Literature DB >> 17938738

Assessing exposure to atrazine and its metabolites using biomonitoring.

Dana B Barr1, Parinya Panuwet, Johnny V Nguyen, Simeon Udunka, Larry L Needham.   

Abstract

BACKGROUND: Atrazine (ATZ) is the second most abundantly applied pesticide in the United States. When we assessed exposure to ATZ by measuring its urinary mercapturic acid metabolite, general population data indicated that < 5% of the population was exposed to ATZ-related chemicals (limit of detection < 0.8 ng/mL).
OBJECTIVES: The aim of our study was to determine if we were underestimating ATZ exposure by measuring its urinary mercapturic acid metabolite and if the urinary metabole profile changed with the exposure scenario.
METHODS: We conducted a small-scale study involving 24 persons classified as high- (n = 8), low(n = 5), and environmental- (n = 11) exposed to ATZ. Using online solid phase extraction high performance liquid chromatography-tandem mass spectrometry, we measured nine ATZ-related metabolites in urine that included dealkylated, hydroxylated, and mercapturic acid metabolites.
RESULTS: We found that the urinary metabolite profiles varied greatly among exposure scenarios and among persons within each exposure scenario. Although diaminochlorotriazine (DACT) appeared to be the predominant urinary metabolite detected in each exposure category, the variation in proportion of total ATZ metabolites among persons was consistently large, suggesting that one metabolite alone could not be measured as a surrogate for ATZ exposure.
CONCLUSIONS: We have likely been underestimating population-based exposures by measuring only one urinary ATZ metabolite. Multiple urinary metabolites must be measured to accurately classify exposure to ATZ and its environmental degradates. Regardless, DACT and desethylatrazine appear to be the most important metabolites to measure to evaluate exposures to ATZ-related chemicals.

Entities:  

Keywords:  atrazine; chlorotriazines; environmental; exposure assessment

Mesh:

Substances:

Year:  2007        PMID: 17938738      PMCID: PMC2022667          DOI: 10.1289/ehp.10141

Source DB:  PubMed          Journal:  Environ Health Perspect        ISSN: 0091-6765            Impact factor:   9.031


Atrazine (ATZ; 2-chloro-4-ethylamino-6-isopropylamino-s-triazine) is a systemic triazine herbicide that blocks photosynthesis in broadleaf weeds and some grassy weeds (Laws and Hayes 1991). ATZ is currently one of the two most widely used agricultural pesticides in the United States, although from 1985 to 2001, it was the most abundantly applied pesticide (Donaldson et al. 2002; Kiely et al. 2004). Approximately 64–80 million pounds of ATZ are applied annually in the United States for agricultural and residential purposes; this amount has remained relatively constant over the past few decades (Kiely et al. 2004). ATZ has been used predominantly in the Midwest (Nelson et al. 2001). About three-fourths of all field corn and sorghum are treated with ATZ annually for weed control. Seventy percent of the ATZ applied to corn and sorghum is used as a preemergence herbicide, and 30% is applied postemergence. ATZ is also used for weed control in sugarcane and wheat fields. In addition to agricultural uses, ATZ is used in residential turf applications in the Southeast, including use on golf courses and sod farms to control weeds (Nelson et al. 2001). ATZ and its degradates are the most commonly detected pesticide(s) in ground and surface waters (Aaronson et al. 1980; Appel and Hudak 2001; Barbash et al. 2001; Barnes and Kalita 2001; Battaglin et al. 2000; Bushway et al. 1992; Clark and Clay et al. 2000; Goolsby 2000; Gaynor et al. 2002). It has been the subject of multiple monitoring programs conducted by various industry and government agencies, especially the U.S. Geological Survey (USGS) (Barbash et al. 2001). The frequent detection of ATZ and its degradates in streams, rivers, groundwater, and reservoirs is related directly to its volume of use, its tendency to persist in soils because of its resistance to photolysis and hydrolysis, and its ability to travel with water systems (Nelson et al. 2001). In water systems, ATZ typically undergoes dealkylation to form desethylatrazine (DEA), desisopropylatrazine (DIA), and the terminal dealklylation product diaminochlorotriazine (DACT) (Nelson et al. 2001) (Figure 1). In plants, ATZ is absorbed by the root system and tends to form hydroxylated metabolites that cannot generally be removed by washing of the vegetable products. Studies reported to the U.S. Environmental Protection Agency (EPA) have suggested that in animals the degradation products that retain the chlorine have biological activity similar to that of atrazine, whereas the hydroxylated metabolites do not retain their biological activity (Nelson et al. 2001). The biological end points observed in animals have been primarily endocrine-mediated, for example, affecting hypothalamic control of pituitary–ovarian function by modulation of luteinizing hormone release (Cooper et al. 2000; Gojmerac et al. 2004; McMullin et al. 2004) and mammary tumor production (Eldridge et al. 1994, 1999; O’Connor et al. 2000; Ueda et al. 2005; Wetzel et al. 1994). ATZ has also been reported to modulate aromatase activity in vivo and in vitro (Crain et al. 1997; Hecker et al. 2004) potentially resulting in hermaphroditic amphiphibians (Hayes et al. 2002), although this health outcome has been debated (Gammon et al. 2005; Renner 2002).
Figure 1

. Proposed metabolism of ATZ. ATZ is shown in black; dealkylated metabolites are shown in green; hydroxylated metabolites are shown in blue; and glutathione-derived mercapturic acid metabolites are shown in red. Abbreviations: ATZ, atrazine; ATZ-OH, hydroxyatrazine; AM, atrazine mercapturate; DACT, diaminochlorotriazine; DATM, diaminotriazine mercapturate; DEA, desethylatrazine; DEAM, desethylatrazine mercapturate; DEA-OH, hydroxydesethylatrazine; DIA, desisopropyl atrazine; DIAM, desisopropylatrazine mercapturate.

Metabolism of ATZ and its degradation products is a complex process resulting in multiple potential metabolites (Figure 1). Many human and animal studies have evaluated ATZ metabolism and the conclusions are variable (Table 1). Some rat and human studies identified DACT as the primary metabolite of ATZ (Bakke et al. 1972; Catenacci et al. 1990, 1993). Other human studies identified atrazine mercapturate (AM) (Figure 1), a glutathione-derived metabolite, as the predominant metabolite (Buchholz et al. 1999; Lucas et al. 1993; Perry et al. 2000). In total, 8–12 ATZ metabolites have been identified or postulated (Bakke et al. 1972; Buchholz et al. 1999; Catenacci et al. 1990, 1993; Perry et al. 2000).
Table 1

Summary of animal and human metabolite studies.a

StudyModelDACTDIADEAAMATZDAtMATZ-OHAmmeline
NovartisbRat1MinorMinorNDND1NDND
Bakke (Bakke et al. 1972)RatND11NDNDND11
DE BradwaybRat111NANANA11
LL EricksonbSwineNANA1NANANANANA
NovartisbMonkey1423NDAfter ivNDND
Catenacci (Catenacci et al. 1993)Human1MinorMinorNAMinorNANANA
Lucas (Lucas et al. 1993)Human (D)MinorMinorMinor1NANANANA
Buchholz (Buchholz et al. 1999)Human (D)2?MinorNA1NA2?NANA
Perry (Perry et al. 2000)HumanNANA21NANANANA
Catenacci (Catenacci et al. 2002)Human1Minor2NAMinorNANANA

Abbreviations: AM, atrazine mercapturate; ATZ, atrazine; ATZ-OH, hydroxyatrazine; DACT, diaminochlorotriazine; DATM, diaminotriazine mercapturate; DEA, desethylatrazine; DIA, desisopropyl atrazine; ND, not detected; NA, not measured or applicable to the study; ?, metabolite with tentative identification; (D), dermal exposure. “After iv” indicates that metabolite was seen only after iv administration of atrazine.

1, a major metabolite; 2, a less abundant metabolite; minor, minor metabolite identified.

Information obtained from documentation of internal studies conducted at Novartis. Information was kindly supplied by Novartis upon request by CDC.

The latter human studies led us to focus our efforts mainly on measuring AM during biomontoring in the pilot phase of the Agricultural Health Study (ca. 1994; Alavanja et al. 1996). AM was frequently detected in the urine of farmer applicators, their spouses, and sometimes children, typically at the highest concentrations on the day after ATZ application (WJ Driskell, unpublished data, 1995). Subsequently, we began measuring AM to evaluate environmental exposures to ATZ; however, this approach limited our ability to detect total exposure to ATZ-related compounds. In the Centers for Disease Control and Prevention (CDC) National Report on Human Exposure to Environmental Chemicals (CDC 2001, 2003, 2005), AM, the only ATZ metabolite measured, was typically detected in < 5% of participants, which did not correspond with its widespread use and frequent detection in ground, surface, and municipal water systems. Similarly, other studies reported low frequencies of detection (e.g., < 3%) of AM (Adgate et al. 2001; Lioy et al. 2000; MacIntosh et al. 1999), even though one of these studies reported frequent detection of ATZ in homes (Lioy et al. 2000). The objective of our study was to evaluate multiple metabolites of ATZ in persons exposed in occupational and environmental scenarios. We wanted to determine if measurement of one metabolite was sufficient to estimate ATZ exposure relative to that in other individuals or whether multiple chemicals must be measured to accurately assess exposure to ATZ.

Experiment

A detailed description of the analytical method can be found in Panuwet et al. (in press). Briefly, we introduced 200 μL urine onto a dual online solid-phase extraction (reversed-phase phenyl–hexyl and strong cation exchange) system, which was operated by a novel switching mechanism. Analytes were preconcentrated using high-performance liquid chromatography on a guard column, and the remaining urine components were washed off, using 10% methanol in 0.1% formic acid, into a waste container. The valves were switched, and the analytes were backwashed onto a reversed-phase or strong anion exchange analytic column and separated using a linear gradient beginning with 10% methanol in 0.1% formic acid and ending with 100% methanol. Samples were analyzed using atmospheric pressure chemical ionization–tandem mass spectrometry with one precursor–product ion pair being used for quantification and two precursor–product ion pairs being used for confirmation (Table 2). Quantification was achieved using isotope dilution calibration, for which isotopically labeled standards were available. When they were not available, the most closely eluting labeled standard was used for quantification. Each analytical run consisted of a full eight-standard calibration set, three positive (i.e., fortified urine samples at three levels spanning calibration range) and two negative (i.e., blank) control samples, and up to 75 unknown samples. The limits of detection ranged from 0.1 to 1 ng/mL, with relative standard deviations typically < 12% over the calibration range.
Table 2

Precursor–product ion pairs for tandem mass spectrometry of each analyte.a

Productions
CompoundPrecursor ion [M+H]QC1C2
ATZ-OH1988615669
DACT146796862
DEAM315185144102
DIA17468132104
DEA188146104110
AM343214102172
ATZ21617410468

Abbreviations: AM, atrazine mercapturate; ATZ-OH, hydroxyatrazine; ATZ, atrazine; C1, confirmation ion 1; C2, confirmation ion 2; [M+H], pseudomolecular ion derived from atmospheric pressure chemical ionization; DACT, diaminochlorotriazine; DATM, diaminotriazine mercapturate; DEA, desethylatrazine; DEAM, desethylatrazine mercapturate; DIA, desisopropyl atrazine; Q, quantification ion.

More details on the method are found in Panuwet et al. (in press).

Human samples were collected from residential turf applicators (i.e., commercial lawn care applicators), nonapplicators with low-level exposures (i.e., nonoccupationally exposed individuals with documented ATZ exposure based upon detectable levels of AM in their urine) and volunteers in Georgia with no known acute exposure to ATZ. All samples were collected as part of previous studies and were reanalyzed to determine total metabolites. All protocols were reviewed and approved by the CDC Institutional Review Board for ethical treatment of human research subjects. Samples were stored at −70°C until used and before analysis were thawed at room temperature and mixed thoroughly. Simple statistics (mean, standard deviation, and ratios) were performed using Excel software (Microsoft, San Jose, CA). Because the number of samples tested was small, no significance testing was performed.

Results

A mass chromatogram of a spiked urine sample is shown in Figure 2. Because the most polar analytes were not adequately retained on the reversed-phase column, a strong cation exchange column was used. DACT was partially retained on the reversed-phase column, and the remainder was retained on the strong cation exchange column resulting in two peaks for DACT. Both peaks were summed to calculate the total amount of DACT present. All peaks were resolved by either time or mass-to-charge ratio.
Figure 2

Mass chromatogram of metabolites measured. AM, atrazine mercapturate; ATZ, atrazine; ATZ-OH, hydroxyatrazine; DACT, diaminochlorotriazine; DEA, desethylatrazine; DEAM, desethylatrazine mercapturate; DEA-OH, hydroxydesethylatrazine; DIA, desisopropyl atrazine; DIA-OH, hydroxydesisopropylatrazine; SCX, strong cation exchange.

The metabolite profile of the higher exposure category of turf applicators is shown in Figure 3 (n = 8). The two graphs represent the exposure assessment using only AM and the exposure assessment using all metabolites. DACT was the most predominantly detected metabolite (mean = 51%), followed closely by DEA (mean = 31%). AM was detected on average in only 12% of the samples tested. The interperson variation (calculated as the relative standard deviation of the percentage of each metabolite percentage among persons) in urinary concentrations among these most detected analytes was between 33 and 51%. The interperson variability was much greater for the less frequently detected metabolites.
Figure 3

Metabolite profile of turf applicators using just AM and multiple metabolites. AM, atrazine mercapturate; ATZ, atrazine; ATZ-OH, hydroxyatrazine; DACT, diaminochlorotriazine; DEA, desethylatrazine; DEA-OH, hydroxydesethylatrazine; DIA, desisopropyl atrazine.

The metabolite profiles for the lower-level exposure category (n = 5) are shown in Figure 4. On average, DEA (33%) and DACT (28%) were detected in about equal proportions, with only 6% detection of AM. Similar to the higher-level exposures, the interperson variation in their urinary concentrations was large.
Figure 4

Metabolite profile of lower level exposures using AM and multiple metabolites. Abbreviations: AM, atrazine mercapturate; ATZ, atrazine; ATZ-OH, hydroxyatrazine; DACT, diaminochlorotriazine; DEA, desethylatrazine; DEA-OH, hydroxydesethylatrazine; DIA, desisopropyl atrazine; DIA-OH, hydroxydesisopropylatrazine.

For the environmental exposure category, DACT was by far the most predominantly detected metabolite (77%). DEA was detected the next most frequently (15%) and AM was detected in only 2% of the samples. Again, the interperson variability in metabolic profile concentrations was large.

Discussion

The small amount of data that we present here clearly demonstrate that exposure to ATZ-related chemicals can be misrepresented by measurement of AM alone. However, it is important to note that the measurement of ATZ or AM in urine would be the only unequivocal indication that a person was exposed to ATZ and not an environmental degradate. Also, the metabolite profiles differ dramatically based upon the exposure scenario (Figure 5). Occupational or lower-level acute exposures, perhaps after ATZ use on lawns, are probably more likely to be direct exposures to ATZ and lesser exposures to the degradation products. However, the environmental exposure scenario is quite different. In environmental exposures, persons likely are exposed through food or water, which would mean that dealkylation and hydrolysis products might make up a larger percentage of the exposure. Of course, exposure to the dealkylation products is still important because these chemicals remain biologically active. Thus, the presence of the chlorinated dealkylation products or their glutathione-mediated mercapturic acid metabolites would indicate exposure to a biologically active component. Presence of the hydroxylated metabolites may indicate exposure to the hydroxylated products themselves or to their chlorinated counterparts.
Figure 5

Average percent contribution of each metabolite to the total atrazine-related metabolite level for high, lower, and environmental exposures. Abbreviations: ATZ, atrazine; ATZ-OH, hydroxyatrazine; AM, atrazine mercapturate; DACT, diaminochlorotriazine; DEA, desethylatrazine; DEA-OH, hydroxydesethylatrazine; DIA, desisopropyl atrazine.

Our data demonstrate that we likely will need to measure most or all metabolites of ATZ to accurately assess ATZ-related exposures. However, further evaluation is necessary because of our small sample size and because the possible presence of glucuronide metabolites was not considered. In the future, we will explore further the role of hydroxyl metabolites in the metabolite profiles by evaluating glucuronide-hydrolyzed urine. Also, we need to include the mercapturates of the dealkylation products in our methodology to glean the full picture of ATZ metabolism. Futhermore, we will use this method to evaluate larger populations with high-level occupational exposures (e.g., manufacturers, farmers) and background exposures in the general U.S. population. Although we found detectable concentrations of ATZ metabolites in most of the urine samples tested, we are uncertain what, if any, health effects result from these levels of exposure. In general, animal dosing studies that have investigated health effects (Ashby et al. 2002; Cooper et al. 1996, 2000) have used doses much larger than those to which we could assume (from back calculation) participants were exposed in our study. Further studies evaluating health outcomes at typical human exposure levels are warranted.

Conclusions

We have clearly been underestimating exposure to ATZ-related metabolites in the U.S. population and in other selected studies. Our newer data are more in line with exposures we might expect to see based upon ATZ use and environmental persistence. It is likely that multiple metabolites must be measured to accurately classify exposure categories. Although DACT appeared to be the predominant metabolite detected in each exposure category, the interperson variations in its concentrations were consistently about 30%. Regardless, DACT and DEA appear to be the most important metabolites to measure to evaluate exposures to ATZ-related chemicals. Clearly, exposure to ATZ or its degradates appears more pervasive than previously believed; however, more data are needed to confirm this observation. Where measures exist to mitigate or lessen exposures to biologically active ATZ degradates such as the use of high efficiency filters in municipal water systems or other mitigation strategies for pond and surface waters (Acosta et al. 2004; Agdi et al. 2000), they should be used to ensure the best protection of public health.

Correction

The percent contribution for “Low-level acute exposures” in Figure 5 was changed from that in the original manuscript published online.
  38 in total

1.  Removal of atrazine and four organophosphorus pesticides from environmental waters by diatomaceous earth-remediation method.

Authors:  K Agdi; A Bouaid; A M Esteban; P F Hernando; A Azmani; C Camara
Journal:  J Environ Monit       Date:  2000-10

2.  Atrazine, alachlor, and carbofuran contamination of well water in central Maine.

Authors:  R J Bushway; H L Hurst; L B Perkins; L Tian; C G Cabanillas; B E Young; B S Ferguson; H S Jennings
Journal:  Bull Environ Contam Toxicol       Date:  1992-07       Impact factor: 2.151

3.  Herbicide movement and dissipation at four Midwestern sites.

Authors:  S A Clay; R H Dowdy; J A Lamb; J L Anderson; B Lowery; R E Knighton; D E Clay
Journal:  J Environ Sci Health B       Date:  2000-05       Impact factor: 1.990

Review 4.  The mammary tumor response in triazine-treated female rats: a threshold-mediated interaction with strain and species-specific reproductive senescence.

Authors:  J C Eldridge; L T Wetzel; J T Stevens; J W Simpkins
Journal:  Steroids       Date:  1999-09       Impact factor: 2.668

5.  Urinary biomarkers of atrazine exposure among farm pesticide applicators.

Authors: 
Journal:  Ann Epidemiol       Date:  2000-10-01       Impact factor: 3.797

6.  Hermaphroditic, demasculinized frogs after exposure to the herbicide atrazine at low ecologically relevant doses.

Authors:  Tyrone B Hayes; Atif Collins; Melissa Lee; Magdelena Mendoza; Nigel Noriega; A Ali Stuart; Aaron Vonk
Journal:  Proc Natl Acad Sci U S A       Date:  2002-04-16       Impact factor: 11.205

7.  [Environmental and biologic monitoring of atrazine exposure at a formulating plant].

Authors:  G Catenacci; G Colli; P Verni; A Barisano
Journal:  G Ital Med Lav Ergon       Date:  2002 Jan-Mar

8.  Effect of atrazine on ovarian function in the rat.

Authors:  R L Cooper; T E Stoker; J M Goldman; M B Parrish; L Tyrey
Journal:  Reprod Toxicol       Date:  1996 Jul-Aug       Impact factor: 3.143

9.  Biological monitoring of human exposure to atrazine.

Authors:  G Catenacci; F Barbieri; M Bersani; A Ferioli; D Cottica; M Maroni
Journal:  Toxicol Lett       Date:  1993-08       Impact factor: 4.372

10.  Evidence that atrazine and diaminochlorotriazine inhibit the estrogen/progesterone induced surge of luteinizing hormone in female Sprague-Dawley rats without changing estrogen receptor action.

Authors:  Tami S McMullin; Melvin E Andersen; Alan Nagahara; Trent D Lund; Toni Pak; Robert J Handa; William H Hanneman
Journal:  Toxicol Sci       Date:  2004-03-31       Impact factor: 4.849

View more
  27 in total

Review 1.  Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses.

Authors:  Laura N Vandenberg; Theo Colborn; Tyrone B Hayes; Jerrold J Heindel; David R Jacobs; Duk-Hee Lee; Toshi Shioda; Ana M Soto; Frederick S vom Saal; Wade V Welshons; R Thomas Zoeller; John Peterson Myers
Journal:  Endocr Rev       Date:  2012-03-14       Impact factor: 19.871

2.  Two-dimensional high performance liquid chromatography separation and tandem mass spectrometry detection of atrazine and its metabolic and hydrolysis products in urine.

Authors:  Zsuzsanna Kuklenyik; Parinya Panuwet; Nayana K Jayatilaka; James L Pirkle; Antonia M Calafat
Journal:  J Chromatogr B Analyt Technol Biomed Life Sci       Date:  2012-06-02       Impact factor: 3.205

3.  Embryonic Atrazine Exposure Elicits Alterations in Genes Associated with Neuroendocrine Function in Adult Male Zebrafish.

Authors:  Sara E Wirbisky; Maria S Sepúlveda; Gregory J Weber; Amber S Jannasch; Katharine A Horzmann; Jennifer L Freeman
Journal:  Toxicol Sci       Date:  2016-07-13       Impact factor: 4.849

4.  Low atrazine dosages reduce sperm quality of Calomys laucha mice.

Authors:  Graciela Quintana Saalfeld; Antônio Sergio Varela Junior; Tiane Castro; Fernanda Alves Pereira; Stela Mari Meneghello Gheller; Alessandra Cardoso da Silva; Carine Dahl Corcini; Carlos Eduardo da Rosa; Elton Pinto Colares
Journal:  Environ Sci Pollut Res Int       Date:  2017-11-16       Impact factor: 4.223

Review 5.  Environmental immune disruptors, inflammation and cancer risk.

Authors:  Patricia A Thompson; Mahin Khatami; Carolyn J Baglole; Jun Sun; Shelley A Harris; Eun-Yi Moon; Fahd Al-Mulla; Rabeah Al-Temaimi; Dustin G Brown; Annamaria Colacci; Chiara Mondello; Jayadev Raju; Elizabeth P Ryan; Jordan Woodrick; A Ivana Scovassi; Neetu Singh; Monica Vaccari; Rabindra Roy; Stefano Forte; Lorenzo Memeo; Hosni K Salem; Amedeo Amedei; Roslida A Hamid; Leroy Lowe; Tiziana Guarnieri; William H Bisson
Journal:  Carcinogenesis       Date:  2015-06       Impact factor: 4.944

6.  Atrazine exposure in public drinking water and preterm birth.

Authors:  Jessica L Rinsky; Claudia Hopenhayn; Vijay Golla; Steve Browning; Heather M Bush
Journal:  Public Health Rep       Date:  2012 Jan-Feb       Impact factor: 2.792

7.  In vitro screening for population variability in toxicity of pesticide-containing mixtures.

Authors:  Nour Abdo; Barbara A Wetmore; Grace A Chappell; Damian Shea; Fred A Wright; Ivan Rusyn
Journal:  Environ Int       Date:  2015-09-19       Impact factor: 9.621

8.  Exposure to atrazine and selected non-persistent pesticides among corn farmers during a growing season.

Authors:  Berit Bakke; Anneclaire J De Roos; Dana B Barr; Patricia A Stewart; Aaron Blair; Laura Beane Freeman; Charles F Lynch; Ruth H Allen; Michael C R Alavanja; Roel Vermeulen
Journal:  J Expo Sci Environ Epidemiol       Date:  2008-12-03       Impact factor: 5.563

9.  Atrazine exposure decreases the activity of DNMTs, global DNA methylation levels, and dnmt expression.

Authors:  Sara E Wirbisky-Hershberger; Oscar F Sanchez; Katharine A Horzmann; Devang Thanki; Chongli Yuan; Jennifer L Freeman
Journal:  Food Chem Toxicol       Date:  2017-08-30       Impact factor: 6.023

10.  Alteration of dopamine uptake into rat striatal vesicles and synaptosomes caused by an in vitro exposure to atrazine and some of its metabolites.

Authors:  Muhammad M Hossain; Nikolay M Filipov
Journal:  Toxicology       Date:  2008-03-14       Impact factor: 4.221

View more

北京卡尤迪生物科技股份有限公司 © 2022-2023.