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1.
Trends Immunol ; 45(6): 400-402, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38789321

RESUMO

Miyamoto et al. report that Marco expression demarcates a population of IL-10-expressing immunosuppressive Kupffer cells (KCs) that are preferentially peri-portally located in the mouse liver, and which limit bacterial dissemination and liver inflammation.


Assuntos
Interleucina-10 , Células de Kupffer , Fígado , Animais , Células de Kupffer/imunologia , Camundongos , Fígado/imunologia , Fígado/patologia , Interleucina-10/metabolismo , Interleucina-10/imunologia , Humanos , Macrófagos/imunologia , Inflamação/imunologia , Receptores Imunológicos/metabolismo , Receptores Imunológicos/imunologia
2.
Health Promot Int ; 39(2)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38501311

RESUMO

Research on social innovations in health has increased in recent years. However, little training is geared toward enhancing social innovation research capacity. Most health training for low- and middle-income countries (LMICs) is developed by individuals in high-income countries, disregarding LMIC researchers' wisdom and insights and the communities' needs. Our team organized a multi-phase investigation involving a series of surveys and co-creation group discussions to assess individuals' training needs that directly informed a subsequent co-created training workshop series. We conducted a Hennessy-Hicks Training Needs Assessment among the Social Innovation in Health Initiative (SIHI) network and formed a co-creation group comprising SIHI fellows to design related training workshops. We ran a final evaluation survey and analyzed the workshop series' strengths, weaknesses and threats. Descriptive and thematic analysis were employed to analyze survey data and open-ended responses. The final evaluation survey captured data from 165 learners in 35 countries, including 26 LMICs. Most participants (67.3%, 111/165) rated the training workshop series as excellent, and 30.3% (50/165) rated it as good on a five-point scale. The need for writing research grants and manuscripts was rated the highest priority. Learners were interested in community-engaged research and diversity, equity and inclusion. This workshop illustrated how co-creation could be an effective tool for developing training materials tailored for LMIC researchers. We also offer a template for conducting a needs assessment and subsequent training workshops for LMICs. The ground-up, locally developed courses may be more effective than externally developed training programs intended for LMICs.


Assuntos
Países em Desenvolvimento , Renda , Humanos , Avaliação das Necessidades , Inquéritos e Questionários , Pesquisadores
3.
medRxiv ; 2024 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-38352394

RESUMO

Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence is increasing in parallel with an obesity pandemic, calling for novel strategies for prevention and treatment. We defined a circulating proteome of human MASLD across ≈7000 proteins in ≈5000 individuals from diverse, at-risk populations across the metabolic health spectrum, demonstrating reproducible diagnostic performance and specifying both known and novel metabolic pathways relevant to MASLD (central carbon and amino acid metabolism, hepatocyte regeneration, inflammation, fibrosis, insulin sensitivity). A parsimonious proteomic signature of MASLD was associated with a protection from MASLD and its related multi-system metabolic consequences in >26000 free-living individuals, with an additive effect to polygenic risk. The MASLD proteome was encoded by genes that demonstrated transcriptional enrichment in liver, with spatial transcriptional activity in areas of steatosis in human liver biopsy and dynamicity for select targets in human liver across stages of steatosis. We replicated several top relations from proteomics and spatial tissue transcriptomics in a humanized "liver-on-a-chip" model of MASLD, highlighting the power of a full translational approach to discovery in MASLD. Collectively, these results underscore utility of blood-based proteomics as a dynamic "liquid biopsy" of human liver relevant to clinical biomarker and mechanistic applications.

4.
Hepatology ; 79(2): 269-288, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37535809

RESUMO

BACKGROUND AND AIMS: Primary sclerosing cholangitis (PSC) is an immune-mediated cholestatic liver disease for which pharmacological treatment options are currently unavailable. PSC is strongly associated with colitis and a disruption of the gut-liver axis, and macrophages are involved in the pathogenesis of PSC. However, how gut-liver interactions and specific macrophage populations contribute to PSC is incompletely understood. APPROACH AND RESULTS: We investigated the impact of cholestasis and colitis on the hepatic and colonic microenvironment, and performed an in-depth characterization of hepatic macrophage dynamics and function in models of concomitant cholangitis and colitis. Cholestasis-induced fibrosis was characterized by depletion of resident KCs, and enrichment of monocytes and monocyte-derived macrophages (MoMFs) in the liver. These MoMFs highly express triggering-receptor-expressed-on-myeloid-cells-2 ( Trem2 ) and osteopontin ( Spp1 ), markers assigned to hepatic bile duct-associated macrophages, and were enriched around the portal triad, which was confirmed in human PSC. Colitis induced monocyte/macrophage infiltration in the gut and liver, and enhanced cholestasis-induced MoMF- Trem2 and Spp1 upregulation, yet did not exacerbate liver fibrosis. Bone marrow chimeras showed that knockout of Spp1 in infiltrated MoMFs exacerbates inflammation in vivo and in vitro , while monoclonal antibody-mediated neutralization of SPP1 conferred protection in experimental PSC. In human PSC patients, serum osteopontin levels are elevated compared to control, and significantly increased in advanced stage PSC and might serve as a prognostic biomarker for liver transplant-free survival. CONCLUSIONS: Our data shed light on gut-liver axis perturbations and macrophage dynamics and function in PSC and highlight SPP1/OPN as a prognostic marker and future therapeutic target in PSC.


Assuntos
Colangite Esclerosante , Colestase , Colite , Humanos , Colangite Esclerosante/patologia , Osteopontina , Cirrose Hepática/patologia , Ductos Biliares/patologia , Colestase/patologia , Macrófagos/patologia
5.
Methods Mol Biol ; 2713: 207-230, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37639126

RESUMO

The study of macrophage functions in the context of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction associated steatohepatitis (MASH) has been hampered by the fact that until recently all macrophages in the liver were thought to be Kupffer cells, the resident macrophages of the liver. With the advent of single-cell technologies, it is now clear that the steatotic liver harbors many distinct populations of macrophages, likely each with their own unique functions as well as subsets of monocytes and dendritic cells which can be difficult to discriminate from one another. Here, we detail the protocols we utilize to (i) induce MASLD/MASH in mice, (ii) isolate cells from the steatotic liver, and (iii) describe reliable gating strategies, which can be used to identify the different subsets of myeloid cells. Finally, we also discuss the issue of increased autofluorescence in the steatotic liver and the techniques we use to minimize this both for flow cytometry and confocal microscopy analyses.


Assuntos
Fígado Gorduroso , Animais , Camundongos , Citometria de Fluxo , Macrófagos , Microscopia Confocal
6.
Front Immunol ; 14: 1283711, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38077359

RESUMO

Microglia, the resident macrophages of the central nervous system (CNS), play a critical role in CNS homeostasis and neuroinflammation. Pexidartinib (PLX3397), a colony-stimulating factor 1 (CSF1) receptor inhibitor, is widely used to deplete microglia, offering flexible options for both long-term depletion and highly versatile depletion-repopulation cycles. However, the potential impact of PLX3397 on peripheral (immune) cells remains controversial. Until now, the microglia-specificity of this type of compounds has not been thoroughly evaluated, particularly in the context of peripherally derived neuroinflammation. Our study addresses this gap by examining the effects of PLX3397 on immune cells in the brain, liver, circulation and bone marrow, both in homeostasis and systemic inflammation models. Intriguingly, we demonstrate that PLX3397 treatment not only influences the levels of tissue-resident macrophages, but also affects circulating and bone marrow immune cells beyond the mononuclear phagocyte system (MPS). These alterations in peripheral immune cells disrupt the response to systemic inflammation, consequently impacting the phenotype irrespective of microglial depletion. Furthermore, we observed that a lower dose of PLX3397, which does not deplete microglia, demonstrates similar (non-)MPS effects, both in the periphery and the brain, but fails to fully replicate the peripheral alterations seen in the higher doses, questioning lower doses as a 'peripheral control' strategy. Overall, our data highlight the need for caution when interpreting studies employing this compound, as it may not be suitable for specific investigation of microglial function in the presence of systemic inflammation.


Assuntos
Microglia , Doenças Neuroinflamatórias , Humanos , Encéfalo , Inflamação/tratamento farmacológico
7.
Int J Cancer ; 152(12): 2615-2628, 2023 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-36912275

RESUMO

Due to a combination of rapid disease progression and the lack of curative treatment options, hepatocellular carcinoma (HCC) is one of the deadliest cancers worldwide. Infiltrated, monocyte-derived, tumor-associated macrophages are known to play a role in HCC pathogenesis, but the involvement of Kupffer cells (KCs) remains elusive. Here, we used the Clec4F-diphteria toxin receptor transgenic mouse model to specifically investigate the effect of KC depletion on HCC initiation, progression and neoplastic growth following liver resection. For this purpose, several HCC mouse models with varying underlying etiologies were used and partial hepatectomy was performed. Our results show that in HCC, developed on a fibrotic or non-alcoholic steatohepatitis background, depletion of embryonic KCs at the onset of HCC induction and the subsequent replacement by monocyte-derived KCs does not affect the tumor burden, tumor microenvironment or the phenotype of isolated KCs at end-stage disease. In non-chronic liver disease-associated diethylnitrosamine-induced HCC, ablation of Clec4F+ KCs did not alter tumor progression or neoplastic growth following liver resection. Our results show that temporal ablation of resident KCs does not impact HCC pathogenesis, neither in the induction phase nor in advanced disease, and indicate that bone marrow-derived KCs are able to swiftly repopulate the available KC niche and adopt their phenotype.


Assuntos
Carcinogênese , Carcinoma Hepatocelular , Células de Kupffer , Neoplasias Hepáticas Experimentais , Neoplasias Hepáticas , Macrófagos Associados a Tumor , Células de Kupffer/imunologia , Progressão da Doença , Carcinoma Hepatocelular/imunologia , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/patologia , Macrófagos Associados a Tumor/imunologia , Macrófagos Associados a Tumor/patologia , Animais , Camundongos , Neoplasias Hepáticas Experimentais/imunologia , Neoplasias Hepáticas Experimentais/patologia , Células Precursoras de Monócitos e Macrófagos/imunologia , Carcinogênese/imunologia , Carcinogênese/patologia , Camundongos Endogâmicos C57BL , Masculino
8.
J Allergy Clin Immunol ; 152(1): 244-256.e4, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36898482

RESUMO

BACKGROUND: IL-33 plays a major role in the pathogenesis of allergic diseases such as asthma and atopic dermatitis. On its release from lung epithelial cells, IL-33 primarily drives type 2 immune responses, accompanied by eosinophilia and robust production of IL-4, IL-5, and IL-13. However, several studies show that IL-33 can also drive a type 1 immune response. OBJECTIVE: We sought to determine the role of A20 in the regulation of IL-33 signaling in macrophages and IL-33-induced lung immunity. METHODS: We studied the immunologic response in lungs of IL-33-treated mice that specifically lack A20 in myeloid cells. We also analyzed IL-33 signaling in A20-deficient bone marrow-derived macrophages. RESULTS: IL-33-induced lung innate lymphoid cell type 2 expansion, type 2 cytokine production, and eosinophilia were drastically reduced in the absence of macrophage A20 expression, whereas neutrophils and interstitial macrophages in lungs were increased. In vitro, IL-33-mediated nuclear factor kappa B activation was only weakly affected in A20-deficient macrophages. However, in the absence of A20, IL-33 gained the ability to activate signal transducer and activator of transcription 1 (STAT1) signaling and STAT1-dependent gene expression. Surprisingly, A20-deficient macrophages produced IFN-γ in response to IL-33, which was fully STAT1-dependent. Furthermore, STAT1 deficiency partially restored the ability of IL-33 to induce ILC2 expansion and eosinophilia in myeloid cell-specific A20 knockout mice. CONCLUSIONS: We reveal a novel role for A20 as a negative regulator of IL-33-induced STAT1 signaling and IFN-γ production in macrophages, which determines lung immune responses.


Assuntos
Imunidade Inata , Interleucina-33 , Pulmão , Animais , Camundongos , Eosinofilia , Pulmão/imunologia , Linfócitos , Macrófagos , Camundongos Knockout
9.
Am J Pathol ; 193(4): 366-379, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36642171

RESUMO

Primary sclerosing cholangitis (PSC) is an idiopathic chronic immune-mediated cholestatic liver disease characterized by fibro-inflammatory bile duct strictures, progressive hepatobiliary fibrosis, and gut-liver axis disruption. The pathophysiology of PSC remains insufficiently characterized, which hampers the development of effective therapies. Hepatic macrophages (MFs) such as Kupffer cells (KCs) are implicated in PSC pathogenesis, but their exact role is unclear. Using the latest markers to discriminate resident KCs (ResKCs) from their monocyte-derived counterparts (MoKCs), and two models of intrahepatic and extrahepatic cholestasis, respectively, this study showed that CLEC4F+TIM4+ ResKCs were depleted after chronic cholestatic liver injury. The infiltrating CLEC4F+TIM4- MoKCs were already enriched during the acute phase of PSC. Transcriptional profiling of hepatic MF subsets during early cholestatic injury indicated that ResKCs were indeed activated and that MoKCs expressed higher levels of pro-inflammatory and proliferative markers compared with those of ResKCs. As indicated in experiments with Clec4fDTR transgenic mice, conditional depletion of KCs, before and during early cholestasis induction, had no effect on the composition of the hepatic myeloid cell pool following injury progression and did not affect disease outcomes. Taken together, these results provide new insights into the heterogeneity of the MF pool during experimental PSC and evidence that depletion of resident and activated KCs during sclerosing cholangitis does not affect disease outcome in mice.


Assuntos
Colangite Esclerosante , Colestase , Camundongos , Animais , Colangite Esclerosante/patologia , Células de Kupffer/patologia , Fígado/patologia , Colestase/patologia
10.
Cell Rep ; 42(2): 112046, 2023 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-36708514

RESUMO

The diversity of mononuclear phagocyte (MNP) subpopulations across tissues is one of the key physiological characteristics of the immune system. Here, we focus on understanding the metabolic variability of MNPs through metabolic network analysis applied to three large-scale transcriptional datasets: we introduce (1) an ImmGen MNP open-source dataset of 337 samples across 26 tissues; (2) a myeloid subset of ImmGen Phase I dataset (202 MNP samples); and (3) a myeloid mouse single-cell RNA sequencing (scRNA-seq) dataset (51,364 cells) assembled based on Tabula Muris Senis. To analyze such large-scale datasets, we develop a network-based computational approach, genes and metabolites (GAM) clustering, for unbiased identification of the key metabolic subnetworks based on transcriptional profiles. We define 9 metabolic subnetworks that encapsulate the metabolic differences within MNP from 38 different tissues. Obtained modules reveal that cholesterol synthesis appears particularly active within the migratory dendritic cells, while glutathione synthesis is essential for cysteinyl leukotriene production by peritoneal and lung macrophages.


Assuntos
Fagócitos , Análise de Célula Única , Animais , Camundongos
11.
Immunity ; 55(9): 1515-1529, 2022 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-36103850

RESUMO

Single-cell and spatial transcriptomic technologies have revealed an underappreciated heterogeneity of liver macrophages. This has led us to rethink the involvement of macrophages in liver homeostasis and disease. Identification of conserved gene signatures within these cells across species and diseases is enabling the correct identification of specific macrophage subsets and the generation of more specific tools to track and study the functions of these cells. Here, we discuss what is currently known about the definitions of these different macrophage populations, the markers that can be used to identify them, how they are wired within the liver, and their functional specializations in health and disease.


Assuntos
Células de Kupffer , Fígado , Homeostase , Macrófagos/fisiologia , Transcriptoma
12.
Body Image ; 43: 170-179, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36152480

RESUMO

Critical comments from parents or coaches about weight or shape have been associated with athletes' body dissatisfaction and disordered eating. However, research is yet to explore how critical comments from an athlete's teammates may impact on eating and exercise psychopathology. This study aimed to (1) explore whether athletes who reported receiving a teammate critical comment have higher eating/exercise psychopathology and poorer psychological wellbeing versus matched athletes who have not, (2) determine whether gender differences exist in the perceived severity of critical comments and (3) evaluate the moderating role of gender when establishing the relative importance of explicit teammate critical comments versus implicit teammate influences (e.g., modelling) on eating/exercise psychopathology. Athletes (N = 646, Mage=23 years, n = 391 female) completed a survey exploring explicit/implicit teammate influences, psychological wellbeing (self-esteem, anxiety, depression) and eating/exercise psychopathology. Athletes receiving a teammate critical comment (n = 323) had significantly higher eating/exercise psychopathology, anxiety, and lower self-esteem compared to those who had not (n = 323). Females (n = 196) perceived the severity of the comment to be significantly worse than males (n = 127). Explicit critical comments had a greater influence on athletes' eating/exercise psychopathology versus implicit teammate influences. Disordered eating/compulsive exercise prevention efforts with athlete populations should highlight the detrimental impact that athletes' comments can have on teammates' wellbeing and body satisfaction.


Assuntos
Imagem Corporal , Transtornos da Alimentação e da Ingestão de Alimentos , Masculino , Humanos , Feminino , Imagem Corporal/psicologia , Atletas/psicologia , Psicopatologia , Exercício Físico/psicologia
13.
Clin Sci (Lond) ; 136(15): 1111-1115, 2022 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-35913023

RESUMO

Non-alcoholic steatohepatitis (NASH) and associated end-stage liver disease is a growing cause of concern throughout the Western world. It constitutes a significant clinical burden for which therapeutic approaches are very limited. Over the last years, considerable attention has therefore been paid to identifying potential therapeutic strategies to reduce this burden. Annexin A1 (AnxA1), a calcium-phospholipid binding protein, has been proposed to be a negative regulator of inflammation in the context of NASH. In a recent publication, Gadipudi, Ramavath, Provera et al. investigated the therapeutic potential of Annexin A1 treatment in preventing the progression of NASH. They demonstrate that treatment of mice with NASH with recombinant human AnxA1 can reduce inflammation and fibrosis without affecting steatosis or metabolic syndrome. This was proposed to be achieved through the modulation of the macrophage populations present in the liver. Here, we discuss the main findings of this work and raise some outstanding questions regarding the possible mechanisms involved and the functions of distinct macrophage populations in NASH.


Assuntos
Anexina A1 , Hepatopatia Gordurosa não Alcoólica , Animais , Anexina A1/metabolismo , Humanos , Inflamação/metabolismo , Fígado/metabolismo , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Hepatopatia Gordurosa não Alcoólica/metabolismo
14.
Nat Protoc ; 17(10): 2354-2388, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35931780

RESUMO

Brain-immune cross-talk and neuroinflammation critically shape brain physiology in health and disease. A detailed understanding of the brain immune landscape is essential for developing new treatments for neurological disorders. Single-cell technologies offer an unbiased assessment of the heterogeneity, dynamics and functions of immune cells. Here we provide a protocol that outlines all the steps involved in performing single-cell multi-omic analysis of the brain immune compartment. This includes a step-by-step description on how to microdissect the border regions of the mouse brain, together with dissociation protocols tailored to each of these tissues. These combine a high yield with minimal dissociation-induced gene expression changes. Next, we outline the steps involved for high-dimensional flow cytometry and droplet-based single-cell RNA sequencing via the 10x Genomics platform, which can be combined with cellular indexing of transcriptomes and epitopes by sequencing (CITE-seq) and offers a higher throughput than plate-based methods. Importantly, we detail how to implement CITE-seq with large antibody panels to obtain unbiased protein-expression screening coupled to transcriptome analysis. Finally, we describe the main steps involved in the analysis and interpretation of the data. This optimized workflow allows for a detailed assessment of immune cell heterogeneity and activation in the whole brain or specific border regions, at RNA and protein level. The wet lab workflow can be completed by properly trained researchers (with basic proficiency in cell and molecular biology) and takes between 6 and 11 h, depending on the chosen procedures. The computational analysis requires a background in bioinformatics and programming in R.


Assuntos
Sequenciamento de Nucleotídeos em Larga Escala , RNA , Animais , Encéfalo , Epitopos , Perfilação da Expressão Gênica/métodos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Camundongos , RNA/genética , Análise de Sequência de RNA/métodos , Análise de Célula Única/métodos , Transcriptoma
15.
Trends Immunol ; 43(9): 687-689, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35963772

RESUMO

Interferon regulatory factor 8 (IRF8) has long been associated with conventional dendritic cell type I (cDC1) development. In a recent study, Lança et al. demonstrate that IRF8 is also crucial in cells already committed to the cDC1 lineage. Here, deletion of IRF8 from the XCR1-expressing pre-cDC1 stage onward leads to a loss of commitment and reprogramming of the cells toward a cDC2-like phenotype.


Assuntos
Células Dendríticas , Fatores Reguladores de Interferon , Animais , Camundongos , Camundongos Endogâmicos C57BL
17.
Cell ; 185(2): 379-396.e38, 2022 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-35021063

RESUMO

The liver is the largest solid organ in the body, yet it remains incompletely characterized. Here we present a spatial proteogenomic atlas of the healthy and obese human and murine liver combining single-cell CITE-seq, single-nuclei sequencing, spatial transcriptomics, and spatial proteomics. By integrating these multi-omic datasets, we provide validated strategies to reliably discriminate and localize all hepatic cells, including a population of lipid-associated macrophages (LAMs) at the bile ducts. We then align this atlas across seven species, revealing the conserved program of bona fide Kupffer cells and LAMs. We also uncover the respective spatially resolved cellular niches of these macrophages and the microenvironmental circuits driving their unique transcriptomic identities. We demonstrate that LAMs are induced by local lipid exposure, leading to their induction in steatotic regions of the murine and human liver, while Kupffer cell development crucially depends on their cross-talk with hepatic stellate cells via the evolutionarily conserved ALK1-BMP9/10 axis.


Assuntos
Evolução Biológica , Hepatócitos/metabolismo , Macrófagos/metabolismo , Proteogenômica , Animais , Núcleo Celular/metabolismo , Fígado Gorduroso/genética , Fígado Gorduroso/patologia , Homeostase , Humanos , Células de Kupffer/metabolismo , Antígenos Comuns de Leucócito/metabolismo , Lipídeos/química , Fígado/metabolismo , Linfócitos/metabolismo , Camundongos Endogâmicos C57BL , Modelos Biológicos , Células Mieloides/metabolismo , Obesidade/patologia , Proteoma/metabolismo , Transdução de Sinais , Transcriptoma/genética
18.
Sci Immunol ; 6(64): eabl5793, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34597120

RESUMO

The transcription factor c-MAF regulates perivascular macrophage phenotypes across tissues, including white adipose tissue, where its loss from murine vasculature­associated macrophages leads to increased vascularization and protection from metabolic syndrome (see the related Research Article by Moura Silva et al.).


Assuntos
Macrófagos , Fatores de Transcrição
19.
Immunity ; 54(9): 1906-1908, 2021 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34525333

RESUMO

To maintain cardiac output, the failing heart undergoes significant remodeling. However, the mechanisms regulating this remain unclear. In this issue of Immunity, Zaman et al. and Wong, Mohan, and Kopecky et al. uncover an interaction between resident cardiac macrophages and cardiomyocytes governing this process.


Assuntos
Macrófagos , Miócitos Cardíacos , Comunicação
20.
Nat Rev Immunol ; 21(10): 623, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34580461
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