Allergic rhinitis is an inflammatory disease characterized by nasal wall remodeling with intense infiltration of eosinophils and mast cells/basophils. Matrix metalloproteinases (MMPs), MMP-2 and MMP-9, are the major proteolytic enzymes that induce airway remodeling. These enzymes are also important in the migration of inflammatory cells through basement membrane components. We evaluated whether tranilast (TR) could inhibit MMP production from nasal fibroblasts in response to tumor necrosis factor-alpha (TNF-alpha) stimulation in vitro. Nasal fibroblasts (NF) were established from nasal polyp tissues taken from patients with allergic rhinitis. NF (2 x 10(5) cells/mL) were stimulated with TNF-alpha in the presence of various concentrations of TR. After 24 hours, the culture supernatants were obtained and assayed for MMP-2, MMP-9, TIMP-1, and TIMP-2 levels by ELISA. The influence of TR on mRNA expression of MMPs and TIMPs in cells cultured for 12 hours was also evaluated by RT-PCR. TR at more than 5 x 10(-5) M inhibited the production of MMP-2 and MMP-9 from NF in response to TNF-alpha stimulation, whereas TIMP-1 and TIMP-2 production was scarcely affected. TR also inhibited MMP mRNA expression in NF after TNF-alpha stimulation. The present data suggest that the attenuating effect of TR on MMP-2 and MMP-9 production from NF induced by inflammatory stimulation may underlie the therapeutic mode of action of the agent in patients with allergic diseases, including allergic rhinitis.
Allergic rhinitis is an inflammatory disease characterized by nasal wall remodeling with intense infiltration of eosinophils and mast cells/basophils. Matrix metalloproteinases (MMPs), MMP-2 and MMP-9, are the major proteolytic enzymes that induce airway remodeling. These enzymes are also important in the migration of inflammatory cells through basement membrane components. We evaluated whether tranilast (TR) could inhibit MMP production from nasal fibroblasts in response to tumor necrosis factor-alpha (TNF-alpha) stimulation in vitro. Nasal fibroblasts (NF) were established from nasal polyp tissues taken from patients with allergic rhinitis. NF (2 x 10(5) cells/mL) were stimulated with TNF-alpha in the presence of various concentrations of TR. After 24 hours, the culture supernatants were obtained and assayed for MMP-2, MMP-9, TIMP-1, and TIMP-2 levels by ELISA. The influence of TR on mRNA expression of MMPs and TIMPs in cells cultured for 12 hours was also evaluated by RT-PCR. TR at more than 5 x 10(-5) M inhibited the production of MMP-2 and MMP-9 from NF in response to TNF-alpha stimulation, whereas TIMP-1 and TIMP-2 production was scarcely affected. TR also inhibited MMP mRNA expression in NF after TNF-alpha stimulation. The present data suggest that the attenuating effect of TR on MMP-2 and MMP-9 production from NF induced by inflammatory stimulation may underlie the therapeutic mode of action of the agent in patients with allergic diseases, including allergic rhinitis.
Allergic rhinitis is defined as an inflammatory response in the
nasal mucosa and is characterized by the clinical symptoms of
sneezing, itching,
congestion, rhinorrhea, and nasal blockage, which make breathing
through the nose difficult [1, 2].
Immunohistochemical
studies of nasal tissues on patients with allergic rhinitis show
the accumulation of eosinophils and basophils/mast cells within
the lamina propria and epithelium [3]. Furthermore, nasal
lavage also reveals the presence of numerous eosinophils in
patients with allergic rhinitis [4].Although the mechanisms of circulating inflammatory cell migration
into the inflammatory sites are not fully understood, much
evidence suggests that inflammatory cell adhesion and the
degradation of extracellular matrix (ECM) proteins are essential
processes for the cell recruitment [5]. The degradation of
ECM proteins by inflammatory cells is accomplished, in part, by
the secretion of matrix metalloproteinases (MMPs), like MMP-2 and
MMP-9, that specifically degrade denatured collagen, native type
IV and type V collagens, and elastin [6,
7].
Furthermore,
structural abnormalities such as fibrosis, thickening of the
basement membrane, and sloughed-off epithelium with areas of
epithelial metaplasia have been well described in patients with
allergic rhinitis [8, 9]. These pathological changes are
called tissue remodeling and are caused by MMPs secreted from
epithelial cells and fibroblasts in addition to infiltrating
inflammatory cells [9, 10,
11]. These MMPs are also responsible
for microvascular permeability leading to edema and cell migration
and ECM remodeling at the site of inflammation [7,
10].Several studies have demonstrated that corticosteroids, which are
commonly used in the management of allergic airway diseases
including allergic rhinitis, can decrease the expression and
release of MMPs from airway epithelial cells and fibroblasts in
vivo and in vitro [12, 13,
14]. Fexofenadine hydrochloride, an
H1-antihistamine, has also been reported to inhibit the production
of MMPs from nasal fibroblasts at therapeutic blood levels in
vitro [15]. In addition to this agent, drugs like tranilast
(TR) and disodium cromoglycate, which exert membrane-stabilizing
activities [16], have been used for the treatment and
management of allergic diseases with remarkable success [17].
However, little information on the influence of membrane
stabilizers on MMP production is available [18]. In the
present study, we examined the effect of TR on MMP production in
nasal fibroblasts (NF) in response to inflammatory stimulation in
vitro.
MATERIALS AND METHODS
Chemicals
TR (Kissei Pharmaceutical Co Ltd, Matsumoto, Japan) as a
preservative-free pure powder was dissolved in antibiotics-free
RPMI-1640 medium (Sigma Chemicals, Co Ltd, St Louis, Mo)
supplemented with 10% heat-inactivated fetal calf serum
(RPMI-FCS; Flow Laboratories, North Ride, Australia) at
10−2 M. This solution was sterilized by passing through a
0.22 μm filter and stored at 4°C as a stock
solution. All dilutions used in this study were prepared from this
stock solution. Recombinant TNF-α (preservative free) was
purchased from Chemicon International, Inc (Temecula, Calif) and
diluted with RPMI-FCS to produce a concentration of
50.0 ng/mL.
Induction of fibroblasts
To induce fibroblasts from nasal polyps, five patients (3 female
and 2 male; 36.6 ± 9.4 years of age) with allergic rhinitis
were recruited at the Department of Otolaryngology Showa
University Hospital. All subjects were nonsmokers and had not been
treated with oral antiallergic agents for at least 2 months. Nasal
polyps were obtained during surgical operations from five patients
after obtaining their written informed consent. The study protocol
was approved by the Ethics Committee of Showa University. The
tissues were rinsed several times with RPMI-FCS that contained
500 U penicillin, 500 μg/mL streptomycin, and
5.0 μg/mL amphotericin B and were cut into small pieces
(approximately 1 mm2). Diced specimens were plated at a
density of 10 pieces in 100 mm tissue culture dishes and
covered with a cover slip adhered to the dish with sterile
vaseline. The dishes were then placed in a humidified atmosphere
containing 5% CO2 at 37°C. When a monolayer of
fibroblast-like cells reached confluence, the explanted tissues
were removed. The cells were then trypsinized and replated at a
concentration of 5 × 105 cells/mL into 100 mm tissue
culture dishes in a final volume of 10.0 mL. The medium was
changed every 3 days for 2–3 weeks until confluence was attained.
Subsequently, the cells were split 1:2 at confluence and passaged
[19, 20]. The cells
were characterized with antibodies
against vimentine, cytokeratin, and fibronectin using fluorescent
microscopy (model no IX 70, OLYMPUS Co Ltd, Tokyo, Japan)
[20]. Fibroblast purity of the NF samples was more than
99%. After characterization, aliquots of cells at each passage
were frozen and stored in liquid nitrogen. Since previous
experiments had revealed that the ability of cells to produce
MMP-2, MMP-9, TIMP-1, and TIMP-2 in response to TNF-α stimulation was
similar for 3rd and 8th passages of cells
[15], 7th to 10th passage NF were used for
the following experiments.
Cell culture
Fibroblasts were washed several times with RPMI-FCS, introduced
into each well of 24-well culture plates in triplicate at a
concentration of 2 × 105 cells/mL in a volume of
1.0 mL, and allowed to adhere for 2 hours. After removing
unattached and dead cells by gently washing the wells with
RPMI-FCS, TNF-α and various concentrations of TR were added
to cell cultures simultaneously to give a final volume of
2.0 mL. The cells were then cultured for 24 hours in a
humidified atmosphere with 5% CO2 at 37°C.
After 24 hours, the culture medium was removed and stored at
−40°C until use. To examine mRNA expression, the cells
were cultured in a similar manner for 12 hours and stored at
−80°C until use. In another experiment, cells
were
treated with various concentrations of TR for 2 hours before the
start of TNF-α stimulation; and the cells were cultured in
a similar manner.
Assay for MMP and TIMP
MMP-2, MMP-9, TIMP-1, and TIMP-2 levels in the culture
supernatants were assayed using commercially available human MMP
and TIMP ELISA test kits (Amersham Biosciences, Bucks, UK)
according to the manufacturer's recommendations. The activities of
MMP-2 and MMP-9 in culture supernatants were also examined by
ELISA test kits (Amersham Biosciences) according to the
manufacturer's instructions. The results are expressed as the mean
ng/mL ± standard error of duplicate assays for the five
subjects.
Assay for mRNA expression
mRNA was extracted from NF using μMACS mRNA isolation kits
(Miltenyi Biotec GmbH, Bergisch Gladbach,
Germany), according to the manufacturer's instructions. The
first-strand cDNA synthesis from 1.0 μg mRNA was
performed using the SuperScript Preamplification System for cDNA
synthesis (Gibco BRL, Gaithersburg, Md). The polymerase chain
reaction (PCR) mixture consisted of 1.0 μL of sample
cDNA solution, 3.3 μL of 10 × PCR buffer
(Takara Shuzo Co Ltd, Shiga, Japan), 2.6 μL of dNTP
mixture (Takara Shuzo), 1.0 μL of both sense and
antisense primers, 0.2 μL of Taq DNA polymerase (Takara
Shuzo), and distilled water to produce a final volume of
30 μL. The primers used for RT-PCR were
5′−AGATCTTCTTCTTCAAGGACCGGTT-3′ (sense) and
5′−GGCTGGTCAGTGGCTTGGGGTA-3′ (antisense) for
MMP-2, 5′−CCCACATTTGACGTCCAGAGAAGAA-3′ (sense) and
5′−GTTTTTGATGCTATTGGCTGAGATCCA-3′ (antisense) for
MMP-9, 5′−CTCGCTGGACGTTGGAGGAAAGAA-3′ (sense) and
5′−AGCCCATCTGGTACCTGTGGTTCA-3′ (antisense) for
TIMP-2, and 5′−CGGAACCGCTCATTGCC-3′ and
5′−ACCCACACTGTGCCCATCTA-3′ for β−actin
[13]. The PCR conditions were as follows: 4 minutes at
94°C, followed by 30 cycles of 30 seconds at
94°C, 30 seconds at 58°C, and 30 seconds at
72°C. After cycling, there was a DNA extension period of
4 minutes at 72°C [13].
The primers used for RT-PCR
of TIMP-1 were 5′−CACCCACAGACGGCCTTCTGCAAT-3′
(sense) and 5′−AGTGTAGGTCTTGGTGAAGCC-3′
(antisense) [21]. The PCR conditions were as follows: 4
minutes at 95°C, followed by 35 cycles of 1 minute at
94°C, 1 minute at 56°C, and 1 minutes at
72°C. After cycling, DNA was extended in a similar
manner [21]. Each
PCR product (10 μL) was run on
3% agarose gels, visualized by UV illuminator after SYBR Green
(BioWhittaker Molecular Applications, Rockland, Me) staining, and photographed.
The intensity of the mRNA levels was corrected using the level of
β−actin transcripts measured by a densitometer.
Statistical analysis
The statistical significance of the difference between the control
and experimental data was analyzed using an ANOVA, followed by
Fisher's PLSD test. A P value less than .05 was considered
statistically significant.
RESULTS
Suppressive activity of TR on the production of MMP-2,
MMP-9, TIMP-1, and TIMP-2 from NF
The first set of experiments was designed to determine the
optimum concentration of TNF-α required to obtain the
maximum production of MMPs from NF. NF (2 × 105 cells/mL) were stimulated with various concentrations
of TNF-α for 24 hours. MMP-2 and MMP-9 levels in the
culture supernatants were then assayed by ELISA. As shown in
Figure 1a, the stimulation of NF with TNF-α at more than 10.0 ng/mL (but not 5.0 ng/mL) caused a
significant increase in MMP-2 production. The ability of NF to
produce MMP-9 was also enhanced by the stimulation of cells with
TNF-α. The minimum concentration of TNF-α, causing
a significant production of MMP-9, was 5.0 ng/mL
(Figure 1b). We then examined the influence of TR on
MMP production from NF stimulated with TNF-α. The
addition of TR at less than 2.5 × 10−5 M did not
cause the suppression of MMP-2 production from NF, which was
increased by TNF-α stimulation. When TR was added at
concentrations of 5.0 × 10−5 M or higher, however,
the ability of cells to produce MMP-2 after TNF-α stimulation was significantly suppressed Figure 2a.
We further examined the influence of TR on MMP-9 production from
NF. As shown in (Figure 2b), low doses (0.5 and
2.5 × 10−5 M) of TR did not affect MMP-9 production
from NF stimulated with TNF-α: MMP-9 levels in the
experimental culture supernatants were nearly identical (not
significant) to those in the control supernatants (TNF alone).
However, the addition of TR at concentrations of 5.0 × 10−5 M or higher significantly inhibited MMP-9 production
from NF induced by TNF-α stimulation
(Figure 2b). The data in Figures 2c and
2d also show that TR at more than 5.0 × 10−5 M could significantly suppress the activity of MMP-2
and MMP-9 in culture supernatants. The fourth
experiment was undertaken to examine the
influence of TR on TIMP-1 and TIMP-2 production
from NF. The data in Figure 3 clearly show that
addition of TR to cell
cultures stimulated with TNF-α suppressed the production
of both TIMP-1 and TIMP-2, when the cells were treated with the
agent at 25.0 × 10−5 M. However, lower doses of TR
(less than 10.0 × 10−5 M) could not exert
suppressive effect on TIMP-1 and TIMP-2 production
(Figure 3). We finally examined whether pretreatment
of cells with TR could also suppress the production of MMPs and
TIMPs from NF induced by TNF-α stimulation. As shown in
Figures 4a and 4b,
pre-treatment with TR
could suppress the production of MMP-2 and MMP-9; and the
significant suppression was firstly noted at 5.0 × 10−5 M. The data in Figures 4c and
4d
also show that pre-treatment with TR at more than 5.0 × 10−5 M caused significant suppression of MMP-2 and MMP-9
activities in culture supernatants. However, TR at 5 × 10−5 M could not inhibit TIMP-1 and TIMP-2 production
from NF (Figure 5). The suppressive activity of TR on
TIMP-1 and TIMP-2 production was only observed when the cells
were pre-treated with TR at 25.0 × 10−5 M
(Figure 5).
Figure 1
Influence of tumor necrosis factor-α
(TNF-α) on the production of (a) MMP-2 and (b) MMP-9 from
nasal polyp fibroblasts. Cells were stimulated with various
concentrations of TNF-α for 24 hours. MMP-2 and MMP-9
levels in the culture supernatants were examined by ELISA. Data
are expressed as the mean ng/mL ± SE of five different
subjects. ∗ means significant (P < .05) compared with 0
control.
Figure 2
Influence of tranilast (TR) on the production of MMP-2
and MMP-9 from nasal fibroblasts in response to TNF-α stimulation and on their activities. Cells were stimulated with
10.0 ng/mL TNF in the presence of various concentrations of
TR for 24 hours. Data are expressed as the mean ng/mL ± SE of
five different subjects. (a) MMP-2 levels; (b) MMP-9 levels; (c)
MMP-2 activities. (d) MMP-9 activities. ∗ means significant
(P < .05) compared with TNF alone.
Figure 3
Influence of
tranilast (TR) on the production of TIMP-1 and TIMP-2 from nasal
fibroblasts in response to TNF-α stimulation. Cells were
stimulated with 10.0 ng/mL TNF in the presence of various
concentrations of TR for 24 hours. Data are expressed as the mean
ng/mL ± SE of five different subjects. NS means not
significant (P > .05); ∗ means significant (P < .05)
compared with TNF alone.
Figure 4
Influence of pretreatment of nasal fibroblast with
tranilast (TR) on the production of MMP-2 and MMP-9 and their
activities. Cells were treated with various concentrations of TR
for 2 hours and then stimulated with TNF-α (TNF) for 24
hours. Data are expressed as the mean ng/mL ± SE of five
different subjects. ∗ means significant (P < .05) compared
with TNF alone.
Figure 5
Influence of
pretreatment of nasal fibroblasts with tranilast (TR) on the
production of TIMP-1 and TIMP-2. Cells were treated with various
concentrations of TR for 2 hours and then stimulated with
TNF-α (TNF) for 24 hours. Data are expressed as the mean
ng/mL ± SE of five different subjects. NS means not
significant (P > .05); ∗ means significant (P < .05)
compared with TNF alone.
Influence of TR on MMP and TIMP mRNA expression
in nasal fibroblasts
An additional set of experiments was performed to examine possible
mechanisms enabling TR to suppress MMP-2 and MMP-9 production, but
not TIMP-1 and TIMP-2 production from NF stimulated with
TNF-α. Cells were cultured with 25.0 ng/mL
TNF-α in the presence of either 0, 2.5, or 5.0 × 10−5 M TR for 12 hours. The levels of mRNA expression were
then evaluated by RT-PCR. Addition of TR at more than 5.0 × 10−5 M significantly suppressed the
TNF-α-induced
enhancement in MMP mRNA expression in NF (Figure 6).
However, TR did not reduce the levels of TIMP mRNA expression in
NF (Figure 7). These findings were confirmed by graphs
showing the ratio of the target to the β−actin mRNA
expression level.
Figure 6
Influence of tranilast (TR) on mRNA expression of (b)
MMP-2 and (c) MMP-9 in nasal polyp fibroblasts after TNF-α stimulation. Cells were stimulated with 10.0 ng/mL
TNF-α in the presence of various concentrations of TR for
12 hours. mRNA expression was examined by RT-PCR. One
representative photograph out of five different subjects is shown.
Densitometric analysis of the results of RT-PCR is shown with the
intensity of MMP-2 and MMP-9. ∗ means significant (P < .05)
compared with TNF-α alone.
Figure 7
Influence of tranilast
(TR) on mRNA expression of TIMP-1 and TIMP-2 in nasal polyp
fibroblasts after TNF-α stimulation. Cells were stimulated
with 10.0 ng/mL TNF-α in the presence of various
concentrations of TR for 12 hours. mRNA expression was examined by
RT-PCR. One representative photograph out of five different
subjects is shown. Densitometric analysis of the results of RT-PCR
is shown with the intensity of MMP-2 and MMP-9. β−actin
mRNA expression was shown in Figure 6. ∗ means
not significant (P < .05) compared with TNF-α alone.
DISCUSSION
In the present study, we clearly demonstrated that TR at 5.0 × 10−5 M, which is lower than therapeutic tissue
levels [21], could inhibit the production of both MMP-2 and
MMP-9 from NF with virtually no effects on the production of
TIMP-1 and TIMP-2. In addition, this inhibitory action of TR on
MMP production is due, at least in part, to its suppressive
activity on MMP mRNA expression.Allergic rhinitis is an inflammatory disorder of the nasal mucosa
and epithelium [1, 2,
3, 11]. Aeroallergen
exposure in patients
with allergic rhinitis results in immune cell activation within
the nasal mucosa along with activation of the resident epithelial
and endothelial cells [22, 24].
Structural changes
within the nasal walls, in addition to
classical inflammatory responses, have also been reported in
patients with allergic rhinitis. These structural changes include
epithelial disruption, mucus gland hypertrophy, enhanced mucosal
collagen deposition, mucosal myofibroblast transformation, and
increased matrix protein deposition. These cellular events are now
called tissue remodeling and involve extensive alteration of
tissue ECM [8, 9].
ECM is involved in tissue homeostasis and
several pathologic conditions such as tumor invasion, wound
healing, and inflammation. Two groups of proteins, MMPs, and their
counterregulatory inhibitors, TIMPs, are important factors for the
maintenance of ECM homeostasis. The MMPs are a large family of
Ca2+-activated, Zn2+-dependent endopeptidases that
have the ability to degrade various components of the ECM and
basement membrane [11, 23]. At least 23 members of the MMP
family have been characterized [11, 23]. Among them, MMP-2 and
MMP-9, also known as gelatinase A and B, respectively, degrade
basement membrane type IV and type V collagen and denatured
collagens [11, 23].
They can also degrade elastine, as they
can also act as elastases
[11, 23]. These
MMPs are produced by
numerous cell types, including fibroblasts, macrophages, and
eosinophils and mediate the transmigration of inflammatory cells
through the basement membrane to propagate inflammation
[12, 24].
MMPs are also responsible for microvasular
permeability leading to edema and enhanced cell migration
[12]. The findings of these reports suggest that the
attenuating effect of TR on MMP-2 and MMP-9 production from NF
induced by inflammatory stimulation may underlie the clinical
efficacy of this therapeutic agent in allergic diseases, including
allergic rhinitis. The activity of MMPs in the extracellular
milieu is controlled by specific and potent inhibitory proteins
known as TIMPs [25]. The present results clearly showed that
TR did not inhibit TIMP-1 and TIMP-2 production from NF in
response to TNF-α stimulation, suggesting that MMPs
secreted in small amounts during TR treatment are inactivated by
TIMP-1 and TIMP-2, and resulted in the favorable
modification of clinical symptoms arising from ECM remodeling in
patientsd with allergic rhinitis. The administration of MMP
inhibitor into mice reportedly reduces the migration of
inflammatory cells through the endothelial and epithelial basement
membrane [26]. This inhibitory action of the MMP inhibitor on
cell migration has been associated with its suppressive effect on
the expression of the adhesion molecules, ICAM-1 and VCAM-1
[5], which are essential for cell migration into inflammatory
tissues. These reports suggest that the negative suppressive
effect of TR on TIMP-1 and TIMP-2 production may contribute, at
least in part, to the modification of clinical symptoms, when TR
is given to patients with allergic rhinitis.TNF-α is well known as a multifunctional cytokine that
plays a role in inflammation, immunity, and a variety of diseases.
It is also accepted that TNF-α activates several
components implicated in cellular signal transduction. Binding of
TNF-α to type 1 TNF receptor causes an increase in
intracellular Ca2+ concentrations through calcium influx
[27], resulting in the activation of transcriptional factors
(NF-κB and AP-1), which are essential for MMP production
[28, 29]. TR
has been reported to inhibit increases in
cellular Ca2+ concentrations through the suppression of
Ca2+ influx from the extracellular space [30].
Judging from these reports, it seems reasonable to speculate that
TR may suppress Ca2+ influx into NF stimulated with
TNF-α, thereby inhibiting the activation of the
transcriptional factors (NF-κB and AP-1) responsible for
inducing MMP mRNA expression. The present observations showing
that MMP mRNA expression in NF was suppressed by TR support this
hypothesis.Prostaglandins (PG), especially PGE1 and PGE2, have been
reported to up regulate the production of MMPs in synoviocytes
[31, 32]
and gingival fibroblasts [33] after inflammatory
stimulation in
vitro. PGs are also involved in the production of MMPs
from human pulp cells [34] and prostate epithelial tumor
cells [35]. The finding that TR inhibited MMP-2 and MMP-9
production suggests that prostaglandin-dependent mechanism(s) may
be involved in MMP production in NF induced by TNF-α stimulation, since TR is reported to decrease PGE2
formation in monocytes after inflammatory stimulation
[36].It has been reported that TR decreased the ability of a human
fibroblast cell line from gastric carcinoma, to produce MMP-2, but
not MMP-9 in response to transforming growth factor-β in
vitro, even when the agent at 3 × 10−5 M was added
to cell cultures [37]. The reasons for the discrepancy
between this report and our data are not clear at present. The
different cell sources of nasal polyps and gastric carcinoma may
be responsible for this phenomenon, because the biological
characteristics of fibroblasts from different tissues were
reported to be quite different [38,
39].Since the concentration of TR that suppressed MMP-2 and MMP-9
production in vitro (5.0 × 10−5 M) was equivalent to
that in therapeutic tissue levels [21], the efficacy of TR in
allergic inflammatory diseases might be explained by these in
vitro data suggesting that TR down regulates fibroblast functions
related to inflammation and tissue remodeling.
Authors: E A Capper; A K Roshak; B J Bolognese; P L Podolin; T Smith; D L Dewitt; K M Anderson; L A Marshall Journal: J Pharmacol Exp Ther Date: 2000-12 Impact factor: 4.030
Authors: Arwin M Valencia; Kay D Beharry; Jorge G Ang; Kamakshi Devarajan; Richard Van Woerkom; Maria Abrantes; Kenji Nishihara; Eileen Chang; Joshua Waltzman; Houchang D Modanlou Journal: Pediatr Pulmonol Date: 2003-06
Authors: Stephanie C Casey; Monica Vaccari; Fahd Al-Mulla; Rabeah Al-Temaimi; Amedeo Amedei; Mary Helen Barcellos-Hoff; Dustin G Brown; Marion Chapellier; Joseph Christopher; Colleen S Curran; Stefano Forte; Roslida A Hamid; Petr Heneberg; Daniel C Koch; P K Krishnakumar; Ezio Laconi; Veronique Maguer-Satta; Fabio Marongiu; Lorenzo Memeo; Chiara Mondello; Jayadev Raju; Jesse Roman; Rabindra Roy; Elizabeth P Ryan; Sandra Ryeom; Hosni K Salem; A Ivana Scovassi; Neetu Singh; Laura Soucek; Louis Vermeulen; Jonathan R Whitfield; Jordan Woodrick; Annamaria Colacci; William H Bisson; Dean W Felsher Journal: Carcinogenesis Date: 2015-06 Impact factor: 4.944
Authors: N Shiota; P T Kovanen; K K Eklund; N Shibata; K Shimoura; T Niibayashi; C Shimbori; H Okunishi Journal: Br J Pharmacol Date: 2010-01-08 Impact factor: 8.739
Authors: Kodappully S Siveen; Kirti S Prabhu; Aeijaz S Parray; Maysaloun Merhi; Abdelilah Arredouani; Mohamed Chikri; Shahab Uddin; Said Dermime; Ramzi M Mohammad; Martin Steinhoff; Ibrahim A Janahi; Fouad Azizi Journal: Sci Rep Date: 2019-02-07 Impact factor: 4.379
Authors: Kristy Swiderski; Michelle Todorov; Stefan M Gehrig; Timur Naim; Annabel Chee; David I Stapleton; René Koopman; Gordon S Lynch Journal: Fibrogenesis Tissue Repair Date: 2014-01-30