Introduction
The retinal pigment epithelium (RPE)
3The abbreviations used are:
RPE
retinal pigment epithelium
AMP
age-related macular degeneration
hfRPE
human fetal retinal pigment epithelium
TCA
tricarboxylic acid
P5C
pyrroline-5-carboxylate
KRB
Krebs-Ringer bicarbonate buffer
αKG
α-ketoglutarate
OAT
ornithine aminotransferase
ECM
extracellular matrix
TER
transepithelial resistance.
in the vertebrate eye is a monolayer of polarized pigmented epithelial cells that is situated between the photoreceptors and the choroidal blood supply. The RPE provides critical support for the function of the neural retina. It has many long microvilli at its apical side that wrap around the photoreceptor outer segments. On its basal side, the RPE forms convoluted microinfolds that increase its surface area. It transports nutrients and metabolites, recycles retinoids, and engulfs shed outer segment (
1.- Lehmann G.L.
- Benedicto I.
- Philp N.J.
- Rodriguez-Boulan E.
Plasma membrane protein polarity and trafficking in RPE cells: past, present and future.
,
2.The retinal pigment epithelium in visual function.
). Failure of the RPE leads to photoreceptor degeneration in diseases including age-related macular degeneration (AMD), bestrophinopathy, and Sorsby fundus dystrophy (
3.- Sparrow J.R.
- Hicks D.
- Hamel C.P.
The retinal pigment epithelium in health and disease.
,
4.Mechanisms of age-related macular degeneration.
,
5.Macular degeneration: recent advances and therapeutic opportunities.
,
6.- Guziewicz K.E.
- Sinha D.
- Gómez N.M.
- Zorych K.
- Dutrow E.V.
- Dhingra A.
- Mullins R.F.
- Stone E.M.
- Gamm D.M.
- Boesze-Battaglia K.
- Aguirre G.D.
Bestrophinopathy: an RPE-photoreceptor interface disease.
,
7.- Weber B.H.
- Vogt G.
- Pruett R.C.
- Stöhr H.
- Felbor U.
Mutations in the tissue inhibitor of metalloproteinases-3 (TIMP3) in patients with Sorsby's fundus dystrophy.
).
A major function of the RPE is to transport metabolites between the choroid and retina. Photoreceptors have a high demand for energy and are highly glycolytic; like many cancer cells, they metabolize about 90% of the glucose they consume into lactate (
8.- Du J.
- Rountree A.
- Cleghorn W.M.
- Contreras L.
- Lindsay K.J.
- Sadilek M.
- Gu H.
- Djukovic D.
- Raftery D.
- Satrústegui J.
- Kanow M.
- Chan L.
- Tsang S.H.
- Sweet I.R.
- Hurley J.B.
Phototransduction influences metabolic flux and nucleotide metabolism in mouse retina.
,
9.- Hurley J.B.
- Lindsay K.J.
- Du J.
Glucose, lactate, and shuttling of metabolites in vertebrate retinas.
). RPE cells directionally transport glucose to the retina and lactate into the blood through highly expressed glucose transporters and monocarboxylate transporters on both the apical and basal membranes (
1.- Lehmann G.L.
- Benedicto I.
- Philp N.J.
- Rodriguez-Boulan E.
Plasma membrane protein polarity and trafficking in RPE cells: past, present and future.
,
10.- Sugasawa K.
- Deguchi J.
- Okami T.
- Yamamoto A.
- Omori K.
- Uyama M.
- Tashiro Y.
Immunocytochemical analyses of distributions of Na, K-ATPase and GLUT1, insulin and transferrin receptors in the developing retinal pigment epithelial cells.
,
11.- Philp N.J.
- Wang D.
- Yoon H.
- Hjelmeland L.M.
Polarized expression of monocarboxylate transporters in human retinal pigment epithelium and ARPE-19 cells.
). Loss of monocarboxylate transporters causes retinal dysfunction and degeneration (
12.- Philp N.J.
- Ochrietor J.D.
- Rudoy C.
- Muramatsu T.
- Linser P.J.
Loss of MCT1, MCT3, and MCT4 expression in the retinal pigment epithelium and neural retina of the 5A11/basigin-null mouse.
,
13.- Ochrietor J.D.
- Linser P.J.
5A11/Basigin gene products are necessary for proper maturation and function of the retina.
). However, less is known about the transport of other nutrients and metabolites through the RPE.
The RPE requires an active metabolism to support its multiple functions. Either suppression of its mitochondrial metabolism or activation of glycolysis can cause RPE dysfunction to induce an AMD-like phenotype in mouse models (
14.- Zhao C.
- Yasumura D.
- Li X.
- Matthes M.
- Lloyd M.
- Nielsen G.
- Ahern K.
- Snyder M.
- Bok D.
- Dunaief J.L.
- LaVail M.M.
- Vollrath D.
mTOR-mediated dedifferentiation of the retinal pigment epithelium initiates photoreceptor degeneration in mice.
,
15.- Kurihara T.
- Westenskow P.D.
- Gantner M.L.
- Usui Y.
- Schultz A.
- Bravo S.
- Aguilar E.
- Wittgrove C.
- Friedlander M.S.
- Paris L.P.
- Chew E.
- Siuzdak G.
- Friedlander M.
Hypoxia-induced metabolic stress in retinal pigment epithelial cells is sufficient to induce photoreceptor degeneration.
). How the RPE imports nutrients to support its own energy demands is still unclear.
Human fetal RPE (hfRPE) cultures have similar morphological and physiological characteristics as native RPE (
16.- Maminishkis A.
- Chen S.
- Jalickee S.
- Banzon T.
- Shi G.
- Wang F.E.
- Ehalt T.
- Hammer J.A.
- Miller S.S.
Confluent monolayers of cultured human fetal retinal pigment epithelium exhibit morphology and physiology of native tissue.
). These cultures have been well-characterized as a useful model for evaluating RPE metabolism (
17.Cultured primary human fetal retinal pigment epithelium (hfRPE) as a model for evaluating RPE metabolism.
) and RPE diseases, including AMD (
18.- Johnson L.V.
- Forest D.L.
- Banna C.D.
- Radeke C.M.
- Maloney M.A.
- Hu J.
- Spencer C.N.
- Walker A.M.
- Tsie M.S.
- Bok D.
- Radeke M.J.
- Anderson D.H.
Cell culture model that mimics drusen formation and triggers complement activation associated with age-related macular degeneration.
). The RPE cultures used in the experiments conducted in this manuscript are of a similar age in culture as the ones used in studies published previously, including investigations of the cause of AMD.
MS provides a sensitive, quantitative, and high-throughput platform to measure metabolites. Transport of metabolites labeled with a stable isotope and biochemical transformations of those metabolites can be monitored. In this report, we use both LC/MS-MS and GC-MS coupled with 13C metabolic flux analysis to investigate how nutrients are consumed and how metabolites are transported through cultured hfRPE cells. Surprisingly, we found that proline is the most preferred fuel for RPE cells. They convert proline into ornithine and mitochondrial intermediates through multiple mitochondrial pathways. We also found that RPE transports metabolic intermediates, including citrate, glutamate, serine, and glycine, to its apical side and that, when these metabolites are released from the apical RPE, they can be taken up by the retina. We report here a comprehensive study of nutrient utilization and metabolite transport in RPE. Our findings provide new insights into RPE biochemistry and physiology and its role in the pathogenesis of retinal diseases, including AMD.
Discussion
RPE culture is an excellent
in vitro model to study RPE function and AMD (
17.Cultured primary human fetal retinal pigment epithelium (hfRPE) as a model for evaluating RPE metabolism.
,
21.Methods for culturing retinal pigment epithelial cells: a review of current protocols and future recommendations.
). In this study, we used targeted metabolomics to study how the RPE consumes nutrients. Unexpectedly, we found that RPE cells prefer proline as an energy substrate. We also developed a stable isotope-based approach to trace metabolite transport out of the RPE to either its apical or its basal side, and we showed that metabolites exported from the RPE can support retinal metabolism.
Proline is consumed by RPE cells faster than any other nutrients in the culture medium. Proline is a non-essential amino acid that is not normally included in standard DMEM preparations. However, proline ranging from 10–115 mg/liter is typically included in most of the widely used protocols for human RPE culture media (
16.- Maminishkis A.
- Chen S.
- Jalickee S.
- Banzon T.
- Shi G.
- Wang F.E.
- Ehalt T.
- Hammer J.A.
- Miller S.S.
Confluent monolayers of cultured human fetal retinal pigment epithelium exhibit morphology and physiology of native tissue.
,
21.Methods for culturing retinal pigment epithelial cells: a review of current protocols and future recommendations.
,
22.- Maminishkis A.
- Miller S.S.
Experimental models for study of retinal pigment epithelial physiology and pathophysiology.
,
23.A cell culture medium that supports the differentiation of human retinal pigment epithelium into functionally polarized monolayers.
,
24.- Gamm D.M.
- Melvan J.N.
- Shearer R.L.
- Pinilla I.
- Sabat G.
- Svendsen C.N.
- Wright L.S.
A novel serum-free method for culturing human prenatal retinal pigment epithelial cells.
,
25.- Akrami H.
- Soheili Z.S.
- Khalooghi K.
- Ahmadieh H.
- Rezaie-Kanavi M.
- Samiei S.
- Davari M.
- Ghaderi S.
- Sanie-Jahromi F.
Retinal pigment epithelium culture: a potential source of retinal stem cells.
,
26.- Sonoda S.
- Spee C.
- Barron E.
- Ryan S.J.
- Kannan R.
- Hinton D.R.
A protocol for the culture and differentiation of highly polarized human retinal pigment epithelial cells.
,
27.- Oka M.S.
- Landers R.A.
- Bridges C.D.
A serum-free defined medium for retinal pigment epithelial cells.
). Proline can be provided within the RPE by synthesis either from glutamate by P5C synthase or from ornithine by ornithine aminotransferase (OAT). Deficiency of OAT can cause gyrate atrophy, an inborn error of metabolism characterized by lobular loss of RPE and choroid (
28.- O'Donnell J.J.
- Sandman R.P.
- Martin S.R.
Gyrate atrophy of the retina: inborn error of L-ornithin:2-oxoacid aminotransferase.
,
29.- Wang T.
- Milam A.H.
- Steel G.
- Valle D.
A mouse model of gyrate atrophy of the choroid and retina: early retinal pigment epithelium damage and progressive retinal degeneration.
). RPE has been identified as the major and most early damaged site in gyrate atrophy (
29.- Wang T.
- Milam A.H.
- Steel G.
- Valle D.
A mouse model of gyrate atrophy of the choroid and retina: early retinal pigment epithelium damage and progressive retinal degeneration.
). Intriguingly, supplementation with proline rescues ornithine cytotoxicity induced by inhibition of OAT in RPE cells (
30.- Ueda M.
- Masu Y.
- Ando A.
- Maeda H.
- Del Monte M.A.
- Uyama M.
- Ito S.
Prevention of ornithine cytotoxicity by proline in human retinal pigment epithelial cells.
,
31.- Ando A.
- Ueda M.
- Uyama M.
- Masu Y.
- Okumura T.
- Ito S.
Heterogeneity in ornithine cytotoxicity of bovine retinal pigment epithelial cells in primary culture.
). Under our experimental conditions, glutamate and arginine (the precursor of ornithine) are not significantly used in 24 h (
Fig. 1B), indicating that proline in RPE cells is more dependent on exogenous supply.
Proline imported into RPE cells can be catabolized into glutamate for mitochondrial intermediates and into ornithine for urea cycle activity. We found that
13C from proline replaced 50% of the endogenous glutamate, ornithine, and mitochondrial intermediates within 1 h (
Fig. 2B). Labeled glutamate and ornithine accumulated at 24 h, even in the presence of abundant glutamate, glutamine, and arginine in the RPE culture medium (
Fig. 2B). These results demonstrate that proline is an important nutrient source for RPE metabolism. In addition to being oxidized through the TCA cycle, proline fuels the active reductive carboxylation pathway we reported previously in RPE cells (
19.- Du J.
- Yanagida A.
- Knight K.
- Engel A.L.
- Vo A.H.
- Jankowski C.
- Sadilek M.
- Tran V.T.
- Manson M.A.
- Ramakrishnan A.
- Hurley J.B.
- Chao J.R.
Reductive carboxylation is a major metabolic pathway in the retinal pigment epithelium.
). Reductive carboxylation increases mitochondrial bioenergetics and cellular resistance against oxidative damage. Both mitochondrial dysfunction and oxidative stress are major contributors to the pathogenesis of AMD. Our findings highlight the need to elucidate how proline catabolism contributes to RPE metabolism
in vivo and how it is influenced in diseased RPE cells.
Proline and its hydroxylated form, hydroxyproline, make up 25% of collagen (
32.- Phang J.M.
- Liu W.
- Zabirnyk O.
Proline metabolism and microenvironmental stress.
), which is the most abundant protein in extracellular matrix (ECM) and in the collagenous zones of the Bruch membrane (BrM). The BrM is located between the RPE and the choroid, and ECM remodeling plays a critical role in the deposition of drusen in the BrM in AMD (
33.- Fernandez-Godino R.
- Pierce E.A.
- Garland D.L.
Extracellular matrix alterations and deposit formation in AMD.
). Mutations of ECM metabolism genes have been identified in AMD patients (
34.- Duvvari M.R.
- van de Ven J.P.
- Geerlings M.J.
- Saksens N.T.
- Bakker B.
- Henkes A.
- Neveling K.
- del Rosario M.
- Westra D.
- van den Heuvel L.P.
- Schick T.
- Fauser S.
- Boon C.J.
- Hoyng C.B.
- et al.
Whole exome sequencing in patients with the cuticular drusen subtype of age-related macular degeneration.
). RPE cells control collagen synthesis for the BrM (
35.- Nita M.
- Strzałka-Mrozik B.
- Grzybowski A.
- Mazurek U.
- Romaniuk W.
Age-related macular degeneration and changes in the extracellular matrix.
). Both [
14C]proline and [
3H]proline were incorporated in newly synthesized collagen in feline RPE cells and aged primate RPE cells (
36.- Li W.
- Stramm L.E.
- Aguirre G.D.
- Rockey J.H.
Extracellular matrix production by cat retinal pigment epithelium in vitro: characterization of type IV collagen synthesis.
,
37.- Hirata A.
- Feeney-Burns L.
Autoradiographic studies of aged primate macular retinal pigment epithelium.
). In our preparations, RPE cells have abundant free hydroxyproline; however, it is not labeled by [
13C]proline in 1 h (
Fig. 2B). This indicates that the hydroxylation of proline occurs after nascent collagen synthesis (
38.- Mitsubuchi H.
- Nakamura K.
- Matsumoto S.
- Endo F.
Inborn errors of proline metabolism.
). It also suggests that the hydroxyproline turnover in collagen synthesis and degradation is a very slow process. Interestingly, one proline transporter, SLC6A20, is one of 154 RPE signature genes that is specifically and highly expressed in human RPE by a comparative study of gene expression from 78 tissues (
39.- Strunnikova N.V.
- Maminishkis A.
- Barb J.J.
- Wang F.
- Zhi C.
- Sergeev Y.
- Chen W.
- Edwards A.O.
- Stambolian D.
- Abecasis G.
- Swaroop A.
- Munson P.J.
- Miller S.S.
Transcriptome analysis and molecular signature of human retinal pigment epithelium.
). Additional investigations will be required to show how carbons from proline are distributed to various metabolic pathways, how proline is transported, and how deprivation of proline in culture impacts RPE differentiation and function.
Besides proline, RPE also consumes substantial amounts of taurine and glucose. Photoreceptors are enriched with taurine, and they use glucose for aerobic glycolysis. RPE expresses glucose transporters and taurine transporters and is enriched with these two nutrients (
10.- Sugasawa K.
- Deguchi J.
- Okami T.
- Yamamoto A.
- Omori K.
- Uyama M.
- Tashiro Y.
Immunocytochemical analyses of distributions of Na, K-ATPase and GLUT1, insulin and transferrin receptors in the developing retinal pigment epithelial cells.
,
40.- Hillenkamp J.
- Hussain A.A.
- Jackson T.L.
- Constable P.A.
- Cunningham J.R.
- Marshall J.
Compartmental analysis of taurine transport to the outer retina in the bovine eye.
,
41.- El-Sherbeny A.
- Naggar H.
- Miyauchi S.
- Ola M.S.
- Maddox D.M.
- Martin P.M.
- Ganapathy V.
- Smith S.B.
Osmoregulation of taurine transporter function and expression in retinal pigment epithelial, ganglion, and Muller cells.
). Taurine supplementation promotes RPE proliferation and suppresses cell death in RPE culture (
42.- Gabrielian K.
- Wang H.M.
- Ogden T.E.
- Ryan S.J.
In vitro stimulation of retinal pigment epithelium proliferation by taurine.
,
43.- Udawatte C.
- Qian H.
- Mangini N.J.
- Kennedy B.G.
- Ripps H.
Taurine suppresses the spread of cell death in electrically coupled RPE cells.
). As a well-known essential nutrient source, glucose is included in almost all RPE culture protocols. Deprivation of glucose reduces RPE viability, and attempts to rescue glucose-deprived RPE using other energy substrates have not been successful (
20.- Wood J.P.
- Chidlow G.
- Graham M.
- Osborne N.N.
Energy substrate requirements of rat retinal pigmented epithelial cells in culture: relative importance of glucose, amino acids, and monocarboxylates.
). These reports are consistent with our finding that the RPE needs these two basic nutrients under standard culture conditions.
We found that RPE cells export metabolic intermediates other than lactate and β-hydroxybutyrate into the culture medium. Citrate, glutamate, and glutamine are predominantly enriched in the culture medium on the apical side. Little is known about plasma membrane transporters for citrate and glutamine in RPE. Glutamate transporters have been found in cultured RPE cells, but their distribution is unknown (
44.- Mäenpää H.
- Gegelashvili G.
- Tähti H.
Expression of glutamate transporter subtypes in cultured retinal pigment epithelial and retinoblastoma cells.
,
45.- Miyamoto Y.
- Del Monte M.A.
Na+-dependent glutamate transporter in human retinal pigment epithelial cells.
). Citrate is a key component of the TCA cycle, an important substrate for lipid biosynthesis, and a chelator for divalent cations like Ca
2+, Zn
2+, Fe
2+, and Mg
2+ (
46.- Westergaard N.
- Waagepetersen H.S.
- Belhage B.
- Schousboe A.
Citrate, a ubiquitous key metabolite with regulatory function in the CNS.
). Citrate is produced in the mitochondria and exported into the cytosol through the mitochondrial citrate transporter (SLC25a1). Alternatively, citrate can also be synthesized in the cytosol from αKG through reductive carboxylation by isocitrate dehydrogenase 1 (
47.- Jiang L.
- Boufersaoui A.
- Yang C.
- Ko B.
- Rakheja D.
- Guevara G.
- Hu Z.
- DeBerardinis R.J.
Quantitative metabolic flux analysis reveals an unconventional pathway of fatty acid synthesis in cancer cells deficient for the mitochondrial citrate transport protein.
). Three citrate transporters (SLC13A2, SLC13A3, and SLC13A5) are responsible for intracellular citrate transport or for import of citrate from blood (
48.Sodium-coupled dicarboxylate and citrate transporters from the SLC13 family.
). The citrate concentration in cerebrospinal fluid is about 0.4 m
m (
49.- Sonnewald U.
- Westergaard N.
- Krane J.
- Unsgård G.
- Petersen S.B.
- Schousboe A.
First direct demonstration of preferential release of citrate from astrocytes using [13C]NMR spectroscopy of cultured neurons and astrocytes.
).
13C NMR spectroscopy has shown that astrocytes, but not neurons, are capable of exporting citrate (
46.- Westergaard N.
- Waagepetersen H.S.
- Belhage B.
- Schousboe A.
Citrate, a ubiquitous key metabolite with regulatory function in the CNS.
,
49.- Sonnewald U.
- Westergaard N.
- Krane J.
- Unsgård G.
- Petersen S.B.
- Schousboe A.
First direct demonstration of preferential release of citrate from astrocytes using [13C]NMR spectroscopy of cultured neurons and astrocytes.
). Microvilli from the RPE surround photoreceptors outer segments. Photoreceptor uptake of citrate derived from the RPE might facilitate glycolysis by supplying oxaloacetate to shuttle reducing power into mitochondria, provide acetyl-CoA for fatty acid synthesis, be utilized directly for the TCA cycle, and/or regulate divalent cations in the outer segment. Our RPE/retina co-culture experiments showing increased lactate, pyruvate, αKG, and glutamine in the mouse retina (
Fig. 6E) support this hypothesis.
In the retina, glutamine is synthesized in glia cells and transported into photoreceptors to generate glutamate. We have reported a neuron-glial metabolism model in which lactate, together with neuron-derived aspartate, is used for glutamine synthesis in Müller cells in the retina (
50.- Lindsay K.J.
- Du J.
- Sloat S.R.
- Contreras L.
- Linton J.D.
- Turner S.J.
- Sadilek M.
- Satrústegui J.
- Hurley J.B.
Pyruvate kinase and aspartate-glutamate carrier distributions reveal key metabolic links between neurons and glia in retina.
). Our RPE/retina co-culture experiments revealed increased labeled glutamine in the retina and the apical medium with no change in RPE cells. Under our culture conditions, it appears that lactate produced either by the RPE or by photoreceptors in the retina contributes to glutamine synthesis within Müller cells. Additionally, glutamate is depleted from the apical medium when retina is present, suggesting that RPE cells might contribute to the glutamine-glutamate cycle.
Serine and glycine are synthesized from 3-phosphoglycerate, a glycolytic intermediate. Surprisingly, RPE causes an ∼7-fold increase in incorporation of
13C from glucose into serine and glycine (
Fig. 6E). Serine is used for biosynthesis of glycerophospholipids, sphingosine, and ceramide. These phospholipids are in high demand for the daily renewal of shed outer segments (
51.- Ruggiero L.
- Finnemann S.C.
Lack of effect of microfilament or microtubule cytoskeleton-disrupting agents on restriction of externalized phosphatidylserine to rod photoreceptor outer segment tips.
). Glycine is essential for purine biosynthesis. Purines like cGMP, ATP, and hypoxanthine are required for phototransduction (
8.- Du J.
- Rountree A.
- Cleghorn W.M.
- Contreras L.
- Lindsay K.J.
- Sadilek M.
- Gu H.
- Djukovic D.
- Raftery D.
- Satrústegui J.
- Kanow M.
- Chan L.
- Tsang S.H.
- Sweet I.R.
- Hurley J.B.
Phototransduction influences metabolic flux and nucleotide metabolism in mouse retina.
). Additionally, metabolism of serine and glycine is an important source of NADPH, which is needed for anti-oxidative stress and lipid synthesis (
52.- Ducker G.S.
- Rabinowitz J.D.
One-carbon metabolism in health and disease.
). Recent genome-wide analyses have shown that several key enzymes in the serine and glycine pathways have common variants associated with macular telangiectasia type 2, a neurovascular degenerative retinal disease (
53.- Scerri T.S.
- Quaglieri A.
- Cai C.
- Zernant J.
- Matsunami N.
- Baird L.
- Scheppke L.
- Bonelli R.
- Yannuzzi L.A.
- Friedlander M.S.
- Egan C.A.
- Fruttiger M.
- Leppert M.
- Allikmets R.
- Bahlo M.
Genome-wide analyses identify common variants associated with macular telangiectasia type 2.
).
In summary, we have shown that proline is a preferred nutrient source for cultured RPE cells. Proline is used to generate mitochondrial intermediates through both oxidative and reductive pathways. We found that RPE cells transport glucose-derived citrate, glutamate, serine, and glycine from their apical surface to be used by the retina. These findings reveal how RPE utilizes substrates and provide insights into RPE biochemistry and retinal diseases. It is important to note that we have shown in this study how RPE cells have these preferences when grown in culture. Additional experiments will be required to confirm that RPE cells in the eye of a live animal have similar preferences for metabolic fuels.
Author contributions
Conceptualization, J. R. C., J. B. H., and J. D.; Investigation, J. R. C., K. K., A. L. E., C. J., Y. W., M. A. M., H. G., D. D., D. R., and J. D.; Writing, J. D., J. B. H., and J. R. C.; Funding Acquisition, J. R. C., J. B. H., and J. D.; Supervision, J. R. C., J. B. H., and J. D.
Article info
Publication history
Published online: June 14, 2017
Received in revised form:
May 30,
2017
Received:
March 27,
2017
Edited by Paul E. Fraser
Footnotes
This work was supported by National Institutes of Health Grants EY026030 (to J. D., J. B. H., and J. R. C.), EY06641 and EY017863 (to J. B. H.), and EY019714 (to J. R. C.) and the Brightfocus Foundation (to J. D. and J. R. C.). The authors declare that they have no conflicts of interest with the contents of this article. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
This article contains supplemental Experimental Procedures, Figs. 1–4, and Tables 1–3.
Copyright
© 2017 ASBMB. Currently published by Elsevier Inc; originally published by American Society for Biochemistry and Molecular Biology.