The course of attention-deficit/hyperactivity disorder through midlife.

Adults Attention-Deficit/Hyperactivity Disorder Clinical follow-up PRS Trajectories

Journal

European archives of psychiatry and clinical neuroscience
ISSN: 1433-8491
Titre abrégé: Eur Arch Psychiatry Clin Neurosci
Pays: Germany
ID NLM: 9103030

Informations de publication

Date de publication:
09 Dec 2022
Historique:
received: 22 07 2022
accepted: 29 11 2022
entrez: 9 12 2022
pubmed: 10 12 2022
medline: 10 12 2022
Statut: aheadofprint

Résumé

The course of ADHD from childhood up to young adulthood has been characterized in several studies. However, little is known about the course of symptoms into middle age and beyond. This study aims to evaluate predictors of ADHD trajectories in midlife based on three assessments. The follow-up sample comprised 323 adults with ADHD, evaluated at baseline and seven and thirteen years later, from the average ages of 34 up to 47 years old. ADHD status at reassessments was used to characterize trajectories. Demographics, ADHD features, comorbidities, and polygenic scores for ADHD and genetically correlated psychiatric disorders were evaluated to predict ADHD trajectories. Study retention rate was 67% at T2 (n = 216) and 62% at T3 (n = 199). Data from patients evaluated three times showed that 68.8% coursed stable, 25.5% unstable, and 5.7% remission trajectory of ADHD. Women, individuals with more severe syndromes, higher frequency of comorbidities at reassessments, and genetic liability to depression present a higher probability of a stable trajectory. Our findings shed light on midlife ADHD trajectories and their gender, genomic and clinical correlates.

Identifiants

pubmed: 36484846
doi: 10.1007/s00406-022-01531-4
pii: 10.1007/s00406-022-01531-4
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Conselho Nacional de Desenvolvimento Científico e Tecnológico
ID : 476529/2012-3
Organisme : Conselho Nacional de Desenvolvimento Científico e Tecnológico
ID : 466722/2014-1
Organisme : Conselho Nacional de Desenvolvimento Científico e Tecnológico
ID : 424041/2016-2
Organisme : Conselho Nacional de Desenvolvimento Científico e Tecnológico
ID : 426905/2016-4
Organisme : Conselho Nacional de Desenvolvimento Científico e Tecnológico
ID : 431472/2018-1
Organisme : Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
ID : Finance Code 001
Organisme : Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
ID : FIPE-HCPA 160600
Organisme : Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul
ID : PqG-19/2551-0001731-6
Organisme : Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul
ID : 19/2551-001668-9

Informations de copyright

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Références

Thapar A, Cooper M, Rutter M (2017) Neurodevelopmental disorders. Lancet. Psychiatry 4:339–346. https://doi.org/10.1016/S2215-0366(16)30376-5
doi: 10.1016/S2215-0366(16)30376-5
Kooij JJS, Buitelaar JK, van den Oord EJ et al (2005) Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med 35:817–827. https://doi.org/10.1017/s003329170400337x
doi: 10.1017/s003329170400337x
Vitola ES, Bau CHD, Salum GA et al (2017) Exploring DSM-5 ADHD criteria beyond young adulthood: phenomenology, psychometric properties and prevalence in a large three-decade birth cohort. Psychol Med 47:744–754. https://doi.org/10.1017/S0033291716002853
doi: 10.1017/S0033291716002853
Caye A, Rocha TB-M, Anselmi L et al (2016) Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome. JAMA Psychiat 73:705–712. https://doi.org/10.1001/jamapsychiatry.2016.0383
doi: 10.1001/jamapsychiatry.2016.0383
Breda V, Rohde LA, Menezes AMB et al (2021) The neurodevelopmental nature of attention-deficit hyperactivity disorder in adults. Br J Psychiatry 218:43–50. https://doi.org/10.1192/bjp.2020.200
doi: 10.1192/bjp.2020.200
Lahey BB, Loeber R, Burke J et al (2002) Waxing and waning in concert: dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 7 years among clinic-referred boys. J Abnorm Psychol 111:556–567. https://doi.org/10.1037//0021-843x.111.4.556
doi: 10.1037//0021-843x.111.4.556
Sibley MH, Arnold LE, Swanson JM et al (2022) Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. Am J Psychiatry 179:142–151. https://doi.org/10.1176/appi.ajp.2021.21010032
doi: 10.1176/appi.ajp.2021.21010032
Caye A, Spadini AV, Karam RG et al (2016) Predictors of persistence of ADHD into adulthood: a systematic review of the literature and meta-analysis. Eur Child Adolesc Psychiatry 25:1151–1159. https://doi.org/10.1007/s00787-016-0831-8
doi: 10.1007/s00787-016-0831-8
Kessler RC, Adler LA, Barkley R et al (2005) Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry 57:1442–1451. https://doi.org/10.1016/j.biopsych.2005.04.001
doi: 10.1016/j.biopsych.2005.04.001
Lara C, Fayyad J, de Graaf R et al (2009) Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the world health organization world mental health survey initiative. Biol Psychiatry 65:46–54. https://doi.org/10.1016/j.biopsych.2008.10.005
doi: 10.1016/j.biopsych.2008.10.005
Lahey BB, Pelham WE, Loney J et al (2005) Instability of the DSM-IV Subtypes of ADHD from preschool through elementary school. Arch Gen Psychiatry 62:896–902. https://doi.org/10.1001/archpsyc.62.8.896
doi: 10.1001/archpsyc.62.8.896
Moffitt TE, Houts R, Asherson P et al (2015) Is adult ADHD a childhood-onset neurodevelopmental disorder? evidence from a four-decade longitudinal cohort study. Am J Psychiatry 172:967–977. https://doi.org/10.1176/appi.ajp.2015.14101266
doi: 10.1176/appi.ajp.2015.14101266
Agnew-Blais JC, Polanczyk GV, Danese A et al (2016) Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood. JAMA Psychiat 73:713–720. https://doi.org/10.1001/jamapsychiatry.2016.0465
doi: 10.1001/jamapsychiatry.2016.0465
Karam RG, Breda V, Picon FA et al (2015) Persistence and remission of ADHD during adulthood: a 7 year clinical follow-up study. Psychol Med 45:2045–2056. https://doi.org/10.1017/S0033291714003183
doi: 10.1017/S0033291714003183
Karam RG, Rovaris DL, Breda V et al (2017) Trajectories of attention-deficit/hyperactivity disorder dimensions in adults. Acta Psychiatr Scand 136:210–219. https://doi.org/10.1111/acps.12757
doi: 10.1111/acps.12757
Edvinsson D, Ekselius L (2018) Six-year outcome in subjects diagnosed with attention-deficit/hyperactivity disorder as adults. Eur Arch Psychiatry Clin Neurosci 268:337–347. https://doi.org/10.1007/s00406-017-0850-6
doi: 10.1007/s00406-017-0850-6
Franke B, Michelini G, Asherson P et al (2018) Live fast, die young? a review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol 28:1059–1088. https://doi.org/10.1016/j.euroneuro.2018.08.001
doi: 10.1016/j.euroneuro.2018.08.001
Riglin L, Collishaw S, Thapar AK et al (2016) Association of genetic risk variants with attention-deficit/hyperactivity disorder trajectories in the general population. JAMA Psychiat 73:1285–1292. https://doi.org/10.1001/jamapsychiatry.2016.2817
doi: 10.1001/jamapsychiatry.2016.2817
Agnew-Blais JC, Belsky DW, Caspi A et al (2021) Polygenic risk and the course of attention-deficit/hyperactivity disorder from childhood to young adulthood: findings from a nationally representative cohort. J Am Acad Child Adolesc Psychiatry 60:1147–1156. https://doi.org/10.1016/j.jaac.2020.12.033
doi: 10.1016/j.jaac.2020.12.033
American Psychiatric Association (1994) DSM-IV: diagnostic and statistical manual of mental disorders, 4th ed. American Psychiatric Association: Washington DC
First MB, Spitzer RL, Gibbon M, Williams JBW (1998) Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Patient Edition (SCID-I/P), 1st ed. Biometrics Research. New York: Biometrics Research
Mercadante MT, Asbarh F, Rosário MC, et al (1995) K-SADS, entrevista semi-estruturada para diagnóstico em psiquiatria da infância, versão epidemiológica. São Paulo, PROTOC – Hospital das Clínicas da FMUSP
Sheehan DV, Lecrubier Y, Sheehan KH, et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33
Grevet EH, Bau CHD, Salgado CAI et al (2006) Lack of gender effects on subtype outcomes in adults with attention-deficit/hyperactivity disorder: support for the validity of subtypes. Eur Arch Psychiatry Clin Neurosci 256:311–319. https://doi.org/10.1007/s00406-006-0639-5
doi: 10.1007/s00406-006-0639-5
Grevet EH, Bau CHD, Salgado CAI et al (2005) Interrater reliability for diagnosis in adults of attention deficit hyperactivity disorder and oppositional defiant disorder using K-SADS-E. Arq Neuropsiquiatr 63:307–310. https://doi.org/10.1590/s0004-282x2005000200019
doi: 10.1590/s0004-282x2005000200019
Karam RG, Bau CHD, Salgado CAI et al (2009) Late-onset ADHD in adults: milder, but still dysfunctional. J Psychiatr Res 43:697–701. https://doi.org/10.1016/j.jpsychires.2008.10.001
doi: 10.1016/j.jpsychires.2008.10.001
Kieling C, Kieling RR, Rohde LA et al (2010) The age at onset of attention deficit hyperactivity disorder. Am J Psychiatry 167:14–16. https://doi.org/10.1176/appi.ajp.2009.09060796
doi: 10.1176/appi.ajp.2009.09060796
Barkley RA, Murphy KR (1998) Attention-deficit hyperactivity disorder: a clinical workbook, 2nd edn. Guilford Press, New York, NY, US
Swanson JM (1992) School-based Assessments and Interventions for ADD Students. Publishing, K. C
IBGE (2002) Perfil dos Idosos Responsáveis pelos Domicílios no Brasil 2000. Estudos and Pesquisas. Informação Sociodemográfica e Socioeconômica 9
Cloninger RC, Przybeck TR, Svrakic DM, Wetzel RD (1994) The temperament and character inventory (TCI): A guide to its development and Use. Arch Gen Psychiatry 50:975–990
doi: 10.1001/archpsyc.1993.01820240059008
Wechsler D (1981) WAIS-R - Manual for the Wechsler Adult Intelligence Scale: Revised. Psychological Corporation, Cleveland, OH
Mattos P, Palmini A, Salgado CA et al (2006) Brazilian consensus of specialists on the diagnosis of attention-deficit/hyperactivity disorder in adults. Rev Psiquiatr Rio Gd Sul 28(1):50–60
doi: 10.1590/S0101-81082006000100007
Kooij JJS, Bijlenga D, Salerno L et al (2019) Updated European consensus statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 56:14–34. https://doi.org/10.1016/j.eurpsy.2018.11.001
doi: 10.1016/j.eurpsy.2018.11.001
da Silva BS, Cupertino RB, Rovaris DL et al (2018) Exocytosis-related genes and response to methylphenidate treatment in adults with ADHD. Mol Psychiatry 23:1446–1452. https://doi.org/10.1038/mp.2017.90
doi: 10.1038/mp.2017.90
Victor MM, Rovaris DL, Salgado CAI et al (2014) Severity but not comorbidities predicts response to methylphenidate in adults with attention-deficit/hyperactivity disorder: results from a naturalistic study. J Clin Psychopharmacol 34:212–217. https://doi.org/10.1097/JCP.0000000000000091
doi: 10.1097/JCP.0000000000000091
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5). American Psychiatric Association: Arlington, VA, USA
Lam M, Awasthi S, Watson HJ et al (2020) RICOPILI: rapid imputation for consortias pipeline. Bioinformatics 36:930–933. https://doi.org/10.1093/bioinformatics/btz633
doi: 10.1093/bioinformatics/btz633
Achenbach TM (2017) The need for evidence-based intake, progress, and outcomes assessment. Eur Child Adolesc Psychiatry 26:1–3. https://doi.org/10.1007/s00787-016-0926-2
doi: 10.1007/s00787-016-0926-2
de Jonge P, Wardenaar KJ, Lim CCW et al (2018) The cross-national structure of mental disorders: results from the World Mental Health Surveys. Psychol Med 48:2073–2084. https://doi.org/10.1017/S0033291717003610
doi: 10.1017/S0033291717003610
Tibshirani R (1996) Regression shrinkage and selection via the lasso. J Roy Stat Soc: Ser B (Methodol) 58:267–288. https://doi.org/10.1111/j.2517-6161.1996.tb02080.x
doi: 10.1111/j.2517-6161.1996.tb02080.x
Friedman J, Hastie T, Tibshirani R (2010) Regularization paths for generalized linear models via coordinate descent. J Stat Softw. https://doi.org/10.18637/jss.v033.i01
doi: 10.18637/jss.v033.i01
Demontis D, Walters GB, Athanasiadis G, et al (2022) Genome-wide analyses of ADHD identify 27 risk loci, refine the genetic architecture and implicate several cognitive domains. medRxiv. https://doi.org/10.1101/2022.02.14.22270780
Anttila V, Bulik-Sullivan B et al (2018) Analysis of shared heritability in common disorders of the brain. Science. https://doi.org/10.1126/science.aap8757
doi: 10.1126/science.aap8757
Howard DM, Adams MJ, Clarke TK et al (2019) Genome-wide meta-analysis of depression identifies 102 independent variants and highlights the importance of the prefrontal regions. Nat Neurosci 22:343. https://doi.org/10.1038/s41593-018-0326-7
doi: 10.1038/s41593-018-0326-7
Mullins N, Forstner AJ, O’Connell KS et al (2021) Genome-wide association study of more than 40,000 bipolar disorder cases provides new insights into the underlying biology. Nat Genet 53:817–829. https://doi.org/10.1038/s41588-021-00857-4
doi: 10.1038/s41588-021-00857-4
Ripke S, Walters JT, O’Donovan MC, Schizophrenia Working Group of the Psychiatric Genomics Consortium (2020) Mapping genomic loci prioritises genes and implicates synaptic biology in schizophrenia. Medrxiv. https://doi.org/10.1101/2020.09.12.20192922
doi: 10.1101/2020.09.12.20192922
Choi SW, O’Reilly PF (2019) PRSice-2: polygenic risk score software for biobank-scale data. Gigascience. https://doi.org/10.1093/gigascience/giz082
doi: 10.1093/gigascience/giz082
Solmi M, Radua J, Olivola M et al (2022) Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 27:281–295. https://doi.org/10.1038/s41380-021-01161-7
doi: 10.1038/s41380-021-01161-7
Wagner J, Lüdtke O, Robitzsch A (2019) Does personality become more stable with age? Disentangling state and trait effects for the big five across the life span using local structural equation modeling. J Pers Soc Psychol 116:666–680. https://doi.org/10.1037/pspp0000203
doi: 10.1037/pspp0000203
Faraone SV, Biederman J, Mick E (2006) The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 36:159–165. https://doi.org/10.1017/S003329170500471X
doi: 10.1017/S003329170500471X
Lecendreux M, Konofal E, Cortese S, Faraone SV (2015) A 4 year follow-up of attention-deficit/hyperactivity disorder in a population sample. J Clin Psychiatry 76:712–719. https://doi.org/10.4088/JCP.14m09555
doi: 10.4088/JCP.14m09555
Jäger M, Bottlender R, Strauss A, Möller H-J (2005) Fifteen-year follow-up of diagnostic and statistical manual of mental disorders, fourth edition depressive disorders: the prognostic significance of psychotic features. Compr Psychiatry. https://doi.org/10.1016/j.comppsych.2005.02.001
doi: 10.1016/j.comppsych.2005.02.001
Penninx BWJH, Eikelenboom M, Giltay EJ et al (2021) Cohort profile of the longitudinal Netherlands study of depression and anxiety (NESDA) on etiology, course and consequences of depressive and anxiety disorders. J Affect Disord 287:69–77. https://doi.org/10.1016/j.jad.2021.03.026
doi: 10.1016/j.jad.2021.03.026
Gunderson JG, Stout RL, McGlashan TH et al (2011) Ten-year course of borderline personality disorder: psychopathology and function from the collaborative longitudinal personality disorders study. Arch Gen Psychiatry 68:827–837. https://doi.org/10.1001/archgenpsychiatry.2011.37
doi: 10.1001/archgenpsychiatry.2011.37

Auteurs

Eugenio Horacio Grevet (EH)

Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Laboratory of Developmental Psychiatry, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Cibele Edom Bandeira (CE)

ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Eduardo Schneider Vitola (ES)

Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Maria Eduarda de Araujo Tavares (ME)

ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Vitor Breda (V)

Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Gregory Zeni (G)

Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Stefania Pigatto Teche (SP)

Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Felipe Almeida Picon (FA)

Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Carlos Alberto Iglesias Salgado (CAI)

Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Rafael Gomes Karam (RG)

ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Bruna Santos da Silva (BS)

ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Margaret H Sibley (MH)

Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, USA.

Luis Augusto Rohde (LA)

Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Laboratory of Developmental Psychiatry, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Renata Basso Cupertino (RB)

ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Diego Luiz Rovaris (DL)

ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Department of Physiology and Biophysics, Instituto de Ciencias Biomedicas Universidade de Sao Paulo, São Paulo, Brazil.

Claiton Henrique Dotto Bau (CHD)

Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. claiton.bau@ufrgs.br.
Laboratory of Developmental Psychiatry, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. claiton.bau@ufrgs.br.
ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. claiton.bau@ufrgs.br.
Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. claiton.bau@ufrgs.br.
Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. claiton.bau@ufrgs.br.

Classifications MeSH