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1.
Vet Pathol ; 50(5): 867-76, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23446432

ABSTRACT

Salmonella enterica serovar Typhimurium (S. Typhimurium) causes systemic inflammatory disease in mice by colonizing cells of the mononuclear leukocyte lineage. Mouse strains resistant to S. Typhimurium, including Sv129S6, have an intact Nramp1 (Slc11a1) allele and survive acute infection, whereas C57/BL6 mice, homozygous for a mutant Nramp1 allele, Nramp1(G169D) , develop lethal infections. Restoration of Nramp1 (C57/BL6 Nramp1(G169) ) reestablishes resistance to S. Typhimurium; mice survive at least 3 to 4 weeks postinfection. Since many transgenic mouse strains are on a C57/BL6 genetic background, C57/BL6 Nramp1(G169) mice provide a model to examine host genetic determinants of resistance to infection. To further evaluate host immune response to S. Typhimurium, we performed comparative analyses of Sv129S6 and C57/BL6 Nramp1(G169) mice 3 weeks following oral S. Typhimurium infection. C57/BL6 Nramp1(G169) mice developed more severe inflammatory disease with splenic bacterial counts 1000-fold higher than Sv129S6 mice and relatively greater splenomegaly and blood neutrophil and monocyte counts. Infected C57/BL6 Nramp1(G169) mice developed higher proinflammatory serum cytokine and chemokine responses (interferon-γ, tumor necrosis factor-α, interleukin [IL]-1ß, and IL-2 and monocyte chemotactic protein-1 and chemokine [C-X-C motif] ligand 1, respectively) and marked decreases in anti-inflammatory serum cytokine concentrations (IL-10, IL-4) compared with Sv129S6 mice postinfection. Splenic dendritic cells and macrophages in infected compared with control mice increased to a greater extent in C57/BL6 Nramp1(G169) mice than in Sv129S6 mice. Overall, data show that despite the Nramp1 gene present in both strains, C57/BL6 Nramp1(G169) mice develop more severe, Th1-skewed, acute inflammatory responses to S. Typhimurium infection compared with Sv129S6 mice. Both strains are suitable model systems for studying inflammation in the context of adaptive immunity.


Subject(s)
Adaptive Immunity/immunology , Disease Models, Animal , Salmonella Infections/immunology , Salmonella Infections/pathology , Salmonella typhimurium , Analysis of Variance , Animals , Cation Transport Proteins/genetics , Chemokines/blood , Cytokines/blood , Dendritic Cells/immunology , Flow Cytometry , Macrophages/immunology , Mice , Mice, Inbred C57BL , Mutation, Missense , Species Specificity
2.
J Exp Med ; 194(5): 669-76, 2001 Sep 03.
Article in English | MEDLINE | ID: mdl-11535634

ABSTRACT

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) characterized by plaques of infiltrating CD4(+) and CD8(+) T cells. Studies of MS and experimental autoimmune encephalomyelitis (EAE), an animal model of MS, focus on the contribution of CD4(+) myelin-specific T cells. The role of CD8(+) myelin-specific T cells in mediating EAE or MS has not been described previously. Here, we demonstrate that myelin-specific CD8(+) T cells induce severe CNS autoimmunity in mice. The pathology and clinical symptoms in CD8(+) T cell-mediated CNS autoimmunity demonstrate similarities to MS not seen in myelin-specific CD4(+) T cell-mediated EAE. These data suggest that myelin-specific CD8(+) T cells could function as effector cells in the pathogenesis of MS.


Subject(s)
Brain/immunology , CD8-Positive T-Lymphocytes/immunology , Multiple Sclerosis/immunology , Myelin Basic Protein/immunology , Spinal Cord/immunology , Adoptive Transfer , Animals , Autoimmunity , Brain/pathology , Brain/physiopathology , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/pathology , CD8-Positive T-Lymphocytes/pathology , Clone Cells , Disease Models, Animal , Mice , Mice, Inbred C3H , Mice, Inbred MRL lpr , Mice, SCID , Multiple Sclerosis/pathology , Multiple Sclerosis/physiopathology , Spinal Cord/pathology , Spinal Cord/physiopathology , T-Lymphocytes/immunology , Time Factors
3.
Am J Physiol Gastrointest Liver Physiol ; 281(3): G764-78, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11518689

ABSTRACT

Inflammatory bowel disease (IBD) is thought to result from a dysregulated mucosal immune response to luminal microbial antigens, with T lymphocytes mediating the colonic pathology. Infection with Helicobacter spp has been reported to cause IBD in immunodeficient mice, some of which lack T lymphocytes. To further understand the role of T cells and microbial antigens in triggering IBD, we infected interleukin (IL)-10(-/-), recombinase-activating gene (Rag)1(-/-), T-cell receptor (TCR)-alpha(-/-), TCR-beta(-/-), and wild-type mice with Helicobacter hepaticus or Helicobacter bilis and compared the histopathological IBD phenotype. IL-10(-/-) mice developed severe diffuse IBD with either H. bilis or H. hepaticus, whereas Rag1(-/-), TCR-alpha(-/-), TCR-beta(-/-), and wild-type mice showed different susceptibilities to Helicobacter spp infection. Proinflammatory cytokine mRNA expression was increased in the colons of Helicobacter-infected IL-10(-/-) and TCR-alpha(-/-) mice with IBD. These results confirm and extend the role of Helicobacter as a useful tool for investigating microbial-induced IBD and show the importance, but not strict dependence, of T cells in the development of bacterial-induced IBD.


Subject(s)
Colon/pathology , Cytokines/metabolism , Helicobacter Infections/complications , Helicobacter Infections/metabolism , Inflammatory Bowel Diseases/microbiology , Inflammatory Bowel Diseases/pathology , Animals , Colon/metabolism , Colon/microbiology , Cytokines/genetics , DNA, Bacterial/analysis , Feces/chemistry , Feces/microbiology , Female , Genes, RAG-1/genetics , Genetic Predisposition to Disease , Helicobacter/isolation & purification , Helicobacter/pathogenicity , Helicobacter Infections/pathology , Histocompatibility Antigens Class II/metabolism , Inflammatory Bowel Diseases/immunology , Interleukin-10/deficiency , Interleukin-10/genetics , Intestinal Mucosa/metabolism , Intestinal Mucosa/microbiology , Intestinal Mucosa/pathology , Mice , Mice, Inbred C57BL , Mice, Knockout , RNA, Messenger/metabolism , Receptors, Antigen, T-Cell/deficiency , Receptors, Antigen, T-Cell/genetics , Species Specificity , Specific Pathogen-Free Organisms , T-Lymphocytes/immunology , T-Lymphocytes/metabolism , Weight Gain
4.
J Immunol ; 166(9): 5773-81, 2001 May 01.
Article in English | MEDLINE | ID: mdl-11313421

ABSTRACT

In myelin basic protein (MBP)-specific TCR-transgenic (Tg) mice, peripheral T cells express the Valpha2.3/Vbeta8.2-Tg TCR, demonstrate vigorous proliferative responses to MBP in vitro, and can exhibit experimental autoimmune encephalomyelitis (EAE) within 5 days of pertussis toxin injection. We explored the effects of oral administration of MBP on the cellular trafficking of the MBP-specific TCR-Tg cells and the ability of oral MBP to protect Tg mice from EAE. Tg mice were fed MBP, OVA or vehicle and sacrificed at various times after feeding. An immediate and dramatic decrease in Valpha2.3/Vbeta8.2(+)-Tg cells was observed in the periphery within 1 h after feeding. By 3 days after feeding, the percentage of Tg cells increased to near control levels, but decreased again by 10 days. When MBP or vehicle-fed Tg mice were challenged for EAE at this point, disease was severe in the vehicle-fed mice and reduced in the MBP-fed mice over the 40-day observation period. In vitro studies revealed a biphasic pattern of MBP proliferative unresponsiveness and an induction of Th1 cytokines. Immunohistochemical staining showed that the number of Tg cells found in the intestinal lamina propria increased dramatically as the number of Tg cells in the periphery decreased. There was no apparent proliferation of Tg cells in the lamina propria, indicating that Tg cells trafficked there from the periphery. Taken together, these results suggest that T cell trafficking into the site of Ag deposition acts to protect the TCR-Tg mouse from EAE.


Subject(s)
Epitopes, T-Lymphocyte/immunology , Lymphocyte Depletion , Mice, Transgenic/immunology , Myelin Basic Protein/administration & dosage , Myelin Basic Protein/immunology , Receptors, Antigen, T-Cell, alpha-beta/genetics , T-Lymphocyte Subsets/immunology , Animals , Cell Movement/genetics , Cell Movement/immunology , Cytokines/metabolism , Encephalomyelitis, Autoimmune, Experimental/genetics , Encephalomyelitis, Autoimmune, Experimental/immunology , Encephalomyelitis, Autoimmune, Experimental/pathology , Encephalomyelitis, Autoimmune, Experimental/prevention & control , Female , Guinea Pigs , Immunophenotyping , Intestinal Mucosa/cytology , Intestinal Mucosa/immunology , Intubation, Gastrointestinal , Lymphocyte Activation/genetics , Male , Mice , Mice, Inbred C57BL , Ovalbumin/administration & dosage , Ovalbumin/immunology , Receptors, Antigen, T-Cell, alpha-beta/biosynthesis , T-Lymphocyte Subsets/cytology , T-Lymphocyte Subsets/metabolism
5.
J Exp Med ; 192(6): 871-80, 2000 Sep 18.
Article in English | MEDLINE | ID: mdl-10993917

ABSTRACT

Multiple sclerosis (MS) is believed to be an autoimmune disease in which autoreactive T cells infiltrate the central nervous system (CNS). Animal models of MS have shown that CNS-specific T cells are present in the peripheral T cell repertoire of healthy mice and cause autoimmune disease only when they are activated by immunization. T cell entry into the CNS is thought to require some form of peripheral activation because the blood-brain barrier prohibits trafficking of this tissue by naive cells. We report here that naive T cells can traffic to the CNS without prior activation. Comparable numbers of T cells are found in the CNS of both healthy recombinase activating gene (Rag)(-/)- T cell receptor (TCR) transgenic mice and nontransgenic mice even when the transgenic TCR is specific for a CNS antigen. Transgenic T cells isolated from the CNS that are specific for non-CNS antigens are phenotypically naive and proliferate robustly to antigenic stimulation in vitro. Strikingly, transgenic T cells isolated from the CNS that are specific for myelin basic protein (MBP) are also primarily phenotypically naive but are unresponsive to antigenic stimulation in vitro. Mononuclear cells from the CNS of MBP TCR transgenic but not nontransgenic mice can suppress the response of peripheral MBP-specific T cells in vitro. These results indicate that naive MBP-specific T cells can traffic to the CNS but do not trigger autoimmunity because they undergo tolerance induction in situ.


Subject(s)
Central Nervous System/immunology , Genes, RAG-1 , Receptors, Antigen, T-Cell/physiology , T-Lymphocytes/immunology , Animals , Crosses, Genetic , Homeodomain Proteins/metabolism , Immune Tolerance , Mice , Mice, Inbred C57BL , Mice, Knockout , Mice, Transgenic , Multiple Sclerosis/immunology , Myelin Basic Protein/immunology , Receptors, Antigen, T-Cell/deficiency , Receptors, Antigen, T-Cell/genetics
6.
Immunity ; 9(2): 179-86, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9729038

ABSTRACT

Using a sensitive molecular marker for positive selection, the appearance of a particular functional TCR alpha chain sequence in cells from mice bearing a transgenic beta chain, we address several aspects of intrathymic T cell development. First, by examining specific TCR prior to and after maturation, we demonstrate how a restricted TCR repertoire is positively selected from a highly diverse immature TCR repertoire. Second, since this molecular marker is enriched in cells progressing toward the CD4 lineage and depleted in cells progressing toward the CD8 lineage, a map of the developmental pathway of alphabeta thymocytes can be inferred. Third, the first cells that show clear signs of positive intrathymic selection are identified.


Subject(s)
T-Lymphocytes/physiology , Amino Acid Sequence , Animals , Antigens, CD/analysis , Antigens, Differentiation, T-Lymphocyte/analysis , CD4-Positive T-Lymphocytes/chemistry , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Cell Differentiation/genetics , Cell Differentiation/immunology , Immunization , Lectins, C-Type , Lymphocyte Activation/genetics , Lymphocyte Activation/immunology , Mice , Mice, Transgenic , Molecular Probes , Peptides/immunology , Receptors, Antigen, T-Cell, alpha-beta/immunology , T-Lymphocytes/immunology , Thymus Gland/chemistry , Thymus Gland/cytology , Thymus Gland/immunology
7.
Immunity ; 8(5): 571-80, 1998 May.
Article in English | MEDLINE | ID: mdl-9620678

ABSTRACT

Experimental allergic encephalomyelitis (EAE) is induced by T cell-mediated immunity to central nervous system antigens. In H-2u mice, EAE is mediated primarily by T cells specific for residues 1-11 of myelin basic protein (MBP). We demonstrate that differential tolerance to MBP1-11 versus epitopes in MBP121-150 is induced by expression of endogenous MBP, reflecting extreme differences in stability of peptide/MHC complexes. The diverse MBP121-150-specific TCR repertoire can be divided into three fine specificity groups. Two groups were identified in wild-type mice despite extensive tolerance, but the third group was not detected. Activated MBP121-150-specific T cells induce EAE in wild-type mice. Thus, encephalitogenic T cells that escape tolerance either recognize short-lived peptide/MHC complexes or express TCRs with unique specificities for stable complexes.


Subject(s)
Epitope Mapping , Epitopes, T-Lymphocyte/immunology , Immune Tolerance/immunology , Myelin Basic Protein/immunology , T-Lymphocytes/immunology , Animals , Encephalomyelitis, Autoimmune, Experimental/immunology , H-2 Antigens/immunology , Hybridomas , Immunoglobulin Variable Region/genetics , Mice , Mice, Inbred C3H , Peptide Fragments/immunology , Receptors, Antigen, T-Cell, alpha-beta/genetics , Sequence Analysis, DNA
8.
Eur J Immunol ; 27(11): 3039-48, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9394835

ABSTRACT

Two aspects of T cell differentiation in T cell receptor (TCR)-transgenic mice, the generation of an unusual population of CD4-CD8-TCR+ thymocytes and the absence of gamma delta cells, have been the focus of extensive investigation. To examine the basis for these phenomena, we investigated the effects of separate expression of a transgenic TCR alpha chain and a transgenic TCR beta chain on thymocyte differentiation. Our data indicate that expression of a transgenic TCR alpha chain causes thymocytes to differentiate into a CD4-CD8-TCR+ lineage at an early developmental stage, depleting the number of thymocytes that differentiate into the alpha beta lineage. Surprisingly, expression of the TCR alpha chain transgene is also associated with the development of T cell lymphosarcoma. In contrast, expression of the transgenic TCR beta chain causes immature T cells to accelerate differentiation into the alpha beta lineage and thus inhibits the generation of gamma delta cells. Our observations provide a model for understanding T cell differentiation in TCR-transgenic mice.


Subject(s)
Cell Transformation, Neoplastic/genetics , Cell Transformation, Neoplastic/immunology , Gene Expression Regulation/immunology , Genes, T-Cell Receptor alpha/immunology , Genes, T-Cell Receptor beta/immunology , T-Lymphocyte Subsets/metabolism , Transgenes/immunology , Animals , CD4 Antigens/analysis , CD8 Antigens/analysis , Cell Differentiation/genetics , Cell Differentiation/immunology , Cell Transformation, Neoplastic/metabolism , Embryonic and Fetal Development/genetics , Embryonic and Fetal Development/immunology , Lymphocyte Count , Lymphocyte Specific Protein Tyrosine Kinase p56(lck)/physiology , Lymphoma, Non-Hodgkin/genetics , Lymphoma, Non-Hodgkin/immunology , Lymphoma, T-Cell/genetics , Lymphoma, T-Cell/immunology , Mice , Mice, Inbred C57BL , Mice, Transgenic , Receptors, Antigen, T-Cell, alpha-beta/biosynthesis , Receptors, Antigen, T-Cell, alpha-beta/genetics , Receptors, Antigen, T-Cell, gamma-delta/biosynthesis , Signal Transduction/genetics , Signal Transduction/immunology , T-Lymphocyte Subsets/cytology , T-Lymphocyte Subsets/pathology
9.
J Immunol ; 159(1): 497-507, 1997 Jul 01.
Article in English | MEDLINE | ID: mdl-9200491

ABSTRACT

The combination of genetic and environmental factors that contribute to human autoimmune responses has made potential triggers of these diseases difficult to identify. We examined how experimental allergic encephalomyelitis (EAE), an animal model of multiple sclerosis, is triggered using TCR-transgenic mice specific for myelin basic protein (MBP). In these TCR-transgenic mice, EAE can be actively induced and also occurs spontaneously. The incidence of spontaneous EAE in this model is largely confined to adolescence and early adulthood and is more prevalent among males than females, indicating that hormonal influences may contribute to triggering central nervous system autoimmune disease. Disease induction studies show that not all stimuli that activate MBP-specific T cells in vivo also induce EAE. Immunization with MBP peptide stimulates the transgenic T cells to produce Th1 cytokines; however, the activated T cells do not accumulate in the central nervous system and induce EAE unless pertussis toxin is also administered. EAE can be induced by intrathecal injection of either stimulated or nonstimulated transgenic T cells into nontransgenic or transgenic recipients. Therefore, gaining access to the central nervous system appears to be the critical step in this model for the induction of EAE, regardless of the activation state of the T cells.


Subject(s)
Autoimmune Diseases/genetics , Mice, Transgenic , Multiple Sclerosis/immunology , Receptors, Antigen, T-Cell/genetics , T-Lymphocytes/immunology , Animals , Disease Models, Animal , Humans , Mice , Multiple Sclerosis/genetics , Myelin Basic Protein/immunology , Receptors, Antigen, T-Cell/immunology
11.
Eur J Immunol ; 27(1): 136-46, 1997 Jan.
Article in English | MEDLINE | ID: mdl-9022010

ABSTRACT

The thymic architecture is normally compartmentalized into a central medulla surrounded by a peripheral cortical region. We investigated how compartmentalization of the thymic stroma is regulated using T cell receptor (TCR)-transgenic mouse models. Our studies show that the signals generated by TCR/peptide/major histocompatibility complex interactions regulate thymic stromal cell compartmentalization. In TCR-transgenic mice, normal stromal cell compartmentalization occurs when the transgenic TCR is expressed on a background that does not result in skewing toward either positive or negative selection. In models representing strong positive selection, the thymic stromal elements do not fully organize into a central medulla. Instead, small medullary foci are dispersed throughout the thymus with some regions residing directly under the capsule. The highest degree of disorganization in medullary epithelial regions is observed in TCR-transgenic mice that exhibit negative selection. Although the medullary foci lack central organization, the expression in these regions of CD80, CD86 and CD40, as well as the clustering of dendritic cells, is similar to that observed in medullae of wild-type mice. Thus, the organization of the medulla appears to occur in two stages: (1) small medullary epithelial regions that are dispersed in fetal thymi expand and associate with antigen-presenting cells, and (2) the expanded medullary foci organize into a central medullary compartment. Our data suggest a model in which this second stage of stromal cell organization is increasingly inhibited as the normal balance of TCR-mediated signals is skewed by higher-avidity interactions between thymocytes and antigen-presenting cells.


Subject(s)
H-2 Antigens/immunology , Receptors, Antigen, T-Cell/physiology , Thymus Gland/cytology , Animals , Antigen-Presenting Cells/immunology , Cell Adhesion , Epithelial Cells , Female , Hematopoiesis , Male , Mice , Mice, Transgenic , Myelin Basic Protein/immunology , Ovalbumin/immunology , Radiation Chimera , Signal Transduction
12.
Crit Rev Immunol ; 17(5-6): 469-80, 1997.
Article in English | MEDLINE | ID: mdl-9419434

ABSTRACT

Our studies addressed the questions of how self-reactive T cells escape tolerance and what stimuli cause these T cells to initiate autoimmune responses. We employed experimental allergic encephalomyelitis (EAE) as an animal model of multiple sclerosis (MS). Endogenous expression of myelin basic protein (MBP) induces tolerance in T cells that recognize one region of MBP, whereas T cells specific for a different region escape tolerance. Triggers of disease induction were investigated in a T-cell receptor (TCR) transgenic model in which the majority of T cells recognize the MBP epitope that does not induce tolerance. EAE occurs spontaneously in this model and the incidence of disease depends on microbial exposure. EAE can also be actively induced by immunization with MBP peptide accompanied by injection of pertussis toxin as well as by administration of pertussis toxin alone. Immunization with MBP peptide without pertussis toxin, however, stimulates the transgenic T cells, but the activated T cells do not accumulate in the central nervous system (CNS) or induce EAE. Our studies suggest that initiation of autoimmune disease involves complex interactions between the neuroendocrine system as well as the innate and specific immune systems.


Subject(s)
Autoimmunity/immunology , Central Nervous System/immunology , Encephalomyelitis, Autoimmune, Experimental/immunology , Multiple Sclerosis/immunology , T-Lymphocytes/immunology , Animals , Antigens/immunology , Disease Models, Animal , Humans , Immune Tolerance , Lymphocyte Activation/immunology , Myelin Basic Protein/immunology
13.
FEBS Lett ; 398(2-3): 217-22, 1996 Dec 02.
Article in English | MEDLINE | ID: mdl-8977110

ABSTRACT

ZAP-70 is a protein tyrosine kinase (PTK) that plays a critical role in T cell activation. To study the role of ZAP-70 catalytic activity in this process, a substrate capable of distinguishing between the activities of ZAP-70 and other PTKs would be useful, especially since it has recently been shown that ZAP-70 interacts with another T cell PTK, Lck. We have thus identified a site of phosphorylation on the cytoplasmic fragment of the erythrocyte band 3 protein that is recognized by ZAP-70, but not Lck. A synthetic peptide based on this site has been demonstrated to be a good in vitro substrate for ZAP-70 and a poor substrate for the T cell PTKs Lck and Itk. This peptide molecule should thus prove useful to many investigators working in the field of T cell activation.


Subject(s)
Anion Exchange Protein 1, Erythrocyte/metabolism , Peptide Fragments/metabolism , Protein-Tyrosine Kinases/metabolism , T-Lymphocytes/enzymology , Amino Acid Sequence , Anion Exchange Protein 1, Erythrocyte/chemistry , Chromatography, High Pressure Liquid , Humans , Lymphocyte Specific Protein Tyrosine Kinase p56(lck) , Mass Spectrometry , Membrane Proteins/metabolism , Molecular Sequence Data , Myelin Basic Protein/metabolism , Peptide Fragments/chemistry , Phosphorylation , Receptors, Antigen, T-Cell/metabolism , Recombinant Proteins/metabolism , Substrate Specificity , ZAP-70 Protein-Tyrosine Kinase , src-Family Kinases/metabolism
15.
Lab Anim Sci ; 45(4): 357-62, 1995 Aug.
Article in English | MEDLINE | ID: mdl-7474871

ABSTRACT

A 3-year-old male grey collie and 4-year-old female grey collie were part of a cyclic hematopoiesis study. Both dogs had experienced numerous bacterial infections, and both dogs were receiving various treatment regimens, including lithium and hematopoietic growth factors, to control the cyclic hematopoiesis. The first dog was presented in acute collapse and had a rapid clinical course. The second dog was presented with pyrexia and subsequently developed anorexia, disorientation, tremors, mild diarrhea, and bruising at venipuncture sites. Postmortem examination revealed pancreatic adenocarcinoma with metastasis in both cases. Pancreatic adenocarcinoma is a rare neoplasm in dogs. The incidence of pancreatic adenocarcinoma noted in this report is more than 150 times that previously reported in dogs. The cause of the increased incidence of pancreatic malignancy in these grey collies is unknown; possible factors include chronic inflammation or infections, chronic drug therapy, or genetic predisposition. Development of an uncommon neoplasm in two young grey collies may offer an opportunity to study the mechanisms of carcinogenesis.


Subject(s)
Adenoma/veterinary , Dog Diseases/diagnosis , Hematopoiesis , Pancreatic Neoplasms/veterinary , Adenoma/diagnosis , Adenoma/pathology , Animals , Dog Diseases/epidemiology , Dog Diseases/pathology , Dogs , Female , Hematopoietic Cell Growth Factors/therapeutic use , Lithium/therapeutic use , Male , Neoplasm Metastasis , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology
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