotype, increasing immune activation and HIV co-receptor expression, yet provided significant protection from SHIV acquisition as interferon response genes were also upregulated. These data suggest that protection from vaginal HIV acquisition may be achieved by activating innate mucosal defenses.


Subject(s)
Antiviral Agents/administration & dosage , Interferon-beta/administration & dosage , Simian Acquired Immunodeficiency Syndrome/prevention & control , Simian Acquired Immunodeficiency Syndrome/transmission , Simian Immunodeficiency Virus/drug effects , Administration, Intravaginal , Administration, Topical , Animals , Biomarkers , CD4 Antigens/metabolism , Female , Gene Expression Regulation/drug effects , Lymphocyte Activation/immunology , Macaca mulatta , Macrophages/immunology , Macrophages/metabolism , Myeloid Cells/drug effects , Myeloid Cells/immunology , Myeloid Cells/metabolism , Phenotype , Receptors, CCR5/metabolism , Simian Acquired Immunodeficiency Syndrome/immunology , Simian Acquired Immunodeficiency Syndrome/virology , Simian Immunodeficiency Virus/immunology , T-Lymphocyte Subsets/drug effects , T-Lymphocyte Subsets/immunology , T-Lymphocyte Subsets/metabolism , Vagina/immunology , Vagina/virology , Viral Load
5.
Mucosal Immunol ; 9(6): 1584-1595, 2016 11.
Article in English | MEDLINE | ID: mdl-26883728

ABSTRACT

Although the development of a fully protective HIV vaccine is the ultimate goal of HIV research, to date only one HIV vaccine trial, the RV144, has successfully induced a weakly protective response. The 31% protection from infection achieved in the RV144 trial was linked to the induction of nonneutralizing antibodies, able to mediate antibody-dependent cell-mediated cytotoxicity (ADCC), suggestive of an important role of Fc-mediated functions in protection. Similarly, Fc-mediated antiviral activity was recently shown to play a critical role in actively suppressing the viral reservoir, but the Fc effector mechanisms within tissues that provide protection from or after infection are largely unknown. Here we aimed to define the landscape of effector cells and Fc receptors present within vulnerable tissues. We found negligible Fc receptor-expressing natural killer cells in the female reproductive and gastrointestinal mucosa. Conversely, Fc receptor-expressing macrophages were highly enriched in most tissues, but neutrophils mediated superior antibody-mediated phagocytosis. Modifications in Fc domain of VRC01 antibody increased phagocytic responses in both phagocytes. These data suggest that non-ADCC-mediated mechanisms, such as phagocytosis and neutrophil activation, are more likely to play a role in preventative vaccine or reservoir-eliminating therapeutic approaches.


Subject(s)
AIDS Vaccines/immunology , HIV Infections/immunology , HIV Infections/metabolism , HIV-1/immunology , Phagocytosis/immunology , Receptors, Fc/metabolism , Adult , Antibodies, Monoclonal/immunology , Biomarkers , Broadly Neutralizing Antibodies , Cytokines/metabolism , Female , Gene Expression , HIV Antibodies/immunology , HIV Infections/prevention & control , HIV Infections/virology , Humans , Immunity, Innate , Inflammation Mediators/metabolism , Killer Cells, Natural/immunology , Killer Cells, Natural/metabolism , Macrophages/immunology , Macrophages/metabolism , Middle Aged , Mucous Membrane/immunology , Mucous Membrane/metabolism , Mucous Membrane/virology , Neutrophils/immunology , Neutrophils/metabolism , Receptors, Fc/genetics , Young Adult
6.
Clin Exp Immunol ; 183(3): 419-30, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26439909

ABSTRACT

Killer immunoglobulin-like receptors (KIRs) interact with human leucocyte antigen (HLA) class I ligands and play a key role in the regulation and activation of NK cells. The functional importance of KIR-HLA interactions has been demonstrated for a number of chronic viral infections, but to date only a few studies have been performed in the context of acute self-limited viral infections. During our investigation of CD8(+) T cell responses to a conserved HLA-B57-restricted epitope derived from dengue virus (DENV) non-structural protein-1 (NS1), we observed substantial binding of the tetrameric complex to non-T/non-B lymphocytes in peripheral blood mononuclear cells (PBMC) from a long-standing clinical cohort in Thailand. We confirmed binding of the NS1 tetramer to CD56(dim) NK cells, which are known to express KIRs. Using depletion studies and KIR-transfected cell lines, we demonstrated further that the NS1 tetramer bound the inhibitory receptor KIR3DL1. Phenotypical analysis of PBMC from HLA-B57(+) subjects with acute DENV infection revealed marked activation of NS1 tetramer-binding natural killer (NK) cells around the time of defervescence in subjects with severe dengue disease. Collectively, our findings indicate that subsets of NK cells are activated relatively late in the course of acute DENV illness and reveal a possible role for specific KIR-HLA interactions in the modulation of disease outcomes.


Subject(s)
Dengue Virus/chemistry , Dengue/immunology , Killer Cells, Natural/immunology , Peptide Fragments/immunology , Receptors, KIR3DL1/immunology , Receptors, KIR3DL1/metabolism , Viral Nonstructural Proteins/immunology , Acute Disease , Adolescent , Child , Child, Preschool , Dengue/physiopathology , Dengue/virology , Dengue Virus/immunology , Epitopes, T-Lymphocyte/immunology , Female , HLA-B Antigens/immunology , Humans , Infant , Killer Cells, Natural/physiology , Leukocytes, Mononuclear/immunology , Male , Peptide Fragments/metabolism , Protein Binding , Viral Nonstructural Proteins/metabolism
8.
Mucosal Immunol ; 5(6): 646-57, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22643849

ABSTRACT

Human immunodeficiency virus (HIV) and Simian immunodeficiency virus (SIV) disease progression is associated with multifocal damage to the gastrointestinal tract epithelial barrier that correlates with microbial translocation and persistent pathological immune activation, but the underlying mechanisms remain unclear. Investigating alterations in mucosal immunity during SIV infection, we found that damage to the colonic epithelial barrier was associated with loss of multiple lineages of interleukin (IL)-17-producing lymphocytes, cells that microarray analysis showed expressed genes important for enterocyte homeostasis, including IL-22. IL-22-producing lymphocytes were also lost after SIV infection. Potentially explaining coordinate loss of these distinct populations, we also observed loss of CD103+ dendritic cells (DCs) after SIV infection, which associated with the loss of IL-17- and IL-22-producing lymphocytes. CD103+ DCs expressed genes associated with promotion of IL-17/IL-22+ cells, and coculture of CD103+ DCs and naïve T cells led to increased IL17A and RORc expression in differentiating T cells. These results reveal complex interactions between mucosal immune cell subsets providing potential mechanistic insights into mechanisms of mucosal immune dysregulation during HIV/SIV infection, and offer hints for development of novel therapeutic strategies to address this aspect of AIDS virus pathogenesis.


Subject(s)
Colon/immunology , Dendritic Cells/immunology , Enterocytes/immunology , Immunity, Mucosal , Simian Acquired Immunodeficiency Syndrome/immunology , Simian Immunodeficiency Virus/physiology , Th17 Cells/immunology , Animals , Antigens, CD/immunology , Cell Differentiation , Cell Lineage , Coculture Techniques , Colon/pathology , Colon/virology , Dendritic Cells/pathology , Dendritic Cells/virology , Enterocytes/pathology , Enterocytes/virology , Gene Expression Regulation , Integrin alpha Chains/deficiency , Integrin alpha Chains/immunology , Interleukin-17/deficiency , Interleukin-17/genetics , Interleukin-17/immunology , Interleukins/deficiency , Interleukins/genetics , Interleukins/immunology , Macaca mulatta , Nuclear Receptor Subfamily 1, Group F, Member 3/genetics , Nuclear Receptor Subfamily 1, Group F, Member 3/immunology , Simian Acquired Immunodeficiency Syndrome/pathology , Simian Acquired Immunodeficiency Syndrome/virology , Th17 Cells/pathology , Th17 Cells/virology , Interleukin-22
9.
Mucosal Immunol ; 5(1): 30-40, 2012 Jan.
Article in English | MEDLINE | ID: mdl-21993602

ABSTRACT

The human gut mucosa is a major site of human immunodeficiency virus (HIV) infection and infection-associated pathogenesis. Increasing evidence shows that natural killer (NK) cells have an important role in control of HIV infection, but the mechanism(s) by which they mediate antiviral activity in the gut is unclear. Here, we show that two distinct subsets of NK cells exist in the gut, one localized to intraepithelial spaces (intraepithelial lymphocytes, IELs) and the other to the lamina propria (LP). The frequency of both subsets of NK cells was reduced in chronic infection, whereas IEL NK cells remained stable in spontaneous controllers with protective killer immunoglobulin-like receptor/human leukocyte antigen genotypes. Both IEL and LP NK cells were significantly expanded in immunological non-responsive patients, who incompletely recovered CD4+ T cells on highly active antiretroviral therapy (HAART). These data suggest that both IEL and LP NK cells may expand in the gut in an effort to compensate for compromised CD4+ T-cell recovery, but that only IEL NK cells may be involved in providing durable control of HIV in the gut.


Subject(s)
HIV Infections/immunology , HIV/immunology , Intestinal Mucosa/metabolism , Killer Cells, Natural/metabolism , Lymphocyte Subsets/metabolism , Antiretroviral Therapy, Highly Active , Biomarkers, Pharmacological/metabolism , Biopsy , Cell Movement/drug effects , Cell Movement/immunology , DNA Mutational Analysis , Genotype , HIV/pathogenicity , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/genetics , HLA Antigens/genetics , HLA Antigens/metabolism , Humans , Intestinal Mucosa/immunology , Intestinal Mucosa/pathology , Killer Cells, Natural/drug effects , Killer Cells, Natural/immunology , Killer Cells, Natural/pathology , Lymphocyte Subsets/drug effects , Lymphocyte Subsets/immunology , Lymphocyte Subsets/pathology , Polymorphism, Genetic , Receptors, KIR/genetics , Receptors, KIR/metabolism
10.
J Intern Med ; 265(1): 29-42, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19093958

ABSTRACT

Increasing evidence supports the notion that the innate immune response, and in particular, natural killer cells play a central role in determining the quality of the host immune response to infection. In this review we highlight recent evidence that suggests that NK cells influence the clinical fate of HIV-infected individuals.


Subject(s)
HIV Infections/immunology , HIV-1/physiology , Killer Cells, Natural/physiology , CD8-Positive T-Lymphocytes/immunology , Female , Genetic Predisposition to Disease , Genotype , Histocompatibility Antigens Class I/immunology , Humans , Immunity, Cellular , Male , Receptors, KIR/immunology
11.
J Immunol ; 171(1): 477-88, 2003 Jul 01.
Article in English | MEDLINE | ID: mdl-12817033

ABSTRACT

Both the magnitude and breadth of HIV-specific immunity were evaluated longitudinally on samples collected from six subjects starting highly active antiretroviral therapy (HAART) preseroconversion (group 1), 11 recently infected subjects starting HAART postseroconversion (group 2), five subjects starting HAART in the second half of the first year of infection (group 3), and six persons starting treatment in the chronic phase of infection (group 4). HIV-specific immunity was measured by IFN-gamma ELISPOT, detecting the frequency of cells responding to a panel of HLA-restricted HIV-1 peptides. Intracellular cytokine staining was used to detect the frequency of HIV-1 Gag p55-specific CD4(+) and CD8(+) T cells in a subset of participants. The magnitude and breadth of HIV-specific responses persisted in all group 1 subjects and in 5 of 11 (45%) group 2 subjects. Both of these parameters declined in 6 of 11 (55%) group 2 and in all group 3 and 4 individuals. All persons who maintained detectable numbers of HIV-1 Gag p55-specific CD4(+) and CD8(+) T cells after starting HAART preserved the intensity and breadth of their HIV-specific effector response. Our results show that HIV-specific immunity can be preserved even if HAART is initiated beyond the acute phase of infection.


Subject(s)
Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , HIV Infections/immunology , HIV-1/immunology , Adult , Age Factors , Amino Acid Sequence , CD4-CD8 Ratio , CD4-Positive T-Lymphocytes/drug effects , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/metabolism , CD4-Positive T-Lymphocytes/virology , CD8-Positive T-Lymphocytes/drug effects , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/metabolism , CD8-Positive T-Lymphocytes/virology , Cell Line, Transformed , Female , HIV Infections/virology , Humans , Interferon-gamma/metabolism , Longitudinal Studies , Male , Middle Aged , Molecular Sequence Data , Retrospective Studies , Viral Load
12.
Biochim Biophys Acta ; 1530(1): 97-110, 2001 Jan 15.
Article in English | MEDLINE | ID: mdl-11341962

ABSTRACT

Utilizing the transphosphatidylation reaction catalyzed by phospholipase D (PLD) in the presence of a primary alcohol and the short-chain phospholipid PC8, we have characterized the enzyme from human neutrophils. A pH optimum of 7.8-8.0 was determined. PIP(2), EDTA/EGTA, and ATP were found to enhance basal PLD activity in vitro. Inhibitory elements were: oleate, Triton X-100, n-octyl-beta-glucopyranoside, divalent cations, GTPgammaS and H(2)O(2). The apparent K(m) for the butanol substrate was 0.1 mM and the V(max) was 6.0 nmol mg(-1) h(-1). Immunochemical analysis by anti-pan PLD antibodies revealed a neutrophil PLD of approximately 90 kDa and other bands recognized minimally by anti-PLD1 or anti-PLD2 antibodies. The 90-kDa protein is tyrosine-phosphorylated upon cell stimulation with GM-CSF and formyl-Met-Leu-Phe. Protein partial purification using column liquid chromatography was performed after cell subfractionation. Based on the enzyme's regulatory and inhibitory factors, and its molecular weight, these data indicate an enzyme isoform that might be different from the mammalian PLD1/2 forms described earlier. The present results lay the foundation for further purification of this granulocyte PLD isoform.


Subject(s)
Neutrophils/enzymology , Phospholipase D/analysis , Adenosine Triphosphate , Cations, Divalent , Chromatography, Ion Exchange , Cloning, Molecular , Detergents , Dithiothreitol , Enzyme Inhibitors/pharmacology , Guanosine 5'-O-(3-Thiotriphosphate) , Humans , Hydrogen Peroxide , Hydrogen-Ion Concentration , Kinetics , Oleic Acid/pharmacology , Phospholipase D/genetics , Phospholipase D/isolation & purification , Phospholipase D/metabolism
13.
Biochim Biophys Acta ; 1545(1-2): 132-45, 2001 Feb 09.
Article in English | MEDLINE | ID: mdl-11342039

ABSTRACT

Cytoplasmic malate dehydrogenase (cMDH) is a key enzyme in several metabolic pathways. Though its activity has been examined extensively, there are lingering mechanistic uncertainties involving substrate and cofactor binding. To more completely understand this enzyme's interactions with cofactor and substrate ligands, a fluorescent reporter group was introduced into the enzyme's structure. This was accomplished by selective modification of Cys 110. The reaction placed an aminonaphthaline sulfonic acid group near the enzyme's active site. Substrate, inhibitor, and NAD binding activities were characterized using changes in this label's fluorescence. Results demonstrated that both substrate and cofactor molecules bound to the enzyme in the absence of their companion ligands. This is in contrast to strictly ordered cofactor then substrate binding as has been suggested by kinetic analyses of closely related enzymes. Binding results also indicated that the cofactor, NAD, bound to cMDH in a negatively cooperative manner, but substrates and the inhibitor, hydroxymalonate, bound non-cooperatively. Multiple substrate binding modes were identified and interactions between substrate and cofactor binding were found.


Subject(s)
Isoenzymes/metabolism , Malate Dehydrogenase/metabolism , NAD/metabolism , Animals , Binding Sites , Binding, Competitive , Cytoplasm/enzymology , Enzyme Inhibitors/pharmacology , Fluorescent Dyes , Fluorometry , Isoenzymes/antagonists & inhibitors , Ligands , Malate Dehydrogenase/antagonists & inhibitors , Malates/metabolism , Models, Molecular , Muscle Proteins/antagonists & inhibitors , Muscle Proteins/metabolism , Myocardium/enzymology , Naphthalenesulfonates , Oxaloacetates/metabolism , Peptide Fragments/chemistry , Protein Binding , Swine , Tartronates/pharmacology
14.
Belg Tijdschr Nieuwste Geschied ; 31(3-4): 453-95, 2001.
Article in English | MEDLINE | ID: mdl-18551800
15.
Biochim Biophys Acta ; 1478(2): 248-56, 2000 May 23.
Article in English | MEDLINE | ID: mdl-10825536

ABSTRACT

Gel exclusion chromatographic studies demonstrate that cytosolic and mitochondrial malate dehydrogenases (cMDH and mMDH) dissociate into subunits in the presence of 0.1% of the non-ionic detergent Triton X-100 (TX-100). The presence of cofactor and catalytically competent cofactor-substrate pairs does not protect mMDH against this dissociation. In contrast, cMDH dimers resist dissociation in the presence of either addition. Since steady state kinetic studies indicate both enzymes are fully active in the presence of 0.1% TX-100, we conclude that quaternary structure is not a kinetically important feature of mMDH structure and cooperativity does not account for mMDH kinetic anomalies. In contrast, cooperativity is a reasonable explanation for cMDH kinetic properties even in the presence of 0.1% TX-100, since this enzyme's subunits associate in the presence of active site ligands. The existence of fully active mMDH subunits raises the possibility that this species rather than the dimer may be a constituent of proposed multi-enzyme complexes of the mitochondrion. Preliminary chromatographic experiments involving gently disrupted mitochondria have found MDH activity in differently sized complexes, all with molecular weights larger than the mMDH dimer but smaller than complexes anticipated for multi-enzyme complexes involving other enzymes and the mMDH dimer.


Subject(s)
Malate Dehydrogenase/chemistry , Mitochondria/enzymology , Animals , Chromatography, Gel , Cytosol/enzymology , Kinetics , Mitochondria, Heart/enzymology , Molecular Weight , Octoxynol , Swine
17.
J Urol ; 161(2): 455-9, 1999 Feb.
Article in English | MEDLINE | ID: mdl-9915425

ABSTRACT

PURPOSE: A phenomenon known as hidden penis has numerous origins, including congenital buried penis and obesity with descent of the escutcheon. No previous report to our knowledge mentions abnormal hypermobility of ventral skin and dartos fascia, which is a major cause of surgical treatment failures. Because the skin and dartos fascia are inadequately attached to Buck's fascia, the corporeal bodies telescope proximally inside the scrotum and pubis. Therefore, the subdermis of the penoscrotal junction must also be tacked to the tunica albuginea ventrally to stabilize the proximal penile skin and prevent the penis from retracting into the scrotum. The surgical technique for correction of the hidden penis in adult and pediatric patients with adequate penile shaft skin is described. MATERIALS AND METHODS: Surgery for hidden penis from multiple causes was performed in 6 adults and 7 children. Tacking sutures were taken from the subdermis of the ventral penoscrotal junction to the tunica albuginea in all cases. A combination procedure with either suprapubic dermatolipectomy, tacking of the penopubic subdermis to the rectus fascia, penoscrotal Z plasty, circumcision revision or lateral penile shaft Z plasty also was performed in some patients. RESULTS: Improvement was noted in all cases. One child requires suprapubic lipectomy for optimal improvement and 3 minor wound problems occurred. CONCLUSIONS: Surgery for hidden penis achieves marked aesthetic and often functional improvement. Surgical failure can be diminished by placing ventral tacking sutures from the tunica albuginea to the subdermis of the penoscrotal junction.


Subject(s)
Penis/abnormalities , Penis/surgery , Urologic Surgical Procedures/methods , Adult , Child , Humans , Male , Middle Aged
19.
Ann Demogr Hist (Paris) ; (2): 31-62, 1999.
Article in French | MEDLINE | ID: mdl-19338102
20.
Tech Urol ; 4(2): 70-6, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9623619

ABSTRACT

Aesthetic surgery to improve the appearance of the penis, scrotum, and pubic region has successfully evolved. Penile lengthening is performed by releasing the suspensory ligament of the penis followed by use of penile weights. Girth is increased by wrapping a dermal-fat graft around the penile circumference. The choice of surgery is determined by the patient's anatomy and desires.


Subject(s)
Penis/surgery , Surgery, Plastic/methods , Adult , Humans , Ligaments/surgery , Male , Middle Aged , Organ Size/physiology , Penile Erection/physiology , Postoperative Care , Surgical Flaps/physiology , Tissue Expansion Devices
SELECTION OF CITATIONS
SEARCH DETAIL
...