Originally published In Press as doi:10.1074/jbc.M200062200 on February 4, 2002
J. Biol. Chem., Vol. 277, Issue 16, 13569-13577, April 19, 2002
Activation of TRPV4 Channels (hVRL-2/mTRP12) by Phorbol
Derivatives*
Hiroyuki
Watanabe
,
John B.
Davis§,
Darren
Smart§,
Jeff C.
Jerman§,
Graham D.
Smith§,
Phil
Hayes§,
Joris
Vriens
,
William
Cairns§,
Ullrich
Wissenbach¶,
Jean
Prenen
,
Veit
Flockerzi¶,
Guy
Droogmans
,
Christopher D.
Benham§, and
Bernd
Nilius
From the
Department of Physiology, Campus
Gasthuisberg, KU Leuven, B-3000 Leuven, Belgium,
§ Neurology CEDD and Discovery Research, GlaxoSmithKline,
CM195AW Harlow, United Kingdom, and the ¶ Institut
für Pharmakologie und Toxikologie, Universität des
Saarlandes, D-66427 Homburg (Saar), Germany
Received for publication, January 3, 2002, and in revised form, January 28, 2002
 |
ABSTRACT |
We have studied activation by phorbol derivatives
of TRPV4 channels, the human VRL-2, and murine TRP12 channels, which
are highly homologous to the human VR-OAC, and the human and murine OTRPC4 channel. 4
-Phorbol 12,13-didecanoate (4
-PDD) induced an
increase in intracellular Ca2+ concentration,
[Ca2+]i, in 1321N1 cells stably transfected with
human VRL-2 (hVRL-2.1321N1) or HEK-293 cells transiently transfected
with murine TRP12, but not in nontransfected or mock-transfected cells. Concomitantly with the increase in [Ca2+]i,
4
-PDD activated an outwardly rectifying cation channel with an
Eisenman IV permeation sequence for monovalent cations that is
Ca2+-permeable with
PCa/PNa = 5.8. Phorbol
12-myristate 13-acetate also induced an increase in
[Ca2+]i but was ~50 times less effective than
4
-PDD. EC50 for Ca2+ increase and current
activation was nearly identical (pEC50 ~ 6.7). Similar
effects were observed in freshly isolated mouse aorta endothelial cells
which express TRP12 endogenously. By using 4
-PDD as a tool to
stimulate TRP12, we showed that activation of this channel is modulated
by [Ca2+]i; an increase in
[Ca2+]i inhibits the channel with an
IC50 of 406 nM. Ruthenium Red at a
concentration of 1 µM completely blocks inward currents at
80 mV but has a smaller effect on outward currents likely indicating a voltage dependent channel block. We concluded that the
phorbol derivatives activate TRPV4 (VR-OAC, VRL-2, OTRPC4, TRP12)
independently from protein kinase C, in a manner consistent with direct
agonist gating of the channel.
 |
INTRODUCTION |
The TRPV subfamily of transient receptor potential cation channels
(for a unified nomenclature, see Ref. 1) consists of members with
completely different mechanisms of gating. Proteins of this subfamily
contain typically three to six ankyrin repeats in the N terminus and
six transmembrane segments with a pore region between segments 5 and 6. The first identified nonmammalian member of this subfamily, the
Caenorhabditis elegans OSM-9 channel, is activated by
changes in osmolarity (2). The second protein identified in the TRPV
family is the mammalian vanilloid receptor channel VR1, which is
activated by vanilloid compounds such as capsaicin, pepper, hot chili,
moderate heat, or protons (3). Unlike VR1, another close relative of
this channel, VRL-1, is constitutively activated by growth factors (4)
or by noxious heat (5). Other members of this family are
mechano-sensitive, such as the stretch-inactivated channel SIC, which
seems to be gated by cell shrinkage (6). In contrast, the highly
Ca2+-selective ECaC1 (CaT2) and ECaC2 (CaT1) channels are
down-regulated by intracellular Ca2+ and have been reported
to be gated by depletion of intracellular Ca2+ stores
(7).
We have studied, in the present report, the gating properties of yet
another cation channel with a moderate Ca2+ permeability,
TRPV4 (also known as OTRPC4, VR-OAC, or TRP12), which senses changes in
cell volume (8-11) by an unknown mechanism, and show that the human
VRL-2 channel (identical to VR-OAC) and the murine TRP12 (identical to
OTRPC4) can also be gated by binding of an agonist; phorbol esters
activate both channels in astrocytoma cells 1321N1 stably transfected
with VRL-2 (hVRL-2.1321N1 cells) and in HEK-293 cells transiently
transfected with TRP12. In addition, we show that these phorbol esters
activate a current in mouse aorta endothelial cells, which endogenously
express TRP12 (8), which is identical to that in cells expressing
recombinant TRP12. These novel findings may catalyze the search for an
endogenous activator of this Ca2+-permeable TRPV channel
and provide a reliable tool to study functional effects of TRPV stimulation.
 |
MATERIALS AND METHODS |
Cell Culture
hVRL-2 Stable Cell Line (hVRL-2.1321N1)--
At the amino acid
level, VRL-2 is 100% identical to hOTRPC4
(GenBankTM accession number AF258465) and differs in
only one amino acid with the human hVROAC (GenBankTM
accession number AF263523). 1321N1 astrocytoma cells, stably transfected with VRL-2, were grown in Dulbecco's modified Eagle's medium containing 10% (v/v) human serum, 2 mM
L-glutamine, 2 units/ml penicillin, and 2 mg/ml
streptomycin at 37 °C in a humidity controlled incubator with 10%
CO2. Quantitative reverse transcriptase-PCR analysis
suggested that there was no expression of VRL-2 in wild type 1321N1 cells.
Transient Expression of mTRP12--
We used the recombinant
bicistronic expression plasmid pdiTRP12, which carries the entire
protein coding region for TRP12 and the green fluorescent protein, GFP
(8), for transient transfection. Human embryonic kidney cells, HEK-293,
were grown in Dulbecco's modified Eagle's medium containing
10% (v/v) human serum, 2 mM L-glutamine, 2 units/ml penicillin, and 2 mg/ml streptomycin at 37 °C in a
humidity-controlled incubator with 10% CO2. HEK-293 cells,
transiently transfected with the above described vector, were visually
identified in the patch clamp set up. GFP was excited at a wavelength
between 425 and 475 nm. The emitted light was passed via a 495 nm
dichroic mirror through a 500 nm long-pass filter. The TRP12-expressing
cells were identified by their green fluorescence. Nontransfected cells
from the same batch were used as controls.
Endothelial Cells--
The "primary explant technique" was
used to study freshly isolated endothelial cells from mouse aorta. This
method is described in detail elsewhere (12, 13). These cells express
TRP12 as previously shown with Northern blot analysis (8). As a
reference we used the endothelial cell line EA.hyb926 (14), which
does not respond to TRP12 activation. These cells were cultured as described elsewhere (15, 16).
Solutions
For electrophysiological measurements, the standard
extracellular solution contained (in mM): 150 NaCl, 6 KCl,
1 MgCl2, 1.5 or 5 CaCl2, 10 glucose, 10 HEPES,
buffered at pH 7.4 with NaOH. The osmolality of this solution, as
measured with a vapor pressure osmometer (Wescor 5500, Schlag,
Gladbach, Germany), was 320 ± 5 mosmol. To compare
volume-activated currents with 4
-PDD activated currents, we used a
solution containing (in mM): 110 NaCl, 1 MgCl2, 1 CaCl2, 10 glucose, 10 HEPES, 95 mannitol, buffered pH 7.4 with NaOH. The normal hypotonic stimulation
(HTS)1 was done by
superfusion of the cells with this solution but without mannitol (240 mosmol, 25% reduction of osmolarity). Pipette solution was
composed of (in mM): 20 CsCl, 100 cesium aspartate,
1 MgCl2, 4 Na2ATP, 0.1 EGTA, 10 HEPES, pH
adjusted to 7.2 with CsOH. If indicated, [Ca2+]i
was buffered in the presence of 10 mM BAPTA to 1 nM or respective intracellular concentrations. 4
-Phorbol
12,13-didecanoate (4
-PDD), a non-PKC-activating phorbol ester, and
phorbol 12-myristate 13-acetate (PMA, both from Sigma) were applied at
concentrations between 10 nM and 30 µM from
30 mM stock solutions in ethanol. Ruthenium Red (Fluka) was
used at a concentration of 1 µM. Resiniferatoxin (RTX,
Sigma) and capsaicin (Sigma) were used in concentrations of 100, 500, and 1000 nM from a stock solution of 1 mM in
ethanol. Capsazepine (Sigma) was used at a concentration of 10 µM. 12-HPETE (12-hydroperoxyeicosatetraenoic acid, Sigma)
was used at a concentration of 10 µM in the pipette
solution. Extra- and intracellular solutions contained Cs+
salts to inhibit K+ currents, which are present in a few,
but not all, HEK cells. For changes in acid load, we have omitted NaOH,
which resulted in a pH of the HEPES-buffered solution of 5.5. All
experiments were performed at room temperature (20-23 °C).
Electrophysiological Recordings
Whole-cell membrane currents were monitored with an EPC-9 (HEKA
Elektronik, Lambrecht, Germany, 8-Pole Bessel filter 2.9 kHz) using
ruptured patches. Patch electrodes had a DC resistance between 2 and 4 M
. An Ag-AgCl wire was used as a reference electrode. Capacitance
and access resistances were monitored continuously. Between 50 and 70%
of the series resistance was electronically compensated to minimize
voltage errors. If not mentioned otherwise, we have applied one of two
ramp protocols. (a) A protocol consisting of a voltage step
to
100 mV for 20 ms followed by a 180-ms linear ramp to +100 mV,
sampling interval: 0.1 ms. This protocol was repeated every 5 or
10 s. (b) A ramp protocol from
150 to +100 mV,
lasting 400 ms and repeated every 5 s, sampling interval 0.8 ms.
Time courses of the whole-cell current and current densities were
obtained by averaging the current in a narrow window around
80 mV
during the voltage ramp protocol.
Measurement of Intracellular Ca2+ Concentrations
Using the FLIPRTM
Intracellular Ca2+ concentrations were monitored
using FLIPRTM (Molecular Devices, Wokingham, UK) as
described previously (17). Briefly, hVRL-2.1321N1 cells, seeded into
96-well plates (25,000 cells per well), were incubated with culture
medium containing the cytoplasmic Ca2+ indicator, Fluo-3 (4 µM; Teflabs, Austin, TX) at 25 °C for 120 min. The
cells were then washed four times with Tyrode medium containing 0.1%
bovine serum albumin, before being incubated for 30 min at 25 °C
with either Tyrode alone (control) or Tyrode containing various
antagonists. The plates were then placed into a FLIPRTM to
monitor cell fluorescence (
ex = 488 nm,
EM = 540 nm) (18) before and after the addition of
various agonists. Responses were measured as peak minus basal
fluorescence intensity and where appropriate expressed as a percentage
of a maximum carbachol-induced response. Data are expressed as
means ± S.E. unless otherwise stated. Curve fitting and parameter
estimation were carried out using GraphPad Prism 3.00 (GraphPad
Software Inc., San Diego, CA). Statistical comparisons were made where
appropriate using Student's t test.
Combined Ca2+ and Patch Clamp Measurements--
For
[Ca2+]i measurements combined with patch clamp,
single cells were loaded with 100 µM Fura-II-potassium
salt. The dye was excited alternately at wavelengths of 360 and 390 nm
through a filter wheel rotating at 2 cycles/second. The fluorescence
was measured at 510 nm and corrected for autofluorescence, measured from the cell-free background. Apparent free [Ca2+] was
calculated from the fluorescence ratio R by
[Ca2+]i = Keff
(R
R0)/(R1
R), where Keff is the
effective binding constant, R0 the fluorescence
ratio at zero Ca2+, and R1 that at
high Ca2+. These calibration constants were determined
experimentally for the given set-up and the actual experimental
conditions used.
Data Analysis--
Electrophysiological data were analyzed using
the WinASCD software (G. Droogmans, Leuven, Belgium). Pooled data are
given as means ± S.E. from n cells. Significance was
tested using Student's paired t test (p < 0.05 are marked with an asterisk). Dose-response curves were fitted
with the following equation,
|
(Eq. 1)
|
where Emax is the maximal effect,
c the agonist concentration, and EC50 the
concentration of half-maximal response. Inhibitory effects were
described by,
|
(Eq. 2)
|
with IC50 as the half-maximal blocking
concentration. The permeability of monovalent cations was obtained from
the shift in the reversal potentials after complete substitution of
extracellular divalent cations (1 nM free
[Ca2+]i buffered by 5 mM EGTA and
nominal Ca2+- and Mg2+-free extracellular
solution) and was calculated by the following equation,
|
(Eq. 3)
|
where Vrev is the measured shift in
reversal potential.
Permeability of the divalent cations Ca2+ and
Ba2+ relative to Na+ was calculated from the
reversal potential measured with 30 mM of the respective
cation in the extracellular solution.
|
(Eq. 4)
|
PX represents the permeability of the
divalent cation, [X]e its extracellular
concentration,
is
PCs/PNa obtained from
Equation 3, [Na+]e, [Na+]i,
and [Cs+]e, [Cs+]i are the
extra- and intracellular concentrations for Na+ and
Cs+, respectively, and Vrev is the
reversal potential (19, 20).
 |
RESULTS |
4
-PDD Activates Ca2+ Entry in hVRL-2-transfected
1321N1 Cells--
In hVRL-2.1321N1 cells capsaicin and RTX were
without effect, while PMA elicited a Ca2+ response with a
slow onset reaching a maintained phase in ~130 s (Fig.
1A). The phorbol ester
4
-PDD, which does not activate PKC, also elicited a Ca2+
response, which was typified by an initially rapid, and later slower,
onset that reached a maintained phase in ~40 s (Fig. 1A). These responses were not observed in the absence of extracellular Ca2+, and all four ligands were inactive in wild type and
mock-transfected 1321N1 cells (data not shown).

View larger version (17K):
[in this window]
[in a new window]
|
Fig. 1.
4 -PDD is an
agonist of hVRL-2. A, [Ca2+]i (as
fluorescent intensity) was monitored using Fluo-3AM in hVRL-2.1321N1
cells before and after the addition of 4 -PDD ( , 1 µM), PMA ( , 3 µM), RTX ( , 100 nM), or capsaicin ( , 100 nM). Data shown are
representative traces, typical of at least n = 5. B, [Ca2+]i was monitored using
Fluo-3AM in hVRL-2.1321N1 cells before and after the addition of
4 -PDD (100 pM to 10 µM) or PMA (100 pM to 10 µM). Responses were measured as peak
increase in fluorescence minus basal, expressed relative to a maximum
carbachol response, evoked by activation of endogenous muscarinic
receptors, and are given as means ± S.E., where n = 5.
|
|
In hVRL-2.1321N1 cells the 4
-PDD- and PMA-induced Ca2+
responses were concentration-dependent, with
pEC50 values of 6.73 ± 0.03 and 5.86 ± 0.10 (n = 5), respectively, although PMA was only a partial
agonist (Emax = 65%) compared with 4
-PDD
(Fig. 1B).
Ruthenium Red (1 µM) abolished both the PMA (3 µM)- and 4
-PDD (1 µM)-induced responses
in hVRL-2.1321N1 cells, whereas capsazepine (10 µM) was
without effect (data not shown).
Activation of hVRL-2 in Stably Transfected 1321N1 Cells--
Fig.
2 shows examples of combined current and
Ca2+ measurements in the control human astrocytoma cell
line 1321N1 and in hVRL-2.1321N1 cells. The control cell line showed
background currents, which were outwardly rectifying with densities of
0.4 ± 0.2 pA/pF at
80 mV and ± 1.8 ± 0.4 pA/pF at
+80 mV and a reversal potential of
7 ± 2 mV (n = 7). After application of 1 µM 4
-PDD neither [Ca2+]i nor the current was increased (Fig. 2,
A-C). If the stable cell line expressing hVRL-2 was used,
application of 4
-PDD increased [Ca2+]i, inward
and outward currents, and shifted the reversal potential of the
activated current toward more positive potentials (Fig. 2,
D-I). The increase in [Ca2+]i was
absent in Ca2+-free bath solutions (n = 7, data not shown). As shown later, monovalent ion current could be
measured in nominally Ca2+-free solutions, indicating that
4
-PDD still functioned as an agonist in these conditions.

View larger version (30K):
[in this window]
[in a new window]
|
Fig. 2.
Stimulating effects of
4 -PDD application on astrocytoma 1321N1 cells
stably expressing hVRL-2 (D-I) and nontransfected control
astrocytoma 1321N1 cells (A-C). A,
Ca2+ measurements in a voltage-clamped 1321N1 astrocytoma
cell, which does not express VRL-2. Holding potential is 0 mV.
Application of 1 µM 4 -PDD does not induce any increase
in [Ca2+]i. B, time course of whole
cell currents obtained from linear voltage ramps. Currents were
measured at 80 and +80 mV. C, IV curves obtained from
voltage ramps from 100 to +100 mV measured at the times indicated in
B. Note that no current is activated during application of
4 -PDD. D, same protocol as in A. Note that 0.1 µM 4 -PDD induced an increase in
[Ca2+]i. E, application of 0.1 µM 4 -PDD activates a current. Time course was measured
as in B. F, IV curves show activation of an
outwardly rectifying current by 4 -PDD. Data are from the time
indicated in E. G, 1 µM 4 -PDD
activates a large increase in [Ca2+]i. The same
protocol as in A was used. H, current activation
by 1 µM 4 -PDD concomitant with the increase in
[Ca2+]i. I, IV curves of current
activated by 1 µM 4 -PDD in both inward and outward
direction.
|
|
Data obtained from all cells are shown in Fig.
3. Half-maximal increase of
[Ca2+]i and the current measured at
80 mV (to
avoid an eventual contribution of Ca2+-activated
Cl
currents at positive potentials) occurred at
pEC50 of 6.71 ± 0.04 and 6.86 ± 0.11 (n between 6 and 17), respectively (Fig. 3, A and
B). The reversal potential shifted by ~5 and 15 mV toward positive potentials after application of 0.1 and 1 µM
4
-PDD, respectively (Fig. 3C). Obviously, 4
-PDD
activated a Ca2+ influx and an outwardly rectifying current
in hVRL-2-expressing, but not in hVRL-2-lacking cells.

View larger version (21K):
[in this window]
[in a new window]
|
Fig. 3.
Concentration response relationship of the
elevation of [Ca2+]i and the increase of the
VRL-2 current by 4 -PDD. A,
dependence of the elevation of [Ca2+]i at a
holding potential of 0 mV on 4 -PDD. Data were fitted to Equation 1
(n indicates the number of cells). A half-maximal activation
was achieved at pEC50 = 6.71. The same experimental
protocol as shown in Fig. 2 was used. All data are given as means ± S.E. B, maximal increase in current at 80 mV during
application of 4 -PDD. Data were obtained from simultaneous
[Ca2+]i current measurements. Note that
[Ca2+]i is not buffered. The pipette solution
contains 0.1 mM EGTA. pEC50 is 6.86. C, application of 4 -PDD induced a shift of reversal
potential Vrev toward more positive potentials.
This shift also depends on the 4 -PDD concentration.
|
|
Current Activation in TRP12-transfected HEK-293 Cells--
TRP12
is a channel cloned from mouse kidney and is ~95% identical to human
VRL-2 (mouse mTRP12; GenBankTM accession number
CAC20703), suggesting that it is the mouse orthologue of VRL-2. Fig.
4 shows combined current and
Ca2+ measurements in nontransfected HEK cells and in HEK
cells transiently transfected with murine TRP12. Background currents in
the control cell line showed weak outward rectification, current
densities of
3 ± 1 pA/pF at
80 mV and 8 ± 5 pA/pF at
+80 mV, and a reversal potential of 5 ± 2 mV (n = 8). The background current in TRP12-expressing cells was
5 ± 3 pA/pF at
80 mV and 13 ± 5 pA/pF at +80 mV (n = 8). The reversal potential of this current was measured at 6 ± 2 mV (n = 8). Application of 1 µM 4
-PDD
induced a small increase in [Ca2+]i in
nontransfected cells, activated an outwardly rectifying current, and
shifted the reversal potential of the net current toward more positive
potentials (Fig. 4, A-C). These effects were significantly
enhanced in TRP12-transfected cells (Fig. 4, D-F). Application of 1 µM 4
-PDD increased
[Ca2+]i to 0.08 ± 0.02 µM in
nontransfected cells (n = 8) and to 0.43 ± 0.1 µM in TRP12-transfected cells (n = 8).

View larger version (37K):
[in this window]
[in a new window]
|
Fig. 4.
Elevation of [Ca2+]i
and current activation by 4 -PDD in a
nontransfected HEK cell and in a HEK cell expressing mTRP12.
A, application of 1 µM 4 -PDD induced in a
nontransfected HEK cell a very small increase in
[Ca2+]i. Cells were clamped at 0 mV. Experimental
protocol was the same as in Fig. 2. Note that the HEK cells used in
these experiments expressed endogenous VRL-2 as shown in reverse
transcriptase-PCR experiments. B, currents measured
before and during application of 4 -PDD, same cell as in
A. C, current-voltage relationships obtained from
voltage ramps measured at the times indicated in B. D, in TRP12-transfected HEK cells a much larger increase in
[Ca2+]i can be observed after application of
4 -PDD. The same protocol as in A was used. E,
current activation from the same cells as shown in D, which
closely correlated to the increase in [Ca2+]i.
Note again that in these cells pipette solution only contains 0.1 mM EGTA. Note that in this experiment
[Ca2+]i is buffered at 1 nM, whereas
in A-G, [Ca2+]i is not buffered. IV
curves were measured at the times indicated in E. Note the
increase in inward and outward currents and the shift of the reversal
potential. F, stimulation of TRP12 by cell swelling (HTS,
solid line above the traces). On top of the HTS stimulus, 1 µM 4 -PDD was applied (dotted line). The
cell was clamped at 0 mV. The same ramp protocol was used as
described in Fig. 2. Current was measured at +80 and 80 mV.
Note that application of NMDG+ completely inhibits the
inward current. G, IV curves measured at the times indicated
in G. Note the increase in inward and outward currents and
the shift of the reversal potential.
|
|
To compare the 4
-PDD stimulation of TRP12 with its
previously described activation by cell swelling, we applied 4
-PDD
during perfusion of the cell with a hypotonic solution. As shown in
Fig. 4G, volume-activated TRP12 currents were stimulated
with a latency and reached a constant level. This behavior has been
described already elsewhere (11). Application of 4
-PDD further
increased the current substantially. The activated current is a cation
current, because its inward component disappeared when permeable
cations were substituted by NMDG+ (Fig. 4G). The
current component activated by 4
-PDD was 9.1 ± 2.2 times
larger than the volume-activated component (n = 6, all
measured at
80 mV). Under both conditions, currents are relatively slowly activated. Current activation appeared with a latency of 22 ± 5 s for 4
-PDD (n = 8) and 29 ± 4 s for cell swelling (n = 15). Peak currents appeared
after 85 ± 26 s for 4
-PDD (n = 8) and
76 ± 9 s for HTS (n = 15).
Concomitantly, the phorbol ester enhanced the amplitude of the
outwardly rectifying current. Application of the phorbol ester PMA (10 µM) also activated TRP12 (Fig.
5, A and B).
However, the maximal effects of PMA were approximately two times
smaller than those of 4
-PDD, and the IC50 value was 10 times higher than for 4
-PDD (Fig. 5C), similar to the
relative efficacy seen in VRL-2 (Fig. 1B). Fig. 5 shows the
dose-response relationship of the current response during application
of 4
-PDD and PMA in cells with a pipette solution with
[Ca2+]i buffered at 1 nM. From the
fit of the current responses at various concentrations of 4
-PDD to
Equation 1, we obtained a maximal current of
131 pA/pF (
80 mV) with
a pEC50 of 6.67 (Fig. 5C). The reversal
potential shifted toward a more positive potential, reaching a maximal
shift of about 10 mV at 1 µM 4
-PDD (Fig.
5D).

View larger version (25K):
[in this window]
[in a new window]
|
Fig. 5.
Dose-response relationship of the current
increase by 4 -PDD and PMA in HEK cells
transiently expressing mTRP12. A, activation of an
outwardly rectifying current after 10 µM PMA. Holding
potential is 0 mV. The same protocol as in Fig. 4 was used.
B, IV relationship measured at the times indicated in
A. C, the increase in current by 4 -PDD
(open circles) was measured at 80 mV. Data were fitted by
Equation 1. Half-maximal activation was obtained at a pEC50
of 6.67, nearly identical to that in VRL-2-transfected cells. Maximal
current was 131 pA/pF. In these cells [Ca2+]i
was buffered at 1 nM, which results in much larger current
as shown in Fig. 4. Dose-response relationship of PMA (open
squares) is characterized by a pEC50 of 5.52 and a
maximal current at 60 pA/pF. D, shift of the reversal
potential depends on the 4 -PDD concentration.
|
|
The characteristics of the 4
-PDD-activated current are similar to
those of the current activated by cell swelling in these same cells
(11). The relative conductance measured at
80 mV changed in the
sequence K+:Cs+:Na+:Li+ = 1.34 ± 0.1:1.1 ± 0.11:1:0.68 ± 0.13 (n = 7, Fig.
6C). The permeability sequence
of the 4
-PDD activated current for various monovalent cations, as
determined from shifts in reversal potential upon extracellular cation
substitution (Fig. 6, A and B), was Eisenman IV
with PK:PCs:PNa:PLi = 1.21 ± 0.02:1.10 ± 0.015:1:0.85 ± 0.03 (n = 7, Fig. 6D). The cation channel
activated by 4
-PDD was also permeable for Ca2+ as
reported elsewhere (9, 11). Fig. 7 shows
an example in which Ca2+ is the only charge carrier for
inward current after substitution of all extracellular monovalent
cations with NMDG+. Stimulation of TRP1-expressing HEK
cells with 1 µM 4
-PDD increased the inward current at
80 mV as well as the outward current at +80 mV (Fig. 7A),
but induced only very small effects in nontransfected cells. This
increase of the current was transient and decreased in the maintained
presence of 4
-PDD. Current-voltage relationships, as shown in Fig.
7B, indicate the activation of a strongly outwardly rectifying current with a
PCa:PNa ratio of 5.8 ± 0.5, as calculated from Equations 3 and 4. The reversal potential of
the current measured in the presence of intracellular Cs+
and 30 mM extracellular Ca2+ as the only cation
was 26.6 ± 1.4 mV. Ba2+ was much less permeable than
Ca2+ with a ratio PBa:PNa of
0.7 ± 0.5 calculated from the reversal potential of 5.4 ± 2.6 mV in the presence of 30 mM Ba2+.
Increasing [Ca2+]e from 1 to 30 mM
shifted the reversal potential by 33 ± 2.5 mV, which is less than
the expected 44-mV shift for a Ca2+-selective cation
channel. Taken together these data indicate that the channel activated
by 4
-PDD is a Ca2+-permeable cation channel as described
for TRP12, OTRPC4, and VR-OAC activated by cell swelling.

View larger version (25K):
[in this window]
[in a new window]
|
Fig. 6.
Permeation properties of the
4 -PDD-activated channel, mTRP12.
A, current-voltage relationships obtained after maximal
stimulation of TRP12-transfected HEK cells with 1 µM
4 -PDD. During stimulation, the extracellular Na+ was
completely substituted by NMDG+, Li+,
Cs+, or K+. The same experimental protocol as
in Fig. 4 was used. B, same cell as in A. The
voltage range close to the reversal potential is zoomed to show the
shift due to the various Na+ substitutions. Note that
K+ is the best permeating cation and Li+ the
least permeable. C, relative conductance was calculated from
the maximal increase in current after application of 1 µM
4 -PDD at 80 mV divided by the current carried by Na+.
Ratios were obtained from the same cells (n = 6).
D, the relative permeability was measured from the shift in
the reversal potentials (B) and calculated by Equation 3.
Data are from six cells with a complete set of substitutions as shown
in A.
|
|

View larger version (17K):
[in this window]
[in a new window]
|
Fig. 7.
Permeation of Ca2+
though the 4 -PDD-activated channel.
A, time course of the whole-cell current measured at 80
and +80 mV from linear voltage ramps. Up to the dotted line,
TRP12-transfected HEK cells were perfused with normal bath solution. At
the time indicated, all monovalent cations were substituted by
NMDG+ and 30 mM Ca2+. Therefore,
inward currents can only be carried by Ca2+. Application of
1 µM 4 -PDD induced a large but transient increase in
both inward and outward current. Ca2+ in the pipette
solution is buffered at 1 nM. B, current-voltage
relationships measured at the times a and b,
indicated in A. Note the rightward shift of the IV
curve.
|
|
To further evaluate whether the slow increase of
[Ca2+]i is indeed the result of a slow influx of
Ca2+ during the slow channel activation, we have activated
TRP12 by 4
-PDD in Ca2+-free solutions and then applied
extracellular Ca2+. Under these conditions, 4
-PDD, as
expected, induced a delayed activation of an outward current (the
inward component is absent because of substitution of all cation by
NMDG+, Fig. 8, A
and C). After activation, 30 mM
[Ca2+]e was applied, which induced a nearly
instantaneous appearance of an inward current and a very fast increase
in [Ca2+]i (Fig. 8B). These data
indicate a fast entry of Ca2+ when the channel has been
pre-activated. In addition, no Ca2+ signal was obtained
during stimulation with 4
-PDD in the absence of
[Ca2+]e, indicating the absence of
Ca2+ release during activation (identical results in five
cells).

View larger version (22K):
[in this window]
[in a new window]
|
Fig. 8.
Fast Ca2+ entry after
pre-activation of TRP12 by 4 -PDD.
A, TRP12-transfected HEK cells were incubated in a
Ca2+-free solution. All extracellular cations have been
substituted by NMDG+. The current at the holding potential
of 0 mV is shown. At the time indicated, 1 µM 4 -PDD
was applied and induced a large outward current but no inward current
because of the absence of permeable extracellular cations.
Reapplication of 30 mM Ca2+ resulted in an
instantaneous appearance of an inward current. B, time
course of [Ca2+]i after reapplication of
Ca2+. Note the fast increase in Ca2+ due to a
fast Ca2+ influx through the pre-activated channel (pipette
solution: 0.1 mM EGTA as in all simultaneous
current/Ca2+ measurements). C, whole cell
current measured at 80 and +80 mV from linear voltage ramps. Note the
appearance of an inward current after Ca2+ reapplication
and the decrease in the outward current. D, current-voltage
relationships measured at the times a, b, and
c indicated in C. Note the rightward shift of the
IV curve.
|
|
We have shown that Ca2+ entry through VRL-2 was blocked by
Ruthenium Red (data not shown). Ruthenium Red at a concentration of 1 µM completely blocked the 4
-PDD-activated inward
current through TRP12, but was less effective on the outward current
(Fig. 9, A-D).

View larger version (23K):
[in this window]
[in a new window]
|
Fig. 9.
Block by Ruthenium Red of mTRP12 channels
activated by 4 -PDD. A,
activation of a membrane current in TRP12-transfected HEK cells by
application of 1 µM 4 -PDD. Experimental protocol is
the same as used in the previous figures. Ruthenium Red (RR,
1 µM) induced a rapid decrease of the holding current at
0 mV. After washing out of RR, the 4 -PDD-induced current reappears.
The spikes in the current recordings are from the 100 to +100 mV
voltage ramps applied every 5 s. B, time course of the
inward current at 80 mV and the outward current at +80 mV. Note the
complete block of the inward current and the partial inhibition of the
outward current. C, IV curves measured at the times
indicated in B show the voltage-dependent block
by RR. D, inhibition of the mTRP12 current by RR at 80 and
+80 mV from five cells.
|
|
Because several members of the TRPV family are modulated by
[Ca2+]i (for a detailed example, see Ref. 21), we
have also studied a possible modulation of the 4
-PDD-activated TRP12
channel by changes in [Ca2+]i. Fig.
10 gives an example for the response to
1 µM 4
-PDD of TRP12-expressing HEK cells that were
dialyzed by intracellular solution in which
[Ca2+]i was buffered at 1, 200, and 1000 nM. The response was clearly reduced when
[Ca2+]i was increased (Fig. 10, A and
B). Both inward and outward currents were reduced to the
same extent. A concentration response plot of the maximal current at
80 mV evoked by 1 µM 4
-PDD showed a half-maximal
inactivation at a Ca2+ concentration of 406 nM
(Fig. 10C). Clearly, TRP12 is inhibited by elevation of
[Ca2+]i.

View larger version (27K):
[in this window]
[in a new window]
|
Fig. 10.
Inhibition of TRP12 currents by
intracellular Ca2+. A, currents were
activated by 1 µM 4 -PDD (three separate
TRP12-transfected HEK cells). [Ca2+]i was
buffered at 1, 200, and 1000 nM. Shown are the time courses
of the whole-cell current at 80 and +80 mV. Note the decrease in
inward and outward current when [Ca2+]i is
increased. B, IV relationships from the times indicated by
the black circles in A. Clearly, current
activation was decreased when [Ca2+]i was
elevated. C, from maximal current at 80 mV the
concentration response curve was measured. Data points were fit to
Equation 2. Assuming a complete block by high
[Ca2+]i, half-maximal inhibition was calculated
to be 406 nM.
|
|
Current Activation in Endothelial Cells Expressing Endogenous
TRP12--
To test whether the novel agonist for TRP12 is also
effective on native channels, we tested freshly isolated mouse aorta
endothelial cells (MAEC). These cells express TRP12 as shown in
Northern blots (8). As a reference we used human umbilical vein
endothelial cell-derived EA cells, which do not express VRL-2.
Stimulation with 1 µM 4
-PDD evoked, in both clamped
and unclamped MAEC, a Ca2+ signal in the presence of 5 mM [Ca2+]e but not in the absence of
extracellular Ca2+ (Fig.
11). The agonist was, however,
ineffective in EA cells. 4
-PDD also activated in MAEC, but not in EA
cells, an outwardly rectifying cation current and a concomitant shift
of the reversal potential toward more positive potentials (Fig.
12). In conclusion, the agonist
4
-PDD induced the same responses in cells that express TRP12
endogenously as in VRL-2- or TRP12-transfected cells.

View larger version (19K):
[in this window]
[in a new window]
|
Fig. 11.
Increase of [Ca2+]i by
4 -PDD in MAEC but not in the EA-926hyb cell
line derived from human umbilical vein endothelium. A,
4 -PDD does not increase [Ca2+]i in EA-926hyb
cells. B, increase in [Ca2+]i in
nonclamped MAEC by 1 µM 4 -PDD. C, pooled
data from clamped (holding potential: 0 mV) and unclamped EA-926hyb and
MAEC. MAEC, which express TRP12, respond to 4 -PDD by an increase in
[Ca2+]i. This increase is accentuated in
nonclamped cells, likely due to activation of BKCa in MAEC
(12, 43).
|
|

View larger version (23K):
[in this window]
[in a new window]
|
Fig. 12.
Increase of [Ca2+]i
and current by 1 µM
4 -PDD in MAEC. A, 4 -PDD
increases [Ca2+]i in voltage-clamped MAEC.
Holding potential: 0 mV. The same protocol as in Figs. 2 and 4 was used
(0.1 mM EGTA in the pipette solution). B,
current activation by 4 -PDD. C, IV curves measured at the
times indicated in B. D, increase in current
measured at 80 mV in TRP12-expressing MAEC and the reference
EA-926hyb cells. E, shift in the reversal potential of the
4 -PDD-activated currents toward positive potentials but not in the
EA-926hyb reference cells, which do not express VRL-2.
|
|
 |
DISCUSSION |
VRL-2 is identical to the human TRPV channel VR-OAC and apparently
represents the human orthologue of the murine TRP12 and OTRPC4 channels
(mouse mTRP12, GenBankTM accession number CAC20703;
hOTRPC4, GenBankTM accession number AF258465; human
hVROAC, GenBankTM accession number AF263523). These
channels belong to the TRPV family and are widely expressed in mammals.
Originally, these channels were considered as sensors of cell volume,
because they can be activated by cell swelling (8-11). These channels
are all Ca2+-permeable, providing an influx route for
extracellular Ca2+ and could therefore play an important
role in Ca2+ signaling during mechanical or osmotic
stimulation as well as under conditions coupled to changes of the cell
volume. In addition, any stimulation of these channels will change the
membrane potential of the stimulated cells. However, the mechanism of
activation by cell swelling was clearly different from activation of
the best studied volume-regulated anion channel, which likely senses changes in cell volume as a variation of intracellular ionic strength (22, 23). It has been shown that in contrast with volume-regulated anion channels TRP12 cannot be activated by a reduction in
intracellular ionic strength or by an intracellular perfusion of
TRP12-expressing cells with GTP
S (11). We have therefore tested
other possibilities of channel activation.
Several members of the TRPV family are agonist-gated channels, which
are opened by binding of capsaicin and related compounds (3, 24).
However, an endogenous ligand remains to be identified (24). Only
recently, the endogenous lipid anandamide, which has some structural
similarities with olvanil, has been identified as a possible endogenous
agonist of the hVR-1 receptor (17). With a similar approach, using the
FLIPRTM screening technique, we have now also identified a
highly selective activator of VRL-2 and its murine orthologue TRP12.
Phorbol derivatives stimulate VRL-2 and TRP12. PMA and 4
-PDD
stimulate both VRL-2 and TRP12, with 4
-PDD being ~50 times more
potent than PMA. Several lines of evidence demonstrate that 4
-PDD
can be considered as a VRL-2 and TRP12 activator; (a)
in the 1321N1 stable cell line transfected with VRL-2, 4
-PDD induces
an increase in [Ca2+]i by entry of extracellular
Ca2+, a concomitant activation of an outwardly rectifying
cation current, and a substantial shift in the reversal potential of
the net whole-cell current toward more positive potentials. All effects
occur with a pEC50 of ~6.8 and are absent in cells that
do not express VRL-2; (b) 4
-PDD induced the same effect
in HEK cells transiently transfected with mTRP12. Current activation
occurs with the same pEC50. The 4
-PDD-activated channel
shows an Eisenman IV permeation profile, which has previously been
shown for TRP12 (11) and has similar Ca2+ over
Na+ permeability as reported for OTRPC4 (9). In wild type
HEK cells, which express VRL-2 under our conditions, 4
-PDD has a small but identical effect as in the cells overexpressing TRP12. (c) In freshly isolated endothelial cells, MAEC, which
substantially express endogenous TRP12 (8), 4
-PDD induced an
identical effect as in the other models used. Because 4
-PDD does not
activate PKC (25), the stimulating effect is obviously not mediated by PKC activation. Several reports have already identified phorbol esters
as direct, PKC-independent channel modulators of N- and L-type Ca2+ channels and KATP
channels (26, 27-31). It is known that phorbol esters bind to a
variety of lipophilic receptors (25) to which now, as a novel target,
VRL-2/TRP12 should be added. From our data, it seems unlikely that the
identified agonist binds to an extracellular site because of the very
slow wash-out (Fig. 9). Furthermore, the slow activation may indicate
that 4
-PDD must enter the cell and may activate the channel by
binding to an intracellular site.
So far, we have not clearly identified an endogenous activator.
However, preliminary experiments showed that anandamide (from Sigma, 10 µM, extracellular application, n = 8) is
a weakly potent and slow activator of TRP12 (n = 8).2
1-Oleolyl-2-acetyl-sn-glycerol (50-100 µM
extracellular, n = 6), 11,12-epoxyeicosatrionic acid
(300 nM, intracellular, n = 5),
leukotriene D4 (100 nM intracellular,
n = 3, and 100 nM extracellular, n = 5), 500 nM extracellular
epoxyeicosatrionic acid (n = 3), 1 µM
capsaicin (extracellular, n = 4), 10 µM
12-HPETE (intracellular, n = 5) and pH 5.5 (n = 3), did not induce any activating
effect.3 However, 4
-PDD
can be used as a robust and reliable tool to study several features of
TRPV channels and to probe functional effects of the activation of this
channel in in vivo systems. As an example, we have already
demonstrated the utility of 4
-PDD for any kind of permeation
studies, including studies on pore mutants. To further characterize
properties of VRL-2/Trp2, we have used 4
-PDD as a tool to
demonstrate inhibition of this channel by elevated
[Ca2+]i. Half-maximal inhibition occurred at 406 nM, which is clearly in the physiological range for many
activated cells. A similar, but more sensitive, inhibition by
intracellular Ca2+ has been also described for ECaC
channels, which are close relatives of the VR1 and VRL channels (21).
We further show that by using 4
-PDD as a reliable tool for
activation of VRL-2 and TRP12, we could demonstrate block of both
channels by Ruthenium Red (RR). This hexavalent cation binds to
phospholipids and fatty acids (32), to many Ca2+-binding
proteins, the mitochondrial Ca2+ uniporter and various
Ca2+ channels (33-35), the ryanodine receptor (36, 37),
and has recently also been identified as a selective blocker of the
founding member of the TRPV family, VR-1 (38). We have recently shown that the TRPC members, ECaC1 and ECaC2, which are about 30% identical at the amino acid level to VR-1, are blocked in the submicromolar range
by RR (39, 40). We show here in addition that block of TRP12 is
voltage-dependent as the block decreased at positive potentials. A voltage-dependent block by RR has been shown
so far only for a plant vascular Ca2+ channel (41). Inward
currents through TRP12 are completely blocked by 1 µM RR.
Therefore, RR might be usable as a high affinity tool for TRP12 and in
general for TRPV-related channels.
For all TRPV4 members (TRP12, OTRPC4, and VR-OAC), it has been shown
that an increase in cell volume activated a current and increased
[Ca2+]i (8-11). The channels activated by an
increase in volume and 4
-PDD are identical referring to
rectification behavior, Ca2+ permeability, and permeability
sequence of monovalent cations. A comparison of the current amplitudes
shows that the volume-activated TRP12 current has a density at
80 mV
of
44 pA/pF (11) and
131 pA/pF after stimulation with 4
-PDD
(Fig. 5). When we compared, in this series of experiments, the
stimulation of TRP12 with 25% hypotonic solution and 1 µM 4
-PDD in the same cells, we even found a 9.1 ± 2.2 times larger activation by the agonist. Although difficult to
compare, the time course of activation by both methods was not
different. This can be explained in the case of 4
-PDD by a slow
diffusion to an intercellular binding site or in the case of cell
swelling by the slow signal transduction in which synthesis of a
messenger could be involved. Thus, an increase in cell volume seems to
be only a partial activator, and both stimuli might act additively. It
is not clear whether cell swelling activates TRP12 via a similar
pathway than 4
-PDD, but with less efficiency, or via another,
independent mechanism. It has also been previously demonstrated that
cell swelling increased [Ca2+]i, probably via an
arachidonic acid-dependent mechanism (42). Therefore, it is
intriguing to speculate that the volume-dependent activation of TRP12 might be due to a messenger, which shares structural similarities with 4
-PDD, and might be related to
metabolites of arachidonic acid or anandamide.
In conclusion, we show here for the first time that binding of a
lipophilic ligand can activate VRL-2 and TRP12. These findings will aid
the search for specific endogenous activators and provide a reliable
tool for studying functional effects of this novel class of TRPV
channels, which were until now only considered as mechano- or
volume-activated Ca2+-permeable cation channels. In
addition, 4
-PDD will be a valuable pharmacological tool with
which to characterize endogenous swelling-activated currents that
may be carried by native VRL-2/TRP12 channels.
 |
FOOTNOTES |
*
This work was supported by the Belgian Federal Government,
the Flemish Government and the Onderzoeksraad KU Leuven (GOA 99/07, F.W.O. G.0237.95, F.W.O. G.0214.99, F.W.O. G. 0136.00;
Interuniversity Poles of Attraction Program, Prime Ministers Office
IUAP Nr.3P4/23), by "Levenslijn" (7.0021.99), and by a grant from
the "Alphonse and Jean FortonFonds-Koning Boudewijn Stichting"
R7115 B0.The costs of publication of this
article were defrayed in part by the
payment of page charges. The article
must therefore be hereby marked
"advertisement" in
accordance with 18 U.S.C. Section
1734 solely to indicate this fact.
To whom correspondence should be addressed: Laboratorium voor
Fysiologie, Campus Gasthuisberg, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium. Tel.: 32-16-34-5937; Fax: 32-16-34-5991; E-mail: bernd.nilius@med.kuleuven.ac.be.
Published, JBC Papers in Press, February 4, 2002, DOI 10.1074/jbc.M200062200
2
H. Watanabe and B. Nilius, unpublished results.
3
J. Vriens, H. Watanabe, and B. Nilius,
unpublished observations.
 |
ABBREVIATIONS |
The abbreviations used are:
HTS, hypotonic stimulation;
4-PDD, 4
-phorbol 12,13-didecanoate;
F, farad;
PKC, protein kinase C;
PMA, phorbol 12-myristate 13-acetate;
RTX, resiniferatoxin;
12-HPETE, 12-hydroperoxyeicosatetraenoic acid;
MAEC, mouse aorta endothelial cells;
GTP
S, guanosine
5'-O-(thiotriphosphate);
RR, Ruthenium Red.
 |
REFERENCES |
| 1.
|
Clapham, D. E.,
Runnels, L. W.,
and Strubing, C.
(2001)
Nat. Rev. Neurosci.
2,
387-396[Medline]
[Order article via Infotrieve]
|
| 2.
|
Colbert, H. A.,
Smith, T. L.,
and Bargmann, C. I.
(1997)
J. Neurosci.
17,
8259-8269[Abstract/Free Full Text]
|
| 3.
|
Caterina, M. J.,
Schumacher, M. A.,
Tominaga, M.,
Rosen, T. A.,
Levine, J. D.,
and Julius, D.
(1997)
Nature
389,
816-824[CrossRef][Medline]
[Order article via Infotrieve]
|
| 4.
|
Kanzaki, M.,
Zhang, Y. Q.,
Mashima, H., Li, L.,
Shibata, H.,
and Kojima, I.
(1999)
Nat. Cell Biol.
1,
165-170[CrossRef][Medline]
[Order article via Infotrieve]
|
| 5.
|
Caterina, M. J.,
Rosen, T. A.,
Tominaga, M.,
Brake, A. J.,
and Julius, D.
(1999)
Nature
398,
436-441[CrossRef][Medline]
[Order article via Infotrieve]
|
| 6.
|
Suzuki, M.,
Sato, J.,
Kutsuwada, K.,
Ooki, G.,
and Imai, M.
(1999)
J. Biol. Chem.
274,
6330-6335[Abstract/Free Full Text]
|
| 7.
|
Yue, L.,
Peng, J. B.,
Hediger, M. A.,
and Clapham, D. E.
(2001)
Nature
410,
705-709[CrossRef][Medline]
[Order article via Infotrieve]
|
| 8.
|
Wissenbach, U.,
Bodding, M.,
Freichel, M.,
and Flockerzi, V.
(2000)
FEBS Lett.
485,
127-134[CrossRef][Medline]
[Order article via Infotrieve]
|
| 9.
|
Strotmann, R.,
Harteneck, C.,
Nunnenmacher, K.,
Schultz, G.,
and Plant, T. D.
(2000)
Nat. Cell Biol.
2,
695-702[CrossRef][Medline]
[Order article via Infotrieve]
|
| 10.
|
Liedtke, W.,
Choe, Y.,
Marti Renom, M. A.,
Bell, A. M.,
Denis, C. S.,
Sali, A.,
Hudspeth, A. J.,
Friedman, J. M.,
and Heller, S.
(2000)
Cell
103,
525-535[CrossRef][Medline]
[Order article via Infotrieve]
|
| 11.
|
Nilius, B.,
Prenen, J.,
Wissenbach, U.,
Bödding, M.,
and Droogmans, G.
(2001)
Pflügers Arch. Eur. J. Physiol.
443,
227-233[CrossRef][Medline]
[Order article via Infotrieve]
|
| 12.
|
Suh, S. H.,
Vennekens, R.,
Manolopoulos, V. G.,
Freichel, M.,
Schweig, U.,
Prenen, J.,
Flockerzi, V.,
Droogmans, G.,
and Nilius, B.
(1999)
Pflügers Arch. Eur. J. Physiol.
438,
612-620[CrossRef][Medline]
[Order article via Infotrieve]
|
| 13.
|
Wei, L.,
Freichel, M.,
Jaspers, M.,
Cuppens, H.,
Cassiman, J. J.,
Droogmans, G.,
Flockerzi, V.,
and Nilius, B.
(2001)
BioMed Central Physiol.
1,
3
|
| 14.
|
Edgell, C. J.,
McDonald, C. C.,
and Graham, J. B.
(1983)
Proc. Natl. Acad. Sci. U. S. A.
80,
3734-3737[Abstract/Free Full Text]
|
| 15.
|
Haburcak, M.,
Wei, L.,
Viana, F.,
Prenen, J.,
Droogmans, G.,
and Nilius, B.
(1997)
Cell Calcium
21,
291-300[CrossRef][Medline]
[Order article via Infotrieve]
|
| 16.
|
Viana, F.,
de Smedt, H.,
Droogmans, G.,
and Nilius, B.
(1998)
Cell Calcium
24,
117-127[CrossRef][Medline]
[Order article via Infotrieve]
|
| 17.
|
Smart, D.,
Gunthorpe, M. J.,
Jerman, J. C.,
Nasir, S.,
Gray, J.,
Muir, A. I.,
Chambers, J. K.,
Randall, A. D.,
and Davis, J. B.
(2000)
Br. J. Pharmacol.
129,
227-230[CrossRef][Medline]
[Order article via Infotrieve]
|
| 18.
|
Jerman, J. C.,
Brough, S. J.,
Prinjha, R.,
Harries, M. H.,
Davis, J. B.,
a |