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Biomedical subjects

H B Fleit

Publications and source records attributed to H B Fleit.

At least 37 records · Page 2Linked to original sources

Monoclonal antibodies to human neutrophil Fc gamma RIII (CD16) identify polypeptide epitopes.

Human neutrophils constitutively express two low-affinity Fc gamma R, Fc gamma RII (CD32) and Fc gamma RIII (CD16). Eleven monoclonal antibodies (mAb) to CD16 were used to identify antigenic differences among Fc gamma RIII-bearing cells, to define functional epitopes of Fc gamma RIII on neutrophils, and to characterize biochemically the epitopes identified by some of these mAb. Flow cytometry demonstrated that 9 of the 11 mAb reacted with neutrophils, 10 of the 11 reacted with natural killer cells, and 9 of 11 reacted with monocytes and monocyte-derived macrophages. These mAb reacted with CD16 positive cells with varying fluorescence intensities. The ability of anti-CD16 mAb to block the binding of 125I-labeled immune complexes to neutrophils was examined. Four monoclonal antibodies strongly inhibited (87-96%) the binding to neutrophils of 125I-labeled immune complexes. Competitive binding assays were performed to determine whether any other anti-CD16 mAb identify the epitope identified by mAb 3G8. Two other mAb, CLBFCGRAN 1 and CLBGRAN 11, blocked binding of 125I-3G8 IgG to neutrophils. Six of the anti-CD16 mAb efficiently immunoprecipitated polypeptides of broad mobility ranging from 45 to 84 kDa from 125I-labeled neutrophils. When Fc gamma RIII, a complex sialoglycoprotein consisting of almost 50% oligosaccharides, was immunoprecipitated from neutrophils with 3G8 Fab Sepharose and subsequently digested with N-glycanase, 5 of the 6 mAb were capable of immunoprecipitating a deglycosylated polypeptide migrating at 29 kDa. These results demonstrate that these 5 mAb identify polypeptide epitopes of Fc gamma RIII, whereas 1 mAb, YFC120.5, may react with a glycosyl moiety or a determinant whose conformation is dependent on the presence of oligosaccharides.

Adult↗

Plasma membrane and intracellular pools of transferrin receptors decline during in vitro cultivation of U937 cells.

Transferrin receptor expression in the monocyte-like cell line U937 was investigated during in vitro cultivation. U937 cells expressed a single class of high affinity surface transferrin receptors (KD approximately 4 nM), with apparent subunit Mr of 90-95,000 Da as determined by SDS-reducing PAGE. [125I]-transferrin binding studies on detergent-solubilized cells revealed that half to two-thirds of the total functional binding sites were located intracellularly. Radioligand binding, immunofluorescence and flow cytometry studies were performed on intact, detergent-solubilized, or saponin-permeabilized cells, using either transferrin or the anti-transferrin receptor monoclonal antibody OKT9 IgG. These studies demonstrated that functional and antigenic transferrin receptor levels were maximal on cells 24 h after subculture at low density and declined during the culture period. Scatchard analysis of radioligand binding data suggested that the decline in functional transferrin binding sites resulted from a decline in the number of available receptors. These results demonstrate that in U937 cells there is a density-dependent regulation of transferrin receptor expression, resulting in a loss of functional and antigenic receptors from both plasma membrane and intracellular locations.

Cell Division↗

Characterization of human alveolar macrophage Fc gamma receptor III: a transmembrane glycoprotein that is shed under in vitro culture conditions.

Three classes of Fc gamma receptors (FcR) have been identified on blood leukocytes: FcRI, FcRII, and FcRIII. Two forms of FcRIII have recently been characterized; a phosphatidylinositol linked form is found on neutrophils, whereas a transmembrane form of the molecule is found on a subset of peripheral blood lymphocytes. Peripheral blood monocytes express low levels of FcRIII on their surface, whereas FcRIII is readily expressed by tissue macrophages. The purpose of this investigation was to characterize the form of FcRIII expressed by normal human alveolar macrophages (AM) obtained from normal subjects by bronchoalveolar lavage. We found FcRIII expressed by AM has a molecular mass of 50 to 60 kD on sodium dodecyl sulfate polyacrylamide gel electrophoresis and migrates as a single band with a molecular mass of 35 kD after digestion with endoglycosidase F. Macrophage FcRIII was resistant to cleavage by phosphatidylinositol-specific phospholipase C. These results demonstrate that FcRIII expressed by AM is a transmembrane glycoprotein similar to the molecule found on peripheral blood lymphocytes. Scatchard binding analysis using 125I-labeled mAb 3G8 showed that AM express similar numbers of FcRIII as found on neutrophils (73,300 +/- 16,300 versus 69,300 +/- 8,500 receptor sites/cell, respectively; P = 0.73), whereas fewer binding sites were found on FcRIII-positive peripheral blood lymphocytes (35,300 +/- 13,900; P = 0.04). Of note, we found expression of FcRIII by AM was selectively and dramatically reduced during short term in vitro incubation at 37 degrees C. Receptor shedding as a result of proteolytic cleavage is probably responsible for the reduced expression that occurs during short-term in vitro culture.

Antibodies, Monoclonal↗

Alveolar and peritoneal macrophages bear three distinct classes of Fc receptors for IgG.

The FcR for IgG on the plasma membrane of cells of the mononuclear phagocyte system mediate a number of different biologic responses such as phagocytosis, pinocytosis, superoxide generation, and antibody-dependent cytotoxicity. In the interest of understanding the pathophysiology of these processes we have begun to characterize the FcR for IgG on two readily available sources of macrophages--the lung and the peritoneum--using antireceptor mAb. We find that all three of the distinct classes of FcR for IgG which have been described in man are present on both pulmonary and peritoneal macrophages. Most monocytes, we suggest, bear low numbers of Fc gamma RIII whereas a small subpopulation of monocytes expresses substantial numbers of Fc gamma RIII. Furthermore, we find that two different forms of Fc gamma RIII differ in their capacity to bind anti-Fc gamma RIII mab 3G8 in the presence of human IgG. Human IgG does not block the binding of mAb 3G8 to neutrophils, but it does block 3G8 binding to macrophages and large granular lymphocytes; this finding correlates with the expression of the two Fc gamma RIII genes, I and II, in man. Studies aimed at illuminating the molecular mechanisms of Fc gamma R-mediated processes in macrophages will require consideration of the receptors of all three classes.

Antibodies, Monoclonal↗

Identification of an oolemmal IgG Fc receptor: its role in promoting binding of antibody-labelled human sperm to zona-free hamster eggs.

Antisperm antibodies (ASAs) present in sera of infertile men and women have been shown either to promote or inhibit penetration of zona-free hamster eggs by antibody-labelled human spermatozoa. Increased numbers of oolemmal-bound sperm have been noted in association with increased sperm penetration frequencies, following antibody labelling, when compared with antibody-free sperm. The promotion of adherence of ASA-labelled sperm to the oolemma could be mediated through the binding of antibodies to common epitopes present on the sperm and egg surfaces or through Fc-mediated binding to an oolemmal Fc receptor. In support of the latter hypothesis, we report that zona-free hamster eggs bind aggregated human IgG and IgG Fc fragments. The presence of an oolemmal IgG Fc receptor has been confirmed using a rat monoclonal antibody (2.4G2) directed against a murine IgG Fc receptor (Fc gamma RII) as judged both by indirect immunofluorescence and by immunobead binding. In addition, the pre-incubation of zona-free hamster eggs with IgG Fc diminished both adhesion to and penetration of the oolemma by human spermatozoa.

Animals↗

Interaction between Borrelia burgdorferi and endothelium in vitro.

During the pathogenesis of Lyme disease, Borrelia burgdorferi spreads hematogenously from the site of a tick bite to several tissues throughout the body. The specific mechanism of spirochete emigration is presently unknown. Using cultured human umbilical vein endothelial cells, we found that Borrelia burgdorferi bound to the endothelial cells and to the subendothelial matrix. Low passage isolates adhered 22-30-fold greater than a strain maintained in culture continuously. Spirochete binding to subendothelial matrix was inhibited 48-63% by pretreatment of the matrix with anti-fibronectin antiserum. Spirochete migration across endothelial monolayers cultured on amniotic membrane was increased when the monolayers were damaged by chemical or physical means. Electron microscopic examination of spirochete-endothelial interactions demonstrated the presence of spirochetes in the intercellular junctions between endothelial cells as well as beneath the monolayers. Scanning electron microscopy identified a mechanism of transendothelial migration whereby spirochetes pass between cells into the amniotic membrane at areas where subendothelium is exposed.

Amnion↗

Functional analysis of monocyte-macrophages derived from nonadherent cord blood progenitor cells: correlation with the ontogeny of cell surface proteins.

In this study we examine some of the phenotypic and functional characteristics that accompany the differentiation of monocyte-macrophages from nonadherent precursors present in cord blood. Class II major histocompatibility complex (MHC) molecules identified by monoclonal antibody (mAb) L243 were the earliest monocyte-macrophage-associated antigens to be expressed. CD14 molecules, identified by mAb MO.2, and the transferrin receptor, identified by mAb OKT9, increased linearly over the 21-day culture period. In contrast, Fc gamma R were not expressed on these cells until 14 days of culture. Fc gamma RI was present on approximately 80% of the cells, whereas Fc gamma RII and Fc gamma RIII were present on 30% and 20% of the cells, respectively. Functional activity of the nonadherent cell-derived monocyte-macrophages paralleled the phenotypic maturation of these cells. The capacity to stimulate a mixed leukocyte reaction paralleled the expression of class II MHC molecules. Similarly, the capacity to phagocytose Escherichia coli and Staphylococcus aureus paralleled the appearance of CR3. Indeed, phagocytosis of these organisms was partially blocked by mAb OKM-1. These studies demonstrate that monocyte-macrophages derived from cord blood nonadherent mononuclear cells are a useful population with which to characterize human macrophage differentiation and functional and phenotypic heterogeneity.

Cell Differentiation↗

Monoclonal antibodies identify three IgG Fc receptors in normal human central nervous system.

Functional Fc receptors have been described in the central nervous system (CNS) in the subependymal periventricular regions, leptomeninges, including brain perivascular tissues, and choroid plexus. The distribution of this receptor activity suggests a role in protection of adjacent nervous tissue from IgG-opsonized antigens, including microorganisms. In this report, we have utilized monoclonal antibodies to human Fc gamma RI, II, and III; 32, IV.3, and 3G8, respectively, to immunohistochemically examine the distribution of these receptors in the CNS. Fc gamma RI was only occasionally present in the CNS where it was identified most often in the choroid plexus. Fc gamma RII was the predominant receptor in brain. It as consistently present in leptomeninges, including brain perivascular regions, arachnoid granulations, and choroid plexus stroma. Some samples of subependymal periventricular tissue also displayed Fc gamma RII. Fc gamma RIII was only identified in subependymal periventricular tissue but not in choroid plexus and arachnoid. These results demonstrate that regions of normal adult brain which produce cerebral spinal fluid (CSF) and border on CSF and vascular compartments display Fc gamma R heterogeneity consistent with that of blood monocytes and systemic macrophages.

Aged↗

Fc and complement receptor (CR1 and CR3) expression on neonatal human polymorphonuclear leukocytes.

Fc gamma receptor III (Fc gamma RIII) and complement receptors (CR1 and CR3) were examined on polymorphonuclear leukocytes (PMN) from neonatal cord blood and adult blood using monoclonal antibodies directed against these receptors. Receptor expression was determined by flow cytometry. Fc gamma RIII, CR1 and CR3 expression was examined in whole blood at 4 degrees C, at 37 degrees C with or without stimulation with the chemotactic peptide f-met-leu-phe, and on PMN isolated by Ficoll-Hypaque centrifugation and dextran sedimentation. There was no significant difference between adult and cord PMN in the percent of cells which expressed Fc gamma RIII, CR1 and CR3 when examined in whole blood at 4 or 37 degrees C, or following stimulation with f-met-leu-phe. The percentage of PMN expressing CR1 and CR3 was lower on cord PMN compared to adult PMN when these cells were examined following Ficoll-Hypaque centrifugation and dextran sedimentation. The mean peak fluorescence of PMN which stained positively for CR1 and CR3 increased following f-met-leu-phe treatment of whole blood from adults and neonates. Since neonatal cord PMN were capable of upregulating complement receptors in response to chemotactic factors these results do not explain the increased susceptibility to infection exhibited by neonates.

Adult↗

Biochemical characterization of an Fc gamma receptor purified from human neutrophils.

The Fc receptor identified by mAb 3G8 (Fc gamma RIII) was isolated by mAb affinity chromatography from 0.5 to 2 x 10(10) neutrophils yielding 33 to 149 micrograms of protein. Iodination of the purified protein identified a polypeptide of broad electrophoretic mobility from Mr 47 to 70 kDa and occasionally a fainter polypeptide at 100 to 130 kDa, which may be dimerized receptor. Two-dimensional isoelectric focusing gel electrophoresis illustrated multiple diffuse polypeptides ranging from a pI of less than 4.7 to 6.5. Treatment of the purified receptor with neuraminidase shifted the mobility of these polypeptides to a more basic pI, ranging from 6 to 8, illustrating the presence of sialic acid residues on Fc gamma RIII. The glycoprotein nature of Fc gamma RIII was characterized by several criteria. The receptor bound to Con A-Sepharose. Treatment of Fc gamma RIII with endoglycosidase H or F, which cleave high mannose and biantennary complex N-linked oligosaccharides, respectively, failed to alter the electrophoretic mobility of the Fc gamma R. Peptide N:glycosidase F, which cleaves all classes of N-linked oligosaccharides, reduced the Mr of Fc gamma RIII by 60% to reveal two poorly resolved polypeptides centered at Mr 25 kDa and ranging from Mr 16 to 28 kDa. Chemical deglycosylation with trifluoromethanesulfonic acid, which cleaves O- and N-linked oligosaccharides except for the asparagine-linked N-acetylglucosamine, reduced the Mr of Fc gamma RIII to 21 to 36 kDa. These results demonstrate that Fc gamma RIII is an acidic complex sialoglycoprotein and suggest that there may be 8 to 15 N-linked oligosaccharide chains on Fc gamma RIII.

Antibodies, Monoclonal↗

Identification of nonadherent mononuclear cells in human cord blood that differentiate into macrophages.

We describe a population of nonadherent cells in neonatal cord blood that, upon in vitro cultivation, develop into monocyte-macrophages. These cells initially are negative for nonspecific esterase cytoplasmic activity, lack the monocyte marker MO.2, fall into smaller, nonmonocytic cell size areas, as determined by fluorescence-activated cell sorter (FACS)-assisted size analysis, and differentiate into macrophages under nonstimulatory culture conditions (in the absence of exogenous colony stimulating factors, less than 0.1 ng/ml endotoxin, and growth in suspension). In contrast to the adherent, committed macrophage precursors in cord blood, which differentiate into macrophages after 2-3 days of culture, the nonadherent precursor does not acquire monocyte-macrophage characteristics until day 14 of culture. Earlier induction is achieved by adding the monocyte-activating agents lipopolysaccharide or 1,25 dihydroxyvitamin D3 to cultures.

Calcitriol↗

Expression of functional cell surface C1-inactivator by U937 cells.

We have previously shown that the human monocyte-like cell line U937 synthesizes C1-INA and expresses cell surface C1-INA. In this report we provide evidence that this surface-expressed C1-INA is functionally active. Intact U937 cells demonstrated functional C1-INA activity in a hemolytic assay. This activity was blocked when the cells were incubated with monospecific antibody to C1-INA, and was not detectable in cell-free supernatants of U937 cells. SDS-PAGE analysis of radiolabeled U937 cell surface proteins purified by anti-C1-INA affinity chromatography revealed two distinct bands. One protein had a Mr of 105 kDa identical to plasma C1-INA, and the second had a Mr of 200 kDa. We were unable to determine the identity of the 200 kDa protein by Western blotting with anti-C1-INA. However, the possibility exists that this 200 kDa molecule may represent a C1-INA receptor, a dimeric form of C1-INA, or an unrelated cell surface protein with affinity for C1-INA. Furthermore, we show that treatment of U937 cells with phorbol ester resulted in an increase in the percentage of cells expressing surface C1-INA. These results suggest that U937 cells express functional cell surface C1-INA, which could function in vivo to protect these human tumor cells from lysis by host complement.

Blotting, Western↗

Characterization of two distinct transglutaminases of murine bone marrow-derived macrophages: effects of exposure of viable cells to cigarette smoke on enzyme activity.

The present study examines the effects of water soluble extracts of gas-phase cigarette smoke on intracellular transglutaminase activities of intact, murine, bone marrow-derived macrophages maintained in culture. Western blotting of cell lysates utilizing noncross-reactive antisera indicate that mouse bone marrow-derived macrophages contain both tissue-type transglutaminase and factor XIII-associated transglutaminase. This finding is also supported by data indicating that the intracellular transglutaminase activity of these cells contains thrombin-dependent and -independent components. Macrophages incubated with cigarette smoke solutions for 15 minutes at 37 degrees C display a dose-dependent decrease (maximum inhibition = 55%, p less than .001) in tissue-type (thrombin-independent) transglutaminase activity, as compared to control cells incubated with phosphate-buffered saline. Factor XIII (zymogen) is not inactivated following incubation of macrophages with smoke extracts. Smoke exposure under the conditions employed has no effect on either cell viability or adherence. Incubation with 2 microM retinoic acid for 24 hours leads to a modest (2-fold) induction of tissue transglutaminase, but does not induce factor XIII; in contrast, incubation with 10% homologous serum for 24 hours results in a decrease in factor XIII, but does not affect tissue transglutaminase. These data indicate that: bone marrow-derived macrophages contain factor XIII as well as tissue-type transglutaminase; and gas-phase cigarette smoke can inactivate tissue transglutaminase within viable murine bone marrow-derived macrophages, but cannot inactivate zymogenic factor XIII.

Animals↗

Characterization of immunoglobulin G-Fc receptor activity in the outflow system of the cerebrospinal fluid.

We have examined IgG Fc receptor (FcR) activity of human and rabbit arachnoid granulations and leptomeninges using antibody (IgG)-coated erythrocytes (EIgG), covalently crosslinked IgG dimers, trimers and oligomers, immune complexes, aggregated Fc fragments and a monoclonal anti-human neutrophil Fc receptor antibody, 3G8. EIgG bound specifically to cells of the leptomeninges and arachnoid granulations; uncoated erythrocytes, F(ab')2-coated, or IgM-coated erythrocytes failed to bind. The specificity of this interaction was demonstrated by inhibition studies. Monomeric IgG and Fc fragments blocked EIgG adherence, whereas bovine serum albumin (BSA), Fab fragments of IgG and the monoclonal anti-neutrophil FcR antibody failed to inhibit EIgG adherence. Monomeric IgG inhibited FcR function in a dose-dependent fashion; maximal inhibition was achieved at 1.7 X 10(-5)M IgG, indicating a relatively low avidity receptor. Oligomers of IgG inhibited EIgG adherence more effectively and inhibition was directly related to oligomer size. Additionally, these tissues were positive for specific and non-specific esterases. These studies suggest that the CSF pathway from the perivascular spaces to the arachnoid granulations plays a protective role in the clearance of IgG and IgG immune complexes in infections and immune-mediated disorders.

Animals↗

High avidity periventricular IgG-Fc receptor activity in human and rabbit brain.

Periventricular tissues from human and rabbit brains were examined for receptors for the Fc domain of immunoglobulin G (Fc receptors). Fc receptors were demonstrated using antibody-coated erythrocytes (EIgG) and covalently cross-linked rabbit IgG. EIgG adhered specifically to nonneuronal periventricular glial areas and was inhibited by IgG and Fc fragments, but not by Fab fragments or albumin. EIgG adherence was 50% inhibited with 6.7 X 10(-9) M IgG. This is 1/1000 the amount of IgG required to produce 50% inhibition of EIgG adherence to arachnoid FcR. Studies with covalently cross-linked IgG demonstrated a linear relationship between ligand size and inhibition of EIgG adherence. Uncoated erythrocytes, IgM-coated erythrocytes, or F(ab')2-coated erythrocytes failed to bind to periventricular tissue. Many nonspecific esterase-positive cells were found in the area of periventricular EIgG adherence; this esterase activity was sensitive to fluoride. These results provide, for the first time, evidence of inherent IgG receptor activity in the periventricular tissues, and suggest that the periventricular tissues play a protective role in the removal of IgG or IgG-antigen complexes which have entered the cerebral spinal fluid.

Adult↗

Fc-mediated endocytosis by human neutrophils. Ultrastructural studies.

Fc Receptors (FcR) mediate the binding and uptake by polymorphonuclear leukocytes (PMN) of antibody-coated particles and soluble immune complexes. We have studied Fc-mediated endocytosis by PMN ultrastructurally using a gold-conjugated monoclonal antibody (3G8) to block or to mark the location of FcR. Phagocytosis of antibody-coated erythrocytes (EIgG) was initiated rapidly after binding to discrete foci on the PMN plasma membrane. After the phagocytosis of EIgG, we examined the distribution of FcR remaining on the PMN plasma membrane. 3G8-Colloidal gold continued to bind to PMN after ingestion of up to three EIgG, demonstrating that all PMN FcR are not utilized during a brief phagocytic event. The endocytosis of soluble immune complexes was examined by labeling plasma membrane-bound rabbit immune complexes with goat anti-rabbit IgG conjugated to colloidal gold. Gold was found in clusters randomly distributed over the plasma membrane at 4 degrees C. When cells were warmed to 37 degrees C, numerous endocytic vesicles were observed as early as 2.5 minutes after warming. After 30 minutes at 37 degrees C, large vesicles, 1 micron in diameter, were found to contain 20 to 30 gold particles. The endocytosis of 3G8 was also examined using colloidal gold. After binding of 3G8-gold at 4 degrees C, clusters of large vesicles, up to 2 micron in diameter, were rapidly formed at 37 degrees C.

Animals↗

Identification of a second class of IgG Fc receptors on human neutrophils. A 40 kilodalton molecule also found on eosinophils.

We describe a newly recognized 40 kD FcR for IgG on human neutrophilic granulocytes. An mAb (IV3) developed against the IgG FcR of K562 cells, and specific as well for a 40 kD FcR on human monocytes and platelets, was found to purify by affinity adsorption a 40 kD protein from detergent lysates of surface-radioiodinated neutrophils. This protein, proteolytically degraded to 33 kD when purified in the absence of diisopropylfluorophosphate, is distinct from the 51-73 kD protein precipitated by the anti-neutrophil FcR mAb, 3G8, previously described by others. Complete inhibition of binding of rabbit IgG-coated erythrocytes to neutrophils was achieved only when both antibodies, IV3 and 3G8, were used. Fab fragments of IV3 were as effective inhibitors as the intact molecule. IV3 IgG or Fab fragments completely and selectively inhibited immune complex-mediated generation of superoxide by human neutrophils; superoxide generation by other stimulants was not abrogated by IV3. This antibody (IV3) bound also to human eosinophils and completely inhibited the binding of IgG-coated erythrocytes to eosinophils. IV3 appears to define the human homolog of the murine macrophage FcRII identified initially by mAb 2.4G2 and present in the mouse on both neutrophils and eosinophils.

Antibodies, Monoclonal↗

Fc receptor function on sheep alveolar macrophages.

We have examined the binding to sheep alveolar macrophages (AM) and peripheral blood polymorphonuclear leukocytes (PMN) of sheep immunoglobulin G subclasses or rabbit IgG immune complexes formed between rabbit anti-DNP IgG and DNP-bovine serum albumin. Binding studies using 125I-rabbit IgG immune complexes demonstrated 6.6 +/- 3.5 X 10(4) receptors per alveolar macrophage; these receptors bound immune complexes with an average association constant of 3.3 X 10(7) M-1. Saturation binding was achieved by 90 minutes at 4 degrees C with 6 X 10(-8) M IgG. Binding of subclasses of sheep IgG was examined by immunofluorescence. Only 10% of alveolar macrophages bound monomeric IgG1 and no binding of sheep IgG2 monomer could be demonstrated. In contrast, most peripheral blood PMN (93.0 +/- 9.5%) bound IgG2, but not IgG1. No binding to adult peripheral blood PMN of rabbit IgG immune complexes could be demonstrated. To study further the development of pulmonary host defense, we examined the expression of receptors for IgG immune complexes (Fc gamma R) on alveolar macrophages obtained from animals aged 8 through 180 days. At 8 and 21 days of age, the number of Fc gamma R varied considerably (75,000-192,000 sites per cell) and equalled or even exceeded that of adult sheep. Fc gamma R number declined by 42 and 90 days of age, where a nadir was reached (37,000 +/- 6,000 and 25,000 +/- 6,000 sites, respectively). By 180 days of age, the number of receptors had approached those of normal adult sheep (70,000 +/- 20,000 sites per cell). These studies parallel previous observations that revealed age-related differences in the phagocytic capacity of ovine alveolar macrophages.

Age Factors↗