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PubMed2004

Sarco(endo)plasmic reticulum Ca2+ ATPase (SERCA) gene silencing and remodeling of the Ca2+ signaling mechanism in cardiac myocytes.

Transient elevations of cytosolic Ca2+ are a common mechanism of cellular signaling. In striated muscle, the sarco(endo)plasmic reticulum Ca2+ ATPase (SERCA) plays an important role in terminating Ca2+ transients by returning cytosolic Ca2+ to intracellular stores. Stored Ca2+ can then be released again for subsequent signaling. We down-regulated SERCA2 gene expression in cultured cardiac myocytes by means of endogenous transcription of small interfering RNA encoded by an exogenous cDNA template. The cDNA template was delivered by adenovirus vector. Reduction of SERCA expression in all myocytes in culture was documented by immunochemistry, real-time RT-PCR, and determination of ATP-dependent Ca2+ transport. The reduction of SERCA2 expression was associated with the up-regulation of transient receptor potential (TRP) channel proteins (TRPC4 and TRPC5) and Na+/Ca2+ exchanger, indicating that intracellular store deficiency was compensated for by Ca2+ fluxes through the plasma membrane. In fact, SERCA silencing was followed by increased transcription of Na+/Ca2+ exchanger, TRPC4, TRPC5, and related transcriptional factors, such as stimulating protein 1, myocyte enhancer factor 2, and nuclear factor of activated cells 4, through activation of calcineurin. This finding demonstrates that the observed compensation occurs through transcriptional crosstalk and the remodeling of Ca2+ signaling pathways. The wide significance of this regulatory mechanism is related to its general involvement in Ca2+ signaling dynamics and in cardiac development and hypertrophy.

Animals↗
PubMed1995

Diabetes and ATP-sensitive potassium channel openers and blockers in isolated ischemic/reperfused hearts.

The incidence of reperfusion ventricular fibrillation (VF) and tachycardia (VT), heart function and the maldistribution of cardiac cations were studied in isolated ischemic/reperfused hearts obtained from streptozotocin-induced diabetic rats. Effects of an ATP-sensitive potassium (KATP) channel opener, cromakalim, and a KATP channel blocker, glibenclamide, also were studied. After 2 and 8 weeks of diabetes, hearts were isolated and subjected to 30 min of ischemia followed by reperfusion. After 2 weeks of diabetes, the incidence of VF and VT was reduced from their nondiabetic control values of 100 and 100 to 42% (P < .05) and 50% (P < .05), respectively. The reduction in VF and VT was not observed with progressive diabetes and after 8 weeks cardiac failure developed. In the 8-week diabetics, the development of cardiac failure was reflected in the aggravation of heart function (26, 16 and 17% reductions in aortic flow, left ventricular developed pressure and first derivative of developed pressure, respectively), and ion shifts (56 and 71% accumulation in cellular Na+ and Ca++, respectively, and 15% loss in cell K+) before the induction of ischemia. After ischemia/reperfusion, these changes were pronounced in diabetic groups. Cromakalim aggravated and glibenclamide attenuated the incidence of arrhythmias, contractile function and ion shifts induced by ischemia/reperfusion in diabetic hearts. The data show that the use of KATP channel openers as anti-ischemic agents may be of particular concern in the population of postinfarction diabetic patients who are known to be at high risk of sudden coronary death.

Adenosine Triphosphate↗
PubMed2000

Development of a combined cardiac and aortic transplant model to investigate the development of transplant arteriosclerosis in the mouse.

BACKGROUND: The degree of transplant arteriosclerosis in murine cardiac allografts is difficult to assess. Aortic allografts represent an alternative model for evaluating the impact of novel transplant strategies on transplant arteriosclerosis in which the vascular changes can be quantified easily. However, it remains controversial as to whether vascular lesions seen in this model are equivalent to those that develop in solid-organ transplants. The aim of this study was to develop a model of combined cardiac and aortic transplantation to allow more precise quantification of transplant arteriosclerosis and to establish a correlation between the lesions that develop in the 2 types of graft. METHODS: CBA (H2(k)) recipients received a C57BL/10 (H2(b)) cervical cardiac allograft on Day 0 and a C57BL/10 (H2(b)) abdominal aortic allograft on Day 1. Recipients were treated with anti-CD154 mAb (MR1) on Days 0, 2, and 4. We performed histology and morphometric measurements for both grafts 30 days after transplantation. RESULTS: We observed significant intimal proliferation in both the cervical cardiac and abdominal aortic allografts from recipients treated with anti-CD154 mAb (heart, 64% +/- 9%; aorta, 67% +/- 8%; n = 5). Abdominal aortic grafts transplanted alone into anti-CD154-treated recipients developed a degree of transplant arteriosclerosis equivalent to that seen in the aortic grafts of the combined group (aorta alone, 68% +/- 9%, vs aorta + heart, 67% +/- 8%; n = 5). CONCLUSIONS: This combined cardiac and aortic transplant model permitted quantitative assessment of transplant arteriosclerosis while monitoring graft survival by cardiac palpation. Furthermore, development of transplant arteriosclerosis was equivalent in abdominal aortic allografts either in the presence or absence of an additional solid- organ transplant.

Animals↗
PubMed1999

Molecular cloning of FOG-2: a modulator of transcription factor GATA-4 in cardiomyocytes.

GATA transcription factors are important regulators of both hematopoiesis (GATA-1/2/3) and cardiogenesis (GATA-4) in mammals. The transcriptional activities of the GATA proteins are modulated by their interactions with other transcription factors and with transcriptional coactivators and repressors. Recently, two related zinc finger proteins, U-shaped (USH) and Friend of GATA-1 (FOG) have been reported to interact with the GATA proteins Pannier and GATA-1, respectively, and to modulate their transcriptional activities in vitro and in vivo. In this report, we describe the molecular cloning and characterization of a third FOG-related protein, FOG-2. FOG-2 is an 1,151 amino acid nuclear protein that contains eight zinc finger motifs that are structurally related to those of both FOG and USH. FOG-2 is first expressed in the mouse embryonic heart and septum transversum at embryonic day 8.5 and is subsequently expressed in the developing neuroepithelium and urogenital ridge. In the adult, FOG-2 is expressed predominately in the heart, brain, and testis. FOG-2 associates physically with the N-terminal zinc finger of GATA-4 both in vitro and in vivo. This interaction appears to modulate specifically the transcriptional activity of GATA-4 because overexpression of FOG-2 in both NIH 3T3 cells and primary rat cardiomyocytes represses GATA-4-dependent transcription from multiple cardiac-restricted promoters. Taken together, these results implicate FOG-2 as a novel modulator of GATA-4 function during cardiac development and suggest a paradigm in which tissue-specific interactions between different FOG and GATA proteins regulate the differentiation of distinct mesodermal cell lineages.

Amino Acid Sequence↗
PubMed1992

Alterations of G protein function in cardiac tissues from streptozotocin-induced chronic diabetic rats.

1. This study was performed to investigate G protein function in cardiac tissues from chronic diabetic rats by using pertussis toxin (PTX) and cholera toxin (CTX) as probes for G(i) and Gs proteins, respectively. 2. In the 10-week control group, i.v. injection of PTX significantly elevated the basal heart rate without having any effect on the chronotropic response of right atria to increasing concentrations of isoproterenol (ISO). In the 10-week diabetic rats, PTX treatment had no effect on the basal heart rate or on the response of right atria to ISO. In the 6-month groups, PTX did not exert any effects on basal or ISO-stimulated heart rate in either control or diabetic rat. 3. The inhibitory effect of carbachol (CCH) on cardiac tension in ISO-stimulated left atria was completely abolished by i.v. injection of PTX in the 10-week groups (both control and diabetic rats). The same treatment, however, only slightly reduced the effect of CCH on left atria contraction in rats from 6-month groups. 4. In both control and diabetic rats in the 10-week groups, incubation with CTX caused a significant increase in heart rate in right atria, and in developed cardiac tension in left atria preparations. The magnitude of the increase was the same in both control and diabetic rats. 5. Studies carried out using ADP-ribosylation technique indicated that the amount of G(i) protein was not changed in the ventricular muscle of the 10-week diabetic rat. Labelling of Gs protein could not be detected in either control or diabetic rat heart.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Diphosphate Ribose↗
PubMed2003

[Retrospective analysis of the patients with penetrating cardiac trauma].

BACKGROUND: Penetrating cardiac stab wounds are among rarely seen traumas, associated with high mortality. We aimed to present and investigate our experience in such cases. METHODS: Eighteen cases with penetrating cardiac stab wounds, between 1993-2001, were investigated retrospectively. Gender, age, conditions at application, injured areas, extent of cardiac damage, accompanying organ damages and outcomes of these patients were studied. RESULTS: All patients were male with a mean age of 25.38 years (between 16-42 years). Heart was the only affected organ in nine 9 patients, whereas there were additional organ injuries in the remaining patients. The injuries were at left ventricle in 11, right ventricle in 4 and right atrium in three patients. Only two patients survived among 14 patients who developed cardiac arrest. There was additional organ damage in three of the six survivors. CONCLUSION: The overall mortality was 66%. Suspect of cardiac injury should be considered in patients who are injured close around cardiac area and one should intervene quickly both in diagnosis and treatment.

Adolescent↗
PubMed2003

Management of Chronic Aortic Regurgitation.

Aortic regurgitation may be the most treacherous of the valvular lesions due to subtlety of symptoms and physical findings and due to difficulty in timing surgical intervention to prevent permanent cardiac dysfunction. Cardiac imaging (eg, echocardiography or magnetic resonance) is critical to quantify the degree of regurgitation and to detect significant left ventricular dysfunction or dilation. Stress testing can be useful in timing surgical intervention in borderline cases. Medical therapy consists of afterload reduction, diuresis, and inotrope administration. Surgical therapy today consists of aortic valve repair in a minority of cases or aortic valve replacement in the remainder. Percutaneous means to replace the aortic valve are in development. Cardiac decompensation may require cardiac transplantation.

Journal Article↗
PubMed1994

Endomyocardial biopsy--technical aspects experience and current status. An Indian perspective.

Our study ellucidates the utility of endomyocardial biopsy (EMB) in various cardiac-muscle disorders seen in a tropical country like India. The procedure has been successfully performed in 501 patients (572 procedures) at our centre from April 1985 to December 1992. This included 60 infants and children. The indications were dilated cardiomyopathy (DCM) in 214, non-specific aortoarteritis in 91, rheumatic heart disease in 75, restrictive cardiomyopathy in 45, constrictive pericarditis in 14 and miscellaneous in 62 patients. There was no mortality, however, one patient developed cardiac tamponade and another sustained ventricular tachycardia requiring cardioversion. There was transient atrial fibrillation in six patients and all these had acute rheumatic heart disease. Transient complete heart block occurred in six patients with underlying left-bundle branch-block. Histological examination of EMB revealed myocarditis in 34/214 (15.4%) patients in DCM group and helped in following up these cases on immunosuppressive treatment. In the presence of restrictive haemodynamics it could identify amyloidosis in four patients. It was also helpful in differentiating between endomyocardial fibrosis and chronic constrictive pericarditis. In patients with non-specific aorto-arteritis significant histological changes of inflammatory myocarditis were observed in patients especially in congestive heart failure. Furthermore, it was helpful in identifying the nature of cardiac tumour in one patient. Its utility has also been evaluated in disorders, including rheumatic heart disease, peripartum cardiomyopathy and systemic disorders like systemic lupus erythematosis. Even in the absence of cardiac-transplant programmes at national level we have found EMB to be a useful investigation in a tropical country like India.

Adolescent↗
PubMed1999

A comparison of troponin T and troponin I as predictors of cardiac events in patients undergoing chronic dialysis at a Veteran's Hospital: a pilot study.

OBJECTIVE: The purpose of this study was to prospectively evaluate the usefulness of the cardiac troponins as predictors of subsequent cardiac events in patients with chronic renal failure undergoing dialysis. BACKGROUND: Cardiac troponin T (cTnT) and I (cTnI) are cardiac markers that are specific for cardiac muscle. They are also excellent prognostic indicators for patients presenting with chest pain. Although cardiac disease is the leading cause of death in dialysis patients, standard methods to diagnose acute coronary syndromes in patients with renal failure are often misleading. METHODS: A six-month prospective study was done in a university-affiliated Veterans Hospital's dialysis clinic. Forty-nine patients undergoing chronic dialysis with no complaints of chest pain were followed for cardiac events occurring in the six months after cardiac troponin measurements. These included unstable angina, acute myocardial infarction and cardiac death. An additional 83 patients with renal failure but who were not undergoing dialysis were also examined. RESULTS: Within six months all three dialysis patients with elevated cTnI at entry into the study suffered an adverse complication (specificity and positive predictive value = 100%). Twenty-five patients had cTnT elevated at >0.10 ng/ml (53%). Patients with diabetes were more likely to have elevated troponin T levels (64% vs. 25%, p = 0.01). All six patients developing cardiac events within three months had elevations of cTnT >0.1 ng/ml (sensitivity = 100%). Whereas the specificity of cTnT was only 56% for a near-term cardiac event, the negative predictive value of cTnT using a cutoff of < or = 0.1 ng/ml was 100%. On restratifying patients using a cutoff value of cTnT of >0.2 ng/ml, only nine of 49 dialysis patients (18%) had elevated levels. In patients with renal failure not undergoing dialysis, only three of 83 (4%) had elevated troponin I or T. None of these patients suffered a cardiac event in the next six months. CONCLUSIONS: This prospective pilot study clearly delineates the troponins as important prognosticators in asymptomatic otherwise "stable" patients on chronic dialysis, especially those with concomitant diabetes mellitus. It also appears that troponins are more likely to be elevated in dialysis patients than other patients with renal failure not on dialysis. The above suggests that the combination of cTnI and cTnT might be very effective in elucidating cardiac risks of patients with renal failure undergoing chronic dialysis.

Angina, Unstable↗
PubMed1983

[Cardiac hydatidosis].

Cardiac localizations in hydatid disease are uncommon and often latent. A mass at the apex of the heart was discovered in a 42-year-old patient who presented with abnormal EKG repolarization. This mass was anechoic. Coronography demonstrated an avascular lesion with displaced coronary arteries. A hydatid cyst was suspected. No other visceral localizations of hydatid disease were detected. The patient refused surgery and was seen two years later with acute pericarditis and rapidly developing cardiac tamponade. A very large amount of pericardial fluid and a single hydatid cyst were discovered upon surgery. The cyst was aspirated and sterilized and the protruding cyst wall was resected. A severe postpericardotomy syndrome and positivation of hydatid disease serological tests occurred during the postoperative course. The patient was then given flubendazole. Prompt recovery occurred and the patient is still doing well under therapy two years later. In hydatid disease, an isolated cardiac localization is uncommon and often latent and may be revealed by complications. Prompt diagnosis should be made by echocardiography.

Adult↗
PubMed2000

CaM kinase signaling induces cardiac hypertrophy and activates the MEF2 transcription factor in vivo.

Hypertrophic growth is an adaptive response of the heart to diverse pathological stimuli and is characterized by cardiomyocyte enlargement, sarcomere assembly, and activation of a fetal program of cardiac gene expression. A variety of Ca(2+)-dependent signal transduction pathways have been implicated in cardiac hypertrophy, but whether these pathways are independent or interdependent and whether there is specificity among them are unclear. Previously, we showed that activation of the Ca(2+)/calmodulin-dependent protein phosphatase calcineurin or its target transcription factor NFAT3 was sufficient to evoke myocardial hypertrophy in vivo. Here, we show that activated Ca(2+)/calmodulin-dependent protein kinases-I and -IV (CaMKI and CaMKIV) also induce hypertrophic responses in cardiomyocytes in vitro and that CaMKIV overexpressing mice develop cardiac hypertrophy with increased left ventricular end-diastolic diameter and decreased fractional shortening. Crossing this transgenic line with mice expressing a constitutively activated form of NFAT3 revealed synergy between these signaling pathways. We further show that CaMKIV activates the transcription factor MEF2 through a posttranslational mechanism in the hypertrophic heart in vivo. Activated calcineurin is a less efficient activator of MEF2-dependent transcription, suggesting that the calcineurin/NFAT and CaMK/MEF2 pathways act in parallel. These findings identify MEF2 as a downstream target for CaMK signaling in the hypertrophic heart and suggest that the CaMK and calcineurin pathways preferentially target different transcription factors to induce cardiac hypertrophy.

Animals↗
PubMed1982

Rat cardiac muscarinic receptors. II. Influence of thyroid status and cardiac hypertrophy.

The effects of the thyroid state and of aortic stenosis on muscarinic cholinergic binding sites in heart membranes were compared (with proper controls) by simultaneously determining total and high-affinity binding sites and estimating low-affinity binding sites by difference. Hyper- and hypothyroidism induced decreased and increased concentration of high-affinity agonist binding sites, respectively, supporting the hypothesis that these sites were directly regulated by thyroid hormones. This was not the case for low-affinity binding sites, as they decreased in number in both hyper- and hypothyroidism. In hyperthyroid rats, this decreased number of low-affinity binding sites could be due to the rapidly developing cardiac hypertrophy. Indeed, cardiac hypertrophy provoked by aortic stenosis led also to a decreased concentration of low-affinity binding sites without affecting the concentration of high-affinity binding sites.

Animals↗
PubMed1983

Cardiac involvement in juvenile rheumatoid arthritis. A follow-up study.

Cardiac involvement was diagnosed in 15 of 320 cases of JRA (4.7%) and was most frequent in children with active systemic disease. Ten children had pericarditis, 2 had myocarditis, 2 had peri-myocarditis and 1 had aortic valvulitis. The highest risk of heart involvement was found during the first three years but it could occur at any time. Recurrent episodes were seen in 60% of cases. The prognosis in pericarditis seems to be good since no patient developed cardiac tamponade or constrictive pericarditis and cardiac function evaluated by echocardiography was normal in all patients at follow-up. In patients with myocarditis and peri-myocarditis, a dilated left ventricle was found in 2 of 4 patients and 1 patient who died, had severe cardiac changes at autopsy. The prognosis in myocarditis thus seems to be worse. In valvulitis the prognosis depends on which valve is involved. The benefit of early treatment with corticosteroids is discussed.

Adolescent↗
PubMed1999

Right intraventricular metastasis of squamous cell carcinoma of the uterine cervix: an autopsy case and literature review.

An autopsy case of squamous cell carcinoma of the uterine cervix, which developed cardiac intracavitary metastasis in a 28-year-old Filipina, is reported. At autopsy, the right ventricle contained a soft, red-purple, cauliflower-like mass. Histologically, this mass was made up of sheets of malignant squamous cells similar to the primary uterine foci. The metastases were extensive and associated with multiple organ involvement. Although this case was stage Ib at operation, vascular invasion at the primary site was characteristic, and the intracavitary tumor of the right ventricle developed without myocardial involvement. The carcinoma of the primary site extended along the inferior vena cava and settled as an intracardiac obstructive mass. A literature review (including the present case) disclosed only 14 uterine cervical carcinomas with right intracavitary metastasis. The mean age of these patients was 46 years of age (range, 28-77 years). The clinical stage was Ib in two cases, IIa in one case, IIb in six cases, and IIIb in two cases. The prognosis of these cases was poor; 13 of the patients died at an average of 19.1 months after diagnosis.

Adult↗
PubMed1990

Spontaneous alterations in left ventricular regional wall motion after acute myocardial infarction.

For assessing the relationship between the left ventricular (LV) wall motion abnormalities and the status of residual flow to the infarcted region, the extent of coronary artery disease and one-year outcome, 60 patients with a first transmural, Q-wave myocardial infarction (MI) underwent serial echocardiographic examinations. The abnormal wall motion (AWM) score was calculated, and the cardiac events (death, reinfarction, severe ventricular arrhythmia or congestive heart failure) after discharge were recorded. The AWM score of the infarcted area was higher in patients with total occlusion than in those with subtotal occlusion (anterior MI: 14.6 +/- 2.4 vs 7.2 +/- 2.1; inferior MI: 9.7 +/- 2.1 vs 5.1 +/-1.2, all P less than 0.01). Regional wall motion of the noninfarcted area was preserved in patients with single vessel disease but decreased in those with multivessel disease. In patients who developed cardiac events in follow-up period a higher AWM (16.4 +/- 3.7) was found than in those who did not (8.9 +/- 3.1, P less than 0.05). A score of greater than 13 had a strong prediction of cardiac events after acute MI, with a sensitivity of 81%, specificity of 94% and positive predictive accuracy of 88%.

Echocardiography↗
PubMed1999

The ins and outs of caveolar signaling. m2 muscarinic cholinergic receptors and eNOS activation versus neuregulin and ErbB4 signaling in cardiac myocytes.

Endothelial cells constitutively express the NOS isoform eNOS, which generates NO in response to specific extracellular signals to regulate vascular smooth muscle tone, vascular permeability, and platelet adhesion, among other actions. In addition to coronary vascular and endocardial endothelium, both atrial and ventricular myocytes express eNOS, the activation of which is also dependent on specific intracellular and extracellular signals. eNOS is targeted in cardiac myocytes to caveolae in plasma membranes and, in the case of cardiac myocytes, possibly T-tubular membranes as well. eNOS targeting to caveolae in cardiac myocytes requires co-translational myristoylation and subsequent palmitoylation for efficient targeting of the enzyme to the specialized lipid microdomains characteristic of caveolae. Although eNOS also contains a caveolin binding motif, this is insufficient for correct targeting of eNOS to caveolae. Recent evidence obtained from ventricular myocytes of mice with targeted disruption of the eNOS gene indicates that the lack of functional eNOS interrupts muscarinic cholinergic control of ICa-L in these cells. eNOS-/- mice are hypertensive and develop cardiac hypertrophy as they age, and these animals also exhibit an accelerated degree of vascular remodeling in response to injury. Reconstitution experiments confirm both the essential role of eNOS in coupling m2 AchR signaling to the control of ICa-L and myocyte automaticity and the importance of eNOS subcellular localization within caveolae in mediating this signal transduction pathway. It appears that translocation into caveolae is essential for signaling. However, this is not the case with all receptors associated with caveolae.

Animals↗
PubMed1993

[A case of Behçet's disease associated with ascending aortitis and aortic regurgitations--surgical repair with Cabrol's method].

This is the case report of a 52 years old female patient operated with Cabrol's method for the inflammatory lesion of the aortic root in Behçet's disease. The diagnosis of incomplete type of Behçet's disease had already been established 4 years ago and the patient had been taking regular check-up since then. About one year ago, newly developed cardiac murmur compatible with aortic regurgitation was detected and the patient was subsequently referred to us for the surgical repair. Although aortic valve replacement (AVR) was attempted first, Cabrol's method was lastly chosen, since inflammatory features on the surface of the ascending aorta associated with slight aortic annular dilatation were observed during the procedure and it was easily anticipated that these might induce postoperative paravalvular leakage and pseudoaneurysm, if AVR were performed. Two weeks after the surgery, the patient developed aphthous stomatitis associated with several other evidences of inflammatory recurrence, the steroid therapy was instituted with prednisolone. Post operative progress was uneventful and the patient has been completely well at the 6th month after the surgery. In conclusion, it is strongly recommended the Cabrol's method should be chosen to prevent post operative unfavourable complications, whenever any evidence of inflammation is observed around the aortic root area.

Aorta, Thoracic↗
PubMed1992

Inhibin alpha- and beta A-subunit immunoreactivity in the chicken embryo during morphogenesis.

Antibodies against synthetic peptides selected from the amino acid sequences of human inhibin alpha- and beta A-subunits were used to examine the distribution of inhibin subunit immunoreactivity in chicken embryos during the first week of development. Inhibin alpha-subunit immunoreactivity was localized in skeletal and smooth muscle myoblasts as well as developing cardiac muscle cells. In somites, immunostaining was seen exclusively in myotomes. The appearance of alpha-subunit immunoreactivity was correlated with myogenic differentiation; immunoreactivity was not seen in non-differentiated mesenchymal cells or in terminally differentiated adult muscle cells. In cardiac muscle, some immunopositive myocytes were seen also in the adult. In the adult heart, the Purkinje fibers were strongly immunoreactive, suggesting a possible role of the immunoreactive protein in the impulse-conducting function of these specialized cells. Inhibin alpha-subunit immunoreactivity was also seen in the visceral and parietal cells of the Bowman's capsule in both mesonephric and metanephric kidneys. In addition to mesodermal derivatives, alpha-subunit immunoreactivity was localized in neuroepithelial cells and axons in the developing central nervous system. Immunoblotting with anti-alpha(1-32) revealed two protein bands with M(r) values of 50,000 and 32,000 in cytosol samples of whole embryos under nonreducing conditions. In reduced samples an approximately 14,000 M(r) protein species was detected. Inhibin beta A-subunit immunoreactivity was detected only in chondrocytes, suggesting that the immunoreactive protein might represent a chicken homologue of the various cartilage and bone morphogenetic proteins expressed in mammals.

Animals↗