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Biomedical subjects

M C Roque-Barreira

Publications and source records attributed to M C Roque-Barreira.

At least 19 recordsLinked to original sources
PubMed2003

Mast cell degranulation induced by lectins: effect on neutrophil recruitment.

The mammalian lectin macrophage-derived neutrophil chemotactic factor (MNCF) and the plant lectin KM+ were characterized for their ability to activate and degranulate mast cells. The association between mast cell activation and the induction of neutrophil migration was also investigated. Incubation of rat peritoneal mast cells with these lectins resulted in degranulation and mediator release. By confocal microscopy, both lectins were evenly distributed on the cell surface. MNCF activated RBL-2H3 mast cells only if the cells had been sensitized with IgE. KM+ was able to activate either unsensitized or IgE sensitized RBL-2H3 cells. In microplate assays MNCF, but not KM+, bound to rat IgE. In rats that were depleted of mast cells, neutrophil recruitment by MNCF and KM+ were significantly reduced indicating that mast cell activation provides an amplification loop for the neutrophil recruitment induced by these lectins. The present study supports the concept that mammalian lectins play a fundamental role in innate immunity.

Animals↗
PubMed2001

Neutrophil migration induced in vivo and in vitro by marine algal lectins.

OBJECTIVE AND DESIGN: Since some plant and mammalian lectins specific for monosaccharides are able to induce neutrophil migration, we studied the neutrophil migration-inducing activities of marine algal lectins, specific for complex oligosaccharides from glycoproteins, from Amansia multifida (AM), Bryothamnion seaforthii (BS), Bryothamnion triquetrum (BT) and Gracilaria caudata (GC). MATERIALS AND METHODS: The neutrophil migration-inducing activity of AM, BS, BT and GC was assayed in vitro and in vivo in the peritoneal cavity or dorsal air pouch of rats or mice, and was inhibited by glycans. RESULTS: AM, BS, BT and GC induced neutrophil migration in vivo and in vitro, determining bell-shaped dose-dependent curves. Maximal neutrophil influx was determined by BT in rats and by AM in mice. Maximal human neutrophil chemotaxis was obtained with GC. These activities were not inhibited by glycoproteins previously identified as being recognized by these lectins. D-mannose was a strong inhibitor, especially of BT activity both in vitro and in vivo. CONCLUSIONS: Algal lectins induced neutrophil migration, which was inhibited by a monosaccharide, contrasting with the view that they only recognize complex oligosaccharides. Neutrophil chemotaxis assays are appropriate to study low molecular mass lectins containing a single carbohydrate recognition domain, as is the case of some lectins from algae and mammals.

Animals↗
PubMed2001

KM(+), a lectin from Artocarpus integrifolia, induces IL-12 p40 production by macrophages and switches from type 2 to type 1 cell-mediated immunity against Leishmania major antigens, resulting in BALB/c mice resistance to infection.

The outcome and severity of some diseases correlate with the dominance of either the T helper 1 (Th1) or Th2 immune response, which is stimulated by IL-12 or IL-4, respectively. In the present study we demonstrate that gamma interferon (IFN-gamma) secretion by murine spleen cells stimulated with KM(+), a mannose-binding lectin from Artocarpus integrifolia, is due to IL-12 induction, because (1) macrophages from several sources (including cell lines) produced IL-12 p40 in response to KM(+), and (2) lectin-free supernatants from J774 cell line cultures stimulated with KM(+) induced the secretion of IFN-gamma by spleen cell cultures, an effect blocked by the supernatant pretreatment with anti-IL-12 antibody. The known pattern of susceptibility of BALB/c mice to infection with Leishmania major, attributed to high levels of IL-4 production leading to a Th2 nonprotective immune response, was modified by administration of KM(+). Draining lymph node cells from these immunized BALB/c mice (in contrast to cells from animals immunized only with soluble leishmanial antigen [SLA]) secreted high levels of IFN-gamma and low levels of IL-4, which characterized a Th1 rather than a Th2 response pattern. The footpad thickness of BALB/c mice immunized with SLA plus KM(+) and challenged with L. major was similar to that of uninfected mice. This beneficial effect against leishmanial infection was blocked by pretreatment of these mice with anti-IL-12 antibody. These observations indicate that KM(+) induces IL-12 p40 in vivo and has a protective effect against L. major infection.

Animals↗
PubMed2001

Toxoplasma gondii micronemal protein MIC1 is a lactose-binding lectin.

Host cell invasion by Toxoplasma gondii is a multistep process with one of the first steps being the apical release of micronemal proteins that interact with host receptors. We demonstrate here that micronemal protein 1 (MIC1) is a lactose-binding lectin. MIC1 and MIC4 were recovered in the lactose-eluted (Lac(+)) fraction on affinity chromatography on immobilized lactose of the soluble antigen fraction from tachyzoites of the virulent RH strain. MIC1 and MIC4 were both identified by N-terminal microsequencing. MIC4 was also identified by sequencing cDNA clones isolated from an expression library following screening with mouse polyclonal anti-60/70 kDa (Lac(+) proteins) serum. This antiserum localized the Lac(+) proteins on the apical region of T. gondii tachyzoites by confocal microscopy. The Lac(+) fraction induced hemagglutination (mainly type A human erythrocytes), which was inhibited by beta-galactosides (3 mM lactose and 12 mM galactose) but not by up to 100 mM melibiose (alpha-galactoside), fucose, mannose, or glucose or 0.2 mg/ml heparin. The lectin activity of the Lac(+) preparation was attributed to MIC1, because blotted MIC1, but not native MIC4, bound human erythrocyte type A and fetuin. The copurification of MIC1 and MIC4 may have been due to their association, as reported by others. These data suggest that MIC1 may act through its lectin activity during T. gondii infection.

Amino Acid Sequence↗
PubMed2000

Neutrophil migration and aggregation induced by euphorbin, a lectin from the latex of Euphorbia milii, var. milii.

OBJECTIVE AND DESIGN: To study the neutrophil migration and aggregation induced by euphorbin, a D-galactose binding lectin from Euphorbia milii var. milli latex. MATERIALS AND METHODS: Euphorbin-induced neutrophil migration was evaluated in vivo and in vitro, in the absence or presence of soluble D-galactose. Neutrophil aggregation induced in vitro by euphorbin was determined by light microscopy. RESULTS: The neutrophil migration inducing activity of euphorbin was dose-dependent and inhibited by soluble D-galactose. Neutrophil aggregation was rapidly reversed when provoked by 0.1 mg/ml euphorbin. In higher concentrations, euphorbin caused persistent and more extensive neutrophil aggregation. CONCLUSIONS: Euphorbin induced neutrophil migration through its sugar recognition property. The transitory neutrophil aggregation, induced by a euphorbin quantity similar to that able to cause maximal chemotactic response, is characteristic of homotypic neutrophil adhesion, whereas persistent aggregation, provoked by higher euphorbin quantities, corresponds to cell agglutination by a multivalent lectin.

Animals↗
PubMed1999

Structural and thermodynamic studies of KM+, a d-mannose binding lectin from Artocarpus integrifolia seeds.

The KM+ lectin exhibits a novel and unusual circular dichroism (CD) spectrum that could be explained by a high proline content that would be inducing deformation of the beta-structure and/or unusual turns. KM+ was shown to be a very rigid lectin, which was very stable under a broad variety of conditions (urea, guanidine, hydrolysis, pH, etc.). Only incubation for 60 min at 333-338 K and extreme basic pH were able to induce conformational changes which could be observed by CD and fluorescence measurements. Data from CD are typical for protein denaturing associated with changes in the overall secondary structure. Data from high-performance size exclusion chromatography (SEC) showed that the denatured forms produced at pH 12.0 are eluted in clusters that co-elute with the native forms. A significant contribution from the tyrosines to the fluorescence emission upon denaturation was observed above 328 K. In fact at 328 K some broadening of the emission spectrum takes place followed by the appearance of a shoulder (approx. 305 nm) at 333 K and above. The sensitivity of tryptophan fluorescence to the addition of sugar suggests a close proximity of the tryptophan residues to the sugar binding site, K(a)=(2.9+/-0.6)x10(3) M(-1). The fraction of chromophore accessible to the quencher obtained is f(a)=0.43+/-0.08, suggesting that approximately 50% of the tryptophan residues are not accessible to quenching by d-mannose. KM+ thermal denaturation was found to be irreversible and was analyzed using a two-state model (N-->D). The results obtained for the activation energy and transition temperature from the equilibrium CD studies were: activation energy, E(a)=134+/-11 kJ/mol and transition temperature, T(m)=339+/-1 K, and from the fluorescence data: E(a)=179+/-18 kJ/mol and T(m)=337+/-1 K. Kinetic studies gave the following values: E(a)=108+/-18 kJ/mol and E(a)=167+/-12 kJ/mol for CD and fluorescence data, respectively.

Journal Article↗
PubMed1999

KM+, a mannose-binding lectin from Artocarpus integrifolia: amino acid sequence, predicted tertiary structure, carbohydrate recognition, and analysis of the beta-prism fold.

The complete amino acid sequence of the lectin KM+ from Artocarpus integrifolia (jackfruit), which contains 149 residues/mol, is reported and compared to those of other members of the Moraceae family, particularly that of jacalin, also from jackfruit, with which it shares 52% sequence identity. KM+ presents an acetyl-blocked N-terminus and is not posttranslationally modified by proteolytic cleavage as is the case for jacalin. Rather, it possesses a short, glycine-rich linker that unites the regions homologous to the alpha- and beta-chains of jacalin. The results of homology modeling implicate the linker sequence in sterically impeding rotation of the side chain of Asp141 within the binding site pocket. As a consequence, the aspartic acid is locked into a conformation adequate only for the recognition of equatorial hydroxyl groups on the C4 epimeric center (alpha-D-mannose, alpha-D-glucose, and their derivatives). In contrast, the internal cleavage of the jacalin chain permits free rotation of the homologous aspartic acid, rendering it capable of accepting hydrogen bonds from both possible hydroxyl configurations on C4. We suggest that, together with direct recognition of epimeric hydroxyls and the steric exclusion of disfavored ligands, conformational restriction of the lectin should be considered to be a new mechanism by which selectivity may be built into carbohydrate binding sites. Jacalin and KM+ adopt the beta-prism fold already observed in two unrelated protein families. Despite presenting little or no sequence similarity, an analysis of the beta-prism reveals a canonical feature repeatedly present in all such structures, which is based on six largely hydrophobic residues within a beta-hairpin containing two classic-type beta-bulges. We suggest the term beta-prism motif to describe this feature.

Amino Acid Sequence↗
PubMed1998

An intravascular chemoattractant lectin inhibits neutrophil migration.

KM+, a lectin purified from Artocarpusintegrifolia seeds, is an attractant for neutrophils, and has properties similar to fMLP, IL-8 and MNCF. The endogenous lectin MNCF, inhibits carrageenan-induced neutrophil migration when intravenously administered in rats. In an attempt to mimic the activity of MNCF with KM+, we determined the effect of intravenous (iv) injection of KM+ (5 microg) on neutrophil migration to the peritoneal cavity of Wistar rats induced by KM+ (50 microg, intraperitoneal, ip), fMLP (5 ng, ip) and carrageenan (300 microg, ip). Initially we evaluated the effect of the time interval between intravenous and intraperitoneal administration of KM+. The intervals ranged from 20 to 120 min and progressively stronger inhibition was observed with increasing time intervals up to a maximum of 60 min, with effect decreasing thereafter. With injections at the optimum interval of 60 min, we observed that KM+ inhibited KM+- and carrageenan-induced neutrophil migration by 72%, and fMLP-induced migration by 56%. White cell counts for Wistar rats that only received KM+iv, performed at 0 to 120 min intervals after injection, revealed early neutropenia lasting 60 min, followed by a marked increase in circulating neutrophils that reached a maximum of twice the initial levels within 90 min and after 120 min returned to levels near to that observed before intravenous administration of KM+. These results indicate that when KM+ is present in the intravascular space, it produces an inhibitory effect on neutrophil migration similar to that caused by the intravenous administration of other chemoattractants, regardless of whether they act through a mechanism independent of carbohydrate recognition, as does IL-8, or are dependent on carbohydrate recognition, like MNCF.

Animals↗
PubMed1998

Heparin potentiates in vivo neutrophil migration induced by IL-8.

Chemokine IL-8 attracts neutrophils by a haptotactic gradient, made possible by its interaction with proteoglycans of the extracellular matrix. Heparan sulfate, but not heparin, potentiates the attraction exerted in vitro by IL-8. In the present study we first confirmed this in vitro phenomenon, observing that IL-8 activity was potentiated 100% by heparan sulfate, but not by heparin. Then, we evaluated the interference of heparan sulfate or heparin on in vivo neutrophil migration induced by IL-8. The activity of rat IL-8 (3.5 microg/animal) preincubated with heparan sulfate (50 microg/animal) or heparin (77 microg/animal) was assayed on the rat dorsal air pouch. Contrary to in vitro experiments, heparin, but not heparan sulfate, potentiated the in vivo IL-8 activity two-fold. We investigated the relationship between this observation and that reported by others, that IL-8-induced migration depends on the presence of mast cells, which contain heparin-rich granules. We studied the neutrophil migration induced by IL-8 (3.5 microg/animal) into the rat peritoneal cavity depleted of mast cells. Neutrophil migration was reduced by 32% when compared to that observed in normal animals. The response of depleted rats was reconstituted by preincubation of IL-8 with heparin (77 microg/animal). These data suggest that heparin released from cytoplasmic granules may be the contribution of mast cells to IL-8-induced neutrophil migration.

Animals↗
PubMed1998

Neutrophil haptotaxis induced by the lectin KM+.

KM+ is a D-mannose binding lectin from Artocarpus integrifolia that induces neutrophil migration in vitro and in vivo. This attractant activity was shown to be caused by haptotaxis rather than chemotaxis. The inhibition by D-mannose of the neutrophil attraction exerted by KM+, both in vitro and in vivo, supports the idea that haptotaxis is triggered in vivo by the sugar binding sites interacting with glycoconjugates located on the neutrophil surface and in the extracellular matrix. In the present study an in vivo haptotaxis assay was performed by intradermally (i.d.) injecting 125I-KM+ (200 ng), which led to a selective staining of loose connective tissue and vascular endothelium. The radiolabelled area exhibited a maximum increase (five-fold) in neutrophil infiltration 3 h after injection, relative to i.d. 200 ng 125I-BSA. We characterized the ex vivo binding of KM+ to tissue elements by immunohistochemistry, using paraformaldehyde-fixed, paraffin-embedded, untreated rat skin. Bound KM+ was detected with an affinity-purified rabbit IgG anti-KM+ and visualized with an alkaline phosphatase based system. KM+ binding to connective tissue and vascular endothelium was inhibited by preincubating KM+ with 0.4 mM D-mannose and was potentiated by heparan sulfate (100 microg ml(-1)). An in vitro assay carried out in a Boyden microchamber showed that heparan sulfate potentiated the attractant effect of 10 microg KM+ by 34%. The present data suggest that KM+ induces neutrophil migration in vivo by haptotaxis and that the haptotactic gradient could be provided by the interaction of the KM+ carbohydrate recognition site(s) with mannose-containing glycoconjugate(s) in vascular endothelium and connective tissue. Heparan sulfate would act as an accessory molecule, enhancing the KM+ tissue binding and potentiating the induced neutrophil haptotaxis.

Animals↗
PubMed1997

Crystallization and preliminary crystallographic data of a neutrophil migration-inducing lectin (KM+) extracted from the seed of Artocarpus integrifolia.

The tetrameric KM+ lectin from the seeds of Artocarpus integrifolia has, when compared to other plant lectins, the singular property of directly inducing neutrophil migration into the peritoneal cavity or into the air pouch of rats. This protein crystals have been grown and they belong to the orthorhombic system with space group C222(1). The unit cell parameters are a = 54.4 A, b = 127.9 A and c = 99.8 A. A native diffraction dataset to 2.8 A was collected and an analysis of the self-rotation function has shown the presence of only one independent non-crystallographic 2-fold axis orthogonal to the crystal b-axis, compatible with a dimer in the asymmetric unit.

Animals↗
PubMed1996

Purification, physicochemical characterization and biological properties of a lectin from Erythrina velutina forma aurantiaca seeds.

A lectin was purified from seeds of Erythrina velutina forma aurantiaca by affinity chromatography on cross-linked guar gum. The lectin is a potent agglutinin for human (minimal concentration of protein able to cause visible agglutination of a 2% erythrocyte suspension varying from 1 to 4 micrograms/ml), rabbit (4 micrograms/ml) and chicken erythrocytes (8 micrograms/ml) but presented low activity against cow (250 micrograms/ml) or sheep (333 micrograms/ml) blood cells. Hemagglutination of human O+ erythrocytes was inhibited by D-lactose (0.2 mM) > D-galactose (0.8 mM) > D-raffinose (2.1 mM). At pH 7.5, chromatography on a Superose 12 HR 10/30 column showed that the lectin was primarily a dimer (56.0 kDa) composed of two identical subunits (31.6 kDa each). A small amount of a tetrameric form was also apparently present. The lectin is a glycoprotein (7.3% carbohydrate), has a pI of 4.5, contains high levels of acidic (Asp and Glu, 64.2 and 51.6 residues/mol, respectively) and hydroxy amino acids (Ser and Thr, 42.9 and 38.5 residues/mol, respectively) but relatively low amounts of sulfur amino acids (Cys and Met, 1.0 and 5.0 residues/mol, respectively) and has an N-terminal sequence of Val-Glu-Thr-Ile/Leu-Pro-Phe-Ser. Its hemagglutinating activity was abolished by heating at 70 degrees C for 10 min. The activation energy (delta G') required for denaturation measured by loss of hemagglutination activity was 24.87 kcal/mol. In rats, the purified lectin (100 micrograms) induced neutrophil migration into the peritoneal cavity (3.7 +/- 0.6 x 10(6) neutrophils/ml) or into the air pouch (2.75 +/- 0.25 x 10(6) neutrophils/ml), 8 and 10 times greater than the negative control, respectively.

Animals↗
PubMed1995

Identification of IgM as the leprosy patient serum factor responsible for rapid sedimentation of formolized sheep erythrocytes.

The serum of some leprosy patients with impaired specific cellular immunity for Mycobacterium leprae causes rapid sedimentation of formolized sheep erythrocytes, a phenomenon known as the Rubino reaction. The Rubino factor was precipitated from positive sera by 5% (w/v) polyethylene glycol (PEG), bound to a concanavalin A (ConA)-Sepharose column and eluted with D-mannose, and was also eluted from a Mono Q column, pH 8.0, with 0.4 M NaCl. The Rubino factor was eluted in a volume which coincided with that of human serum IgM from a Sepharose 6 column. IgM was present in the preparation obtained by this sequence of chromatographic procedures. The correspondence of IgM with the Rubino factor was demonstrated by the following data: a) the Rubino factor was adsorbed to rabbit IgG antihuman IgM-agarose and the activity was recovered in the acid eluate of the column; b) the Rubino reaction was inhibited in the presence of rabbit antihuman IgM antibodies. This behavior was not observed when the same procedures were carried out using anti-alpha 2-macroglobulin antibodies as a control. The rapid sedimentation of formolized sheep red cells caused by the serum of lepromatous leprosy patients was not inhibited by phenolic glycolipid-I, suggesting that the IgM responsible for the Rubino reaction is not directed to this antigen which is specific for M. leprae. There was no correlation between the positivity of the Rubino reaction and the increase in total serum IgM levels observed in 42% of the lepromatous patients evaluated. The demonstration that the Rubino factor is an IgM now permits the identification of the epitope recognized by it, and this may be used as a tool to understand the specific cellular immune unresponsiveness which characterizes lepromatous leprosy.

Animals↗
PubMed1994

A neutrophil migration-inducing lectin from Artocarpus integrifolia.

A neutrophil migration-inducing protein has been isolated from the saline extract of Artocarpus integrifolia seeds by successive sugar affinity chromatography steps during which the protein was not absorbed by D-galactose resin, and then was absorbed to and eluted from D-mannose resin by 0.1 M D-mannose. Gel filtration on Superdex 75 HR indicated a molecular mass of 52 kDa when 0.1 M D-mannose was present in the elution buffer. A single band of apparent molecular mass of 13 kDa was demonstrable by SDS-PAGE only after heating, both in the presence and absence of reducing agent, suggesting that the molecule is a tetramer formed by the noncovalent association of 13 kDa chains. Isoelectric forms corresponding to isoelectric points of 4.0, 4.2, 5.0, and 5.2 were demonstrable by isoelectric focusing-PAGE, and four active forms having the same isoelectric points were separated by chromatofocusing. The minimal m.w. calculated from amino acid analysis data was 13,193. The protein, denoted KM+, stimulated neutrophil migration in the rat peritoneal cavity assay in a dose-related manner in the range of 1 to 300 micrograms per rat. The dose-response curve of the in vitro chemotactic activity of KM+ was bell shaped and its ascending limb was dose dependent in the range of 1 ng to 10 micrograms/well. D-Mannose (0.1 M) inhibited the in vitro (80%) and in vivo (60%) neutrophil migration-inducing activities of KM+ and also its hemmaglutinating activity. The chemotactic activity was shown to be caused by haptotaxis rather than chemokinesis. The physical and biologic properties of KM+ suggest that this lectin may attract neutrophils by a mechanism involving a haptotactic gradient as has been proposed for IL-8. KM+ might be used as tool to study protein-carbohydrate interactions during neutrophil migration through the extracellular matrix.

Amino Acids↗
PubMed1993

Macrophage-released neutrophil chemotactic factor (MNCF) induces PMN-neutrophil migration through lectin-like activity.

We have previously reported that rat peritoneal macrophages stimulated with LPS release a factor (MNCF) which induces neutrophil migration that is not blocked by glucocorticoids. The supernatant of macrophage monolayers stimulated with LPS was submitted to affinity chromatography on immobilized sugar columns. We observed that the D-gal binding fraction retained MNCF activity. This fraction, consisting of four protein components, was submitted to chromatography on Superdex 75, yielding a homogeneous preparation of the active component. MNCF has a MW of 54 KDa (gel filtration and SDS-PAGE) and pI < 4.0 (isoelectrofocusing and chromatofocusing). D-gal did not interfere with the behaviour of known interleukins (IL-1 beta, IL-6, IL-8 TNF-alpha), but blocked MNCF activity in an in vitro migration assay. The present results reinforce our previous suggestion that MNCF may correspond to a novel monokine which induces neutrophil migration through a direct mechanism involving the D-gal binding site of the molecule.

Animals↗
PubMed1992

Immune complex glomerulonephritis in experimental kala-azar. II: Detection and characterization of parasite antigens and antibodies eluted from kidneys of Leishmania donovani-infected hamsters.

In a previous report analysing kidney sections by immunofluorescence we showed that hamsters infected with L. donovani develop a glomerulonephritis (GN) associated with deposition of hamster immunoglobulins and parasite antigens in the glomeruli. In this study we characterize these immune components eluted from the kidneys. The eluted immunoglobulins showed specificity for L. donovani antigens and hamster immunoglobulins (rheumatoid factor-like activity). The four isotypes IgG1, IgG2, IgA and IgM were detected. Several L. donovani antigens were detected in the renal eluates by Western blot and immunoprecipitation using 125I-labelled eluates. Proteins with mol. wt of 134, 82, 52, 31, and 26 kD were detected by Western blot and proteins with 134, 110, 93, 89 and 48 kD were detected by immunoprecipitation. With the exception of the 134 kD protein which was recognized by both rabbit anti-promastigote and rabbit anti-amastigote sera all the others were recognized only by the anti-amastigote serum. The 134 kD protein was the only one isolated from the kidneys of infected hamster immunocomplexed with IgG and was the only one detected in a promastigote lysate using IgG from L. donovani-infected hamsters.

Animals↗
PubMed1992

Antigenemia in paracoccidioidomycosis.

Severe forms of paracoccidioidomycosis (Pcm) are accompanied by intense immunological involvement characterized by depression of the cell-mediated immune response and by high levels of antibodies in serum with no protective function. These changes can be reversed by antifungal treatment. It has been suggested that antigens of Paracoccidioides brasiliensis released into the circulation during the active phase of the disease may be involved in the genesis of the changes in the immune response. In the present study, we evaluated the antigenemia of patients with Pcm using a competitive enzyme-linked immunosorbent assay (ELISA-c) capable of detecting 6 ng of antigen per ml of serum. Twenty-seven of 88 serum samples tested gave positive results, with the highest frequency of positivity being detected in patients with the severe acute form of the disease; these patients had the highest antigen levels (0.03 to 3.4 micrograms/ml). Follow-up of one case showed a correlation between antigen levels in serum and evolution of the disease. False-positive reactions were observed in sera from patients with histoplasmosis, aspergillosis, and cryptococcosis. The results indicate that the described method has potential for clinical application, especially with respect to the evaluation of disease activity. Quantification of fungal antigens in the serum of patients with active Pcm represents an objective parameter for the study of the physiopathology of the disease.

Acute Disease↗