2,6-Diaminopurine as a highly potent corrector of UGA nonsense mutations.


Journal

Nature communications
ISSN: 2041-1723
Titre abrégé: Nat Commun
Pays: England
ID NLM: 101528555

Informations de publication

Date de publication:
20 03 2020
Historique:
received: 24 01 2019
accepted: 21 02 2020
entrez: 22 3 2020
pubmed: 22 3 2020
medline: 18 7 2020
Statut: epublish

Résumé

Nonsense mutations cause about 10% of genetic disease cases, and no treatments are available. Nonsense mutations can be corrected by molecules with nonsense mutation readthrough activity. An extract of the mushroom Lepista inversa has recently shown high-efficiency correction of UGA and UAA nonsense mutations. One active constituent of this extract is 2,6-diaminopurine (DAP). In Calu-6 cancer cells, in which TP53 gene has a UGA nonsense mutation, DAP treatment increases p53 level. It also decreases the growth of tumors arising from Calu-6 cells injected into immunodeficient nude mice. DAP acts by interfering with the activity of a tRNA-specific 2'-O-methyltransferase (FTSJ1) responsible for cytosine 34 modification in tRNA

Identifiants

pubmed: 32198346
doi: 10.1038/s41467-020-15140-z
pii: 10.1038/s41467-020-15140-z
pmc: PMC7083880
doi:

Substances chimiques

Codon, Nonsense 0
2-Aminopurine 452-06-2
2,6-diaminopurine 49P95BAU4Z
RNA, Transfer 9014-25-9
tRNA Methyltransferases EC 2.1.1.-
Ftsj1 protein, mouse EC 2.1.1.205

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1509

Références

Mort, M., Ivanov, D., Cooper, D. N. & Chuzhanova, N. A. A meta-analysis of nonsense mutations causing human genetic disease. Hum. Mutat. 29, 1037–1047 (2008).
pubmed: 18454449 doi: 10.1002/humu.20763
Gupta, P. & Li, Y. R. Upf proteins: highly conserved factors involved in nonsense mRNA mediated decay. Mol. Biol. Rep. 45, 39–55 (2018).
pubmed: 29282598 doi: 10.1007/s11033-017-4139-7
Karousis, E. D., Nasif, S. & Muhlemann, O. Nonsense-mediated mRNA decay: novel mechanistic insights and biological impact. Wiley Interdiscip. Rev. RNA 7, 661–682 (2016).
pubmed: 27173476 pmcid: 6680220 doi: 10.1002/wrna.1357
Hug, N., Longman, D. & Caceres, J. F. Mechanism and regulation of the nonsense-mediated decay pathway. Nucleic Acids Res. 44, 1483–1495 (2016).
pubmed: 26773057 pmcid: 4770240 doi: 10.1093/nar/gkw010
Popp, M. W. & Maquat, L. E. The dharma of nonsense-mediated mRNA decay in mammalian cells. Mol. Cells 37, 1–8 (2014).
pubmed: 24552703 pmcid: 3907001 doi: 10.14348/molcells.2014.2193
Lejeune, F. Nonsense-mediated mRNA decay at the crossroads of many cellular pathways. BMB Rep. 50, 175–185 (2017).
pubmed: 28115040 pmcid: 5437961 doi: 10.5483/BMBRep.2017.50.4.015
Kuzmiak, H. A. & Maquat, L. E. Applying nonsense-mediated mRNA decay research to the clinic: progress and challenges. Trends Mol. Med. 12, 306–316 (2006).
pubmed: 16782405 doi: 10.1016/j.molmed.2006.05.005
Floquet, C., Hatin, I., Rousset, J. P. & Bidou, L. Statistical analysis of readthrough levels for nonsense mutations in mammalian cells reveals a major determinant of response to gentamicin. PLoS Genet. 8, e1002608 (2012).
pubmed: 22479203 pmcid: 3315467 doi: 10.1371/journal.pgen.1002608
Han, L. & Phizicky, E. M. A rationale for tRNA modification circuits in the anticodon loop. RNA 24, 1277–1284 (2018).
pubmed: 30026310 pmcid: 6140457 doi: 10.1261/rna.067736.118
Tuorto, F. & Lyko, F. Genome recoding by tRNA modifications. Open Biol. 6, 160287 (2016).
pubmed: 27974624 pmcid: 5204126 doi: 10.1098/rsob.160287
Grosjean, H. & Westhof, E. An integrated, structure- and energy-based view of the genetic code. Nucleic Acids Res. 44, 8020–8040 (2016).
pubmed: 27448410 pmcid: 5041475 doi: 10.1093/nar/gkw608
Guy, M. P. et al. Defects in tRNA anticodon loop 2’-O-methylation are implicated in nonsyndromic X-linked intellectual disability due to mutations in FTSJ1. Hum. Mutat. 36, 1176–1187 (2015).
pubmed: 26310293 pmcid: 4643400 doi: 10.1002/humu.22897
Sarin, L. P. & Leidel, S. A. Modify or die?—RNA modification defects in metazoans. RNA Biol. 11, 1555–1567 (2014).
pubmed: 25692999 doi: 10.4161/15476286.2014.992279
Keeling, K. M., Xue, X., Gunn, G. & Bedwell, D. M. Therapeutics based on stop codon readthrough. Annu. Rev. Genomics Hum. Genet. 15, 371–394 (2014).
pubmed: 24773318 pmcid: 5304456 doi: 10.1146/annurev-genom-091212-153527
Benhabiles, H., Jia, J. & Lejeune, F. Nonsense Mutation Correction in Human Diseases: An Approach for Targeted Medicine (Elsevier, 2016).
Bidou, L., Allamand, V., Rousset, J. P. & Namy, O. Sense from nonsense: therapies for premature stop codon diseases. Trends Mol. Med. 18, 679–688 (2012).
pubmed: 23083810 doi: 10.1016/j.molmed.2012.09.008
Dabrowski, M., Bukowy-Bieryllo, Z. & Zietkiewicz, E. Advances in therapeutic use of a drug-stimulated translational readthrough of premature termination codons. Mol. Med. 24, 25 (2018).
pubmed: 30134808 pmcid: 6016875 doi: 10.1186/s10020-018-0024-7
Beaudet, A. L. & Meng, L. Gene-targeting pharmaceuticals for single-gene disorders. Hum. Mol. Genet. 25, R18–R26 (2016).
pubmed: 26628634 doi: 10.1093/hmg/ddv476
Gonzalez-Hilarion, S. et al. Rescue of nonsense mutations by amlexanox in human cells. Orphanet J. Rare Dis. 7, 58 (2012).
pubmed: 22938201 pmcid: 3562214 doi: 10.1186/1750-1172-7-58
Linde, L. et al. Nonsense-mediated mRNA decay affects nonsense transcript levels and governs response of cystic fibrosis patients to gentamicin. J. Clin. Invest. 117, 683–692 (2007).
pubmed: 17290305 pmcid: 1783999 doi: 10.1172/JCI28523
Welch, E. M. et al. PTC124 targets genetic disorders caused by nonsense mutations. Nature 447, 87–91 (2007).
pubmed: 17450125 doi: 10.1038/nature05756
Kayali, R. et al. Read-through compound 13 restores dystrophin expression and improves muscle function in the mdx mouse model for Duchenne muscular dystrophy. Hum. Mol. Genet. 21, 4007–4020 (2012).
pubmed: 22692682 pmcid: 3607466 doi: 10.1093/hmg/dds223
Kuschal, C., DiGiovanna, J. J., Khan, S. G., Gatti, R. A. & Kraemer, K. H. Repair of UV photolesions in xeroderma pigmentosum group C cells induced by translational readthrough of premature termination codons. Proc. Natl Acad. Sci. USA 110, 19483–19488 (2013).
pubmed: 24218596 doi: 10.1073/pnas.1312088110
Friesen, W. J. et al. The nucleoside analog clitocine is a potent and efficacious readthrough agent. RNA 23, 567–577 (2017).
pubmed: 28096517 pmcid: 5340919 doi: 10.1261/rna.060236.116
Xue, X. et al. Synthetic aminoglycosides efficiently suppress cystic fibrosis transmembrane conductance regulator nonsense mutations and are enhanced by ivacaftor. Am. J. Respir. Cell Mol. Biol. 50, 805–816 (2014).
pubmed: 24251786 pmcid: 4068923 doi: 10.1165/rcmb.2013-0282OC
Shulman, E. et al. Designer aminoglycosides that selectively inhibit cytoplasmic rather than mitochondrial ribosomes show decreased ototoxicity: a strategy for the treatment of genetic diseases. J. Biol. Chem. 289, 2318–2330 (2014).
pubmed: 24302717 doi: 10.1074/jbc.M113.533588
Du, L. et al. Nonaminoglycoside compounds induce readthrough of nonsense mutations. J. Exp. Med. 206, 2285–2297 (2009).
pubmed: 19770270 pmcid: 2757881 doi: 10.1084/jem.20081940
Manuvakhova, M., Keeling, K. & Bedwell, D. M. Aminoglycoside antibiotics mediate context-dependent suppression of termination codons in a mammalian translation system. RNA 6, 1044–1055 (2000).
pubmed: 10917599 pmcid: 1369979 doi: 10.1017/S1355838200000716
Friesen, W. J. et al. The minor gentamicin complex component, X2, is a potent premature stop codon readthrough molecule with therapeutic potential. PLoS ONE 13, e0206158 (2018).
pubmed: 30359426 pmcid: 6201930 doi: 10.1371/journal.pone.0206158
Correa-Cerro, L. S. et al. DHCR7 nonsense mutations and characterisation of mRNA nonsense mediated decay in Smith–Lemli–Opitz syndrome. J. Med. Genet. 42, 350–357 (2005).
pubmed: 15805162 pmcid: 1736027 doi: 10.1136/jmg.2004.022749
Kerem, E. et al. Effectiveness of PTC124 treatment of cystic fibrosis caused by nonsense mutations: a prospective phase II trial. Lancet 372, 719–727 (2008).
pubmed: 18722008 doi: 10.1016/S0140-6736(08)61168-X pmcid: 18722008
Kerem, E. et al. Ataluren for the treatment of nonsense-mutation cystic fibrosis: a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Respir. Med. 2, 539–547 (2014).
pubmed: 24836205 doi: 10.1016/S2213-2600(14)70100-6 pmcid: 24836205
Benhabiles, H. et al. Optimized approach for the identification of highly efficient correctors of nonsense mutations in human diseases. PLoS ONE 12, e0187930 (2017).
pubmed: 29131862 pmcid: 5683606 doi: 10.1371/journal.pone.0187930
Bidou, L. et al. Premature stop codons involved in muscular dystrophies show a broad spectrum of readthrough efficiencies in response to gentamicin treatment. Gene Ther. 11, 619–627 (2004).
pubmed: 14973546 doi: 10.1038/sj.gt.3302211 pmcid: 14973546
Gurskaya, N. G., Pereverzev, A. P., Staroverov, D. B., Markina, N. M. & Lukyanov, K. A. Analysis of nonsense-mediated mRNA decay at the single-cell level using two fluorescent proteins. Methods Enzymol. 572, 291–314 (2016).
pubmed: 27241760 doi: 10.1016/bs.mie.2016.02.008 pmcid: 27241760
Burchenal, J. H. et al. The effects of the folic acid antagonists and 2,6-diaminopurine on neoplastic disease, with special reference to acute leukemia. Cancer 4, 549–569 (1951).
pubmed: 14839611 doi: 10.1002/1097-0142(195105)4:3<549::AID-CNCR2820040308>3.0.CO;2-J pmcid: 14839611
Friend, C. Effect of 2,6-diaminopurine on virus of Russian spring summner encephalitis in tissue culture. Proc. Soc. Exp. Biol. Med. 78, 150–153 (1951).
pubmed: 14891950 doi: 10.3181/00379727-78-19004 pmcid: 14891950
Margolis, D. M. et al. The use of beta-D-2,6-diaminopurine dioxolane with or without mycophenolate mofetil in drug-resistant HIV infection. AIDS 21, 2025–2032 (2007).
pubmed: 17885292 doi: 10.1097/QAD.0b013e3282364381 pmcid: 17885292
Zouharova, D. et al. Antiviral activities of 2,6-diaminopurine-based acyclic nucleoside phosphonates against herpesviruses: In vitro study results with pseudorabies virus (PrV, SuHV-1). Vet. Microbiol. 184, 84–93 (2016).
pubmed: 26854349 doi: 10.1016/j.vetmic.2016.01.010 pmcid: 26854349
Kamiya, Y. et al. Introduction of 2,6-diaminopurines into serinol nucleic acid improves anti-miRNA performance. Chembiochem 18, 1917–1922 (2017).
pubmed: 28748559 doi: 10.1002/cbic.201700272
Pintard, L. et al. Trm7p catalyses the formation of two 2’-O-methylriboses in yeast tRNA anticodon loop. EMBO J. 21, 1811–1820 (2002).
pubmed: 11927565 pmcid: 125368 doi: 10.1093/emboj/21.7.1811
Guy, M. P. et al. Yeast Trm7 interacts with distinct proteins for critical modifications of the tRNAPhe anticodon loop. RNA 18, 1921–1933 (2012).
pubmed: 22912484 pmcid: 3446714 doi: 10.1261/rna.035287.112
Ren, G., Zhao, Y. P., Yang, L. & Fu, C. X. Anti-proliferative effect of clitocine from the mushroom Leucopaxillus giganteus on human cervical cancer HeLa cells by inducing apoptosis. Cancer Lett. 262, 190–200 (2008).
pubmed: 18222036 doi: 10.1016/j.canlet.2007.12.013
el-Deiry, W. S. et al. WAF1, a potential mediator of p53 tumor suppression. Cell 75, 817–825 (1993).
pubmed: 8242752 doi: 10.1016/0092-8674(93)90500-P
Wang, H., Mohammad, R. M., Werdell, J. & Shekhar, P. V. p53 and protein kinase C independent induction of growth arrest and apoptosis by bryostatin 1 in a highly metastatic mammary epithelial cell line: In vitro versus in vivo activity. Int. J. Mol. Med. 1, 915–923 (1998).
pubmed: 9852625
Geller, A. I. & Rich, A. A. UGA termination suppression tRNATrp active in rabbit reticulocytes. Nature 283, 41–46 (1980).
pubmed: 7350525 doi: 10.1038/283041a0
Urban, C., Zerfass, K., Fingerhut, C. & Beier, H. UGA suppression by tRNACmCATrp occurs in diverse virus RNAs due to a limited influence of the codon context. Nucleic Acids Res. 24, 3424–3430 (1996).
pubmed: 8811098 pmcid: 146097 doi: 10.1093/nar/24.17.3424
Dewez, M. et al. The conserved Wobble uridine tRNA thiolase Ctu1-Ctu2 is required to maintain genome integrity. Proc. Natl Acad. Sci. USA 105, 5459–5464 (2008).
pubmed: 18391219 doi: 10.1073/pnas.0709404105
Marchand, V., Blanloeil-Oillo, F., Helm, M. & Motorin, Y. Illumina-based RiboMethSeq approach for mapping of 2’-O-Me residues in RNA. Nucleic Acids Res. 44, e135 (2016).
pubmed: 27302133 pmcid: 5027498 doi: 10.1093/nar/gkw547
Prokhorova, I. et al. Aminoglycoside interactions and impacts on the eukaryotic ribosome. Proc. Natl Acad. Sci. USA 114, E10899–E10908 (2017).
pubmed: 29208708 doi: 10.1073/pnas.1715501114
Atkinson, J. & Martin, R. Mutations to nonsense codons in human genetic disease: implications for gene therapy by nonsense suppressor tRNAs. Nucleic Acids Res. 22, 1327–1334 (1994).
pubmed: 8190621 pmcid: 307985 doi: 10.1093/nar/22.8.1327
Weckbecker, G. & Cory, J. G. Metabolic activation of 2,6-diaminopurine and 2,6-diaminopurine-2’-deoxyriboside to antitumor agents. Adv. Enzym. Regul. 28, 125–144 (1989).
doi: 10.1016/0065-2571(89)90068-X
Blanchet, S. et al. Deciphering the reading of the genetic code by near-cognate tRNA. Proc. Natl Acad. Sci. USA 115, 3018–3023 (2018).
pubmed: 29507244 doi: 10.1073/pnas.1715578115
Schmeing, T. M., Voorhees, R. M., Kelley, A. C. & Ramakrishnan, V. How mutations in tRNA distant from the anticodon affect the fidelity of decoding. Nat. Struct. Mol. Biol. 18, 432–436 (2011).
pubmed: 21378964 pmcid: 3072312 doi: 10.1038/nsmb.2003
Voorhees, R. M. et al. The structural basis for specific decoding of AUA by isoleucine tRNA on the ribosome. Nat. Struct. Mol. Biol. 20, 641–643 (2013).
pubmed: 23542153 pmcid: 3672977 doi: 10.1038/nsmb.2545
Haas, M. et al. European Medicines Agency review of ataluren for the treatment of ambulant patients aged 5 years and older with Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene. Neuromuscul. Disord. 25, 5–13 (2015).
pubmed: 25497400 doi: 10.1016/j.nmd.2014.11.011
Hettig, R. A. & Adcock, J. D. Studies on the toxicity of streptomycin for man; a preliminary report. Science 103, 355–357 (1946).
pubmed: 21017953 doi: 10.1126/science.103.2673.355
Greenwood, G. J. Neomycin ototoxicity; report of a case. AMA Arch. Otolaryngol. 69, 390–397 (1959).
pubmed: 13636576 doi: 10.1001/archotol.1959.00730030400002
Moosajee, M. et al. Functional rescue of REP1 following treatment with PTC124 and novel derivative PTC-414 in human choroideremia fibroblasts and the nonsense-mediated zebrafish model. Hum. Mol. Genet. 25, 3416–3431 (2016).
pubmed: 27329764 doi: 10.1093/hmg/ddw184
Rowe, S. M. et al. Suppression of CFTR premature termination codons and rescue of CFTR protein and function by the synthetic aminoglycoside NB54. J. Mol. Med. 89, 1149–1161 (2011).
pubmed: 21779978 pmcid: 3204584 doi: 10.1007/s00109-011-0787-6
Wang, D. et al. The designer aminoglycoside NB84 significantly reduces glycosaminoglycan accumulation associated with MPS I-H in the Idua-W392X mouse. Mol. Genet. Metab. 105, 116–125 (2012).
pubmed: 22056610 doi: 10.1016/j.ymgme.2011.10.005
Engelman, J. A. et al. MET amplification leads to gefitinib resistance in lung cancer by activating ERBB3 signaling. Science 316, 1039–1043 (2007).
pubmed: 17463250 doi: 10.1126/science.1141478
Lejeune, F. & Maquat, L. E. Immunopurification and analysis of protein and RNA components of mRNP in mammalian cells. Methods Mol. Biol. 257, 115–124 (2004).
pubmed: 14770001

Auteurs

Carole Trzaska (C)

Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-UMR-S 1277, CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France.

Séverine Amand (S)

Muséum National d'Histoire Naturelle, Centre National de la Recherche Scientifique, Laboratory Molecules of Communication and Adaptation of Microorganisms (MCAM), UMR 7245 CNRS-MNHN, 75005, Paris, France.

Christine Bailly (C)

Muséum National d'Histoire Naturelle, Centre National de la Recherche Scientifique, Laboratory Molecules of Communication and Adaptation of Microorganisms (MCAM), UMR 7245 CNRS-MNHN, 75005, Paris, France.

Catherine Leroy (C)

Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-UMR-S 1277, CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France.

Virginie Marchand (V)

Next-Generation Sequencing Core Facility, UMS2008 IBSLor CNRS-Université de Lorraine-INSERM, BioPôle, 54505, Vandoeuvre-les-Nancy, France.

Evelyne Duvernois-Berthet (E)

Muséum National d'Histoire Naturelle, Centre National de la Recherche Scientifique, Laboratoire Physiologie Moléculaire et Adaptation (PhyMA), UMR7221 CNRS-MNHN, 75005, Paris, France.

Jean-Michel Saliou (JM)

CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, U1019, UMR 8204, CIIL‑Centre d'Infection et d'Immunité de Lille, University of Lille, 59000, Lille, France.

Hana Benhabiles (H)

Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-UMR-S 1277, CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France.

Elisabeth Werkmeister (E)

Cellular Microbiology and Physics of Infection Group, Center for Infection and Immunity of Lille, CNRS UMR8204, INSERM U1019, Institut Pasteur de Lille, Lille Regional Univ. Hosp. Centr., Lille Univ., Lille, 59000, France.

Thierry Chassat (T)

Institut Pasteur de Lille - PLEHTA (Plateforme d'expérimentation et de Haute Technologie Animale), 59019, Lille, France.

Romain Guilbert (R)

Institut Pasteur de Lille - PLEHTA (Plateforme d'expérimentation et de Haute Technologie Animale), 59019, Lille, France.

David Hannebique (D)

Institut Pasteur de Lille - PLEHTA (Plateforme d'expérimentation et de Haute Technologie Animale), 59019, Lille, France.

Anthony Mouray (A)

Institut Pasteur de Lille - PLEHTA (Plateforme d'expérimentation et de Haute Technologie Animale), 59019, Lille, France.

Marie-Christine Copin (MC)

Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-UMR-S 1277, CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France.

Pierre-Arthur Moreau (PA)

Univ. Lille, Fac. Pharmacie Lille, ULR 4515, LGCgE, Laboratoire de Génie Civil et géo-Environnement, 59000, Lille, France.

Eric Adriaenssens (E)

Univ. Lille, CNRS, INSERM, CHU.Lille, Centre Oscar Lambert, UMR9020-UMR1277, CANTHER - Cancer Heterogeneity, Plasticity and Résistance to Therapies, 59000, Lille, France.

Andreas Kulozik (A)

Department of Pediatric Oncology, Hematology and Immunology, Children's Hospital and Hopp Children's Tumor Center Heidelberg, EMBL/Medical Faculty Molecular Medicine Partnership Unit, 69120, Heidelberg, Germany.

Eric Westhof (E)

Architecture and Reactivity of RNA, Institute of Molecular and Cellular Biology of the CNRS UPR9002/University of Strasbourg, Strasbourg, 67084, France.

David Tulasne (D)

Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-UMR-S 1277, CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France.

Yuri Motorin (Y)

Ingénierie Moléculaire et Physiopathologie Articulaire, UMR7365, CNRS - Université de Lorraine, 54505, Vandoeuvre-les-Nancy, France.

Sylvie Rebuffat (S)

Muséum National d'Histoire Naturelle, Centre National de la Recherche Scientifique, Laboratory Molecules of Communication and Adaptation of Microorganisms (MCAM), UMR 7245 CNRS-MNHN, 75005, Paris, France.

Fabrice Lejeune (F)

Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-UMR-S 1277, CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France. fabrice.lejeune@inserm.fr.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH