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1.
PLoS One ; 7(8): e42134, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22870290

RESUMO

An increasing amount of evidence supports pleiotropic metabolic roles of the cannibinoid-1 receptor (CB1R) in peripheral tissues such as adipose, liver, skeletal muscle and pancreas. To further understand the metabolic consequences of specific blockade of CB1R function in peripheral tissues, we performed a 10-week-study with an anti-sense oligonucleotide directed against the CB1R in diet-induced obese (DIO) AKR/J mice. DIO AKR/J mice were treated with CB1R ASO Isis-414930 (6.25, 12.5 and 25 mg/kg/week) or control ASO Isis-141923 (25 mg/kg/week) via intraperitoneal injection for 10 weeks. At the end of the treatment, CB1R mRNA from the 25 mg/kg/week CB1R ASO group in the epididymal fat and kidney was decreased by 81% and 63%, respectively. Body weight gain was decreased in a dose-dependent fashion, significantly different in the 25 mg/kg/week CB1R ASO group (46.1±1.0 g vs veh, 51.2±0.9 g, p<0.05). Body fat mass was reduced in parallel with attenuated body weight gain. CB1R ASO treatment led to decreased fed glucose level (at week 8, 25 mg/kg/week group, 145±4 mg/dL vs veh, 195±10 mg/dL, p<0.05). Moreover, CB1R ASO treatment dose-dependently improved glucose excursion during an oral glucose tolerance test, whereas control ASO exerted no effect. Liver steatosis was also decreased upon CB1R ASO treatment. At the end of the study, plasma insulin and leptin levels were significantly reduced by 25 mg/kg/week CB1R ASO treatment. SREBP1 mRNA expression was decreased in both epididymal fat and liver. G6PC and fatty acid translocase/CD36 mRNA levels were also reduced in the liver. In summary, CB1R ASO treatment in DIO AKR/J mice led to improved insulin sensitivity and glucose homeostasis. The beneficial effects of CB1R ASO treatment strongly support the notion that selective inhibition of the peripheral CB1R, without blockade of central CB1R, may serve as an effective approach for treating type II diabetes, obesity and the metabolic syndrome.


Assuntos
Dieta/efeitos adversos , Obesidade/tratamento farmacológico , Oligodesoxirribonucleotídeos Antissenso/farmacologia , RNA Mensageiro/antagonistas & inibidores , Receptor CB1 de Canabinoide/antagonistas & inibidores , Tecido Adiposo Branco/metabolismo , Tecido Adiposo Branco/patologia , Animais , Antígenos CD36/genética , Antígenos CD36/metabolismo , Relação Dose-Resposta a Droga , Fígado Gorduroso/induzido quimicamente , Fígado Gorduroso/genética , Fígado Gorduroso/metabolismo , Fígado Gorduroso/patologia , Feminino , Glucose/genética , Glucose/metabolismo , Insulina/genética , Insulina/metabolismo , Fígado/metabolismo , Fígado/patologia , Masculino , Síndrome Metabólica/induzido quimicamente , Síndrome Metabólica/genética , Síndrome Metabólica/metabolismo , Síndrome Metabólica/patologia , Camundongos , Camundongos Endogâmicos AKR , Obesidade/induzido quimicamente , Obesidade/genética , Obesidade/metabolismo , Especificidade de Órgãos/efeitos dos fármacos , Especificidade de Órgãos/genética , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Receptor CB1 de Canabinoide/genética , Receptor CB1 de Canabinoide/metabolismo , Proteína de Ligação a Elemento Regulador de Esterol 1/genética , Proteína de Ligação a Elemento Regulador de Esterol 1/metabolismo
2.
BMC Pharmacol ; 10: 9, 2010 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-20712891

RESUMO

BACKGROUND: Cannabinoid 1 (CB1) receptor antagonists exhibit pharmacological properties favorable for the treatment of obesity and other related metabolic disorders. CE-178253 (1-[7-(2-Chlorophenyl)-8-(4-chlorophenyl)-2-methylpyrazolo[1,5-a]-[1,3,5]triazin-4-yl]-3-ethylaminoazetidine-3-carboxylic acid hydrochloride) is a recently discovered selective centrally-acting CB1 receptor antagonist. Despite a large body of knowledge on cannabinoid receptor antagonists little data exist on the quantitative pharmacology of this therapeutic class of drugs. The purpose of the current studies was to evaluate the quantitative pharmacology and concentration/effect relationships of CE-178253 based on unbound plasma concentration and in vitro pharmacology data in different in vivo preclinical models of FI and energy expenditure. RESULTS: In vitro, CE-178253 exhibits sub-nanomolar potency at human CB1 receptors in both binding (Ki = 0.33 nM) and functional assays (Ki = 0.07 nM). CE-178253 has low affinity (Ki > 10,000 nM) for human CB2 receptors. In vivo, CE-178253 exhibits concentration-dependent anorectic activity in both fast-induced re-feeding and spontaneous nocturnal feeding FI models. As measured by indirect calorimetry, CE-178253 acutely stimulates energy expenditure by greater than 30% in rats and shifts substrate oxidation from carbohydrate to fat as indicated by a decrease the respiratory quotient from 0.85 to 0.75. Determination of the concentration-effect relationships and ex vivo receptor occupancy in efficacy models of energy intake and expenditure suggest that a greater than a 2-fold coverage of the Ki (50-75% receptor occupancy) is required for maximum efficacy. Finally, in two preclinical models of obesity, CE-178253 dose-dependently promotes weight loss in diet-induced obese rats and mice. CONCLUSIONS: We have combined quantitative pharmacology and ex vivo CB1 receptor occupancy data to assess concentration/effect relationships in food intake, energy expenditure and weight loss studies. Quantitative pharmacology studies provide a strong a foundation for establishing and improving confidence in mechanism as well as aiding in the progression of compounds from preclinical pharmacology to clinical development.


Assuntos
Depressores do Apetite/farmacologia , Depressores do Apetite/uso terapêutico , Azetidinas/farmacologia , Azetidinas/uso terapêutico , Obesidade/tratamento farmacológico , Receptor CB1 de Canabinoide/antagonistas & inibidores , Triazinas/farmacologia , Triazinas/uso terapêutico , Redução de Peso/efeitos dos fármacos , Animais , Depressores do Apetite/metabolismo , Depressores do Apetite/farmacocinética , Azetidinas/metabolismo , Azetidinas/farmacocinética , Ligação Competitiva , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Linhagem Celular , Relação Dose-Resposta a Droga , Ingestão de Alimentos/efeitos dos fármacos , Metabolismo Energético/efeitos dos fármacos , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/sangue , Obesidade/metabolismo , Consumo de Oxigênio/efeitos dos fármacos , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Receptor CB1 de Canabinoide/genética , Receptor CB1 de Canabinoide/metabolismo , Receptor CB2 de Canabinoide/antagonistas & inibidores , Receptor CB2 de Canabinoide/genética , Receptor CB2 de Canabinoide/metabolismo , Triazinas/metabolismo , Triazinas/farmacocinética
3.
Biochem Biophys Res Commun ; 394(2): 366-71, 2010 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-20211605

RESUMO

Cannabinoid CB(1) receptor antagonists exhibit pharmacologic properties favorable for the treatment of metabolic disease. CP-945,598 (1-[9-(4-chlorophenyl)-8-(2-chlorophenyl)-9H-purin-6-yl]-4-ethylamino piperidine-4-carboxylic acid amide hydrochloride) is a recently discovered selective, high affinity, competitive CB(1) receptor antagonist that inhibits both basal and cannabinoid agonist-mediated CB(1) receptor signaling in vitro and in vivo. CP-945,598 exhibits sub-nanomolar potency at human CB(1) receptors in both binding (K(i)=0.7 nM) and functional assays (K(i)=0.2 nM). The compound has low affinity (K(i)=7600 nM) for human CB(2) receptors. In vivo, CP-945,598 reverses four cannabinoid agonist-mediated CNS-driven responses (hypo-locomotion, hypothermia, analgesia, and catalepsy) to a synthetic cannabinoid receptor agonist. CP-945,598 exhibits dose and concentration-dependent anorectic activity in two models of acute food intake in rodents, fast-induced re-feeding and spontaneous, nocturnal feeding. CP-945,598 also acutely stimulates energy expenditure in rats and decreases the respiratory quotient indicating a metabolic switch to increased fat oxidation. CP-945,598 at 10mg/kg promoted a 9%, vehicle adjusted weight loss in a 10 day weight loss study in diet-induced obese mice. Concentration/effect relationships combined with ex vivo brain CB(1) receptor occupancy data were used to evaluate efficacy in behavioral, food intake, and energy expenditure studies. Together, these in vitro, ex vivo, and in vivo data indicate that CP-945,598 is a novel CB(1) receptor competitive antagonist that may further our understanding of the endocannabinoid system.


Assuntos
Fármacos Antiobesidade/farmacologia , Obesidade/tratamento farmacológico , Piperidinas/farmacologia , Purinas/farmacologia , Receptor CB1 de Canabinoide/antagonistas & inibidores , Animais , Fármacos Antiobesidade/uso terapêutico , Peso Corporal/efeitos dos fármacos , Linhagem Celular , Ingestão de Alimentos/efeitos dos fármacos , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Consumo de Oxigênio , Piperidinas/uso terapêutico , Purinas/uso terapêutico , Ratos , Ratos Sprague-Dawley
4.
J Med Chem ; 52(9): 2652-5, 2009 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-19351113

RESUMO

We report the design, synthesis, and structure-activity relationships of novel bicyclic lactam-based cannabinoid type 1 (CB(1)) receptor antagonists. Members of these series are potent, selective antagonists in in vitro/in vivo efficacy models of CB(1) antagonism and exhibit robust oral activity in rodent models of food intake. These efforts led to the identification of 19d, which has been advanced to human clinical trials for weight management.


Assuntos
Descoberta de Drogas , Lactamas/síntese química , Lactamas/farmacologia , Obesidade/tratamento farmacológico , Oxazepinas/síntese química , Oxazepinas/farmacologia , Receptor CB1 de Canabinoide/antagonistas & inibidores , Animais , Ensaios Clínicos como Assunto , Cristalografia por Raios X , Humanos , Lactamas/química , Lactamas/uso terapêutico , Oxazepinas/química , Oxazepinas/uso terapêutico , Pirazóis/síntese química , Pirazóis/química , Pirazóis/farmacologia , Pirazóis/uso terapêutico , Ratos
5.
J Med Chem ; 52(2): 234-7, 2009 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-19102698

RESUMO

We report the structure-activity relationships, design, and synthesis of the novel cannabinoid type 1 (CB1) receptor antagonist 3a (CP-945,598). Compound 3a showed subnanomolar potency at human CB1 receptors in binding (Ki = 0.7 nM) and functional assays (Ki = 0.12 nM). In vivo, compound 3a reversed cannabinoid agonist-mediated responses, reduced food intake, and increased energy expenditure and fat oxidation in rodents.


Assuntos
Piperidinas/farmacologia , Purinas/farmacologia , Receptor CB1 de Canabinoide/antagonistas & inibidores , Animais , Cães , Descoberta de Drogas , Metabolismo Energético , Gorduras/metabolismo , Oxirredução , Piperidinas/química , Purinas/química , Relação Estrutura-Atividade
6.
Am J Physiol Endocrinol Metab ; 295(5): E1142-51, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18728225

RESUMO

c-Jun NH(2)-terminal kinase (JNK) plays an important role in insulin resistance; however, identification of pharmacologically potent and selective small molecule JNK inhibitors has been limited. Compound A has a cell IC(50) of 102 nM and is at least 100-fold selective against related kinases and 27-fold selective against glycogen synthase kinase-3beta and cyclin-dependent kinase-2. In C57BL/6 mice, compound A reduced LPS-mediated increases in both plasma cytokine levels and phosphorylated c-Jun in adipose tissue. Treatment of mice fed a high-fat diet with compound A for 3 wk resulted in a 13.1 +/- 1% decrease in body weight and a 9.3 +/- 1.5% decrease in body fat, compared with a 6.6 +/- 2.1% increase in body weight and a 6.7 +/- 2.1% increase in body fat in vehicle-treated mice. Mice pair fed to those that received compound A exhibited a body weight decrease of 7 +/- 1% and a decrease in body fat of 1.6 +/- 1.3%, suggesting that reductions in food intake could not account solely for the reductions in adiposity observed. Compound A dosed at 30 mg/kg for 13 days in high-fat fed mice resulted in a significant decrease in phosphorylated c-Jun in adipose tissue accompanied by a decrease in weight and reductions in glucose and triglycerides and increases in insulin sensitivity to levels comparable with those in lean control mice. The ability of compound A to reduce the insulin-stimulated phosphorylation of insulin receptor substrate-1 (IRS-1) von Ser307 and partially reverse the free fatty acid inhibition of glucose uptake in 3T3L1 adipocytes, suggests that enhancement of insulin signaling in addition to weight loss may contribute to the effects of compound A on insulin sensitization in vivo. Pharmacological inhibition of JNK using compound A may therefore offer an effective therapy for type 2 diabetes mediated at least in part via weight reduction.


Assuntos
Aminopiridinas/farmacologia , Proteínas Quinases JNK Ativadas por Mitógeno/antagonistas & inibidores , Inibidores de Proteínas Quinases/farmacologia , Células 3T3-L1 , Tecido Adiposo Branco/efeitos dos fármacos , Tecido Adiposo Branco/metabolismo , Aminopiridinas/farmacocinética , Animais , Glicemia/metabolismo , Peso Corporal/efeitos dos fármacos , Citocinas/sangue , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/farmacologia , Ingestão de Alimentos/efeitos dos fármacos , Humanos , Insulina/sangue , Insulina/farmacologia , Proteínas Substratos do Receptor de Insulina/metabolismo , Resistência à Insulina , Proteínas Quinases JNK Ativadas por Mitógeno/metabolismo , Lipopolissacarídeos/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Proteína Quinase 8 Ativada por Mitógeno/antagonistas & inibidores , Proteína Quinase 8 Ativada por Mitógeno/metabolismo , Obesidade/tratamento farmacológico , Obesidade/etiologia , Obesidade/patologia , Fosforilação/efeitos dos fármacos , Inibidores de Proteínas Quinases/farmacocinética , Proteínas Proto-Oncogênicas c-jun/metabolismo , Fator de Necrose Tumoral alfa/farmacologia , Células U937
7.
Bioorg Med Chem Lett ; 16(3): 731-6, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16263283

RESUMO

A series of conformationally constrained bicyclic derivatives derived from SR141716 was prepared and evaluated as hCB(1)-R antagonists and inverse agonists. Optimization of the structure-activity relationships around the 2,6-dihydro-pyrazolo[4,3-d]pyrimidin-7-one derivative 2a led to the identification of two compounds with oral activity in rodent feeding models (2h and 4a). Replacement of the PP group in 2h with other bicyclic groups resulted in a loss of binding affinity.


Assuntos
Analgésicos/síntese química , Analgésicos/farmacologia , Compostos Bicíclicos Heterocíclicos com Pontes/química , Comportamento Alimentar/efeitos dos fármacos , Receptor CB1 de Canabinoide/antagonistas & inibidores , Animais , Sítios de Ligação , Comportamento Alimentar/fisiologia , Modelos Biológicos , Piperidinas/química , Pirazóis/química , Pirazolonas/química , Pirimidinonas/química , Receptor CB1 de Canabinoide/agonistas , Rimonabanto , Roedores , Relação Estrutura-Atividade
8.
Curr Opin Investig Drugs ; 5(4): 389-94, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15134279

RESUMO

The cannabinoid-1 (CB1) receptor plays a role in the regulation of appetitive behavior. Exogenously administered cannabinoid receptor agonists stimulate food consumption in animals and humans. Endogenous cannabinoid receptor agonists are present in the brain, and the brain level of these agonists increases with greater demand of food by rodents. Specific CB1 receptor antagonist compounds have been discovered that display high affinity and selectivity for the CB1 receptor. CB1 receptor antagonists inhibit both acute and long-term food intake in rodents. Chronic treatment with CB1 antagonists results in a sustained reduction in body weight in rodents (5 weeks), and weight loss in humans (16 weeks). Patent literature indicates CB1 receptor antagonist discovery efforts at a number of pharmaceutical companies. The CB1 receptor antagonist, rimonabant (SR-141716), discovered by Sanofi-Synthélabo, is in phase III clinical trials for the treatment of obesity and has been found to decrease appetite and body weight in humans.


Assuntos
Antagonistas de Receptores de Canabinoides , Obesidade/tratamento farmacológico , Fármacos Antiobesidade/farmacologia , Fármacos Antiobesidade/uso terapêutico , Apetite/fisiologia , Moduladores de Receptores de Canabinoides/metabolismo , Humanos , Obesidade/metabolismo , Receptor CB1 de Canabinoide/antagonistas & inibidores , Receptor CB1 de Canabinoide/metabolismo , Receptores de Canabinoides/metabolismo
9.
J Clin Invest ; 112(2): 197-208, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12843127

RESUMO

The serine/threonine kinase Akt/PKB plays key roles in the regulation of cell growth, survival, and metabolism. It remains unclear, however, whether the functions of individual Akt/PKB isoforms are distinct. To investigate the function of Akt2/PKBbeta, mice lacking this isoform were generated. Both male and female Akt2/PKBbeta-null mice exhibit mild growth deficiency and an age-dependent loss of adipose tissue or lipoatrophy, with all observed adipose depots dramatically reduced by 22 weeks of age. Akt2/PKBbeta-deficient mice are insulin resistant with elevated plasma triglycerides. In addition, Akt2/PKBbeta-deficient mice exhibit fed and fasting hyperglycemia, hyperinsulinemia, glucose intolerance, and impaired muscle glucose uptake. In males, insulin resistance progresses to a severe form of diabetes accompanied by pancreatic beta cell failure. In contrast, female Akt2/PKBbeta-deficient mice remain mildly hyperglycemic and hyperinsulinemic until at least one year of age. Thus, Akt2/PKBbeta-deficient mice exhibit growth deficiency similar to that reported previously for mice lacking Akt1/PKBalpha, indicating that both Akt2/PKBbeta and Akt1/PKBalpha participate in the regulation of growth. The marked hyperglycemia and loss of pancreatic beta cells and adipose tissue in Akt2/PKBbeta-deficient mice suggest that Akt2/PKBbeta plays critical roles in glucose metabolism and the development or maintenance of proper adipose tissue and islet mass for which other Akt/PKB isoforms are unable to fully compensate.


Assuntos
Tecido Adiposo/patologia , Envelhecimento , Diabetes Mellitus Experimental/patologia , Proteínas Serina-Treonina Quinases , Proteínas Proto-Oncogênicas/fisiologia , Tecido Adiposo/metabolismo , Animais , Peso Corporal , Caspase 3 , Caspases/metabolismo , Feminino , Vetores Genéticos , Glucose/metabolismo , Teste de Tolerância a Glucose , Glucose-6-Fosfatase/metabolismo , Glicogênio Sintase/metabolismo , Hiperglicemia/genética , Hiperglicemia/patologia , Hiperinsulinismo/genética , Imuno-Histoquímica , Insulina/sangue , Insulina/metabolismo , Ilhotas Pancreáticas/patologia , Fígado/metabolismo , Masculino , Camundongos , Camundongos Transgênicos , Modelos Genéticos , Músculos/metabolismo , Tamanho do Órgão , Fenótipo , Fosfoenolpiruvato Carboxiquinase (GTP)/biossíntese , Fosfoenolpiruvato Carboxiquinase (GTP)/genética , Reação em Cadeia da Polimerase , Isoformas de Proteínas , Proteínas Proto-Oncogênicas/química , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas c-akt , Fatores de Tempo , Tomografia Computadorizada por Raios X
10.
Eur J Pharmacol ; 462(1-3): 125-32, 2003 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-12591104

RESUMO

We determined the effect of a cannabinoid CB1 receptor antagonist (AM-251; N-(Piperidin-1-yl)-5-(4-iodophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide) on food intake, body weight and adipose tissue mass in Western diet-induced obese (DIO) mice using a chronic, interrupted, oral dosing paradigm. The dosing paradigm was 2 weeks on treatment (treatment 1), 2 weeks off-treatment, followed by 2 weeks on treatment (treatment 2). During treatment 1 and treatment 2, food intake and body weight were reduced after a single dose. At 30 mg/kg/day, anorectic efficacy was maintained through 12 days (treatment 1) and 7 days (treatment 2). Body weight of AM-251-treated mice remained less than vehicle-treated mice throughout treatment 1 and treatment 2. Administration of AM-251 reduced inguinal subcutaneous, retroperitoneal and mesenteric adipose tissue mass. Antiobesity effects of AM-251 were lost during the off-treatment period, and hyperphagia was observed in treated animals. With re-initiation of AM-251 treatment, mice again responded to the effects of the compound. These results support the hypothesis that chronic treatment of obese individuals with cannabinoid CB1 receptor antagonists is a viable pharmacologic approach to sustained weight loss.


Assuntos
Gorduras na Dieta/administração & dosagem , Obesidade/prevenção & controle , Piperidinas/farmacologia , Pirazóis/farmacologia , Receptores de Droga/antagonistas & inibidores , Animais , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Peso Corporal/efeitos dos fármacos , Colesterol/sangue , Relação Dose-Resposta a Droga , Ingestão de Alimentos/efeitos dos fármacos , Insulina/sangue , Leptina/sangue , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/sangue , Obesidade/etiologia , Receptores de Canabinoides , Triglicerídeos/sangue
11.
J Pharmacol Toxicol Methods ; 47(2): 99-106, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12459149

RESUMO

INTRODUCTION: Obesity is a significant public health concern with considerable academic and industrial research effort underway to discover novel drugs to treat this disease. The aim of this study was to validate a recently developed high-resolution X-ray computed tomography (micro CT) system capable of measuring murine adipose tissue depot mass in situ. METHODS: The micro CT was used to generate a series of cross-sectional X-ray images from which individual adipose tissue depot mass was quantified. Four individual adipose tissue depots were studied: inguinal subcutaneous, epididymal, retroperitoneal, and mesenteric. The relationship between micro CT-derived adipose tissue mass and adipose mass measured gravimetrically was determined. The effect of strain (C57/Bl6, C3H/HeNCR1BR, and db/db) and age (49 vs. 99 days) on adipose tissue depot mass was studied. RESULTS: Validation studies in which adipose tissue depot mass was determined by micro CT and by gravimetry were conducted in the three strains of mice at 49 and 99 days of age. The correlation of micro CT and gravimetric measures of adipose tissue mass exceeded 90% in all strains at 99 days, and in the C57/Bl6 and C3H/HeNCR1BR strains at 49 days. At 49 days, the correlation in the db/db strain was 82%. Micro CT methodology distinguished both age and strain differences in the adipose tissue depots studied (P<.0001, in all cases). DISCUSSION: Micro CT is a valid method to quantify the mass of individual adipose tissue depots in mice. This method of determining adipose tissue mass is not a terminal procedure; thus, this methodology may be particularly useful for the longitudinal assessment of the effects of drug intervention on adipose tissue depot mass.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Envelhecimento , Animais , Peso Corporal , Masculino , Camundongos , Camundongos Endogâmicos , Obesidade/diagnóstico por imagem , Tamanho do Órgão , Reprodutibilidade dos Testes , Especificidade da Espécie
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