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K Trombitás

Publications and source records attributed to K Trombitás.

At least 19 recordsLinked to original sources

Connecting filaments: a historical prospective.

This short review covers the development of the extensible filament research from the very beginning until the most recent results. This work emphasizes the milestones of discovery, which led us from initial observations that were solely ultrastructural to the molecular understanding of the extensible process of these filaments.

Actin Cytoskeleton↗

Mechanical properties of titin isoforms.

Titin is a giant filamentous polypeptide of multi-domain construction spanning between the Z- and M-lines of the sarcomere. As a result of differential splicing, length variants of titin are expressed in different skeletal and cardiac muscles. Here we first briefly review some of our previous work that has revealed that titin develops force in sarcomeres either stretched beyond their slack length (passive force) or shortened to below the slack length (restoring force) and that titin's force underlies a large fraction of the diastolic force of cardiac muscle. Next we present our mechanical and immunoelectron microscopical (IEM) studies of skeletal and cardiac muscles that express titin isoforms. The previously deduced molecular properties of titin were used to model titin's extensible region in the sarcomere as serially linked WLCs: rigid segments (containing folded Ig/Fn domains) and more flexible segments (PEVK segment). The model was tested on skeletal muscle fibers that express titin isoforms with tandem Ig and PEVK length variants. The model adequately predicts titin's behavior along a wide sarcomere length range in skeletal muscle, but at long sarcome lengths (SLs), predicted forces are much higher than those determined experimentally. IEM reveals that this may result from Ig domain unfolding. Experiments were also performed on cardiac myocytes from mouse and cow that express predominantly a small cardiac titin isoform (N2B titin) or a large isoform (N2BA titin), respectively. The passive tension-SL relation of myocytes was found to increase more steeply with SL in mouse than in cow. IEM revealed an additional source of extensibility within both of these cardiac titins: the unique N2B sequence (absent in skeletal muscle). Furthermore, the PEVK segment of the N2BA isoform extended to a maximal length of approximately 200 nm, as opposed to approximately 60 nm for the N2B isoform. We propose that, along the physiological SL range, the long PEVK segment found in N2BA titins results in a low PEVK fractional extension and that this underlies the lower passive tensions of N2BA-expressing cow myocytes.

Animals↗

From connecting filaments to co-expression of titin isoforms.

The molecular basis of elasticity in insect flight muscle has been analyzed using both the mechanism of extensibility of titin filaments (Trombitás et al., J. Cell Biol. 1998;140:853-859), and the sequence of projectin (Daley et al., J. Mol. Biol. 1998;279:201-210). Since a PEVK-like domain is not found in the projectin sequence, it is suggested that the sarcomere elongation causes the slightly "contracted" projectin extensible region to straighten without requiring Ig/Fn domain unfolding. Thus, the extensible region of the projectin may be viewed as a single entropic spring. The serially linked entropic spring model developed for skeletal muscle titin was applied to titin in the heart. The discovery of unique N2B sequence extension in physiological sarcomere length range (Helmes et al., Circ. Res. 1999;84:1339-1352) suggests that cardiac titin can be characterized as a serially linked three-spring system. Two different cardiac titin isoform (N2BA and N2B) co-exist in the heart. These isoforms can be differentiated by immunoelectron microscopy using antibody against sequences C-terminal of the unique N2B sequence, which is present in both isoforms. Immunolabeling experiments show that the two different isoform are co-expressed within the same sarcomere.

Animals↗

Molecular tools for the study of titin's differential expression.

Although vertebrate genomes appear to contain only one titin gene, a large variety of quite distinct titin isoforms are expressed in striated muscle tissues. The isoforms appear to be generated by a series of complex, not yet fully characterized differential splicing mechanisms. Here, we provide an overview of the titin-specific antibodies that have been raised by our laboratory to study individual differentially expressed isoforms of titin. The staining patterns obtained in different tissues will contribute to the identification of both the particular titin isoforms that are expressed in the different tissues, as well as their intracellular distributions. In addition, antibodies to titin that are available are rapidly allowing for the refinement of our knowledge of titin's elastic spring properties. Knowledge of the nature and structure of vertebrate titins that may also be expressed in nonmuscle tissues may be broadened using these antibodies.

Actin Cytoskeleton↗

Mechanically driven contour-length adjustment in rat cardiac titin's unique N2B sequence: titin is an adjustable spring.

The giant elastic protein titin is largely responsible for passive forces in cardiac myocytes. A number of different titin isoforms with distinctly different structural elements within their central I-band region are expressed in human myocardium. Their coexpression has so far prevented an understanding of the respective contributions of the isoforms to myocardial elasticity. Using isoform-specific antibodies, we find in the present study that rat myocardium expresses predominantly the small N2B titin isoform, which allows us to characterize the elastic behavior of this isoform. The extensibility and force response of N2B titin were studied by using immunoelectron microscopy and by measuring the passive force-sarcomere length (SL) relation of single rat cardiac myocytes under a variety of mechanical conditions. Experimental results were compared with the predictions of a mechanical model in which the elastic titin segment behaves as two wormlike chains, the tandem immunoglobulin (Ig) segments and the PEVK segment (rich in proline [P], glutamate [E], valine [V], and lysine [K] residues), connected in series. The overall contour length was predicted from the sequence of N2B cardiac titin. According to mechanical measurements, above approximately 2.2 microm SL titin's elastic segment extends beyond its predicted contour length. Immunoelectron microscopy indicates that a prominent source of this contour-length gain is the extension of the unique N2B sequence (located between proximal tandem Ig segment and PEVK), and that Ig domain unfolding is negligible. Thus, the elastic region of N2B cardiac titin consists of three mechanically distinct extensible segments connected in series: the tandem Ig segment, the PEVK segment, and the unique N2B sequence. Rate-dependent and repetitive stretch-release experiments indicate that both the contour-length gain and the recovery from it involve kinetic processes, probably unfolding and refolding within the N2B segment. As a result, the contour length of titin's extensible segment depends on the rate and magnitude of the preceding mechanical perturbations. The rate of recovery from the length gain is slow, ensuring that the adjusted length is maintained through consecutive cardiac cycles and that hysteresis is minimal. Thus, as a result of the extensible properties of the unique N2B sequence, the I-band region of the N2B cardiac titin isoform functions as a molecular spring that is adjustable.

Animals↗

Molecular dissection of N2B cardiac titin's extensibility.

Titin is a giant filamentous polypeptide of multidomain construction spanning between the Z- and M-lines of the cardiac muscle sarcomere. Extension of the I-band segment of titin gives rise to a force that underlies part of the diastolic force of cardiac muscle. Titin's force arises from its extensible I-band region, which consists of two main segment types: serially linked immunoglobulin-like domains (tandem Ig segments) interrupted with a proline (P)-, glutamate (E)-, valine (V)-, and lysine (K)-rich segment called PEVK segment. In addition to these segments, the extensible region of cardiac titin also contains a unique 572-residue sequence that is part of the cardiac-specific N2B element. In this work, immunoelectron microscopy was used to study the molecular origin of the in vivo extensibility of the I-band region of cardiac titin. The extensibility of the tandem Ig segments, the PEVK segment, and that of the unique N2B sequence were studied, using novel antibodies against Ig domains that flank these segments. Results show that only the tandem Igs extend at sarcomere lengths (SLs) below approximately 2.0 microm, and that, at longer SLs, the PEVK and the unique sequence extend as well. At the longest SLs that may be reached under physiological conditions ( approximately 2.3 microm), the PEVK segment length is approximately 50 nm whereas the unique N2B sequence is approximately 80 nm long. Thus, the unique sequence provides additional extensibility to cardiac titins and this may eliminate the necessity for unfolding of Ig domains under physiological conditions. In summary, this work provides direct evidence that the three main molecular subdomains of N2B titin are all extensible and that their contribution to extensibility decreases in the order of tandem Igs, unique N2B sequence, and PEVK segment.

Animals↗

Muscle carnitine acetyltransferase and carnitine deficiency in a case of mitochondrial encephalomyopathy.

Profound decrease of the carnitine acetyltransferase activity (0.08 U/g wet weight; 1.67% of control) and carnitine deficiency (total carnitine was 230 nmol/g wet weight in the patient vs 2730 in the controls) was detected in the skeletal muscle of a female paediatric patient. She died of her illness, which included cerebellar symptoms and slight muscle spasticity affecting mainly the lower extremities, at 1 year of age. Histological examination of the autopsy specimens revealed a selective Purkinje cell degeneration in the cerebellum: the cells had abnormal position, were shrunken and decreased in number, and displayed abnormal dendritic trees and fragmented, disorganized axons. Electron microscopy revealed mitochondrial abnormalities in skeletal and cardiac muscle and also in the Purkinje cells. Deletions of the mitochondrial DNA were detected in the muscle in heteroplasmic form (up to 7%). Mainly the ND4-ND4L region was affected, as evidenced by the PCR; however, other regions of the mitochondrial genome also showed deletions of varying size and extent, suggesting multiple deletions of the mitochondrial DNA.

Brain↗

Adaptation of a super-sensitive epitope detection technique for the immunoelectron microscopy of titin filaments in vertebrate striated muscle.

A super-sensitive epitope-detection technique based on gold-silver intensification was adapted for pre-embedding immunolabelling of titin filaments in vertebrate striated muscle. Indirect immunoelectron microscopy of titin filaments was performed with monoclonal titin antibodies as primary antibodies and Fab anti-mouse IgG conjugated with 1.4 nm gold particles as secondary antibodies. The secondary antibodies penetrated easily into the tissue owing to their reduced size and the very small gold particles. After the labelling procedure, the tissue was fixed in glutaraldehyde. Since the gold particles were not visible by conventional transmission electron microscopy, they were intensified with a silver developing system. Although the particle size varied nonlinearly with the developing time, very fine grain size was achievable. The technique provided super-sensitive detection with excellent contrast and demonstrated epitopes with both strong and weak affinities.

Animals↗

The NH2 terminus of titin spans the Z-disc: its interaction with a novel 19-kD ligand (T-cap) is required for sarcomeric integrity.

Titin is a giant elastic protein in vertebrate striated muscles with an unprecedented molecular mass of 3-4 megadaltons. Single molecules of titin extend from the Z-line to the M-line. Here, we define the molecular layout of titin within the Z-line; the most NH2-terminal 30 kD of titin is located at the periphery of the Z-line at the border of the adjacent sarcomere, whereas the subsequent 60 kD of titin spans the entire width of the Z-line. In vitro binding studies reveal that mammalian titins have at least four potential binding sites for alpha-actinin within their Z-line spanning region. Titin filaments may specify Z-line width and internal structure by varying the length of their NH2-terminal overlap and number of alpha-actinin binding sites that serve to cross-link the titin and thin filaments. Furthermore, we demonstrate that the NH2-terminal titin Ig repeats Z1 and Z2 in the periphery of the Z-line bind to a novel 19-kD protein, referred to as titin-cap. Using dominant-negative approaches in cardiac myocytes, both the titin Z1-Z2 domains and titin-cap are shown to be required for the structural integrity of sarcomeres, suggesting that their interaction is critical in titin filament-regulated sarcomeric assembly.

Actinin↗

Titin extensibility in situ: entropic elasticity of permanently folded and permanently unfolded molecular segments.

Titin (also known as connectin) is a giant protein that spans half of the striated muscle sarcomere. In the I-band titin extends as the sarcomere is stretched, developing what is known as passive force. The I-band region of titin contains tandem Ig segments (consisting of serially linked immunoglobulin-like domains) with the unique PEVK segment in between (Labeit, S., and B. Kolmerer. 1995. Science. 270:293-296). Although the tandem Ig and PEVK segments have been proposed to behave as stiff and compliant springs, respectively, precise experimental testing of the hypothesis is still needed. Here, sequence-specific antibodies were used to mark the ends of the tandem Ig and PEVK segments. By following the extension of the segments as a function of sarcomere length (SL), their respective contributions to titin's elastic behavior were established. In slack sarcomeres (approximately 2.0 micron) the tandem Ig and PEVK segments were contracted. Upon stretching sarcomeres from approximately 2.0 to 2.7 micron, the "contracted" tandem Ig segments straightened while their individual Ig domains remained folded. When sarcomeres were stretched beyond approximately 2.7 micron, the tandem Ig segments did not further extend, instead PEVK extension was now dominant. Modeling tandem Ig and PEVK segments as entropic springs with different bending rigidities (Kellermayer, M., S. Smith, H. Granzier, and C. Bustamante. 1997. Science. 276:1112-1116) indicated that in the physiological SL range (a) the Ig-like domains of the tandem Ig segments remain folded and (b) the PEVK segment behaves as a permanently unfolded polypeptide. Our model provides a molecular basis for the sequential extension of titin's different segments. Initially, the tandem Ig segments extend at low forces due to their high bending rigidity. Subsequently, extension of the PEVK segment occurs only upon reaching sufficiently high external forces due to its low bending rigidity. The serial linking of tandem Ig and PEVK segments with different bending rigidities provides a unique passive force-SL relation that is not achievable with a single elastic segment.

Chemical Phenomena↗

PEVK extension of human soleus muscle titin revealed by immunolabeling with the anti-titin antibody 9D10.

Titin is a giant protein that spans half of the striated muscle sarcomere. The I-band portion of titin extends as the sarcomere is stretched, developing what is known as passive force. This portion of the molecule is composed mainly of tandem immunoglobulin (Ig) segments, consisting of serially linked Ig-like domains, and a recently discovered unique sequence termed the PEVK segment. The tandem Ig and PEVK segments have been suggested to extend sequentially when sarcomeres are stretched, with PEVK extension dominating at moderate to high degrees of sarcomere stretch (M. Gautel and D. Goulding, 1996, FEBS Lett. 385, 11-14; W. Linke et al., 1996, J. Mol. Biol. 261, 62-71; K. Trombitás et al., 1998). Previously we observed that the anti-titin antibody 9D10 labels a region in the I-band that increases in width as sarcomeres are stretched. Here we tested whether 9D10 labels the PEVK segment. The 9D10-labeled region of human soleus fibers was followed by immunoelectron microscopy as sarcomeres were stretched. It was found that 9D10 labeled a region in the I-band that was approximately 100 nm wide at a sarcomere length of 2.4 micrometer and approximately 550 nm wide at a sarcomere length of 4.0 micrometer. Results were compared with those obtained with sequence-specific antibodies that were used to mark the boundaries of the PEVK segment. Findings indicate that 9D10 labels the PEVK segment from close to its N-terminal end to its C-terminal end. Consistent with this conclusion are the results on cardiac myocytes that express a much shorter PEVK segment than skeletal muscle and where 9D10 labels a region that is much less wide than in skeletal muscle. The anti-titin antibody 9D10 is a useful tool for investigating the extensible behavior of the PEVK segment in both skeletal and cardiac muscles.

Animals↗

Titin elasticity and mechanism of passive force development in rat cardiac myocytes probed by thin-filament extraction.

Titin (also known as connectin) is a giant filamentous protein whose elastic properties greatly contribute to the passive force in muscle. In the sarcomere, the elastic I-band segment of titin may interact with the thin filaments, possibly affecting the molecule's elastic behavior. Indeed, several studies have indicated that interactions between titin and actin occur in vitro and may occur in the sarcomere as well. To explore the properties of titin alone, one must first eliminate the modulating effect of the thin filaments by selectively removing them. In the present work, thin filaments were selectively removed from the cardiac myocyte by using a gelsolin fragment. Partial extraction left behind approximately 100-nm-long thin filaments protruding from the Z-line, whereas the rest of the I-band became devoid of thin filaments, exposing titin. By applying a much more extensive gelsolin treatment, we also removed the remaining short thin filaments near the Z-line. After extraction, the extensibility of titin was studied by using immunoelectron microscopy, and the passive force-sarcomere length relation was determined by using mechanical techniques. Titin's regional extensibility was not detectably affected by partial thin-filament extraction. Passive force, on the other hand, was reduced at sarcomere lengths longer than approximately 2.1 microm, with a 33 +/- 9% reduction at 2.6 microm. After a complete extraction, the slack sarcomere length was reduced to approximately 1.7 microm. The segment of titin near the Z-line, which is otherwise inextensible, collapsed toward the Z-line in sarcomeres shorter than approximately 2.0 microm, but it was extended in sarcomeres longer than approximately 2.3 microm. Passive force became elevated at sarcomere lengths between approximately 1.7 and approximately 2.1 microm, but was reduced at sarcomere lengths of >2.3 microm. These changes can be accounted for by modeling titin as two wormlike chains in series, one of which increases its contour length by recruitment of the titin segment near the Z-line into the elastic pool.

Amino Acid Sequence↗

Interaction between titin and thin filaments in intact cardiac muscle.

A 'freeze break' technique and immunoelectron microscopy were used to study the elastic properties of cardiac titin filaments. Small bundles consisting of a few fibres from freshly prepared dog papillary muscle were quickly frozen and broken under liquid nitrogen to fracture sarcomeres in planes perpendicular to the filament axes. Breaks occurred at each of several regions along the sarcomeres. The still-frozen specimens were thawed during fixation to allow elastic filaments to retract. The broken muscle segments were then treated with monoclonal titin antibody 9D10 which labelled a unique epitope in the I-band. In sarcomeres broken at the A-I junction, the titin filaments reacted toward the Z-line, independently of the thin filaments. The retracted epitopes did not reach the Z-line; retraction stopped at the N1-line level. In sarcomeres broken near the Z-line, the titin filaments retracted in the opposite direction, to the tip of the thick filaments. When the break occurred in the A-band, by contrast, the titin-epitope position was unaffected. On the basis of these results, and despite the reported interaction of titin and actin in vitro, it appears that cardiac titin molecules form elastic filaments that are functionally independent of the thin filaments. Near the Z-line, however, the titin filaments seem to associate firmly with the thin filaments.

Actins↗

Valproate treatment induces lipid globule accumulation with ultrastructural abnormalities of mitochondria in skeletal muscle.

In skeletal muscle of seven children treated with valproic acid (VPA) microvesicular (0.05-2 microns) lipid droplets were observed between the myofibrils predominantly adjacent to the mitochondria. Most of the mitochondria showed ultrastructural abnormalities: several mitochondria were deformed and in several mitochondria abnormal configuration of cristae was observed. The size of some organelles reached the 10-20 microns length with normal diameter. The elongated mitochondria were located either in the long axis of the fibers or in the transverse direction near to the Z discs. In rats receiving valproic acid intraperitoneally for 14 days in daily dose of 100 mg/kg, steatosis developed in the liver, and focal lipid droplets could also be found in the skeletal muscle. The mitochondria of the rat liver appeared as normal, but in muscle the structure and organization of the cristae were disoriented. These observations show that treatment with valproate causes a kind of drug-induced mitochondrial cytopathy with microvesicular lipid deposition in the muscle. The lipid deposits are likely a result of the inhibited mitochondrial fatty acid oxidation. The formation of the abnormal mitochondrial structure could serve as background for the visible consequences of affected lipid metabolism.

Animals↗

Actin removal from cardiac myocytes shows that near Z line titin attaches to actin while under tension.

The I band of cardiac sarcomeres contains both actin and titin/connectin filaments. Earlier work has suggested that titin binds to actin in situ. This interaction must be weak in the region of the I band where titin behaves elastically. On the other hand, titin may bind strongly to actin in the approximately 100-nm-wide region adjoining the Z line, where titin has been found to be inelastic. To study the putative interaction between titin and actin, techniques for selective removal of actin from different regions of the I band are needed. Here we report studies with a gelsolin fragment (FX-45) and extract actin from rat cardiac myocytes. Actin extraction was biphasic: the majority of actin was extracted in approximately 10 min, whereas actin near the Z line (where titin is inelastic) required a approximately 10-fold longer extraction time. Thus, by controlling the extraction time, we could remove either the full actin filament outside the Z line or just the segment of the actin filament that extends beyond the inelastic region of titin that adjoins the Z line. The actin filament-free I band contained titin filaments, typically with one filament extending from each thick filament. In addition, we observed a dark transverse line (junction line), the location of which in the sarcomere varied linearly with sarcomere length. The position in the sarcomere of the junction line coincided with the binding site of the anti-titin antibody 9D10. Actin removal significantly affected the slack sarcomere length. Slack sarcomere length was 1.85 +/- 0.04 microns in control cells and decreased to 1.71 +/- 0.05 microns after actin near the Z line was extracted. This length reduction may be caused by contraction of the titin segment that becomes exposed after actin removal near the Z line, indicating that titin is not only attached to the actin filament but is also under tension.

Actins↗

Nonuniform elasticity of titin in cardiac myocytes: a study using immunoelectron microscopy and cellular mechanics.

Titin (also known as connectin) is a muscle-specific giant protein found inside the sarcomere, spanning from the Z-line to the M-line. The I-band segment of titin is considered to function as a molecular spring that develops tension when sarcomeres are stretched (passive tension). Recent studies on skeletal muscle indicate that it is not the entire I-band segment of titin that behaves as a spring; some sections are inelastic and do not take part in the development of passive tension. To better understand the mechanism of passive tension development in the heart, where passive tension plays an essential role in the pumping function, we investigated titin's elastic segment in cardiac myocytes using structural and mechanical techniques. Single cardiac myocytes were stretched by various amounts and then immunolabeled and processed for electron microscopy in the stretched state. Monoclonal antibodies that recognize different titin epitopes were used, and the locations of the titin epitopes in the sarcomere were studied as a function of sarcomere length. We found that only a small region of the I-band segment of titin is elastic; its contour length is estimated at approximately 75 nm, which is only approximately 40% of the total I-band segment of titin. Passive tension measurements indicated that the fundamental determinant of how much passive tension the heart develops is the strain of titin's elastic segment. Furthermore, we found evidence that in sarcomeres that are slack (length, approximately 1.85 microns) the elastic titin segment is highly folded on top of itself. Based on the data, we propose a two-stage mechanism of passive tension development in the heart, in which, between sarcomere lengths of approximately 1.85 microns and approximately 2.0 microns, titin's elastic segment straightens and, at lengths longer than approximately 2.0 microns, the molecular domains that make up titin's elastic segment unravel. Sarcomere shortening to lengths below slack (approximately 1.85 microns) also results in straightening of the elastic titin segment, giving rise to a force that opposes shortening and that tends to bring sarcomeres back to their slack length.

Animals↗

Titin develops restoring force in rat cardiac myocytes.

When relaxed after contraction, isolated cardiac myocytes quickly relengthen back to their slack length. The molecular basis of the force that underlies passive relengthening, known as restoring force, is not well understood. In a previous study of titin's elasticity in cardiac myocytes, we proposed that titin/connectin develops restoring force, in addition to passive force. This study tested whether titin indeed contributes to the restoring force in cardiac myocytes. Skinned rat cardiac myocytes in suspension were shortened by approximately 20%, using Ca(2+)-independent shortening, followed by relaxation. Cells were observed to relengthen until they reached their original slack sarcomere length. However, the ability to relengthen was abolished after cells had been treated for 12 minutes with trypsin (0.25 microgram/mL, 20 degrees C). Gel electrophoresis showed that this treatment had degraded titin without clearly affecting other proteins, and immunoelectron microscopy revealed that the elastic segment of titin in the I band was missing from the sarcomere. Restoring force was also directly measured, before and after trypsin treatment. Restoring force of control cells was -61 +/- 20 micrograms (per cell) at a sarcomere length of 1.70 microns. Comparison of our results with those of activated trabeculae indicated that a large fraction of restoring force of cardiac muscle originates from within the myocyte. Restoring force of myocytes was found to be depressed after titin had been degraded with trypsin. We conclude that cardiac, titin indeed develops restoring force in shortened cardiac myocytes, in addition to passive force in stretched cells, and that titin functions as a bidirectional spring. Our work suggests that at the level of the whole heart, part of the actomyosin-based active force that is developed during systole is harnessed by titin, allowing for elastic diastolic recoil and aiding in ventricular filling.

Animals↗

[Mitochondrial DNA deletion in hereditary cardio-encephalo-myopathy].

The case of a female patient with cardio-encephalo-myopathy who died of her illness at one year of age, similarly to her three sisters, is reported. In autopsy samples, like muscle, heart, liver and cerebellum activities of several mitochondrial enzymes were determined. In the skeletal muscle serious decrease of carnitine acetyltransferase was observed (from the normal 4.8 U/g to 0.08 U/g wet weight), while in other tissues this activity was normal. In the muscle activities of several other mitochondrial enzymes were also decreased (cytochrome oxidase, NADH cytochrome C oxidoreductase, citrate synthase), while in other tissues there were no similar changes. Serious distortion was observed in the structure of the majority of mitochondria of muscle and heart by electronmicroscopy. The number of the Purkinje-cells in the cerebellum decreased, and the cells were shrunken, their axons were fragmented and disoriented. Also the structure of the mitochondria was abnormal in the Purkinje-cells, while it was normal in other areas of the cerebrum. In te tissues of the patient normal and deleted mitochondrial DNA coexisted as which could explain the genetic background of this disease at molecular level.

Autopsy↗