@phdthesis{Ku2022, author = {Ku, Hsing-Ping}, title = {Cadherin-13 Deficiency Impacts Murine Serotonergic Circuitries and Cognitive Functions}, doi = {10.25972/OPUS-25144}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-251446}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Cadherin-13 (CDH13) is a member of the cadherin superfamily that lacks the typical transmembrane domain for classical cadherins and is instead attached to the cell membrane with a GPI-anchor. Over the years, numerous genome-wide association (GWA) studies have identified CDH13 as a risk factor for neurodevelopmental disorders, including attention- deficit/hyperactivity disorder (ADHD) and autism spectrum disorder. Further evidence using cultured cells and animal models has shown that CDH13 plays important roles in cell migration, neurite outgrowth and synaptic function of the central nervous system. Research in our laboratory demonstrated that the CDH13 deficiency resulted in increased cell density of serotonergic neurons of the dorsal raphe (DR) in developing and mature mouse brains as well as serotonergic hyperinnervation in the developing prefrontal cortex, one of the target areas of DR serotonergic neurons. In this study, the role of CDH13 was further explored using constitutive and serotonergic system-specific CDH13-deficient mouse models. Within the adult DR structure, the increased density of DR serotonergic neurons was found to be topographically restricted to the ventral and lateral-wing, but not dorsal, clusters of DR. Furthermore, serotonergic hyperinnervation was observed in the target region of DR serotonergic projection neurons in the lateral wings. Unexpectedly, these alterations were not observed in postnatal day 14 brains of CDH13-deficient mice. Additionally, behavioral assessments revealed cognitive deficits in terms of compromised learning and memory ability as well as impulsive-like behaviors in CDH13-deficient mice, indicating that the absence of CDH13 in the serotonergic system alone was sufficient to impact cognitive functions and behavioral competency. Lastly, in order to examine the organization of serotonergic circuitries systematically and to tackle limitations of conventional immunofluorescence, a pipeline of the whole-mount immunostaining in combination with the iDISCO+ based rapid tissue clearing techniques was established. This will facilitate future research of brain neurotransmitter systems at circuitry and/or whole-brain levels and provide an excellent alternative for visualizing detailed and comprehensive information about a biological system in its original space. In summary, this study provided new evidence of CDH13's contribution to proper brain development and cognitive function in mice, thereby offering insights into further advancement of therapeutic approaches for neurodevelopmental disorders.}, language = {en} } @article{SvirinVeniaminovaCostaNunesetal.2022, author = {Svirin, Evgeniy and Veniaminova, Ekaterina and Costa-Nunes, Jo{\~a}o Pedro and Gorlova, Anna and Umriukhin, Aleksei and Kalueff, Allan V. and Proshin, Andrey and Anthony, Daniel C. and Nedorubov, Andrey and Tse, Anna Chung Kwan and Walitza, Susanne and Lim, Lee Wei and Lesch, Klaus-Peter and Strekalova, Tatyana}, title = {Predation stress causes excessive aggression in female mice with partial genetic inactivation of tryptophan hydroxylase-2: evidence for altered myelination-related processes}, series = {Cells}, volume = {11}, journal = {Cells}, number = {6}, issn = {2073-4409}, doi = {10.3390/cells11061036}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-267250}, year = {2022}, abstract = {The interaction between brain serotonin (5-HT) deficiency and environmental adversity may predispose females to excessive aggression. Specifically, complete inactivation of the gene encoding tryptophan hydroxylase-2 (Tph2) results in the absence of neuronal 5-HT synthesis and excessive aggressiveness in both male and female null mutant (Tph2\(^{-/-}\)) mice. In heterozygous male mice (Tph2\(^{+/-}\)), there is a moderate reduction in brain 5-HT levels, and when they are exposed to stress, they exhibit increased aggression. Here, we exposed female Tph2\(^{+/-}\) mice to a five-day rat predation stress paradigm and assessed their emotionality and social interaction/aggression-like behaviors. Tph2\(^{+/-}\) females exhibited excessive aggression and increased dominant behavior. Stressed mutants displayed altered gene expression of the 5-HT receptors Htr1a and Htr2a, glycogen synthase kinase-3 β (GSK-3β), and c-fos as well as myelination-related transcripts in the prefrontal cortex: myelin basic protein (Mbp), proteolipid protein 1 (Plp1), myelin-associated glycoprotein (Mag), and myelin oligodendrocyte glycoprotein (Mog). The expression of the plasticity markers synaptophysin (Syp) and cAMP response element binding protein (Creb), but not AMPA receptor subunit A2 (GluA2), were affected by genotype. Moreover, in a separate experiment, na{\"i}ve female Tph2\(^{+/-}\) mice showed signs of enhanced stress resilience in the modified swim test with repeated swimming sessions. Taken together, the combination of a moderate reduction in brain 5-HT with environmental challenges results in behavioral changes in female mice that resemble the aggression-related behavior and resilience seen in stressed male mutants; additionally, the combination is comparable to the phenotype of null mutants lacking neuronal 5-HT. Changes in myelination-associated processes are suspected to underpin the molecular mechanisms leading to aggressive behavior.}, language = {en} } @article{StrekalovaPavlovTrofimovetal.2022, author = {Strekalova, Tatyana and Pavlov, Dmitrii and Trofimov, Alexander and Anthony, Daniel C. and Svistunov, Andrei and Proshin, Andrey and Umriukhin, Aleksei and Lyundup, Alexei and Lesch, Klaus-Peter and Cespuglio, Raymond}, title = {Hippocampal over-expression of cyclooxygenase-2 (COX-2) is associated with susceptibility to stress-induced anhedonia in mice}, series = {International Journal of Molecular Sciences}, volume = {23}, journal = {International Journal of Molecular Sciences}, number = {4}, issn = {1422-0067}, doi = {10.3390/ijms23042061}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284056}, year = {2022}, abstract = {The phenomenon of individual variability in susceptibility/resilience to stress and depression, in which the hippocampus plays a pivotal role, is attracting increasing attention. We investigated the potential role of hippocampal cyclooxygenase-2 (COX-2), which regulates plasticity, neuroimmune function, and stress responses that are all linked to this risk dichotomy. We used a four-week-long chronic mild stress (CMS) paradigm, in which mice could be stratified according to their susceptibility/resilience to anhedonia, a key feature of depression, to investigate hippocampal expression of COX-2, a marker of microglial activation Iba-1, and the proliferation marker Ki67. Rat exposure, social defeat, restraints, and tail suspension were used as stressors. We compared the effects of treatment with either the selective COX-2 inhibitor celecoxib (30 mg/kg/day) or citalopram (15 mg/kg/day). For the celecoxib and vehicle-treated mice, the Porsolt test was used. Anhedonic (susceptible) but not non-anhedonic (resilient) animals exhibited elevated COX-2 mRNA levels, increased numbers of COX-2 and Iba-1-positive cells in the dentate gyrus and the CA1 area, and decreased numbers of Ki67-positive cells in the subgranular zone of the hippocampus. Drug treatment decreased the percentage of anhedonic mice, normalized swimming activity, reduced behavioral despair, and improved conditioned fear memory. Hippocampal over-expression of COX-2 is associated with susceptibility to stress-induced anhedonia, and its pharmacological inhibition with celecoxib has antidepressant effects that are similar in size to those of citalopram.}, language = {en} } @article{SchapovalovaGorlovadeMunteretal.2022, author = {Schapovalova, Olesia and Gorlova, Anna and de Munter, Johannes and Sheveleva, Elisaveta and Eropkin, Mikhail and Gorbunov, Nikita and Sicker, Michail and Umriukhin, Aleksei and Lyubchyk, Sergiy and Lesch, Klaus-Peter and Strekalova, Tatyana and Schroeter, Careen A.}, title = {Immunomodulatory effects of new phytotherapy on human macrophages and TLR4- and TLR7/8-mediated viral-like inflammation in mice}, series = {Frontiers in Medicine}, volume = {9}, journal = {Frontiers in Medicine}, issn = {2296-858X}, doi = {10.3389/fmed.2022.952977}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-286301}, year = {2022}, abstract = {Background While all efforts have been undertaken to propagate the vaccination and develop remedies against SARS-CoV-2, no satisfactory management of this infection is available yet. Moreover, poor availability of any preventive and treatment measures of SARS-CoV-2 in economically disadvantageous communities aggravates the course of the pandemic. Here, we studied a new immunomodulatory phytotherapy (IP), an extract of blackberry, chamomile, garlic, cloves, and elderberry as a potential low-cost solution for these problems given the reported efficacy of herbal medicine during the previous SARS virus outbreak. Methods The key feature of SARS-CoV-2 infection, excessive inflammation, was studied in in vitro and in vivo assays under the application of the IP. First, changes in tumor-necrosis factor (TNF) and lnteurleukin-1 beta (IL-1β) concentrations were measured in a culture of human macrophages following the lipopolysaccharide (LPS) challenge and treatment with IP or prednisolone. Second, chronically IP-pre-treated CD-1 mice received an agonist of Toll-like receptors (TLR)-7/8 resiquimod and were examined for lung and spleen expression of pro-inflammatory cytokines and blood formula. Finally, chronically IP-pre-treated mice challenged with LPS injection were studied for "sickness" behavior. Additionally, the IP was analyzed using high-potency-liquid chromatography (HPLC)-high-resolution-mass-spectrometry (HRMS). Results LPS-induced in vitro release of TNF and IL-1β was reduced by both treatments. The IP-treated mice displayed blunted over-expression of SAA-2, ACE-2, CXCL1, and CXCL10 and decreased changes in blood formula in response to an injection with resiquimod. The IP-treated mice injected with LPS showed normalized locomotion, anxiety, and exploration behaviors but not abnormal forced swimming. Isoquercitrin, choline, leucine, chlorogenic acid, and other constituents were identified by HPLC-HRMS and likely underlie the IP immunomodulatory effects. Conclusions Herbal IP-therapy decreases inflammation and, partly, "sickness behavior," suggesting its potency to combat SARS-CoV-2 infection first of all via its preventive effects.}, language = {en} } @article{OpitzSchuwerkPaulusetal.2021, author = {Opitz, Timm and Schuwerk, Tobias and Paulus, Markus and Kloo, Daniela and Osterhaus, Christopher and Lesch, Klaus-Peter and Sodian, Beate}, title = {No links between genetic variation and developing theory of mind: A preregistered replication attempt of candidate gene studies}, series = {Developmental Science}, volume = {24}, journal = {Developmental Science}, number = {5}, doi = {10.1111/desc.13100}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-238812}, year = {2021}, abstract = {Genetic variability is being discussed as a source of inter-individual differences in Theory of Mind development. Previous studies documented an association between variations in DRD4 VNTR 48 bp, OXTR rs53576, COMT rs4680, and Theory of Mind task performance. As empirical evidence on these associations is sparse, we conducted a preregistered replication attempt of a study reporting a link between DRD4 VNTR 48 bp and false belief understanding in 50-month-old children [Lackner, C., Sabbagh, M. A., Hallinan, E., Liu, X., \& Holden, J. J. (2012). Developmental Science, 15(2), 272-280.]. Additionally, we attempted a replication of studies on the role of OXTR rs53576 and COMT rs4680 in Theory of Mind. In both replication attempts, we did not find any evidence for associations between the sampled genetic markers and Theory of Mind ability in a series of analyses. Extending the replication attempt of Lackner et al., we employed longitudinal data from several tasks and measurement points, which allowed us to run follow-up robustness checks with more reliable scores. These extensive analyses corroborated our null finding. This comprehensive non-replication is important to balance current research on genetic markers of Theory of Mind. In a combined evaluation of our own and previous studies, we point to substantial methodological issues that research on the genetic basis of Theory of Mind development faces. We conclude that these limitations currently prevent firm conclusions on genetic influences on Theory of Mind development.}, language = {en} } @article{StrekalovaVeniaminovaSvirinetal.2021, author = {Strekalova, Tatyana and Veniaminova, Ekaterina and Svirin, Evgeniy and Kopeikina, Ekaterina and Veremeyko, Tatyana and Yung, Amanda W. Y. and Proshin, Andrey and Tan, Shawn Zheng Kai and Khairuddin, Sharafuddin and Lim, Lee Wei and Lesch, Klaus-Peter and Walitza, Susanne and Anthony, Daniel C. and Ponomarev, Eugene D.}, title = {Sex-specific ADHD-like behaviour, altered metabolic functions, and altered EEG activity in sialyltransferase ST3GAL5-deficient mice}, series = {Biomolecules}, volume = {11}, journal = {Biomolecules}, number = {12}, issn = {2218-273X}, doi = {10.3390/biom11121759}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-250071}, year = {2021}, abstract = {A deficiency in GM3-derived gangliosides, resulting from a lack of lactosylceramide-alpha-2,3-sialyltransferase (ST3GAL5), leads to severe neuropathology, including epilepsy and metabolic abnormalities. Disruption of ganglioside production by this enzyme may also have a role in the development of neuropsychiatric disorders. ST3Gal5 knock-out (St3gal5\(^{-/-}\)) mice lack a-, b-, and c-series gangliosides, but exhibit no overt neuropathology, possibly owing to the production of compensatory 0-series glycosphingolipids. Here, we sought to investigate the possibility that St3gal5\(^{-/-}\) mice might exhibit attention-deficit/hyperactivity disorder (ADHD)-like behaviours. In addition, we evaluated potential metabolic and electroencephalogram (EEG) abnormalities. St3gal5\(^{-/-}\) mice were subjected to behavioural testing, glucose tolerance tests, and the levels of expression of brain and peripheral A and B isoforms of the insulin receptor (IR) were measured. We found that St3gal5\(^{-/-}\) mice exhibit locomotor hyperactivity, impulsivity, neophobia, and anxiety-like behavior. The genotype also altered blood glucose levels and glucose tolerance. A sex bias was consistently found in relation to body mass and peripheral IR expression. Analysis of the EEG revealed an increase in amplitude in St3gal5\(^{-/-}\) mice. Together, St3gal5\(^{-/-}\) mice exhibit ADHD-like behaviours, altered metabolic and EEG measures providing a useful platform for better understanding of the contribution of brain gangliosides to ADHD and associated comorbidities.}, language = {en} } @article{FernandezCastilloCabanaDominguezKappeletal.2021, author = {Fern{\`a}ndez-Castillo, No{\`e}lia and Cabana-Dom{\´i}nguez, Judit and Kappel, Djenifer B. and Torrico, B{\`a}rbara and Weber, Heike and Lesch, Klaus-Peter and Lao, Oscar and Reif, Andreas and Cormand, Bru}, title = {Exploring the contribution to ADHD of genes involved in Mendelian disorders presenting with hyperactivity and/or inattention}, series = {Genes}, volume = {13}, journal = {Genes}, number = {1}, issn = {2073-4425}, doi = {10.3390/genes13010093}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-252346}, year = {2021}, abstract = {Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder characterized by hyperactivity, impulsivity, and/or inattention, which are symptoms also observed in many rare genetic disorders. We searched for genes involved in Mendelian disorders presenting with ADHD symptoms in the Online Mendelian Inheritance in Man (OMIM) database, to curate a list of new candidate risk genes for ADHD. We explored the enrichment of functions and pathways in this gene list, and tested whether rare or common variants in these genes are associated with ADHD or with its comorbidities. We identified 139 genes, causal for 137 rare disorders, mainly related to neurodevelopmental and brain function. Most of these Mendelian disorders also present with other psychiatric traits that are often comorbid with ADHD. Using whole exome sequencing (WES) data from 668 ADHD cases, we found rare variants associated with the dimension of the severity of inattention symptoms in three genes: KIF11, WAC, and CRBN. Then, we focused on common variants and identified six genes associated with ADHD (in 19,099 cases and 34,194 controls): MANBA, UQCC2, HIVEP2, FOPX1, KANSL1, and AUH. Furthermore, HIVEP2, FOXP1, and KANSL1 were nominally associated with autism spectrum disorder (ASD) (18,382 cases and 27,969 controls), as well as HIVEP2 with anxiety (7016 cases and 14,475 controls), and FOXP1 with aggression (18,988 individuals), which is in line with the symptomatology of the rare disorders they are responsible for. In conclusion, inspecting Mendelian disorders and the genes responsible for them constitutes a valuable approach for identifying new risk genes and the mechanisms of complex disorders.}, language = {en} } @article{RiveroAlhamaRibaKuetal.2021, author = {Rivero, Olga and Alhama-Riba, Judit and Ku, Hsing-Ping and Fischer, Matthias and Ortega, Gabriela and {\´A}lmos, P{\´e}ter and Diouf, David and van den Hove, Daniel and Lesch, Klaus-Peter}, title = {Haploinsufficiency of the Attention-Deficit/Hyperactivity Disorder Risk Gene St3gal3 in Mice Causes Alterations in Cognition and Expression of Genes Involved in Myelination and Sialylation}, series = {Frontiers in Genetics}, volume = {12}, journal = {Frontiers in Genetics}, issn = {1664-8021}, doi = {10.3389/fgene.2021.688488}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-246855}, year = {2021}, abstract = {Genome wide association meta-analysis identified ST3GAL3, a gene encoding the beta-galactosidase-alpha-2,3-sialyltransferase-III, as a risk gene for attention-deficit/hyperactivity disorder (ADHD). Although loss-of-function mutations in ST3GAL3 are implicated in non-syndromic autosomal recessive intellectual disability (NSARID) and West syndrome, the impact of ST3GAL3 haploinsufficiency on brain function and the pathophysiology of neurodevelopmental disorders (NDDs), such as ADHD, is unknown. Since St3gal3 null mutant mice display severe developmental delay and neurological deficits, we investigated the effects of partial inactivation of St3gal3 in heterozygous (HET) knockout (St3gal3±) mice on behavior as well as expression of markers linked to myelination processes and sialylation pathways. Our results reveal that male St3gal3 HET mice display cognitive deficits, while female HET animals show increased activity, as well as increased cognitive control, compared to their wildtype littermates. In addition, we observed subtle alterations in the expression of several markers implicated in oligodendrogenesis, myelin formation, and protein sialylation as well as cell adhesion/synaptic target glycoproteins of ST3GAL3 in a brain region- and/or sex-specific manner. Taken together, our findings indicate that haploinsufficiency of ST3GAL3 results in a sex-dependent alteration of cognition, behavior and markers of brain plasticity.}, language = {en} } @article{LueffeD'OrazioBaueretal.2021, author = {L{\"u}ffe, Teresa M. and D'Orazio, Andrea and Bauer, Moritz and Gioga, Zoi and Schoeffler, Victoria and Lesch, Klaus-Peter and Romanos, Marcel and Drepper, Carsten and Lillesaar, Christina}, title = {Increased locomotor activity via regulation of GABAergic signalling in foxp2 mutant zebrafish - implications for neurodevelopmental disorders}, series = {Translational Psychiatry}, volume = {11}, journal = {Translational Psychiatry}, doi = {10.1038/s41398-021-01651-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-264713}, year = {2021}, abstract = {Recent advances in the genetics of neurodevelopmental disorders (NDDs) have identified the transcription factor FOXP2 as one of numerous risk genes, e.g. in autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD). FOXP2 function is suggested to be involved in GABAergic signalling and numerous studies demonstrate that GABAergic function is altered in NDDs, thus disrupting the excitation/inhibition balance. Interestingly, GABAergic signalling components, including glutamate-decarboxylase 1 (Gad1) and GABA receptors, are putative transcriptional targets of FOXP2. However, the specific role of FOXP2 in the pathomechanism of NDDs remains elusive. Here we test the hypothesis that Foxp2 affects behavioural dimensions via GABAergic signalling using zebrafish as model organism. We demonstrate that foxp2 is expressed by a subset of GABAergic neurons located in brain regions involved in motor functions, including the subpallium, posterior tuberculum, thalamus and medulla oblongata. Using CRISPR/Cas9 gene-editing we generated a novel foxp2 zebrafish loss-of-function mutant that exhibits increased locomotor activity. Further, genetic and/or pharmacological disruption of Gad1 or GABA-A receptors causes increased locomotor activity, resembling the phenotype of foxp2 mutants. Application of muscimol, a GABA-A receptor agonist, rescues the hyperactive phenotype induced by the foxp2 loss-of-function. By reverse translation of the therapeutic effect on hyperactive behaviour exerted by methylphenidate, we note that application of methylphenidate evokes different responses in wildtype compared to foxp2 or gad1b loss-of-function animals. Together, our findings support the hypothesis that foxp2 regulates locomotor activity via GABAergic signalling. This provides one targetable mechanism, which may contribute to behavioural phenotypes commonly observed in NDDs.}, language = {en} } @phdthesis{Mortimer2021, author = {Mortimer, Niall Patrick}, title = {ADHD Genetics in Mouse and Man}, doi = {10.25972/OPUS-23626}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-236265}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with an estimated heritability of around 70\%. In order to fully understand ADHD biology it is necessary to incorporate multiple different types of research. In this thesis, both human and animal model research is described as both lines of research are required to elucidate the aetiology of ADHD and development new treatments. The role of a single gene, Adhesion G protein-coupled receptor L3 (ADGRL3) was investigated using a knockout mouse model. ADGRL3 has putative roles in neuronal migration and synapse function. Various polymorphisms in ADGRL3 have been linked with an increased risk of attention deficit/hyperactivity disorder (ADHD) in human studies. Adgrl3-deficient mice were examined across multiple behavioural domains related to ADHD: locomotive activity, visuospatial and recognition memory, gait impulsivity, aggression, sociability and anxiety-like behaviour. The transcriptomic alterations caused by Adgrl3-depletion were analysed by RNA-sequencing of three ADHD-relevant brain regions: prefrontal cortex (PFC), hippocampus and striatum. Increased locomotive activity in Adgrl3-/- mice was observed across all tests with the specific gait analysis revealing subtle gait abnormalities. Spatial memory and learning domains were also impaired in these mice. Increased levels of impulsivity and sociability accompanying decreased aggression were also detected. None of these alterations were observed in Adgrl3+/- mice. The numbers of genes found to exhibit differential expression was relatively small in all brain regions sequenced. The absence of large scale gene expression dysregulation indicates a specific pathway of action, rather than a broad neurobiological perturbation. The PFC had the greatest number of differentially expressed genes and gene-set analysis of differential expression in this brain region detected a number of ADHD-relevant pathways including dopaminergic synapses as well as cocaine and amphetamine addiction. The most dysregulated gene in the PFC was Slc6a3 which codes for the dopamine transporter, a molecule vital to current pharmacological treatment of ADHD. The behavioural and transcriptomic results described in this thesis further validate Adgrl3 constitutive knockout mice as an experimental model of ADHD and provide neuroanatomical targets for future studies involving ADGRL3 modified animal models. The study of ADHD risk genes such as ADGRL3 requires the gene to be first identified using human studies. These studies may be genome based such as genome wide association studies (GWAS) or transcriptome based using microarray or RNA sequencing technology. To explore ADHD biology in humans the research described in this thesis includes both GWAS and trancriptomic data. A two-step transcriptome profiling was performed in peripheral blood mononuclear cells (PBMCs) of 143 ADHD subjects and 169 healthy controls. We combined GWAS and expression data in an expression-based Polygenic Risk Score (PRS) analysis in a total sample of 879 ADHD cases and 1919 controls from three different datasets. Through this exploratory study we found eight differentially expressed genes in ADHD and no support for the genetic background of the disorder playing a role in the aberrant expression levels identified. These results highlight promising candidate genes and gene pathways for ADHD and support the use of peripheral tissues to assess gene expression signatures for ADHD. This thesis illustrates how both human and animal model research is required to increase our understanding of ADHD. The animal models provide biological insight into the targets identified in human studies and may themselves provide further relevant gene targets. Only by combining research from disparate sources can we develop the thorough understanding on ADHD biology required for treatment development, which is the ultimate goal of translational science research.}, language = {en} }