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Biomedical subjects

A H Chester

Publications and source records attributed to A H Chester.

At least 37 records · Page 2Linked to original sources

Comparison of the morphologic and vascular reactivity of the proximal and distal radial artery.

BACKGROUND: Variations in the morphology and vascular reactivity of the proximal and distal radial artery might influence its performance as a bypass conduit. METHODS: The morphologic and functional characteristics of the proximal and distal RAs were compared with those of the left and right internal mammary arteries by using histologic and in vitro organ bath techniques. RESULTS: Proximal RA had a significantly greater medial cross-sectional area compared with that of the distal RA (2.48+/-0.27 mm2 compared with 1.86+/-0.21 mm2, p< 0.05), which were both significantly greater than the left internal mammary artery (0.54+/-0.09 mm2) or the right internal mammary artery (0.67+/-0.03 mm2). Proximal RA had a significantly greater response to 90 mmol/L potassium chloride than that of distal RA (88.4+/-7.3 compared with 60.2+/-10.3 mN, p<0.05), and both contracted more than the left internal mammary artery (30.3+/-2.9 mN) and the right internal mammary artery (32.6+/-4.1 mN). There was no difference in the response to noradrenaline and adrenaline between proximal and distal RA, both of which contracted more than the left and right internal mammary arteries. CONCLUSIONS: When choosing a segment of RA for use as a bypass conduit, regional variations in biologic properties should be considered.

Aged↗

Induction of nitric oxide synthase in human vascular smooth muscle: interactions between proinflammatory cytokines.

OBJECTIVE: We have attempted to demonstrate the induction of inducible nitric oxide synthase in human vascular tissue and define the capacity of different cytokines to induce this enzyme. METHODS: Segments of human arteries were stimulated with lipopolysaccharide (10 micrograms/ml), interleukin-1 beta (5 U/ml), tumor necrosis factor-alpha (10 U/ml), and interferon-gamma (200 U/ml). Cytokines were either used alone or in certain combinations, as well as in the presence of L-NG-monomethyl-arginine (100 mumol/l) or cycloheximide (1 mumol/l). Induction was assessed by measurement of mRNA expression, immunocytochemical localisation of the expressed protein, nitric oxide synthase activity and levels of nitrite, a product of nitric oxide formation. RESULTS: PCR analysis showed the presence of mRNA for iNOS in stimulated samples which could be inhibited by cycloheximide. There was positive staining with an antibody against human iNOS in the media of stimulated vessel segments. Stimulated segments were also shown to contain Ca(2+)-independent nitric oxide synthase activity. The cytokines and lipopolysaccharide together gave a significant rise in levels of nitrite in the medium after 36 and 48 h, which was inhibited by L-NG-monomethyl-arginine and cycloheximide. Only interferon-gamma incubated alone was capable of increasing nitrite levels. This effect was enhanced by co-incubation with either interleukin-1 beta, tumor necrosis factor-alpha or lipopolysaccharide. CONCLUSION: We have shown that increased production of nitrite by human vascular tissue in response to cytokines is associated with induction of iNOS as shown at the molecular and protein levels, and further supported by the presence of increased Ca(2+)-independent nitric oxide synthase activity following cytokine stimulation.

Cycloheximide↗

Differential action of angiotensin II and activity of angiotensin-converting enzyme in human bypass grafts.

OBJECTIVE: The activity of the renin-angiotensin system may be important in determining the performance of coronary artery bypass grafts. We have examined the activity of tissue angiotensin-converting enzyme and the effects of angiotensin II in vessels used as bypass grafts. METHODS: Organ bath studies were used to determine the vasoactive effect of angiotensin II. The activity of the angiotensin-converting enzyme was assessed by metabolism of a specific synthetic substrate. RESULTS: The saphenous vein produced greater maximum responses to angiotensin II than did the internal thoracic artery. This response was not modified by inhibition of nitric oxide synthase, cyclooxygenase, or by an endothelin receptor antagonist in either vessel. Losartan, an AT1 receptor antagonist, inhibited the vasoconstrictor response in both blood vessels. Homogenates of saphenous vein and internal thoracic artery displayed tissue angiotensin-converting enzyme activity, which was inhibited by captopril. Enzyme activity was threefold greater in the vein. Both the contractile response to angiotensin II and the enzyme activity were retained in venous grafts removed up to 20 years after coronary bypass surgery. CONCLUSIONS: These data demonstrate that marked differences exist in angiotensin-converting enzyme activity and AT1 receptor responses in the saphenous vein compared with the internal thoracic artery. These findings may have important implications for the performance of the vein when used as a coronary artery bypass graft and may have clinical implications for the use of angiotensin-converting inhibitors and AT1 receptor antagonists in the prevention and treatment of vein graft disease.

Adult↗

Alternative pathways of angiotensin II production in the human saphenous vein.

1. The aim of our study was to demonstrate the existence, location and functional importance of an alternative angiotensin II-forming pathway other than angiotensin converting enzyme (ACE) in the human saphenous vein (SV). 2. Vascular reactivity studies using an in vitro organ bath technique showed that the SV (n=20) produced similar maximum contractions in response to angiotensin I (41.5+/-5.4 mN) compared to those observed to angiotensin II (46.7+/-10.9 mN). The response to angiotensin I could be significantly inhibited (P<0.05) by incubation with the AT1 receptor antagonist losartan (1 microM). 3. Prior incubation of segments of SV with either captopril (1 microM) (n=6), quinaprilat (1 microM) (n=7), or the chymase inhibitor soya bean trypsin inhibitor (SBTI) (10 microM) (n=7) singularly failed to have any inhibitory effect on the response to angiotensin I. However when vessel segments (n=7) were co-incubated with quinaprilat (1 microM) and SBTI (10 microM), the SV exhibited a rightward shift in curve profile to angiotensin I and a markedly reduced maximum response 12.5+/-2.4 mN, when compared to control (30.4+/-7.6 mN), quinaprilat (24.5+/-9.4 mN), and SBTI (31.6+/-10.7 mN) on their own. 4. An immunohistochemical technique employing streptavidin biotin peroxidase localised ACE to both endothelial cells and smooth muscle cells while chymase was confined to mast cells in the adventitia of the vessel wall. 5. In conclusion, our results demonstrate the existence of an alternative angiotensin I converting pathway to that of ACE, involving chymase. Therefore, there is the capacity for a continuation of angiotensin II formation, in the presence of ACE inhibition.

Angiotensin II↗

Contrasting effects of platelet-derived growth factor (PDGF) isomers on mitogenesis, contraction and intracellular calcium concentration in human vascular smooth muscle.

The present study was aimed at characterizing the responses of human vascular smooth muscle to all three dimeric isomers of platelet-derived growth factor (PDGF-AA, -AB and -BB) in terms of mitogenesis, contraction and intracellular calcium concentration. The potential of interaction between PDGF and endothelin-1 (ET-1) was also investigated. All three PDGF isoforms (0.1-20 ng mL-1) stimulated DNA synthesis in cultured human coronary artery and saphenous vein vascular smooth muscle cells (VSMC), measured by [3H]thymidine incorporation. PDGF-AB and -BB elicited comparable large increases in DNA synthesis of maximum 595 +/- 149% (P = 0.001, n = 9) and 576 +/- 17% (P < 0.001, n = 5), respectively, whereas PDGF-AA was only weakly mitogenic (61 +/- 16% increase; P < 0.05, n = 3). At a threshold concentration, PDGF acted in synergy with ET-1 to enhance DNA synthesis (816 +/- 337% increase; P < 0.05, n = 7). In contrast to mitogenesis, none of the three PDGF isomers had any effect on contraction of human saphenous veins in vitro, nor did they affect the contractile response to ET-1, 5-HT or the thromboxane mimetic U46619. The effects of the three PDGF isomers on intracellular calcium ([Ca2+]i) rises in cultured human VSMC were heterogeneous, with PDGF-BB inducing the largest increase in [Ca2+]i (442 +/- 53 nmol L-1) vs. PDGF-AB (290 +/- 28 nmol L-1), whilst PDGF-AA had no effect. Both the responses to PDGF-AB and-BB relied upon intracellular calcium release, whilst only PDGF-AB showed additional dependence on influx of extracellular calcium. In summary, PDGF is strongly mitogenic and comitogenic with ET-1, despite not being a vasoconstrictor, for human VSMC. Also, human VSMC showed heterogeneous responses to the three PDGF isoforms. These results implicate PDGF, and in particular the PDGF receptor-beta, as important role players in the development of vascular smooth muscle-mediated intimal thickening in humans.

Anticoagulants↗

Vascular biology of the radial artery.

In recent years, the use of the radial artery as a coronary artery bypass graft has enjoyed a revival. This follows the initial disappointing results with the use of this blood vessel experienced by Carpentier and colleagues in the early 1970s. The improvement in the performance of the radial artery is believed to be caused by improved harvesting techniques and the use of vasodilator drugs. However, compared with the other blood vessels used as bypass grafts, little is known about the vascular biology of this artery. The reactivity of the smooth muscle and protection offered by the vascular endothelium are known to be important factors that may determine the suitability of different arteries and veins to act as bypass conduits. The aim of this review is to examine how the properties of the vessel wall may contribute to the performance of the radial artery when used as a coronary artery bypass graft.

Coronary Artery Bypass↗

Atypical antagonism observed with BQ-123 in human saphenous vein.

At present, endothelin (ET) receptor classification remains controversial. We investigated the presence of atypical ETA receptors in human saphenous veins (SV). Human SV was obtained from 24 patients undergoing coronary artery bypass grafting. Vessels were set up in organ baths, stretched to a tension of 6 g, and left to relax before being challenged with 90 mM KCl. After KCl challenge, tissues were incubated with 2.8 microM indomethacin and 100 microM L-NMMA for 30 min followed by 30 min in the presence of antagonist before a concentration-response curve to ET-1 or sarafotoxin 6b (S6b) (10(-10)-10(-7) M) was constructed. In endothelium-intact vessels, incubated with indomethacin and L-NMMA, BQ-123 (1 microM) caused nonparallel shifts, with lower concentrations of ET-1 being antagonized more than higher concentrations. This antagonism with BQ-123 was unaffected by BQ-788 (0.1 microM; n = 6) or by desensitization of ETB receptors with S6c (0.1 microM; n = 8). Blocking the Ca2+ channels with nifedipine (1 microM; n = 5) did not affect the antagonism, nor did denuding the endothelium or leaving the endothelium intact (n = 5). When S6b was used as an agonist, BQ-123 (0.3-3 microM) caused concentration-dependent biphasic shifts, with low concentrations of S6b not being antagonized. In conclusion, the antagonism observed with BQ-123 is not due to the action of ET-1 at ETB receptors, changes in Ca2+ handling, or endothelium. This unusual action of BQ-123 suggests subtypes of the ETA receptor.

Adult↗

Growth response of human coronary smooth muscle cells to angiotensin II and influence of angiotensin AT1 receptor blockade.

BACKGROUND: The renin-angiotensin system has been implicated in the development of vascular wall thickening in cardiovascular disease, through the growth-promoting actions of the vasoconstrictive agent, angiotensin II, on vascular smooth muscle cells. OBJECTIVE: To investigate the effect of angiotensin II on growth of human coronary artery smooth muscle cells (cSMCs) in culture, and to identify the angiotensin receptor(s) mediating such a response. METHODS: Human cSMCs were isolated from coronary arteries of recipient hearts obtained during transplantation, and characterized by immunohistochemistry. The effect of angiotensin II on protein synthesis by cSMCs was measured by [3H]leucine incorporation and protein concentration assays. Human cSMC proliferation was assessed by [3H]thymidine incorporation assay and cell count. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect angiotensin receptor expression. Transient increases in intracellular calcium concentration in cSMCs in response to angiotensin II stimulation were visualized under fura-2 fluorescence microscopy. RESULTS: Angiotensin II (1 nmol/l-10 mumol/l) stimulated protein synthesis in cSMCs (maximum 24 +/- 2% increase in incorporation of [3H]leucine over 48 h; n = 4, P < 0.01). An increase in cellular protein content was also measured. However, angiotensin II had no effect on proliferation of quiescent cSMCs. The increased protein synthesis was completely inhibited by pretreatment with the angiotensin AT1 receptor antagonist, losartan, but not the AT2 receptor antagonist, PD123319. Expression of the angiotensin AT1 receptor subtype was detected in cSMCs by RT-PCR. Angiotensin II stimulation of cells triggered transient increases in intracellular calcium concentration, which were abolished by losartan, but were insensitive to PD123319 and pertussis toxin. CONCLUSIONS: The results of this study in human coronary VSMCs indicate that angiotensin II and the AT1 receptor may be involved in the development of coronary artery disease in man.

Angiotensin II↗

Structural, biochemical and functional effects of distending pressure in the human saphenous vein: implications for bypass grafting.

BACKGROUND: Distension of the saphenous vein before and after coronary artery bypass grafting results in damage to mechanisms that regulate vascular tone. We have investigated the relationship between the magnitude of distending pressure and the degree of structural, biochemical and functional damage to the vessel wall. METHODS: Vessel segments that had been distended to either 100 or 300 mmHg were set up in isolated organ baths and the function of the smooth muscle and endothelial cells examined. All segments examined were then fixed for assessment of structural damage by scanning electron microscopy and for immunocytochemical localisation of endothelial nitric oxide synthase. RESULTS: Segments of saphenous vein distended to 100 mmHg retained their responsiveness to KCl (90 mmol/l) and phenylephrine (10(-6) mol/l), but those pressurised to 300 mmHg had significantly reduced responses to both agents. There was also a significant reduction in response to the endothelium-dependent dilators, acetylcholine (10(-10)-10(-6) mol/l) and bradykinin (10(-10)-10(-6) mol/l) in those segments distended to 300 mmHg. Quantitative studies of structural endothelial damage showed a significant loss of endothelium at 300 mmHg distension pressure. Remaining endothelial cells retained strong positive staining for endothelial nitric oxide synthase. By electron microscopic examination, those vessels distended to 100 mmHg showed lifting and rounding of individual cells, whereas segments distended to 300 mmHg revealed major areas of denuded endothelium. CONCLUSIONS: Distension of saphenous veins to pressures equivalent to those in the systemic circulation result in structural and biochemical changes in the endothelium that are not paralleled by immediate functional vasomotor changes.

Aged↗

Inhibition of endogenous endothelin during cardioplegia improves low coronary reflow following prolonged hypothermic arrest.

OBJECTIVE: Endothelin-1 (ET) is a potent endogenous vasoconstrictor which has been shown to be increased following ischaemia and cardiopulmonary bypass. We tested the hypothesis that inhibition of ET synthesis during cardioplegic arrest using phosphoramidon (an ET converting enzyme inhibitor) or blockade of ET receptors using bosentan (a mixed ET(A)/ET(B) antagonist), might improve the postischaemic recovery of coronary flow. METHODS: Using an isolated Langendorff perfused rat heart model we compared the addition of phosphoramidon or bosentan to St Thomas' Hospital No. cardioplegia vs. control (plain cardioplegia). We measured recovery of coronary flow following 4 h of cardioplegic arrest at 4 degrees C. In a second series of experiments using an isolated working rat heart model we measured the recovery of cardiac function following 4 h of cardioplegic arrest at 4 degrees C. Results are expressed as percentages of preischaemic values (+/- S.E.M). RESULTS: In the first series of experiments, addition of phosphoramidon to cardioplegia improved the postischaemic recovery of coronary flow after 30 min of reperfusion: control 81.3% (+/- 3.5); phosphoramidon 10(-6) M 86.2% (+/- 3.1); phosphoramidon 10(-5) M 95.0% (+/- 3.0) P = 0.03 vs. control. Likewise, addition of bosentan 10(-5) M improved coronary flow following 20 min of reperfusion: control 96.7% (+/- 4.0), and bosentan 109.6% (+/- 4.7) P = 0.04. The addition of phosphoramidon or bosentan had no effect on the postischaemic recovery of mechanical function following 30 min of reperfusion. CONCLUSION: Both inhibition of ET synthesis and ET receptor blockade during prolonged hypothermic arrest improves postischaemic coronary flow, but appears to have no effect on the recovery of cardiac mechanical function.

Animals↗

Assessment of human long saphenous vein function with minimally invasive harvesting with the Mayo stripper.

BACKGROUND: The use of the Mayo Stripper to harvest the long saphenous vein has been shown to improve morbidity from leg wound incisions. It has not been universally accepted because of a perceived increase in injury to the venous conduit. OBJECTIVE: To compare the function of undistended autologous long saphenous vein harvested by a Mayo stripper with the traditional 'open' technique in the same patient (n = 12) appearance. METHODS: Vascular reactivity was assessed in isolated organ baths. Contractile function was measured in response to increasing concentrations (10(-9)-10(-5) mol) of 5-hydroxytryptamine and noradrenaline. This was calculated as a percentage of the maximum contractile response to 90 mM KCl measured in millinewtons (mN) (control 41.4 +/- 12.1, (n = 11), open technique 35.8 +/- 11.1, (n = 11), Mayo stripper 33.7 +/- 15.9, (n = 11)). The endothelial dependent and independent function was assessed with acetylcholine and sodium nitroprusside, respectively. RESULTS: There was no significant difference in response to both constrictors and dilators between vein taken with the Mayo stripper compared with the traditional open technique (n = 6 for each observation; P > 0.05 by ANOVA). Histological examination by light microscopy of the vessel segments removed with the Mayo stripper was unable to show any significant damage to the vessel wall. Both functional and morphological studies were conducted by 'blinded' observers. One-year follow-up with magnetic resonance angiography (MRA) and stress thallium tomography demonstrated a patency rate with lower and upper estimates of 80 and 94%. CONCLUSIONS: We have shown that harvesting the long saphenous vein with a Mayo stripper does not compromise vascular reactivity of the long saphenous vein or long-term patency.

Analysis of Variance↗

ATP-sensitive potassium channels mediate vasodilatation produced by calcitonin gene-related peptide in human internal mammary but not gastroepiploic arteries.

The purpose of this study was to elucidate the mechanism of action of calcitonin gene-related peptide-induced vasodilatation of human gastroepiploic and internal mammary arteries. Calcitonin gene-related peptide (0.1-100 nmol L-1) elicited relaxations of preconstricted vessels, with a significantly greater effect in the gastroepiploic artery (P < 0.05). This effect was independent of endothelium-derived vasodilating substances. The response of the internal mammary artery but not the gastroepiploic artery to calcitonin gene-related peptide was attenuated by glybenclamide (1.0 mumol L-1) (P < 0.05). In vitro autoradiography indicated that [125I]-calcitonin gene-related peptide bound to the tunica media but not the endothelial cells in both types of artery, with a significantly higher degree of binding in the gastroepiploic artery. It is concluded that calcitonin gene-related peptide acts directly on vascular smooth muscle via specific binding sites to induce vasodilatation. In addition, KATP channels are involved in the action of calcitonin gene-related peptide in the internal mammary artery but not in the gastroepiploic artery.

Adenosine Triphosphate↗

Molecular mechanisms of vascular smooth muscle cell growth.

In recent years, much progress has been made in elucidating the complex but orchestrated series of molecular events that drives a vascular smooth muscle cell to undergo proliferation. These events are initiated by mitogenic stimuli, such as platelet-derived growth factor binding to its receptor and triggering an intracellular signal transduction cascade, leading ultimately to cell-cycle progression and cell division. The signaling pathways that take place in response to both hyperplastic and hypertrophic agents, which include the mitogen-activated protein kinase and p70 S6 kinase, are discussed. In addition, novel protein kinase mediators, such as phosphatidylinositol 3-kinase and protein kinase B, and mechanisms that have recently been implicated in vascular smooth muscle cell growth are described.

Animals↗

Explanted vein grafts with an intact endothelium demonstrate reduced focal expression of endothelial nitric oxide synthase specific to atherosclerotic sites.

The endothelial L-arginine:nitric oxide (NO) system is fundamental to vascular function. It is becoming evident that this system is compromised in aorto-coronary vein grafts, although it is not clear how it is affected. It was postulated that the development of intimal lesions in vein grafts may be associated with reduced expression or loss of endothelial NO synthase (eNOS). The immunocytochemical localization and quantitative expression of eNOS were therefore investigated in normal human saphenous veins (n = 6) and explanted vein grafts (n = 6). The vein grafts demonstrated marked morphological changes evident as fibro-intimal hyperplasia (FIH) and focal sites of atherosclerosis, often occurring along the same length of graft. Staining for eNOS was abundantly evident in the endothelium of normal veins but revealed a differential reduction in staining intensity in vein grafts. Staining intensity measurements revealed a significant reduction (P < 0.001) in the amount of eNOS present in areas of atherosclerosis as compared with normal veins and areas of vein graft with FIH changes alone. This reduction in the relative quantity of antigen was specific to eNOS, since the endothelial markers von Willebrand factor (vWf) and CD31 showed no such variations. These data support the view that vascular activity of NO is impaired in atherosclerosis and indicate that reduced expression of eNOS, and therefore by inference lower NO production, may make an important contribution to this phenomenon.

Arteriosclerosis↗

Vascular reactivity of arterial coronary artery bypass grafts--implications for their performance.

Specific properties of the vessel wall of arteries employed as coronary bypass grafts are thought to play an important role in the short- and long-term performance of these conduits. Heterogeneity in the endothelial and smooth muscle cell function between different arteries may provide particular vessels with properties which will favor them for use as bypass conduits. The aim of this review is to provide an insight into how the vascular reactivity of presently used arterial conduits varies and to discuss the clinical implications of these findings both in terms of flow modulation in response to physiologic and exogenous vasoactive mediators and long-term patency.

Arteries↗

Aging reduces postischemic recovery of coronary endothelial function.

The aging process is known to be associated with profound changes in the heart. To determine whether resistance of coronary endothelial and vascular smooth muscle function to ischemia may be related to age, four groups of rats (n = 6 in each group) of different ages (1, 5, 15, and 26 months) were subjected to cardioplegic arrest for 4 hours at 4 degrees C. The postischemic basal release of nitric oxide by endothelium, as assessed by the percentage loss of coronary flow in response to 0.5 mmol/L L-monomethylarginine, an inhibitor of nitric oxide synthase, was as follows: (mean +/- standard error of the mean): 87.1% +/- 1.7%, 81.2% +/- 2.3%, 79.6% +/- 1.9%, and 74.9% +/- 2.4% in groups 1, 2, 3, and 4, respectively. Stimulated release of nitric oxide, as assessed by percentage increase of coronary flow to 10(-5) mmol/L 5-hydroxytryptamine, an endothelium-dependent vasodilator, was as follows (mean +/- standard error of the mean): 88.3% +/- 1.5%, 83.4% +/- 2.4%, 71.1% +/- 2.7%, and 63.1% +/- 3.3% in groups 1, 2, 3, and 4, respectively. Significant differences were found between each group (p < 0.05) for both basal and stimulated release of nitric oxide. Vascular smooth muscle function, as assessed by the percentage increase in coronary flow in response to glyceryl trinitrate, an endothelium-independent vasodilator, was (mean +/- standard error of the mean): 96.7% +/- 2.1%, 92.3% +/- 5.2%, 92.9% +/- 5.0%, and 98.1% +/- 2.4% in groups 1, 2, 3, and 4 respectively. No significant difference was found between groups (p = not significant). In a protocol mimicking conditions for transplantation, the postischemic recovery of the basal and stimulated release of nitric oxide, but not vascular smooth muscle function, diminished with age.

Aging↗

Vascular adhesion molecules and immunogenicity in blood vessels used as coronary artery bypass grafts.

OBJECTIVE: The performance of coronary bypass grafts can be affected by a variety of circulating cell types. The initial event in any biological effect of such cells is adherence to the vascular endothelium prior to migration into the perivascular space. We aimed to investigate the expression of molecules that regulate cell adhesion in blood vessels employed as bypass conduits. METHODS: Segments of human saphenous vein, internal mammary artery, gastroepiploic artery and inferior epigastric artery were stained using specific monoclonal antibodies against the endothelial workers EN-4, Pal-E, von Willebrand factor small (vWF), and the cell adhesion molecules platelet-endothelium cell adhesion molecule (PECAM), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, the leucocyte marker (CD45) and major histocompatibility complex (MHC) class I and II antigens, with visualisation by ABC immunoperoxidase method. RESULTS: All vessels had a strong expression of the endothelial specific antigens EN4, vWF, and PECAM as well as MHC class I. However, there was less expression of Pal-E, ICAM-1, E-Selectin and of the DR determinant of MHC class II. VCAM-1, DP and DQ determinants of MHC class II were expressed to a weaker extent. There were no marked differences in the expression of all the molecules examined between the four vessel types. CONCLUSION: Thus vessels used as bypass grafts are immunogenic and possess the potential to attract and interact with blood elements. Definition of the molecules responsible could offer opportunities for modulating the response to such interactions.

Adolescent↗