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1.
J Biol Chem ; 292(16): 6438-6451, 2017 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-28235800

RESUMO

Tumor necrosis factor-α (TNF) exerts its biological effect through two types of receptors, p55 TNF receptor (TNFR1) and p75 TNF receptor (TNFR2). An inflammatory response is known to be induced mainly by TNFR1, whereas an anti-inflammatory reaction is thought to be mediated by TNFR2 in some autoimmune diseases. We have been investigating the use of an antagonistic TNF mutant (TNFR1-selective antagonistic TNF mutant (R1antTNF)) to reveal the pharmacological effect of TNFR1-selective inhibition as a new therapeutic modality. Here, we aimed to further improve and optimize the activity and behavior of this mutant protein both in vitro and in vivo Specifically, we examined a trimeric structural fusion of R1antTNF, formed via the introduction of short peptide linkers, as a strategy to enhance bioactivity and molecular stability. By comparative analysis with R1antTNF, the trimeric fusion, referred to as single-chain R1antTNF (scR1antTNF), was found to retain in vitro molecular properties of receptor selectivity and antagonistic activity but displayed a marked increase in thermal stability. The residence time of scR1antTNF in vivo was also significantly prolonged. Furthermore, molecular modification using polyethylene glycol (PEG) was easily controlled by limiting the number of reactive sites. Taken together, our findings show that scR1antTNF displays enhanced molecular stability while maintaining biological activity compared with R1antTNF.


Assuntos
Proteínas Mutantes/química , Mutação , Receptores Tipo I de Fatores de Necrose Tumoral/antagonistas & inibidores , Fator de Necrose Tumoral alfa/química , Fator de Necrose Tumoral alfa/genética , Animais , Anti-Inflamatórios/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Sítios de Ligação , Varredura Diferencial de Calorimetria , Linhagem Celular Tumoral , Citocinas/metabolismo , Desenho de Fármacos , Feminino , Fibroblastos/metabolismo , Humanos , Inflamação , Camundongos , Camundongos Endogâmicos BALB C , Polietilenoglicóis/química , Conformação Proteica , Engenharia de Proteínas , Multimerização Proteica , Receptores Tipo II do Fator de Necrose Tumoral/antagonistas & inibidores , Proteínas Recombinantes de Fusão/química
2.
Nat Biotechnol ; 21(4): 399-404, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12612587

RESUMO

We have synthesized a polymeric drug carrier, polyvinylpyrrolidone-co-dimethyl maleic anhydride [poly(VP-co-DMMAn)], for use in renal drug delivery. About 80% of the 10-kDa poly(VP-co-DMMAn) selectively accumulated in the kidneys 24 h after intravenous administration to mice. Although this accumulated poly(VP-co-DMMAn) was gradually excreted in the urine, about 40% remained in the kidneys 96 h after treatment. Poly(VP-co-DMMAn) was taken up by the renal proximal tubular epithelial cells and no cytotoxicity was noted. Higher doses did not produce toxicity in the kidneys or other tissues. In contrast, polyvinylpyrrolidone of the same molecular weight did not show any tissue-specific distribution. Poly(VP-co-DMMAn)-modified superoxide dismutase accumulated in the kidneys after intravenous administration and accelerated recovery from acute renal failure in a mouse model. In contrast, polyvinylpyrrolidone-modified superoxide dismutase and native superoxide dismutase were not as effective. Thus, poly(VP-co-DMMAn) is a useful candidate as a targeting carrier for renal drug delivery systems.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Epitélio/metabolismo , Pirrolidinas/farmacocinética , Compostos de Vinila/farmacocinética , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/tratamento farmacológico , Animais , Células Cultivadas , Sistemas de Liberação de Medicamentos/instrumentação , Epitélio/efeitos dos fármacos , Humanos , Injeções Intravenosas , Túbulos Renais Proximais/efeitos dos fármacos , Túbulos Renais Proximais/metabolismo , Masculino , Cloreto de Mercúrio , Camundongos , Polímeros/administração & dosagem , Polímeros/síntese química , Polímeros/farmacocinética , Pirrolidinas/administração & dosagem , Pirrolidinas/toxicidade , Superóxido Dismutase/administração & dosagem , Compostos de Vinila/administração & dosagem , Compostos de Vinila/toxicidade
3.
Clin Cancer Res ; 10(7): 2545-50, 2004 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-15073135

RESUMO

PURPOSE: In this study, to optimize the polymeric drug delivery system for cancer chemotherapy, we developed a new pH-sensitive polymeric carrier, poly(vinylpyrrolidone-co-dimethylmaleic anhydride) [PVD], that could gradually release native form of drugs with full activity, from the conjugates in response to changes in pH. We examined the usefulness of PVD as a polymeric drug carrier. EXPERIMENTAL DESIGN: PVD was radically synthesized with vinylpyrrolidone and 2,3-dimethylmaleic anhydride, which is known to be a pH-reversible amino-protecting reagent. Conjugates between PVD and other drugs, such as Adriamycin (ADR), were prepared under the slightly basic conditions (pH 8.5). The drug-release pattern and the antitumor activity of PVD were examined. RESULTS: At pH 8.5, the release of the drugs from the conjugate was not observed. In contrast, PVD could release fully active drugs in the native form in response to the change in pH near neutrality, and gradually released drugs at neutral pH (7.0) and slightly acidic pH (6.0). The drug-release pattern in serum was almost similar to that observed during these physiological conditions. The PVD-conjugated ADR showed superior antitumor activity against sarcoma-180 solid tumor in mice, and it had less toxic side effects than free ADR. This enhancement in the antitumor therapeutic window may be due to not only the improvement of plasma half-lives and tumor accumulation of ADR, but also its controlled and sustained release from the conjugates in vivo. CONCLUSIONS: These results indicate that PVD is an effective polymeric carrier for optimizing cancer therapy.


Assuntos
Portadores de Fármacos , Neoplasias/tratamento farmacológico , Polímeros/química , Animais , Antineoplásicos/administração & dosagem , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Relação Dose-Resposta a Droga , Doxorrubicina/administração & dosagem , Corantes Fluorescentes/farmacologia , Concentração de Íons de Hidrogênio , Isoquinolinas/farmacologia , Camundongos , Modelos Químicos , Transplante de Neoplasias , Neoplasias Experimentais/tratamento farmacológico , Pirrolidinas/farmacologia , Fatores de Tempo , Compostos de Vinila/farmacologia
4.
Clin Cancer Res ; 10(24): 8293-300, 2004 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-15623605

RESUMO

PURPOSE: In this study, the optimization of antitumor therapy with tumor necrosis factor-alpha (TNF-alpha) was attempted. EXPERIMENTAL DESIGN: Using the phage display technique, we created a lysine-deficient mutant TNF-alpha (mTNF-K90R). This mutant had higher affinities to both TNF receptors, despite reports that certain lysine residues play important roles in trimer formation and receptor binding. RESULTS: The mTNF-K90R showed an in vivo therapeutic window that was 13-fold higher than that of the wild-type TNF-alpha (wTNF-alpha). This was due to the synergistic effect of its 6-fold stronger in vitro bioactivity and its 2-fold longer plasma half-life derived from its surface negative potential. The reason why the mTNF-K90R showed a higher bioactivity was understood by a molecular modeling analysis of the complex between the wTNF-alpha and TNF receptor-I. The mTNF-K90R, which was site-specifically mono-PEGylated at the NH2 terminus (sp-PEG-mTNF-K90R), had a higher in vitro bioactivity and considerably longer plasma half-life than the wTNF-alpha, whereas the randomly mono-PEGylated wTNF-alpha had 6% of the bioactivity of the wTNF-alpha. With regard to effectiveness and safety, the in vivo antitumor therapeutic window of the sp-PEG-mTNF-K90R was 60-fold wider than that of the wTNF-alpha. CONCLUSIONS: These results indicated that this functionalized TNF-alpha may be useful not only as an antitumor agent but also as a selective enhancer of vascular permeability in tumors for improving antitumor chemotherapy.


Assuntos
Antineoplásicos/farmacologia , Mutação/genética , Biblioteca de Peptídeos , Polietilenoglicóis/química , Sarcoma Experimental/tratamento farmacológico , Fator de Necrose Tumoral alfa/química , Fator de Necrose Tumoral alfa/farmacologia , Animais , Antineoplásicos/química , Feminino , Fibrossarcoma/tratamento farmacológico , Fibrossarcoma/metabolismo , Lisina/química , Camundongos , Camundongos Endogâmicos BALB C , Modelos Moleculares , Polietilenoglicóis/metabolismo , Polietilenoglicóis/farmacologia , Receptores Tipo I de Fatores de Necrose Tumoral/química , Receptores Tipo I de Fatores de Necrose Tumoral/metabolismo , Sarcoma Experimental/metabolismo , Relação Estrutura-Atividade , Fator de Necrose Tumoral alfa/genética
5.
Biomaterials ; 25(16): 3259-66, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-14980420

RESUMO

To achieve an optimum drug delivery such as targeting or controlled release utilizing bioconjugation with polymeric modifier, the conjugate between drugs and polymeric modifiers must be designed to show desirable pharmacokinetic characteristics in vivo. In this study, we assessed the biopharmaceutical properties of various nonionic water-soluble polymers as polymeric drug carriers. Polyvinylpyrrolidone (PVP) showed the longest mean resident time (MRT) after i.v. injection of all nonionic polymers with the same molecular size. In fact, tumor necrosis factor-alpha (TNF-alpha) bioconjugated with PVP (PVP-TNF-alpha) circulated longer than TNF-alpha bioconjugated with polyethylene glycol (PEG-TNF-alpha) with the same molecular size. Each nonionic polymeric modifier showed a different tissue distribution. Dextran was accumulated in the spleen and liver. Polydimethylacrylamide (PDAAm) tended to distribute in the kidney. However, PVP showed the minimum volume of tissue distribution. These results suggested that PVP is the most suitable polymeric modifier for prolonging the circulation lifetime of a drug and localizing the conjugated drug in blood.


Assuntos
Portadores de Fármacos/farmacocinética , Fibrossarcoma/metabolismo , Povidona/farmacocinética , Fator de Necrose Tumoral alfa/administração & dosagem , Fator de Necrose Tumoral alfa/análise , Animais , Linhagem Celular Tumoral , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/química , Avaliação de Medicamentos/métodos , Estabilidade de Medicamentos , Feminino , Meia-Vida , Masculino , Taxa de Depuração Metabólica , Camundongos , Camundongos Endogâmicos BALB C , Especificidade de Órgãos , Polímeros/administração & dosagem , Polímeros/química , Polímeros/farmacocinética , Povidona/administração & dosagem , Povidona/química , Distribuição Tecidual , Fator de Necrose Tumoral alfa/química , Fator de Necrose Tumoral alfa/metabolismo
6.
Biomaterials ; 25(18): 4309-15, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15046921

RESUMO

We reported that the co-polymer composed of vinylpyrrolidone and maleic acid selectively distributed into the kidneys after i.v. injection. To further optimize the renal drug delivery system, we assessed the renal targeting capability of anionized polyvinylpyrrolidone (PVP) derivatives after intravenous administration in mice. The elimination of anionized PVP derivatives from the blood decreased with increasing anionic groups, and the clearance of carboxylated PVP and sulfonated PVP from the blood was almost similar. But carboxylated PVP efficiently accumulated in the kidney, whereas sulfonated PVP was rapidly excreted in the urine. The renal levels of carboxylated PVP were about five-fold higher than sulfonated PVP. Additionally, carboxylated PVP was effectively taken up by the renal proximal tubular epithelial cells in vivo after i.v. injection. These anionized PVP derivatives did not show any cytotoxicity against renal tubular cells and endothelial cells in vitro. Thus, these carboxylated and sulfonated PVPs may be useful polymeric carriers for drug delivery to the kidney and bladder, respectively.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Células Endoteliais/efeitos dos fármacos , Túbulos Renais/efeitos dos fármacos , Rim/metabolismo , Povidona/administração & dosagem , Povidona/farmacocinética , Sarcoma/patologia , Animais , Ânions , Sobrevivência Celular/efeitos dos fármacos , Relação Dose-Resposta a Droga , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/farmacocinética , Avaliação Pré-Clínica de Medicamentos/métodos , Células Endoteliais/patologia , Humanos , Injeções Intravenosas , Túbulos Renais/patologia , Masculino , Taxa de Depuração Metabólica , Camundongos , Camundongos Endogâmicos A , Especificidade de Órgãos , Povidona/toxicidade
7.
J Biomed Mater Res A ; 70(2): 219-23, 2004 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-15227666

RESUMO

To optimize polymer-conjugated drugs as a polymeric drug delivery system, it is essential to design polymeric carriers with tissue-specific targeting capacity. Previously, we showed that polyvinylpyrrolidone (PVP) was the most suitable polymeric carrier for prolonging the blood-residency of drugs, and was one of the best parent polymers to design the polymeric carriers with targeting capacity. In this study, we synthesized some hydrophobic PVP derivatives, poly(vinylpyrrolidone-co-styrene) [poly(VP-co-S)] and poly(vinylpyrrolidone-co-vinyl laurate) [poly(VP-co-VL)], and assessed their biopharmaceutical properties after intravenous administration in mice. The elimination of hydrophobic PVP derivatives from blood was the same as PVP, and the plasma half-lives of poly(VP-co-S) were almost similar to that of poly(VP-co-VL). Poly(VP-co-VL) efficiently accumulated in the spleen, whereas poly(VP-co-S) effectively accumulated in the liver. The level of poly(VP-co-VL) in the spleen was about 20 times higher than PVP and poly(VP-co-S). These hydrophobic PVP derivatives did not show any cytotoxicity against endothelial cells in vitro. Thus, poly(VP-co-VL) may be a useful polymeric carrier for drug delivery to the spleen. This study will provide useful information to design optimal polymeric carriers with targeting capacity to the spleen and liver.


Assuntos
Materiais Biocompatíveis/farmacocinética , Povidona/farmacocinética , Baço/metabolismo , Animais , Materiais Biocompatíveis/síntese química , Materiais Biocompatíveis/química , Portadores de Fármacos/síntese química , Portadores de Fármacos/química , Portadores de Fármacos/farmacocinética , Sistemas de Liberação de Medicamentos , Fluorescência , Interações Hidrofóbicas e Hidrofílicas , Masculino , Teste de Materiais , Camundongos , Conformação Molecular , Povidona/síntese química , Povidona/química , Distribuição Tecidual
8.
Nanoscale Res Lett ; 6(1): 464, 2011 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-21777482

RESUMO

Amorphous silica nanoparticles (nSP) have been used as a polishing agent and/or as a remineralization promoter for teeth in the oral care field. The present study investigates the effects of nSP on osteoclast differentiation and the relationship between particle size and these effects. Our results revealed that nSP exerted higher cytotoxicity in macrophage cells compared with submicron-sized silica particles. However, tartrate-resistant acid phosphatase (TRAP) activity and the number of osteoclast cells (TRAP-positive multinucleated cells) were not changed by nSP treatment in the presence of receptor activator of nuclear factor κB ligand (RANKL) at doses that did not induce cytotoxicity by silica particles. These results indicated that nSP did not cause differentiation of osteoclasts. Collectively, the results suggested that nanosilica exerts no effect on RANKL-induced osteoclast differentiation of RAW264.7 cells, although a detailed mechanistic examination of the nSP70-mediated cytotoxic effect is needed.

9.
J Control Release ; 149(1): 8-14, 2011 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-20036293

RESUMO

Multiple sclerosis (MS) is an inflammatory demyelinating disease, the pathogenesis of which is related to elevated serum levels of tumor necrosis factor-α (TNF). Although anti-TNF therapy has been tested as a potential treatment for MS, no remission of symptoms was observed. Recent reports indicated that the TNFR1 signal was responsible for the pathogenesis of murine experimental autoimmune encephalomyelitis (EAE), while the TNFR2 signal was responsible for recovery of the pathogenesis of EAE. Therefore, selective blocking of TNFR1 appears to be a promising strategy for the treatment of MS. In this regard, we previously succeeded in developing a novel TNFR1-selective antagonistic TNF mutant (R1antTNF) by using phage display technology. Here, we have examined the therapeutic potential of R1antTNF using EAE mice. Treatment with PEGylated R1antTNF (PEG-R1antTNF) significantly improved the clinical score and cerebral demyelination at the onset of EAE. Considerable suppression of Th1 and Th17-type response was also observed in spleen and lymph node cells of mice given PEG-R1antTNF. Moreover, the administration of PEG-R1antTNF suppressed the infiltration of inflammatory cells containing Th1 and Th17 cells into the spinal cord. These results suggest that selective blocking of TNFR1 by PEG-R1antTNF could be an effective therapeutic strategy against MS.


Assuntos
Portadores de Fármacos/química , Encefalomielite Autoimune Experimental/tratamento farmacológico , Proteínas Mutantes/uso terapêutico , Polietilenoglicóis/química , Receptores Tipo I de Fatores de Necrose Tumoral/antagonistas & inibidores , Fator de Necrose Tumoral alfa/uso terapêutico , Animais , Proliferação de Células/efeitos dos fármacos , Citocinas/sangue , Citocinas/imunologia , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/patologia , Linfonodos/efeitos dos fármacos , Linfonodos/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Mutantes/administração & dosagem , Proteínas Mutantes/genética , Mutação , Medula Espinal/efeitos dos fármacos , Medula Espinal/imunologia , Medula Espinal/patologia , Baço/efeitos dos fármacos , Baço/imunologia , Linfócitos T/efeitos dos fármacos , Linfócitos T/imunologia , Fator de Necrose Tumoral alfa/administração & dosagem , Fator de Necrose Tumoral alfa/genética
10.
Biomaterials ; 30(19): 3318-23, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19304319

RESUMO

Protein transduction domains (PTDs), such as HIV-derived Tat, have been successfully used as functional biomaterials for intracellular delivery of anti-cancer macromolecular drugs (protein, peptides, and oligonucleotides). Although there were therefore great expectations regarding the therapeutic potential of PTDs for the development of anti-cancer therapeutics, their clinical application so far has been extremely limited because of the relatively high concentrations required to mediate any effects on cancer cells in vitro or in vivo. In this context, improving the transduction efficiency of PTDs using phage display-based molecular evolution techniques may be useful for creating artificial PTDs with high efficiency and safety. Here, we report an evaluation of transduction efficiency and toxicity of such artificial PTDs (designated mT02 and mT03) compared with Tat. The internalization of mT02 was the most rapid and efficient by a mechanism different from the usual macropinocytosis. Furthermore, we found that artificial PTDs fused with survivin antagonistic peptide potentiate tumor cell-cytostatic activity. Thus, the results of this work provide new insights for designing new-generation peptide therapeutics for a wide variety of cancers as well as those expressing survivin.


Assuntos
Peptídeos/metabolismo , Estrutura Terciária de Proteína , Transporte Proteico/fisiologia , Transdução Genética/métodos , Sequência de Aminoácidos , Materiais Biocompatíveis/química , Materiais Biocompatíveis/metabolismo , Linhagem Celular , Citocalasina D/metabolismo , Citostáticos/metabolismo , Portadores de Fármacos/química , Portadores de Fármacos/metabolismo , Sistemas de Liberação de Medicamentos/métodos , Humanos , Dados de Sequência Molecular , Fragmentos de Peptídeos/genética , Fragmentos de Peptídeos/metabolismo , Peptídeos/genética , Peptídeos/uso terapêutico , Pinocitose/fisiologia , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , Proteínas Recombinantes de Fusão/uso terapêutico , beta-Ciclodextrinas/metabolismo , Produtos do Gene tat do Vírus da Imunodeficiência Humana/genética , Produtos do Gene tat do Vírus da Imunodeficiência Humana/metabolismo
11.
Anticancer Agents Med Chem ; 6(3): 251-8, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16712453

RESUMO

In recent years, clinical applications of recombinantly produced bioactive proteins such as cytokines have attracted attention. However, since these recombinant proteins are rather unstable in vivo, their clinical use as therapeutic agents requires frequent administration at a high dosage. This regimen disrupts homeostasis and results in severe side effects. To overcome these problems, bioactive proteins have been conjugated with water-soluble synthetic (WSS) polymeric carriers. Chemical modification of a protein with a WSS polymeric carrier (bioconjugation) regulates tissue distribution, resulting in a selective increase in its desirable therapeutic effects and a decrease in undesirable side effects. Among several drug delivery system (DDS) technologies, bioconjugation has been recognized as one of the most efficient methods for improving therapeutic potency of proteins. However, for further enhancement of the therapeutic potency and safety of conjugated bioactive proteins, more precise regulation of the in vivo behavior of each protein is necessary for selective expression of its therapeutic effect. Therefore, alternative WSS polymeric modifiers in which new functions such as targeting and controlled release of drugs can be added are required for further development of bioconjugated drugs. Recently, we have synthesized a novel polymeric drug carrier, poly(vinylpyrrolidone-co-dimethyl maleic anhydride) [PVD], which was a powerful candidate drug carrier for cancer therapy. In this review, we introduce useful information that enabled us to design polymeric drug carriers and their application for protein therapy.


Assuntos
Antineoplásicos/administração & dosagem , Sistemas de Liberação de Medicamentos/métodos , Desenho de Fármacos , Proteínas/administração & dosagem , Antineoplásicos/síntese química , Portadores de Fármacos/síntese química , Humanos , Neoplasias/tratamento farmacológico , Polietilenoglicóis/administração & dosagem , Polímeros/síntese química , Povidona/administração & dosagem
12.
Biol Pharm Bull ; 27(3): 437-9, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14993819

RESUMO

Clinical approach using tumor necrosis factor-alpha (TNF-alpha) as selective destruction against tumor endothelial cells and selective enhancer of tumor vascular permeability for effective accumulation of antitumor chemotherapeutic agents has attracted attention. However, the clinical application of TNF-alpha as a systemic antitumor agent has been limited because of toxic side-effects. To systemically use TNF-alpha as an antitumor agent and the selective enhancer of tumor vascular permeability, we assessed the usefulness of PEGylated TNF-alpha (PEG-TNF-alpha). PEG-TNF-alpha at a dose of 1000 JRU showed marked hemorrhagic necrosis in S-180 tumors without side-effects due to selective destruction of tumor vasculature, whereas wild-type TNF-alpha at a dose of 10,000 JRU showed a little hemorrhagic necrosis with severe side-effects. PEG-TNF-alpha induced the enhancement of tumor vascular permeability. The permeability was increased at 1 h, after an i.v. injection of PEG-TNF-alpha and returned to the basal level at 2 h. In addition, high molecular weight of PEG (molecular weight; 500K) accumulated in tumor tissue as well as low molecular weight of PEG (molecular weight; 12K). On the other hand, PEG-TNF-alpha didn't affect the permeability of normal tissue and inflammation site. This data suggested that PEG-TNF-alpha was useful agent as selective enhancer of tumor vascular permeability with safe.


Assuntos
Antineoplásicos/farmacologia , Permeabilidade Capilar/efeitos dos fármacos , Polietilenoglicóis/química , Fator de Necrose Tumoral alfa/farmacologia , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos/química , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Peso Molecular , Sarcoma 180/irrigação sanguínea , Sarcoma 180/tratamento farmacológico , Distribuição Tecidual , Fator de Necrose Tumoral alfa/efeitos adversos , Fator de Necrose Tumoral alfa/química
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