Trichomonas vaginalis is a flagellate protozoan that parasitises the urogenital human tract and causes trichomoniasis. During the infection, the acquisition of nutrients, such as iron and purine and pyrimidine nucleosides, is essential for the survival of the parasite. The enzymes for purinergic signalling, including adenosine deaminase (ADA), which degrades adenosine to inosine, have been characterised in T. vaginalis. In the evaluation of the ADA profile in different T. vaginalis isolates treated with different iron sources or with limited iron availability, a decrease in activity and an increase in ADA gene expression after iron limitation by 2,2-bipyridyl and ferrozine chelators were observed. This supported the hypothesis that iron can modulate the activity of the enzymes involved in purinergic signalling. Under bovine serum limitation conditions, no significant differences were observed. The results obtained in this study allow for the assessment of important aspects of ADA and contribute to a better understanding of the purinergic system in T. vaginalis and the role of iron in establishing infection and parasite survival.
Trichomonas vaginalis is a flagellate protozoan that parasitises the urogenital human tract and causes trichomoniasis. During the infection, the acquisition of nutrients, such as iron and purine and pyrimidine nucleosides, is essential for the survival of the parasite. The enzymes for purinergic signalling, including adenosine deaminase (ADA), which degrades adenosine to inosine, have been characterised in T. vaginalis. In the evaluation of the ADA profile in different T. vaginalis isolates treated with different iron sources or with limited iron availability, a decrease in activity and an increase in ADA gene expression after iron limitation by 2,2-bipyridyl andferrozine chelators were observed. This supported the hypothesis that iron can modulate the activity of the enzymes involved in purinergic signalling. Under bovine serum limitation conditions, no significant differences were observed. The results obtained in this study allow for the assessment of important aspects of ADA and contribute to a better understanding of the purinergic system in T. vaginalis and the role of iron in establishing infection and parasite survival.
Trichomonas vaginalis is a flagellate that parasitises the human
urogenital tract and causes trichomoniasis, the most common, nonviral sexually transmitted
disease (STD) in the world. The worldwide prevalence of this infection is 187 million
people (WHO 2012). In women, the clinical
characteristics of the infection are associated with vaginitis and cervicitis (Petrin et al. 1998). In men, trichomoniasis may occur
as urethritis or prostatitis (Sutcliffe 2010).
Complications from this STD are associated with cervical cancer (Viikki et al. 2000), infertility (Goldstein et al. 1993), adverse pregnancy outcomes (Klebanoff et al. 2001), preterm delivery, low birth weight (Cotch et al. 1991, 1997), aggressive prostate cancers (Sutcliffe
2010) and increased risk of humanimmunodeficiency virus contraction and
transmission (Sorvillo et al. 2001). The
establishment and maintenance of a T. vaginalisinfection depends on the
successful colonisation of the mucous membranes, adherence, cytotoxicity against vaginal
epithelial cells or prostatic cells and the ability to evade the immune system and acquire
nutrients (Lehker & Sweeney 1999, Figueroa-Angulo et al. 2012).In addition to iron, purine and pyrimidine nucleosides are among the essential nutrients
for T. vaginalis survival. In vivo, these nutrients are acquired from
vaginal microorganisms and host cells (Petrin et al.
1998). In vitro, culture media are typically supplemented with bovine or horse
serum, which provides these nutrients (Linstead
1989). Adenosine is the primary precursor of all purine nucleotides inT.
vaginalis, but because it lacks de novo purine and pyrimidine
synthesis, it depends on the salvage pathway for their acquisition (Munagala & Wang 2003). Iron plays a crucial role in trichomoniasis
pathogenesis (Lehker & Alderete 1992, Garcia et al. 2003).T. vaginalis
possesses multiple iron uptake systems (Ardalan et
al. 2009, Torres-Romero & Arroyo
2009). Studies have demonstrated that iron influences the expression of multiple
genes that are implicated in virulence factors (Figueroa-Angulo et al. 2012). Hydrolysis of extracellular nucleotides, such as
extracellular adenosine triphosphate (ATP), adenosine diphosphate (ADP) and adenosine
monophosphate (AMP), is also modulated by iron (Tasca et
al. 2005, de Jesus et al. 2006).ATP and adenosine are involved in various biological and pathological processes. ATP is
released during stress, anoxia or injury and acts as a signalling molecule for the immune
system (Robson et al. 2006). During purinergic
signalling, nucleotide metabolism is a crucial factor that modulates inflammation and
specific immune responses (Sansom et al. 2008). This
nucleotide metabolism is performed by an enzymatic chain consisting of ectonucleoside
triphosphate diphosphohydrolase (ecto-NTPDase family), ecto-5'-nucleotidase and adenosine
deaminase [(ADA); EC 3.5.4.4). Ecto-NTPDase hydrolyses nucleotide di and triphosphates to
form monophosphate nucleotide. Ecto-5'-nucleotidase breaks down monophosphate nucleotides,
which, in turn, leads to the activation of the P1 receptor or deamination by ADA (Tasca et al. 2004, Weizenmann et al. 2011). ADA degrades either adenosine or 2'-deoxyadenosine to
produce inosine or 2'-deoxyinosine, respectively (Franco et
al. 1997). ADA has been described in mammalian cells and tissues, haematophagous
insects, mollusks, bacteria and parasites, such as Plasmodium
lophurae,Plasmodium falciparum, Trypanosoma
evansi,Trichinella spiralis, Fasciola
gigantica,Hyalomma dromedarii, as well as T.
vaginalis(Ribeiro et al. 2001, Downie et al. 2008, Silva et al. 2011, Weizenmann et al.
2011, Miller et al. 2012).The presence of ADA in T. vaginalis was first mentioned in a study on the
characterisation and expression of S-adenosylhomocysteine, in which ADA activity was
observed to be very low or even absent (Minotto et al.
1998). Subsequently, ADA activity was identified in T.
vaginalislysates. Recently, our research group characterised the kinetics and
demonstrated the gene expression of ADA in intact T. vaginalistrophozoites
(Munagala & Wang 2003,Weizenmann et al. 2011). The presence of ADA, taken together with the
presence of NTPDase and ecto-5'-nucleotidase in T. vaginalis, suggests a
possible modulation of the concentrations of nucleotides/nucleosides during an inflammatory
and immune response because extracellular ATP is a potent proinflammatory molecule. On the
other hand, adenosine and inosine are antiinflammatory agents that regulate inflammation
outcomes. Considering the questions regarding the role of ADA in this parasite's survival,
this study investigated the effect of essential nutrients, bovine serum and iron on enzyme
activity and gene expression.
SUBJECTS, MATERIALS AND METHODS
T. vaginalis culture and parasite suspension preparation - In this
study the T. vaginalis isolates 30236 and 30238 from the American Type
Culture Collection (ATCC) and the fresh clinical isolates TV-LACM1, TV-LACM2 (from
female patients), TV-LACH1 and TV-LACH2 (from male patients), from the Clinical
Laboratory, Federal University of Rio Grande do Sul (UFRGS), Brazil (approved by UFRGS
Ethical Committee, protocol 18923) were used. The parasites were cultured axenically in
trypticase-yeast extract-maltose (TYM) medium (Diamond
1957), pH 6.0, supplemented with 10% (v/v) heat-inactivated bovine serum
(HIBS) and incubated at 37ºC. Organisms in the logarithmic phase of growth and
exhibiting normal morphology were used in the experiments with microscopic evaluations
performed before and after motility and trypan blue (0.2%) viability exclusion assays.
Parasites were then harvested by centrifugation and washed three times with
phosphate-buffered saline (PBS).To remove zinc and other divalent cations that are
capable of interacting with amino acid (aa) residues and inducing the inhibition of ADA
activity (Cooper et al. 1997), 2.0 mM
ethylenediamine tetraacetic acid and 2.0 mM ethylene glycol tetraacetic acid were added.
The final pellet was resuspended and used in subsequent assays.Serum limitation condition - To investigate the influence of serum
limitation, T. vaginalis isolates were incubated with an initial
inoculum of 2.0 x 105 trophozoites mL-1 in TYM medium supplemented
with 1% (v/v) HIBS as the serum limitation condition or TYM supplemented with 10% (v/v)
HIBS as the control (Frasson et al. 2012). After
24 h of incubation, an ADA assay was carried out. Experiments were performed in
triplicate with at least three independent experiments (using different cultures).Treatments with iron - To evaluate the effect of iron on ADA enzyme
activity, initially 2.0 x 105 trophozoites mL-1 were inoculated in
TYM-serum containing 50 μM of the iron chelator 2,2-bipyridyl (2,2-DP) (Sigma Chemical
Co, USA) at 37ºC for 24 h to obtain low-iron-grown trichomonads (Lehker et al. 1991). These organisms were then suspended in
TYM-serum supplemented with 50 μM 2,2-DP for an additional 24 h incubation before the
experiments. The iron chelator-treated parasites were then washed once and resuspended
in TYM-serum medium containing 200 μM ferrous sulphate (FS) (Sigma; high-iron
condition), 25 μM haemoglobin (HB) (Sigma) or 25 μM haemin (HM) (Sigma) to obtain
iron-replete organisms. The parasites were then incubated for an additional 24 h at 37ºC
in the presence of 50 μM 2,2-DP as the low-iron condition. Untreated parasites were used
as control. All experiments with the isolates grown under different conditions were
performed at least three times in triplicate with different trophozoite suspensions.Treatment with ferrozine chelator - To confirm the iron limitation
effect on ADA activity, treatment with a ferrozine chelator was performed by inoculating
2.0 x 105 trophozoites mL-1 in TYM-serum containing 125 μM
ferrozine (Sigma) at 37ºC for 24 h. The TYM medium was then replaced by ferrozine for an
additional 24 h incubation period (Lehker & Sweeney
1999). Untreated parasites were used as control. The experiments were
performed at least three times in triplicate.ADA assay - An ADA enzyme assay was performed by adding a parasite
suspension in a reaction mixture containing 50 mM sodium phosphate buffer (pH 7.5) with
a protein concentration of 400 μg mL-1 to a final volume of 200 μL. The
samples were then pre-incubated for 10 min at 37ºC. The reaction was initiated with the
addition of the substrate adenosine (3.0 mM) and stopped after 20 min in order to add
the samples to 500 μL of the phenol nitroprusside reagent (50.4 mg of phenol and 0.4 mg
of sodium nitroprusside mL-1). The controls that had the enzyme preparation
added after the reaction had been terminated were used to correct for the nonenzymatic
deamination of the substrate. Then, 500 μL of alkaline hypochlorite reagent (sodium
hypochlorite to 0.125% available chlorine, in 0.6 M NaOH) were added to the reaction
mixtures. Samples were incubated at 37ºC for 15 min. The colorimetric assay was carried
out at 635 nm to measure the ammonia produced by the enzymatic reaction. ADA activity
was expressed as nmol NH3 min-1mg-1 protein (Giusti 1974). All the assays were performed in
triplicate with at least three different experiments. Protein quantification was
performed in triplicate using bovine serum albumin as the standard for the parasite
suspensions (Bradford 1976).Quantitative reverse transcription-polymerase chain reaction (qRT-PCR)
- To evaluate the iron limitation effect on the gene expression of T. vaginalisADA, a qRT-PCR assay was performed. After treatment with 2,2-DP and ferrozine,
T. vaginalistrophozoites were centrifuged and washed three times
with PBS buffer (pH 7.2) for total RNA extraction using TRIzol® (Invitrogen,
USA), following the manufacturer's instructions. Then, RNA was quantified by calculating
the ratio between the absorbance values at 260 nm and 280 nm. Using 2 μg of total RNA,
cDNA was synthesised using the SuperScript® III First Strand Synthesis System
for RT-PCR kit (Invitrogen). The amount of cDNA was quantified and its integrity was
confirmed by electrophoresis through a 1% agarose gel containing SYBR®Green
and visualised with an ultraviolet light. qRT-PCRs were performed using
280 nM of each primer, 100 ng of cDNA and Power SYBR®Green PCR Master Mix
(Invitrogen) in a 14 μL total reaction volume using Step One™ Real Time PCR System
(Applied Biosystems) equipment. Parallel reactions performed with the cDNA of untreated
parasites were used as the positive controls and without reverse transcriptase as the
negative controls. During the exponential phase of the qRT-PCR, the threshold cycle (Ct)
and baseline were set according to the Applied Biosystems protocols (Miguel et al. 2010). Data from different samples
were interpolated on a line created by running standard curves for each primer set and
then normalised against the α-tubulin housekeeping gene. All samples and points of the
standard curve were performed in duplicate in two independent experiments and analysed
according to Livak and Schmittgen (2001). The
real-time primer pair sequences that were used are shown in Table.
F - CACCTCTCATGAACAATGCCCTC R -
CGAGAACGATCTTTGCGACG
57
XM_001317196
TVAG_206890 (α-tubulin)
F - GCCAACATGATGGTTAAGTGCGATCCAC
R - CAGCTTCTTCCATACCCTCACCGACG
61
XM_001330630
ADA: adenosine deaminase.
ADA: adenosine deaminase.Statistical analysis - ADA activity data were expressed as the mean ±
standard deviation and analysed by a one-way analysis of variance followed by Tukey's
multiple range test, with p < 0.05 as significant. The analyses were performed using
the Statistical Package for the Social Sciences software v.18.
RESULTS
The effect of the serum limitation condition (1% HIBS) on ADA activity in T.
vaginalis trophozoites was evaluated. First, the cellular integrity and
viability were examined before and after the enzymatic assays by trypan blue dye
exclusion. Motility and viability were not affected under any culture conditions. Next,
the experimental condition that used trophozoites that had been previously inoculated
with 1% HIBS demonstrated that ADA activity was not affected by this condition (data not
shown).The effect of the different iron treatments on adenosine deamination in T.
vaginalis was then evaluated. Cellular integrity was assessed by motility
and viability of the trophozoites by trypan blue exclusion before and after all
enzymatic assays. Trophozoite integrity was not affected by treatments with iron. The
ATCC isolates that had been cultured long-term and the fresh clinical isolates from
female or male patients had a decrease in ADA activity after treatment with 2,2-DP
(Fig. 1). Decreased enzymatic activity was
observed in ATCC 30236 (29%), ATCC 30238 (67.8%), TV-LACM1 (41.8%), TV-LACM2 (27.7%),
TV-LACH1 (47.6%) and TV-LACH2 (68.1%). However, trophozoites treated for 24 h with FS,
HB and HM did not exhibit significant differences in ADA activity compared with the
controls, which indicates that the activity was re-established after treatment with the
iron chelator (Fig. 2). To assess whether the
decrease in ADA activity that followed 2,2-DP treatment was due to an effect on ADA gene
expression inT. vaginalis, qPCR experiments were performed. The gene
expression of two ADA sequences obtained from the T. vaginalisgenome
was evaluated: TVAG_430670 (ada 125) and TVAG_416510 (ada
231), both with 733 aa. A comparison of the gene expression in the control
trophozoites and that of the T. vaginalistreated with the iron chelator
2,2-DP was performed by evaluating the Ct and the baseline obtained during the
exponential phase of the qRT-PCR technique and normalising them to the α-tubulin
housekeeping gene by calculating the enzyme/α-tubulin ratio. The results indicated that
2,2-DP treatment increased both TVAG_430670 (ada 125) and, to a greater
extent, TVAG_416510 (ada 231) transcript levels in T.
vaginalisisolates (Fig. 3).
TVAG_430670 (ada 125) and TVAG_416510 (ada 231) genes
transcript levels were increased 1.5 and 2.41 times in the ATCC 30236 isolate, 1.37 and
1.50 times in ATCC30238, 1.36 and 3.3 times in TV-LACM1, 5.65 and 12.81 times in
TV-LACM2, 7.41 and 7.78 times in TV-LACH1 and 6.19 and 13.83 times in TV-LACH2 (Fig. 3), respectively. To confirm the previous
findings, another iron chelator, ferrozine, was tested. Treatment with ferrozine led to
the same profile found after 2,2-DP treatment: an 81.7% decrease was observed in the
enzymatic activity of the ATCC 30236 isolate. However, for the isolates ATCC 30238,
TV-LACM1, TV-LACM2, TV-LACH1 and TV-LACH2, the activity decreased by 51.8%, 72.2%,
80.7%, 65.82% and 66%, respectively (Fig. 4).
Additionally, an increase in the transcript levels of TVAG_430670 (ada
125) and TVAG_416510 (ada 231) genes were observed in ATCC
30236 (1.64 and 1.52 times, respectively), ATCC 30238 (1.34 and 1.76 times,
respectively), TV-LACM1 (3.58 and 11.79 times, respectively), TV-LACM2 (1.71 and 6.68
times, respectively), TV-LACH1 (1.50 and 2.62 times, respectively) and TV-LACH2 (2.62
and 11.63 times, respectively) (Fig. 5).
Fig. 1:
effect of 2,2-bipyridyl (2,2-DP) treatment on Trichomonas vaginalis
adenosine deaminase activity. There was a significant reduction in
enzyme activity when T. vaginalistrophozoites were treated
with the iron chelator, 2,2-DP, in all isolates tested. Asterisk means
significant difference from controls. Bars represent the mean ± standard
deviation of three different experiments (parasite suspensions) performed in
triplicate. Data were analysed by analysis of variance followed by Tukey's test
(p ≤ 0.05). TV-LACH1 and TV-LACH2: fresh clinical isolates from male patients;
TV-LACM1 and TV-LACM2: fresh clinical isolates from female patients.
Fig. 2:
effect of different iron sources treatment, ferrous sulphate (FS),
haemoglobin (HB) and haemin (HM), on Trichomonas vaginalis
adenosine deaminase activity. No significant alteration in enzyme activity was
observed. Bars represent the mean ± standard deviation of at least three
experiments, each in triplicate, evaluated by analysis of variance followed by
Tukey's test (p ≤ 0.05). TV-LACH1 and TV-LACH2: fresh clinical isolates from
male patients; TV-LACM1 and TV-LACM2: fresh clinical isolates from female
patients.
Fig. 3:
gene expression patterns of adenosine deaminase (ADA) members after iron
chelator 2,2-bipyridyl (2,2-DP) treatment in Trichomonas
vaginalis. There were a increase in gene expression when the
parasites were treated with 2,2-DP, providing an iron limitation condition.
Data were obtained in duplicate. Data were analysed by analysis of variance
followed by Tukey's test (p ≤ 0.05). Asterisk means difference from control
TV-LACH1 and TV-LACH2: fresh clinical isolates from male patients; TV-LACM1 and
TV-LACM2: fresh clinical isolates from female patients.
Fig. 4:
effect of ferrozine treatment on Trichomonas vaginalis
adenosine deaminase activity. There was a significant reduction in enzyme
activity when T. vaginalistrophozoites were treated with the
iron chelator ferrozine in all isolates tested. Asterisk means significant
difference from controls. Bars represent the mean ± standard deviation of three
different experiments (parasite suspensions) performed in triplicate. Data were
analysed by analysis of variance followed by Tukey's test (p ≤ 0.05). Asterisk
means difference from control. TV-LACH1 and TV-LACH2: fresh clinical isolates
from male patients; TV-LACM1 and TV-LACM2: fresh clinical isolates from female
patients.
Fig. 5:
gene expression patterns of adenosine deaminase (ADA) members after
treatment with iron chelator ferrozine in Trichomonas
vaginalis. There was an increase in gene expression when the
parasites were treated with ferrozine, providing an iron limitation condition.
Data were obtained in duplicate. TV-LACH1 and TV-LACH2: fresh clinical isolates
from male patients; TV-LACM1 and TV-LACM2: fresh clinical isolates from female
patients.
DISCUSSION
This report assesses the effects of bovine serum limitation and treatment with different
iron sources on T. vaginalis and highlights the role of iron for these
parasites. To investigate the effect of essential nutrients on ADA activity and evaluate
a possible heterogeneity among the different isolates, the serum limitation condition
assay and treatment with different iron sources or iron limitation conditions were
performed using ATCC isolates and fresh clinical isolates from female and male patients.
In the serum limitation condition test (1% HIBS), the ADA activity maintenance profile
of the control organisms (10% HIBS) was similar to that of all the T. vaginalis
isolates. These results were not surprising, taking into account that
T. vaginalis trophozoites do not perform de novo
purine synthesis and that the serum added to the culture medium is a source of
important molecules for parasite survival, especially adenosine. Our findings are in
agreement with recent data published by our research group (Frasson et al. 2012), which show a pronounced increase in NTPDase
and ecto-5'-nucleotidase activities (increased ATP, ADP and AMP hydrolysis) in parasites
in 1% HIBS, compared to the control group. Because adenosine is essential for the
parasite, under the serum limitation condition, trophozoites compensate for the levels
of adenosine required by not altering ADA enzymatic activity.Regarding the experiments performed to determine the influence of iron and its role in
limiting ADA activity, T. vaginalis trophozoites were submitted to
different iron treatment conditions. The low-iron treatment condition (iron chelators,
2,2-DP and ferrozine) caused a significant decrease in ADA activity. In contrast, under
the other conditions, the enzyme activity was similar to that of the controls.
T. vaginalis trophozoites were able to re-establish ADA activity
after a 24 h exposure period to iron sources (FS, HB and HM). These results are in
agreement with the findings by Tasca et al.
(2005) in which T. vaginalis that had been submitted to high
or low-iron treatment conditions did not present changes in NTPDase activity, but
ecto-5'-nucleotidase had reduced activity after iron limitation, an effect that did not
revert after treatment with a high-iron concentration. In a similar study, de Jesus et al. (2006) investigated the influence of
iron in ecto-ATPase and ectophosphatase enzymes by demonstrating a decrease in enzymatic
activities with limited iron concentrations and re-established activities after 24 h of
treatment with high concentrations of this cation. The observed decrease in the
deamination of adenosine to inosine by the lower ADA activity in low-iron concentrations
is in agreement with previous findings, considering that adenosine is quickly uptaken to
be the primary precursor of the entire purine nucleotide pool in T. vaginalis
(Harris et al. 1988, Munagala & Wang 2003). In this context, iron can
act as a modulator of the enzymatic activities that hydrolyse purine nucleotides and
nucleosides.The qRT-PCR results demonstrated that in all the T. vaginalisisolates
tested, the iron limitation caused by treatment with chelators was able to regulate ADA
transcriptional expression and, surprisingly, promote increased levels of mRNA. The
concept that the amount of mRNA must be proportional to the enzyme activity has been put
to the test with the advancements published in innovative studies, particularly in the
proteomic and DNA sequencing fields of research. Current data demonstrate that
approximately 40% of the amount of protein produced is proportional to the values found
in mRNA. However, in the remaining 60%, the mRNA undergoes post-transcriptional
regulation, which includes (i) translational interference by RNA-binding proteins or
interference RNA or (ii) degradation of translated protein by other proteins (Vogel & Marcotte 2012). Studies in fungus and
bacteria show that levels of mRNA and protein suffered post-transcriptional regulation
in response to disturbances observed in situations of oxidative and osmolarity stress
(Lee et al. 2011, Vogel et al. 2011). The lack of iron in the culture medium caused a
stress condition in T. vaginalis, explaining the relationship between
the transcription/activity of ADA enzyme.Furthermore, several authors have reported that a lack or excess of iron may modulate
the gene expression of adhesins, immunogenic proteins, protein and metabolic
hydrogenosomal enzymes and cysteine proteinases in T. vaginalis(Torres-Romero & Arroyo 2009). A proteomic study
on T. vaginalis trophozoites cultured in the presence or absence of
iron showed changes in proteome profiles as a function of iron concentration. Mass
spectrometry detected 600-640 and 540-570 spots in gels with protein samples from
T. vaginalis grown in high-iron and low-iron conditions,
respectively. Of the proteins expressed by the parasites cultured in low-iron medium, 12
were up-regulated, 19 were down-regulated and 11 had their expression abolished (de
Jesus et al. 2007). The decrease in ADA
activity and the increase in ADA transcription in response to iron limitation reported
here support the hypothesis that iron can modulate the activity of the enzymes involved
in purinergic signalling because the vaginal environment undergoes constant changes and
iron levels at this site are influenced by the menstrual cycle. Therefore, in these
hostile situations, enzymes are dependent on precise gene expression regulation for
rapid adaptation to the environment and development of the appropriate responses to
ensure the survival of the parasitic protest (Figueroa-Angulo et al. 2012).Our findings show that serum-limitation-cultured parasites did not affect ADA activity.
Conversely, iron limitation decreased enzymatic activity and increased ADA gene
expression, indicating a modulation by iron. Overall, this study presents important
aspects of ADA in intact trophozoites and contributes to a better understanding of the
role of purinergic signalling in T. vaginalis.
Authors: M A Klebanoff; J C Carey; J C Hauth; S L Hillier; R P Nugent; E A Thom; J M Ernest; R P Heine; R J Wapner; W Trout; A Moawad; K J Leveno; M Miodovnik; B M Sibai; J P Van Dorsten; M P Dombrowski; M J O'Sullivan; M Varner; O Langer; D McNellis; J M Roberts Journal: N Engl J Med Date: 2001-08-16 Impact factor: 91.245
Authors: B F Cooper; V Sideraki; D K Wilson; D Y Dominguez; S W Clark; F A Quiocho; F B Rudolph Journal: Protein Sci Date: 1997-05 Impact factor: 6.725
Authors: Ana F Garcia; Te-Hung Chang; Marlene Benchimol; David Jichael Klumpp; Michael W Lehker; John F Alderete Journal: Mol Microbiol Date: 2003-03 Impact factor: 3.501