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1.
Arch Med Res ; 24(3): 269-74, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8298277

RESUMO

The Aspergillus cell wall contains most of the antigens secreted by the fungus during its active in vitro or in vivo growth. These antigens, which bind to the IgE and IgG of allergic and aspergilloma patients or are secreted in the biological fluids of patients with invasive aspergillosis, are of primary importance in the diagnosis of aspergillosis. Located at the interface between host and pathogen cells, the fungal cell wall plays a major role during fungal invasion. It contains several surface receptors involved in adhesion of the fungus to host proteins and cells. Some of the wall antigens are also directly involved in the colonization of the host tissues by the fungus. Very few of these putative virulence factors have been purified until now. A 33-kDa alkaline protease of the subtilisin family can hydrolyze several extracellular matrix proteins such as collagen, fibrinogen, elastin. However, gene disruption experiments have shown that protease-deficient mutants are still able to infect mice. An 18-kDa antigen, which has been detected in the urine of patients with invasive aspergillosis, is present in vivo in the lung of mice infected with A. fumigatus. It has a ribonuclease activity that cleaves a single phosphodiester bond in a highly conserved region of the ribosomal RNA. Its role in the virulence of A. fumigatus has not been demonstrated until now. Biochemical and molecular characterization of the wall antigenic aggressins should be pursued.


Assuntos
Alérgenos , Antígenos de Fungos/imunologia , Aspergillus fumigatus/imunologia , Parede Celular/imunologia , Animais , Anticorpos Antifúngicos/imunologia , Antígenos de Fungos/genética , Antígenos de Fungos/fisiologia , Antígenos de Plantas , Aspergilose/imunologia , Aspergillus fumigatus/genética , Aspergillus fumigatus/patogenicidade , Proteínas Fúngicas/genética , Proteínas Fúngicas/imunologia , Genes Fúngicos , Humanos , Camundongos , Ribonucleases/genética , Ribonucleases/imunologia , Virulência
2.
Nihon Ishinkin Gakkai Zasshi ; 43(4): 203-13, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12402022

RESUMO

Experimental animals are an obligate screen to investigate microorganism pathogenicity. Numerous animal models have been used to analyse the virulence of the opportunistic human pathogen Aspergillus fumigatus but none of the experimental models used previously have been satisfactory. This report discuss these models and presents a murine model of pulmonary aspergillosis that is very easy and the most adapted to compare the pathogenicity of A. fumigatus strains. Strains to be tested are inoculated intranasally and synchronously to mice and strains isolated from the lung of mice killed by the infection are typed. The number of colonies recovered is directly correlated to the virulence of the strain.


Assuntos
Aspergilose/microbiologia , Aspergillus fumigatus/patogenicidade , Modelos Animais de Doenças , Pneumopatias Fúngicas/microbiologia , Camundongos , Animais , Aspergillus fumigatus/classificação , Aspergillus fumigatus/genética , Aspergillus fumigatus/isolamento & purificação , Impressões Digitais de DNA , DNA Fúngico , Humanos , Virulência
3.
Med Mycol ; 43 Suppl 1: S15-22, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-16110787

RESUMO

The cell wall of Aspergillus fumigatus is composed of a branched beta1,3 glucan covalently bound to chitin, beta1,3, beta1,4 glucans, and galactomannan, that is embedded in an amorphous cement composed of alpha1,3 glucan, galactomannan and polygalactosamin. The mycelial cell wall of A. fumigatus is very different from the yeast Saccharomyces cerevisiae cell wall, and in particular lacks beta1,6 glucans and proteins covalently bound to cell wall polysaccharides. The differences in cell wall composition between the mould A. fumigatus and the yeast S. cerevisiae are also reflected at the genomic level where unique features have been identified in A. fumigatus. A single gene codes for the glucan synthase catalytic subumit; this finding has lead to the development of a RNAi methodology for the disruption of essential genes in A. fumigatus. In contrast to the glucan synthase, multiple genes have been found in the chitin synthase and the alpha glucan synthase families; in spite of homologous sequences, each gene in each family have very different function. Similarly homologous mannosyltransferase genes are found in yeast and moulds but they lead to the synthesis of very different N-mannan structures. This chemo-genomic comparative analysis has also suggested that GPI-anchored proteins do not have a role of linker in the three dimensional organization of the fungal cell wall.


Assuntos
Aspergillus fumigatus/enzimologia , Aspergillus fumigatus/genética , Parede Celular/química , Parede Celular/metabolismo , Polissacarídeos/biossíntese , Aspergillus fumigatus/metabolismo , Aspergillus fumigatus/ultraestrutura , Proteínas Fúngicas/metabolismo , Glicosilfosfatidilinositóis/metabolismo , Humanos , Polissacarídeos/química
4.
Eukaryot Cell ; 4(7): 1308-16, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16002656

RESUMO

Galactofuranose-containing molecules have been repeatedly shown to be important antigens among human fungal pathogens, including Aspergillus fumigatus. Immunogenic galactofuran determinants have been poorly characterized chemically, however. We reported here the characterization of two glycoproteins of A. fumigatus with an N-glycan containing galactofuranose. These proteins are a phospholipase C and a phytase. Chemical characterization of the N-glycan indicates that it is a mixture of Hex(5-13)HexNAc(2) oligosaccharides, the major molecular species corresponding to Hex(6-8)HexNAc(2). The N-glycan contained one galactofuranose unit that was in a terminal nonreducing position attached to the 2 position of Man. This single terminal nonreducing galactofuranose is essential for the immunoreactivity of the N-glycans assessed either with a monoclonal antibody that recognizes a tetra-beta-1,5-galactofuran chain of galactomannan or with Aspergillus-infected patient sera.


Assuntos
Antígenos de Fungos/química , Aspergillus fumigatus/química , Glicoproteínas de Membrana/química , 6-Fitase/química , 6-Fitase/imunologia , 6-Fitase/isolamento & purificação , Anticorpos Antifúngicos/sangue , Anticorpos Antifúngicos/imunologia , Antígenos de Fungos/análise , Antígenos de Fungos/imunologia , Antígenos de Fungos/isolamento & purificação , Aspergilose/diagnóstico , Aspergilose/microbiologia , Aspergillus fumigatus/imunologia , Aspergillus fumigatus/isolamento & purificação , Ensaio de Imunoadsorção Enzimática/métodos , Cromatografia Gasosa-Espectrometria de Massas/métodos , Humanos , Ácido Fluorídrico/química , Glicoproteínas de Membrana/imunologia , Glicoproteínas de Membrana/isolamento & purificação , Polissacarídeos/química , Polissacarídeos/metabolismo , Sensibilidade e Especificidade , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Fosfolipases Tipo C/química , Fosfolipases Tipo C/imunologia , Fosfolipases Tipo C/isolamento & purificação , alfa-Manosidase/metabolismo
5.
Mycopathologia ; 69(3): 187-92, 1979 Dec 28.
Artigo em Francês | MEDLINE | ID: mdl-119164

RESUMO

The aflatoxinogenesis of Aspergillus parasiticus is significantly enhanced by the presence, in the medium, of sterigmatocystin at a high level (35--50 microgram/ml); low concentrations, in the order of 175 microgram/ml, have no effect on the production of aflatoxins. During the period where the aflatoxinogenesis of the culture is high, no variation of the sterigmatocystin level is noted, Experiments with 14C-sterigmatocystin indicate that the mold does not utilize the metabolite itself as a precursor of aflatoxins.


Assuntos
Aflatoxinas/biossíntese , Aspergillus/efeitos dos fármacos , Esterigmatocistina/farmacologia , Xantenos/farmacologia , Aspergillus/metabolismo , Aspergillus flavus/efeitos dos fármacos , Aspergillus flavus/metabolismo , Relação Dose-Resposta a Droga , Esterigmatocistina/metabolismo
6.
J Chromatogr ; 198(4): 481-8, 1980 Oct 24.
Artigo em Francês | MEDLINE | ID: mdl-7440682

RESUMO

Two methods are proposed for the determination of PR-toxin. One allows a direct quantitative estimation of the mycotoxin, the other utilizes an imine formation after reaction with ammonium hydroxide. In both cases a fluorodensitometric assay on thin-layer chromatographic plates is carried out after spraying with p-dimethylaminobenzaldehyde reagent. The two procedures can be applied to estimate the toxin in foodstuffs at levels as low as 10 and 1 microgram/kg, respectively.


Assuntos
Cromatografia em Camada Fina/métodos , Densitometria/métodos , Micotoxinas/análise , Penicillium , Laticínios/análise , Análise de Alimentos/métodos
7.
Mycopathologia ; 66(1-2): 11-6, 1978 Dec 29.
Artigo em Francês | MEDLINE | ID: mdl-375091

RESUMO

A new class of mycotoxins has been characterized from a strain of Aspergillus fumigatus: the fumitoxins A, B, C and D. The in vitro production of these metabolites is studied. Fumitoxins are common in cultures extracts of most strains of A. fumigatus. They are not detected from A. fischeri. Variations of the levels of these products during the incubation of cultures, and also by using different media, are noted. At all events, the toxicity of crude extracts of the mould, for the chick embryo, is equal to the one of the fumitoxins.


Assuntos
Aspergillus fumigatus/metabolismo , Micotoxinas/biossíntese , Animais , Embrião de Galinha , Meios de Cultura , Micotoxinas/toxicidade , Especificidade da Espécie
8.
Appl Environ Microbiol ; 36(1): 8-10, 1978 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-358921

RESUMO

Extracts of cultures of Aspergillus fumigatus isolated from silage were lethal to chicken embryos. Using this test and thin-layer chromatography, four UV-absorbing toxins, designated as fumitoxins A, B, C and D, were isolated. Analysis and mass spectrometry of crystallized fumitoxin A, the most abundant in the extract, established its molecular formula to be C31H42O8. Infrared, UV spectroscopy, and chemical reactions suggested that fumitoxin A is a steroid. Fumitoxins appear to be clearly different from the previously described toxins recognized in A. fumigatus.


Assuntos
Aspergillus fumigatus/metabolismo , Micotoxinas/biossíntese , Animais , Embrião de Galinha , Micotoxinas/isolamento & purificação , Micotoxinas/toxicidade
9.
C R Acad Hebd Seances Acad Sci D ; 286(5): 431-4, 1978 Feb 06.
Artigo em Francês | MEDLINE | ID: mdl-418904

RESUMO

A strain of Aspergillus fumigatus Fres., isolated from sugar-beet draffs, synthesizes in vitro four toxic metabolites which have not yet been described in these fungal species. Toxic effects of the most abundant of these metabolites "fumitoxin A" have been studed on chick embryo. Artemia salina larvae, cell cultures, and on mice.


Assuntos
Aspergillus fumigatus/análise , Micotoxinas/isolamento & purificação , Animais , Células Cultivadas , Embrião de Galinha , Decápodes/efeitos dos fármacos , Dose Letal Mediana , Camundongos , Micotoxinas/toxicidade
10.
Appl Environ Microbiol ; 37(3): 365-8, 1979 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-453818

RESUMO

Sixteen strains of Penicillium roqueforti Thom, isolated from blue-molded cheeses, were studied. In vitro, all of these strains produced mycophenolic acid, some on the order of 0.8 to 4 mg/g od dry culture. The greatest yields were obtained after 10 days of incubation of cultures at 15 degrees C. However, under some experimental conditions, mycophenolic acid was not alone responsible for the toxicity of culture extracts to chicken embryos.


Assuntos
Queijo , Microbiologia de Alimentos , Ácido Micofenólico/biossíntese , Penicillium/metabolismo , Animais , Embrião de Galinha , Meios de Cultura , Ácido Micofenólico/toxicidade
11.
Infect Immun ; 61(11): 4767-71, 1993 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8406876

RESUMO

An 88-kDa component secreted in vitro by Aspergillus fumigatus has been purified by sequential chromatographic procedures. The molecule is a glycoprotein with an N-linked sugar moiety composed of mannose glucose, and galactose (16:10:1). It is recognized by antibodies from patients with aspergilloma and has potential for the immunodiagnosis of aspergilloma. The antigenicity is associated with the polypeptide part of the molecule (79 kDa).


Assuntos
Antígenos de Fungos/isolamento & purificação , Aspergillus fumigatus/imunologia , Glicoproteínas/isolamento & purificação , Animais , Antígenos de Fungos/imunologia , Ensaio de Imunoadsorção Enzimática , Glicoproteínas/imunologia , Glicosilação , Humanos , Peso Molecular , Ratos
12.
Infect Immun ; 65(8): 3080-5, 1997 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9234757

RESUMO

To determine if cases of invasive aspergillosis (IA) were caused by strains of Aspergillus fumigatus with unique characteristics, strains from immunosuppressed patients with IA were compared to strains obtained from sputa of patients with cystic fibrosis and to strains from the environment. An extremely high genomic diversity was observed among the 879 strains typed by Southern blotting with a retrotransposon-like element from A. fumigatus (C. Neuvéglise, J. Sarfati, J. P. Latgé, and S. Paris, Nucleic Acids Res. 24:1428-1434, 1996). Analysis of Southern blot hybridization patterns showed the absence of clustering between environmental isolates and clinical isolates from patients with IA or cystic fibrosis. In addition, strains could not be clustered depending on their geographical location. This study implies that practically any strain of A. fumigatus is potentially pathogenic and can provoke a case of IA when it encounters a favorable environment in an immunosuppressed host.


Assuntos
Aspergillus fumigatus/genética , Aspergillus fumigatus/patogenicidade , Fibrose Cística/microbiologia , Microbiologia Ambiental , Variação Genética , Humanos , Família Multigênica , Virulência
13.
J Biol Chem ; 272(10): 6238-44, 1997 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-9045640

RESUMO

A novel dipeptidyl-peptidase (DPP V) was purified from the culture medium of Aspergillus fumigatus. This is the first report of a secreted dipeptidyl-peptidase. The enzyme had a molecular mass of 88 kDa and contained approximately 9 kDa of N-linked carbohydrate. The expression and secretion of dipeptidyl-peptidase varied with the growth conditions; maximal intra- and extracellular levels were detected when the culture medium contained only proteins or protein hydrolysates in the absence of sugars. The gene of DPP V was cloned and showed significant sequence homology to other eukaryotic dipeptidyl-peptidase genes. Unlike the other dipeptidyl-peptidases, which are all intracellular, DPP V contained a signal peptide. Like the genes of other dipeptidyl-peptidases, that of DPP V displayed the consensus sequences of the catalytic site of the nonclassical serine proteases. The biochemical properties of native and recombinant DPP V obtained in Pichia pastoris were unique and were characterized by a substrate specificity limited to the hydrolysis of X-Ala, His-Ser, and Ser-Tyr dipeptides at a neutral pH optimum. In addition, we showed that DPP V is identical to one of the two major antigens used for the diagnosis of aspergillosis.


Assuntos
Antígenos de Fungos/química , Aspergillus fumigatus/enzimologia , Dipeptidil Peptidases e Tripeptidil Peptidases/química , Sequência de Aminoácidos , Aspergillus fumigatus/imunologia , Clonagem Molecular , Dipeptidil Peptidases e Tripeptidil Peptidases/antagonistas & inibidores , Dipeptidil Peptidases e Tripeptidil Peptidases/imunologia , Genes Fúngicos , Glicoproteínas/química , Dados de Sequência Molecular , Peso Molecular , Mapeamento de Peptídeos , Homologia de Sequência de Aminoácidos , Especificidade por Substrato
14.
Pathol Biol (Paris) ; 42(7): 632-9, 1994 Sep.
Artigo em Francês | MEDLINE | ID: mdl-7877854

RESUMO

Development of A. fumigatus in the host tissues is due to the intrinsic biological characteristics of this fungus and to the impairment of the cellular defence reactions of the host. However, even today the understanding of the factors governing the infectivity of A. fumigatus remains very limited. For example, the cellular mechanisms involved in the killing of A. fumigatus are still not elucidated. The cellular site(s) of infection and the role of the different lung epithelia in the establishment of the fungus are unknown. No specific fungal virulence factors have been identified until now. Molecular biology techniques are powerful tools to investigate the pathogenesis of invasive aspergillosis. Recent developments in the study of this mycosis are presented in this review.


Assuntos
Aspergilose/microbiologia , Aspergillus fumigatus/patogenicidade , Pneumopatias Fúngicas/microbiologia , Aspergilose/imunologia , Aspergillus fumigatus/classificação , Aspergillus fumigatus/isolamento & purificação , Humanos , Pneumopatias Fúngicas/imunologia , Técnicas de Tipagem Micológica , Fagocitose , Virulência
15.
J Allergy Clin Immunol ; 88(6): 902-8, 1991 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-1744361

RESUMO

A component of Alternaria extract, previously identified as the major allergen, Alt a I1563, was purified to homogeneity from Alternaria mycelium by means of acetone precipitation and ion-exchange chromatography. The homogeneity of Alt a I1563 was assessed by one single band after sodium dodecyl sulfate-polyacrylamide gel electrophoresis, by one single radiolabeled band after transfer to nitrocellulose, and by one single peak after size-exclusion chromatography by high-performance liquid chromatography. Alt a I1563 was isolated as a heat-stable acidic glycoprotein (carbohydrate content, 20%; pI, 4.0 to 4.5; 31 kd). The role of the carbohydrate moiety in the allergenicity is suggested. This major allergen is located in the cytoplasm of mycelium and spore.


Assuntos
Alérgenos/isolamento & purificação , Alternaria/imunologia , Alérgenos/análise , Alérgenos/imunologia , Alternaria/química , Alternaria/ultraestrutura , Animais , Anticorpos Antifúngicos/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Proteínas Fúngicas/análise , Humanos , Imunização , Imunoglobulina E/sangue , Camundongos , Camundongos Endogâmicos BALB C , Microscopia Imunoeletrônica , Peso Molecular , Testes Cutâneos
16.
Protein Expr Purif ; 5(1): 84-8, 1994 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8167478

RESUMO

A proteinase was purified from the human pathogenic fungus Aspergillus fumigatus. The four chromatographic steps, a "negative" dye column, a "positive" dye column, hydroxyapatite Ultrogel, and modified TSK gel (HW 55), gave a 14% overall yield. The protein migrated as a single band on SDS-PAGE and isoelectric focusing, with an M(r) of 82,000 and a pI of 5.6. Inhibitor studies suggested that the enzyme was a metalloproteinase. It hydrolyzed phenylazobenzyloxycarbonyl-Pro-Leu-Gly-Pro-Arg and cleaved native rat type I collagen.


Assuntos
Aspergillus fumigatus/enzimologia , Colagenases/isolamento & purificação , Proteínas Fúngicas/isolamento & purificação , Metaloendopeptidases/isolamento & purificação , Sequência de Aminoácidos , Animais , Cromatografia de Afinidade , Cromatografia em Gel , Cromatografia Líquida , Colágeno/metabolismo , Colagenases/metabolismo , Corantes , Proteínas Fúngicas/metabolismo , Focalização Isoelétrica , Metaloendopeptidases/metabolismo , Dados de Sequência Molecular , Ratos
17.
Infect Immun ; 59(8): 2586-94, 1991 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1855978

RESUMO

One of the major antigens secreted in vitro by Aspergillus fumigatus is an 18-kDa basic protein which has been purified by cation-exchange chromatography. It is recognized by sera from aspergilloma patients. It is also the major circulating antigen found in urine of patients with invasive aspergillosis. Our results indicated that this antigen has potential for the diagnosis of both aspergilloma and invasive aspergillosis.


Assuntos
Antígenos de Fungos/metabolismo , Aspergillus fumigatus/imunologia , Anticorpos Antifúngicos/imunologia , Antígenos de Fungos/imunologia , Antígenos de Fungos/isolamento & purificação , Antígenos de Fungos/urina , Aspergilose/imunologia , Candidíase/imunologia , Precipitação Química , Cromatografia Líquida de Alta Pressão , Ensaio de Imunoadsorção Enzimática , Etanol , Humanos , Immunoblotting , Solubilidade , Água/química
18.
J Biol Chem ; 271(43): 26843-9, 1996 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-8900166

RESUMO

Cell wall transferases utilizing beta-(1-3)-glucan chains as substrates may play important roles in cell wall assembly and rearrangement, as beta-(1-3)-glucan is a major structural component of the cell wall of many fungi. A novel beta-(1-3)-glucanosyltransferase was purified to apparent homogenei ty from an autolysate of the cell wall of Aspergillus fumigatus. The enzyme had a molecular mass of 49 kDa and contained approximately 5 kDa of N-linked carbohydrate. The enzyme catalyzed an initial endo-type splitting of a beta-(1-3)-glucan molecule, followed by linkage of the newly generated reducing end to the nonreducing end of another beta-(1-3)-glucan molecule. Laminarioligosaccharides of size G10 and greater were donor substrates for the transferase. Laminarioligosaccharides of size G5 and greater formed acceptors. The enzyme was able to reuse initial transferase products as donors and acceptors in extended incubations, resulting in the formation of increasingly larger transferase products until they became insoluble. The major initial products from an incubation of the transferase with borohydride-reduced G11 (rG11) were rG6 and rG16. 1H NMR analysis of the rG16 transferase product showed it was a laminarioligosaccharide, indicating that the enzyme forms a beta-(1-3)-linkage during transfer. The enzyme may have a key function in vivo by allowing the integration of newly synthesized glucan into the wall and promoting cell wall expansion during cell growth.


Assuntos
Aspergillus fumigatus/enzimologia , Transferases/metabolismo , Parede Celular/enzimologia , Cromatografia Líquida de Alta Pressão , Cromatografia por Troca Iônica , Especificidade por Substrato , Transferases/isolamento & purificação
19.
Infect Immun ; 64(10): 4401-5, 1996 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8926121

RESUMO

Aspergillus fumigatus mutants that are deficient in the de novo UMP biosynthesis pathway because of a mutation in the pyrG gene encoding orotidine-5'-phosphate decarboxylase (and therefore auxotrophic for uridine or uracil) were evaluated in a murine model of invasive aspergillosis. These mutants were entirely nonpathogenic, and mutant conidia remained ungerminated in alveolar macrophages. Both the germination and virulence defects could be restored by supplementing the drinking water of the animals with uridine. DNA-mediated transformation of one of the pyrG mutants with the Aspergillus niger pyrG gene also restored virulence. These results suggest that uridine and uracil are limiting in the lung environment, thus preventing conidium germination and hence virulence of the pyrG mutants.


Assuntos
Aspergillus fumigatus/patogenicidade , Uracila/metabolismo , Uridina/metabolismo , Animais , Aspergillus fumigatus/metabolismo , Feminino , Camundongos , Uridina Monofosfato/biossíntese , Virulência
20.
Eur J Clin Microbiol Infect Dis ; 16(10): 747-50, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9405946

RESUMO

The colonization over time of cystic fibrosis patients by Aspergillus fumigatus was investigated using a DNA fingerprinting method. Aspergillus fumigatus isolates collected sequentially for more than one year from six patients with cystic fibrosis were typed by Southern blot hybridization with a repetitive DNA sequence. Each cystic fibrosis patient harbored several strains of Aspergillus fumigatus that were isolated recurrently over time. Isolates collected from a cystic fibrosis patient with aspergilloma displayed the same genotype, suggesting that the infection was due to a single strain. Continuous isolation of the same genotype in another cystic fibrosis patient, however, was not correlated clinically with an Aspergillus infection.


Assuntos
Aspergilose/epidemiologia , Aspergilose/genética , Aspergillus fumigatus/isolamento & purificação , Fibrose Cística/complicações , DNA Fúngico/análise , Adolescente , Aspergilose/prevenção & controle , Aspergillus fumigatus/genética , Criança , Pré-Escolar , Impressões Digitais de DNA , Feminino , Humanos , Estudos Longitudinais , Masculino , Epidemiologia Molecular , Recidiva , Fatores de Tempo
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