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Identification and characterization of a novel heparan sulfate-binding domain in Activin A longest variants and implications for function
Authors: Evan Yang aff001; Christina Mundy aff001; Eric F. Rappaport aff002; Maurizio Pacifici aff001; Paul C. Billings aff001
Authors place of work: Translational Research Program in Pediatric Orthopaedics, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America aff001; Molecular Genetics Core, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America aff002
Published in the journal: PLoS ONE 14(9)
Category: Research Article
doi: https://doi.org/10.1371/journal.pone.0222784Summary
Activins regulate numerous processes including inflammation and are synthesized as precursors consisting of a long N-terminal pro-region and a mature protein. Genomic human databases currently list three activin A (Act A) variants termed X1, X2 and X3. The X3 variant is the shortest, lacks N-terminal segments present in X1 and X2, and has been the focus of most past literature. Here, we asked whether these variants are expressed by human cells and tissues and what structural features are contained within their pro-regions. Human monocytic-like cells THP1 and U937 expressed X1 and X2 variants after exposure to phorbol ester or granulocyte-macrophage colony-stimulating factor, while X2 transcripts were present in placenta. Expression vectors encoding full length X2 or X3 variants resulted in production and secretion of biologically active Act A from cultured cells. Previous studies reported a putative HS-binding domain (HBD) in the X3 pro-region. Here, we identified a novel HBD with consensus HS-binding motifs near the N-terminal end of X1 and X2 pro-regions. Peptides encompassing this new domain interacted with substrate-bound HS with nanomolar affinity, while peptides from putative X3 HBD did not. In good agreement, full length X2 pro-region interacted with heparin-agarose, while the X3 pro-region did not. In sum, our study reveals that Act A variants are expressed by inflammatory cells and placenta and yield biological activity. The high affinity HBD in X1 and X2 pro-region and its absence in X3 could greatly influence overall Act A distribution, availability and activity in physiological and pathological circumstances.
Keywords:
Biology and life sciences – Biochemistry – Research and analysis methods – proteins – Molecular biology – Macromolecular structure analysis – Database and informatics methods – Bioinformatics – Sequence analysis – Molecular biology techniques – Medicine and health sciences – Sequence motif analysis – Protein interactions – pharmacology – Protein domains – Drugs – Artificial gene amplification and extension – Polymerase chain reaction – Protein structure – Heparin – Protein structure prediction – Extracellular matrix proteins
Introduction
Activins are members of the transforming growth factor-β (TGF-β) superfamily of signaling and growth factor proteins that include bone morphogenetic proteins (BMPs) and growth and differentiation factors (GDFs) [1, 2]. Activin A (Act A) was originally purified from gonadal fluids and found to stimulate release of pituitary follicle stimulating hormone [3, 4]. Since then, it has become apparent that Act A regulates many physiologic processes and events including cell proliferation and differentiation, wound repair and immune responses [5–8]. Changes in Act A availability or function contribute to various pathologies [9].
As other TGF-β superfamily members, Act A is initially synthesized as a pre-pro-protein that encompasses a large N-terminal pro-region and a smaller mature protein portion which is subsequently dimerized by a C-terminal disulfide bond [10, 11]. While transitioning through the secretory pathway, the precursors undergo processing by furin-like proteases that cleave them at a prescribed and obligatory cluster of basic amino acids, but do not disrupt the association of pro-region and mature protein [8, 12, 13]. The processed pro-region/mature protein dimeric complexes are finally secreted, and evidence indicates that they can exert autocrine or paracrine roles in multiple tissue and organ functions [8, 9]. Previous studies have examined activin interactions with protein antagonists including follistatin (Fs) [14] and the ability of activins to form diffusion gradients [15], presumably via interactions with extracellular matrix components [16].
The NCBI database lists three human Act A variants, termed X1, X2, and X3. These variants were initially identified and sequenced by the Mammalian Gene Collection (MGC) Program Team as expressed sequence tags (ESTs) [17], but their differences in expression or function have yet to be examined empirically in human cells and tissues. The three variants are predicted to contain the same mature protein, but differ in the length of their pro-region as a result of alternative splicing and translation start site. Much of the past and recent literature has focused on the shortest X3 variant that lacks the longer N-terminal segments characterizing the X1 and X2 variants [8, 11]. In vitro studies have indicated that bioactivity of the entire X3 Act A protein complex is similar to that of the mature protein alone, suggesting that the X3 pro-region may have roles other than influencing ligand availability or receptor-ligand interactions [18]. A previous structural analysis of the X3 variant reported the presence of a putative domain in the middle of the pro-region seemingly able to interact with heparan sulfate (HS) and heparin [19]. To date, similar analyses have not been reported for the X1 and X2 variants.
In other TFG-β superfamily members and BMPs in particular, there is ample evidence that their distribution, availability, bioactivity and turn over are tightly regulated by interactions with HS-rich proteoglycans on the cell surface and extracellular matrix [20, 21]. In pioneering studies, Cardin and Weintraub were among the first investigators to identify and characterize protein domain(s) responsible for interaction with HS [22]. Comparative analyses on vitronectin, platelet factor-4, apoliprotein A and apoliprotein B led them to identify two HS-binding amino acid sequences -XBBXBX and XBBBXXBX-, thus named CW motifs, where B represents basic residues (usually Arg or Lys) interacting with reciprocally-charged sulfated carbohydrate residues and X represents non-charged residues. Subsequent studies by multiple investigators have verified these original findings and identified similar motifs or variations in many other proteins [23, 24]. Notably, the HS chains themselves are endowed with remarkable variability in their patterns of: O-sulfation at C2, C3 and/or C6 positions and N-deacetylation and N-sulfation in glucosamine residues, and C5 epimerization of D-glucuronic acid to L-iduronic acid residues [25, 26]. These overall modifications create short segments with specific sulfation patterns and sugar structure that exhibit binding avidity toward different CW domains on various proteins [27].
One example of the fundamental importance of HS-protein interactions was provided by studies showing that mutation of basic residues within the HS-binding domain (HBD) of BMP2 and BMP4 reduced their ability to interact with HS, but greatly increased their biological activity and potency as revealed by in vitro and in vivo assays [28, 29]. These studies showed that at least for certain BMPs, interactions with HS normally serve to restrain, delimit and define their biological activities [30]. Further, we recently showed that while the HBD in BMP2 and BMP4 resides near the N-terminus of the mature protein, that domain resides at the C-terminus in BMP5, BMP6 and BMP7 [31]. Structural analyses suggested that the HBDs in these two BMP subgroups have distinct structural characteristics and spatial orientation, indicating that HBD location and structure are protein-specific [32]. In good agreement, we also found that the congenital HS deficiency characteristic of the pediatric disorder Hereditary Multiple Exostoses (HME) triggers excessive and ectopic canonical BMP signaling in growth plate perichondrium and leads to exostosis (osteochondroma) formation [33, 34], demonstrating that aberrations in normal HS-protein interactions can have severe pathological consequences.
In the present study, we have carried out a detailed examination of Act A variants and in particular, asked whether the X1 and X2 variants are expressed by human cells and tissues and what possible additional structural features may be provided by their longer N-terminal pro-regions. Our data reveal for the first time that the X1 and X2 variants are in fact expressed by human cells and placenta and contain a previously unidentified high affinity HBD toward the N-terminal end of their pro-region that is absent in the X3 pro-region. The diverse structural features of the variants could influence overall Act A availability, range and activity in physiological and pathological circumstances.
Results
Human inhibin genes and expression variants
Previous studies have provided general information and insights into the genomic organization of the human inhibinβ genes, designated INHβA, INHβB, INHβC and INHβE, that encode Act A, activin B (Act B), activin C (Act C) and activin E (Act E), respectively [35–37]. To gain further structural details, we relied on the UCSC Genome Browser (genome.ucsc.edu) and NCBI sequence and gene structure databases. Computer-driven algorithms indicated that human INHβA resides on the short arm of chromosome 7 and is characterized by 7 coding exons spanning an overall genomic segment of about 25Kb (Fig 1, Tables 1–3 and S1 Fig).
Fig. 1. Human INHβA genomic organization.
Tab. 1. Chromosomal location and genomic organization of human activin genes.
Tab. 2. Exon locations within human activin genes.
Tab. 3. Human activin isoforms and variants.
The NCBI database lists three variants for human INHβA designated X1, X2 and X3 and alignment of the nucleotide and amino acid sequences indicate that the variants are the product of alternative splicing and translation start sites (Fig 1). The X1 variant is encoded by exons 2, 3, 6, and 7 and the X2 variant is encoded by exons 1, 6, and 7. The X3 variant includes exons 6 and 7 only, but results from the use of an alternative translation start site within exon 6 (Fig 1, arrow in X3). The mature protein is encoded by approximately the 3’ half of exon 7 and is common to all Act A variants, which differ in the length of their pro-regions (Fig 1 and S2 Fig). It remains to be clarified whether exons 4 and 5 are incorporated into other as yet undiscovered Act A variants, if other potential exons reside upstream of coding exon 1, and what are the promoter/enhancer elements regulating INHβA gene expression [1].
It should be noted that the above transcript/protein predictions of variants are based on computational genomic analyses that were conducted initially by the MGC team using ESTs to explore the transcriptome and then subsequently confirmed by whole genome sequencing and bioinformatics [17]. Much of the past and recent extensive literature on Act A has utilized recombinant forms of the X3 variant [14, 18], but currently there is little information about the expression and structural characteristics of the X1 and X2 variants. Thus, we first asked whether these variants are expressed by myeloid - lineage cells that are amongst the cell types known to produce Act A [38, 39]. For these studies, we utilized the human monocytic-like cell lines THP1 and U937 that have the capacity to differentiate into macrophages following appropriate stimulation [40]. For initial experiments, cells were treated with phorbol 12-Myristate 13-Acetate (PMA) for 4 hrs to induce differentiation, total cellular RNAs were isolated and processed for cDNA synthesis and semi-quantitative PCR. We used unique forward primers anchored at the ATG start sites of X1 or X2 variants and combined with a common reverse primer that includes the TAG stop codon in exon 7 (Table 4). We found that PMA stimulated expression of transcripts encoding the X2 variant in U937 cells, whose identity was confirmed by Sanger sequencing of the purified PCR product (Fig 2A, lane 2, S5 Fig); however, expression of the X1 variant was undetectable (Fig 2A, lane 8). Because the X3 variant shares its entire composition with the X1 and X2 variants and does not have a unique 5’ end (Fig 1), we did not test its expression using this approach. Granulocyte macrophage-colony stimulating factor (GM-CSF) induces strong expression of Act A in purified human monocytes [41]. Thus, U937 and THP1 cells were untreated or treated with GM-CSF (1 ng/ml; 8 hr) and the resulting RNA samples were processed for PCR analysis as above. Interestingly, GM-CSF upregulated the X2 variant in both cell lines (Fig 2A, Lanes 3, 6), but only stimulated expression of the X1 variant in U937 cells (Fig 2A, lane 9). To make sure both cell lines have the cell surface machinery to respond to GM-CSF, we subjected them to FACS analysis using antibodies to its receptor CD116 or pre-immune IgGs as control. Both cell lines exhibited readily detectable levels of CD116 (Fig 2B and 2C).
Tab. 4. PCR Primers used to amplify human activin transcripts.
Fig. 2. Human monocytic-like cells express Act A X1 and/or X2 variants and CD116.
A, Cells were treated with PMA or GM-CSF. Following treatment, RNAs were processed for PCR analysis of Act A variant expression. Amplified bands were purified from the gels and subjected to Sanger sequencing to confirm transcript identity. Treatment of U937 cells with PMA induced expression of Act A-X2 (lane 2), while treatment with GM-CSF induced expression of both Act A-X2 and -X1 (lanes 3, 9). Treatment of THP-1 cells with GM-CSF induced expression of Act A-X2 (lane 6). Lane 10, Fisher exACTGene DNA ladder. B and C, Scatter plot and histogram depicting CD116 detection. U937 and THP1 cells were incubated with anti-CD116-PE antibody or IgG-PE control. The cells were washed, and antibody binding was determined by FACS. Note that both cell lines contain cell surface CD116. Statistical Analysis (Student’s t test) for B: IgG vs CD116: ****: P< = 0.0001, *: P< = 0.05.
To determine which Act A variant(s) are expressed under normal physiological conditions, we prepared cDNA from human placental RNA and processed it for PCR using different primer sets. A first set amplified an amplicon covering exons 6 and 7, present in all three Act A variants (Fig 3A and 3C, black arrows). Next, we used primer sets containing unique forward primers specific for the 5’ ends of X1 or X2 variants (Fig 3B, white arrows). This yielded a product encoding the 5’ region of the X2 variant, but no amplification product homologous to the X1 5’ region was obtained (not shown). Thus, the Act A X2 variant is expressed in human placenta.
Fig. 3. Normal human placenta tissues contain transcripts encoding Act A X2 variant.
Together, the data provide new evidence that Act A X1 and X2 variants are expressed by differentiating human monocytic cell lines and human tissue. Because the X1 and/or X2 variants are expressed in response to specific chemical or biological cues, it is possible that they may be expressed and utilized in vivo during specific stages of development and under certain pathologic conditions.
AD293 and COS1 cells secrete biologically active Act A following transfection with X2 and X3 expression vectors
Next, we explored the biological activity of Act A produced and secreted by cultured cells. The entire open reading frame encoding each variant was cloned into the mammalian expression vector pcDNA3.1+, which utilizes the CMV promotor to drive protein expression. Following verification of constructs by DNA sequencing, each expression construct along with a construct expressing green fluorescent protein (GFP) was transfected into AD293 cells using FuGENE 6 Transfection Reagent (Promega), resulting in a transfection efficiency of > 90% (Fig 4B). Three days after transfection, conditioned medium was harvested and the remaining cells were scraped from the dishes, RNA was isolated, treated with DNAse and subsequently used for cDNA synthesis. Cells transfected with each Act A variant expressed the appropriate mRNA (Fig 4C, lanes 3–5). Removal of plasmid DNA was confirmed using PCR primers specific for beta-lactamase, which encodes the AmpR gene on pcDNA3.1 expression plasmid (Fig 4C, right). This amplicon was readily amplified from plasmid DNA (Fig 4C, lane 6), but was absent in cDNAs prepared from cells (Fig 4C, lanes 7–10).
Fig. 4. Expression and secretion of Act A variants.
Expression constructs for full length X1, X2 and X3 variants were cloned into pcDNA 3.1 and transfected into AD293 and COS1 cells. A, diagram of Act A expression cassette with His tag on the 3’ end. B, GFP detection indicates that transfection efficiency was > 90%. C, RT-PCR analysis (left panel) demonstrating that X1, X2 and X3 transcripts were efficiently expressed following transfection (lanes 3–5), producing an amplicon identical to that of the expression plasmid (lane 1). Untransfected cells are shown in lane 2. RT-PCR analysis (right panel) indicating that plasmid DNA was efficiently removed from our RNA preps (lanes 8–10) but was amplified from plasmid DNA itself (lane 6). D, immunoblots of conditioned medium samples separated under reducing conditions and probed with anti-His tag antibody. Note that samples from AD293 and COS1 cells transfected with X2 or X3 expression constructs exhibit an immunoreactive band ~13 kDa that has the predicted size of mature Act A monomer (lanes 2, 3, 5, 6, 10 and 11). The band was undetectable in conditioned medium from cells transfected with the X1 vector (lanes 1, 4 and 9) or un-transfected cells (lanes 7 and 8). Lanes 4–6 are a longer exposure of lanes 1–3. E, THP1 cells were incubated for 2 hrs with conditioned media from AD293 cells that were untransfected (U) or transfected with X2 or X3 constructs. The cells were processed for q-PCR analysis of TIEG expression, an early response gene induced by Act A and TGF-β. Note that TIEG expression is up-regulated by treatment with recombinant human Act A (rhActA; lane 2, positive control) as well as conditioned medium from X2 or X3 expressing cells (lanes 4 and 6). This induction was blocked by pre-incubation with a neutralizing antibody to Act A (lanes 3, 5 and 7). Conditioned medium from untransfected cells elicited no TIEG expression (U, lane 1). Statistical Analysis (Student’s t test): 1 vs 2, 1 vs 4 and 1 vs 6; *: P< = 0.05, ***: P< = 0.001.
To assess protein expression, the conditioned media sample from each transfected cell population was incubated with Talon resin, and the bound proteins were eluted with 0.5M Imidazole and analyzed on immunoblots. AD293 Cells transfected with X2 or X3 expression vectors both secreted a protein of about 13 kDa, consistent with the mass of mature Act A protein under reducing conditions (Fig 4D, lanes 2, 3, 5 and 6; note that lanes 4–6 are over-exposed images of lanes 1–3). This protein band was more prominent in X2 versus X3 transfected cells, but was not detectable in cells transfected with X1 construct (Fig 4D, lanes 1 and 4). To verify these results, Cos1 cells were transfected with each Act A variant expression construct. Again, immunoblot analysis of conditioned media samples showed secretion of mature Act A ligand only by cells transfected with X2 or X3 variant constructs (Fig 4D, lanes 10 and 11). To test whether the secreted proteins were biologically active, THP1 cells were treated with commercially available recombinant Act A (rhAct A) or conditioned medium samples obtained from cells transfected with the Act A expression constructs. After 2 hr treatment, RNA was extracted, cDNA was prepared and expression of TIEG -an early response gene upregulated by Act A or TGF-β was assessed [42]. As expected, TIEG was rapidly upregulated when cells were treated with rhAct A used as positive control (Fig 4E, lane 2). A similar strong up-regulation was observed when the cells were exposed to the conditioned medium from cells transfected with X2 and X3 expression constructs (Fig 4E, lanes 4 and 6). Medium from un-transfected cells produced no response (Fig 4E, lane 1). TIEG induction was blocked when the cells were co-treated with a monoclonal Act A neutralizing antibody (Fig 4E, lanes 3, 5 and 7). Thus, AD293 and Cos1 cells transfected with X2 and X3 variant expression vectors secrete biologically active Act A.
Act A X1 and X2 variants contain a previously unsuspected HS-binding domain (HBD)
Many TFG-β superfamily members are known to establish high affinity interactions with HS-rich proteoglycans on the cell surface and extracellular matrix that regulate protein distribution, availability, bioactivity and turn over [20, 21]. A study published in 2010 analyzed the HS-binding properties of Act A X3 variant and reported the identification of a putative HBD located toward the middle of the pro-region and encompassing amino acids 259 to 272 (Fig 5A) [19]. This segment corresponds to amino acids 381–394 and 316–329 in the X1 and X2 variants, respectively (Fig 5A) and contains several clusters of lysine residues (Fig 5A–5D, highlighted in green). Notably, this domain also contains four glutamic acid residues, which are predicted to interfere with interactions with the anionic sulfate groups in HS. Thus, we closely reexamined the entire amino acid sequence of the X3 variant and compared it to the X1 and X2 variants. We noted the presence of another basic residue-rich domain located near the N-terminal end of the X1 and X2 pro-regions that closely resembled a CW motif (Fig 5A, highlighted in light blue). The domain spans amino acids 78–102 in X1 and amino acids 13–37 in X2, but is absent in X3 (Fig 5A–5D).
Fig. 5. Schematic representation of human Act A variants.
A, the three variants, X1, X2, and X3 listed in the NCBI protein database are depicted as a linear segment proportional to their protein sizes that are 548, 483 and 426 amino acids long, respectively. The box colored in aqua depicts the location of the novel high affinity HBD identified in the X1 and X2 variants. The green box depicts the location of the previously-reported region in the X3 variant (presumed to bind to HS) that is also present in the X1 and X2 variants. B-D, the entire amino acid sequences of the X1, X2 and X3 variants are shown in which the highlights in aqua and green depict the protein segments as in A, while the highlight in yellow depicts the mature protein portion shared by all variants.
To determine whether the newly identified domain is in fact endowed with HS binding capacity, we prepared a synthetic peptide encompassing this region, which was biotinylated on the N-terminus. The domain is identical in X1 and X2 variants and denoted as X213-37 (Fig 6A). In addition, we prepared a biotinylated peptide encompassing the previously described putative HS-binding region in X3 pro-region [19], which is designated X3259-272 (Fig 6B). The peptides were tested in solid-phase binding assays, employing 96 well plates pre-coated with HS, following standard protocols established in our previous studies [31]. We found that the X213-37 peptide interacted with HS with high affinity, exhibiting a Kd of 4 ± 2 nM (n = 3); binding was blocked by pre-incubation of the peptide with excess heparin serving as competitor (Fig 6C). As we anticipated given its amino acid composition, the X3259-272 failed to interact with HS at any concentration tested (Fig 6C). Changing incubation conditions or lengthening assay time did not change outcomes.
Fig. 6. Peptides corresponding to the novel HBD bind HS with high affinity.
96-well plates were coated with HS and incubated with tetrameric peptide complexes (HBC) for 2 hrs. Plates were washed, and bound peptides were assessed by addition of OPD substrate. A and B, schematic diagram depict the amino acid sequences of Act A- X213-37 and Act A- X3259-272 peptides and their location within the full-length proteins, respectively. C, solid phase binding assays of Act A peptides to HS. Note that Act A- X213-37 binds HS with high affinity and its binding is blocked by addition of soluble heparin. In contrast, Act A-X3259-272 displays minimal binding. Inset, double reciprocal plot that yields a Kd of 4 nM (n = 3) for Act A- X213-37. NA-HRP backbone displays minimal binding to HS.
Solid-phase assays are widely used to test macromolecular interactions, but may not fully reflect biological conditions. Thus, we tested the peptides for interaction with the cell surface. U937 cells were lightly fixed with formalin to preserve the cell surface and then incubated with biotinylated peptides complexed with NA-488 [31]. After careful rinsing, cells were processed for FACS analysis. The X213-37 peptide readily and efficiently interacted with the cell surface, and binding was blocked by pre-treatment with heparin (Fig 7A and 7B). However, X3259-272 peptide failed to interact with the cells (Fig 7A and 7C), consistent with results from the solid phase binding assay (Fig 6C). To verify assay reliability, we concurrently tested a peptide that encompasses the HBD of BMP4, characterized in a previous study [31]. As expected, the BMP4 peptide effectively interacted with the cell surface and was competed out by excess heparin (Fig 7A). No fluorescence signal was generated by untreated control cells or by cells incubated with NA-488 in the absence of peptides.
Fig. 7. HBD peptides bind to the cell surface with avidity.
A, U937 cells were incubated with peptide complexes consisting of biotinylated peptides pre-incubated with NA-488. Following incubation, the cells were washed, and bound peptide was assessed by FACS analysis. Note that Act A- X213-37 readily binds to the cell surface, and its interaction is blocked by soluble heparin competitor. In contrast, Act A-X3259-272 peptide fails to bind. Binding specificity was verified using a previously characterized peptide encompassing the high affinity HBD from BMP4. B, representative FACS plots show binding of Act A- X213-37 in the absence (blue line) or presence (red line) of heparin competitor. C, representative FACS plots showing binding of Act A- X213-37 (blue line), lack of binding by Act A-X3259-272 (red line) and background signal generated by U937 cells alone (green line). Statistical Analysis (Student’s t test): NA488 vs ActA X213-37, NA488 vs BMP4: ****: P< = 0.0001, **: P< = 0.01.
To further verify the results, we prepared His-tagged expression constructs in pcDNA3.1 vector encompassing the entire pro-region of X2 and X3 variants and transfected each into AD293 cells. Each construct was efficiently transcribed into mRNA (Fig 8B). Conditioned media samples were incubated with Talon resin or heparin agarose, bound protein was eluted and analyzed on immunoblots with His-tag antibodies. Both pro-regions were produced and secreted by the cells (Fig 8C, lanes 2 and 3). In good agreement with the data above, the secreted X2 pro-region interacted with heparin agarose, while the X3 pro-region did not (Fig 8C, lanes 5 and 6).
Fig. 8. Expression and binding characteristics of Act A X2 and X3 pro-regions.
A, diagram of Act A pro-region expression cassette with HIS tag on 3’ end. Cassette was cloned into pcDNA 3.1. Expression constructs encoding the entire pro-region of Act A X1, X2 or X3 variants were transfected into AD293. Cells were processed for RT-PCR analysis four days later. B, RT-PCR product analysis shows that each variant was expressed efficiently (lanes 3–5) and the amplification product matched that produced by expression vector itself (lane 1). RNA from un-transfected cells (U, lane 2) produced a faint band likely representing endogenous Act A transcripts. C, conditioned media samples from each cell population above were incubated with TALON resin or heparin agarose (30 min, 4C). After rinsing, bound proteins were eluted and analyzed by immunoblot with anti-His tag antibody. Note the presence of a thick protein band of ~ 40 kDa (exhibiting the predicted size of the pro-region) in samples from both X2 or X3 pro-region-expressing cells (lanes 2 and 3) but not in samples from un-transfected cells (U, lane 1). Note also that only the X2 encoded pro-region binds heparin agarose (lane 5), while X3 encoded pro-region does not (lane 6).
3D peptide and protein conformation analyses
The above data predict that the X213-37 HBD should possess a 3D configuration and amino acid distribution able to create a surface(s) amenable to interactions with HS. However, these features and properties should be absent or disrupted in the segment encompassing the X3259-272 segment. To test these predictions, we utilized the I-TASSER server [43] as in previous structural studies on BMP family members [20, 31]. We found that the X213-37 domain displayed a helical structure Fig 9A). When examined using helical wheel diagrams, it displayed basic residues (i.e., Lys) mostly on one side, thus generating a cationic surface on one face of the helix, conducive to HS binding (Fig 9A, 9C and 9E). The X3259-272 segment also displayed a helical configuration, but structural views and helical wheel projections showed that its residues did not elicit a cationic surface suitable for HS interaction (Fig 9B, 9D and 9F). Again, the presence of negative charges from the 4 glutamic acid residues within this sequence are predicted to interfere with HS binding (Fig 9F, highlighted in red).
Fig. 9. Peptides display a helical configuration.
Three dimensional analyses and structure predictions were carried out using the I-TASSER server. A-B, side views of peptides oriented with the N-terminus labeled (N) on the left indicate that both the Act A-X213-37 and Act A-X3259-272 peptides are predicted to possess a helical configuration. C-D, side-view of models depicted in A-B are rotated 90° and provide a frontal view down the axis of the alpha helix, beginning with the N-terminus. Acidic and basic residues are highlighted as follows: Glu; red; Lys, purple; and Arg, cyan. Overall amino acid sequences are noted below, with putative CW motifs underlined. Note in C that the distribution of Lys and Arg residues in Act A-X213-37 elicits uniformly basic surfaces amenable to HS binding. In contrast, the 4 Glu residues in Act A-X3259-272 would disrupt such HS interactions (D). E-F, helical wheel diagrams illustrate the stereological position of amino acids in sequences underlined in C and D, respectively. It is evident that the glutamic acid residues (in red) prevent formation of a uniform basic surface around the helix.
Next, we used the I-TASSER server to visualize the relative location, orientation and configuration of the X213-37 and X3259-272 domains within the full-length X2 variant. The generated structures revealed that the domains occupy locations on opposite sides of the protein (Fig 10 and S1 and S2 Videos). As also seen in previous crystallography studies of the full-length X3 variant [18], the pro-region is physically separated from the mature protein and connected to it via the latency lasso (Fig 10B). To more clearly determine whether the X213-37 domain created an exposed HS-binding surface, we analyzed the structures at different rotational angles. Orthogonal views revealed that the domain created a cationic surface facing away from the protein moiety and likely accessible for interactions with HS (see S6 and S7 V\. In contrast, the X3259-272 segment was also positioned on the outer perimeter of the protein, but its acidic amino acid composition prevented it from generating a suitable cationic surface (Figs 9 and 10).
Fig. 10. Predicted structure of Act A variants and location of putative HBDs.
Discussion
Our data reveal that the X1 and X2 variants of Act A are expressed by human inflammatory cells in response to PMA and GM-CSF and in human placenta. The variants differ from each other at the N-terminal end of their pro-region, but share the bulk of the pro-region and the entire mature protein. Our data also show for the first time that the X1 and X2 variants possess a domain in the pro-region that exhibits typical CW characteristics and binds to HS and the cell surface readily and with high affinity. As suggested by 3D stereological analysis, the basic residues in the domain are organized to produce an anionic surface that is adept at HS binding and oriented toward the outer perimeter of the pro-region. Because Act A is assembled and secreted as a dimer held together by an intermolecular disulfide bond [18], each dimer would possess two such HBDs oriented away from each other and potentially functioning autonomously. This is reminiscent of the situation in certain BMP family members such as BMP2 and BMP4 in which the two HBDs in each dimer are distinct in terms of location, action and interactions and act in a bivalent manner in binding assays [29]. However, this appears not be the case for BMP5, BMP6 and BMP7 where the two HBDs come together to form a single central cationic surface within each dimer, likely as a result of their location at the C-terminus of each of the two closely juxtaposed mature proteins [31]. These observations and considerations highlight the fact that the HBDs in different proteins differ in location, organization, specific amino acid sequences and number of basic clusters, though they all share fundamental traits of CW motifs. The significant structural variability amongst HBDs in different proteins are likely to have physiological significance in terms of protein availability, distribution and orientation within the extracellular matrix or cell surface as well as with respect to protein interactions with specific HS-proteoglycans and even endogenous protein competitors and antagonists [20]. This conclusion is also sustained by the fact that the domains in many such proteins are evolutionarily conserved [20], but details about their functional significance still need to be fully clarified and understood.
In the standard binding assays used here, peptide X3259-272 spanning the previously reported HS-binding region of the X3 variant [19] failed to interact with substrate-bound HS or the cell surface (Figs 6 and 7). Moreover, the entire pro-region of X3 failed to interact with heparin, while the pro-region of the X2 variant did interact (Fig 8). These results are not surprising given that the clusters of basic residue clusters within X3259-272 contain 4 intervening glutamic acid residues, which would be predicted to prevent the formation of a uniform cationic HS-binding surface, as our 3D data indicate. How then can our data be reconciled with those of Li et al. [19]? A major difference is that in our solid phase and FACs assays (Figs 6 and 7) we made use of peptides corresponding to specific protein domains, while Li et al. made use of full length recombinant X3 variant and perlecan in their solid phase and pulldown experiments. It is possible that full length proteins are able to establish a number of diverse macromolecular interactions with each other in addition to those involving specific segments or motifs interacting with HS chains [44]. HS-rich glypican family members have been shown to interact with Wnts, hedgehogs and other signaling proteins in complex manners, also involving their core protein [45, 46]. In addition, differences in experimental conditions including salt concentration, stringency, washing conditions, buffers, detergents and other parameters could influence outcomes in different studies. We have tested HS derived from different sources including kidney, basement membranes of Engelbreth-Holm-Swarm mouse sarcoma and obtained from different vendors, but the results were the same. Nonetheless, the inhibition of X3 variant/perlecan interactions by heparitinase pre-treatment or mutation of basic residue clusters observed by Li et al. [19] does suggest that those clusters could have some binding roles, despite the presence of acidic residues. However, their affinity and binding strengths for HS could be far lower than those of the new HBD, X213-37, described here. It is worth recalling that the three major follistatin variants differ in their ability to bind HS, with the shorter variant Fs288 exhibiting the highest affinity and the longest variant Fs315 exhibiting the lowest, likely due to the presence of acidic residues [47]. Hence, future studies will be needed to compare side-by-side the binding affinities and kinetics of the X1, X2 and X3 variants and their respective mutants to HS-rich proteoglycans, define the binding hierarchy of different domains, and decipher their roles and underlying mechanisms.
The biosynthesis and elongation of HS chains at serine residues on the proteoglycan core proteins are complex processes involving over 25 enzymes. As indicated above, these step-wise biosynthetic steps results in the creation of segments with specific sulfation and sugar structure patterns, also referred to as ‘sulfation codes’ [26]. Following secretion, the chains can be further modified by tissue-specific sulfatases that selectively remove sulfate groups at specific positions. The resulting diversity and complexity of sulfated segments along the HS chains are thought to serve as specific sites of protein interactions [20, 21]. Complementarily, the diverse HBDs identified in different proteins likely add specificity and enable each protein to recognize and bind distinct segments along HS chains with specific sulfation codes. Some of the most characterized protein-HS interactions are those by members of the fibroblast growth factor (FGF) family of signaling molecules [48, 49]. FGFs contain a nine amino acid domain or ‘glycine box’ that mediates the ability of full-length proteins to selectively bind octasaccharides with different sulfation patterns [48]. Our group recently demonstrated that the HBD present in BMP2 and BMP4 competitively inhibits binding of full-length BMP2 protein to HS, while the HBD in BMP5 does not [31]. While we do not know the preferred sulfation code recognized by ActAX213-37 HBD, it may enable the pro-region/mature protein complex for X1 and X2 variants to specifically interact with HS-rich proteoglycans on the cell surface and extracellular matrix, thereby regulating signaling, turn over and function.
As pointed out above, past and recent studies on Act A biology and function have made use of the X3 variant or the mature protein but to our knowledge, the X1 or X2 variants have not been tested. For example, Harrington et al. used recombinant Act A mature protein to clarify the structural basis by which Fs inhibits Act A signaling [14]. They found that Fs dimers wrap themselves around the back of activin dimer wings reorienting their own EGF - and Kazal-like subdomains. Wang et al. carried out a detailed analysis of mechanisms involved in initiation of Act A biological activity, using the X3 variant [18]. They found that intracellular furin cleavage is required to turn on the biological activity of the newly-synthesized X3 variant; as already pointed out above, the signaling potency of the furin-cleaved X3 complex, containing the pro-region and active ligand, was nerly identical to that of mature protein. Notably, this group found that removal of residues 259 to 272, encompassing the X3259-272 domain described by Li et al. [19], had no effect on biological activity, pointing to a minor if any role of that domain as our data also suggest. Quaternary crystal structure analysis indicated that the two X3 chains form a cross-armed, domain-swapped dimer in which the two central disulfide-linked mature domains wrap around each other and create a connecting bridge to the reminder of the outward oriented globular pro-regions, a configuration different from that in other superfamily members such as TGF-β1. Lastly, Johnson et al. compared the biological activity and half-life of recombinant (cleaved) X3 variant versus mature protein after intravenous injection in male rats [50]. They found that both proteins elicited similar biological activity (monitored by follicle stimulating hormone levels), but the circulating half-life of the entire X3 variant was approximately twice as long as the mature protein (t1/2 fast = 12.5 min vs 5.5 min, respectively). Undoubtedly, the above studies and related efforts [5] have provided numerous important and novel insights into Act A biology. However, in view of the data described here, one has to wonder whether testing the X3 variant and mature protein only can actually uncover and clarify the overall physiologic spectrum of Act A activities and underlying mechanisms. Given that the X1 and X2 variants have a more extended N-terminal pro-region and possess a high affinity HBD that is absent in the X3 variant, the X1 and X2 variants could behave and act differently than the X3 variant or mature protein. For instance, the half-life of systemically-injected X1 and X2 variants is likely to be significantly different compared with that of X3 variant or mature protein, given their expected ability to interact with multiple constituents in both blood and tissues through their high affinity HBD. Interactions of X1 and X2 variants with follistatin could also differ from those of X3 due to their larger structure and presence of the high affinity HBD (X213-37) which could affect the binding of Fs288 or Fs315 variants. Within developing embryonic tissues, Act A is thought to form signaling gradients, but this important process has mainly been studied using exogenous mature protein [51]. It will be interesting to reexamine these issues using the X1 and X2 variants and determine endogenous Act A variant expression, diffusion and gradient formation. In sum, it is possible that previous observations and conclusions derived from studies utilizing mature Act A or the X3 variant may need to be verified and extended by also focusing on the X1 and X2 variants.
In the musculoskeletal research field, interest in Act A biology has been re-invigorated by recent evidence of its pathogenic roles in the pediatric congenital disorder Fibrodysplasia Ossificans Progressiva (FOP) [52]. FOP is characterized by episodic formation of extraskeletal cartilage and bone tissue–a process collectively termed heterotopic ossification (HO)—at multiple sites, eventually involving much of the body [53]. HO is preceded by local inflammation and over time, the accumulated ectopic tissue causes multiple health problems and impediments—including skeletal deformities, chronic pain, growth impairment and joint ankylosis—that increasingly interfere with basic daily functions and can lead to breathing difficulties and premature death. FOP patients bear a missense activating mutation in ACVR1 that encodes the BMP receptor ALK2 [54]. It was previously thought that activity of mutant ALK2 would be boosted by BMP ligands present at HO initiation sites; given that ALK2-driven BMP signaling mediated by canonical phosphorylated SMAD1/5/8 is chondrogenic, its enhanced activity would lead to local chondrogenesis followed by osteogenesis and ultimately, HO development [55]. However, recent studies have indicated that unlike wild type ALK2, mutant ALK2 can also respond to Act A and elicits pSMAD1/5/8 signaling, thus directly linking inflammation to ectopic chondrogenesis and HO formation [52]. These interesting and important studies have left many questions unanswered. It is assumed that inflammatory cells invariably recruited to the prospective site of HO formation are the source of Act A, but to date, this has not been demonstrated. Further, it is unclear which Act A variant(s) are expressed and how the mature protein ligand becomes available for interaction with mutant ALK2 in skeletogenic cells. Likewise, Act A normally signals via pSMAD2/3 [2], and it remains unknown how its interactions with mutant ALK2 would elicit a switch to pSMAD1/5/8 signaling and what combination(s) of type I and type II receptors are involved. Given our demonstration of the high affinity HBD in the pro-region of X1 and X2 Act A variants, it will be interesting to consider the possibility that synthetic mimetic HS oligomers [56] could be used to sequester Act A precursors, rendering the mature protein less available for action at sites of HO formation.
Experimental procedures
Reagents
Human Placental (AM7950), Liver (AM7960) and Lung (AM7968) RNA, NeutrAvidin (NA), NA-HRP and NA-DyLight 488 (NA-488) and Fisher exACTGene DNA Ladder (100–10,000 bp) were obtained from Thermo-Fisher. Heparin was obtained from Sagent Pharmaceuticals and HS was obtained from Millipore-Sigma (www.sigmaaldrich.com). Phorbol 12-myristate 13-acetate (PMA; aka 12-O-Tetradecanoylphorbol-13-Acetate) was obtained from Cell Signaling (#4174). All DNA Oligonucleotide primers were obtained from Integrated DNA Technologies (www.idtdna.com) and are listed in Table 4.
RNA, PCR & DNA sequencing
Total RNA was isolated using TRIzol Reagent (Thermo-Fisher) following the manufacturers protocol. Five μg of glycogen (Thermo-Fisher AM9510) was added to the aqueous phase prior to the addition of isopropanol to facilitate RNA precipitation. For some experiments, RNA quantification was determined using a Nanodrop spectrophotometer. cDNA was prepared from 2 μg of purified RNA, using oligo dT as primer, supplied with the Verso cDNA synthesis kit (Thermo-Fisher # AB1453A) or SuperScript IV Reverse Transcriptase (Thermo-Fisher #18090010) following the manufactures protocol. All PCR reactions were performed using Act A specific primers and GoTaq Green Master Mix (Promega) following the manufacturers protocols. PCR reactions were optimized by gradient PCR, using an Applied Biosystems Veriti Thermal Cycler. PCR products were size fractionated on 1% agarose gels, the bands were isolated, DNA was extracted from gel slices using Micro Bio-Spin columns (Bio Rad# 7326204) and sequenced. All DNA sequencing was performed by the NAPCore Facility at CHOP.
Design of Act A protein expression constructs
The entire open reading frame for Act A variants X1, X2 and X3 were cloned into the EcoRI/XbaI site of the mammalian expression vector pcDNA3.1 (+). A poly-His tag was added to the 3’ end (i.e., C-terminus) to facilitate purification via immobilized metal affinity chromatography (IMAC). The pro-region from each variant was cloned in an analogous manner, except that the His tag was placed before the Furin cleavage site (QSEDHPHHHHHHHH) (see Table 5). Each expression construct was analyzed by Sanger DNA sequencing for verification. For transfection, 2.5 μg of plasmid DNA plus 7.5 μl FuGENE 6 Transfection Reagent (Promega) was added to 0.25 ml Opti-MEM medium and incubated for 15 minutes at room temperature. The transfection mix was subsequently added to cells growing in medium containing 10% fetal calf serum and 24 hr later, the medium was changed to Serum-free media containing Insulin-Transferrin-Sodium Selenite supplement (Roche 11074547001) and G418 (100 μg/ml). Cells were grown for 3 days, the medium was collected, clarified by centrifugation and incubated with TALON Metal Affinity Resin (Takara Bio USA). The resin was washed with PBS, transferred to a Micro Bio-Spin 6 Column (Bio-Rad); bound protein was eluted with 0.5M Imidazole. Purified proteins were analyzed on SDS-polyacrylamide gels/Western blots under reducing conditions and probed with anti-His Tag Monoclonal Antibody (HIS.H8). Western blots were developed using HRP - or IRDye - tagged Secondary Antibodies (Li-Cor).
Tab. 5. Human activin A full-length and pro-regions.
mRNA expression of Act A constructs
To evaluate expression of Act A expression constructs, transfected cells were washed and pelleted. RNA was isolated by combining Trizol and Direct-zol RNA MiniPrep Kit (Zymo Research #2050) following the manufacturers protocols. During isolation, RNA is treated with DNAase, to remove any contaminating plasmid or genomic DNA. RNA concentration and purity was assessed using a NanoDrop 2000 spectrophotometer. Act A mRNA expression was evaluated using forward and reverse primers by RT-PCR.
Biological activity of secreted Act A
To assess biological activity of the expressed Act A variants, THP1 cells were incubated with 3 ml of conditioned medium obtained from cells transfected with each Act A variant for 2 hr, in the absence or presences of an ActA neutralizing antibody (BioLegend # 94746) the cells were pelleted and total RNA was isolated using TRIzol Reagent as described above. Induction of Kruppel-like factor 10 (KLF10, TIEG; accession NM_005655) mRNA, an early response gene induced by Act A and TGF-β was assessed by qPCR.
Peptides
Peptides encompassing the heparin binding domains, contained the putative Cardin-Weintraub (CW) motif and a minimum of 2 flanking amino acids on the N - and C - terminal sides of the domain. Three Glycine residues were added to the N-terminus of each peptide to provide a flexible linker between an N-terminal biotin tag and the peptide itself (See Table 6). Peptides were purified by reverse phase HPLC and peptide mass was confirmed by MALDI-TOF mass spectrometry. All peptides were synthesized and purified by Peptide 2 (Chantilly, VA). Where indicated, biotinylated peptides were oligomerized into tetramers by incubation with NAHRP (each avidin molecule binding 4 biotins ([57]) as described [31].
Tab. 6. Activin peptides.
Cells
U937 (human pro-monocytic) and THP-1 (human monocytic) cell lines were grown in RPMI containing 10% fetal bovine serum in a humidified atmosphere of 5% CO2. Cells were treated with PMA (100 ng/ml; 160 nM) for 4 hr (23) or GM-CSF (1 ng/ml) for 8 hr in RPMI containing 1% fetal bovine serum.
FACS analysis
Expression of CD116 (α subunit of GM-CSF receptor). U937 and THP1 cells were washed with PBS and fixed with 2% buffered formalin on ice for 20 min. The cells were washed with PBS and blocked by incubation in PBS, 1% BSA for 20 min. Cells were incubated with anti-Human CD116-PE (BD 551373) or IgG-ĸ-PE isotype control (BD 554680) on ice for 2 hr, washed with PBS and analyzed on a BD Accuri Flow Cytometer (FL2 channel), located in the Flow Cytometry Core Laboratory at CHOP.
Peptide binding to intact cells
U937 cells were washed with PBS and fixed with 2% buffered formalin for 20 min on ice. The cells were washed with PBS and blocked by incubation in PBS, 1% BSA for 20 min on ice. Approximately 106 cells (100 μl) were incubated with peptide tetramers consisting of biotinylated peptide complexed with NA-488. Following incubation for 2 hr on ice, the cells were washed and analyzed on a BD Accuri Flow Cytometer (FL1 channel), located in the Flow Cytometry Core Laboratory at CHOP.
In Silico modeling
Amino acid sequence alignments were performed using the T-coffee alignment tool (tcoffee.crg.cat). Helical wheel projections were constructed using using NetWheels: Peptides Helical Wheel and Net projections maker (lbqp.unb.br/NetWheels). Secondary structure predictions were carried out using the I-TASSER server for protein structure and function prediction [43] and the resulting structures were visualized using Chimera (www.cgl.ucsf.edu/chimera). The structures of Act A-X1 and Act A-X2 are based on the crystal structure of pro-TGF-β1 (PDB: 3RJR).
Solid phase binding assays
Nunc MaxiSorp flat bottom 96 well plates were coated with HS in 50 mM carbonate buffer (pH 9.4) overnight at 4°C as described [31]. All binding assays were carried out in 1 x PBS, 0.1% tween 20 (PBST) containing 1% bovine serum albumin. Plates were incubated with peptides for a minimum of 2 hr at room temperature with gentle shaking. At the termination of the assay, the plates were washed 3 times with PBST and a final rinse with PBS. Plates were developed by addition of HRP substrate O-phenylenediamine dihydrochloride (OPD) in Citrate-Phosphate buffer (25 mM citric acid, 50 mM sodium phosphate, pH 5) and read at 450 nm in a Bio-Tek Synergy HT plate reader. Very low levels of background binding were exhibited by NA-HRP alone or when complexed with biotinylated-BSA.
Statistical analysis
Statistical evaluation of data was performed using Student’s t-test employing GraphPad Prism software (www.graphpad.com).
Supporting information
S1 Fig [docx]
Genomic organization of human Activin B, C & E.S2 Fig [sp]
Protein Sequences of full-length human Activins.S3 Fig [arg]
Border region between prodomain (light gray) and active ligand (dark gray) of Activins.S4 Fig [2015]
Alignment and structure of human Activin ligands.S5 Fig [docx]
Sanger sequencing results.S1 Video [mp4]
ActA X1 mp4.S2 Video [mp4]
ActA X2 mp4.
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- Retraction: Comprehensive Comparison of Three Different Immunosuppressive Regimens for Liver Transplant Patients with Hepatocellular Carcinoma: Steroid-Free Immunosuppression, Induction Immunosuppression and Standard Immunosuppression
- Can acute suicidality be predicted by Instagram data? Results from qualitative and quantitative language analyses
- Computational and experimental analysis of the glycophosphatidylinositol-anchored proteome of the human parasitic nematode Brugia malayi
- Antibacterial activity of silver nanoparticles of different particle size against Vibrio Natriegens
- Genetic variations associated with response to dutasteride in the treatment of male subjects with androgenetic alopecia
- To eat or not to eat: Reward delay impulsivity in children with loss of control eating, attention deficit / hyperactivity disorder, a double diagnosis, and healthy children
- Factors associated with newborn care knowledge and practices in the upper Himalayas
- Correction: A more physiological approach to lipid metabolism alterations in cancer: CRC-like organoids assessment
- Correlates of concurrent partnerships and patterns of condom use among men who have sex with men and transgender women in Peru
- Ocular and systemic risk factors associated with recurrent disc hemorrhage in primary open-angle glaucoma
- Development of a denoising convolutional neural network-based algorithm for metal artifact reduction in digital tomosynthesis for arthroplasty: A phantom study
- Low-level sensory processes play a more crucial role than high-level cognitive ones in the size-weight illusion
- The prevalence of asthma and allergic rhinitis in Nigeria: A nationwide survey among children, adolescents and adults
- Retraction: Human Cystathionine-β-Synthase Phosphorylation on Serine227 Modulates Hydrogen Sulfide Production in Human Urothelium
- Which clinical and biochemical predictors should be used to screen for diabetes in patients with serious mental illness receiving antipsychotic medication? A large observational study
- Characteristics of diabetic macular edema patients refractory to anti-VEGF treatments and a dexamethasone implant
- Correction: Effects of dietary n-6: n-3 polyunsaturated fatty acid ratios on meat quality, carcass characteristics, tissue fatty acid profiles, and expression of lipogenic genes in growing goats
- Speckle tracking derived reference values of myocardial deformation and impact of cardiovascular risk factors – Results from the population-based STAAB cohort study
- Impact of pterygium on the ocular surface and meibomian glands
- Lack of association between hypothyroxinemia of prematurity and transient thyroid abnormalities with adverse long term neurodevelopmental outcome in very low birth weight infants
- Transcriptome divergence during leaf development in two contrasting switchgrass (Panicum virgatum L.) cultivars
- Study on Dalfampridine in the treatment of Multiple Sclerosis Mobility Disability: A meta-analysis
- Circulating progenitor cells and the expression of Cxcl12, Cxcr4 and angiopoietin-like 4 during wound healing in the murine ear
- EUSKOR: End-to-end coreference resolution system for Basque
- Inactivating pathogenic bacteria in greywater by biosynthesized Cu/Zn nanoparticles from secondary metabolite of Aspergillus iizukae; optimization, mechanism and techno economic analysis
- Exopolysaccharide producing rhizobacteria and their impact on growth and drought tolerance of wheat grown under rainfed conditions
- Structural equation modeling for hypertension and type 2 diabetes based on multiple SNPs and multiple phenotypes
- Correction: Association between ultraviolet radiation exposure dose and cataract in Han people living in China and Taiwan: A cross-sectional study
- Short-term exercise training improves cardiac function associated to a better antioxidant response and lower type 3 iodothyronine deiodinase activity after myocardial infarction
- Unexpected low genetic variation in the South American hystricognath rodent Lagostomus maximus (Rodentia: Chinchillidae)
- PRC2 activates interferon-stimulated genes indirectly by repressing miRNAs in glioblastoma
- Surgical resection is sufficient for incidentally discovered solitary pulmonary nodule caused by nontuberculous mycobacteria in asymptomatic patients
- “I do all I can but I still fail them”: Health system barriers to providing Option B+ to pregnant and lactating women in Malawi
- Impact of major illnesses and geographic regions on do-not-resuscitate rate and its potential cost savings in Taiwan
- Implementation of intermittent theta burst stimulation compared to conventional repetitive transcranial magnetic stimulation in patients with treatment resistant depression: A cost analysis
- Genome-wide analysis of DNA methylation profile identifies differentially methylated loci associated with human intervertebral disc degeneration
- Correction: Artificial neural networks reveal individual differences in metacognitive monitoring of memory
- Combining fish and environmental PCR for diagnostics of diseased laboratory zebrafish in recirculating systems
- Reading skill modulates the effect of parafoveal distractors on foveal lexical decision in deaf students
- Association between the posterior part of the circle of Willis and the vertebral artery hypoplasia
- Exposure to marital conflict: Gender differences in internalizing and externalizing problems among children
- Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials
- The effect of age and perturbation time on online control during rapid pointing
- Oilseed rape (Brassica napus) resistance to growth of Leptosphaeria maculans in leaves of young plants contributes to quantitative resistance in stems of adult plants
- Lymphocyte proliferation induced by high-affinity peptides for HLA-B*51:01 in Behçet’s uveitis
- Sensitization of avian pathogenic Escherichia coli to amoxicillin in vitro and in vivo in the presence of surfactin
- Genomic characterization of the complete terpene synthase gene family from Cannabis sativa
- Inhibition of gap junctional intercellular communication by an anti-migraine agent, flunarizine
- Levels of serum eosinophil cationic protein are associated with hookworm infection and intensity in endemic communities in Ghana
- Plant growth promoting rhizobacterium Stenotrophomonas maltophilia BJ01 augments endurance against N2 starvation by modulating physiology and biochemical activities of Arachis hypogea
- Hierarchical integrated and segregated processing in the functional brain default mode network within attention-deficit/hyperactivity disorder
- Rising co-payments coincide with unwanted effects on continuity of healthcare for patients with schizophrenia in the Netherlands
- Analysis of Zobellella denitrificans ZD1 draft genome: Genes and gene clusters responsible for high polyhydroxybutyrate (PHB) production from glycerol under saline conditions and its CRISPR-Cas system
- False-negative errors in next-generation sequencing contribute substantially to inconsistency of mutation databases
- Identification of potassium phosphite responsive miRNAs and their targets in potato
- Quantification of bell-shaped size selectivity in shrimp trawl fisheries using square mesh panels and a sorting cone after a Nordmøre grid
- Deactivation of somatosensory and visual cortices during vestibular stimulation is associated with older age and poorer balance
- Combined immunization with attenuated live influenza vaccine and chimeric pneumococcal recombinant protein improves the outcome of virus-bacterial infection in mice
- Flooding performance evaluation of alkyl aryl sulfonate in various alkaline environments
- An artificial intelligent diagnostic system on mobile Android terminals for cholelithiasis by lightweight convolutional neural network
- Enhanced detection of prion infectivity from blood by preanalytical enrichment with peptoid-conjugated beads
- COI metabarcoding primer choice affects richness and recovery of indicator taxa in freshwater systems
- Retraction: APRIL Induces Tumorigenesis and Metastasis of Colorectal Cancer Cells via Activation of the PI3K/Akt Pathway
- The intake pattern and feed preference of layer hens selected for high or low feed conversion ratio
- Individualized pattern recognition for detecting mind wandering from EEG during live lectures
- Ontogenetic expression of thyroid hormone signaling genes: An in vitro and in vivo species comparison
- Post-activation potentiation effect of eccentric overload and traditional weightlifting exercise on jumping and sprinting performance in male athletes
- Effectiveness of different central venous catheter fixation suture techniques: An in vitro crossover study
- Quantitative detection of ALK fusion breakpoints in plasma cell-free DNA from patients with non-small cell lung cancer using PCR-based target sequencing with a tiling primer set and two-step mapping/alignment
- Nuclei deformation reveals pressure distributions in 3D cell clusters
- Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study
- Rapid evolution of Mexican H7N3 highly pathogenic avian influenza viruses in poultry
- Certified service dogs – A cost-effectiveness analysis appraisal
- Endothelial dysfunction and low-grade inflammation in the transition to renal replacement therapy
- Assessing the impact of a research funder’s recommendation to consider core outcome sets
- Validity of six consumer-level activity monitors for measuring steps in patients with chronic heart failure
- Detection of deceptive motions in rugby from visual motion cues
- The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis
- Epidemiological investigation and management of bloody diarrhea among children in India
- Irisin promotes C2C12 myoblast proliferation via ERK-dependent CCL7 upregulation
- Bacteria isolated from Bengal cat (Felis catus × Prionailurus bengalensis) anal sac secretions produce volatile compounds potentially associated with animal signaling
- Petri net–based model of the human DNA base excision repair pathway
- Complexation and conformation of lead ion with poly-γ-glutamic acid in soluble state
- The effects of sympathetic activity induced by ice water on blood flow and brachial artery flow-mediated dilatation response in healthy volunteers
- The Youth-Physical Activity Towards Health (Y-PATH) intervention: Results of a 24 month cluster randomised controlled trial
- The COPD multi-dimensional phenotype: A new classification from the STORICO Italian observational study
- Morphological identification of Amphitetranychus species (Acari: Tetranychidae) with crossbreeding, esterase zymograms and DNA barcode data
- Maintaining hope after a disabling stroke: A longitudinal qualitative study of patients’ experiences, views, information needs and approaches towards making treatment decisions
- Cultural differences in the use of acoustic cues for musical emotion experience
- Effects of a rifampicin pre-treatment on linezolid pharmacokinetics
- High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands
- Infection/inflammation-associated preterm delivery within 14 days of presentation with symptoms of preterm labour: A multivariate predictive model
- Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: A meta-analysis
- Correction: Early life predictors of midlife allostatic load: A prospective cohort study
- PCR-free whole exome sequencing: Cost-effective and efficient in detecting rare mutations
- Epstein-Barr virus genome packaging factors accumulate in BMRF1-cores within viral replication compartments
- Symbiotic incompatibility between soybean and Bradyrhizobium arises from one amino acid determinant in soybean Rj2 protein
- Does anticoagulation needed for distally located incidental pulmonary thromboembolism in patients with active cancer?
- Control of human testis-specific gene expression
- Speaking up culture of medical students within an academic teaching hospital: Need of faculty working in patient safety
- Appraisal on the wound healing potential of Melaleuca alternifolia and Rosmarinus officinalis L. essential oil-loaded chitosan topical preparations
- Understanding parental perspectives on outcomes following paediatric encephalitis: A qualitative study
- Results of scoping review do not support mild traumatic brain injury being associated with a high incidence of chronic cognitive impairment: Commentary on McInnes et al. 2017
- Native seed, soil and atmosphere respond to boreal forest topsoil (LFH) storage
- Development of a quantitative polymerase chain reaction assay and environmental DNA sampling methods for Giant Gartersnake (Thamnophis gigas)
- Genetic diversity and population structure of four Chinese rabbit breeds
- Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study
- Correction: An impact evaluation of two rounds of mass drug administration on the prevalence of active trachoma: A clustered cross sectional survey
- Comparative prognostic accuracy of sepsis scores for hospital mortality in adults with suspected infection in non-ICU and ICU at an academic public hospital
- Graph convolutional network approach applied to predict hourly bike-sharing demands considering spatial, temporal, and global effects
- Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh
- Feeling the heat: Elevated temperature affects male display activity of a lekking grassland bird
- Constructing a comprehensive disaster resilience index: The case of Italy
- Intraocular pressure according to different types of tonometry (non-contact and Goldmann applanation) in patients with different degrees of bilateral tearing
- Prevalent vertebral fracture is dominantly associated with spinal microstructural deterioration rather than bone mineral density in patients with type 2 diabetes mellitus
- Silent volumetric multi-contrast 7 Tesla MRI of ocular tumors using Zero Echo Time imaging
- Nonverbal synchrony in virtual reality
- Do speed cameras reduce road traffic collisions?
- A zero-shot learning approach to the development of brain-computer interfaces for image retrieval
- Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d’Ivoire, West Africa: A cross-sectional study
- DNA barcoding of southern African crustaceans reveals a mix of invasive species and potential cryptic diversity
- Development of an international external quality assurance program for HIV-1 incidence using the Limiting Antigen Avidity assay
- Correction: The mean cell volume difference (dMCV) reflects serum hypertonicity in diabetic dogs
- Structural characteristics of lipocalin allergens: Crystal structure of the immunogenic dog allergen Can f 6
- Transport oil product consumption and GHG emission reduction potential in China: An electric vehicle-based scenario analysis
- Ontogenetic shift in the energy allocation strategy and physiological condition of larval plaice (Pleuronectes platessa)
- Increased proliferation and altered cell cycle regulation in pancreatic stem cells derived from patients with congenital hyperinsulinism
- Diagnostic accuracy of Xpert MTB/RIF assay and non-molecular methods for the diagnosis of tuberculosis lymphadenitis
- Assessment of glucose-6-phosphate dehydrogenase activity using CareStart G6PD rapid diagnostic test and associated genetic variants in Plasmodium vivax malaria endemic setting in Mauritania
- Spatial distribution of breast cancer in Sudan 2010-2016
- Human-induced fire regime shifts during 19th century industrialization: A robust fire regime reconstruction using northern Polish lake sediments
- Enhanced effectiveness of oil dispersants in destabilizing water-in-oil emulsions
- Development of UV spectrophotometry methods for concurrent quantification of amlodipine and celecoxib by manipulation of ratio spectra in pure and pharmaceutical formulation
- Iron and manganese co-limit growth of the Southern Ocean diatom Chaetoceros debilis
- Bilateral and unilateral load-velocity profiling in a machine-based, single-joint, lower body exercise
- Veterans Health Administration nurses’ training and beliefs related to care of patients with traumatic brain injury
- Supplementation strategies affect the feed intake and performance of grazing replacement heifers
- Active transcutaneous bone conduction hearing implants: Systematic review and meta-analysis
- Parameterization-induced uncertainties and impacts of crop management harmonization in a global gridded crop model ensemble
- Acidification effects on isolation of extracellular vesicles from bovine milk
- GPR40 full agonism exerts feeding suppression and weight loss through afferent vagal nerve
- Mining version history to predict the class instability
- Humpback whale song occurrence reflects ecosystem variability in feeding and migratory habitat of the northeast Pacific
- A phase 2 study of an oral mTORC1/mTORC2 kinase inhibitor (CC-223) for non-pancreatic neuroendocrine tumors with or without carcinoid symptoms
- Asprosin response in hypoglycemia is not related to hypoglycemia unawareness but rather to insulin resistance in type 1 diabetes
- Muscle oxygenation maintained during repeated-sprints despite inspiratory muscle loading
- Reconstructing systematic persistent impacts of promotional marketing with empirical nonlinear dynamics
- Trans-national conservation and infrastructure development in the Heart of Borneo
- Prediction of cardiovascular disease risk among people with severe mental illness: A cohort study
- Data in question: A survey of European biobank professionals on ethical, legal and societal challenges of biobank research
- Hypertensive APOL1 risk allele carriers demonstrate greater blood pressure reduction with angiotensin receptor blockade compared to low risk carriers
- Reconstructing birth in Australopithecus sediba
- Value of contrast-enhanced ultrasound for preoperative assessment of liver reserve function in patients with liver tumors
- Correction: Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians’ weight screening practice in outpatient clinics, Saudi Arabia
- Incidence and risk factors of loss to follow-up among HIV-infected children in an antiretroviral treatment program
- Changes in intracellular folate metabolism during high-dose methotrexate and Leucovorin rescue therapy in children with acute lymphoblastic leukemia
- Functional role and evolutionary contributions of floral gland morphoanatomy in the Paleotropical genus Acridocarpus (Malpighiaceae)
- On the efficiency of HIV transmission: Insights through discrete time HIV models
- Metabolic cost calculations of gait using musculoskeletal energy models, a comparison study
- Comparison of molecular profile in triple-negative inflammatory and non-inflammatory breast cancer not of mesenchymal stem-like subtype
- Evolutionary analysis of six chloroplast genomes from three Persea americana ecological races: Insights into sequence divergences and phylogenetic relationships
- Cultural transmission in a food preparation task: The role of interactivity, innovation and storytelling
- Correction: Effects of affective priming through music on the use of emotion words
- Safety and immunogenicity of investigational seasonal influenza hemagglutinin DNA vaccine followed by trivalent inactivated vaccine administered intradermally or intramuscularly in healthy adults: An open-label randomized phase 1 clinical trial
- Estimation of vaccination coverage from electronic healthcare records; methods performance evaluation – A contribution of the ADVANCE-project
- Dietary phytogenics and galactomannan oligosaccharides in low fish meal and fish oil-based diets for European sea bass (Dicentrarchus labrax) juveniles: Effects on gut health and implications on in vivo gut bacterial translocation
- Suicide by hanging: Results from a national survey in Switzerland and its implications for suicide prevention
- Gene dysregulation in peripheral blood of moyamoya disease and comparison with other vascular disorders
- Genome wide genetic dissection of wheat quality and yield related traits and their relationship with grain shape and size traits in an elite × non-adapted bread wheat cross
- Safety and tolerability of artesunate-amodiaquine, artemether-lumefantrine and quinine plus clindamycin in the treatment of uncomplicated Plasmodium falciparum malaria in Kinshasa, the Democratic Republic of the Congo
- Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach
- Comparison of post-traumatic changes in circulating and bone marrow leukocytes between BALB/c and CD-1 mouse strains
- Physiological stress reactivity and recovery related to behavioral traits in dogs (Canis familiaris)
- Associations between birth order with mental wellbeing and psychological distress in midlife: Findings from the 1970 British Cohort Study (BCS70)
- Non-steroidal anti-inflammatory drugs use in older adults decreases risk of Alzheimer’s disease mortality
- The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis
- Ancient technology and punctuated change: Detecting the emergence of the Edomite Kingdom in the Southern Levant
- Flowers as viral hot spots: Honey bees (Apis mellifera) unevenly deposit viruses across plant species
- Randomized control trial of Tools of the Mind: Marked benefits to kindergarten children and their teachers
- Preserving cultural heritage: Analyzing the antifungal potential of ionic liquids tested in paper restoration
- PNPLA3 rs738409 G allele carriers with genotype 1b HCV cirrhosis have lower viral load but develop liver failure at younger age
- Correction: Unraveling the genetic complexity underlying sorghum response to water availability
- Impact of tear metrics on the reliability of perimetry in patients with dry eye
- Using DNA barcoding to improve invasive pest identification at U.S. ports-of-entry
- Correction: Effects of Lactobacillus plantarum 15-1 and fructooligosaccharides on the response of broilers to pathogenic Escherichia coli O78 challenge
- Physico-chemical characterization and transcriptome analysis of 5-methyltryptophan resistant lines in rice
- Patient factors affecting successful linkage to treatment in a cervical cancer prevention program in Kenya: A prospective cohort study
- Is this a man’s world? The effect of gender diversity and gender equality on firm innovativeness
- Procalcitonin to stop antibiotics after cardiovascular surgery in a pediatric intensive care unit—The PROSACAB study
- Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock
- Quantitation of free glycation compounds in saliva
- Resolving an 87-year-old taxonomical curiosity with the description of Psylla frodobagginsi sp. nov. (Hemiptera: Sternorrhyncha: Psyllidae), a second distinct Psylla species on the New Zealand endemic plant kōwhai
- The effect of cathodal tDCS on fear extinction: A cross-measures study
- Physiological responses to affiliation during conversation: Comparing neurotypical males and males with Asperger syndrome
- Human cord blood (hCB)-CD34+ humanized mice fail to reject human acute myeloid leukemia cells
- Investigating the dispersal of antibiotic resistance associated genes from manure application to soil and drainage waters in simulated agricultural farmland systems
- Continuous norming of psychometric tests: A simulation study of parametric and semi-parametric approaches
- Phylogenetic microbiota profiling in fecal samples depends on combination of sequencing depth and choice of NGS analysis method
- Cost-effectiveness of apixaban compared to other anticoagulants in patients with atrial fibrillation in the real-world and trial settings
- Biochemical profile and in vitro biological activities of extracts from seven folk medicinal plants growing wild in southern Tunisia
- Low genetic differentiation yet high phenotypic variation in the invasive populations of Spartina alterniflora in Guangxi, China
- A mathematical model for designing networks of C-Reactive Protein point of care testing
- Prevalence of hypochondriac symptoms among health science students in China: A systematic review and meta-analysis
- Femtosecond laser induced step-like structures inside transparent hydrogel due to laser induced threshold reduction
- From In Situ to satellite observations of pelagic Sargassum distribution and aggregation in the Tropical North Atlantic Ocean
- The polyether ionophore salinomycin targets multiple cellular pathways to block proliferative vitreoretinopathy pathology
- BRAF V600E and Pten deletion in mice produces a histiocytic disorder with features of Langerhans cell histiocytosis
- HIV prevalence and risk behavior among male and female adults screened for enrolment into a vaccine preparedness study in Maputo, Mozambique
- Sputum microbiota and inflammation at stable state and during exacerbations in a cohort of chronic obstructive pulmonary disease (COPD) patients
- Direct estimation of the parameters of a delayed, intermittent activation feedback model of postural sway during quiet standing
- Occurrence mechanism and coping paths of accidents of highly aggregated tourist crowds based on system dynamics
- Correction: Low Dose Aerosol Fitness at the Innate Phase of Murine Infection Better Predicts Virulence amongst Clinical Strains of Mycobacterium tuberculosis
- Effects of enalapril and paricalcitol treatment on diabetic nephropathy and renal expressions of TNF-α, p53, caspase-3 and Bcl-2 in STZ-induced diabetic rats
- Correction: Public reaction to Chikungunya outbreaks in Italy—Insights from an extensive novel data streams-based structural equation modeling analysis
- Correction: Comparison of neurodegenerative types using different brain MRI analysis metrics in older adults with normal cognition, mild cognitive impairment, and Alzheimer’s dementia
- Intra-individual variability of sleep and nocturnal cardiac autonomic activity in elite female soccer players during an international tournament
- Therapeutic efficacy of equine botulism heptavalent antitoxin against all seven botulinum neurotoxins in symptomatic guinea pigs
- Interleukin 10 knock-down in bovine monocyte-derived macrophages has distinct effects during infection with two divergent strains of Mycobacterium bovis
- Clinical outcomes of bortezomib-based therapy in Taiwanese patients with multiple myeloma: A nationwide population-based study and a single-institute analysis
- Scope and efficacy of the broad-spectrum topical antiseptic choline geranate
- Hematological and biochemical parameters for Chinese rhesus macaque
- Veterinary peer study groups as a method of continuous education—A new approach to identify and address factors associated with antimicrobial prescribing
- Correction: The prognosis of heart failure patients: Does sodium level play a significant role?
- Maternal malaria but not schistosomiasis is associated with a higher risk of febrile infection in infant during the first 3 months of life: A mother-child cohort in Benin
- Systematic identification of facility-based stillbirths and neonatal deaths through the piloted use of an adapted RAPID tool in Liberia and Nepal
- Effects of salbutamol and phlorizin on acute pulmonary inflammation and disease severity in experimental sepsis
- Correction: Age, sex and storage time influence hair cortisol levels in a wild mammal population
- Reasons to care: Personal motivation as a key factor in the practice of the professional foster carer in Romania
- Determinants of clinical, functional and personal recovery for people with schizophrenia and other severe mental illnesses: A cross-sectional analysis
- Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff
- EGF receptor stimulation shifts breast cancer cell glucose metabolism toward glycolytic flux through PI3 kinase signaling
- The Better Management of Patients with Osteoarthritis Program: Outcomes after evidence-based education and exercise delivered nationwide in Sweden
- The negative effects of short-term extreme thermal events on the seagrass Posidonia oceanica are exacerbated by ammonium additions
- Pathogen invasion history elucidates contemporary host pathogen dynamics
- Chinese herbal formulae for the treatment of menopausal hot flushes: A systematic review and meta-analysis
- Healthcare resource utilization and costs for multiple sclerosis management in the Campania region of Italy: Comparison between centre-based and local service healthcare delivery
- Deconstruction of central line insertion guidelines based on the positive deviance approach—Reducing gaps between guidelines and implementation: A qualitative ethnographic research
- PBMCs transcriptome profiles identified breed-specific transcriptome signatures for PRRSV vaccination in German Landrace and Pietrain pigs
- The impact of admission serum lactate on children with moderate to severe traumatic brain injury
- Hypervirulent Klebsiella pneumoniae serotype K1 clinical isolates form robust biofilms at the air-liquid interface
- Determination of the bruise degree for cherry using Vis-NIR reflection spectroscopy coupled with multivariate analysis
- Genome-wide identification and expression profile analysis of nuclear factor Y family genes in Sorghum bicolor L. (Moench)
- Trends in maternal prepregnancy body mass index (BMI) and its association with birth and maternal outcomes in California, 2007–2016: A retrospective cohort study
- Distribution of the Duffy genotypes in Malaysian Borneo and its relation to Plasmodium knowlesi malaria susceptibility
- Hippocampal connectivity with sensorimotor cortex during volitional finger movements: Laterality and relationship to motor learning
- A self-adaptive deep learning method for automated eye laterality detection based on color fundus photography
- The effect of child marriage on the utilization of maternal health care in Nepal: A cross-sectional analysis of Demographic and Health Survey 2016
- Identification of QTLs for powdery mildew (Podosphaera aphanis; syn. Sphaerotheca macularis f. sp. fragariae) susceptibility in cultivated strawberry (Fragaria ×ananassa)
- Chemical volatiles present in cotton gin trash: A by-product of cotton processing
- PTP1B negatively regulates nitric oxide-mediated Pseudomonas aeruginosa killing by neutrophils
- Differential metabolomics networks analysis of menopausal status
- Experimental study of the temporal profile of breath alcohol concentration in a Chinese population after a light meal
- Association between regional brain volumes and BMI z-score change over one year in children
- Relationships between Potentially Toxic Elements in intertidal sediments and their bioaccumulation by benthic invertebrates
- Long-term outcomes of dialysis in patients with chronic kidney disease and new-onset atrial fibrillation: A population-based cohort study
- Hospital burden of pulmonary arterial hypertension in France
- Understanding the variability of Australian fire weather between 1973 and 2017
- Photon-counting cine-cardiac CT in the mouse
- Ecophysiological impacts of Esca, a devastating grapevine trunk disease, on Vitis vinifera L.
- Black “Reading the Mind in the Eyes” task: The development of a task assessing mentalizing from black faces
- Osmolytes ameliorate the effects of stress in the absence of the heat shock protein Hsp104 in Saccharomyces cerevisiae
- Reliable and robust method for abdominal muscle mass quantification using CT/MRI: An explorative study in healthy subjects
- Validation of the Rainbow Model of Integrated Care Measurement Tools (RMIC-MTs) in renal care for patient and care providers
- Multiple origins and the population genetic structure of Rubus takesimensis (Rosaceae) on Ulleung Island: Implications for the genetic consequences of anagenetic speciation
- Genetic profiling of fatty acid desaturase polymorphisms identifies patients who may benefit from high-dose omega-3 fatty acids in cardiac remodeling after acute myocardial infarction—Post-hoc analysis from the OMEGA-REMODEL randomized controlled trial
- A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders
- Optimising outputs from a validated online instrument to measure health-related quality of life (HRQL) in dogs
- Young adults’ perceptions of using wearables, social media and other technologies to detect worsening mental health: A qualitative study
- Characteristics of prescription in 29 Level 3 Neonatal Wards over a 2-year period (2017-2018). An inventory for future research
- Genetic characterization of fall armyworm (Spodoptera frugiperda) in Ecuador and comparisons with regional populations identify likely migratory relationships
- Correction: Lkb1 Deficiency Alters Goblet and Paneth Cell Differentiation in the Small Intestine
- Cardiac resynchronization therapy-heart failure (CRT-HF) clinic: A novel model of care
- Synteny and phylogenetic analysis of paralogous thyrostimulin beta subunits (GpB5) in vertebrates
- Dual-Subpopulation as reciprocal optional external archives for differential evolution
- NGS analysis in Marfan syndrome spectrum: Combination of rare and common genetic variants to improve genotype-phenotype correlation analysis
- Optimization of cataract surgery follow-up: A standard set of questions can predict unexpected management changes at postoperative week one
- Silymarin in non-cirrhotics with non-alcoholic steatohepatitis: A randomized, double-blind, placebo controlled trial
- Clinical evaluation of General Electric new Swiftscan solution in bone scintigraphy on NaI-camera: A head to head comparison with Siemens Symbia
- Pharmacist-led academic detailing improves statin therapy prescribing for Malaysian patients with type 2 diabetes: Quasi-experimental design
- Proton pump inhibitors attenuate myofibroblast formation associated with thyroid eye disease through the aryl hydrocarbon receptor
- Clinical outcomes with neoadjuvant versus adjuvant chemotherapy for triple negative breast cancer: A report from the National Cancer Database
- Identification and characterization of a novel heparan sulfate-binding domain in Activin A longest variants and implications for function
- Wikipedia network analysis of cancer interactions and world influence
- Using path signatures to predict a diagnosis of Alzheimer’s disease
- Development and verification of prediction models for preventing cardiovascular diseases
- Additive and heterozygous (dis)advantage GWAS models reveal candidate genes involved in the genotypic variation of maize hybrids to Azospirillum brasilense
- Fish tank granuloma: An emerging skin disease in Iran mimicking Cutaneous Leishmaniasis
- Transience effect in capture-recapture studies: The importance of its biological meaning
- Detailed global modelling of soil organic carbon in cropland, grassland and forest soils
- Oral dosing for antenatal corticosteroids in the Rhesus macaque
- Retraction: Modulation of the Pentose Phosphate Pathway Induces Endodermal Differentiation in Embryonic Stem Cells
- An analysis on HBsAg, Anti-HCV, Anti-HIV½ and VDRL test results in blood donors according to gender, age range and years
- Clinical factors associated with bacterial translocation in Japanese patients with type 2 diabetes: A retrospective study
- Meaningful work and resilience among teachers: The mediating role of work engagement and job crafting
- The conditional Fama-French model and endogenous illiquidity: A robust instrumental variables test
- Breast cancers utilize hypoxic glycogen stores via PYGB, the brain isoform of glycogen phosphorylase, to promote metastatic phenotypes
- Characterization of sequentially-staged cancer cells using electrorotation
- Vancomycin-laden calcium phosphate-calcium sulfate composite allows bone formation in a rat infection model
- Genetic evidence for plural introduction pathways of the invasive weed Paterson’s curse (Echium plantagineum L.) to southern Australia
- Risk of major autoimmune diseases in female breast cancer patients: A nationwide, population-based cohort study
- Real-time three-dimensional MRI for the assessment of dynamic carpal instability
- Interim report on the effective intraperitoneal therapy of insulin-dependent diabetes mellitus in pet dogs using “Neo-Islets,” aggregates of adipose stem and pancreatic islet cells (INAD 012-776)
- The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: A single centre experience
- Retraction: Analysis of Mycobacterium tuberculosis-Specific CD8 T-Cells in Patients with Active Tuberculosis and in Individuals with Latent Infection
- The association between role model presence and self-regulation in early adolescence: A cross-sectional study
- Correction: A controlled-release oral opioid supports S. aureus survival in injection drug preparation equipment and may increase bacteremia and endocarditis risk
- Methamphetamine regulation of activity and topology of ventral midbrain networks
- Evaluation and treatment of latent tuberculosis infection among healthcare workers in Korea: A multicentre cohort analysis
- Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA
- TCF4 induces enzalutamide resistance via neuroendocrine differentiation in prostate cancer
- Structural characterization of EGFR exon 19 deletion mutation using molecular dynamics simulation
- Comparing infiltration rates in soils managed with conventional and alternative farming methods: A meta-analysis
- Correction: Permissivity of Primary Human Hepatocytes and Different Hepatoma Cell Lines to Cell Culture Adapted Hepatitis C Virus
- Radiomics features of the primary tumor fail to improve prediction of overall survival in large cohorts of CT- and PET-imaged head and neck cancer patients
- The complete mitochondrial genome of Calyptogena marissinica (Heterodonta: Veneroida: Vesicomyidae): Insight into the deep-sea adaptive evolution of vesicomyids
- Correction: In vitro larval rearing protocol for the stingless bee species Melipona scutellaris for toxicological studies
- Correction: Morphological and molecular identification of the dioecious “African species Volvox rousseletii (Chlorophyceae) in the water column of a Japanese lake based on field-collected and cultured materials
- Upper versus lower airway microbiome and metagenome in children with cystic fibrosis and their correlation with lung inflammation
- “…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study
- Does a spinal implant alter dual energy X-ray absorptiometry body composition measurements?
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- Effectiveness, safety/tolerability of OBV/PTV/r ± DSV in patients with HCV genotype 1 or 4 with/without HIV-1 co-infection, chronic kidney disease (CKD) stage IIIb-V and dialysis in Spanish clinical practice – Vie-KinD study
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- Effect of PEPFAR funding policy change on HIV service delivery in a large HIV care and treatment network in Nigeria
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- Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique
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- Preferences for formal and traditional sources of childbirth and postnatal care among women in rural Africa: A systematic review
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- A review of the elusive bicolored iris Snouted Treefrogs (Anura: Hylidae:Scinax uruguayus group)
- Development of peptide biosensor for the detection of dengue fever biomarker, nonstructural 1
- The predictive performance of SAPS 2 and SAPS 3 in an intermediate care unit for internal medicine at a German university transplant center; A retrospective analysis
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- Mapping online hate: A scientometric analysis on research trends and hotspots in research on online hate
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- Small molecule inhibition of lysine-specific demethylase 1 (LSD1) and histone deacetylase (HDAC) alone and in combination in Ewing sarcoma cell lines
- Governing Tripolye: Integrative architecture in Tripolye settlements
- In vitro selective cytotoxicity of the dietary chalcone cardamonin (CD) on melanoma compared to healthy cells is mediated by apoptosis
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- Robust methods in Mendelian randomization via penalization of heterogeneous causal estimates
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- Studying the link between physiological performance of Crotalaria ochroleuca and the distribution of Ca, P, K and S in seeds with X-ray fluorescence
- Characterization of bony changes localized to the cervical articular processes in a mixed population of horses
- Heat shock-induced chaperoning by Hsp70 is enabled in-cell
- Disability and its association with sociodemographic factors among elderly persons residing in an urban resettlement colony, New Delhi, India
- Correlates of prenatal and postnatal mother-to-infant bonding quality: A systematic review
- IGFBP2 promotes immunosuppression associated with its mesenchymal induction and FcγRIIB phosphorylation in glioblastoma
- Dietary supplementation with the extract from Eucommia ulmoides leaves changed epithelial restitution and gut microbial community and composition of weanling piglets
- How did that interaction make you feel? The relationship between quality of everyday social experiences and emotion in people with and without schizophrenia
- Effects of Lyse-It on endonuclease fragmentation, function and activity
- Overexpression of rice gene OsATG8b confers tolerance to nitrogen starvation and increases yield and nitrogen use efficiency (NUE) in Arabidopsis
- Gait can reveal sleep quality with machine learning models
- Blast vacuolization in AML patients indicates adverse-risk AML and is associated with impaired survival after intensive induction chemotherapy
- Mitochondrial fragmentation and network architecture in degenerative diseases
- Quadriceps muscle strength is a discriminant predictor of dependence in daily activities in nursing home residents
- Discovery of novel West Nile Virus protease inhibitor based on isobenzonafuranone and triazolic derivatives of eugenol and indan-1,3-dione scaffolds
- Skin-associated lactic acid bacteria from North American bullfrogs as potential control agents of Batrachochytrium dendrobatidis
- Microbiota of MR1 deficient mice confer resistance against Clostridium difficile infection
- The responses of extracellular enzyme activities and microbial community composition under nitrogen addition in an upland soil
- Post-translational S-glutathionylation of cofilin increases actin cycling during cocaine seeking
- Absolute pitch can be learned by some adults
- Anger while driving in Mexico City
- Glomerular hyperfiltration may be a novel risk factor of restrictive spirometry pattern: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2015
- Survival of infants ≤24 months of age with brain tumors: A population-based study using the SEER database
- Multiple evoked and induced alpha modulations in a visual attention task: Latency, amplitude and topographical profiles
- Heart rate variability reduction is related to a high amount of visceral adiposity in healthy young women
- Serum and urinary metabolomics and outcomes in cirrhosis
- Optimal threshold of adherence to lipid lowering drugs in predicting acute coronary syndrome, stroke, or mortality: A cohort study
- Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis
- How Knowledge Stock Exchanges can increase student success in Massive Open Online Courses
- CT-perfusion in peripheral arterial disease – Correlation with angiographic and hemodynamic parameters
- Pattern of health care utilization and traditional and complementary medicine use among Ebola survivors in Sierra Leone
- Respiratory variations in pulse pressure and photoplethysmographic waveform amplitude during positive expiratory pressure and continuous positive airway pressure in a model of progressive hypovolemia
- Dorsal tongue porphyrin autofluorescence and Candida saprophytism: A prospective observational study
- A usability study to improve a clinical decision support system for the prescription of antibiotic drugs
- Occurrence of and risk factors for extended-spectrum cephalosporin-resistant Enterobacteriaceae determined by sampling of all Norwegian broiler flocks during a six month period
- Healthcare facility-based strategies to improve tuberculosis testing and linkage to care in non-U.S.-born population in the United States: A systematic review
- Correction: Reward abundance interferes with error-based learning in a visuomotor adaptation task
- Correction: Potential user interest in new long-acting contraceptives: Results from a mixed methods study in Burkina Faso and Uganda
- Correction: Recombinant rabbit beta nerve growth factor production and its biological effects on sperm and ovulation in rabbits
- Critically ill patients with community-onset intraabdominal infections: Influence of healthcare exposure on resistance rates and mortality
- Validating a popular outpatient antibiotic database to reliably identify high prescribing physicians for patients 65 years of age and older
- Metabolisable energy content in canine and feline foods is best predicted by the NRC2006 equation
- Group conquers efficacy: Preschoolers’ imitation under conflict between minimal group membership and behavior efficacy
- Warmth and competence stereotypes about immigrant groups in Germany
- Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: A mixed-methods study
- ER stress activation in the intestinal mucosa but not in mesenteric adipose tissue is associated with inflammation in Crohn’s disease patients
- Enhancing percutaneous pedicle screw fixation with hydroxyapatite granules: A biomechanical study using an osteoporotic bone model
- Optimum plant density for crowding stress tolerant processing sweet corn
- Sign and goal tracker rats process differently the incentive salience of a conditioned stimulus
- Interocular symmetry, intraobserver repeatability, and interobserver reliability of cone density measurements in the 13-lined ground squirrel
- Plasma metabolite biomarkers for multiple system atrophy and progressive supranuclear palsy
- Knowledge, attitudes and practices of livestock and aquaculture producers regarding antimicrobial use and resistance in Vietnam
- Scientific sinkhole: The pernicious price of formatting
- Resource consumption of multi-substance users in the emergency room: A neglected patient group
- Association between distress and knowledge among parents of autistic children
- Surgical approach for complete cochlear coverage in EAS-patients after residual hearing loss
- The impact of a rapid molecular identification test on positive blood cultures from critically ill with bacteremia: A pre-post intervention study
- Shortening duration of ertapenem in outpatient parenteral antimicrobial therapy for complicated urinary tract infections: A retrospective study
- Measurement and analysis of partial lightning currents in a head phantom
- Within species expressed genetic variability and gene expression response to different temperatures in the rotifer Brachionus calyciflorus sensu stricto
- Repeated transspinal stimulation decreases soleus H-reflex excitability and restores spinal inhibition in human spinal cord injury
- Expression of Concern: Resveratrol Enhances Antitumor Activity of TRAIL in Prostate Cancer Xenografts through Activation of FOXO Transcription Factor
- Correlation of CT texture changes with treatment response during radiation therapy for esophageal cancer: An exploratory study
- Modeling spatial variation in density of golden eagle nest sites in the western United States
- Retraction: Autophagy in Muscle of Glucose-Infusion Hyperglycemia Rats and Streptozotocin-Induced Hyperglycemia Rats via Selective Activation of m-TOR or FoxO3
- Correction: In Porphyromonas gingivalis VimF Is Involved in Gingipain Maturation through the Transfer of Galactose
- Gibberellic acid in Citrus spp. flowering and fruiting: A systematic review
- Discharge care quality in hospitalised elderly patients: Extended validation of the Discharge Care Experiences Survey
- A novel therapeutic strategy for esophageal varices using endoscopic treatment combined with splenic artery embolization according to the Child-Pugh classification
- Correction: Development of a high-throughput assay to measure measles neutralizing antibodies
- Correction: Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana
- Correction: Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis
- Potential impact of efflux pump genes in mediating rifampicin resistance in clinical isolates of Mycobacterium tuberculosis from India
- Feed-forward visual processing suffices for coarse localization but fine-grained localization in an attention-demanding context needs feedback processing
- Level Set method-based two-dimensional numerical model for simulation of nonuniform open-channel flow
- Compared to non-drinkers, individuals who drink alcohol have a more favorable multisystem physiologic risk score as measured by allostatic load
- Effect of poor glycaemic control on plasma levels and activity of protein C, protein S, and antithrombin III in type 2 diabetes mellitus
- Retraction: IL-21 Regulates the Differentiation of a Human γδ T Cell Subset Equipped with B Cell Helper Activity
- Sugar transporters in Fabaceae, featuring SUT MST and SWEET families of the model plant Medicago truncatula and the agricultural crop Pisum sativum
- Prediction of lymphovascular space invasion in endometrial cancer using the 55-gene signature selected by DNA microarray analysis
- Research on multi-agent genetic algorithm based on tabu search for the job shop scheduling problem
- Diagnosing the current state of out-of-field teaching in high school science and mathematics
- Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production
- Comorbidity of age-related macular degeneration with Alzheimer’s disease: A histopathologic case-control study
- Acute ex vivo changes in brain white matter diffusion tensor metrics
- Regulatory interaction between the ZPBP2-ORMDL3/Zpbp2-Ormdl3 region and the circadian clock
- The effect of bacteria on planula-larvae settlement and metamorphosis in the octocoral Rhytisma fulvum fulvum
- Sodium alginate potentiates antioxidant defense and PR proteins against early blight disease caused by Alternaria solani in Solanum lycopersicum Linn.
- Ground reaction forces and muscle activity while walking on sand versus stable ground in individuals with pronated feet compared with healthy controls
- Correction: Roadway traffic crash prediction using a state-space model based support vector regression approach
- MET as resistance factor for afatinib therapy and motility driver in gastric cancer cells
- Genetic analysis and fine mapping of a qualitative trait locus wpb1 for albino panicle branches in rice
- Clinical features of pulmonary embolism in patients with lung cancer: A meta-analysis
- Cinobufacini ameliorates experimental colitis via modulating the composition of gut microbiota
- Factors restraining the population growth of Varroa destructor in Ethiopian honey bees (Apis mellifera simensis)
- Coastal proximity of populations in 22 Pacific Island Countries and Territories
- DKK1 promotes hepatocellular carcinoma inflammation, migration and invasion: Implication of TGF-β1
- Genetic characterization of Angiostrongylus larvae and their intermediate host, Achatina fulica, in Thailand
- Targeted in-vitro-stimulation reveals highly proliferative multi-virus-specific human central memory T cells as candidates for prophylactic T cell therapy
- Influence of ocean circulation and the Kuroshio large meander on the 2018 Japanese eel recruitment season
- Growth response of the ichthyotoxic haptophyte, Prymnesium parvum Carter, to changes in sulfate and fluoride concentrations
- Letrozole treatment of pubertal female mice results in activational effects on reproduction, metabolism and the gut microbiome
- Prognostic nomogram predicts overall survival in pulmonary large cell neuroendocrine carcinoma
- Microbiome profiling of the onion thrips, Thrips tabaci Lindeman (Thysanoptera: Thripidae)
- Characteristics of proximal early gastric cancer differentiating distal early gastric cancer
- Retraction: Impacts of rock properties on Danxia landform formation based on lithological experiments at Kongtongshan National Geopark, northwest China
- Correction: SVR12 rates higher than 99% after sofosbuvir/velpatasvir combination in HCV infected patients with F0-F1 fibrosis stage: A real world experience
- Retraction: Plexin-B1 Activates NF-κB and IL-8 to Promote a Pro-Angiogenic Response in Endothelial Cells
- Relationship between cognitive behavioral variables and mental health status among university students: A meta-analysis
- Association between temperature, sunlight hours and alcohol consumption
- Using graph learning to understand adverse pregnancy outcomes and stress pathways
- Correction: The step-to-step transition mode: A potential indicator of first-fall risk in elderly adults?
- Surgical referral systems in low- and middle-income countries: A review of the evidence
- In vivo clearance of nanoparticles by transcytosis across alveolar epithelial cells
- Correction: The Economic Impact of Malignant Catarrhal Fever on Pastoralist Livelihoods
- Correction: Identification of miRNAs involved in fruit ripening by deep sequencing of Olea europaea L. transcriptome
- Correction: Characterization of ecto- and endoparasite communities of wild Mediterranean teleosts by a metabarcoding approach
- Correction: Vascular Endothelial Growth Factor Receptor-2 Couples Cyclo-Oxygenase-2 with Pro-Angiogenic Actions of Leptin on Human Endothelial Cells
- Correction: Plant traits linked to field-scale flammability metrics in prescribed burns in Eucalyptus forest
- Correction: Maturation of three-dimensional, hiPSC-derived cardiomyocyte spheroids utilizing cyclic, uniaxial stretch and electrical stimulation
- Correction: To keep or not to keep? Decision making in adolescent pregnancies in Jamestown, Ghana
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