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Biomedical subjects

D R Gardner

Publications and source records attributed to D R Gardner.

At least 19 recordsLinked to original sources

Swainsonine-induced lysosomal storage disease in goats caused by the ingestion of Turbina cordata in Northeastern Brazil.

A disease of the central nervous system in goats was observed in the municipalities of Juazeiro, Casa Nova and Curaça, state of Bahia, and Petrolina, state of Pernambuco, Northeastern Brazil. The disease was produced experimentally in two goats by the administration of dry Turbina cordata mixed with grain. Clinical signs were observed after the ingestion of 62 and 106 g/kg body weight in 28 and 54 days, respectively. The concentration of swainsonine in the plant varied from less than 0.001% to 0.14% (dry weight). Clinical signs of natural and experimental cases included difficulties in standing, ataxia, hypermetria, wide-based stance, intention tremors, spastic paresis mainly in the hind legs, nystagmus, abnormal postural reactions, head tilting, and falling. Diffuse vacuolation of neurons, epithelial cells of pancreas, thyroids, and renal tubules were observed on the histology. From the electron microscopy of Purkinje cells the vacuoles represented dilated lysosomes. These findings demonstrated that T. cordata causes an acquired glycoprotein lysosomal storage disease. The intoxication occurs at least in an area of 27,000 km2 causing severe losses in goats, and some farmers report the disease also in cattle.

Animals↗

Intoxication by Ipomoea sericophylla and Ipomoea riedelii in goats in the state of Paraíba, Northeastern Brazil.

A disease of the nervous system was observed in goats from two farms of the semiarid of the state of Paraíba, northeastern Brazil. Ipomoea sericophylla was found in one farm and I. riedelii in the other. Both plants were administered experimentally to five goats each. Both plants induced clinical signs similar to those observed in spontaneous cases. Two goats died spontaneously and five were euthanatized. Three goats recovered after the withdrawal of the plants. Histological examination showed that all goats that died spontaneously or were euthanized had diffuse vacuolation of neurons, macrophages of lymphatic tissues, and epithelial cells of pancreas, thyroid, renal tubules and liver. On electron microscopy of Purkinje cells, numerous dilated membrane bordered vacuoles were identified as lysosomes. On lectin-histochemical analysis, cerebellar cells gave positive reactions to Concanavalia ensiformis, Triticum vulgaris, and succinylated-T. vulgaris, which indicate the storage of alpha-D-mannose, alpha-D-glucose, beta-D-N-acetyl-glucosamine, and acetyl-neuraminic acid. The chemical analysis of I. sericophylla and I. riedelii showed 0.11 and 0.14% of swainsonine, respectively. The latter also contained calystegines B1, B2 and C1. It is concluded that I. sericophylla and I. riedelli cause a lysosomal storage disease.

Alkaloids↗

Locoweed (Oxytropis sericea)-induced lesions in mule deer (Odocoileius hemionus).

Locoweed poisoning has been reported in wildlife, but it is unknown whether mule deer (Odocoileius hemionus) are susceptible. In areas that are heavily infested with locoweed, deer and elk (Cervus elaphus nelsoni) have developed a spongiform encephalopathy, chronic wasting disease (CWD). Although these are distinct diseases, no good comparisons are available. The purpose of this study was to induce and describe chronic locoweed poisoning in deer and compare it with the lesions of CWD. Two groups of four mule deer were fed either a complete pelleted ration or a similar ration containing 15% locoweed (Oxytropis sericea). Poisoned deer lost weight and developed a scruffy, dull coat. They developed reluctance to move, and movement produced subtle intention tremors. Poisoned deer had extensive vacuolation of visceral tissues, which was most severe in the exocrine pancreas. Thyroid follicular epithelium, renal tubular epithelium, and macrophages in many tissues were mildly vacuolated. The exposed deer also had mild neuronal swelling and cytoplasmic vacuolation that was most obvious in Purkinje cells. Axonal swelling and dystrophy was found in many white tracts, but it was most severe in the cerebellar peduncles and the gracilis and cuneate fasciculi. These findings indicate that deer are susceptible to locoweed poisoning, but the lesions differ in severity and distribution from those of other species. The histologic changes of locoweed poisoning are distinct from those of CWD in deer; however, the clinical presentation of locoweed poisoning in deer is similar. Histologic and immunohistochemical studies are required for a definitive diagnosis.

Animals↗

Efects of the pine needle abortifacient, isocupressic acid, on bovine oocyte maturation and preimplantation embryo development.

Isocupressic acid (ICA) [15-hydroxylabda-8 (17), 13E-dien-19-oic acid], a labdane diterpene acid, isolated from ponderosa pine (Pinus ponderosa), Lodgepole pine (Pinus contorta), common juniper (Juniperus communis) and Monterey cypress (Cupressus macrocarpa), induces abortion in pregnant cows when ingested primarily during the last trimester. The objective of this study was to investigate the effects of isocupressic acid on bovine oocyte maturation (in vitro maturation (IVM)-Experiment I) and preimplantation embryo development (in vitro culture (IVC)-Experiment II) using in vitro embryo production techniques and to subsequently evaluate viability and developmental competence of ICA-cultured embryos via embryo transfer to recipient heifers (Experiment III). A complete randomized block experimental design was used. In Experiment I and II, isocupressic acid was added to IVM or IVC media at 0 (TRT1, control), 1.3 (TRT2), and 2.6 microg/ml (TRT3) Results from Experiment I and II indicated that ICA did not inhibit oocyte maturation and did not adversely affect preinpiantation embryo development. Furthermore, results from Experiment II demonstrated that isocupressic acid enhanced bovine preimplantation embryo development in vitro in a dose dependent manner. Subsequently, Day 8 (Day 0 = IVF) blastocysts cultured in vitro in the medium containing 2.6 microg/ml ICA were transferred to recipient heifers and resulted in normal pregnancies as determined by ultrasound imaging. Subsequently, all but two births were normal as evaluated by post natal veterinary examination. In conclusion, ICA showed no adverse effects on oocyte maturation and preimplantation embryo development in vitro or subsequent viability in vivo using the ICA concentrations and in vitro culture parameters of this study.

Animals↗

Tremorgenic syndrome in goats caused by Ipomoea asarifolia in Northeastern Brazil.

Green leaves of Ipomoea asarifolia were dosed to 10 goats. Nine goats ingesting 5-37 g/kg bw daily had clinical signs in 4-38 days. One goat ingesting 2.5 g/kg bw daily during 125 days and two control goats had no clinical signs. Clinical signs were characteristic for a tremorgenic syndrome. Five goats recovered in 4-9 days after the withdrawal of the plant. Two goats died spontaneously and three were euthanased for histologic and ultrastructural studies. No significant lesions were observed at necropsies or on the histologic and ultrastructural studies. Samples of the plant analyzed for enzymatic inhibitors were negative for calystegines and contained an almost undetectable amount of swainsonine (less than 0.001%). It is concluded that I. asarifolia causes a tremorgenic syndrome due to an unknown tremorgenic phytotoxins or mycotoxins.

Animals↗

Distribution of norditerpene alkaloids in tall larkspur plant parts through the growing season.

Previous research showed that toxic and total alkaloid pools in tall larkspur (Delphinium barbeyi) increased during early growth, then declined precipitously during the late flower and pod stage of growth. The objective of this study was to measure the concentration and pools of toxic and total alkaloids in tall larkspur plant parts, including roots, and to evaluate the changes in these pools over the growing season as an estimate of diterpenoid alkaloid kinetics in tall larkspur. Twenty entire plants were harvested at each phenological stage: beginning of growth in the spring, early flower, early pod, late pod, and senescence. The plants were separated into their respective parts, freeze-dried, extracted, and analyzed for toxic and total alkaloid concentration, and alkaloid pools were calculated. Concentration of toxic and total alkaloids in leaves and stems declined as the plants matured, while concentration in flowers and pods increased (P < 0.004). Concentration of alkaloids in the root declined in the early growth, then increased at the end of the season (P = 0.002). Alkaloid pools in the root decreased during early growth, with a corresponding increase of pools in foliar parts. In the late flower and pod stage, alkaloid pools in the leaves and stems declined rapidly, while the pool in the crown and roots tended to increase.

Delphinium↗

Evaluation of vaccination against methyllycaconitine toxicity in mice.

The purpose of this study was to determine whether larkspur toxins conjugated to protein carriers would promote active immunity in mice. Mice were injected with several larkspur toxin-protein conjugates or adjuvant alone to determine whether the resulting immunological response altered animal susceptibility to methyllycaconitine, the major toxic larkspur alkaloid. Although vaccinations increased the calculated lethal dose 50% (LD50) for intravenous methyllycaconitine toxicity, overlapping confidence intervals did not provide evidence of differences between the vaccinated and control groups. In the lycoctonine conjugate (LYC)-vaccinated group, mouse survival was related (P = 0.001) to serum titers for methyllycaconitine doses up to 4.5 mg/kg of body weight. When mice withlow antibody titers were removed from the vaccinated groups in which titer was related to survival, the recalculated LD50 estimates were 20% greater than the LD50 of the control group. However, the 95% confidence intervals of the recalculated LD50 groups overlapped with the control groups. Overall, these results suggest that vaccination altered methyllycaconitine toxicity in mice and that vaccination may be useful in decreasing the effects of larkspur toxins in animals. Additional studies are warranted to continue development of potential larkspur vaccines for livestock.

Aconitine↗

The toxicity and kinetics of larkspur alkaloid, methyllycaconitine, in mice.

Larkspur poisoning sporadically kills from 5 to 15% of the cattle on North American mountain rangelands. Of the 40 different diterpenoid larkspur alkaloids, the one that is thought to be responsible for much of the toxicity has been identified as methyllycaconitine (MLA). Little is known of MLA toxicokinetics or excretion. The purpose of this study was to further characterize the clinical effects of MLA toxicity in mice and determine the toxicokinetics of MLA excretion. Eight groups of mice were dosed intravenously with 2.0 mg/kg of BW of MLA, killed, and necropsied at 0, 1, 2, 5,10,15, 30, and 60 min after injection. Treated animals were reluctant to move, trembled, and developed dyspnea, muscular twitches, and convulsions. Within several minutes, the clinical signs abated and behavior slowly returned to normal over approximately 20 min. At necropsy serum, brain, liver, kidney, and skeletal muscle were collected and frozen. Blood and tissues were extracted and analyzed for MLA with HPLC and electron spray mass spectrometry. Blood MLA elimination followed a normal biphasic redistribution and excretion pattern (r = 0.99) with a K of elimination of 0.0376 and half-life of 18.4 min. Other tissues had similar clearance rates. These data indicate the MLA is rapidly distributed and excreted. In mice, the clinical effects of poisoning seem to affect the central nervous system, causing dyspnea and "explosive" muscular twitches and convulsions. Because livestock commonly eat larkspur at subclinical doses, they are likely to have larkspur alkaloids in many tissues. These results suggest that animals exposed to larkspur should rapidly excrete MLA (within several hours) and that the residues in animal tissues are not likely to be a problem if animals are given several days to allow toxin clearance.

Aconitine↗

Grazing of spotted locoweed (Astragalus lentiginosus) by cattle and horses in Arizona.

Spotted locoweed (Astragalus lentiginosus var. diphysus) is a toxic, perennial plant that may, if sufficient precipitation occurs, dominate the herbaceous vegetation of pinyon-juniper woodlands on the Colorado Plateau. Six cow/calf pairs and four horses grazed a 20-ha pasture with dense patches of locoweed in eastern Arizona during spring 1998. Locoweed density was 0.7 plants/m2 in the pasture. Locoweed averaged 30.4% NDF and 18.4% CP. Concentrations of the locoweed toxin, swainsonine, fluctuated from 1.25 to 2 mg/g in locoweed. Horses ate more (P < 0.01) bites of locoweed than did cows (15.4 and 5.1% of bites, respectively). Horses generally increased locoweed consumption over time since they ate approximately 5% of bites in the preflower stage compared with 25% of bites in the pod stage. Cattle consumed almost no locoweed (< 1% of bites) until the pod stage, when they increased consumption to 15% of bites. Horses were very avid (approximately 65 to 95% of bites) in selecting the small quantities (approximately 40 to 150 kg/ha) of available green grass, and it appeared that their propensity to eat scarce green forage influenced their locoweed consumption as well. Horses ate relatively little dry grass, even when it was abundant, whereas cattle ate large amounts of dry grass until green grasses became more abundant. Calves began eating locoweed on the same day as their dams and ate approximately 20% of their bites as locoweed. Serum concentrations of swainsonine were higher (P < 0.05) in horses than in cattle (433 vs. 170 ng/mL, respectively). Baseline swainsonine was zero in all animals, but swainsonine was rapidly increased to above 800 ng/mL in serum of horses as they ate locoweed. Horses exhibited depression after eating locoweed for about 2 wk; after 5 wk of exposure, horses became anorectic and behaviorally unstable. Although limited in scope, this study indicates that horses should not be exposed to spotted locoweed.

Animal Feed↗

Distribution of locoweed toxin swainsonine in populations of Oxytropis lambertii.

Oxytropis lambertii has been considered to be one of the major locoweeds responsible for livestock poisoning on rangelands, but there has been much confusion as to its taxonomic identity. The objective of this study was to conduct a field survey of several populations of each of the three varieties [var. lambertii Pursh; var higelovii A. Gray; var. articulata (E. Greene) Barneby] to document the presence or absence of the locoweed toxin, swainsonine. Swainsonine was found at detectable levels (>0.001% dry weight) in only five populations of var. higelovii in the southwest portion of its distribution in southern Utah, Arizona, and southwestern New Mexico, USA. No swainsonine was detected in populations in the northeast areas of its distribution (eastern Utah, Colorado, northeastern New Mexico, USA). The other varieties, articulata and lambertii, also did not contain swainsonine. It is suspected that a plant fungal endophyte may be responsible for the high variability in swainsonine content in populations of O. lambertii.

Analysis of Variance↗

Predicting toxicity of tall larkspur (Delphinium barbeyi): measurement of the variation in alkaloid concentration among plants and among years.

Tall larkspur (Delphinium barbeyi) is the principal mountain larkspur responsible for the majority of cattle deaths on mountain rangelands in western Colorado and central and southern Utah in the United States. Ten plants in each of two tall larkspur populations in the mountains near Ferron and Salina, Utah, were marked, and single stalks were harvested periodically through the growing season for 4 yr. Toxic alkaloid concentration [alkaloids containing the N-(methylsuccimimido)-anthranilik ester group] was determined by Fourier transform infrared (FTIR) spectroscopy. Individual larkspur plants varied in alkaloid concentrations, especially in early growth (14-38 mg/g). As the concentration declined over the growing season, variation among plants also declined. There were yearly differences in alkaloid concentration among individual plants (P < 0.01) and populations (P < 0.001), even after accounting for differences in phenological growth between years. Variables such as precipitation, temperature, days since snow melt, growing degree days (sum of mean temperature each day from snow melt), and plant height and weight were all considered in a Mallows Cp multiple regression selection procedure to predict alkaloid concentration. The mixed model procedure in SAS adjusted the regression equation for locations and years. Growing degree days was the best single predictor of alkaloid levels: In y = (3.581 - 0.00423 GDD), R2 = 0.85. Internal validation of this equation within individual years and locations from which the equation was developed, produced correlations between observed versus predicted values ranging from r = 0.73 to 0.93. External validations on nine other larkspur populations produced correlations ranging from r = 0.76 to 0.99. This predictive equation can provide a tool for ranchers and land managers to make management decisions of when to graze cattle in larkspur areas.

Alkaloids↗

Conditioning taste aversions to locoweed (Oxytropis sericea) in horses.

Locoweed (Oxytropis sericea) is a serious poisoning problem for horses grazing on infested rangelands in the western United States. Our objectives were to determine 1) whether lithium chloride or apomorphine would condition aversions to palatable foods, and at what doses, and 2) whether horses could be averted to fresh locoweed in a pen and grazing situation. Apomorphine was not an acceptable aversive agent because at the dose required to condition an aversion (> or = 0.17 mg/kg BW), apomorphine induced unacceptable behavioral effects. Lithium chloride given via stomach tube at 190 mg/kg BW conditioned strong and persistent aversions to palatable feeds with minor signs of distress. Pen and grazing tests were conducted in Colorado to determine if horses could be averted to fresh locoweed. Pen tests indicated that most horses (5/6) were completely averted from locoweed. Treated horses ate 34 g of fresh locoweed compared to 135 g for controls (P < 0.01) during three pen tests when offered 150 g per test. One horse (T) in the treatment group ate locoweed each time it was offered in the pen, but ate no locoweed while grazing. In the grazing trial, control horses averaged 8.6% of bites of locoweed (P < 0.01) during the grazing portion of the study, whereas treated horses averaged <0.5%. One treated horse (S) accounted for all consumption; he consumed 15% of his bites as locoweed in a grazing bout on d 2 of the field study. Thereafter, he was dosed a second time with lithium chloride and ate no locoweed in the subsequent 5 d. Three of six horses required two pairings of lithium chloride with fresh locoweed to condition a complete aversion. The results of this study indicate that horses can be averted from locoweed using lithium chloride as an aversive agent, and this may provide a management tool to reduce the risk of intoxication for horses grazing locoweed-infested rangeland.

Animals↗

Development of enzyme-linked immunosorbent assays for the hepatotoxic alkaloids riddelliine and riddelliine N-oxide.

Pyrrolizidine alkaloid-containing plants are widely distributed throughout the world and are particularly common in the genus Senecio. The structural types and concentrations of the alkaloids vary among plant species. In addition, within a species of plant, concentrations vary with environment and location. Many pyrrolizidine alkaloids are toxic and cause poisoning in livestock and in humans. Rapid, sensitive, and specific diagnostic techniques are needed to identify poisoned animals and to determine the particular plants and conditions under which livestock are likely to be poisoned. In this study, two competitive inhibition enzyme-linked immunosorbent assays for riddelliine, riddelliine N-oxide, and other closely related pyrrolizidine alkaloids were developed using polyclonal antibodies. One assay is class specific toward the free base forms of the pyrrolizidine alkaloids; the other assay showed cross-reactivity to both the free base and N-oxide forms of the alkaloids. The assay with the lowest limit of detection had an I(50) of 803.9 pg with a limit of detection of 47.5 pg for riddelliine. Spike and recovery studies for riddelliine in bovine blood ranged from 45 to 74%. The assay that showed cross-reactivity between the N-oxide and free base forms of the pyrrolizidine alkaloids allowed estimation of the total pyrrolizidine alkaloid content in Senecio riddellii in admixture with alfalfa. These findings suggest that these techniques will be excellent tools to diagnose poisoned animals and identify highly toxic plants.

Animals↗

Analysis of swainsonine: extraction methods, detection, and measurement in populations of locoweeds (Oxytropis spp.).

An analytical method has been developed to measure the locoweed toxin, swainsonine, in locoweed plant material. Dry ground plant samples were extracted using a small-scale liquid/liquid extraction procedure followed by isolation of the swainsonine by solid phase extraction with a cation-exchange resin. Detection and quantitation of the swainsonine were accomplished using reversed phase high-performance liquid chromatography coupled to atmospheric pressure chemical ionization tandem mass spectrometry (LC-MS(2)). The limit of quantitation was estimated to be 0.001% swainsonine by weight in dry plant material, which corresponds to the lower threshold for toxicity of locoweeds. The method of analysis was applied to the analysis of Oxytropis sericea (white locoweed) and Oxytropis lambertii (Lambert locoweed) plant samples to measure the variability of individual plant swainsonine levels within populations and within species. Individual plant variability was found to be highly significant for both O. sericea and O. lambertii populations. The combined three-year mean swainsonine values taken from three populations of O. sericea ranged from 0.046% in Utah to 0.097% in a New Mexico population. Sixteen individual populations of O. lambertii were sampled from eight different U.S. states. Swainsonine was detected at levels >0.001% in only 5 of the 16 collection sites. Those populations of O. lambertii found to contain higher swainsonine levels were restricted to the most southern and western portion of its distribution, and all were identified as belonging to var. bigelovii, whereas var. articulata and var. lambertii samples contained swainsonine at levels <0.001%.

Chromatography, High Pressure Liquid↗

Influence of defoliation on toxic alkaloid concentration and alkaloid pools in tall larkspur.

This study was replicated at two locations in the mountains of central Utah. In 1997, ten uniform plants of tall larkspur (Delphinium barbeyi) in the early bud stage (40 cm in height) were selected at each site and clipped at 5 cm above soil level. In 1998, one stalk from each plant was harvested on a weekly basis; in 1999, one stalk was harvested at four times during its phenological development. Toxic and total alkaloid concentrations were measured and alkaloid pools in the entire stalk were calculated. Clipping reduced stalk height to less than 50 cm in 1998 and 65 cm in 1999, compared to over 100 cm in unclipped control plants. Alkaloid concentration was similar to control plants, but toxic alkaloid pools were 70% lower than control plants, because of the reduction in biomass of the stalks. Clipping reduced subsequent vigor and the amount of toxic and total alkaloids in tall larkspur.

Alkaloids↗

Beef cattle losses after grazing Lupinus argenteus (silvery lupine).

Ten yearling steers weighing 270-360 kg died acutely after eating early seed pod stage Lupinus argenteus (silvery lupine) containing high levels of piperidine alkaloids, including ammodendrine and N-methylammodendrine. Reduced availability of Quality feed from range moderately depleted of Quality grasses appeared a major factor in causing the cattle to graze lupine. Proximate analysis of whole plant, seed pods and seed showed high levels of crude protein ranging from 16.4 to 48% for whole plant and seed. Alkaloid analysis of the whole plant and individual plant parts such as seed and seed pods (30-40% seed shatter) showed total alkaloid levels ranging from 0.70 to 2.5% (0.70-2.5 mg/100 mg plant) dry weight. Ammodendrine levels ranged from 0.24% in seed pods with >70% seed loss to 1.35% in early growth plant with no seed. N-methylammodendrine levels ranged from 0.38% in seed pods with >70 % seed shatter to 1.04 % in pure seed. Other minor alkaloids totaled 0.08% in seed pods with >70% seed shatter to 0.60% in early growth plant before seed pod formation. These cattle ate an estimated 1.8 g/kg dry weight (486 g to 648 g) of lupine in 24 h. This appears the first report of acute death in cattle associated with piperidine alkaloid-containing Lupinus argenteus.

Alkaloids↗

The isolation and identification of steroidal sapogenins in switchgrass.

Switchgrass (Panicum virgatum L.) has been reported to be hepatotoxic, causing photosensitization in lambs and horses. In this study we show the presence of steroidal saponins in two samples of switchgrass that has been implicated in the poisonings of sheep and horses. After hydrolysis of the saponins, diosgenin was determined to be the major sapogenin in both switchgrass samples. We also confirmed the presence of diosgenin in kleingrass after hydrolysis of saponins extracted from it.

Chromatography, High Pressure Liquid↗

Comparison of cleft palate induction by Nicotiana glauca in goats and sheep.

The induction of cleft palate by Nicotiana glauca (wild tree tobacco) during the first trimester of pregnancy was compared between Spanish-type goats and crossbred western-type sheep. Cleft palate was induced in 100% of the embryonic/fetal goats when their pregnant mothers were gavaged with N. glauca plant material or with anabasine-rich extracts from the latter, during gestation days 32-41. Seventy-five percent of newborn goats had cleft palate after maternal dosing with N. glauca during gestation days 35-41, while no cleft palates were induced when dosing periods included days 36-40, 37-39, or day 38 only. The induced cleft palates were bilateral, involving the entire secondary palates with complete detachment of the vomer. Eleven percent of the newborn goats from does gavaged during gestation days 32-41 had extracranial abnormalities, most often contractures of the metacarpal joints. Most of these contractures resolved spontaneously by 4-6 weeks postpartum. One newborn kid also had an asymmetric skull due to apparent fetal positioning. No cleft palates were induced in lambs whose mothers were gavaged with N. glauca plant or anabasine-rich extracts during gestation days 34-41, 35-40, 35-41, 36-41, 35-51, or 37-50. Only one of five lambs born to three ewes gavaged with N. glauca plant material during gestation days 34-55 had a cleft palate, but all five of these lambs had moderate to severe contractures in the metacarpal joints. The slight to moderate contracture defects resolved spontaneously by 4-6 weeks postpartum, but the severe contractures resolved only partially. Embryonic/fetal death and resorption (determined by ultrasound) occurred in 25% of pregnant goats fed N. glauca compared to only 4% of pregnant sheep. Nicotiana glauca plant material contained the teratogenic alkaloid anabasine at 0.175% to 0.23%, dry weight, demonstrating that Spanish-type goats are susceptible to cleft palate induction by the natural toxin anabasine, while crossbred western-type sheep are resistant. However, clinical signs of toxicity were equally severe in goats and sheep, even though maternal alkaloid tolerance was generally lower in sheep. We postulate that an alkaloid-induced reduction in fetal movement during the period of normal palate closure is the cause of the cleft palate and multiple flexion contractures. Teratology 61:203-210, 2000. Published 2000 Wiley-Liss, Inc.

Abnormalities, Drug-Induced↗