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1.
J Am Chem Soc ; 134(17): 7384-91, 2012 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-22480322

RESUMEN

Post-translational attachment of geranylgeranyl isoprenoids to Rab GTPases, the key organizers of intracellular vesicular transport, is essential for their function. Rab geranylgeranyl transferase (RabGGTase) is responsible for prenylation of Rab proteins. Recently, RabGGTase inhibitors have been proposed to be potential therapeutics for treatment of cancer and osteoporosis. However, the development of RabGGTase selective inhibitors is complicated by its structural and functional similarity to other protein prenyltransferases. Herein we report identification of the natural product psoromic acid (PA) that potently and selectively inhibits RabGGTase with an IC(50) of 1.3 µM. Structure-activity relationship analysis suggested a minimal structure involving the depsidone core with a 3-hydroxyl and 4-aldehyde motif for binding to RabGGTase. Analysis of the crystal structure of the RabGGTase:PA complex revealed that PA forms largely hydrophobic interactions with the isoprenoid binding site of RabGGTase and that it attaches covalently to the N-terminus of the α subunit. We found that in contrast to other protein prenyltransferases, RabGGTase is autoinhibited through N-terminal (α)His2 coordination with the catalytic zinc ion. Mutation of (α)His dramatically enhances the reaction rate, indicating that the activity of RabGGTase is likely regulated in vivo. The covalent binding of PA to the N-terminus of the RabGGTase α subunit seems to potentiate its interaction with the active site and explains the selectivity of PA for RabGGTase. Therefore, psoromic acid provides a new starting point for the development of selective RabGGTase inhibitors.


Asunto(s)
Transferasas Alquil y Aril/antagonistas & inhibidores , Benzoxepinas/farmacología , Ácidos Carboxílicos/farmacología , Inhibidores Enzimáticos/farmacología , Prenilación de Proteína/efectos de los fármacos , Transferasas Alquil y Aril/química , Transferasas Alquil y Aril/metabolismo , Animales , Benzoxepinas/química , Ácidos Carboxílicos/química , Línea Celular , Inhibidores Enzimáticos/química , Humanos , Modelos Moleculares , Relación Estructura-Actividad
2.
Int J Cancer ; 131(11): 2704-9, 2012 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-22447389

RESUMEN

Post-translational modifications of histones by chromatin modifying enzymes regulate chromatin structure and gene expression. As deregulation of histone modifications contributes to cancer progression, inhibition of chromatin modifying enzymes such as histone demethylases is an attractive therapeutic strategy to impair cancer growth. Lysine-specific demethylase 1 (LSD1) removes mono- and dimethyl marks from lysine 4 or 9 of histone H3. LSD1 in association with the androgen receptor (AR) controls androgen-dependent gene expression and prostate tumor cell proliferation, thus highlighting LSD1 as a drug target. By combining protein structure similarity clustering and in vitro screening, we identified Namoline, a γ-pyrone, as a novel, selective and reversible LSD1 inhibitor. Namoline blocks LSD1 demethylase activity in vitro and in vivo. Inhibition of LSD1 by Namoline leads to silencing of AR-regulated gene expression and severely impairs androgen-dependent proliferation in vitro and in vivo. Thus, Namoline is a novel promising starting compound for the development of therapeutics to treat androgen-dependent prostate cancer.


Asunto(s)
Inhibidores Enzimáticos/farmacología , Histona Demetilasas/antagonistas & inhibidores , Neoplasias de la Próstata/tratamiento farmacológico , Pironas/farmacología , Andrógenos/metabolismo , Animales , Procesos de Crecimiento Celular/efectos de los fármacos , Línea Celular Tumoral , Cromatina/genética , Cromatina/metabolismo , Histona Demetilasas/genética , Histona Demetilasas/metabolismo , Histonas/genética , Histonas/metabolismo , Humanos , Masculino , Metilación/efectos de los fármacos , Ratones , Ratones Desnudos , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patología , Procesamiento Proteico-Postraduccional/efectos de los fármacos , Receptores Androgénicos/metabolismo , Ensayos Antitumor por Modelo de Xenoinjerto
3.
Nat Chem Biol ; 6(6): 449-56, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20418879

RESUMEN

Cycles of depalmitoylation and repalmitoylation critically control the steady-state localization and function of various peripheral membrane proteins, such as Ras proto-oncogene products. Interference with acylation using small molecules is a strategy to modulate cellular localization--and thereby unregulated signaling--caused by palmitoylated Ras proteins. We present the knowledge-based development and characterization of a potent inhibitor of acyl protein thioesterase 1 (APT1), a bona fide depalmitoylating enzyme that is, so far, poorly characterized in cells. The inhibitor, palmostatin B, perturbs the cellular acylation cycle at the level of depalmitoylation and thereby causes a loss of the precise steady-state localization of palmitoylated Ras. As a consequence, palmostatin B induces partial phenotypic reversion in oncogenic HRasG12V-transformed fibroblasts. We identify APT1 as one of the thioesterases in the acylation cycle and show that this protein is a cellular target of the inhibitor.


Asunto(s)
Inhibidores Enzimáticos/farmacología , Propiolactona/análogos & derivados , Tioléster Hidrolasas/antagonistas & inhibidores , Tioléster Hidrolasas/química , Proteínas ras/fisiología , Animales , Línea Celular , Perros , Regulación hacia Abajo , Inhibidores Enzimáticos/síntesis química , Inhibidores Enzimáticos/química , Humanos , Riñón/efectos de los fármacos , Riñón/fisiología , Ligandos , Lipasa/química , Lipasa/metabolismo , Lipoilación/efectos de los fármacos , Modelos Moleculares , Propiolactona/síntesis química , Propiolactona/química , Propiolactona/farmacología , Conformación Proteica , Proto-Oncogenes Mas , Transducción de Señal , Estómago/enzimología , Tioléster Hidrolasas/genética , Proteínas ras/efectos de los fármacos , Proteínas ras/metabolismo
4.
Nat Chem Biol ; 5(8): 581-3, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19561620

RESUMEN

We describe Scaffold Hunter, a highly interactive computer-based tool for navigation in chemical space that fosters intuitive recognition of complex structural relationships associated with bioactivity. The program reads compound structures and bioactivity data, generates compound scaffolds, correlates them in a hierarchical tree-like arrangement, and annotates them with bioactivity. Brachiation along tree branches from structurally complex to simple scaffolds allows identification of new ligand types. We provide proof of concept for pyruvate kinase.


Asunto(s)
Química Farmacéutica/métodos , Simulación por Computador , Bases de Datos Factuales , Modelos Moleculares , Bibliotecas de Moléculas Pequeñas/química , Programas Informáticos
5.
Nat Chem Biol ; 5(8): 585-92, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19561619

RESUMEN

The structure- and chemistry-based hierarchical organization of library scaffolds in tree-like arrangements provides a valid, intuitive means to map and navigate chemical space. We demonstrate that scaffold trees built using bioactivity as the key selection criterion for structural simplification during tree construction allow efficient and intuitive mapping, visualization and navigation of the chemical space defined by a given library, which in turn allows correlation of this chemical space with the investigated bioactivity and further compound design. Brachiation along the branches of such trees from structurally complex to simple scaffolds with retained yet varying bioactivity is feasible at high frequency for the five major pharmaceutically relevant target classes and allows for the identification of new inhibitor types for a given target. We provide proof of principle by identifying new active scaffolds for 5-lipoxygenase and the estrogen receptor ERalpha.


Asunto(s)
Química Farmacéutica/métodos , Simulación por Computador , Bases de Datos Factuales , Modelos Moleculares , Bibliotecas de Moléculas Pequeñas/química , Programas Informáticos , Araquidonato 5-Lipooxigenasa/química , Receptor alfa de Estrógeno/química , Unión Proteica , Bibliotecas de Moléculas Pequeñas/farmacología , Relación Estructura-Actividad
6.
Angew Chem Int Ed Engl ; 50(46): 10800-26, 2011 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-22038946

RESUMEN

Which compound classes are best suited as probes and tools for chemical biology research and as inspiration for medicinal chemistry programs? Chemical space is enormously large and cannot be exploited conclusively by means of synthesis efforts. Methods are required that allow one to identify and map the biologically relevant subspaces of vast chemical space, and serve as hypothesis-generating tools for inspiring synthesis programs. Biology-oriented synthesis builds on structural conservatism in the evolution of proteins and natural products. It employs a hierarchical classification of bioactive compounds according to structural relationships and type of bioactivity, and selects the scaffolds of bioactive molecule classes as starting points for the synthesis of compound collections with focused diversity. Navigation in chemical space is facilitated by Scaffold Hunter, an intuitively accessible and highly interactive software. Small molecules synthesized according to BIOS are enriched in bioactivity. They facilitate the analysis of complex biological phenomena by means of acute perturbation and may serve as novel starting points to inspire drug discovery programs.


Asunto(s)
Productos Biológicos/síntesis química , Química Farmacéutica , Productos Biológicos/química , Inhibidores Enzimáticos/síntesis química , Inhibidores Enzimáticos/química , Estructura Terciaria de Proteína , Proteínas/antagonistas & inhibidores , Proteínas/química , Bibliotecas de Moléculas Pequeñas/química
7.
Angew Chem Int Ed Engl ; 50(42): 9832-7, 2011 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-21905185

RESUMEN

A matter of common sense: a common recognition motif consisting of a negatively charged group five to six bonds away (red) from the (thio)ester functionality (green) and a positively charged tail group ten to twelve bonds away (blue) was identified in two native acyl protein thioesterase 1 (APT1) substrates. This similarity led to the design of potent inhibitors of the Ras-depalmitoylating enzyme APT1.


Asunto(s)
Diseño de Fármacos , Inhibidores Enzimáticos/farmacología , Lactonas/farmacología , Tioléster Hidrolasas/antagonistas & inhibidores , Factores de Intercambio de Guanina Nucleótido ras/metabolismo , Animales , Línea Celular , Perros , Relación Dosis-Respuesta a Droga , Inhibidores Enzimáticos/síntesis química , Inhibidores Enzimáticos/química , Humanos , Lactonas/síntesis química , Lactonas/química , Modelos Moleculares , Estructura Molecular , Relación Estructura-Actividad , Especificidad por Sustrato , Tioléster Hidrolasas/metabolismo
8.
Bioorg Med Chem ; 17(3): 1079-87, 2009 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-18321716

RESUMEN

D-Alanine-D-alanine ligase (DDl) is an essential enzyme in bacterial cell wall biosynthesis and an important target for developing new antibiotics. Here, we describe a new approach to identify new inhibitor scaffolds for DDl based on similarity in the ATP binding region of different kinases and DDl. After an initial screening of several protein kinase inhibitors, we found that the Brutons's tyrosine kinase inhibitor LFM-A13, an analog of the Leflunomide metabolite A771726, inhibits DDl with a K(i) of 185 microM. A series of malononitrilamide and salicylamide derivatives of LFM-A13 has been synthesized to confirm the validity of this scaffold as an inhibitor of DDl.


Asunto(s)
Adenosina Trifosfato/química , Amidas/química , Antibacterianos/química , Nitrilos/química , Péptido Sintasas/antagonistas & inhibidores , Inhibidores de Proteínas Quinasas/química , Amidas/síntesis química , Amidas/farmacología , Antibacterianos/síntesis química , Antibacterianos/farmacología , Sitios de Unión , Isoxazoles/síntesis química , Isoxazoles/química , Leflunamida , Nitrilos/síntesis química , Nitrilos/farmacología , Péptido Sintasas/metabolismo , Inhibidores de Proteínas Quinasas/síntesis química , Inhibidores de Proteínas Quinasas/farmacología , Salicilatos/síntesis química , Salicilatos/química , Relación Estructura-Actividad
11.
Microbiol Res ; 169(2-3): 107-20, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24360837

RESUMEN

Due to evolutionary conservation of biology, experimental knowledge captured from genetic studies in eukaryotic model organisms provides insight into human cellular pathways and ultimately physiology. Yeast chemogenomic profiling is a powerful approach for annotating cellular responses to small molecules. Using an optimized platform, we provide the relative sensitivities of the heterozygous and homozygous deletion collections for nearly 1800 biologically active compounds. The data quality enables unique insights into pathways that are sensitive and resistant to a given perturbation, as demonstrated with both known and novel compounds. We present examples of novel compounds that inhibit the therapeutically relevant fatty acid synthase and desaturase (Fas1p and Ole1p), and demonstrate how the individual profiles facilitate hypothesis-driven experiments to delineate compound mechanism of action. Importantly, the scale and diversity of tested compounds yields a dataset where the number of modulated pathways approaches saturation. This resource can be used to map novel biological connections, and also identify functions for unannotated genes. We validated hypotheses generated by global two-way hierarchical clustering of profiles for (i) novel compounds with a similar mechanism of action acting upon microtubules or vacuolar ATPases, and (ii) an un-annotated ORF, YIL060w, that plays a role in respiration in the mitochondria. Finally, we identify and characterize background mutations in the widely used yeast deletion collection which should improve the interpretation of past and future screens throughout the community. This comprehensive resource of cellular responses enables the expansion of our understanding of eukaryotic pathway biology.


Asunto(s)
Proteínas de Saccharomyces cerevisiae/genética , Saccharomyces cerevisiae/química , Saccharomyces cerevisiae/genética , Antifúngicos/farmacología , Vías Biosintéticas , Farmacorresistencia Fúngica , Regulación Fúngica de la Expresión Génica , Ensayos Analíticos de Alto Rendimiento , Datos de Secuencia Molecular , Filogenia , Saccharomyces cerevisiae/clasificación , Saccharomyces cerevisiae/efectos de los fármacos , Proteínas de Saccharomyces cerevisiae/metabolismo
13.
Nat Chem ; 5(1): 21-8, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23247173

RESUMEN

Fragment-based ligand and drug discovery predominantly employs sp(2)-rich compounds covering well-explored regions of chemical space. Despite the ease with which such fragments can be coupled, this focus on flat compounds is widely cited as contributing to the attrition rate of the drug discovery process. In contrast, biologically validated natural products are rich in stereogenic centres and populate areas of chemical space not occupied by average synthetic molecules. Here, we have analysed more than 180,000 natural product structures to arrive at 2,000 clusters of natural-product-derived fragments with high structural diversity, which resemble natural scaffolds and are rich in sp(3)-configured centres. The structures of the cluster centres differ from previously explored fragment libraries, but for nearly half of the clusters representative members are commercially available. We validate their usefulness for the discovery of novel ligand and inhibitor types by means of protein X-ray crystallography and the identification of novel stabilizers of inactive conformations of p38α MAP kinase and of inhibitors of several phosphatases.


Asunto(s)
Productos Biológicos/química , Descubrimiento de Drogas , Ligandos , Proteína Quinasa 14 Activada por Mitógenos/antagonistas & inhibidores , Bibliotecas de Moléculas Pequeñas/química , Algoritmos , Cristalografía por Rayos X , Concentración 50 Inhibidora , Estructura Molecular , Quinonas/química , Quinonas/farmacología , Bibliotecas de Moléculas Pequeñas/farmacología , Tetrahidroisoquinolinas/química , Tetrahidroisoquinolinas/farmacología
15.
J Med Chem ; 55(13): 5989-6001, 2012 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-22537178

RESUMEN

Natural products are a heterogeneous group of compounds with diverse, yet particular molecular properties compared to synthetic compounds and drugs. All relevant analyses show that natural products indeed occupy parts of chemical space not explored by available screening collections while at the same time largely adhering to the rule-of-five. This renders them a valuable, unique, and necessary component of screening libraries used in drug discovery. With ChemGPS-NP on the Web and Scaffold Hunter two tools are available to the scientific community to guide exploration of biologically relevant NP chemical space in a focused and targeted fashion with a view to guide novel synthesis approaches. Several of the examples given illustrate the possibility of bridging the gap between computational methods and compound library synthesis and the possibility of integrating cheminformatics and chemical space analyses with synthetic chemistry and biochemistry to successfully explore chemical space for the identification of novel small molecule modulators of protein function.The examples also illustrate the synergistic potential of the chemical space concept and modern chemical synthesis for biomedical research and drug discovery. Chemical space analysis can map under explored biologically relevant parts of chemical space and identify the structure types occupying these parts. Modern synthetic methodology can then be applied to efficiently fill this "virtual space" with real compounds.From a cheminformatics perspective, there is a clear demand for open-source and easy to use tools that can be readily applied by educated nonspecialist chemists and biologists in their daily research. This will include further development of Scaffold Hunter, ChemGPS-NP, and related approaches on the Web. Such a "cheminformatics toolbox" would enable chemists and biologists to mine their own data in an intuitive and highly interactive process and without the need for specialized computer science and cheminformatics expertise. We anticipate that it may be a viable, if not necessary, step for research initiatives based on large high-throughput screening campaigns,in particular in the pharmaceutical industry, to make the most out of the recent advances in computational tools in order to leverage and take full advantage of the large data sets generated and available in house. There are "holes" in these data sets that can and should be identified and explored by chemistry and biology.


Asunto(s)
Productos Biológicos/química , Descubrimiento de Drogas/métodos , Bibliotecas de Moléculas Pequeñas/química , Productos Biológicos/síntesis química , Productos Biológicos/farmacología , Bases de Datos Factuales , Diseño de Fármacos , Descubrimiento de Drogas/tendencias , Industria Farmacéutica/métodos , Industria Farmacéutica/tendencias , Modelos Moleculares , Estructura Molecular , Análisis de Componente Principal , Relación Estructura-Actividad
17.
J Med Chem ; 52(24): 8025-37, 2009 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-19894725

RESUMEN

Rab geranylgeranyl transferase (RabGGTase) catalyzes the attachment of geranylgeranyl isoprenoids to Rab guanine triphosphatases, which are key regulators in vesicular transport. Because geranylgeranylation is required for proper function and overexpression of Rabs has been observed in various cancers, RabGGTase may be a target for novel therapeutics. The development of selective inhibitors is, however, difficult because two related enzymes involved in other cellular processes exist in eukaryotes and because RabGGTase recognizes protein substrates indirectly, resulting in relaxed specificity. We report the synthesis of a peptidic library based on the farnesyl transferase inhibitor pepticinnamin E. Of 469 compounds investigated, several were identified as selective for RabGGTase with low micromolar IC(50) values. The compounds were not generally cytotoxic and inhibited Rab isoprenylation in COS-7 cells. Crystal structure analysis revealed that selective inhibitors interact with a tunnel unique to RabGGTase, implying that this structural motif is an attractive target for improved RabGGTase inhibitors.


Asunto(s)
Transferasas Alquil y Aril/antagonistas & inhibidores , Inhibidores Enzimáticos/química , Inhibidores Enzimáticos/farmacología , Oligopéptidos/química , Oligopéptidos/farmacología , Transferasas Alquil y Aril/química , Animales , Células COS , Dominio Catalítico , Chlorocebus aethiops , Inhibidores Enzimáticos/síntesis química , Cinética , Modelos Moleculares , Oligopéptidos/síntesis química , Biblioteca de Péptidos , Relación Estructura-Actividad , Especificidad por Sustrato
18.
Chemistry ; 14(29): 8847-8860, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18767075

RESUMEN

The biological activity of macrocyclic natural products depends on their conformational properties. For both the elucidation of enzyme binding affinities as well as the development of selective drugs, rigid macrocyclic scaffolds carry high potential. In this study, 13-membered cyclodepsipeptides based on the structure of naturally occurring stevastelins were studied in detail. Six diastereomeric stevastelin C3 analogues and four phosphorylated derivatives were synthesized. The synthesis of linear precursors was achieved on solid support by starting from stereoisomerically pure 2-methyl-3-hydroxy acids. Subsequent macro-lactamization gave the cyclic depsipeptides in very good yields (36-62%). The conformational space of these stevastelin C3 analogues was computationally investigated. On the basis of NMR spectroscopic data, homogeneous conformations were determined for each benzylated depsipeptide and the influence of phosphorylation on the overall conformation was investigated. Importantly, phosphorylation was found to significantly weaken the conformational preferences of the 13-membered depsipeptides. Finally, the cyclic depsipeptides were tested for activity against phosphatases. Inhibitory activity on vaccina H1-related phosphatase was observed depending on the derivatization of the cycles. The activity profiles are discussed in the light of the structural data.


Asunto(s)
Depsipéptidos/síntesis química , Inhibidores Enzimáticos/síntesis química , Inhibidores Enzimáticos/farmacología , Monoéster Fosfórico Hidrolasas/antagonistas & inhibidores , Monoéster Fosfórico Hidrolasas/metabolismo , Virus Vaccinia/efectos de los fármacos , Virus Vaccinia/enzimología , Depsipéptidos/química , Inhibidores Enzimáticos/química , Humanos , Espectroscopía de Resonancia Magnética , Modelos Moleculares , Conformación Molecular , Fosforilación
19.
J Chem Inf Model ; 47(1): 47-58, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17238248

RESUMEN

A hierarchical classification of chemical scaffolds (molecular framework, which is obtained by pruning all terminal side chains) has been introduced. The molecular frameworks form the leaf nodes in the hierarchy trees. By an iterative removal of rings, scaffolds forming the higher levels in the hierarchy tree are obtained. Prioritization rules ensure that less characteristic, peripheral rings are removed first. All scaffolds in the hierarchy tree are well-defined chemical entities making the classification chemically intuitive. The classification is deterministic, data-set-independent, and scales linearly with the number of compounds included in the data set. The application of the classification is demonstrated on two data sets extracted from the PubChem database, namely, pyruvate kinase binders and a collection of pesticides. The examples shown demonstrate that the classification procedure handles robustly synthetic structures and natural products.


Asunto(s)
Clasificación , Estructura Molecular , Compuestos Orgánicos/química , Bases de Datos Factuales , Ligandos , Plaguicidas , Piruvato Quinasa
20.
Cardiovasc Intervent Radiol ; 29(5): 862-5, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16794897

RESUMEN

Percutaneous vertebroplasty (PVP) is carried out under fluoroscopic control in most centers. The exclusion of implant leakage and the assessment of implant distribution might be difficult to assess based on two-dimensional radiographic projection images only. We evaluated the feasibility of performing a follow-up examination after PVP with rotational acquisitions and volumetric reconstructions in the angio suite. Twenty consecutive patients underwent standard PVP procedures under fluoroscopic control. Immediate postprocedure evaluation of the implant distribution in the angio suite (BV 3000; Philips, The Netherlands) was performed using rotational acquisitions (typical parameters for the image acquisition included a 17-cm field-of-view, 200 acquired images for a total angular range of 180 degrees ). Postprocessing of acquired volumetric datasets included multiplanar reconstruction (MPR), maximum intensity projection (MIP), and volume rendering technique (VRT) images that were displayed as two-dimensional slabs or as entire three-dimensional volumes. Image evaluation included lesion and implant assessment with special attention given to implant leakage. Findings from rotational acquisitions were compared to findings from postinterventional CT. The time to perform and to postprocess the rotational acquisitions was in all cases less then 10 min. Assessment of implant distribution after PVP using rotational image acquisition methods and volumetric reconstructions was possible in all patients. Cement distribution and potential leakage sites were visualized best on MIP images presented as slabs. From a total of 33 detected leakages with CT, 30 could be correctly detected by rotational image acquisition. Rotational image acquisitions and volumetric reconstruction methods provided a fast method to control radiographically the result of PVP in our cases.


Asunto(s)
Cementos para Huesos/uso terapéutico , Fluoroscopía , Fracturas Espontáneas/terapia , Imagenología Tridimensional , Radiografía Intervencional , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/terapia , Anciano , Anciano de 80 o más Años , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico por imagen , Femenino , Fracturas Espontáneas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
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