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1.
Annu Rev Biochem ; 2024 Apr 09.
Article in English | MEDLINE | ID: mdl-38594929

ABSTRACT

Lysosomes are the degradative endpoints of material delivered by endocytosis and autophagy and are therefore particularly prone to damage. Membrane permeabilization or full rupture of lysosomal or late endosomal compartments is highly deleterious because it threatens cellular homeostasis and can elicit cell death and inflammatory signaling. Cells have developed a complex response to endo-lysosomal damage that largely consists of three branches. Initially, a number of repair pathways are activated to restore the integrity of the lysosomal membrane. If repair fails or if damage is too extensive, lysosomes are isolated and degraded by a form of selective autophagy termed lysophagy. Meanwhile, an mTORC1-governed signaling cascade drives biogenesis and regeneration of new lysosomal components to reestablish the full lysosomal capacity of the cell. This damage response is vital to counteract the effects of various conditions, including neurodegeneration and infection, and can constitute a critical vulnerability in cancer cells.

2.
Mol Cell ; 84(8): 1556-1569.e10, 2024 Apr 18.
Article in English | MEDLINE | ID: mdl-38503285

ABSTRACT

Cells respond to lysosomal membrane permeabilization by membrane repair or selective macroautophagy of damaged lysosomes, termed lysophagy, but it is not fully understood how this decision is made. Here, we uncover a pathway in human cells that detects lipid bilayer perturbations in the limiting membrane of compromised lysosomes, which fail to be repaired, and then initiates ubiquitin-triggered lysophagy. We find that SPG20 binds the repair factor IST1 on damaged lysosomes and, importantly, integrates that with the detection of damage-associated lipid-packing defects of the lysosomal membrane. Detection occurs via sensory amphipathic helices in SPG20 before rupture of the membrane. If lipid-packing defects are extensive, such as during lipid peroxidation, SPG20 recruits and activates ITCH, which marks the damaged lysosome with lysine-63-linked ubiquitin chains to initiate lysophagy and thus triages the lysosome for destruction. With SPG20 being linked to neurodegeneration, these findings highlight the relevance of a coordinated lysosomal damage response for cellular homeostasis.


Subject(s)
Lysosomes , Macroautophagy , Humans , Autophagy/physiology , Intracellular Membranes/metabolism , Lipids , Lysosomes/metabolism , Ubiquitin/genetics , Ubiquitin/metabolism
3.
Mol Cell ; 82(14): 2633-2649.e7, 2022 07 21.
Article in English | MEDLINE | ID: mdl-35793674

ABSTRACT

Lysosomal membrane permeabilization (LMP) is an underlying feature of diverse conditions including neurodegeneration. Cells respond by extensive ubiquitylation of membrane-associated proteins for clearance of the organelle through lysophagy that is facilitated by the ubiquitin-directed AAA-ATPase VCP/p97. Here, we assessed the ubiquitylated proteome upon acute LMP and uncovered a large diversity of targets and lysophagy regulators. They include calponin-2 (CNN2) that, along with the Arp2/3 complex, translocates to damaged lysosomes and regulates actin filaments to drive phagophore formation. Importantly, CNN2 needs to be ubiquitylated during the process and removed by VCP/p97 for efficient lysophagy. Moreover, we identified the small heat shock protein HSPB1 that assists VCP/p97 in the extraction of CNN2 and show that other membrane regulators including SNAREs, PICALM, AGFG1, and ARL8B are ubiquitylated during lysophagy. Our data reveal a framework of how ubiquitylation and two effectors, VCP/p97 and HSPB1, cooperate to protect cells from the deleterious effects of LMP.


Subject(s)
Macroautophagy , Ubiquitin , Actins/metabolism , Adenosine Triphosphatases/metabolism , Cell Cycle Proteins/metabolism , Lysosomes/metabolism , Ubiquitin/metabolism , Valosin Containing Protein/genetics , Valosin Containing Protein/metabolism
4.
Nat Struct Mol Biol ; 28(12): 964-971, 2021 12.
Article in English | MEDLINE | ID: mdl-34824462

ABSTRACT

The AAA-ATPase VCP/p97/Cdc48 unfolds proteins by threading them through its central pore, but how substrates are recognized and inserted into the pore in diverse pathways has remained controversial. Here, we show that p97, with its adapter p37, binds an internal recognition site (IRS) within inhibitor-3 (I3) and then threads a peptide loop into its channel to strip I3 off protein phosphatase-1 (PP1). Of note, the IRS is adjacent to the prime interaction site of I3 to PP1, and IRS mutations block I3 processing both in vitro and in cells. In contrast, amino- and carboxy-terminal regions of I3 are not required, and even circularization of I3 does not prevent I3 processing. This was confirmed by an in vitro Förster resonance energy transfer assay that allowed kinetic analysis of the reaction. Thus, our data uncover how PP1 is released from its inhibitory partner for activation and demonstrate a remarkable plasticity in substrate threading by p97.


Subject(s)
Adaptor Proteins, Signal Transducing/metabolism , Protein Phosphatase 1/metabolism , Valosin Containing Protein/metabolism , Animals , Binding Sites/genetics , Catalytic Domain/genetics , Cell Line , Fluorescence Resonance Energy Transfer , HEK293 Cells , Humans , Protein Binding/genetics , Protein Unfolding , Sf9 Cells
5.
J Mol Biol ; 432(1): 231-239, 2020 01 03.
Article in English | MEDLINE | ID: mdl-31449799

ABSTRACT

Lysosomal membrane permeabilization or full rupture of lysosomes is a common and severe stress condition that is relevant for degenerative disease, infection and cancer. If damage is limited, cells can repair lysosomes by means of the endosomal sorting complex required for transport (ESCRT) machinery. Presumably, if repair fails, lysosomes are tagged with ubiquitin to initiate clearance by selective macroautophagy, termed lysophagy. Accumulating evidence suggests damage-induced exposure of luminal glycans to the cytosol as the key trigger for ubiquitination. In this review, we discuss recent data on cellular damage sensing, the underlying ubiquitination and autophagy machinery as well as additional layers of regulation such as processing of ubiquitinated proteins by the AAA-ATPase VCP/p97. We conclude with thoughts on how these mechanisms may regulate decision making between lysosome repair and lysophagy.


Subject(s)
Lysosomes/metabolism , Macroautophagy , Animals , Humans , Permeability , Ubiquitin/metabolism , Ubiquitination , Valosin Containing Protein/metabolism
6.
Autophagy ; 16(1): 179-180, 2020 01.
Article in English | MEDLINE | ID: mdl-31679434

ABSTRACT

Lysosomal membrane permeabilization or full rupture of lysosomes is a common and severe stress condition that is relevant for degenerative disease, infection and cancer. Cells respond with extensive ubiquitination of damaged lysosomes, which triggers selective macroautophagy/autophagy of the whole organelle, termed lysophagy. We screened an siRNA library targeting human E2-conjugating enzymes and identified UBE2QL1 as critical for efficient lysosome ubiquitination after chemically-induced lysosomal damage. UBE2QL1 translocates to lysosomes upon damage and associates with autophagy regulators. Loss of UBE2QL1-mediated ubiquitination reduces association of the autophagy receptor SQSTM1/p62 and the LC3-decorated phagophore, and prevents recruitment of the ubiquitin-targeted AAA-ATPase VCP/p97 that facilitates lysophagy. Even in unchallenged cells, UBE2QL1 depletion leads to MTOR dissociation and TFEB activation, and mutation of the homolog UBC-25 destabilizes lysosomes in C. elegans, indicating that UBE2QL1 is critical for maintaining lysosome integrity in addition to lysophagy.


Subject(s)
Autophagy/physiology , Lysosomes/metabolism , Macroautophagy/physiology , Ubiquitin-Conjugating Enzymes/metabolism , Animals , Humans , Intracellular Membranes/metabolism , Organelles/metabolism
7.
Cells ; 8(8)2019 08 20.
Article in English | MEDLINE | ID: mdl-31434353

ABSTRACT

The protein kinase Csnk2/CK2 is important for cell proliferation, differentiation, and survival. Previously, we showed that CK2 binds distinctive proteins at neuromuscular junctions (NMJs) of mice and phosphorylates some of them. CK2 likely stabilizes clustered nicotinic acetylcholine receptors (AChRs). In the absence of the ß-subunit of CK2 in skeletal muscle fibers, mice develop an age-dependent decrease of grip strength accompanied by NMJ fragmentation and impairments of neuromuscular transmission. However, the precise role of CK2ß regarding the clustering of AChRs and downstream signaling at NMJs is unknown. Here, we compared conditional CK2ß-deficient mice with controls and found in the mutants (1) a lower decrement of endplate potentials after repetitive stimulation and decrements of nerve-evoked compound muscle action potentials decayed more rapidly after synaptic transmission was partially blocked, (2) that their muscle weakness was partially rescued by administration of an acetylcholine esterase inhibitor, (3) fragmented NMJs and impaired AChR clustering was detected in muscles and cultured muscle cells, (4) enlarged myonuclei, (5) impaired synaptic gene expression, and (6) a high turnover rate of their AChR clusters in vivo. Altogether, our data demonstrate a role for CK2 at the NMJ by maintaining a high density of AChRs and ensuring physiological synaptic gene expression.


Subject(s)
Casein Kinase II/metabolism , Muscle Fibers, Skeletal/physiology , Muscle, Skeletal/physiology , Neuromuscular Junction/physiology , Receptors, Nicotinic/metabolism , Animals , Gene Expression , Mice , Synaptic Transmission
8.
EMBO Rep ; 20(10): e48014, 2019 10 04.
Article in English | MEDLINE | ID: mdl-31432621

ABSTRACT

The autophagic clearance of damaged lysosomes by lysophagy involves extensive modification of the organelle with ubiquitin, but the underlying ubiquitination machinery is still poorly characterized. Here, we use an siRNA screening approach and identify human UBE2QL1 as a major regulator of lysosomal ubiquitination, lysophagy, and cell survival after lysosomal damage. UBE2QL1 translocates to permeabilized lysosomes where it associates with damage sensors, ubiquitination targets, and lysophagy effectors. UBE2QL1 knockdown reduces ubiquitination and accumulation of the critical autophagy receptor p62 and abrogates recruitment of the AAA-ATPase VCP/p97, which is essential for efficient lysophagy. Crucially, it affects association of LC3B with damaged lysosomes indicating that autophagosome formation was impaired. Already in unchallenged cells, depletion of UBE2QL1 leads to increased lysosomal damage, mTOR dissociation from lysosomes, and TFEB activation pointing to a role in lysosomal homeostasis. In line with this, mutation of the homologue ubc-25 in Caenorhabditis elegans exacerbates lysosome permeability in worms lacking the lysosome stabilizing protein SCAV-3/LIMP2. Thus, UBE2QL1 coordinates critical steps in the acute endolysosomal damage response and is essential for maintenance of lysosomal integrity.


Subject(s)
Autophagy , Endosomes/metabolism , Lysosomes/metabolism , Ubiquitin-Conjugating Enzymes/metabolism , Adenosine Triphosphatases , Animals , Caenorhabditis elegans/metabolism , Caenorhabditis elegans Proteins/metabolism , Cell Survival , Endosomes/ultrastructure , Galectins/metabolism , HeLa Cells , Humans , Lysine/metabolism , Lysosomes/ultrastructure , Microtubule-Associated Proteins/metabolism , Nuclear Proteins , Permeability , RNA, Small Interfering/metabolism , Sequestosome-1 Protein/metabolism , Ubiquitin/metabolism , Ubiquitination , Ubiquitins/metabolism
9.
Mol Cell Proteomics ; 17(7): 1295-1307, 2018 07.
Article in English | MEDLINE | ID: mdl-29599191

ABSTRACT

The ubiquitin-directed AAA-ATPase VCP/p97 facilitates degradation of damaged or misfolded proteins in diverse cellular stress response pathways. Resolving the complexity of its interactions with partner and substrate proteins and understanding its links to stress signaling is therefore a major challenge. Here, we used affinity-purification SWATH mass spectrometry (AP-SWATH) to identify proteins that specifically interact with the substrate-trapping mutant, p97-E578Q. AP-SWATH identified differential interactions over a large detection range from abundant p97 cofactors to pathway-specific partners and individual ligases such as RNF185 and MUL1 that were trapped in p97-E578Q complexes. In addition, we identified various substrate proteins and candidates including the PP1 regulator CReP/PPP1R15B that dephosphorylates eIF2α and thus counteracts attenuation of translation by stress-kinases. We provide evidence that p97 with its Ufd1-Npl4 adapter ensures rapid constitutive turnover and balanced levels of CReP in unperturbed cells. Moreover, we show that p97-mediated degradation, together with a reduction in CReP synthesis, is essential for timely stress-induced reduction of CReP levels and, consequently, for robust eIF2α phosphorylation to enforce the stress response. Thus, our results demonstrate that p97 not only facilitates bulk degradation of misfolded proteins upon stress, but also directly modulates the integrated stress response at the level of signaling.


Subject(s)
Adenosine Triphosphatases/metabolism , Chromatography, Affinity/methods , Mass Spectrometry/methods , Nuclear Proteins/metabolism , Protein Phosphatase 1/metabolism , Proteolysis , Signal Transduction , Stress, Physiological , Arsenites/pharmacology , Eukaryotic Initiation Factor-2/metabolism , HEK293 Cells , HeLa Cells , Humans , Mutation/genetics , Phosphorylation/drug effects , Proteolysis/drug effects , Reproducibility of Results , Stress, Physiological/drug effects , Substrate Specificity , Ubiquitin-Protein Ligases/metabolism , Ultraviolet Rays
10.
Autophagy ; 14(2): 311-335, 2018.
Article in English | MEDLINE | ID: mdl-29165030

ABSTRACT

In yeast, Tom22, the central component of the TOMM (translocase of outer mitochondrial membrane) receptor complex, is responsible for the recognition and translocation of synthesized mitochondrial precursor proteins, and its protein kinase CK2-dependent phosphorylation is mandatory for TOMM complex biogenesis and proper mitochondrial protein import. In mammals, the biological function of protein kinase CSNK2/CK2 remains vastly elusive and it is unknown whether CSNK2-dependent phosphorylation of TOMM protein subunits has a similar role as that in yeast. To address this issue, we used a skeletal muscle-specific Csnk2b/Ck2ß-conditional knockout (cKO) mouse model. Phenotypically, these skeletal muscle Csnk2b cKO mice showed reduced muscle strength and abnormal metabolic activity of mainly oxidative muscle fibers, which point towards mitochondrial dysfunction. Enzymatically, active muscle lysates from skeletal muscle Csnk2b cKO mice phosphorylate murine TOMM22, the mammalian ortholog of yeast Tom22, to a lower extent than lysates prepared from controls. Mechanistically, CSNK2-mediated phosphorylation of TOMM22 changes its binding affinity for mitochondrial precursor proteins. However, in contrast to yeast, mitochondrial protein import seems not to be affected in vitro using mitochondria isolated from muscles of skeletal muscle Csnk2b cKO mice. PINK1, a mitochondrial health sensor that undergoes constitutive import under physiological conditions, accumulates within skeletal muscle Csnk2b cKO fibers and labels abnormal mitochondria for removal by mitophagy as demonstrated by the appearance of mitochondria-containing autophagosomes through electron microscopy. Mitophagy can be normalized by either introduction of a phosphomimetic TOMM22 mutant in cultured myotubes, or by in vivo electroporation of phosphomimetic Tomm22 into muscles of mice. Importantly, transfection of the phosphomimetic Tomm22 mutant in muscle cells with ablated Csnk2b restored their oxygen consumption rate comparable to wild-type levels. In sum, our data show that mammalian CSNK2-dependent phosphorylation of TOMM22 is a critical switch for mitophagy and reveal CSNK2-dependent physiological implications on metabolism, muscle integrity and behavior.


Subject(s)
Casein Kinase II/metabolism , Mitochondria, Muscle/physiology , Mitochondrial Membrane Transport Proteins/metabolism , Mitochondrial Membranes/enzymology , Mitophagy/physiology , Muscle, Skeletal/enzymology , Animals , Autophagy , Casein Kinase II/genetics , HEK293 Cells , Humans , Mice , Mice, Knockout , Mitochondrial Precursor Protein Import Complex Proteins , Mitophagy/genetics , Models, Animal , Phosphorylation , Protein Transport , Signal Transduction
11.
Nat Commun ; 8(1): 1249, 2017 11 01.
Article in English | MEDLINE | ID: mdl-29093487

ABSTRACT

Muscular dystrophies (MDs) are often characterized by impairment of both skeletal and cardiac muscle. Regenerative strategies for both compartments therefore constitute a therapeutic avenue. Mesodermal iPSC-derived progenitors (MiPs) can regenerate both striated muscle types simultaneously in mice. Importantly, MiP myogenic propensity is influenced by somatic lineage retention. However, it is still unknown whether human MiPs have in vivo potential. Furthermore, methods to enhance the intrinsic myogenic properties of MiPs are likely needed, given the scope and need to correct large amounts of muscle in the MDs. Here, we document that human MiPs can successfully engraft into the skeletal muscle and hearts of dystrophic mice. Utilizing non-invasive live imaging and selectively induced apoptosis, we report evidence of striated muscle regeneration in vivo in mice by human MiPs. Finally, combining RNA-seq and miRNA-seq data, we define miRNA cocktails that promote the myogenic potential of human MiPs.


Subject(s)
Heart/growth & development , Induced Pluripotent Stem Cells/cytology , Mesoderm/cytology , MicroRNAs/genetics , Muscle Development/genetics , Muscle, Skeletal/growth & development , Muscular Dystrophy, Animal/pathology , Myocardium/cytology , Animals , Cell Differentiation , Echocardiography , Heart/diagnostic imaging , Humans , Mice , Muscle, Skeletal/cytology , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/pathology , Muscular Dystrophy, Animal/diagnostic imaging , Myocardium/pathology , Regeneration
12.
J Neurochem ; 143(5): 569-583, 2017 12.
Article in English | MEDLINE | ID: mdl-28555889

ABSTRACT

Inherited deficiency in ether lipids, a subgroup of phospholipids whose biosynthesis needs peroxisomes, causes the fatal human disorder rhizomelic chondrodysplasia punctata. The exact roles of ether lipids in the mammalian organism and, therefore, the molecular mechanisms underlying the disease are still largely enigmatic. Here, we used glyceronephosphate O-acyltransferase knockout (Gnpat KO) mice to study the consequences of complete inactivation of ether lipid biosynthesis and documented substantial deficits in motor performance and muscle strength of these mice. We hypothesized that, probably in addition to previously described cerebellar abnormalities and myelination defects in the peripheral nervous system, an impairment of neuromuscular transmission contributes to the compromised motor abilities. Structurally, a morphologic examination of the neuromuscular junction (NMJ) in diaphragm muscle at different developmental stages revealed aberrant axonal branching and a strongly increased area of nerve innervation in Gnpat KO mice. Post-synaptically, acetylcholine receptor (AChR) clusters colocalized with nerve terminals within a widened endplate zone. In addition, we detected atypical AChR clustering, as indicated by decreased size and number of clusters following stimulation with agrin, in vitro. The turnover of AChRs was unaffected in ether lipid-deficient mice. Electrophysiological evaluation of the adult diaphragm indicated that although evoked potentials were unaltered in Gnpat KO mice, ether lipid deficiency leads to fewer spontaneous synaptic vesicle fusion events but, conversely, an increased post-synaptic response to spontaneous vesicle exocytosis. We conclude from our findings that ether lipids are essential for proper development and function of the NMJ and may, therefore, contribute to motor performance. Read the Editorial Highlight for this article on page 463.


Subject(s)
Muscle Strength/physiology , Muscle Weakness/physiopathology , Neuromuscular Junction/physiopathology , Phospholipids/deficiency , Animals , Diaphragm/metabolism , Disease Models, Animal , Mice, Knockout , Muscle Weakness/metabolism , Neuromuscular Junction/metabolism , Receptor Protein-Tyrosine Kinases/metabolism , Receptors, Cholinergic/metabolism , Synaptic Transmission/physiology
13.
Development ; 143(17): 3128-42, 2016 09 01.
Article in English | MEDLINE | ID: mdl-27578179

ABSTRACT

Canonical Wnt/ß-catenin signaling plays an important role in myogenic differentiation, but its physiological role in muscle fibers remains elusive. Here, we studied activation of Wnt/ß-catenin signaling in adult muscle fibers and muscle stem cells in an Axin2 reporter mouse. Axin2 is a negative regulator and a target of Wnt/ß-catenin signaling. In adult muscle fibers, Wnt/ß-catenin signaling is only detectable in a subset of fast fibers that have a significantly smaller diameter than other fast fibers. In the same fibers, immunofluorescence staining for YAP/Taz and Tead1 was detected. Wnt/ß-catenin signaling was absent in quiescent and activated satellite cells. Upon injury, Wnt/ß-catenin signaling was detected in muscle fibers with centrally located nuclei. During differentiation of myoblasts expression of Axin2, but not of Axin1, increased together with Tead1 target gene expression. Furthermore, absence of Axin1 and Axin2 interfered with myoblast proliferation and myotube formation, respectively. Treatment with the canonical Wnt3a ligand also inhibited myotube formation. Wnt3a activated TOPflash and Tead1 reporter activity, whereas neither reporter was activated in the presence of Dkk1, an inhibitor of canonical Wnt signaling. We propose that Axin2-dependent Wnt/ß-catenin signaling is involved in myotube formation and, together with YAP/Taz/Tead1, associated with reduced muscle fiber diameter of a subset of fast fibers.


Subject(s)
Adaptor Proteins, Signal Transducing/metabolism , Axin Protein/metabolism , DNA-Binding Proteins/metabolism , Phosphoproteins/metabolism , Transcription Factors/metabolism , Wnt Signaling Pathway/physiology , beta Catenin/metabolism , Acyltransferases , Adaptor Proteins, Signal Transducing/genetics , Animals , Axin Protein/genetics , Cell Cycle Proteins , DNA-Binding Proteins/genetics , Intercellular Signaling Peptides and Proteins/genetics , Intercellular Signaling Peptides and Proteins/metabolism , Mice , Muscle Development/genetics , Muscle Development/physiology , Phosphoproteins/genetics , TEA Domain Transcription Factors , Transcription Factors/genetics , Wnt Signaling Pathway/genetics , Wnt3A Protein/genetics , Wnt3A Protein/metabolism , YAP-Signaling Proteins
14.
J Neurochem ; 139(3): 381-395, 2016 11.
Article in English | MEDLINE | ID: mdl-27321929

ABSTRACT

Erbin, Lano, Scribble, and Densin-180 belong to LAP (leucine-rich repeats and PDZ domain) adaptor proteins involved in cell signaling pathways. Previously, we identified Erbin, Lano, and Scribble, but not Densin-180, in muscle cells, where they are involved in regulating the aggregation of nicotinic acetylcholine receptors in vitro. Here, we analyzed their cellular localization at the neuromuscular junction (NMJ) in skeletal muscles of mice. Erbin, Lano, and Scribble were significantly accumulated at NMJs and localized in different synaptic cells. Moreover, we used mouse mutants to analyze the role of Erbin at the NMJ. We used two Erbin mutant mouse strains that either completely lack Erbin protein (Erbinnull/null ) or express a truncated Erbin mutant where the carboxy-terminal PDZ domain is replaced by ß-galactosidase (ErbinΔC/ΔC ) thereby abolishing its interaction with ErbB receptor tyrosine kinases. Neither the lack of the PDZ domain of Erbin, nor its complete absence interfered with the general localization of LAP proteins at NMJs, but Lano and Scribble transcript levels were up-regulated in homozygous Erbin-null muscles. Furthermore, grip strength was reduced and neural transmission impaired in homozygous aged Erbin-null but not Erbin-ΔC mice. Erbin-null skeletal muscles did not reveal any conspicuous impairment of the muscle fiber. Localization of other NMJ marker proteins was not affected either. Quantitative 3D morphometry showed that NMJs of Erbin-null muscles were significantly smaller and fragmented in the soleus. We speculate that Erbin, Lano, and Scribble act at the post-synaptic membrane of NMJs in a concerted fashion to regulate nicotinic acetylcholine receptors cluster morphology and neural transmission. Cover Image for this issue: doi: 10.1111/jnc.13340.


Subject(s)
Neuromuscular Junction/physiology , Proteins/genetics , Synapses/ultrastructure , Synaptic Membranes/metabolism , Synaptic Transmission/genetics , Synaptic Transmission/physiology , Animals , Carrier Proteins/genetics , Carrier Proteins/physiology , Hand Strength/physiology , Intracellular Signaling Peptides and Proteins/genetics , Intracellular Signaling Peptides and Proteins/metabolism , Leucine-Rich Repeat Proteins , Male , Membrane Glycoproteins , Mice , Mice, Inbred C57BL , Mice, Knockout , Muscle Fibers, Skeletal/physiology , Muscle Fibers, Skeletal/ultrastructure , Muscle, Skeletal/innervation , Mutation/genetics , Nerve Tissue Proteins , Neuromuscular Junction/ultrastructure , PDZ Domains/genetics
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