PubMed Health⌕ Search

Biomedical subjects

J Ros

Publications and source records attributed to J Ros.

At least 37 records · Page 2Linked to original sources

Identification of the major oxidatively damaged proteins in Escherichia coli cells exposed to oxidative stress.

In the present study we have analyzed protein oxidation on Escherichia coli when these cells were submitted to different stress conditions such as hydrogen peroxide, superoxide-generating compounds, and iron overloading. Carbonyl groups on oxidized cell proteins were examined by Western blot immunoassay. When anaerobically grown E. coli cells were exposed to hydrogen peroxide stress, alcohol dehydrogenase E, elongation factor G, the heat shock protein DNA K, oligopeptide-binding protein A, enolase, and the outer membrane protein A were identified as the major protein targets. A similar immunostained band pattern was found when cells were shifted from anaerobic to aerobic conditions in the presence of different concentrations of iron; it is relevant to note that oxidation of outer membrane protein C, not observed in peroxide stress conditions, was clearly detected as the concentration of iron was increased in the culture media. The hydrogen peroxide stress performed under aerobic conditions affected the beta-subunit of F0F1-ATPase; the rest of the oxidized protein pattern was very similar to that found for anaerobic conditions, with the exception of alcohol dehydrogenase E, a protein not synthesized aerobically. Cells submitted to superoxide stress using menadione showed a more specific pattern in which elongation factor G and the beta-subunit of F0F1-ATPase were affected significantly. When paraquat was used, although the degree of oxidative damage was lower, the same two modified proteins were detected, and DNA K was also clearly damaged. Cell viability was affected to different extents depending on the type of stress exerted. The results described in this paper provide data about the in vivo effects of oxidative stress on protein oxidation and give insights into understanding how such modifications can affect cellular functions.

Aerobiosis↗

Increased renal expression of nitric oxide synthase type III in cirrhotic rats with ascites.

This article assesses the circulating levels of L-arginine, the renal response to L-arginine infusion, and the renal expression of inducible and constitutive nitric oxide synthase (NOS II and NOS III, respectively) in cirrhotic rats with ascites. Systemic and renal hemodynamics and renal function were measured in basal conditions and following two doses of L-arginine (5 and 10 mg x kg(-1) x min for 40 minutes). Renal NOS II and III messenger RNA (mRNA) expression was evaluated in basal conditions by polymerase chain reaction and Northern blot, respectively. Renal NOS II and III protein expression was assessed by Western blot and immunohistochemistry. Plasma concentration of L-arginine was significantly lower in cirrhotic rats than in control rats (48+/-11 vs. 86+/-9 micromol/L, P < .025). In both groups L-arginine infusion had no effect on systemic hemodynamics, but markedly increased renal perfusion. This effect was significantly more intense in cirrhotic rats. A very weak signal of similar intensity was found for NOS II mRNA in both groups of animals. However, no NOS II protein expression was detected. In contrast, higher NOS III mRNA abundance and protein expression, which was mainly located in the endothelial lining of the renal arterioles, were found in the kidney of cirrhotic animals. These results indicated increased renal expression of NOS III mRNA and protein, deficient circulating levels of L-arginine, and increased renal hemodynamic response to this amino acid in cirrhotic rats with ascites. Our results suggest that L-arginine supplementation at doses not affecting arterial pressure could have beneficial effects on renal perfusion in cirrhosis.

Animals↗

Altered biosynthesis of leukotrienes and lipoxins and host defense disorders in patients with cirrhosis and ascites.

BACKGROUND & AIMS: Advanced cirrhosis is associated with impaired leukocyte function, but the mechanism underlying this host defense alteration is unknown. The aim of this study was to investigate the lipoxygenase pathway of arachidonic acid metabolism and its influence in leukocyte trafficking in patients with cirrhosis and ascites. METHODS: Neutrophils (polymorphonuclear leukocytes [PMN]) were isolated from patients with cirrhosis and ascites and healthy subjects, and 5-lipoxygenase (5-LO) messenger RNA levels and 5-LO-derived products were measured. The effect of leukotrienes (LT) and lipoxins (LX) on PMN adhesion and migration was also assessed. RESULTS: PMN from patients with cirrhosis showed increased 5-LO messenger RNA expression. However, in vitro generation of LTB4, cysteinyl-containing LT and LX was significantly decreased in cirrhotic patients. Interestingly, a close relationship between the activity of the renin-angiotensin system and LXA4 biosynthesis was observed both in vitro and in vivo. PMN isolated from cirrhotic patients with ascites showed significantly decreased adhesion and migration in response to LTB4. LXA4 did not provoke PMN adhesion and migration, but rather abrogated the differences between control and cirrhotic PMN. Cirrhotic monocytes showed marked impairment in adherence to laminin when stimulated with either LTB4 or LXA4. CONCLUSIONS: These results show the existence of altered biosynthesis of LT and LX and defective response to these lipoxygenase products in leukocytes from patients with cirrhosis and ascites. This abnormality may be relevant to the pathogenesis of host defense disorders in chronic liver disease.

Angiotensin II↗

Tetrahydrobiopterin modulates cyclooxygenase-2 expression in human mesangial cells.

Tetrahydrobiopterin (BH4) biosynthetic pathways are stimulated under inflammatory conditions. The newly synthesized BH4 serves as a cofactor for optimal activity of inducible nitric oxide synthase (NOS2). In human mesangial cells (HMC), BH4 is also a limiting factor for NOS2 expression. In this study we show that BH4 availability can also play a modulatory role in the expression of cyclooxygenase 2 (COX-2) in HMC. Supplementing HMC with the BH4 donor sepiapterin potentiated IL-1beta/TNF-alpha-induced COX-2 expression by approximately 2-fold. This effect was abolished by methotrexate. In contrast, the NOS inhibitor L-NAME and the soluble guanylate cyclase inhibitor ODQ did not block sepiapterin amplification of COX-2 expression. Moreover, sepiapterin was found to modulate the tyrosine phosphorylation of several cellular substrates, an early event which occurred well before the induction of NOS2 could be evidenced. These findings suggest a role for BH4 in the modulation of mesangial cell responses to pro-inflammatory stimuli.

Biopterins↗

Effect of bacterial lipopolysaccharide on endothelin-1 production in human vascular endothelial cells.

BACKGROUND/AIMS: The plasma levels of endothelin (ET) are 2-5 fold higher in patients with cirrhosis than in healthy subjects. It has been proposed that endotoxemia could be a mechanism responsible for this phenomenon. However, investigations in rats with cirrhosis indicate that a differential regulation for prepro ET-1 mRNA expression occurs in the liver tissue of these animals but not in the aorta or other organs. The aim of the study was to investigate the effect of bacterial lipopolysaccharide (LPS) on endothelin-1 synthesis and release in cultured human vascular endothelial cells (HUVEC). METHODS: Confluent HUVEC at passage levels 3 and 4 were exposed to increasing doses of LPS (1-1000 ng/ml) for 4 h at 37 degrees C and prepro ET-1 mRNA accumulation and big ET-1 and ET-1 concentrations in the conditioned medium were measured. RESULTS: Endotoxin had a dual effect on HUVEC. LPS at doses ranging between 250 and 1000 ng/ml induced a progressive diminution in ET-1 concentration in the culture medium. However, lower LPS concentrations dose-dependently increased big ET-1 and ET-1 release by HUVEC without altering prepro ET-1 mRNA expression. CONCLUSIONS: These results suggest that low LPS concentrations promote ET-1 release in HUVEC by a post-transcriptional mechanism located upstream of big ET-1 in the biosynthetic pathway of ET-1. These findings could explain the existence of high circulating levels of ET-1 in cirrhosis in spite of transcriptional activation of prepro ET-1 mRNA only occurring in the liver.

Cells, Cultured↗

Nitric oxide production by peritoneal macrophages of cirrhotic rats: a host response against bacterial peritonitis.

BACKGROUND & AIMS: Patients and rats with cirrhosis and ascites are prone to develop peritonitis. The aim of this study was to assess whether peritoneal macrophages of cirrhotic rats without peritoneal infection produce nitric oxide and express inducible NO synthase (iNOS). METHODS: NO2- accumulation produced by macrophages from control rats and cirrhotic rats with ascites was determined. iNOS messenger RNA and protein expression were analyzed by Northern and Western blot and immunocytochemical analysis. The in vivo effects of inhibiting iNOS were investigated by giving the specific iNOS inhibitor L-N-(1-iminoethyl)-lysine (L-NIL) or sterile saline to 9 and 7 cirrhotic rats with ascites, respectively. RESULTS: Cirrhotic macrophages produced NO2- that was around fourfold greater than that of control macrophages after 30 hours in culture. Northern and Western blot and immunocytochemical analysis showed the presence of iNOS messenger RNA and protein in macrophages of cirrhotic rats. Ascites cultures were positive in all rats administered L-NIL and negative in those administered saline. CONCLUSIONS: Macrophages of cirrhotic rats produce NO and express iNOS messenger RNA and protein, and these changes are not a consequence of overt bacterial infection. Because iNOS inhibition results in peritoneal infection, these results suggest that iNOS induction in macrophages of cirrhotic rats is a host defense response to prevent bacterial peritonitis.

Animals↗

Arginine vasopressin induces contraction and stimulates growth of cultured human hepatic stellate cells.

BACKGROUND & AIMS: Hepatic stellate cells (HSCs) are perisinusoidal cells believed to participate in the regulation of hepatic blood flow because of their contractile properties and presence of receptors for several vasoactive factors. It is unknown whether HSCs have receptors for vasopressin, one of the most potent endogenous vasoconstrictors. This study investigated the existence of receptors for and the effects of arginine vasopressin (AVP) on cultured human HSCs. METHODS: intracellular calcium concentration ([Ca2+]i) and cell contraction were measured in individual cells loaded with fura-2 using a morphometric method with an epifluorescence microscope coupled to a CCD imaging system (Photometrics, Tucson, AZ). AVP-specific binding was measured with [3H]AVP. Mitogen-activated protein kinase (MAPk) activity and DNA synthesis were measured by in vitro phosphorylation of myelin basic protein and [3H]thymidine incorporation, respectively. Parallel experiments were performed in vascular smooth muscle cells. RESULTS: AVP elicited a dose-dependent increase in [Ca2+]i and contraction of HSCs. Moreover, AVP increased MAPk activity, DNA synthesis, and cell number. These effects were similar to those observed in vascular smooth muscle cells and were blocked by a V1 receptor antagonist. The existence of V1 receptors was further confirmed by binding studies. CONCLUSIONS: Human HSCs have V1-vasopressin receptors that induce effects similar to those observed in vascular smooth muscle cells. AVP may play a role in the regulation of HSC function.

Animals↗

Differential inactivation of alcohol dehydrogenase isoenzymes in Zymomonas mobilis by oxygen.

Zymomonas mobilis is endowed with two isoenzymes of fermentative alcohol dehydrogenase, a zinc-containing enzyme (ADH I) and an iron-containing enzyme (ADH II). The activity of ADH I remains fully conserved, while ADH II activity decays when anaerobic cultures are shifted to aerobiosis. This differential response depends on the metal present on each isoenzyme, since pure preparations of ADH I are resistant to oxidative inactivation and preparations of zinc-containing ADH II, obtained by incubation of pure ADH II with ZnCl2, showed no modification of the target for oxidative damage (His277-containing peptide). It was consistently found that the activity of the zinc-containing ADH II, once submitted to oxidative treatment, was fully restored when iron was reintroduced into the enzyme structure. These results indicate that zinc bound to these proteins plays an important role in the protection of their active centers against oxidative damage and may have relevant biochemical and physiological consequences in this species.

Aerobiosis↗

[Compromized postadenoidectomy respiration in a child with obstructive sleep apnea syndrome].

A two-year-old boy with a history of slow growth, snoring during sleep and adenoid hypertrophy underwent adenoidectomy and transtympanic drainage under general anesthesia. Immediately after extubation, severe inspiratory stridor and shallow labored breathing began and persisted over a period of two hours, in spite of corticoid administration and oxygen therapy. The signs receded partially when the patient was seated and with a mandibular traction maneuver. As symptoms persisted, foreign body obstruction was ruled out by examination of the cavum and upper airway under general anesthesia and with orotracheal intubation. The patient was transferred to the pediatric intensive care unit, where he remained intubated for 18 hours. After extubation, stridor and shallow labored breathing reappeared but gradually receded as the residual effects of sedation disappeared. The parents mentioned symptoms suggestive of obstructive sleep apnea syndrome (OSAS) occurring since the boy was 6 months old and that had worsened in recent months. OSAS in children is characterized by intermittent obstruction of the upper airway during sleep, causing snoring and periods of apnea/hypopnea that lead to hypoxemia and hypercapnia. The most frequent cause is hypertrophy of the adenoid and tonsils, and the treatment of choice is adenotonsillectomy, although the risk of postoperative respiratory distress in such children is high. It is important to rule out OSAS in children who are candidates for adenotonsillectomy so that such patients are not scheduled for ambulatory surgery, but rather given adequate postoperative monitoring and treatment.

Adenoidectomy↗

Increased nitric oxide synthase expression in arterial vessels of cirrhotic rats with ascites.

Arterial vasodilatation is thought to play a major role in the pathogenesis of systemic hemodynamics and renal disturbances occurring in cirrhotic patients. Recent investigations suggest that an increased vascular nitric oxide (NO) production could be implicated in this abnormality. The current study assessed whether increased expression of inducible and/or endothelial nitric oxide synthase (iNOS and eNOS, respectively) occurs in arterial vessels of cirrhotic rats. The investigation was performed in thoracic and abdominal aortas and mesenteric arteries of 10 control rats and 16 cirrhotic rats with ascites. iNOS and eNOS messenger RNA (mRNA) expression were evaluated by polymerase chain reaction and ribonuclease protection assay, respectively. Endothelial NOS protein expression was assessed by Western blot. No iNOS mRNA was detected in arterial vessels of control rats. In contrast iNOS mRNA was consistently detected in all arteries of cirrhotic rats with ascites, the weakest signal being observed in the thoracic aorta and the strongest in the mesenteric artery. Enhanced eNOS mRNA abundance was found in the aorta of cirrhotic animals as compared with controls. Higher eNOS protein expression was noted in the thoracic aorta of cirrhotic rats. These results indicate the existence of increased eNOS and iNOS expression in arterial vessels of cirrhotic rats, suggesting that transcriptional activation of vascular NOSs and the associated nitric oxide hyperproduction may be of major importance in the pathogenesis of arterial vasodilation in cirrhosis.

Animals↗

Role of nitric oxide and prostacyclin in the control of renal perfusion in experimental cirrhosis.

Nitric oxide (NO) and prostacyclin (PGI2) are two important modulators of renal function under normal conditions; however, little is known on their contributory role in cirrhosis with ascites. In this study, mean arterial pressure, renal hemodynamics, and sodium excretion were measured in 15 rats with cirrhosis and ascites and 16 control rats. Animals were studied in normal conditions, after inhibiting the synthesis of NO (N omega-nitro-L-arginine, 50 micrograms.kg-1.min-1) or prostaglandins (lysin acetylsalicylate, 15 mg.kg-1).min-1 and following the concomitant inhibition of both systems. Cirrhotic rats showed increased systemic pressure sensitivity and blunted renal vasoconstrictor response to nitric oxide inhibition as compared with control rats. As a consequence, the glomerular filtration rate increased in cirrhotic rats but not in control rats. In both groups of animals, NO inhibition was associated with significant increased urinary sodium and fractional sodium excretion. The only significant effect observed after prostaglandin biosynthesis inhibition was a decrease in renal plasma flow in cirrhotic rats. The concomitant inhibition of both systems reduced renal plasma flow and did not change glomerular filtration rate, with no differences between control and cirrhotic rats. Prostaglandin inhibition did not prevent the natriuretic effect of the NO inhibitor in both groups of animals. These results indicate that in experimental cirrhosis both NO and PGI2 play an important role in the maintenance of renal perfusion within normal limits.

Animals↗

[Anuria in the third trimester of pregnancy in a patient with renal transplant].

We present a pregnant patient with a transplanted kidney experiencing chronic rejection, with chronic kidney failure and arterial hypertension. During the third trimester the patient's kidney function deteriorated somewhat and hypertension worsened. In the thirty-second week of pregnancy uterine activity increased, fetal movement decreased and oliguria progressed rapidly to anuria, leading to an emergency cesarean section. Surgery was performed under epidural anesthesia; after removal of the fetus diuresis immediately began and was maintained. Both mother and infant recovered, but after three months the patient entered a hemodialysis program due to terminal kidney failure. The risk of acute kidney failure is greater in the parturient who has been the recipient of a transplanted kidney because of the functional overload that pregnancy involves, the possible exacerbation of acute or chronic rejection, and the higher incidence of pyelonephritis and preeclampsia. The extraperitoneal location of the transplanted organ in the iliac fossa may cause obstructive anuria. Our patient's recovery of diuresis immediately after removal of the fetus suggests that the excretory channel coming from the kidney was compressed by the uterus.

Acute Kidney Injury↗

Nitric oxide production in arterial vessels of cirrhotic rats.

Indirect evidence exists implicating vascular nitric oxide in the pathogenesis of arterial vasodilation in cirrhosis. In the current study, a coincubation assay to estimate the vascular nitric oxide production was developed and the nitric oxide production by arterial segments of cirrhotic and control rats was assessed. In the assay, measurement of reporter monolayer cell-associated cGMP levels allows the influence of nitric oxide released by arterial segments to be determined. RFL-6 cells served as reporter cells. Nitric oxide production was determined in thoracic aorta and mesenteric arteries of 22 control rats, 10 cirrhotic rats without ascites, and 12 cirrhotic rats with ascites. Basal and bradykinin-stimulated (10(-6) mol/L) intracellular content of nitric oxide-dependent cGMP was significantly higher in RFL-6 cells coincubated with aortic segments of cirrhotic rats with (21.3 +/- 3.6 pmol/10(5) cells, P < .05 and 44.7 +/- 7.0 pmol/10(5) cells, P < .025) and without ascites (15.3 +/- 3.0 pmol/10(5) cells, P < .05 and 43.2 +/- 7.6 pmol/10(5) cells, P < .05) than in those incubated with aortic segments of control rats (9.7 +/- 1.3 and 19.5 +/- 2.5 pmol/10(5) cells). RFL-6 cells exposed to bradykinin-stimulated mesenteric arterial segments of cirrhotic rats also showed increased cGMP content (ascitic: 2.73 +/- 0.31 pmol/10(5) cells, P < .005; nonascitic: 2.58 +/- 0.51 pmol/10(5) cells, P < .025) compared with cells exposed to control mesenteric arterial segments (1.28 +/- 0.15 pmol/10(5) cells). No differences between cirrhotic and control vessels were observed after endothelium denudation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

New indices from the H*2 analyser improve differentiation between heterozygous beta or delta beta thalassaemia and iron-deficiency anaemia.

The two main causes of microcytic and hypochromic anaemia are iron deficiency (IDA) and thalassaemia (THAL) traits. In the Mediterranean area there is a high prevalence of beta and delta-beta THAL minor. The differentiation between these causes of microcytosis can be significantly improved with two new indices, percentage of microcytes (%Mi) and percentage of hypochromic red blood cells (%Hy), and the direct determination of MCHC, provided by the technological advances of the H*2 analyser. Our discriminant analysis, based on the minimization of Wilk's lambda (lambda) criterion, was used to select the best predictive variables to differentiate between IDA and THAL and has resulted in the highest diagnostic efficiency published to date. The discriminant function obtained is a simple linear combination of the following variables: D = 1.145 RBC-0.174 MCV + 0.091 MCHC + 0.787 square root of (%Hy/%Mi)-22.119. The overall correct classification was 97.6% on the training sample (79 THAL and 90 IDA) and 96.7% on a validation sample of microcytic patients (72 THAL and 80 IDA). The sensitivity and diagnostic specificity were 97.5% and 97.8%, respectively, for the training sample, and 95.8% and 97.5% for the control group.

Anemia, Iron-Deficiency↗

Metal-catalyzed oxidation of Fe2+ dehydrogenases. Consensus target sequence between propanediol oxidoreductase of Escherichia coli and alcohol dehydrogenase II of Zymomonas mobilis.

We have studied two enzymes of a newly described family of dehydrogenases with high sequence homology, 1,2-propanediol oxidoreductase of Escherichia coli and alcohol dehydrogenase II of Zymomonas mobilis. These enzymes perform their metabolic role under anaerobic conditions; in the presence of oxygen, they show a very similar inactivation pattern by a metal-catalyzed oxidation system. Titration of histidine residues with diethyl pyrocarbonate showed one histidine residue less in the oxidized enzymes. Comparison of subtilisin peptide maps of active and inactivated enzymes showed a difference in one histidine-containing peptide, the sequence of which is YNTPH277GVAN for propanediol oxidoreductase and YNLPH277GV for alcohol dehydrogenase II. This histidine residue lies 10 residues away from a proposed metal-binding site, H263XXXH267, necessary to explain a site-specific free radical mechanism. The three histidine residues here described are strictly conserved in all enzymes of this family. In this report we propose that histidine 277 is a target for oxidation by a metal-catalyzed oxidation system and that this modification leads to the irreversible inactivation of both enzymes.

Alcohol Dehydrogenase↗

Increased nitric oxide-dependent vasorelaxation in aortic rings of cirrhotic rats with ascites.

To assess whether aortic vessels of rats with cirrhosis and ascites possess an enhanced vascular response to endothelium-derived, nitric oxide-dependent vasodilators, we performed relaxation studies in isolated aortic rings of 21 control rats and 24 rats with carbon tetrachloride-induced cirrhosis and ascites. We carried out studies after contracting the vessels with norepinephrine. We measured endothelium-dependent vasodilator response by administering increasing concentrations of acetylcholine (10(-6) to 10(-2) mol/L) and ADP (10(-7) to 10(-4) mol/L). We evaluated endothelium-independent response by giving increased concentration of sodium nitrite (10(-5) to 10(-2) mol/L). The maximal absolute tension developed in response to norepinephrine was significantly decreased in cirrhotic rings (816 +/- 72 mg, p < 0.025) compared with control (1,425 +/- 75 mg) rings. Dose-response curves for endothelium-dependent vasodilators were shifted to the left in aortic rings of cirrhotic rats, and EC50 for acetylcholine and ADP were significantly decreased in cirrhotic (0.8 +/- 0.15 mmol/L and 0.42 +/- 0.16 mumol/L, p < 0.025 and p < 0.01, respectively) than in control rings (1.91 +/- 0.33 mmol/L and 3.09 +/- 0.82 mumol/L). In both acetylcholine- and ADP-stimulated vessels, differences between cirrhotic and control rings disappeared after nitric oxide synthesis inhibition with N omega-nitro-L-arginine (10(-4) mol/L). No difference in the relaxing effect of sodium nitrite was observed between cirrhotic and control rings. These results therefore demonstrate for the first time enhanced in vitro vascular responsiveness to nitric oxide-dependent vasodilators in rats with cirrhosis and ascites, giving further support to the concept that nitric oxide activity is increased in cirrhosis.

Acetylcholine↗

Blunted natriuretic response to human urine extracts with Na+,K(+)-ATPase inhibiting activity in experimental cirrhosis.

Human urine and plasma extracts contain a material that inhibits the enzyme Na+,K(+)-ATPase (the endogenous sodium pump) and produces natriuresis in the bioassay animal. This endogenous sodium pump inhibitor(s), also known as digitalis-like factor, is thought to be involved in sodium and extracellular fluid volume homeostasis. Increased urine and plasma sodium pump inhibiting activity have been reported in patients with cirrhosis and sodium retention. The aim of the study was to assess the renal response to i.v. administration (0.2 ml/min per kg bw for 10 min) of a human urine extract containing sodium pump inhibiting activity (28.5 nmol equivalent ouabain/ml) in eight conscious rats with cirrhosis and ascites and eight control rats. Baseline urinary excretion of Na+,K(+)-ATPase inhibiting activity was significantly higher in cirrhotic rats with ascites than in control rats (235 +/- 40 vs 91 +/- 16; p < 0.01). Human urine extract induced a significant (p < 0.05) increase in glomerular filtration rate in control (3.2 +/- 0.4 to 4.2 +/- 0.5 ml/min) and cirrhotic rats (3.0 +/- 0.3 to 4.0 +/- 0.5 ml/min). In control rats it also increased urinary sodium excretion (1.47 +/- 0.22 to 2.43 +/- 0.5 microEq/min, p < 0.01) and fractional sodium excretion (0.29 +/- 0.01 to 0.43 +/- 0.04%, p < 0.025). In contrast, in cirrhotic rats with ascites neither sodium excretion nor fractional sodium excretion was significantly affected. No changes were observed in plasma aldosterone and atrial natriuretic peptide concentrations in either group. These data suggest that in cirrhosis there is a renal resistance to the natriuretic effect of endogenous sodium pump inhibitor(s).

Animals↗