Unbiased screening identifies regulators of cell-cell adhesion and treatment options in pemphigus.


Journal

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

Informations de publication

Date de publication:
14 Sep 2024
Historique:
received: 23 08 2023
accepted: 15 08 2024
medline: 14 9 2024
pubmed: 14 9 2024
entrez: 13 9 2024
Statut: epublish

Résumé

Cell-cell junctions, and specifically desmosomes, are crucial for robust intercellular adhesion. Desmosomal function is compromised in the autoimmune blistering skin disease pemphigus vulgaris. We combine whole-genome knockout screening and a promotor screen of the desmosomal gene desmoglein 3 in human keratinocytes to identify novel regulators of intercellular adhesion. Kruppel-like-factor 5 (KLF5) directly binds to the desmoglein 3 regulatory region and promotes adhesion. Reduced levels of KLF5 in patient tissue indicate a role in pemphigus vulgaris. Autoantibody fractions from patients impair intercellular adhesion and reduce KLF5 levels in in vitro and in vivo disease models. These effects were dependent on increased activity of histone deacetylase 3, leading to transcriptional repression of KLF5. Inhibiting histone deacetylase 3 increases KLF5 levels and protects against the deleterious effects of autoantibodies in murine and human pemphigus vulgaris models. Together, KLF5 and histone deacetylase 3 are regulators of desmoglein 3 gene expression and intercellular adhesion and represent potential therapeutic targets in pemphigus vulgaris.

Identifiants

pubmed: 39271654
doi: 10.1038/s41467-024-51747-2
pii: 10.1038/s41467-024-51747-2
doi:

Substances chimiques

Desmoglein 3 0
Kruppel-Like Transcription Factors 0
histone deacetylase 3 EC 3.5.1.98
KLF5 protein, human 0
Autoantibodies 0
Histone Deacetylases EC 3.5.1.98
DSG3 protein, human 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

8044

Subventions

Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (Swiss National Science Foundation)
ID : 197764

Informations de copyright

© 2024. The Author(s).

Références

Nelson, W. J. The glue that binds us: the hunt for the molecular basis for multicellularity. Cell 181, 495–497 (2020).
pubmed: 32234519 doi: 10.1016/j.cell.2020.03.017
Green, K. J., Roth-Carter, Q., Niessen, C. M. & Nichols, S. A. Tracing the evolutionary origin of desmosomes. Curr. Biol. 30, R535–R543 (2020).
pubmed: 32428495 pmcid: 7310670 doi: 10.1016/j.cub.2020.03.047
Waschke, J. The desmosome and pemphigus. Histochem. Cell Biol. 130, 21–54 (2008).
pubmed: 18386043 pmcid: 2413110 doi: 10.1007/s00418-008-0420-0
Delva, E., Tucker, D. K. & Kowalczyk, A. P. The desmosome. Cold Spring Harb. Perspect. Biol. 1, a002543 (2009).
pubmed: 20066089 pmcid: 2742091 doi: 10.1101/cshperspect.a002543
Yeruva, S. & Waschke, J. Structure and regulation of desmosomes in intercalated discs: lessons from epithelia. J. Anat. 242, 81–90 (2023).
pubmed: 35128661 doi: 10.1111/joa.13634
Broussard, J. A., Getsios, S. & Green, K. J. Desmosome regulation and signaling in disease. Cell Tissue Res. 360, 501–512 (2015).
pubmed: 25693896 pmcid: 4489137 doi: 10.1007/s00441-015-2136-5
Spindler, V. et al. Meeting report - desmosome dysfunction and disease: alpine desmosome disease meeting. J. Cell Sci. 136, jcs260832 (2023).
pubmed: 36594662 doi: 10.1242/jcs.260832
Spindler, V. & Waschke, J. Pemphigus-a disease of desmosome dysfunction caused by multiple mechanisms. Front. Immunol. 9, 136 (2018).
pubmed: 29449846 pmcid: 5799217 doi: 10.3389/fimmu.2018.00136
Corrado, D., Link, M. S. & Calkins, H. Arrhythmogenic right ventricular cardiomyopathy REPLY. N. Engl. J. Med. 376, 1489–1490 (2017).
pubmed: 28402769 doi: 10.1056/NEJMra1509267
Schinner, C. et al. Defective desmosomal adhesion causes arrhythmogenic cardiomyopathy by involving an integrin-alphaVbeta6/TGF-beta signaling cascade. Circulation 146, 1610–1626 (2022).
pubmed: 36268721 pmcid: 9674449 doi: 10.1161/CIRCULATIONAHA.121.057329
Tzelepis, K. et al. A CRISPR dropout screen identifies genetic vulnerabilities and therapeutic targets in acute myeloid leukemia. Cell Rep. 17, 1193–1205 (2016).
pubmed: 27760321 pmcid: 5081405 doi: 10.1016/j.celrep.2016.09.079
Doench, J. G. et al. Optimized sgRNA design to maximize activity and minimize off-target effects of CRISPR-Cas9. Nat. Biotechnol. 34, 184–191 (2016).
pubmed: 26780180 pmcid: 4744125 doi: 10.1038/nbt.3437
Spindler, V. et al. Mechanisms causing loss of keratinocyte cohesion in pemphigus. J. Invest. Dermatol. 138, 32–37 (2018).
pubmed: 29037765 doi: 10.1016/j.jid.2017.06.022
Tang, J. et al. LncRNA PVT1 regulates triple-negative breast cancer through KLF5/beta-catenin signaling. Oncogene 37, 4723–4734 (2018).
pubmed: 29760406 doi: 10.1038/s41388-018-0310-4
Lyu, Y. et al. KLF5 governs sphingolipid metabolism and barrier function of the skin. Genes Dev. 36, 822–842 (2022).
pubmed: 36008138 pmcid: 9480852 doi: 10.1101/gad.349662.122
Payne, A. S. et al. Genetic and functional characterization of human pemphigus vulgaris monoclonal autoantibodies isolated by phage display. J. Clin. Invest. 115, 888–899 (2005).
pubmed: 15841178 pmcid: 1070425 doi: 10.1172/JCI24185
Matsumura, T. et al. The deacetylase HDAC1 negatively regulates the cardiovascular transcription factor Kruppel-like factor 5 through direct interaction. J. Biol. Chem. 280, 12123–12129 (2005).
pubmed: 15668237 doi: 10.1074/jbc.M410578200
Tao, R. et al. HDAC-mediated deacetylation of KLF5 associates with its proteasomal degradation. Biochem Biophys. Res. Commun. 500, 777–782 (2018).
pubmed: 29679567 pmcid: 5940529 doi: 10.1016/j.bbrc.2018.04.153
Zheng, B. et al. HDAC2 phosphorylation-dependent Klf5 deacetylation and RAR alpha acetylation induced by RAR agonist switch the transcription regulatory programs of p21 in VSMCs. Cell Res. 21, 1487–1508 (2011).
pubmed: 21383775 pmcid: 3193446 doi: 10.1038/cr.2011.34
Urnov, F. D. et al. Targeting of N-CoR and histone deacetylase 3 by the oncoprotein v-erbA yields a chromatin infrastructure-dependent transcriptional repression pathway. EMBO J. 19, 4074–4090 (2000).
pubmed: 10921888 pmcid: 306612 doi: 10.1093/emboj/19.15.4074
Szigety, K. M. et al. HDAC3 ensures stepwise epidermal stratification via NCoR/SMRT-reliant mechanisms independent of its histone deacetylase activity. Genes Dev. 34, 973–988 (2020).
pubmed: 32467224 pmcid: 7328513 doi: 10.1101/gad.333674.119
Mavropoulos, A. et al. p38 MAPK signaling in pemphigus: implications for skin autoimmunity. Autoimmune Dis. 2013, 728529 (2013).
pubmed: 23936634 pmcid: 3722958
Berkowitz, P. et al. Desmosome signaling. Inhibition of p38MAPK prevents pemphigus vulgaris IgG-induced cytoskeleton reorganization. J. Biol. Chem. 280, 23778–23784 (2005).
pubmed: 15840580 doi: 10.1074/jbc.M501365200
Berkowitz, P. et al. p38MAPK inhibition prevents disease in pemphigus vulgaris mice. Proc. Natl Acad. Sci. USA 103, 12855–12860 (2006).
pubmed: 16908851 pmcid: 1568937 doi: 10.1073/pnas.0602973103
Malvaez, M. et al. HDAC3-selective inhibitor enhances extinction of cocaine-seeking behavior in a persistent manner. Proc. Natl Acad. Sci. USA 110, 2647–2652 (2013).
pubmed: 23297220 pmcid: 3574934 doi: 10.1073/pnas.1213364110
Spindler, V., Vielmuth, F., Schmidt, E., Rubenstein, D. S. & Waschke, J. Protective endogenous cyclic adenosine 5’-monophosphate signaling triggered by pemphigus autoantibodies. J. Immunol. 185, 6831–6838 (2010).
pubmed: 21037102 doi: 10.4049/jimmunol.1002675
Egu, D. T., Walter, E., Spindler, V. & Waschke, J. Inhibition of p38MAPK signalling prevents epidermal blistering and alterations of desmosome structure induced by pemphigus autoantibodies in human epidermis. Br. J. Dermatol. 177, 1612–1618 (2017).
pubmed: 28600798 doi: 10.1111/bjd.15721
Egu, D. T. et al. A new ex vivo human oral mucosa model reveals that p38MAPK inhibition is not effective in preventing autoantibody-induced mucosal blistering in pemphigus. Br. J. Dermatol. 182, 987–994 (2020).
pubmed: 31218663 doi: 10.1111/bjd.18237
van der Kammen, R. et al. Knockout of the Arp2/3 complex in epidermis causes a psoriasis-like disease hallmarked by hyperactivation of transcription factor Nrf2. Development 144, 4588–4603 (2017).
pubmed: 29113991 doi: 10.1242/dev.156323
Gladden, A. B., Hebert, A. M., Schneeberger, E. E. & McClatchey, A. I. The NF2 tumor suppressor, Merlin, regulates epidermal development through the establishment of a junctional polarity complex. Dev. Cell 19, 727–739 (2010).
pubmed: 21074722 pmcid: 3033574 doi: 10.1016/j.devcel.2010.10.008
Nekrasova, O. et al. Desmosomal cadherin association with Tctex-1 and cortactin-Arp2/3 drives perijunctional actin polymerization to promote keratinocyte delamination. Nat. Commun. 9, 1053 (2018).
pubmed: 29535305 pmcid: 5849617 doi: 10.1038/s41467-018-03414-6
Nekrasova, O. & Green, K. J. Desmosome assembly and dynamics. Trends Cell Biol. 23, 537–546 (2013).
pubmed: 23891292 pmcid: 3913269 doi: 10.1016/j.tcb.2013.06.004
Hegazy, M. et al. Epidermal stratification requires retromer-mediated desmoglein-1 recycling. Dev. Cell 57, 2683–2698 e2688 (2022).
pubmed: 36495876 pmcid: 9973369 doi: 10.1016/j.devcel.2022.11.010
Sanger, A., Hirst, J., Davies, A. K. & Robinson, M. S. Adaptor protein complexes and disease at a glance. J. cell Sci. 132, jcs222992 (2019).
pubmed: 31636158 doi: 10.1242/jcs.222992
Sur, I., Rozell, B., Jaks, V., Bergstrom, A. & Toftgard, R. Epidermal and craniofacial defects in mice overexpressing Klf5 in the basal layer of the epidermis. J. Cell Sci. 119, 3593–3601 (2006).
pubmed: 16912082 doi: 10.1242/jcs.03070
Kenchegowda, D., Harvey, S. A., Swamynathan, S., Lathrop, K. L. & Swamynathan, S. K. Critical role of Klf5 in regulating gene expression during post-eyelid opening maturation of mouse corneas. PLoS ONE 7, e44771 (2012).
pubmed: 23024760 pmcid: 3443110 doi: 10.1371/journal.pone.0044771
Liu, Y., Chidgey, M., Yang, V. W. & Bialkowska, A. B. Krüppel-like factor 5 is essential for maintenance of barrier function in mouse colon. Am. J. Physiol. Gastrointest. Liver Physiol. 313, G478–g491 (2017).
pubmed: 28864500 pmcid: 5792213 doi: 10.1152/ajpgi.00172.2017
Harman, K. E. et al. British Association of Dermatologists’ guidelines for the management of pemphigus vulgaris 2017. Br. J. Dermatol. 177, 1170–1201 (2017).
pubmed: 29192996 doi: 10.1111/bjd.15930
Hertl, M. et al. Pemphigus. S2 guideline for diagnosis and treatment-guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV). J. Eur. Acad. Dermatol Venereol. 29, 405–414 (2015).
pubmed: 25338479 doi: 10.1111/jdv.12772
MacIsaac, J. et al. Systematic review of rituximab for autoimmune diseases: a potential alternative to intravenous immune globulin. Transfusion 58, 2729–2735 (2018).
pubmed: 30244480 doi: 10.1111/trf.14841
Jennings, J. M. et al. Desmosome disassembly in response to pemphigus vulgaris IgG occurs in distinct phases and can be reversed by expression of exogenous Dsg3. J. Invest. Dermatol. 131, 706–718 (2011).
pubmed: 21160493 doi: 10.1038/jid.2010.389
Mao, X. M., Cho, M. J. T., Ellebrecht, C. T., Mukherjee, E. M. & Payne, A. S. Stat3 regulates desmoglein 3 transcription in epithelial keratinocytes. JCI Insight 2, e92253 (2017).
pubmed: 28469076 pmcid: 5414550 doi: 10.1172/jci.insight.92253
Nguyen, V. T. et al. Pemphigus vulgaris IgG and methylprednisolone exhibit reciprocal effects on keratinocytes. J. Biol. Chem. 279, 2135–2146 (2004).
pubmed: 14600150 doi: 10.1074/jbc.M309000200
Grando, S. A., Laquer, V. T. & Le, H. M. Sirolimus for acute pemphigus vulgaris: a case report and discussion of dualistic action providing for both immunosuppression and keratinocyte protection. J. Am. Acad. Dermatol. 65, 684–686 (2011).
pubmed: 21839342 doi: 10.1016/j.jaad.2011.01.029
Poot, A. M. & Jonkman, M. F. Topical sirolimus for oral pemphigus vulgaris: 3 unresponsive cases. J. Am. Acad. Dermatol. 67, E228–E229 (2012).
pubmed: 23062929 doi: 10.1016/j.jaad.2012.04.032
Saggar, S., Zeichner, J. A., Brown, T. T., Phelps, R. G. & Cohen, S. R. Kaposi’s sarcoma resolves after sirolimus therapy in a patient with pemphigus vulgaris. Arch. Dermatol. 144, 654–657 (2008).
pubmed: 18490593 doi: 10.1001/archderm.144.5.654
Emmett, M. J. & Lazar, M. A. Integrative regulation of physiology by histone deacetylase 3. Nat. Rev. Mol. Cell Biol. 20, 102–115 (2019).
pubmed: 30390028 pmcid: 6347506 doi: 10.1038/s41580-018-0076-0
Sun, Z. et al. Deacetylase-independent function of HDAC3 in transcription and metabolism requires nuclear receptor corepressor. Mol. Cell 52, 769–782 (2013).
pubmed: 24268577 doi: 10.1016/j.molcel.2013.10.022
Merritt, A. J. et al. Suprabasal desmoglein 3 expression in the epidermis of transgenic mice results in hyperproliferation and abnormal differentiation. Mol. Cell. Biol. 22, 5846–5858 (2002).
pubmed: 12138195 pmcid: 133994 doi: 10.1128/MCB.22.16.5846-5858.2002
Hartlieb, E., Rotzer, V., Radeva, M., Spindler, V. & Waschke, J. Desmoglein 2 compensates for desmoglein 3 but does not control cell adhesion via regulation of p38 mitogen-activated protein kinase in keratinocytes. J. Biol. Chem. 289, 17043–17053 (2014).
pubmed: 24782306 pmcid: 4059146 doi: 10.1074/jbc.M113.489336
Walter, E. et al. Role of Dsg1- and Dsg3-mediated signaling in pemphigus autoantibody-induced loss of keratinocyte cohesion. Front. Immunol. 10, 1128 (2019).
pubmed: 31178865 pmcid: 6543754 doi: 10.3389/fimmu.2019.01128
Zhao, M. et al. Aberrant epigenetic modifications in peripheral blood mononuclear cells from patients with pemphigus vulgaris. Br. J. Dermatol. 167, 523–531 (2012).
pubmed: 22512277 doi: 10.1111/j.1365-2133.2012.11007.x
Spadoni, M. B., Bumiller-Bini, V., Petzl-Erler, M. L., Augusto, D. G. & Boldt, A. B. W. First glimpse of epigenetic effects on pemphigus foliaceus. J. Invest. Dermatol. 140, 488–491 e481 (2020).
pubmed: 31376384 doi: 10.1016/j.jid.2019.07.691
Kaur, B. et al. Mechanism-based therapeutic targets of pemphigus vulgaris: a scoping review of pathogenic molecular pathways. Exp. Dermatol. 31, 154–171 (2022).
pubmed: 34435386 doi: 10.1111/exd.14453
Egu, D. T., Schmitt, T. & Waschke, J. Mechanisms causing acantholysis in pemphigus-lessons from human skin. Front. Immunol. 13, 884067 (2022).
pubmed: 35720332 pmcid: 9205406 doi: 10.3389/fimmu.2022.884067
Ivars, M. et al. The involvement of ADAM10 in acantholysis in mucocutaneous pemphigus vulgaris depends on the autoantibody profile of each patient. Br. J. Dermatol. 182, 1194–1204 (2020).
pubmed: 31370093 doi: 10.1111/bjd.18382
Bektas, M., Jolly, P. S., Berkowitz, P., Amagai, M. & Rubenstein, D. S. A pathophysiologic role for epidermal growth factor receptor in pemphigus acantholysis. J. Biol. Chem. 288, 9447–9456 (2013).
pubmed: 23404504 pmcid: 3611014 doi: 10.1074/jbc.M112.438010
Radeva, M. Y. et al. ST18 enhances PV-IgG-induced loss of keratinocyte cohesion in parallel to increased ERK activation. Front. Immunol. 10, 770 (2019).
pubmed: 31057535 pmcid: 6478701 doi: 10.3389/fimmu.2019.00770
Egu, D. T., Kugelmann, D. & Waschke, J. Role of PKC and ERK signaling in epidermal blistering and desmosome regulation in pemphigus. Front. Immunol. 10, 2883 (2019).
pubmed: 31867019 pmcid: 6910072 doi: 10.3389/fimmu.2019.02883
Sanchez-Carpintero, I. et al. In vivo blockade of pemphigus vulgaris acantholysis by inhibition of intracellular signal transduction cascades. Br. J. Dermatol. 151, 565–570 (2004).
pubmed: 15377341 doi: 10.1111/j.1365-2133.2004.06147.x
Vielmuth, F., Radeva, M. Y., Yeruva, S., Sigmund, A. M. & Waschke, J. cAMP: a master regulator of cadherin-mediated binding in endothelium, epithelium and myocardium. Acta Physiol. 238, e14006 (2023).
doi: 10.1111/apha.14006
Sigmund, A. M. et al. Apremilast prevents blistering in human epidermis and stabilizes keratinocyte adhesion in pemphigus. Nat. Commun. 14, 116 (2023).
pubmed: 36624106 pmcid: 9829900 doi: 10.1038/s41467-022-35741-0
Boukamp, P. et al. Normal keratinization in a spontaneously immortalized aneuploid human keratinocyte cell line. J. Cell Biol. 106, 761–771 (1988).
pubmed: 2450098 doi: 10.1083/jcb.106.3.761
Waschke, J., Bruggeman, P., Baumgartner, W., Zillikens, D. & Drenckhahn, D. Pemphigus foliaceus IgG causes dissociation of desmoglein 1-containing junctions without blocking desmoglein 1 transinteraction. J. Clin. Invest. 115, 3157–3165 (2005).
pubmed: 16211092 pmcid: 1242188 doi: 10.1172/JCI23475
Sanjana, N. E., Shalem, O. & Zhang, F. Improved vectors and genome-wide libraries for CRISPR screening. Nat. Methods 11, 783–784 (2014).
pubmed: 25075903 pmcid: 4486245 doi: 10.1038/nmeth.3047
Martin, M. Cutadapt removes adapter sequences from high-throughput sequencing reads. EMBnet.journal 17, 3 (2011).
doi: 10.14806/ej.17.1.200
Li, W. et al. MAGeCK enables robust identification of essential genes from genome-scale CRISPR/Cas9 knockout screens. Genome Biol. 15, 554 (2014).
pubmed: 25476604 pmcid: 4290824 doi: 10.1186/s13059-014-0554-4
Blighe K, Rana, S. & Lewis, M. EnhancedVolcano: publication-ready volcano plots with enhanced colouring and labeling. (2020).
Wang, B. et al. Integrative analysis of pooled CRISPR genetic screens using MAGeCKFlute. Nat. Protoc. 14, 756–780 (2019).
pubmed: 30710114 pmcid: 6862721 doi: 10.1038/s41596-018-0113-7
Shannon, P. et al. Cytoscape: a software environment for integrated models of biomolecular interaction networks. Genome Res. 13, 2498–2504 (2003).
pubmed: 14597658 pmcid: 403769 doi: 10.1101/gr.1239303
Maere, S., Heymans, K. & Kuiper, M. BiNGO: a cytoscape plugin to assess overrepresentation of gene ontology categories in biological networks. Bioinformatics 21, 3448–3449 (2005).
pubmed: 15972284 doi: 10.1093/bioinformatics/bti551
Bluhm, A., Casas-Vila, N., Scheibe, M. & Butter, F. Reader interactome of epigenetic histone marks in birds. Proteomics 16, 427–436 (2016).
pubmed: 26703087 doi: 10.1002/pmic.201500217
Bovio, P., Roidl, D., Heidrich, S., Vogel, T. & Franz, H. Isolation and cultivation of neural progenitors followed by chromatin-immunoprecipitation of histone 3 lysine 79 dimethylation mark. J. Vis. Exp. https://doi.org/10.3791/56631 (2018).

Auteurs

Henriette Franz (H)

Department of Biomedicine, University of Basel, Basel, Switzerland.

Maitreyi Rathod (M)

Department of Biomedicine, University of Basel, Basel, Switzerland.
Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany.

Aude Zimmermann (A)

Department of Biomedicine, University of Basel, Basel, Switzerland.

Chiara Stüdle (C)

Department of Biomedicine, University of Basel, Basel, Switzerland.
Theodor Kocher Institute, University of Bern, Bern, Switzerland.

Vivien Beyersdorfer (V)

Department of Biomedicine, University of Basel, Basel, Switzerland.
Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany.

Karen Leal-Fischer (K)

Department of Biomedicine, University of Basel, Basel, Switzerland.

Pauline Hanns (P)

Department of Biomedicine, University of Basel, Basel, Switzerland.

Tomás Cunha (T)

Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland.

Dario Didona (D)

Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland.

Michael Hertl (M)

Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland.

Marion Scheibe (M)

Institute of Molecular Biology (IMB), Mainz, Germany.
Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institute, Greifswald, Germany.

Falk Butter (F)

Institute of Molecular Biology (IMB), Mainz, Germany.
Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institute, Greifswald, Germany.

Enno Schmidt (E)

Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute for Experimental Dermatology, University of Lübeck, Lübeck, Germany.

Volker Spindler (V)

Department of Biomedicine, University of Basel, Basel, Switzerland. v.spindler@uke.de.
Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany. v.spindler@uke.de.

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