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1.
Nature ; 607(7920): 776-783, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35859176

RESUMEN

Mutations of the ADAR1 gene encoding an RNA deaminase cause severe diseases associated with chronic activation of type I interferon (IFN) responses, including Aicardi-Goutières syndrome and bilateral striatal necrosis1-3. The IFN-inducible p150 isoform of ADAR1 contains a Zα domain that recognizes RNA with an alternative left-handed double-helix structure, termed Z-RNA4,5. Hemizygous ADAR1 mutations in the Zα domain cause type I IFN-mediated pathologies in humans2,3 and mice6-8; however, it remains unclear how the interaction of ADAR1 with Z-RNA prevents IFN activation. Here we show that Z-DNA-binding protein 1 (ZBP1), the only other protein in mammals known to harbour Zα domains9, promotes type I IFN activation and fatal pathology in mice with impaired ADAR1 function. ZBP1 deficiency or mutation of its Zα domains reduced the expression of IFN-stimulated genes and largely prevented early postnatal lethality in mice with hemizygous expression of ADAR1 with mutated Zα domain (Adar1mZα/- mice). Adar1mZα/- mice showed upregulation and impaired editing of endogenous retroelement-derived complementary RNA reads, which represent a likely source of Z-RNAs activating ZBP1. Notably, ZBP1 promoted IFN activation and severe pathology in Adar1mZα/- mice in a manner independent of RIPK1, RIPK3, MLKL-mediated necroptosis and caspase-8-dependent apoptosis, suggesting a novel mechanism of action. Thus, ADAR1 prevents endogenous Z-RNA-dependent activation of pathogenic type I IFN responses by ZBP1, suggesting that ZBP1 could contribute to type I interferonopathies caused by ADAR1 mutations.


Asunto(s)
Adenosina Desaminasa , Interferón Tipo I , Proteínas de Unión al ARN , Adenosina Desaminasa/genética , Adenosina Desaminasa/metabolismo , Animales , Apoptosis , Caspasa 8/metabolismo , Interferón Tipo I/antagonistas & inhibidores , Interferón Tipo I/inmunología , Ratones , Mutación , Necroptosis , ARN Bicatenario/metabolismo , Proteínas de Unión al ARN/química , Proteínas de Unión al ARN/genética , Proteínas de Unión al ARN/metabolismo
2.
Cancers (Basel) ; 14(10)2022 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-35626041

RESUMEN

SQSTM1/p62 is a multitasking protein that functions as an autophagy receptor, but also as a signaling hub regulating diverse cellular pathways. p62 accumulation in mice with autophagy-deficient hepatocytes mediates liver damage and hepatocarcinogenesis through Nrf2 overactivation, yet the role of the p62-Keap1-Nrf2 axis in cell death and hepatocarcinogenesis in the absence of underlying autophagy defects is less clear. Here, we addressed the role of p62 and Nrf2 activation in a chronic liver disease model, namely mice with liver parenchymal cell-specific knockout of NEMO (NEMOLPC-KO), in which we demonstrate that they show no inherent autophagy impairment. Unexpectedly, systemic p62 ablation aggravated the phenotype and caused early postnatal lethality in NEMOLPC-KO mice. Expression of a p62 mutant (p62ΔEx2-5), which retains the ability to form aggregates and activate Nrf2 signaling, did not cause early lethality, but exacerbated hepatocarcinogenesis in these mice. Our immunohistological and molecular analyses showed that the increased tumor burden was only consistent with increased expression/stability of p62ΔEx2-5 driving Nrf2 hyperactivation, but not with other protumorigenic functions of p62, such as mTOR activation, cMYC upregulation or increased fibrosis. Surprisingly, forced activation of Nrf2 per se did not increase liver injury or tumor burden in NEMOLPC-KO mice, suggesting that autophagy impairment is a necessary prerequisite to unleash the Nrf2 oncogenic potential in mice with autophagy-competent hepatocytes.

3.
Mucosal Immunol ; 14(5): 1160-1171, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34045680

RESUMEN

Regulation of epithelial cell death has emerged as a key mechanism controlling immune homeostasis in barrier surfaces. Necroptosis is a type of regulated necrotic cell death induced by receptor interacting protein kinase 3 (RIPK3) that has been shown to cause inflammatory pathologies in different tissues. The role of regulated cell death and particularly necroptosis in lung homeostasis and disease remains poorly understood. Here we show that mice with Airway Epithelial Cell (AEC)-specific deficiency of Fas-associated with death domain (FADD), an adapter essential for caspase-8 activation, developed exacerbated allergic airway inflammation in a mouse model of asthma induced by sensitization and challenge with house dust mite (HDM) extracts. Genetic inhibition of RIPK1 kinase activity by crossing to mice expressing kinase inactive RIPK1 as well as RIPK3 or MLKL deficiency prevented the development of exaggerated HDM-induced asthma pathology in FADDAEC-KO mice, suggesting that necroptosis of FADD-deficient AECs augmented the allergic immune response. These results reveal a role of AEC necroptosis in amplifying airway allergic inflammation and suggest that necroptosis could contribute to asthma exacerbations caused by respiratory virus infections inducing AEC death.


Asunto(s)
Alérgenos/inmunología , Asma/etiología , Asma/metabolismo , Necroptosis/inmunología , Pyroglyphidae/inmunología , Mucosa Respiratoria/inmunología , Mucosa Respiratoria/metabolismo , Remodelación de las Vías Aéreas (Respiratorias) , Animales , Asma/patología , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico/metabolismo , Biomarcadores , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Susceptibilidad a Enfermedades , Activación Enzimática , Proteína de Dominio de Muerte Asociada a Fas/deficiencia , Inmunoglobulina E/inmunología , Inmunohistoquímica , Ratones , Ratones Noqueados , Proteína Serina-Treonina Quinasas de Interacción con Receptores/metabolismo , Receptores de Hidrocarburo de Aril/metabolismo , Mucosa Respiratoria/patología
4.
High Blood Press Cardiovasc Prev ; 28(2): 103-114, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33660234

RESUMEN

The objective of this literature review was to explore the long-term cardiovascular effects of preeclampsia in women. The primary goal was to determine which organs were most commonly affected in this population. Although it was previously believed that preeclampsia is cured after the delivery of the fetus and the placenta current evidence supports an association between preeclampsia and cardiovascular disease later in life, many years after the manifestation of this hypertensive pregnancy related disorder. Therefore preeclampsia may be emerging as a novel cardiovascular risk factor for women, which requires long-term follow up.


Asunto(s)
Presión Sanguínea , Enfermedades Cardiovasculares/epidemiología , Preeclampsia/epidemiología , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/terapia , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Preeclampsia/diagnóstico , Preeclampsia/fisiopatología , Preeclampsia/terapia , Embarazo , Pronóstico , Medición de Riesgo , Factores de Tiempo , Rigidez Vascular
5.
Cancer Res ; 78(13): 3634-3644, 2018 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-29724718

RESUMEN

Pathogenesis and progression of lung cancer are governed by complex interactions between the environment and host genetic susceptibility, which is further modulated by genetic and epigenetic changes. Autotaxin (ATX, ENPP2) is a secreted glycoprotein that catalyzes the extracellular production of lysophosphatidic acid (LPA), a growth-factor-like phospholipid that is further regulated by phospholipid phosphatases (PLPP). LPA's pleiotropic effects in almost all cell types are mediated through at least six G-protein coupled LPA receptors (LPAR) that exhibit overlapping specificities, widespread distribution, and differential expression profiles. Here we use both preclinical models of lung cancer and clinical samples (from patients and healthy controls) to investigate the expression levels, activity, and biological role of the above components of the ATX/LPA axis in lung cancer. ENPP2 was genetically altered in 8% of patients with lung cancer, whereas increased ATX staining and activity were detected in patient biopsies and sera, respectively. Moreover, PLPP3 expression was consistently downregulated in patients with lung cancer. Comparable observations were made in the two most widely used animal models of lung cancer, the carcinogen urethane-induced and the genetically engineered K-rasG12D -driven models, where genetic deletion of Enpp2 or Lpar1 resulted in disease attenuation, thus confirming a procarcinogenic role of LPA signaling in the lung. Expression profiling data analysis suggested that metabolic rewiring may be implicated in the procarcinogenic effects of the ATX/LPA axis in K-ras- G12D -driven lung cancer pathogenesis.Significance: These findings establish the role of ATX/LPA in lung carcinogenesis, thus expanding the mechanistic links between pulmonary fibrosis and cancer. Cancer Res; 78(13); 3634-44. ©2018 AACR.


Asunto(s)
Carcinogénesis/patología , Neoplasias Pulmonares/patología , Lisofosfolípidos/metabolismo , Fosfatidato Fosfatasa/metabolismo , Hidrolasas Diéster Fosfóricas/metabolismo , Anciano , Animales , Conjuntos de Datos como Asunto , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Pulmón/patología , Neoplasias Pulmonares/genética , Masculino , Ratones , Persona de Mediana Edad , Neoplasias Experimentales/inducido químicamente , Neoplasias Experimentales/genética , Neoplasias Experimentales/patología , Hidrolasas Diéster Fosfóricas/genética , Receptores del Ácido Lisofosfatídico/genética , Receptores del Ácido Lisofosfatídico/metabolismo , Transducción de Señal , Uretano/toxicidad
6.
PLoS One ; 10(7): e0133619, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26196781

RESUMEN

Acute Lung Injury (ALI) is a life-threatening, diffuse heterogeneous lung injury characterized by acute onset, pulmonary edema and respiratory failure. Lipopolysaccharide (LPS) is a common cause of both direct and indirect lung injury and when administered to a mouse induces a lung phenotype exhibiting some of the clinical characteristics of human ALI. Here, we report that LPS inhalation in mice results in increased bronchoalveolar lavage fluid (BALF) levels of Autotaxin (ATX, Enpp2), a lysophospholipase D largely responsible for the conversion of lysophosphatidylcholine (LPC) to lysophosphatidic acid (LPA) in biological fluids and chronically inflamed sites. In agreement, gradual increases were also detected in BALF LPA levels, following inflammation and pulmonary edema. However, genetic or pharmacologic targeting of ATX had minor effects in ALI severity, suggesting no major involvement of the ATX/LPA axis in acute inflammation. Moreover, systemic, chronic exposure to increased ATX/LPA levels was shown to predispose to and/or to promote acute inflammation and ALI unlike chronic inflammatory pathophysiological situations, further suggesting a differential involvement of the ATX/LPA axis in acute versus chronic pulmonary inflammation.


Asunto(s)
Lesión Pulmonar Aguda/metabolismo , Lisofosfolípidos/toxicidad , Hidrolasas Diéster Fosfóricas/metabolismo , Lesión Pulmonar Aguda/etiología , Lesión Pulmonar Aguda/patología , Animales , Líquido del Lavado Bronquioalveolar/química , Lipopolisacáridos/toxicidad , Lisofosfolípidos/metabolismo , Ratones , Ratones Endogámicos C57BL
7.
Am J Respir Cell Mol Biol ; 47(5): 566-74, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22744859

RESUMEN

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic form of diffuse lung disease occurring mainly in older adults. Increased lysophosphatidic acid (LPA) concentrations have been reported in the alveolar space of both idiopathic pulmonary fibrosis patients and a corresponding animal model, whereas the genetic deletion or pharmacological inhibition of LPA receptor 1 attenuated the development of the modeled disease, suggesting a direct involvement of LPA in disease pathogenesis. In this report, increased concentrations of autotaxin (ATX; ENPP2), the enzyme largely responsible for extracellular LPA production, were detected in both murine and human fibrotic lungs. The genetic deletion of ATX from bronchial epithelial cells or macrophages attenuated disease severity, establishing ATX as a novel player in IPF pathogenesis. Furthermore, the pharmacological inhibition of ATX attenuated the development of the modeled disease, suggesting that ATX is a possible therapeutic target in IPF.


Asunto(s)
Fibrosis Pulmonar Idiopática/enzimología , Pulmón/enzimología , Hidrolasas Diéster Fosfóricas/metabolismo , Adulto , Anciano , Anilidas/farmacología , Animales , Líquido del Lavado Bronquioalveolar/química , Femenino , Expresión Génica , Técnicas de Inactivación de Genes , Humanos , Fibrosis Pulmonar Idiopática/patología , Lisofosfolípidos/metabolismo , Macrófagos Alveolares/enzimología , Macrófagos Alveolares/patología , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Persona de Mediana Edad , Organofosfonatos/farmacología , Inhibidores de Fosfodiesterasa/farmacología , Hidrolasas Diéster Fosfóricas/genética , Mucosa Respiratoria/enzimología , Mucosa Respiratoria/patología
8.
J Exp Med ; 209(5): 925-33, 2012 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-22493518

RESUMEN

Rheumatoid arthritis is a destructive arthropathy characterized by chronic synovial inflammation that imposes a substantial socioeconomic burden. Under the influence of the proinflammatory milieu, synovial fibroblasts (SFs), the main effector cells in disease pathogenesis, become activated and hyperplastic, releasing proinflammatory factors and tissue-remodeling enzymes. This study shows that activated arthritic SFs from human patients and animal models express significant quantities of autotaxin (ATX; ENPP2), a lysophospholipase D that catalyzes the conversion of lysophosphatidylcholine to lysophosphatidic acid (LPA). ATX expression from SFs was induced by TNF, and LPA induced SF activation and effector functions in synergy with TNF. Conditional genetic ablation of ATX in mesenchymal cells, including SFs, resulted in disease attenuation in animal models of arthritis, establishing the ATX/LPA axis as a novel player in chronic inflammation and the pathogenesis of arthritis and a promising therapeutic target.


Asunto(s)
Artritis Experimental/fisiopatología , Artritis Reumatoide/fisiopatología , Fibroblastos/metabolismo , Hidrolasas Diéster Fosfóricas/metabolismo , ARN Mensajero/metabolismo , Membrana Sinovial/citología , Animales , Artritis Experimental/metabolismo , Artritis Reumatoide/metabolismo , Cromatografía Liquida , Galactósidos , Eliminación de Gen , Humanos , Inmunohistoquímica , Indoles , Lisofosfolípidos/metabolismo , Espectrometría de Masas , Ratones , Ratones Noqueados , Hidrolasas Diéster Fosfóricas/genética , ARN Mensajero/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Factor de Necrosis Tumoral alfa/metabolismo
9.
Dev Biol ; 339(2): 451-64, 2010 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-20079728

RESUMEN

Autotaxin (ATX) is a secreted glycoprotein widely present in biological fluids, originally isolated from the supernatant of melanoma cells as an autocrine motility stimulation factor. Its enzymatic product, lysophosphatidic acid (LPA), is a phospholipid mediator that evokes growth-factor-like responses in almost all cell types through G-protein coupled receptors. To assess the role of ATX and LPA signalling in pathophysiology, a conditional knockout mouse was created. Ubiquitous, obligatory deletion resulted to embryonic lethality most likely due to aberrant vascular branching morphogenesis and chorio-allantoic fusion. Moreover, the observed phenotype was shown to be entirely depended on embryonic, but not extraembryonic or maternal ATX expression. In addition, E9.5 ATX null mutants exhibited a failure of neural tube closure, most likely independent of the circulatory failure, which correlated with decreased cell proliferation and increased cell death. More importantly, neurite outgrowth in embryo explants was severely compromised in mutant embryos but could be rescued upon the addition of LPA, thus confirming a role for ATX and LPA signalling in the development of the nervous system. Finally, expression profiling of mutant embryos revealed attenuated embryonic expression of HIF-1a in the absence of ATX, suggesting a novel effector pathway of ATX/LPA.


Asunto(s)
Embrión de Mamíferos , Regulación del Desarrollo de la Expresión Génica , Lisofosfolípidos/metabolismo , Complejos Multienzimáticos/genética , Sistema Nervioso/embriología , Fosfodiesterasa I/genética , Pirofosfatasas/genética , Transducción de Señal , Animales , Diferenciación Celular , Embrión de Mamíferos/inervación , Embrión de Mamíferos/metabolismo , Ratones , Ratones Noqueados , Complejos Multienzimáticos/metabolismo , Mutación , Sistema Nervioso/metabolismo , Fosfodiesterasa I/metabolismo , Hidrolasas Diéster Fosfóricas , Pirofosfatasas/metabolismo
10.
Am J Respir Cell Mol Biol ; 41(4): 426-32, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19202007

RESUMEN

Mechanical ventilation, an essential life-support modality of patients with acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS), exerts its detrimental effects through largely unknown mechanisms. Gelsolin (GSN), an actin-binding protein and a substrate of caspase-3, was recently shown to play a major role in bleomycin- or lipopolysaccharide-induced lung injury. To dissect a possible role of GSN in the pathogenesis of ventilator-induced lung injury (VILI), genetically modified mice lacking GSN expression and wild-type controls underwent mechanical ventilation with high tidal volumes. GSN was found up-regulated in the airways upon VILI, and its genetic ablation led to almost complete disease protection as manifested by reduced edema formation, reduced lung injury, attenuated epithelial apoptosis, diminished cytokine expression, and impaired neutrophil infiltration. GSN fragmentation was shown to be an effector mechanism in VILI-induced apoptosis, while GSN expression was shown to be necessary for efficient neutrophil infiltration, which was found to be a prerequisite for VILI induction in this model. Therefore, intracellular GSN and GSN-mediated responses were shown to be an important player in the pathogenesis of VILI.


Asunto(s)
Gelsolina/fisiología , Ventilación de Alta Frecuencia/efectos adversos , Lesión Pulmonar Inducida por Ventilación Mecánica/fisiopatología , Resistencia de las Vías Respiratorias , Animales , Apoptosis , Líquido del Lavado Bronquioalveolar/citología , Permeabilidad Capilar , Citocinas/metabolismo , Gelsolina/deficiencia , Gelsolina/genética , Pulmón/patología , Rendimiento Pulmonar , Ratones , Ratones Noqueados , Neutrófilos/patología , Edema Pulmonar/etiología , Edema Pulmonar/fisiopatología , Edema Pulmonar/prevención & control , Estrés Mecánico , Lesión Pulmonar Inducida por Ventilación Mecánica/etiología , Lesión Pulmonar Inducida por Ventilación Mecánica/patología , Lesión Pulmonar Inducida por Ventilación Mecánica/prevención & control
11.
Am J Respir Crit Care Med ; 176(11): 1108-19, 2007 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-17761615

RESUMEN

RATIONALE: Despite intense research efforts, the etiology and pathogenesis of idiopathic pulmonary fibrosis remain poorly understood. OBJECTIVES: To discover novel genes and/or cellular pathways involved in the pathogenesis of the disease. METHODS: We performed expression profiling of disease progression in a well-characterized animal model of the disease. Differentially expressed genes that were identified were compared with all publicly available expression profiles both from human patients and animal models. The role of hypoxia-inducible factor (HIF)-1alpha in disease pathogenesis was examined with a series of immunostainings, both in the animal model as well as in tissue microarrays containing tissue samples of human patients, followed by computerized image analysis. MEASUREMENTS AND MAIN RESULTS: Comparative expression profiling produced a prioritized gene list of high statistical significance, which consisted of the most likely disease modifiers identified so far in pulmonary fibrosis. Extending beyond target identification, a series of meta-analyses produced a number of biological hypotheses on disease pathogenesis. Among them, the role of HIF-1 signaling was further explored to reveal HIF-1alpha overexpression in the hyperplastic epithelium of fibrotic lungs, colocalized with its target genes p53 and Vegf. CONCLUSIONS: Comparative expression profiling was shown to be a highly efficient method in identifying deregulated genes and pathways. Moreover, tissue microarrays and computerized image analysis allowed for the high-throughput and unbiased assessment of histopathologic sections, adding substantial confidence in pathologic evaluations. More importantly, our results suggest an early primary role of HIF-1 in alveolar epithelial cell homeostasis and disease pathogenesis, provide insights on the pathophysiologic differences of different interstitial pneumonias, and indicate the importance of assessing the efficacy of pharmacologic inhibitors of HIF-1 activity in the treatment of pulmonary fibrosis.


Asunto(s)
Perfilación de la Expresión Génica , Subunidad alfa del Factor 1 Inducible por Hipoxia/genética , Fibrosis Pulmonar/genética , Fibrosis Pulmonar/fisiopatología , Animales , Apoptosis , Progresión de la Enfermedad , Epitelio/metabolismo , Humanos , Procesamiento de Imagen Asistido por Computador , Pulmón/metabolismo , Pulmón/fisiopatología , Ratones , Ratones Endogámicos C57BL , Modelos Biológicos , Análisis de Secuencia por Matrices de Oligonucleótidos , Neumonía/metabolismo , Fibrosis Pulmonar/metabolismo , Fibrosis Pulmonar/patología , Transducción de Señal , Distribución Tisular , Proteína p53 Supresora de Tumor/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo
12.
PLoS One ; 1: e108, 2006 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-17205112

RESUMEN

BACKGROUND: Fibrosis, the replacement of functional tissue with excessive fibrous tissue, can occur in all the main tissues and organ systems, resulting in various pathological disorders. Idiopathic Pulmonary Fibrosis is a prototype fibrotic disease involving abnormal wound healing in response to multiple sites of ongoing alveolar epithelial injury. METHODOLOGY/PRINCIPAL FINDINGS: To decipher the role of TNF and TNF-mediated inflammation in the development of fibrosis, we have utilized the bleomycin-induced animal model of Pulmonary Fibrosis and a series of genetically modified mice lacking components of TNF signaling. Transmembrane TNF expression is shown to be sufficient to elicit an inflammatory response, but inadequate for the transition to the fibrotic phase of the disease. Soluble TNF expression is shown to be crucial for lymphocyte recruitment, a prerequisite for TGF-b1 expression and the development of fibrotic lesions. Moreover, through a series of bone marrow transfers, the necessary TNF expression is shown to originate from the non-hematopoietic compartment further localized in apoptosing epithelial cells. CONCLUSIONS: These results suggest a primary detrimental role of soluble TNF in the pathologic cascade, separating it from the beneficial role of transmembrane TNF, and indicate the importance of assessing the efficacy of soluble TNF antagonists in the treatment of Idiopathic Pulmonary Fibrosis.


Asunto(s)
Inflamación/etiología , Inflamación/metabolismo , Fibrosis Pulmonar/etiología , Fibrosis Pulmonar/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo , Animales , Bleomicina/toxicidad , Trasplante de Médula Ósea , Modelos Animales de Enfermedad , Humanos , Fibrosis Pulmonar Idiopática/tratamiento farmacológico , Fibrosis Pulmonar Idiopática/etiología , Inflamación/inducido químicamente , Inflamación/patología , Linfocitos/patología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Fibrosis Pulmonar/inducido químicamente , Fibrosis Pulmonar/patología , ARN Mensajero/genética , ARN Mensajero/metabolismo , Receptores del Factor de Necrosis Tumoral/deficiencia , Receptores del Factor de Necrosis Tumoral/genética , Receptores Tipo I de Factores de Necrosis Tumoral/deficiencia , Receptores Tipo I de Factores de Necrosis Tumoral/genética , Transducción de Señal , Solubilidad , Factor de Crecimiento Transformador beta1/biosíntesis , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/deficiencia , Factor de Necrosis Tumoral alfa/genética
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