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PubMed2004

The flurbiprofen derivatives HCT1026 and HCT1027 inhibit bone resorption by a mechanism independent of COX inhibition and nitric oxide production.

Prostaglandins and nitric oxide both modulate bone resorption and bone formation. We previously reported that a nitrosylated derivative of flurbiprofen, termed HCT1026, exerted inhibitory effects on osteoclastic bone resorption, which could not be reproduced by combining the parent compound with nitric oxide (NO) donors. The aim of this study was to investigate the mechanism by which HCT1026 inhibits bone resorption. We compared the effects of flurbiprofen and HCT1026 on osteoclast and osteoblast activity with those of HCT1027--an analogue of HCT1026, which lacks an NO-donating moiety. We found that HCT1026 and HCT1027 inhibited bone resorption in interleukin (IL)-1-stimulated murine osteoblast-bone marrow cocultures, with half-maximal effects (IC50) at 20 +/- 5 microM for HCT1026 and 25 +/- 6 microM for HCT1027 compared with 399 +/- 25 microM for flurbiprofen (P < 0.0001). These differences were unrelated to cyclooxygenase (COX) inhibition since HCT1026 and HCT1027 were about seven to eight times less potent than flurbiprofen at inhibiting COX-1 activity and half as potent at inhibiting COX-2 activity. Further studies showed that HCT1026 and HCT1027 activated caspase-3 in rabbit osteoclasts and promoted osteoclast apoptosis, as assessed by nuclear morphology and TUNEL assays. We conclude that HCT1026 and HCT1027 inhibit osteoclast formation and activity by a mechanism that is independent of NO production and COX inhibition. This raises the possibility that both compounds interact with a novel molecular target expressed on osteoclasts to promote apoptosis and inhibit bone resorption. This demonstrates that HCT1026 and derivatives could represent a novel class of antiresorptive drugs with therapeutic value in the treatment of bone diseases associated with accelerated bone loss due to osteoclast activation.

Animals↗

PubMed2004

[Therapeutic effect of aqueous-extract from a traditional Chinese medical herb Drynaria fortunei on rat experimental model of alveolar bone resorption].

OBJECTIVE: To establish a rat model of experimental alveolar bone resorption and understand the therapeutic effect of a traditional Chinese medical herb Drynaria fortunei (DFS) on the rats suffering from alveolar bone resorption. METHOD: A SD rat model with experimental alveolar bone resorption was established by using injection with E. coli Lipopolysaccharide (E-LPS) in local tissue of the animals. A DFS preparation (DFS aqueous-extract) was extracted with distilled water. The modeled rats were administrated by perfusion with DFS aqueous-extract at a dosage of 15 g crude drug/kg once a day for 10, 20 and 30 d, respectively. The effects of DFS aqueous extract on experimental alveolar bone resorption were estimated by detections of serum alkali phosphate (ALP) activity, Ca2+ and osteocalcin (OC) levels, and TRAP stained osteoclast count, bone mineral density (BMD) measurement and HE stained histopathological examination of the tooth-periodontal samples. RESULT: In comparison with the controls, BMD values of the alveolar bones at experimental tooth sites of the tested rats with DFS aqueous-extract for 10 d administration were obviously increased (P < 0.05). In the tooth-periodontal samples from the rats for 10 d administration, disappearance of the osteoclast, decrease of Howship's lacuna numbers and formation of new non-calcified bone-like matrix attached by osteoblasts in alveolar bone at the root furcation from most of the samples occurred. Similar examining results in the tooth-periodontal samples from the rats for 20 and 30 d administrations were obtained, respectively. However, no statistically significant differences of the serum ALP activity, Ca2+ and OC levels among the tested rats for 10-30 d treatment and the controls (P > 0.05) were found. CONCLUSION: The DFS aqueous extract has exact therapeutic effect on rat experimental alveolar bone resorption through suppressing bone resorption and promoting bone regeneration. Serum ALP activity, Ca2+ and osteocalcin (OC) levels can not be used as the effective index for examining alveolar bone resorption and regeneration in animal models.

Alkaline Phosphatase↗

PubMed2000

Proteinases in bone resorption: obvious and less obvious roles.

Bone resorption is critical for the development and the maintenance of the skeleton, and improper regulation of bone resorption leads to pathological situations. Proteinases are necessary for this process. In this review, we show that this need of proteinases is not only because they are required for the solubilization of bone matrix, but also because they are key components of the mechanism that determines where and when bone resorption will be initiated. Moreover, there are indications that proteinases may also determine whether resorption will be followed by bone formation. Some of the proteinases involved in these different steps of the resorption processes were recently identified, as for instance cathepsin K, MMP-9 (gelatinase B), and interstitial collagenase. However, there is also increasing evidence showing that the critical proteinase(s) may vary depending on the bone type or on other factors.

Bone Diseases↗

PubMed1977

The cellular basis of bone turnover and bone loss: a rebuttal of the osteocytic resorption--bone flow theory.

There is now sufficient evidence to conclude that the osteocytic resorption--bone flow theory of bone turnove is untenable. According to this theory bone is resorbed not from the surface by osteoclasts but from within by osteocytes, towards which bone flows through tissue space away from bone forming surfaces. The need to invoke resorption by osteocytes stems from the belief that too few osteoclasts are present to account for normal bone resoption, a belief which reflects unawareness of the enormous capacity of the osteoclast and the rapidity of its advance. The belief that osteocytes resorb substantial amounts of bone rests on invalid conclusions from indirect techniques, various artifacts of specimen processing and unawareness of the microscopic characteristics of woven bone. Osteocytes enlarge their lacunae by resorbing bone only as a prelude to resorption from the surface, the osteocyte and osteoclast working together as a resorbing unit. The belief that bone can flow is incompatible both with the physical properties of bone and with a substantial body of evidence relating to Haversian remodelling; the experimental data purporting to demonstrate such flow can all be explained by conventional concepts of bone turnover.

Animals↗

PubMed1990

Preventive effect of zinc against cadmium-induced bone resorption.

The effects of cadmium and zinc on bone resorption were investigated using fetal mouse calvaria organ culture. Cadmium treatment (0.5 microM) stimulated bone resorption in fetal mouse calvaria via prostaglandin E2 production. Concomitant treatment of zinc with cadmium prevented bone resorption by cadmium in a dose-dependent manner of zinc. The zinc treatment also prevented the stimulation of prostaglandin E2 production by cadmium. ID50 of zinc for bone resorption showed high similarity to that for prostaglandin E2 production (1.2 microM and 1.6 microM, respectively). To simplify the system, we used osteoclast-enriched and osteoblast-enriched cell populations obtained from mice calvariae by collagenase digestion method. Prostaglandin E2 was produced in osteoblast-enriched cell culture more than in osteoclast-enriched cell culture. Cadmium stimulated prostaglandin E2 production in osteoblast-enriched cell culture, but not in osteoclast-enriched cell culture. Zinc also prevented the stimulatory effect of cadmium on prostaglandin E2 production in osteoblast-enriched cell culture. Zinc partially, but significantly, inhibited cadmium-accumulation in both calvaria and osteoblast-enriched cell culture. These results strongly suggest that zinc prevents cadmium-induced prostaglandin E2 production and bone resorption through the interaction between the two metals on osteoblasts involved in the inhibition of cadmium-accumulation.

Animals↗

PubMed1985

A mouse tumor-derived osteolytic factor stimulates bone resorption by a mechanism involving local prostaglandins production in bone.

Culture medium which was conditioned by tissue of a CE mouse breast tumor in vitro contained dose-dependent osteolytic activity. The osteolytic activity was not soluble in dichloromethane and ethylacetate, indicating that it was not attributable to vitamin D metabolites or prostaglandins. However, breast tumor-conditioned medium stimulated production and release of prostaglandin E2 from mouse calvaria in vitro, and the stimulation of bone resorption in vitro by breast tumor-conditioned medium was blocked by a dose of indomethacin that prevented stimulation of mouse calvarial prostaglandin E2 production and release. The resorptive activity of parathyroid hormone (PTH) was not affected by the same dose of indomethacin, suggesting that the osteolytic factor was not PTH. This was further supported by observation that mouse kidney cell cAMP production was stimulated by PTH, but not by the aqueous phase of ethylacetate-extracted breast tumor-conditioned medium. In addition to osteolytic activity, breast tumor-conditioned medium contained a dose-dependent bone cell mitogenic activity, demonstrated by the stimulation of [3H]thymidine incorporation into trichloroacetic acid-insoluble macromolecules and a corresponding increase in bone cell number in monolayer cultures of bone cells. Breast tumor-conditioned medium also contained a dose-dependent transforming growth factor-(TGF-) like activity as defined by its ability to transform anchorage-dependent growth of nontransformed cells to anchorage-independent growth. The TGF in breast tumor-conditioned medium did not compete with epidermal growth factor (EGF) for EGF receptor binding, but its transforming activity was greatly enhanced by EGF, indicating that it was a beta-type TGF. Both the osteolytic and mitogenic activities were nondialyzable, sensitive to reducing agent, and not removable by dichloromethane and ethylacetate extractions. Furthermore, the TGF activity was not removed by ethylacetate extraction. Thus, the possibility that these activities in breast tumor-conditioned medium might be mediated by the same molecule must be considered. In summary, our data suggest that the CE mouse mammary carcinoma cells produce and secrete into the culture medium an osteolytic factor which is neither PTH nor prostaglandin and which stimulates local synthesis in bone of prostaglandin E2 which in turn increases bone resorption in vitro.

Animals↗

PubMed2001

[Role of EP4 receptor in bone resorption induced by PGE].

Prostaglandin E2 (PGE2) acts as a potent stimulator of bone resorption. We examined PGE2-induced bone resorption using mice lacking each subtype (EP1, EP2, EP3 and EP4) of PGE receptor and identified the PGE receptor subtype(s) mediating PGE2 action. In calvarial culture from EP1-, EP2-, and EP3- knockout mice, PGE2 stimulated bone resorption to a similar extent to that found in calvaria from the wild-type mice. On the other hand, a marked reduction in bone resorption in response to PGE2 was found in the calvarial culture from EP4-knockout/mice. DbcAMP greatly stimulated bone resorption similarly in both wild-type and EP4-knockout mice. In mouse calvarial cultures, EP4-agonist markedly stimulated bone resorption, but its maximal stimulation was less than that induced by PGE2. EP2-agonist also stimulated bone resorption, but only slightly, EP1- and EP3-agonists did not stimulate it at all. These findings suggest that PGE2 stimulates bone resorption by a mechanism involving cAMP, which is mediated mainly by EP4 and partially by EP2.

Animals↗

PubMed1988

Forskolin mimics the effects of calcitonin but not parathyroid hormone on bone resorption in vitro.

Parathyroid hormone (PTH) and calcitonin stimulate bone adenylate cyclase activity and increase bone cAMP content, but PTH enhances and calcitonin inhibits bone resorption. This study examined the effects of forskolin, a non-hormonal activator of adenylate cyclase, on bone resorption and cAMP accumulation in 19-day fetal rat limb bones. Forskolin (10(-9) to 10(-5) M) stimulated bone cAMP generation in a concentration-dependent manner. However, in contrast to bPTH(1-34), which also stimulated cAMP accumulation, forskolin did not stimulate bone resorption. Moreover, forskolin did not augment the bone-resorbing activity of PTH even though it potentiated PTH stimulation of bone cAMP levels. Rather, high doses of forskolin (10(-6) to 10(-5) M) exhibited a calcitonin-like effect to inhibit PTH-mediated bone resorption. These results support a second-messenger function of cAMP for the inhibitory effects of calcitonin, but not for the stimulatory effects of PTH on bone resorption.

Adenylyl Cyclases↗

PubMed2005

Reduction of bone resorption by the application of fibrin glue in the reconstruction of the alveolar cleft.

A major complication in 30% to 75% of cases of surgical treatment of alveolar cleft is resorption of the bone graft. A treatment alternative is the application of fibrin glue, which has the capacity to favor the integration of the graft. The main objective of the study was to evaluate if the use of the fibrin glue reduces bone resorption when it is applied locally. The authors designed a randomized clinical trial. Patients were divided into two groups: group 1, fibrin glue; and group 2, control. Pre- and postoperative graft volume, bone density, bone quality (Lekholm and Zarb, and Norton and Gamble classifications), and postoperative complications were evaluated. The follow-up for all patients was 3 months after discharge. Twenty-seven patients were surgically treated, 13 in group 1 and 14 in group 2. Group 1 had increased graft volume compared with group 2 (64.32 cm v 21.70 cm; P < 0.0001). Bone density was higher in group 1 than in group 2 (396.57 v 245.68; P > 0.076). Bone quality was type 1, 2 and 3 and 4 in group 1. Resorption in group 2 was 62.26%; in group 1, it was 29.72% (P > 0.081). The observed complications were infection and dehiscence of sutures (P > 0.537). The authors conclude that the fibrin glue significantly diminishes bone resorption, allowing improved graft integration and quality.

Adolescent↗

PubMed1996

Role of calcium intake in modulating age-related increases in parathyroid function and bone resorption.

Serum parathyroid hormone (PTH) and bone resorption increase in elderly women and contribute to age-related bone loss. Whether these abnormalities are caused by calcium deficiency resulting from age-related decreases in absorption and renal conservation is unclear. We studied 28 normal elderly women (mean +/- SD, age 69.3 +/- 2.7 yr) who were maintained for 3 yr on usual calcium intake levels (20.4 +/- 7.2 mmol/day [815 +/- 289 mg/day]; n = 15) (known as the usual calcium group) or high calcium intake levels (60.4 +/- 6.5 mmol/day [2414+/260 mg/day]; n = 13) (known as the high calcium group) and a reference group of 12 normal young adult women (age 30.1 +/- 4.4 yr), whose calcium intake was 23.0 +/- 4.8 mmol/day (918 +/- 193 mg/day) (known as the young group). Serum PTH was measured every 2 h, and urinary excretion of deoxypyridinoline (Dpd), a new marker for bone resorption, was measured in 4 h collections. Parathyroid gland secretory capacity was assessed during induced hypocalcemia. The mean 24 h serum PTH was 40% lower (P < 0.001), and the mean 24 h urinary Dpd was 35% lower (P < 0.005) in the high than in the usual calcium group. Mean parathyroid gland secretory capacity also was 47% lower (P < 0.005) in the high calcium group than in the usual calcium group. However, the usual calcium group had a mean 24 h serum PTH level that was 70% higher (P < 0.001) and a mean 24 h urinary Dpd level that was 30% higher (P < 0.005) than the young group, whereas the high calcium group was indistinguishable from the young group. Thus, failure of elderly women to increase their calcium intake to offset age-related increases in calcium requirement contributes substantially to their development of increased parathyroid activity and increased bone resorption, whereas a high calcium intake can reverse both abnormalities.

Adult↗

PubMed1983

Inhibition of bone resorption and increased incorporation of 3H-glucosamine into hyaluronate in bone organ cultures treated with dibutyryl cyclic AMP and colchicine.

Addition of dibutyryl adenosine 3':5'-monophosphate (DBCAMP), colchicine or dbcAMP/colchicine to bone organ cultures markedly inhibited bone resorption. Calvaria of newborn mice labeled with 45Ca 3 days before sacrifice were removed and cultured in medium containing 3H-glucosamine. Both agents alone and in combination inhibited 45Ca release. DEAE-cellulose chromatography of the papain-digested medium and bone resolved the 3H-glucosamine-labeled macromolecular material into four peaks. A marked increase in radioactivity was observed in the hyaluronate fraction (peak III) of the chromatographed bone samples. The results indicate that dbcAMP does not mimic the effect of parathyroid hormone on bone resorption, but that it is similar to colchicine in both the inhibition of bone resorption and the increased incorporation of 3H-glucosamine into hyaluronate. Although the role of hyaluronate, if any, in this experimental system remain elusive, the increased radioactivity associated with the hyaluronate fraction may be due to decreased degradation resulting from decreased hyaluronidase synthesis.

Animals↗

PubMed1986

Forskolin-induced bone resorption in neonatal mouse calvaria in vitro.

The role of cyclic adenosine 3',5'-monophosphate (cAMP) in inducing bone resorption was studied in neonatal mouse calvaria in vitro. Forskolin, a stimulator of adenylate cyclase, increased the medium calcium concentration at 96 hr of incubation, indicating enhanced bone resorption. Bone resorption was observed between 1 X 10(-4) and 1 X 10(-6) M forskolin; the maximal effect was at 1 X 10(-5) M and there was no effect at 1 X 10(-7) M. Lactic acid release was increased during the 96 hr of incubation in proportion to the calcium release in the media. The bone acid phosphatase activity was increased and the alkaline phosphatase activity was decreased. Bone carbonic anhydrase activity was increased more than twofold. Forskolin-induced bone resorption was significantly but incompletely inhibited by 10(-4) M acetazolamide, a carbonic acid anhydrase inhibitor. These findings support the concept that carbonic anhydrase plays a significant role in bone resorption.

Acetazolamide↗

PubMed1997

Osteoclasts constitutively express regulators of bone resorption: an immunohistochemical and in situ hybridization study.

Bone resorption is controlled by the local production of soluble regulatory molecules within the marrow microenvironment that mediate osteoclast recruitment, differentiation, and activation. Under normal conditions osteoclasts are rarely seen; in many pathologic states, however, the number of osteoclasts is dramatically increased, resulting in a net-loss of bone mass. The role of the osteoclasts as autocrine regulators of bone resorption in either normal or pathologic conditions has not been extensively investigated. The expression of IL-1 beta, IL-6, and TNF-alpha was examined in osteoclasts by immunohistochemistry under conditions of normal, reactive, and pathologic bone resorption, including growth plate (3 cases), fracture callus (5 cases), osteomyelitis (3 cases), Paget's disease (6 cases), giant-cell tumor of bone (14 cases), and brown tumor of hyperparathyroidism (2 cases). In each case, osteoclasts demonstrated immunoreactivity for IL-1 beta, IL-6, and TNF-alpha. In areas of active bone resorption, the intensity and uniformity of staining among the various conditions were similar, suggesting constitutive expression of these cytokines by activated osteoclasts. Giant-cell tumors of bone showed cytokine reactivity in over half of the giant cells, whereas stromal cells showed scattered staining. In acute osteomyelitis, inflammatory cells (mainly macrophages) and osteoclasts were intensely positive for all three cytokines. The immunohistochemical findings were confirmed by in situ hybridization using probes specific for IL-6 and TNF-alpha, the pattern of mRNA expression paralleled that of immunoreactivity for these cytokines. These findings support the notion of autocrine/paracrine regulation of bone remodeling by osteoclasts. Because overproduction of these cytokines may enhance bone resorption through the stimulation of osteoclast progenitor cells as well as mature osteoclasts, pathologic bone lesions with a large increase in the number of osteoclasts may be self-perpetuating. Alteration in the synthesis, secretion, or activity of these important regulatory molecules may in turn alter bone remodeling and loss.

Bone Diseases↗

PubMed1998

Adhesive and bone resorptive activities of isolated osteoclasts from hen medullary bone.

In the present study, osteoclasts were isolated from hen medullary bones at the formative and resorptive phases. The cells were cultured on glass culture dishes and bone slices. After culturing, the adhesion activity of the isolated osteoclasts with the substrates was estimated with a light microscope, and the surfaces of the bone slices were observed with a scanning electron microscope. The results showed that the adhesion activity of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts is higher at the bone resorptive phase than at the bone formative phase, and this tendency in isolated osteoclasts was observed more frequently on the bone slices than on the glass culture dishes. Furthermore, scanning electron microscopy showed that the isolated osteoclasts in the bone resorptive phase adhered to the bone surface with developed-cytoplasmic projections and formed broad pits where collagen fibrils were exposed. On the other hand, isolated osteoclasts in the bone formative phase adhered to the bone slice with board-shaped cytoplasmic projections and did not form any pits. These results suggest that isolated osteoclasts in the bone resorptive phase have a high level of adhesion activity and actively resorb the bone, whereas isolated osteoclasts in the bone formative phase have a low level of adhesion activity and cease bone resorption. The procedure reported here is useful for studying the bone-resorptive mechanism of authentic osteoclasts.

Acid Phosphatase↗

PubMed1996

A comparison of the urinary excretion of bone resorptive products in white and black children.

Bone density is greater in blacks than in whites regardless of age. In adults, bone formation was shown previously to be much lower in blacks than in whites. A lower bone turnover in adult blacks may preserve a high bone density acquired earlier in life. Whether there is a difference in bone turnover in blacks and whites early in life is not known. Bone resorption is known to parallel bone formation, and thus in the present study we looked for racial differences in bone turnover in children by measuring the nocturnal urinary excretion of three markers of bone resorption: hydroxyproline and the pyridinium cross-links, pyridinoline and deoxypyridinoline. Sixty-four black and 145 white children ages 6 through 15 years were studied. We found excretion of hydroxyproline to be similar in whites and blacks. Urinary excretion of the cross-links was about 10% to 15% lower in blacks, but only the excretion of pyridinoline in boys was significantly lower in blacks (p = 0.031). Overnight urinary calcium excretion was about 30% lower in blacks than in whites (p = 0.0016 for boys and p = 0.008 for girls), as has been reported previously by others. In summary, the excretion rates of bone resorptive products in white and black children were similar, suggesting nearly equal bone turnover in the two racial groups, a finding that contrasts with observations made previously in adults.

Adolescent↗

PubMed1978

Mechanism of osteoclastic bone resorption: a new hypothesis.

Osteoclastic bone resorption involves the solubilization of the mineral salts and the degradation of noncollagen bone matrix and collagen fibrils. As no recognizable collagen fibrils have ever been reported within cytoplasmic vacuoles in osteoclasts, it is generally assumed that the collagen fibrils are digested extracellularly in the resorption zone. The extent to which lysis occurs extracellularly and whether or not the osteoclasts phagocytose the degradation products remain to be established. In the present communication, a hypothesis is presented suggesting the possibility that osteoclastic resorption of bone involves the participation of two different cell types. According to this hypothesis, osteoclastic bone resorption is initiated by osteoclasts that demineralize areas of bone and degrade noncollagen bone matrix. After the osteoclasts have moved away or become partially detached from the demineralized site, the exposed collagen fibrils are phagocytosed by mononuclear, fibroblast-like or monocyte-derived cells.

Bone Matrix↗

PubMed2002

Increased production of IL-7 uncouples bone formation from bone resorption during estrogen deficiency.

Postmenopausal bone loss stems from the inability of osteoblastic activity to match the increase in osteoclastic bone resorption induced by estrogen deficiency. However, the mechanism that uncouples osteoblast from osteoclast activities remains unexplained. We show that ovariectomy enhances the production of the osteoclastogenic cytokine IL-7, and that its neutralization in vivo prevents ovariectomy-induced bone loss. Surprisingly, serum osteocalcin levels, a biochemical marker of bone formation, suggested that the bone-sparing effects of IL-7 neutralization were due not only to inhibition of bone resorption, but also to stimulation of bone formation. Consistent with these data, addition of IL-7 to neonatal calvarial organ cultures blocked new bone formation, and injection of IL-7 into mice in vivo inhibited bone formation as measured by calcein incorporation into long bones. The antianabolic effects of IL-7 were consistent with an observed downregulation of the osteoblast-specific transcription factor core-binding factor alpha1/Runx2. Thus, because it targets both the osteoclast and the osteoblast pathways, IL-7 is central to the altered bone turnover characteristic of estrogen deficiency.

Animals↗

PubMed1993

Effect of outer membrane of Treponema denticola on bone resorption.

The effect of the outer membrane (outer sheath) of Treponema denticola on bone resorption was studied. Bone resorption was measured by the release of previously incorporated 45Ca from the shafts of the radii and ulnae of 19-day fetal rats. A treated-over-control ratio (T/C ratio) significantly greater than 1 indicated the stimulation of bone resorption by the test substance. The addition of outer membrane of T. denticola increased the release of 45Ca from the assay bones. The minimum concentrations required to yield significant 45Ca release from the assay bones were 15, 22 and 75 micrograms protein/ml for serovars a, b and c, respectively. These protein values corresponded to estimated lipopolysaccharide contents of 0.6, 0.8 and 2.8 micrograms/ml, based on 3-deoxy-2-manno-octulosonate analysis. Heat treatment of outer membrane (60 degrees for 30 min) did not change the effect on 45Ca release. Parathyroid hormone or prostaglandin E2, known to act synergistically with lipopolysaccharides in bone resorption, was also added to the assay system. Neither prostaglandin E2 at 10(-7) M nor parathyroid hormone at 40 ng/ml, by itself, increased 45Ca release. However, in the presence of 10 micrograms protein/ml of outer membrane of serovar b at 120 h, the T/C ratio was increased to 1.31 +/- 0.07 and 1.58 +/- 0.118, respectively. These results suggest that a lipopolysaccharide-like material is present in the outer membrane of T. denticola that may be responsible for bone resorption in the in vitro system.

Animals↗