Miwa Yamazaki1, Akira Suzuki2, Keiichi Ozono3, Toshimi Michigami1. 1. Department of Environmental Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. 2. Department of Environmental Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan ; Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan. 3. Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.
Abstract
In an attempt to study the roles of G-protein stimulatory subunit α (Gsα) in osteoblasts, we introduced an expression vector encoding Gsα into human osteoblastic cell line SaOS-2, and established the clones stably overexpressing Gsα (SaOS-2-Gsα). In SaOS-2-Gsα, the intracellular content of cyclic AMP (cAMP) was increased compared with the parental SaOS-2 cells. In addition, when treated with PTH[1-34], SaOS-2-Gsα exhibited more accumulation of intracellular cAMP compared with the parental cells, suggesting an increased responsiveness to PTH. We evaluated the proliferation rates of SaOS-2-Gsα and the parental SaOS-2 cells, and found that the proliferation was accelerated in SaOS-2-Gsα cells. Reverse transcription-polymerase chain reaction (RT-PCR) analyses exhibited the increased expression of Runx2, a transcription factor involved in osteoblast differentiation, in SaOS-2-Gsα cells. Finally, to examine the osteoblastic function in vivo, we inoculated SaOS-2-Gsα or parental SaOS-2 cells subcutaneously to immunocompromised nude mice. Although tumors in nude mice were not formed after inoculation of parental SaOS-2 cells, SaOS-2-Gsα cells proliferated in host animals leading to the formation of tumors with mineralized bone-like tissues. Taken together, these results suggest that the signals via Gsα play critical roles in the proliferation and osteogenic functions of osteoblasts.
In an attempt to study the roles of G-protein stimulatory subunit α (Gsα) in osteoblasts, we introduced an expression vector encoding Gsα into human osteoblastic cell line SaOS-2, and established the clones stably overexpressing Gsα (SaOS-2-Gsα). In SaOS-2-Gsα, the intracellular content of cyclic AMP (cAMP) was increased compared with the parental SaOS-2 cells. In addition, when treated with PTH[1-34], SaOS-2-Gsα exhibited more accumulation of intracellular cAMP compared with the parental cells, suggesting an increased responsiveness to PTH. We evaluated the proliferation rates of SaOS-2-Gsα and the parental SaOS-2 cells, and found that the proliferation was accelerated in SaOS-2-Gsα cells. Reverse transcription-polymerase chain reaction (RT-PCR) analyses exhibited the increased expression of Runx2, a transcription factor involved in osteoblast differentiation, in SaOS-2-Gsα cells. Finally, to examine the osteoblastic function in vivo, we inoculated SaOS-2-Gsα or parental SaOS-2 cells subcutaneously to immunocompromised nude mice. Although tumors in nude mice were not formed after inoculation of parental SaOS-2 cells, SaOS-2-Gsα cells proliferated in host animals leading to the formation of tumors with mineralized bone-like tissues. Taken together, these results suggest that the signals via Gsα play critical roles in the proliferation and osteogenic functions of osteoblasts.
G-proteins are a family of guanine-nucleotide binding proteins coupled to seven
transmembrane domain receptors, and are involved in signal transductions of several
extracellular stimuli including hormones and peptides (1). Gs activates and Gi inhibits adenylyl cyclase in
response to hormonal stimuli; transducin (Gt) regulates cyclic GMP
phosphodiesterase activity, and Go is another G-protein expressed predominantly
in brain (1). G-proteins function as heterotrimers
composed of α, β, and γ subunits, and Gsα is one of the subunits inducing the
stimulation of adenylyl cyclase, which leads to the production of cyclic AMP (cAMP) as a
second messenger (2).GNAS1 is the gene encoding Gsα protein, and mutations in this gene are
associated with heterogeneous clinical manifestations. Deficiency or loss of function
mutations of Gsα lead to resistance to PTH [pseudohypoparathyroidism (PHP)] and
other hormones (TSH, gonadotropins, glucagon, epinephrine) as well as Albright’s hereditary
osteodystrophy (AHO) (OMIM: 103580) (3,4,5,6,7). On the other
hand, somatic gain of function mutation in GNAS1 results in McCune-Albright syndrome (OMIM:
#174800), which is characterized by polyostotic fibrous dysplasia, pigment patches of the
skin and endocrinologic abnormalities, including precocious puberty, thyrotoxicosis,
pituitary gigantism, and Cushing syndrome (8). The fact
that the conditions caused by the mutations of Gsα are often associated with bone
phenotype suggests that Gsα plays a role in skeletal development. In addition, it
is known that intermittent administration of PTH leads to increased bone formation, which
also indicates the critical role of PTH signaling mediated by Gsα in osteoblast
function (9). However, the molecular mechanisms
underlying the regulation of osteoblast function by Gsα are still not fully
understood.In the current study, to investigate the role of Gsα in osteoblast function, we
established an osteoblastic cell line overexpressing Gsα. These cells exhibited
increased intracellular accumulation of cAMP, accelerated proliferation and enhanced
expression of Runx2, a transcription factor involved in osteoblast differentiation. When
subcutaneously inoculated into nude mice, the cells overexpressing Gsα formed
ossified tumors. These findings provide evidence for the critical roles of Gsα in
the proliferation and function of osteoblasts.
Materials and Methods
Cell culture and establishment of Gsα-overexpressing cells
The human osteoblastic cell line SaOS-2 was obtained from the American Type Culture
Collection, and was maintained in α-MEM (Nikken, Kyoto, Japan) supplemented with 10% fetal
bovine serum (FBS, ICN Biomedicals, Inc., Aurora, OH, USA) and antibiotics under a 5%
CO2 atmosphere. To establish SaOS-2 cells overexpressing Gsα, the expression
vector pcDNA3.1-Gsα was constructed and introduced into SaOS-2 cells using Lipofectamine
reagent (Invitrogen, Carlsbad, CA, USA), and the stable transfectants were selected for
resistance to neomycin (Promega, Madison, WI, USA).
Western blot analysis
Whole cell extracts were harvested in RIPA buffer [1% Triton, 1% Na deoxycholate, 0.1%
SDS, 150 mM NaCl, 10 mM Tris-Cl (pH 7.4), 5 mM EDTA, and protease inhibitor cocktail
(Complete™; Roche Diagnostics GmbH, Mannheim, Germany)]. The cell lysates containing 10 µg
of each protein were then subjected to SDS-PAGE, and were transferred to PVDF membrane
(Biorad, Helcules, CA, USA). After blocking with Block Ace reagent (Dainippon
Pharmaceuticals, Osaka, Japan), the membranes were incubated with anti-Gsα antibody (Santa
Cruz Biotechnology, Santa Cruz, CA, USA). After incubation with the corresponding
secondary antibody, the proteins were visualized using the enhanced chemiluminescence
detection system (Amersham Biosciences, Piscataway, NJ, USA).
Measurement of intracellular cAMP content
Cells were plated onto 96-well culture plates at the density of 1 × 104/well.
On the next day, the cells were incubated in 0–5 μM PTH [1-34] (Sigma, St. Louis, MO, USA)
for 25 min. Then, the intracellular cAMP contents were determined using cAMP EIA system
(Amersham) following the manufacturer’s protocols.
Cell proliferation assay
The proliferation rate of the parental SaOS-2 cells and SaOS-2-Gsα cells were
evaluated using CellTiter 96® Non-radioactive Cell Proliferation Assay kit
(Promega), which is based on the cellular conversion of a tetrazolium salt into a formazan
product.
Characterization of osteoblastic phenotype by RT-PCR analysis
Total RNA was extracted from SaOS-2-Gsα and the parental SaOS-2 cells using
TRIZOL reagent (Invitrogen). Then, total RNA (2.5 µg) was reverse transcribed using a
random hexamer (Promega) and SuperScript II (Invitrogen), and PCR was performed using the
following sets of human-specific primers: alkaline phosphatase (ALP): sense,
5′-GGATGGGTGTCTCCACAGT-3′ and antisense, 5′-TTCCACCAGCAAGAAGAAGCC-3′; osteocalcin: sense,
5′-ATGAGAGCCC- TCACACTCCTC-3′ and antisense, 5′-CTAGACCGGGCCGTAGAAGCG-3′; bone
morphogenetic protein (BMP)-2: sense, 5′-TCATAAAACCTGCAACAGCCAACTCG-3′ and antisense,
5′-CACCCACAGCGATCATGTCG-3′; BMP-4: sense, 5′-GACCTATGGAGCCATTCCGTA-3′ and antisense,
5′-TCAGGGATGC- TGCTGAGGTT-3′; Runx2: sense, 5′-ATTTAGGGCGCATTCCTCATC-3′ and antisense,
5′-GTGGTGGAGTGGATGGATGG-3′; β-actin: sense, 5′-GTGGGGCGCCCCAGGCACCA-3′ and antisense,
5′-CTCCTTAATGTCACGCACGATTTC-3′. Amplification of the expected fragments was confirmed by
sequencing using an automated sequencer (377A model; Perkin-Elmer Corp., Norwalk, CT,
USA).
Cell inoculation into nude mice
Animal protocols were approved by the Institutional Animal Care and Use Committee of
Osaka Medical Center and Research Institute for Maternal and Child Health. Four-week-old
female nude mice (BALB/cA Jcl-nu, nu/nu) were supplied by Clea Japan (Tokyo, Japan) and
kept under pathogen-free conditions. Parental SaOS-2 or SaOS-2-Gsα cells [2.5 ×
107 cells in 100 µl of phosphate-buffered saline (PBS)] were mixed with the
same volume of Matrigel™ (Becton Dickinson Collaborative Biomedical Products, Bedford, MA,
USA) and subcutaneously injected into the back of nude mice.
X-ray of mice
Animals in a prone position against film were X-rayed using SOFTEX CBM-2 (SOFTEX Co.
LTD., Tokyo, Japan) under anesthesia.
Analysis of tumors
Four weeks after the cell inoculation, the mice were sacrificed, and the tumors that had
formed at the inoculation sites were excised from subcutaneous tissue. After fixation in
10% buffered formalin and decalcification in a 14% EDTA solution (pH 7.4), the tumor
specimens were embedded in paraffin and cut into 5-μm thick sections. Slides were then
subjected to hematoxylin and eosin (H&E) staining and in situ hybridization as
described below.
Preparation of RNA probes for in situ hybridization
To identify the origin of the cells found in the tumors, we performed in situ
hybridization using human- or mouse-specific Alu sequences as probes. The probes were
generated by polymerase chain reaction (PCR) using specific primers (human Alu: sense,
5′-GTGGCTCACGCCTGTAATCC-3′ and antisense, 5′-TTTTTTGAGACGGAGTCTCGC-3′; mouse Alu: sense,
5′-GAGTCTATTAGTTACCTTTT-3′ and antisense, 5′-GCAGCCAGTTCTCTTAACC-3′) to amplify the Alu
sequences specific to the human and mouse genomes, respectively, followed by cloning of
the PCR products into pGEM3zf (+) vector (Promega). The sequences of the fragments were
confirmed using a model 377 sequencer (Perkin-Elmer). Digoxigenin (DIG)-labeled sense and
antisense probes were prepared with SP6 and T7 RNA polymerase using DIG RNA Labeling Mix
(Roche).
In situ hybridization
The deparaffinized sections were immersed in 0.2 N HCl for 20 min, washed in PBS, and
then treated with 50 µg/ml of proteinase K at room temperature for 10 min. Then the
sections were fixed again in 4% paraformaldehyde in PBS for 5 min, treated with 0.25%
acetic anhydride containing 0.1 M triethanolamine (pH 8.0) for 10 min, and dehydrated in a
series of increasing concentrations of ethanol. The dried sections were incubated in 50%
formamide containing 2 × SSC (pH 4.5) at 45 °C for 60 min. The sections were then heated
at 95 °C for 5 min to denature the genomic DNA, and hybridized at 45 °C overnight with
denatured DIG-labeled antisense or sense RNA probes in hybridization solution [1 mg/ml
yeast tRNA, 20 mM Tris buffer (pH 8.0), 2.5 mM EDTA (pH 8.0), 1 × Denhardt’s, 300 mM NaCl,
50% deionized formamide, and 10% dextran sulfate]. After being washed in 50% formamide
containing 2 × SSC and 50% formamide containing 1 × SSC, the sections were treated with
10 µg/ml of RNase A at 37 °C for 30 min. The sections were washed again in 50% formamide
in 2 × SSC, 50% formamide in 1 × SSC, incubated in blocking solution (Roche), and reacted
with anti-DIG antibody-coupled alkaline phosphatase at 4 °C overnight. The probed
molecules were detected using NBT/BCIP for the anti-DIG antibody-coupled alkaline
phosphatase (Roche).
Results
Establishment of SaOS-2 cells overexpressing Gsα
As described in "Materials and Methods", we introduced the expression vector
pcDNA-Gsα into osteoblastic SaOS-2 cells, and selected the clones for
resistance to neomycin. Then, the selected clones were subjected to Western blot analyses
using antibody against Gsα. As a result, the overexpression of Gsα
in the clone #2 (SaOS-2-Gsα #2) was confirmed, but not in the clone #1 (Fig. 1A). Therefore, clone #2 was subjected to further analyses. The intracellular content
of cAMP in the steady state was increased in SaOS-2-Gsα #2 compared with the
parental cells (59.2 vs. 26.4 fmol/well). The intracellular accumulation of cAMP in
response to PTH was also increased in SaOS-2-Gsα #2 (Fig. 1B).
Fig. 1
Establishment of SaOS-2 cells overexpressing Gsα. (A) Overexpression of
Gsα in the clone SaOS-2-Gsα #2. Cell lysates (10 µg each)
harvested from the parental SaOS-2 cells or the neomycin-resistant clones were
subjected to Western blot analysis using an antibody against Gsα. (B)
Increased intracellular accumulation of cAMP in SaOS-2-Gsα #2 cells. The
parental SaOS-2 cells (open columns) or the SaOS-2-Gsα #2 cells (hatched
columns) were incubated in various concentrations of PTH (0–5 μM) for 25 min, and
the intracellular cAMP contents were determined. The data are expressed as mean ± SE
(n=3). *Significantly different from the values in untreated cells (p<0.001).
**Significantly different from the values in parental cells (p<0.001).
Establishment of SaOS-2 cells overexpressing Gsα. (A) Overexpression of
Gsα in the clone SaOS-2-Gsα #2. Cell lysates (10 µg each)
harvested from the parental SaOS-2 cells or the neomycin-resistant clones were
subjected to Western blot analysis using an antibody against Gsα. (B)
Increased intracellular accumulation of cAMP in SaOS-2-Gsα #2 cells. The
parental SaOS-2 cells (open columns) or the SaOS-2-Gsα #2 cells (hatched
columns) were incubated in various concentrations of PTH (0–5 μM) for 25 min, and
the intracellular cAMP contents were determined. The data are expressed as mean ± SE
(n=3). *Significantly different from the values in untreated cells (p<0.001).
**Significantly different from the values in parental cells (p<0.001).
Characterization of SaOS-2-Gsα
#2 cells in vitro
The proliferation rate determined by CellTiter 96® Non-radioactive Cell
Proliferation Assay (Promega) was increased in SaOS-2-Gsα #2 cells compared
with the parental SaOS-2 cells (Fig. 2).
Fig. 2
Proliferation of SaOS-2-Gsα #2 (closed circles) was accelerated
compared with the parental SaOS-2 cells (open circles). The proliferation rate of
the cells was evaluated using a non-radioactive proliferation assay kit based on
cellular conversion of a tetrazolium salt into a formazan product. The data are
expressed as mean ± SE (n=3). *Significantly different from the values in parental
cells (p<0.001).
Proliferation of SaOS-2-Gsα #2 (closed circles) was accelerated
compared with the parental SaOS-2 cells (open circles). The proliferation rate of
the cells was evaluated using a non-radioactive proliferation assay kit based on
cellular conversion of a tetrazolium salt into a formazan product. The data are
expressed as mean ± SE (n=3). *Significantly different from the values in parental
cells (p<0.001).The expression of osteoblastic marker genes in SaOS-2-Gsα #2 and the parental
SaOS-2 cells were examined by RT-PCR analyses. Among the molecules examined, we found that
the expression of Runx2, which is a critical transcription factor in osteoblast
differentiation, was markedly enhanced in SaOS-2-Gsα #2 cells (Fig. 3). The expression of ALP, osteocalcin, BMP-2 and -4 were comparable between
SaOS-2-Gsα #2 and the parental SaOS-2 cells.
Fig. 3
Characterization of SaOS-2-Gsα #2 by RT-PCR analyses. The expressions
of alkaline phosphatase (ALP), osteocalcin (OC), BMP-2, BMP-4 and Runx2 were
examined. The expression of β-actin as an internal control is also depicted.
Characterization of SaOS-2-Gsα #2 by RT-PCR analyses. The expressions
of alkaline phosphatase (ALP), osteocalcin (OC), BMP-2, BMP-4 and Runx2 were
examined. The expression of β-actin as an internal control is also depicted.
Mineralized tumor formation by SaOS-2-Gsα
#2 cells in nude mice
As others have reported, SaOS-2 parental cells do not form tumors in nude mice, although
they can mineralize in vitro (10). However, we found
that with SaOS-2-Gsα #2, mineralized tumors were formed 4 weeks after
subcutaneous inoculation into nude mice as observed by X-ray (Fig. 4A, B). We performed the inoculation 48 times (4 sites/mouse, 12 mice), and obtained 48
mineralized tumors. Histological examination revealed the tumors contained lamellar bone
matrix with osteoblastic cells, osteoclasts and bone marrow (Fig. 4C). There was no cartilaginous tissue in the tumor at 4 weeks
after inoculation. We confirmed that all of the xenografts originated from
SaOS-2-Gsα #2 cells contained bone-like tissue.
Fig. 4
Mineralized tumors formed by SaOS-2-Gsα #2 cells. SaOS-2-Gsα
#2 cells (2.5 × 107/site) were inoculated subcutaneously at 4 sites into
the back of 4-week-old nude mice. The mice were X-rayed 2 weeks (A) and 4 weeks (B)
after the inoculation. The white arrows indicate the mineralized tumors. (C)
H&E-stained section of tumor excised 4 weeks after the cell inoculation.
Lamellar bone matrix with bone marrow, cuboidal active osteoblasts attached to the
bone surface (arrow) and multinucleated osteoclasts (arrowhead) are observed.
Mineralized tumors formed by SaOS-2-Gsα #2 cells. SaOS-2-Gsα
#2 cells (2.5 × 107/site) were inoculated subcutaneously at 4 sites into
the back of 4-week-old nude mice. The mice were X-rayed 2 weeks (A) and 4 weeks (B)
after the inoculation. The white arrows indicate the mineralized tumors. (C)
H&E-stained section of tumor excised 4 weeks after the cell inoculation.
Lamellar bone matrix with bone marrow, cuboidal active osteoblasts attached to the
bone surface (arrow) and multinucleated osteoclasts (arrowhead) are observed.
Origin of the bone cells in the tumors
It was reported that SaOS-2 cells expressed various kinds of BMPs and induced the
formation of ectopic bone when defatted, freeze-dried cells were implanted into nude
mice (10). Therefore, to test the possibility that
SaOS-2-Gsα #2 cells formed bone by promoting the differentiation of
osteogenic cells of host mice, we investigated the origin of the cells in ectopic bones.
In situ hybridization using the human-specific Alu sequence as a probe revealed the human
origins of some of the osteoblastic cells located on the bone surface (Fig. 5B). The absence of signals in osteoclasts and bone marrow cells suggested a murine
origin for these cells. In situ hybridization using a mouse-specific Alu sequence as a
probe revealed that the formed bone also included cells of host origin (Fig. 5C); osteocytes, some of the osteoblastic cells
adherent to bone, osteoclasts and bone marrow cells were of murine origin. RT-PCR using
total RNA extracted from the ectopic bone followed by sequencing revealed the expression
of humanRunx2/cbfa-1, which is further evidence of the existence of human osteoblasts in
the ossified tumors (data not shown). These results suggest that ossified bone formed by
SaOS-2-Gsα #2 cells contains both human and mouse cells.
Fig. 5
Determination of the origin of the bone cells in the tumor formed by
SaOS-2-Gsα #2 cells. Serial sections were prepared from the tumor, and
were subjected to H&E staining (A) and in situ hybridization using human (B) or
mouse (C) genome-specific Alu sequences as probes. Note that some of the
osteoblastic cells attached to the bone surface are of human origin. Osteocytes and
bone marrow cells were of murine origin. Representative signals are shown by
arrows.
Determination of the origin of the bone cells in the tumor formed by
SaOS-2-Gsα #2 cells. Serial sections were prepared from the tumor, and
were subjected to H&E staining (A) and in situ hybridization using human (B) or
mouse (C) genome-specific Alu sequences as probes. Note that some of the
osteoblastic cells attached to the bone surface are of human origin. Osteocytes and
bone marrow cells were of murine origin. Representative signals are shown by
arrows.
Discussion
In the current study, to investigate the roles of Gsα in osteoblast function, we
established Gsα-overexpressing osteoblastic cells by introducing an expression
vector coding Gsα into an osteoblastic cell line, SaOS-2. The obtained clone
SaOS-2-Gsα #2 exhibited increased accumulation of cAMP both in the steady state
and in response to PTH treatment, indicating that the downstream signaling was enhanced by
overexpression of Gsα. In SaOS-2-Gsα cells, the proliferation in vitro
was accelerated compared with the parental cells. In addition, SaOS-2-Gsα
reproducibly formed tumors after subcutaneous inoculation into nude mice, while the parental
SaOS-2 failed to induce tumor formation. These observations support the notion that the
overexpression of Gsα results in accelerated proliferation in vivo as well as in
vitro. In parallel with our findings, it was reported that osteoblastic cells expressing
constitutively active Gsα isolated from displastic bone lesions in patients with
McCune-Albright syndrome exhibited increased cell proliferation compared with normal cells
from the same patient (11). Therefore, we speculate
that Gsα is involved in the regulation of proliferation of osteoblastic
cells.Interestingly, the tumors formed after inoculation of SaOS-2-Gsα cells contained
bone-like tissue. SaOS-2 cells are known to express several kinds of BMPs and have
bone-inducing activity when a defatted cell pellet is inoculated into the muscle of
immunocompromized mice, although they themselves do not form tumors (10). In that experiment, however, mesenchymal progenitor cells of host
mice differentiated into bone via the formation of cartilaginous tissue. In contrast, living
SaOS-2-Gsα cells, at least partly, but not exclusively, contributed to the bone
formation. In situ hybridization using the human or murine genome-specific Alu sequences as
probes revealed the existence of osteoblastic cells of both human and murine origin in the
tumor (Fig. 5). Osteoclasts and bone marrow cells
in the tumor were originated from host cells. BMPs produced by inoculated
SaOS-2-Gsα cells might be responsible for the recruitment of osteoprogenitors
of host origin to the inoculation site.In SaOS-2-Gsα cells, the expression of Runx2 was increased compared with the
parental SaOS-2 cells. Runx2, also called Cbfa1, is a transcription factor playing a
critical role in osteoblast differentiation (12, 13). It has been reported that Runx2 regulates the
expression of some osteoblast-specific genes including the osteocalcin gene (12). In addition, targeted disruption of Runx2 results in
a complete lack of bone formation, and heterozygous mutation of the gene causes
cleidocranial dysplasia (13). These results indicate
the indispensable role of Runx2 in skeletal development. Therefore, we assume that the
increased expression of Runx2 in SaOS-2-Gsα might be due to its involvement in
the osteogenic activity of these cells, although the mechanisms for up-regulation of Runx2
remain to be elucidated.In conclusion, using SaOS-2 cells overexpressing Gsα as a cell model, we
obtained the results suggesting the involvement of Gsα in the proliferation and
function of osteoblasts. Particularly, the in vivo data obtained by the inoculation of the
cells into nude mice demonstrated that the introduction of Gsα leads to increased
osteogenic activity. Based on these findings, we assume that Gsα might be a
molecular target for the treatment of various bone diseases, especially osteoporosis.
Authors: M A Levine; T G Ahn; S F Klupt; K D Kaufman; P M Smallwood; H R Bourne; K A Sullivan; C Van Dop Journal: Proc Natl Acad Sci U S A Date: 1988-01 Impact factor: 11.205
Authors: T Komori; H Yagi; S Nomura; A Yamaguchi; K Sasaki; K Deguchi; Y Shimizu; R T Bronson; Y H Gao; M Inada; M Sato; R Okamoto; Y Kitamura; S Yoshiki; T Kishimoto Journal: Cell Date: 1997-05-30 Impact factor: 41.582
Authors: M A Levine; R W Downs; A M Moses; N A Breslau; S J Marx; R D Lasker; R E Rizzoli; G D Aurbach; A M Spiegel Journal: Am J Med Date: 1983-04 Impact factor: 4.965
Authors: J C Carel; C Le Stunff; L Condamine; E Mallet; J L Chaussain; P Adnot; M Garabédian; P Bougnères Journal: J Clin Endocrinol Metab Date: 1999-11 Impact factor: 5.958