Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
1.
PLoS One ; 11(9): e0162803, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27643883

RESUMEN

Live attenuated influenza vaccine (LAIV) has demonstrated varying levels of efficacy against seasonal influenza; however, LAIV may be used as a tool to measure interactions between the human microbiome and a live, replicating virus. To increase our knowledge of this interaction, we measured changes to the nasal microbiome in subjects who received LAIV to determine if associations between influenza-specific IgA production and the nasal microbiome exist after immunization with a live virus vaccine. The anterior nares of 47 healthy subjects were swabbed pre- (Day 0) and post- (Days 7 and 28) LAIV administration, and nasal washes were conducted on Days 0 and 28. We performed next-generation sequencing on amplified 16s rRNA genes and measured mucosal influenza-specific IgA titers via enzyme-linked immunosorbent assay (ELISA). A significant increase in alpha diversity was identified (Observed, CHAO, and ACE) between Days 7 vs 0 (p-values = 0.017, 0.005, 0.005, respectively) and between Days 28 vs 0 (p-values = 0.054, 0.030, 0.050, respectively). Several significant associations between the presence of different microbial species, including Lactobacillus helveticus, Prevotella melaninogenica, Streptococcus infantis, Veillonella dispar, and Bacteroides ovatus, and influenza-specific H1 and H3 IgA antibody response were demonstrated. These data suggest that LAIV alters the nasal microbiome, allowing several less-abundant OTUs to establish a community niche. Additionally, specific alterations in the nasal microbiome are significantly associated with variations in influenza-specific IgA antibody production and could be clinically relevant.


Asunto(s)
Bacterias/inmunología , Inmunoglobulina A/inmunología , Virus de la Influenza A/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/prevención & control , Microbiota , Cavidad Nasal/microbiología , Vacunas Atenuadas/inmunología , Adolescente , Adulto , Anticuerpos Antivirales/inmunología , Bacterias/clasificación , Femenino , Glicoproteínas Hemaglutininas del Virus de la Influenza/inmunología , Humanos , Gripe Humana/inmunología , Gripe Humana/microbiología , Masculino , Adulto Joven
2.
PLoS One ; 10(3): e0122282, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25816015

RESUMEN

BACKGROUND: Although influenza causes significant morbidity and mortality in the elderly, the factors underlying the reduced vaccine immunogenicity and efficacy in this age group are not completely understood. Age and immunosenescence factors, and their impact on humoral immunity after influenza vaccination, are of growing interest for the development of better vaccines for the elderly. METHODS: We assessed associations between age and immunosenescence markers (T cell receptor rearrangement excision circles - TREC content, peripheral white blood cell telomerase - TERT expression and CD28 expression on T cells) and influenza A/H1N1 vaccine-induced measures of humoral immunity in 106 older subjects at baseline and three timepoints post-vaccination. RESULTS: TERT activity (TERT mRNA expression) was significantly positively correlated with the observed increase in the influenza-specific memory B cell ELISPOT response at Day 28 compared to baseline (p-value=0.025). TREC levels were positively correlated with the baseline and early (Day 3) influenza A/H1N1-specific memory B cell ELISPOT response (p-value=0.042 and p-value=0.035, respectively). The expression and/or expression change of CD28 on CD4+ and/or CD8+ T cells at baseline and Day 3 was positively correlated with the influenza A/H1N1-specific memory B cell ELISPOT response at baseline, Day 28 and Day 75 post-vaccination. In a multivariable analysis, the peak antibody response (HAI and/or VNA at Day 28) was negatively associated with age, the percentage of CD8+CD28 low T cells, IgD+CD27- naïve B cells, and percentage overall CD20- B cells and plasmablasts, measured at Day 3 post-vaccination. The early change in influenza-specific memory B cell ELISPOT response was positively correlated with the observed increase in influenza A/H1N1-specific HAI antibodies at Day 28 and Day 75 relative to baseline (p-value=0.007 and p-value=0.005, respectively). CONCLUSION: Our data suggest that influenza-specific humoral immunity is significantly influenced by age, and that specific markers of immunosenescence (e.g., the baseline/early expression of CD28 on CD4+ and/or CD8+ T cells and T cell immune abnormalities) are correlated with different humoral immune response outcomes observed after vaccination in older individuals, and thus can be potentially used to predict vaccine immunogenicity.


Asunto(s)
Inmunidad Humoral , Inmunosenescencia , Subtipo H1N1 del Virus de la Influenza A/inmunología , Gripe Humana/inmunología , Gripe Humana/prevención & control , Vacunación , Factores de Edad , Anciano , Anciano de 80 o más Años , Linfocitos B/inmunología , Linfocitos B/metabolismo , Femenino , Humanos , Vacunas contra la Influenza/inmunología , Gripe Humana/genética , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Linfocitos T/inmunología , Linfocitos T/metabolismo , Telomerasa/genética , Factores de Tiempo
3.
J Infect Dis ; 211(6): 898-905, 2015 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-25293367

RESUMEN

Vaccination with live attenuated rubella virus induces a strong immune response in most individuals. However, small numbers of subjects never reach or maintain protective antibody levels, and there is a high degree of variability in immune response. We have previously described genetic polymorphisms in HLA and other candidate genes that are associated with interindividual differences in humoral immunity to rubella virus. To expand our previous work, we performed a genome-wide association study (GWAS) to discover single-nucleotide polymorphisms (SNPs) associated with rubella virus-specific neutralizing antibodies. We identified rs2064479 in the HLA-DPB1 genetic region as being significantly associated with humoral immune response variations after rubella vaccination (P = 8.62 × 10(-8)). All other significant SNPs in this GWAS were located near the HLA-DPB1 gene (P ≤ 1 × 10(-7)). These findings demonstrate that polymorphisms in HLA-DPB1 are strongly associated with interindividual differences in neutralizing antibody levels to rubella vaccination and represent a validation of our previous HLA work.


Asunto(s)
Cadenas beta de HLA-DP/genética , Vacuna contra la Rubéola/inmunología , Virus de la Rubéola/inmunología , Rubéola (Sarampión Alemán)/prevención & control , Vacunación , Regiones no Traducidas 3' , Adolescente , Anticuerpos Neutralizantes/sangre , Anticuerpos Antivirales/sangre , Niño , Femenino , Estudio de Asociación del Genoma Completo , Humanos , Inmunidad Humoral , Desequilibrio de Ligamiento , Masculino , Polimorfismo de Nucleótido Simple , Rubéola (Sarampión Alemán)/inmunología , Adulto Joven
4.
Hum Genet ; 133(11): 1407-17, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25098560

RESUMEN

Rubella virus causes a relatively benign disease in most cases, although infection during pregnancy can result in serious birth defects. An effective vaccine has been available since the early 1970s and outbreaks typically do not occur among highly vaccinated (≥2 doses) populations. Nevertheless, considerable inter-individual variation in immune response to rubella immunization does exist, with single-dose seroconversion rates ~95 %. Understanding the mechanisms behind this variability may provide important insights into rubella immunity. In the current study, we examined associations between single nucleotide polymorphisms (SNPs) in selected cytokine, cytokine receptor, and innate/antiviral genes and immune responses following rubella vaccination in order to understand genetic influences on vaccine response. Our approach consisted of a discovery cohort of 887 subjects aged 11-22 at the time of enrollment and a replication cohort of 542 older adolescents and young adults (age 18-40). Our data indicate that SNPs near the butyrophilin genes (BTN3A3/BTN2A1) and cytokine receptors (IL10RB/IFNAR1) are associated with variations in IFNγ secretion and that multiple SNPs in the PVR gene, as well as SNPs located in the ADAR gene, exhibit significant associations with rubella virus-specific IL-6 secretion. This information may be useful, not only in furthering our understanding immune responses to rubella vaccine, but also in identifying key pathways for targeted adjuvant use to boost immunity in those with weak or absent immunity following vaccination.


Asunto(s)
Inmunidad Celular/genética , Vacuna contra el Sarampión-Parotiditis-Rubéola/inmunología , Polimorfismo de Nucleótido Simple , Virus de la Rubéola/inmunología , Rubéola (Sarampión Alemán)/prevención & control , Adolescente , Adulto , Niño , Estudios de Cohortes , Citocinas/inmunología , Femenino , Genotipo , Humanos , Masculino , Fenotipo , Receptores de Citocinas/inmunología , Especificidad de la Especie , Vacunación , Población Blanca/genética , Adulto Joven
5.
PLoS One ; 9(6): e99997, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24945853

RESUMEN

BACKGROUND: Viral attachment and cell entry host factors are important for viral replication, pathogenesis, and the generation and sustenance of immune responses after infection and/or vaccination, and are plausible genetic regulators of vaccine-induced immunity. METHODS: Using a tag-SNP approach in candidate gene study, we assessed the role of selected cell surface receptor genes, attachment factor-related genes, along with other immune genes in the genetic control of immune response variations after live rubella vaccination in two independent study cohorts. RESULTS: Our analysis revealed evidence for multiple associations between genetic variants in the PVR, PVRL2, CD209/DC-SIGN, RARB, MOG, IL6 and other immune function-related genes and rubella-specific neutralizing antibodies after vaccination (meta p-value <0.05). CONCLUSION: Our results indicate that multiple SNPs from genes involved in cell adhesion, viral attachment, and viral entry, as well as others in genes involved in signaling and/or immune response regulation, play a role in modulating humoral immune responses following live rubella vaccination.


Asunto(s)
Anticuerpos Antivirales/biosíntesis , Inmunidad Humoral , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Polimorfismo de Nucleótido Simple , Receptores Virales/genética , Rubéola (Sarampión Alemán)/prevención & control , Adolescente , Adulto , Anticuerpos Neutralizantes/biosíntesis , Moléculas de Adhesión Celular/genética , Moléculas de Adhesión Celular/inmunología , Niño , Estudios de Cohortes , Femenino , Expresión Génica , Interacciones Huésped-Patógeno , Humanos , Interleucina-6/genética , Interleucina-6/inmunología , Lectinas Tipo C/genética , Lectinas Tipo C/inmunología , Masculino , Vacuna contra el Sarampión-Parotiditis-Rubéola/inmunología , Glicoproteína Mielina-Oligodendrócito/genética , Glicoproteína Mielina-Oligodendrócito/inmunología , Receptores de Superficie Celular/genética , Receptores de Superficie Celular/inmunología , Receptores de Ácido Retinoico/genética , Receptores de Ácido Retinoico/inmunología , Receptores Virales/inmunología , Rubéola (Sarampión Alemán)/inmunología , Rubéola (Sarampión Alemán)/virología , Virus de la Rubéola/inmunología , Vacunación , Acoplamiento Viral/efectos de los fármacos , Internalización del Virus/efectos de los fármacos
6.
Immunogenetics ; 66(7-8): 493-9, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24811271

RESUMEN

Genetic polymorphisms are known to affect responses to both viral infection and vaccination. Our previous work has described genetic polymorphisms significantly associated with variations in immune response to rubella vaccine from multiple gene families with known immune function, including HLA, cytokine and cytokine receptor genes, and in genes controlling innate and adaptive immunity. In this study, we assessed cellular immune responses (IFNγ and IL-6) in a cohort of healthy younger individuals and performed genome-wide SNP analysis on these same individuals. Here, we report the first genome-wide association study focused on immune responses following rubella vaccination. Our results indicate that rs16928280 in protein tyrosine phosphatase delta (PTPRD) and a collection of SNPs in ACO1 (encoding an iron regulatory protein) are associated with interindividual variations in IFNγ response to rubella virus stimulation. In contrast, we did not identify any significant genetic associations with rubella-specific IL-6 response. These genetic regions may influence rubella vaccine-induced IFNγ responses and warrant further studies in additional cohorts in order to confirm these findings.


Asunto(s)
Citocinas/biosíntesis , Vacuna contra el Sarampión-Parotiditis-Rubéola/inmunología , Polimorfismo de Nucleótido Simple , Virus de la Rubéola/inmunología , Inmunidad Adaptativa/genética , Adolescente , Niño , Estudios de Cohortes , Femenino , Estudio de Asociación del Genoma Completo , Humanos , Fenómenos Inmunogenéticos , Interferón gamma/biosíntesis , Interleucina-6/biosíntesis , Proteína 1 Reguladora de Hierro/genética , Masculino , Proteínas Tirosina Fosfatasas Clase 2 Similares a Receptores/genética , Adulto Joven
7.
Curr Opin Immunol ; 29: 62-8, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24820347

RESUMEN

Aging can lead to immunosenescence, which dramatically impairs the hosts' ability to develop protective immune responses to vaccine antigens. Reasons for this are not well understood. This topic's importance is reflected in the increases in morbidity and mortality due to infectious diseases among elderly persons, a population growing in size globally, and the significantly lower adaptive immune responses generated to vaccines in this population. Here, we endeavor to summarize the existing data on the genetic and immunologic correlates of immunosenescence with respect to vaccine response. We cover how the application of systems biology can advance our understanding of vaccine immunosenescence, with a view toward how such information could lead to strategies to overcome the lower immunogenicity of vaccines in the elderly.


Asunto(s)
Envejecimiento/inmunología , Biología de Sistemas , Vacunas/inmunología , Senescencia Celular , Variación Genética , Humanos , Biología de Sistemas/métodos
8.
Expert Rev Vaccines ; 13(5): 657-69, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24702429

RESUMEN

The impact of vaccines on public health and wellbeing has been profound. Smallpox has been eradicated, polio is nearing eradication, and multiple diseases have been eliminated from certain areas of the world. Unfortunately, we now face diseases such as hepatitis C, malaria or tuberculosis, as well as new and re-emerging pathogens for which we lack effective vaccines. Empirical approaches to vaccine development have been successful in the past, but may not be up to the current infectious disease challenges facing us. New, directed approaches to vaccine design, development, and testing need to be developed. Ideally these approaches will capitalize on cutting-edge technologies, advanced analytical and modeling strategies, and up-to-date knowledge of both pathogen and host. These approaches will pay particular attention to the causes of inter-individual variation in vaccine response in order to develop new vaccines tailored to the unique needs of individuals and communities within the population.


Asunto(s)
Inmunidad Celular/inmunología , Fenómenos Inmunogenéticos/inmunología , Medicina de Precisión/tendencias , Vacunación/tendencias , Animales , Humanos , Medicina de Precisión/métodos , Valor Predictivo de las Pruebas , Vacunación/métodos
9.
Vaccine ; 32(17): 1946-53, 2014 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-24530932

RESUMEN

INTRODUCTION: Immune response variations after vaccination are influenced by host genetic factors and demographic variables, such as race, ethnicity and sex. The latter have not been systematically studied in regard to live rubella vaccine, but are of interest for developing next generation vaccines for diverse populations, for predicting immune responses after vaccination, and for better understanding the variables that impact immune response. METHODS: We assessed associations between demographic variables, including race, ethnicity and sex, and rubella-specific neutralizing antibody levels and secreted cytokines (IFNγ, IL-6) in two independent cohorts (1994 subjects), using linear and linear mixed models approaches, and genetically defined racial and ethnic categorizations. RESULTS: Our replicated findings in two independent, large, racially diverse cohorts indicate that individuals of African descent have significantly higher rubella-specific neutralizing antibody levels compared to individuals of European descent and/or Hispanic ethnicity (p<0.001). CONCLUSION: Our study provides consistent evidence for racial/ethnic differences in humoral immune response following rubella vaccination.


Asunto(s)
Negro o Afroamericano , Inmunidad Humoral , Vacuna contra la Rubéola/inmunología , Población Blanca , Adolescente , Adulto , Anticuerpos Neutralizantes/sangre , Anticuerpos Antivirales/sangre , Niño , Estudios de Cohortes , Femenino , Humanos , Interferón gamma/inmunología , Interleucina-6/inmunología , Modelos Lineales , Masculino , Rubéola (Sarampión Alemán)/prevención & control , Adulto Joven
10.
Clin Vaccine Immunol ; 21(3): 340-6, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24391140

RESUMEN

Rubella remains a social and economic burden due to the high incidence of congenital rubella syndrome (CRS) in some countries. For this reason, an accurate and efficient high-throughput measure of antibody response to vaccination is an important tool. In order to measure rubella-specific neutralizing antibodies in a large cohort of vaccinated individuals, a high-throughput immunocolorimetric system was developed. Statistical interpolation models were applied to the resulting titers to refine quantitative estimates of neutralizing antibody titers relative to the assayed neutralizing antibody dilutions. This assay, including the statistical methods developed, can be used to assess the neutralizing humoral immune response to rubella virus and may be adaptable for assessing the response to other viral vaccines and infectious agents.


Asunto(s)
Anticuerpos Neutralizantes/sangre , Anticuerpos Antivirales/sangre , Calorimetría/métodos , Ensayos Analíticos de Alto Rendimiento/métodos , Virus de la Rubéola/inmunología , Rubéola (Sarampión Alemán)/inmunología , Adolescente , Adulto , Niño , Femenino , Humanos , Inmunoensayo/métodos , Masculino , Modelos Estadísticos , Adulto Joven
11.
Immunol Res ; 58(1): 1-8, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24375276

RESUMEN

Although vaccination campaigns have significantly reduced the global burden of rubella disease, there are still regional outbreaks and cases of congenital rubella syndrome. Rubella vaccination elicits a strong humoral as well as cellular response. The relationship between these two measures in response to rubella vaccine is poorly understood. We have previously reported no correlation between rubella-virus-specific cytokine secretion and IgG antibody levels after rubella vaccination. In the current study, we extend our previous work to report correlations between secreted cytokines and functional neutralizing antibodies after rubella vaccination in four distinct cohorts. There was evidence of significant differences (p < 0.05) in rubella-virus-specific humoral and cellular responses between cohorts. When investigating relationships between rubella-vaccine-specific humoral and cellular immunity, we observed a significant correlation between neutralizing antibodies and IFN-γ (r(s) = 0.21, p = 0.0004). We also observed correlations in subjects with extreme humoral immune phenotypes and IFN-γ levels in two of the four cohorts (r(s) = 0.32, p = 0.01; r(s) = 0.36, p = 0.01, respectively). These findings indicate that there is a high level of heterogeneity in rubella-specific immune responses between study populations. We believe that the novel correlation discovered between IFN-γ and neutralizing antibody titers will give future insight into the functional mechanisms of immunity induced by rubella virus and other live viral vaccines.


Asunto(s)
Vacuna contra la Rubéola/administración & dosificación , Virus de la Rubéola/inmunología , Rubéola (Sarampión Alemán)/inmunología , Rubéola (Sarampión Alemán)/prevención & control , Adolescente , Adulto , Anticuerpos Neutralizantes/sangre , Anticuerpos Neutralizantes/inmunología , California , Niño , Estudios de Cohortes , Femenino , Humanos , Inmunidad Celular , Inmunidad Humoral , Interferón gamma/sangre , Interferón gamma/inmunología , Interleucina-6/sangre , Interleucina-6/inmunología , Leucocitos Mononucleares/inmunología , Masculino , Minnesota , Vacuna contra la Rubéola/inmunología , Estadísticas no Paramétricas , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/inmunología , Adulto Joven
12.
Semin Immunol ; 25(2): 89-103, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23755893

RESUMEN

Vaccines, like drugs and medical procedures, are increasingly amenable to individualization or personalization, often based on novel data resulting from high throughput "omics" technologies. As a result of these technologies, 21st century vaccinology will increasingly see the abandonment of a "one size fits all" approach to vaccine dosing and delivery, as well as the abandonment of the empiric "isolate-inactivate-inject" paradigm for vaccine development. In this review, we discuss the immune response network theory and its application to the new field of vaccinomics and adversomics, and illustrate how vaccinomics can lead to new vaccine candidates, new understandings of how vaccines stimulate immune responses, new biomarkers for vaccine response, and facilitate the understanding of what genetic and other factors might be responsible for rare side effects due to vaccines. Perhaps most exciting will be the ability, at a systems biology level, to integrate increasingly complex high throughput data into descriptive and predictive equations for immune responses to vaccines. Herein, we discuss the above with a view toward the future of vaccinology.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Vacunas , Animales , Descubrimiento de Drogas/métodos , Descubrimiento de Drogas/tendencias , Ensayos Analíticos de Alto Rendimiento , Humanos , Medicina de Precisión , Biología de Sistemas/tendencias
13.
Expert Rev Vaccines ; 11(8): 985-94, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23002979

RESUMEN

Annual vaccination against seasonal influenza is recommended to decrease disease-related mortality and morbidity. However, one population that responds suboptimally to influenza vaccine is adults over the age of 65 years. The natural aging process is associated with a complex deterioration of multiple components of the host immune system. Research into this phenomenon, known as immunosenescence, has shown that aging alters both the innate and adaptive branches of the immune system. The intricate mechanisms involved in immune response to influenza vaccine, and how these responses are altered with age, have led us to adopt a more encompassing systems biology approach to understand exactly why the response to vaccination diminishes with age. Here, the authors review what changes occur with immunosenescence, and some immunogenetic factors that influence response, and outline the systems biology approach to understand the immune response to seasonal influenza vaccination in older adults.


Asunto(s)
Inmunidad Adaptativa , Inmunidad Innata , Vacunas contra la Influenza/inmunología , Gripe Humana/inmunología , Estaciones del Año , Biología de Sistemas/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Envejecimiento/inmunología , Humanos , Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H1N1 del Virus de la Influenza A/patogenicidad , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Linfocitos T/inmunología , Vacunación
14.
Infect Immun ; 79(11): 4438-46, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21859850

RESUMEN

We demonstrate that 2-month-old female B10.T(6R) mice are highly resistant to systemic infection with the KIM5 strain of Yersinia pestis and that B10.T(6R) mice become susceptible to Y. pestis infection by the age of 5 months. In this study, young (2-month-old) and middle-aged (5- to 12-month-old) B10.T(6R) mice were infected with equal CFU counts of Y. pestis. The 50% lethal dose (LD(50)) for young B10.T(6R) mice was ∼1.4 × 10(4) CFU, while middle-aged B10.T(6R) mice exhibited an LD(50) of ∼60 CFU. Elevated bacterial burdens were found in the spleens of middle-aged mice at 24 and 60 h and in the livers at 60 h postinfection. Immune cell infiltration was greater in the livers of resistant young mice than in those of middle-aged mice and mice of the susceptible C57BL/6N strain. Unlike susceptible mice, young B10.T(6R) mice did not develop necrotic lesions throughout the liver. Instead, livers from young B10.T(6R) mice contained granuloma-like structures. Immunohistochemical staining of liver sections from these mice at 60 h postinfection revealed that the majority of immune cells present in these structures were neutrophils. These findings suggest that resistance to plague in B10.T(6R) mice correlates with early formation of neutrophilic lesions in the liver.


Asunto(s)
Envejecimiento/inmunología , Susceptibilidad a Enfermedades/inmunología , Peste/inmunología , Yersinia pestis/inmunología , Animales , Quimiocinas/genética , Quimiocinas/metabolismo , Femenino , Regulación de la Expresión Génica/inmunología , Granuloma/microbiología , Granuloma/patología , Interleucina-6/genética , Interleucina-6/metabolismo , Masculino , Ratones , Ratones Endogámicos , Bazo/patología , Células Madre , Factores de Tiempo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...