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1.
Nat Commun ; 12(1): 262, 2021 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431859

RESUMO

The pathogenesis of ulcerative colitis (UC), a major type of inflammatory bowel disease, remains unknown. No model exists that adequately recapitulates the complexity of clinical UC. Here, we take advantage of induced pluripotent stem cells (iPSCs) to develop an induced human UC-derived organoid (iHUCO) model and compared it with the induced human normal organoid model (iHNO). Notably, iHUCOs recapitulated histological and functional features of primary colitic tissues, including the absence of acidic mucus secretion and aberrant adherens junctions in the epithelial barrier both in vitro and in vivo. We demonstrate that the CXCL8/CXCR1 axis was overexpressed in iHUCO but not in iHNO. As proof-of-principle, we show that inhibition of CXCL8 receptor by the small-molecule non-competitive inhibitor repertaxin attenuated the progression of UC phenotypes in vitro and in vivo. This patient-derived organoid model, containing both epithelial and stromal compartments, will generate new insights into the underlying pathogenesis of UC while offering opportunities to tailor interventions to the individual patient.


Assuntos
Colite Ulcerativa/patologia , Organoides/patologia , Junções Aderentes/metabolismo , Caderinas/metabolismo , Progressão da Doença , Epitélio/patologia , Fibroblastos/patologia , Humanos , Inflamação/patologia , Omento/transplante , Fenótipo , Análise de Componente Principal , Análise de Sequência de RNA , Sulfonamidas/farmacologia , Transcriptoma/genética , beta Catenina/metabolismo
2.
Neoplasia ; 21(3): 269-281, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30738331

RESUMO

Dysfunctional inflammatory pathways are associated with an increased risk of cancer, including colorectal cancer. We have previously identified and enriched for a self-renewing, colon cancer stem cell (CCSC) subpopulation in primary sporadic colorectal cancers (CRC) and a related subpopulation in ulcerative colitis (UC) patients defined by the stem cell marker, aldehyde dehydrogenase (ALDH). Subsequent work demonstrated that CCSC-initiated tumors are dependent on the inflammatory chemokine, CXCL8, a known inducer of tumor proliferation, angiogenesis and invasion. Here, we use RNA interference to target CXCL8 and its receptor, CXCR1, to establish the existence of a functional signaling pathway promoting tumor growth initiated by sporadic and colitis CCSCs. Knocking down either CXCL8 or CXCR1 had a dramatic effect on inhibiting both in vitro proliferation and angiogenesis. Likewise, tumorigenicity was significantly inhibited due to reduced levels of proliferation and angiogenesis. Decreased expression of cycle cell regulators cyclins D1 and B1 along with increased p21 levels suggested that the reduction in tumor growth is due to dysregulation of cell cycle progression. Therapeutically targeting the CXCL8-CXCR1 signaling pathway has the potential to block sustained tumorigenesis by inhibiting both CCSC- and pCCSC-induced proliferation and angiogenesis.


Assuntos
Transformação Celular Neoplásica/metabolismo , Neoplasias do Colo/etiologia , Neoplasias do Colo/metabolismo , Inflamação/metabolismo , Interleucina-8/metabolismo , Células-Tronco Neoplásicas/metabolismo , Receptores de Interleucina-8A/metabolismo , Transdução de Sinais , Animais , Biomarcadores , Linhagem Celular Tumoral , Proliferação de Células , Colite/complicações , Colite/genética , Colite/metabolismo , Neoplasias do Colo/patologia , Modelos Animais de Doenças , Dosagem de Genes , Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Técnicas de Silenciamento de Genes , Xenoenxertos , Humanos , Imunofenotipagem , Inflamação/complicações , Inflamação/genética , Interleucina-8/genética , Camundongos , Modelos Biológicos , Neovascularização Patológica/genética , Neovascularização Patológica/metabolismo , Receptores de Interleucina-8A/genética
3.
Oncotarget ; 9(16): 13048-13059, 2018 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-29560130

RESUMO

Inflammatory bowel disease (IBD) affects one million people in the US. Ulcerative colitis (UC) is a subtype of IBD that can lead to colitis-associated cancer (CAC). In UC, the rate of CAC is 3-5-fold greater than the rate of sporadic colorectal cancer (CRC). The pathogenesis of UC and CAC are due to aberrant interactions between host immune system and microenvironment, but precise mechanisms are still unknown. In colitis and CAC, microenvironmental fibroblasts exhibit an activated, inflammatory phenotype that contributes to tumorigenesis accompanied by excessive secretion of the chemokine CXCL8. However, mechanisms regulating CXCL8 secretion are unclear. Since it is known that miRNAs regulate chemokines such as CXCL8, we queried a microRNA library for mimics affecting CXCL8 secretion. Among the identified microRNAs, miR-20a/b was further investigated as its stromal expression levels inversely correlated with the amounts of CXCL8 secreted and predicted fibroblast tumor-promoting activity. Indeed, miR-20a directly bound to the 3'UTR of CXCL8 mRNA and regulated its expression by translational repression. In vivo co-inoculation studies with CRC stem cells demonstrated that fibroblasts characterized by high miR-20a expression had reduced tumor-promoting activities. These studies reveal that in stromal fibroblasts, miR-20a modulates CXCL8 function, therefore influencing tumor latency.

4.
Oncotarget ; 8(31): 50476-50488, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28881576

RESUMO

In sporadic colon cancer, colon cancer stem cells (CCSCs) initiate tumorigenesis and may contribute to late disease recurrences and metastases. We previously showed that aldehyde dehydrogenase (ALDH) activity (as indicated by the ALDEFLUOR® assay) is an effective marker for highly enriching CCSCs for further evaluation. Here, we used comparative transcriptome and proteome approaches to identify signaling pathways overrepresented in the CCSC population. We found overexpression of several components of the phosphoinositide 3-kinase (PI3K)/Akt/mechanistic target of rapamycin (mTOR) signaling pathway, including PI3KR2, a regulatory subunit of PI3K. LY294002, a PI3K inhibitor, defined the contribution of the PI3K/Akt/mTOR signaling pathway in CCSCs. LY294002-treated CCSCs showed decreases in proliferation, sphere formation and self-renewal, in phosphorylation-dependent activation of Akt, and in expression of cyclin D1. Inhibition of PI3K in vivo reduced tumorigenicity, increased detection of cleaved caspase 3, an indicator of apoptosis, and elevated expression of the inflammatory chemokine, CXCL8. Collectively, these results indicate that PI3K/Akt/mTOR signaling controls CCSC proliferation and CCSC survival, and suggests that it would be useful to develop therapeutic agents that target this signaling pathway.

5.
Proc Natl Acad Sci U S A ; 112(28): 8732-7, 2015 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-26124098

RESUMO

A new paradigm in oncology establishes a spectrum of tumorigenic potential across the heterogeneous phenotypes within a tumor. The cancer stem cell hypothesis postulates that a minute fraction of cells within a tumor, termed cancer stem cells (CSCs), have a tumor-initiating capacity that propels tumor growth. An application of this discovery is to target this critical cell population using chemotherapy; however, the process of isolating these cells is arduous, and the rarity of CSCs makes it difficult to test potential drug candidates in a robust fashion, particularly for individual patients. To address the challenge of screening drug libraries on patient-derived populations of rare cells, such as CSCs, we have developed a drug-eluting microarray, a miniaturized platform onto which a minimal quantity of cells can adhere and be exposed to unique treatment conditions. Hundreds of drug-loaded polymer islands acting as drug depots colocalized with adherent cells are surrounded by a nonfouling background, creating isolated culture environments on a solid substrate. Significant results can be obtained by testing <6% of the cells required for a typical 96-well plate. Reliability was demonstrated by an average coefficient of variation of 14% between all of the microarrays and 13% between identical conditions within a single microarray. Using the drug-eluting array, colorectal CSCs isolated from two patients exhibited unique responses to drug combinations when cultured on the drug-eluting microarray, highlighting the potential as a prognostic tool to identify personalized chemotherapeutic regimens targeting CSCs.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Neoplasias Colorretais/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Células-Tronco Neoplásicas/efeitos dos fármacos , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/patologia , Humanos , Pessoa de Meia-Idade , Células Tumorais Cultivadas
6.
Cancer Res ; 72(19): 5091-100, 2012 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-22902411

RESUMO

Ulcerative colitis (UC) increases the risk of colorectal cancer (CRC), but the mechanisms involved in colitis-to-cancer transition (CCT) are not well understood. CCT may involve a inflammation-dysplasia-carcinoma progression sequence compared with the better characterized adenoma-carcinoma progression sequence associated with sporadic CRC. One common thread may be activating mutations in components of the Wnt/ß-catenin signaling pathway, which occur commonly as early events in sporadic CRC. To examine this hypothesis, we evaluated possible associations between Wnt/ß-catenin signaling and CCT based on the cancer stem cell (CSC) model. Wnt/ß-catenin immunostaining indicated that UC patients have a level of Wnt-pathway-active cells that is intermediate between normal colon and CRC. These UC cells exhibiting activation of the Wnt pathway constituted a major subpopulation (52% + 7.21) of the colonic epithelial cells positive for aldehyde dehydrogenase (ALDH), a putative marker of precursor colon CSC (pCCSC). We further fractionated this subpopulation of pCCSC using a Wnt pathway reporter assay. Over successive passages, pCCSCs with the highest Wnt activity exhibited higher clonogenic and tumorigenic potential than pCCSCs with the lowest Wnt activity, thereby establishing the key role of Wnt activity in driving CSC-like properties in these cells. Notably, 5/20 single cell injections of high-Wnt pCCSC resulted in tumor formation, suggesting a correlation with CCT. Attenuation of Wnt/ß-catenin in high-Wnt pCCSC by shRNA-mediated downregulation or pharmacological inhibition significantly reduced tumor growth rates. Overall, the results of our study indicates (i) that early activation of Wnt/ß-catenin signaling is critical for CCT and (ii) that high levels of Wnt/ß-catenin signaling can further demarcate high-ALDH tumor-initiating cells in the nondysplastic epithelium of UC patients. As such, our findings offer plausible diagnostic markers and therapeutic target in the Wnt signaling pathway for early intervention in CCT.


Assuntos
Colite/metabolismo , Neoplasias do Colo/metabolismo , Células-Tronco Neoplásicas/metabolismo , Via de Sinalização Wnt , Aldeído Desidrogenase/metabolismo , Animais , Western Blotting , Transformação Celular Neoplásica , Colite/genética , Colite/patologia , Neoplasias do Colo/genética , Neoplasias do Colo/patologia , Progressão da Doença , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Humanos , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Neoplasias Experimentais/genética , Neoplasias Experimentais/metabolismo , Neoplasias Experimentais/patologia , Células-Tronco Neoplásicas/patologia , Interferência de RNA , Esferoides Celulares/metabolismo , Esferoides Celulares/patologia , Transplante Heterólogo , Carga Tumoral , Células Tumorais Cultivadas , beta Catenina/genética , beta Catenina/metabolismo
7.
Neurosurgery ; 66(3): 544-50; discussion 550, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20173550

RESUMO

BACKGROUND: Although there are several large-species animal models for saccular aneurysms, there is a need for a simple, reproducible saccular aneurysm model in mice. OBJECTIVE: To develop a murine saccular aneurysm model, which replicates key characteristics that occur in the formation of human cerebral aneurysms. METHODS: Elastase is applied extravascularly to the right common carotid artery. We induced saccular aneurysm formation by our method in C57BL/6 mice (n = 30). Aneurysms and control arteries (left common carotid arteries) were harvested at 1 week, 2 weeks, and 3 weeks postinjury (n = 10 for each time point), measured, and stained for elastin content. To demonstrate BMP-derived cell recruitment to the aneurysms, bone marrow from UBC-gfp transgenic mice was transplanted into irradiated C57BL/6 recipients to create C57BL/6.gfp chimeras. Additionally, bone marrow from DsRed transgenic mice was transplanted into irradiated C57BL/6 recipients to create C57BL/6.DsRed chimeras, and bone marrow from B5/EGFP transgenic mice was transplanted into irradiated FVB recipients to create FVB.gfp chimeras. The elastase injury or sham operations were performed in the C57BL/6.gfp, C57BL/6.DsRed, and FVB.gfp chimeras. Aneurysms and sham vessels were harvested at 3 weeks and examined for BMP-derived cell recruitment. Additionally, aneurysms were stained for matrix metalloproteinase-9, which is overexpressed in human cerebral aneurysm tissue. RESULTS: Aneurysms consistently demonstrated significant loss of elastin in the vessel wall and had significantly larger diameters than control vessels (591 +/- 238 microm vs 328 +/- 61 microm; P = .003 for aneurysms 3 weeks postinjury). Aneurysms from C57BL/6.gfp, FVB.gfp, and C57BL/6.DsRed chimeras consistently revealed significant BMP-derived cell recruitment in the aneurysm wall that was not seen in sham-operated vessels nor in control left common carotid arteries. Aneurysms demonstrated overexpression of matrix metalloproteinase-9. CONCLUSION: We describe a novel murine elastase saccular aneurysm model that replicates the histopathology and BMP-derived cell-mediated processes that will be a valuable instrument for studying the cell-mediated processes in cerebral aneurysm formation.


Assuntos
Aneurisma/etiologia , Aneurisma/patologia , Células da Medula Óssea/patologia , Modelos Animais de Doenças , Elastase Pancreática/efeitos adversos , Animais , Células da Medula Óssea/metabolismo , Artéria Carótida Primitiva/patologia , Artéria Carótida Primitiva/cirurgia , Proteínas de Fluorescência Verde/genética , Proteínas de Fluorescência Verde/metabolismo , Proteínas Luminescentes/genética , Proteínas Luminescentes/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Células-Tronco/metabolismo , Células-Tronco/patologia , Fatores de Tempo
8.
Exp Hematol ; 35(10): 1567-79, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17697746

RESUMO

INTRODUCTION: Little is known about the sites and kinetics of thrombopoiesis following bone marrow transplant. The spleen is a site of hematopoiesis in a healthy mouse, and hematopoietic activity increases in response to stress. We hypothesized that the spleen is a major site of early post-transplant thrombopoiesis. METHODS: We transplanted whole bone marrow (WBM) or lineage depleted progenitor subsets fractionated based on expression of c-kit and Sca-1 from transgenic mice expressing green fluorescent protein into lethally irradiated C57BL/6 recipients. We also transplanted whole bone marrow cells into healthy and splenectomized mice. Post-transplant megakaryopoiesis was assessed by measuring circulating platelet number, percent donor-derived platelets, bone marrow cellularity, splenic weight, megakaryocyte size, and megakaryocyte concentration from hour 3 to day 28 post transplant. RESULTS: Following transplant, circulating donor-derived platelets were derived only from c-kit expressing subsets. Donor-derived platelets first appeared on post-transplant day five. Splenectomy reduced the number of these earliest circulating platelets. Splenic megakaryopoiesis increased dramatically from day 7-14 post-transplant. However, splenectomy accelerated platelet engraftment during this time frame. CONCLUSION: Overall, these results demonstrate that the first platelets are produced by c-kit expressing megakaryocyte progenitors in the bone marrow and spleen. After post-transplant day 5, the net effect of the spleen on thrombopoiesis is to slow engraftment due to immune effects or hypersplenism.


Assuntos
Transplante de Medula Óssea , Hematopoese Extramedular , Megacariócitos/metabolismo , Baço/metabolismo , Trombopoese , Animais , Antígenos Ly/biossíntese , Antígenos Ly/imunologia , Sobrevivência de Enxerto/imunologia , Sobrevivência de Enxerto/efeitos da radiação , Hematopoese Extramedular/imunologia , Hematopoese Extramedular/efeitos da radiação , Hiperesplenismo/imunologia , Hiperesplenismo/metabolismo , Hiperesplenismo/patologia , Cinética , Masculino , Megacariócitos/imunologia , Megacariócitos/patologia , Proteínas de Membrana/biossíntese , Proteínas de Membrana/imunologia , Camundongos , Camundongos Transgênicos , Proteínas Proto-Oncogênicas c-kit/biossíntese , Proteínas Proto-Oncogênicas c-kit/imunologia , Baço/imunologia , Baço/patologia , Trombopoese/imunologia , Trombopoese/efeitos da radiação , Fatores de Tempo , Irradiação Corporal Total
9.
Lab Invest ; 87(7): 702-12, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17483848

RESUMO

Hepatic oval cells have shown the potential to transdifferentiate into insulin-producing cells when cultured with high glucose concentrations. However, it remains unknown whether the oval cells can contribute to insulin production in diabetic mice. In this study, our aim was to investigate the response of activated hepatic oval cells to hyperglycemic conditions. C57BL/6 mice were fed a diet containing 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) for 4 weeks to activate the hepatic oval cell population before inducing hyperglycemia with streptozotocin (STZ). Despite the initial hyperglycemia (341+/-15 mg/dl), the blood glucose levels of DDC-STZ-treated mice were significantly improved within 6 weeks (185+/-12 mg/dl). During the initial hyperglycemic stage, DDC-STZ-treated livers expressed pancreatic developmental, endocrine and exocrine genes. Hepatic insulin production was confirmed by immunohistochemistry and ELISA. These results suggested that transdifferentiated hepatic oval cell population contributed to the amelioration of hyperglycemia. We additionally determined that DDC-STZ-treated pancreata played a critical role in complete reversal of hyperglycemia as evidenced by extensive beta-cell regeneration and increase of pancreatic insulin content after STZ treatment, which is rarely observed in other adult STZ models. Reversal of hyperglycemia in this model seems to be accomplished by biphasic insulin augmentation, first by hepatic transdifferentiation, and followed by endogenous beta-cell regeneration in the pancreas. The DDC-STZ treatment provides a novel injury model for better understanding of the functional behavior of hepatic and pancreatic stem/progenitor cell population under hyperglycemic condition, which may yield critical information for developing beta-cell-based therapies to treat diabetes.


Assuntos
Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Experimental/fisiopatologia , Hepatócitos/patologia , Células Secretoras de Insulina/patologia , Fígado/patologia , Fígado/fisiopatologia , Animais , Glicemia/metabolismo , Diferenciação Celular , Diabetes Mellitus Experimental/induzido quimicamente , Dicarbetoxi-Di-Hidrocolidina , Modelos Animais de Doenças , Regulação da Expressão Gênica no Desenvolvimento , Hepatócitos/classificação , Hiperglicemia/metabolismo , Insulina/metabolismo , Secreção de Insulina , Células Secretoras de Insulina/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Especificidade de Órgãos , Regeneração , Estreptozocina
10.
Paediatr Respir Rev ; 7(2): 135-40, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16765300

RESUMO

One of the most active areas of research in medicine today is stem cell biology. This review introduces the reader to the field of stem cell biology and its therapeutic potential. More importantly, the potential application of stem cell therapy in acute lung injury will be explored.


Assuntos
Pneumopatias/terapia , Transplante de Células-Tronco , Células-Tronco/fisiologia , Animais , Órgãos Bioartificiais , Pesquisa Biomédica , Sistemas de Liberação de Medicamentos , Humanos , Engenharia Tecidual
11.
Stem Cells ; 23(9): 1400-8, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16210411

RESUMO

Historically, physicians have attributed delayed platelet engraftment following umbilical cord blood transplant to decreased numbers of stem cells in cord blood compared with adult bone marrow. However, recent studies suggest that delayed platelet engraftment may be caused by an intrinsic inability of neonatal stem cells to produce mature, polyploid megakaryocytes. We tested this hypothesis by transplanting adult bone marrow and newborn liver hematopoietic stem and progenitor cells from transgenic mice expressing green fluorescent protein into myeloablated wild-type recipients and comparing the size and ploidy levels of megakaryocytes that developed in adult transplant recipients. Transplanted stem and progenitor cells, regardless of their source, gave rise to megakaryocytes that were larger than normal adult megakaryocytes as early as 7 days post-transplant. However, megakaryocytes that developed after transplant of neonatal stem and progenitor cells were significantly smaller than those derived from adult stem and progenitor cells. Furthermore, megakaryocytes derived from neonatal cells had lower ploidy values than megakaryocytes derived from adult cells at 18 days post-transplant, when ploidy could first be reliably measured in the bone marrow. These differences in size and ploidy disappeared by 1 month post-transplant. The largest megakaryocytes developed in the spleen. These results suggest that, in the mouse, the microenvironment is responsible for some of the maturational differences in size and ploidy between neonatal and adult megakaryocytes. Furthermore, neonatal and adult megakaryocyte progenitors also have cell-intrinsic differences in the way they engraft and respond to thrombocytopenic stress. These differences may contribute to the delay in platelet engraftment that frequently complicates cord blood transplants.


Assuntos
Megacariócitos/citologia , Megacariócitos/fisiologia , Transplante de Células-Tronco de Sangue Periférico , Trombopoese/fisiologia , Fatores Etários , Animais , DNA/genética , DNA/metabolismo , Citometria de Fluxo , Proteínas de Fluorescência Verde/biossíntese , Hematopoese/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Transfusão de Plaquetas , Ploidias , Células-Tronco/citologia , Células-Tronco/fisiologia , Trombopoese/genética
12.
Leuk Res ; 28(1): 83-9, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14630084

RESUMO

Despite normal levels of erythropoiesis in PU.1(-/-) embryos, PU.1(-/-) fetal hematopoietic progenitors are unable to establish sustained erythropoiesis in the adult bone marrow. This study demonstrates that PU.1(-/-) fetal erythroid progenitors are synergistically expanded by TPO plus SCF, but not combinations of EPO plus SCF, IL-3 or GM-CSF. The EPO defect is not corrected by a constitutively active variant of EPOR. Microarray analysis identified several candidate PU.1 target genes known to affect cytokine signaling and gene regulation in the erythroid lineage. These data suggest that PU.1 plays an important role in regulating the proliferation of immature erythroid progenitors.


Assuntos
Embrião de Mamíferos/citologia , Células Precursoras Eritroides/citologia , Eritropoese/fisiologia , Eritropoetina/metabolismo , Proteínas do Leite , Proteínas Proto-Oncogênicas/metabolismo , Transativadores/metabolismo , Animais , Biomarcadores/análise , Divisão Celular , Células Cultivadas , Proteínas de Ligação a DNA/metabolismo , Embrião de Mamíferos/imunologia , Embrião de Mamíferos/metabolismo , Células Precursoras Eritroides/imunologia , Células Precursoras Eritroides/metabolismo , Perfilação da Expressão Gênica , Fator Estimulador de Colônias de Granulócitos e Macrófagos/metabolismo , Proteínas de Fluorescência Verde , Interleucina-3/metabolismo , Peptídeos e Proteínas de Sinalização Intracelular , Proteínas Luminescentes/metabolismo , Camundongos , Camundongos Knockout , Análise de Sequência com Séries de Oligonucleotídeos , Proteína Tirosina Fosfatase não Receptora Tipo 6 , Proteínas Tirosina Fosfatases/metabolismo , Proteínas Proto-Oncogênicas/genética , Receptores da Eritropoetina , Proteínas Recombinantes de Fusão/metabolismo , Fator de Transcrição STAT5 , Fator de Células-Tronco/metabolismo , Trombopoetina/metabolismo , Transativadores/genética
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