covid
Buscar en
Allergologia et Immunopathologia
Toda la web
Inicio Allergologia et Immunopathologia T-cell proliferation by surface molecules expression on polymorphonuclear neutro...
Journal Information
Vol. 40. Issue 2.
Pages 81-87 (March - April 2012)
Share
Share
Download PDF
More article options
Visits
3579
Vol. 40. Issue 2.
Pages 81-87 (March - April 2012)
Original article
Full text access
T-cell proliferation by surface molecules expression on polymorphonuclear neutrophils stimulated with IL-4 in superantigen presence
Visits
3579
B.K.A. Abdel-Salam
Department of Zoology, Faculty of Science, 61519 Minia University, El-Minia, Egypt
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (5)
Show moreShow less
Abstract
Background

Polymorphonuclear neutrophils (PMNs) were originally described as short lived and terminally differentiated phagocytes that contribute only to the innate immune response. Some studies of PMNs cytokine production and expression of numerous cell surface proteins has suggested that PMNs are likely to influence adaptive responses and may satisfy the criteria of antigen presenting cells.

Aim of the study

This work aimed to study the effect of IL-4 in the function of PMNs as antigen presenting cells.

Methods

Flow cytometry was used in the present study for the detection of cell surface human leukocyte antigen (HLA) class II, CD80 and CD86 required for antigen presentation and subsequent T-cell activation in the presence of Staphylococcus aureus enterotoxin (A). Human peripheral blood neutrophils were used for this purpose.

Results

This study has shown that IL-4 stimulated PMNs for 24h expressed HLA class II, CD80 and CD86 that involved in antigen presentation. It also indicated that co-cultivation of IL-4 stimulated PMNs with autologous T-cells and in the presence of S. aureus enterotoxin (A) induced T-cell proliferation.

Conclusions

In vitro stimulation of PMNs with IL-4 showed expression of surface molecules involved in antigen presentation. In addition, the co-culture of T-Cells and stimulated PMNs showed high T-Cells proliferation in the presence of superantigens.

Keywords:
IL-4
HLA class II
PMNs
Staphylococcus aureus A
T-cells
Abbreviations:
PMNs
HLA
IL
Full Text
Introduction

Polymorphonuclear neutrophils (PMNs) possess a very short half-life in the circulation because they constitutively undergo apoptosis.1,2 Under certain conditions PMNs play an important role in the effectors arm of host immune defence through the clearance of immune complexes, the phagocytosis of opsonised particles, and the release of inflammatory mediators.3–5 During the last years the image of PMNs has changed considerably. Traditionally considered to be the first line of defense against bacterial infection, it became increasingly clear that PMNs also participate in chronic inflammation disease and regulation of the immune response when appropriately activated.6 For surface molecules, there are several reports that PMNs from a variety of species can express human leukocyte antigen (HLA) class II and costimulatory molecules (CD80 and CD86).7–10 Under certain stimulation murine neutrophils present HLA class II restricted antigen.11

PMNs function and recruitment to the site of inflammation have been shown to be upregulated by various cytokines, including interleukin (IL)-1, IL-8, tumour necrosis factor (TNF), interferon-γ (IFN-γ), and granulocyte macrophage-colony stimulating factor (GM-CSF).5,12 In addition, IL-15 stimulated PMNs acquire HLA-DR.13

IL-4 production has been found to occur in thymocytes, mature T-cells, certain malignant T-cells, mast-cells and basophiles and occasionally, in transformed B-cells.14 It has an effect on B-cells, T-cells, monocytes, mast-cells, endothelial cells, and fibroblasts.15 Directly and/or indirectly, IL-2 has a prominent role in the regulation of IL-4 producing cells.14 IL-4 binds to a high-affinity cell-surface receptor (IL-4R) to exert its effects.16 It promotes the growth and differentiation of activated human B-lymphocytes and shares many biological functions with IL-13.17

Following this approach, the present study was aimed to estimate the expression of the antigen presenting molecule HLA class II and the co-stimulatory molecules CD80 and CD86 on PMNs stimulated with IL-4. The expression of these surface molecules prompted us to test the T-cell proliferation by their co-culture with IL-4 stimulated PMNs in the presence Staphylococcus aureus enterotoxin (A) as a superantigen.

Materials and methods

Blood was taken from 10 healthy Egyptian people by venous puncture using 7.5ml heparin-coated tubes (Sarstedt, Nümbrecht, Germany) and was analysed within 2h. Recombinant human (rh) IL-4 was purchased from Sigma (St Louis, MO, USA). For fluorescence-activated cell sorter (FACS) analysis of whole blood, erythrocyte FACS lysing solution was obtained from Becton Dichinson (Heidelberg, Germany) and diluted 1:10 in bidistilled water. For cytofluorometry fluorescein isothiocyanate (FITC) and phycoerythrin (PE)-labelled murine MoAbs were used. Mouse IgG1 FITC, IgG2a PE, CD66b-FITC, HLA-DP+DQ+DR:PE, CD80:PE and CD86:PE were obtained from Coulter Immunotech (Marseille, France).

For double labelling, anti-CD66b-FITC as a PMNs marker and the respective PE-labelled antibody were used in equal protein concentrations. Cells in whole blood were analysed by FACSCalibur and CellQuest software (Becton Dickinson, SanDiego, CA, USA). Results were expressed as the percentage of positive cells in the respective gate or quadrant. In FACS plots, there are different populations. So, gates were made around population with high CD66b-FITC.

In all FACS experiments, PMNs in heparinised blood were cultured in 24-well plate, 2ml/well and incubated in the presence or absence of IL-4 (6ng/ml) for about 24h at 37°C with 5% CO2.

For the co-culture of T-cells and PMNs, cells were isolated by Polymorph Prep® (Nycomed; Oslo, Norway). PMNs and T-cells fraction were further purified by adsorption to CD15 and CD3 beads (Miltenyi Biotec; Bergisch Gladbach, Germany), respectively, by magnetic cell separation using the devices supplied by Milteny Biotech (Bergisch-Gladbach, Germany).

Highly purified PMNs (1×106/ml) were cultivated in AIM V (Gibco BRL; Paisley, Scotland)) with 2.5% autologous normal human serum, NHS (inactivated at 56°C for 30min.). T-cells were cultured in RPMI 1640 (Gibco BRL; Paisley, Scotland) supplemented with 10% fetal calf serum (FCS) (PAN Biotech GmbH; Aidenbach, Germany), 100U/ml penicillin/streptomycin (Gibco BRL; Paisley, Scotland), 2mM l-glutamine (Gibco BRL; Paisley, Scotland)), and 10mM HEPES (Gibco BRL; Paisley, Scotland). All cells were incubated at 37°C and 5% CO2 for the times indicated.

Unstimulated and stimulated PMNs (1×103) in 100μl were added per well of a 96-well concave-bottom plate (Greiner; Nuertingen, Germany). Then, 1×104 T-cells (100μl) were added to each well together with 25ng S. aureus enterotoxins A (Sigma; Munich, Germany). After coincubation for four days at 37°C with 5% CO2, proliferation was tested by adding 1mCi of 3H-thymidine (Amer-sham Life Science; Braunschweig, Germany) for 6–8h [3H] TdR incorporation into DNA was measured and expressed as counts per minute (cpm). The values represent the mean±SE of 6–12 parallel wells.

Statistical analysis of the obtained data was performed using one way analysis of variance (ANOVA) test followed by least square differences (LSD) analysis for comparison between means. Results were expressed as mean±standard error (SE), and differences were considered to be significant at P<0.05.

Results

Results were expressed as percentage of positive cells in the respective gate or quadrant. Each set of experiments was repeated in vitro ten times.

In vitro expression of HLA class II on PMNs

The majority of healthy donors PMNs expressed CD66b (Fig. 1a–c). In the first set of experiments the effect of IL-4 on the expression of HLA class II was tested, where we found that PMNs on whole blood showed expression of HLA class II recording 7.77% (Fig. 1c) by using IL-4, as stimulators. In contrast, fresh and unstimulated cells cultured with medium only counted 1.05% (Fig. 1a) and 2.71% (Fig. 1b), respectively.

Figure 1.

Direct flow cytometry of the HLA class II induction in whole blood PMN. (A) Unstimulated PMN (0h). (B) Unstimulated PMN (24h). (C) Stimulated PMN with IL-4 (24h).

(0.28MB).
In vitro induction of CD80 on PMNs

As shown for HLA class II, surface expression of CD80 was most impressive following cultivation of whole blood with the stimuli for 24h. The proportion of double-positive cells (right upper quadrant) was estimated, where CD80 positive cells was slightly higher in stimulated cells recording 4.06% by using IL-4 (Fig. 2c) than unstimulated PMNs cultured with medium for 24h (1.12%) and fresh cells, 0.05% (Fig. 2a and b, respectively).

Figure 2.

Direct flow cytometry of the CD80 induction in whole blood PMN. (A) Unstimulated PMN (0h). (B) Unstimulated PMN (24h). (C) Stimulated PMN with IL-4 (24h).

(0.24MB).
In vitro induction of CD86 on PMNs

For CD86, high expression was recorded on the surface of IL-4 stimulated PMNs in whole blood recorded 20.48% (Fig. 3c), while percentage of CD86 molecules on the surface of unstimulated PMNs measured 6.97 (Fig. 3b). Fresh PMNs in while blood had 1.55% (Fig. 3a).

Figure 3.

FACS for CD86 surface expression in whole blood PMN. (A) Unstimulated PMN (0h). (B) Unstimulated PMN (24h). (C) Stimulated PMN with IL-4 (24h).

(0.26MB).

Statistical analysis of HLA class II, CD80 and CD86 experimental sets showed that there is a significant difference between IL-4 stimulated cells and unstimulated cells, P<0.05 (Fig. 4).

Figure 4.

Changes in HLA class II (A), CD80 (B) and CD86 (C) expression on unstimulated and IL-4 stimulated PMN. Statistical analysis showed that, there is a significant difference between IL-4 stimulated cells and unstimulated cells, P<0.05.

(0.13MB).
Interaction of IL-4 stimulated PMNs with peripheral T-cells

For these experiments highly purified PMNs were cultivated with IL-4 for 24h and then co-cultivated with highly purified isolated T-cells in the absence or presence of SEA. The differences between the groups in the sets of experiments related to the interaction of HLA class II positive PMNs with peripheral T-cells showed a significant difference, where P<0.05 (Fig. 5).

Figure 5.

Changes in the proliferation of T-Cells co-cultured with either unstimulated or IL-4 stimulated PMN in the presence and absence of superantigen. Statistical analysis showed that, there is a significant difference in T-Cells proliferation between T-Cells co-cultured with IL-4 stimulated and unstimulated PMN in superantigen presence, where P<0.05.

(0.06MB).
Discussion

PMNs are considered short-lived cells undergoing spontaneous apoptosis in vivo as well as in culture.18 Previous studies have demonstrated that PMNs can be induced in vitro to synthesize and release various cytokines, suggesting that these cells can contribute significantly to the initiation and amplification of cellular and humoral immune responses.5 The detection of these molecules, therefore, provides strong support for the hypothesis that human PMNs can actively synthesize immunoregulatory molecules19 and have the potential to act as antigen presenting cells.8

Recently, it has become increasingly evident that culturing PMNs in the presence of cytokines extends their life span.20–23 Cultured PMNs synthesize and release immunomodulatory cytokines by which they may participate in the afferent limb of the immune response.5

This study has clearly shown that PMNs could be induced to express HLA class II, CD80 and CD86 after activation with IL-4. These data are in accordance with other results where HLA class II, CD80 and CD86 were expressed on the PMNs surface after exposure to GM-CSF and/or INF-γ.6

The antigen presenting molecule HLA class II and the co-stimulatory molecules CD80 and CD86 play an important role in T-cell proliferation, where HLA class II presents the engulfed antigen to T-cells.6 CD80 and CD86 act as second signal molecules involving in the stimulation of T-cells to produce the autocrine growth factor IL-2 without which T-cells are thus unable to proliferate.24

The activation and recruitment of PMNs were also regulated by IL-15,13 IFN-γ,25 CSF-CSF26–28 and IL-8.29 In addition, PMNs posses IL-2Rβ chain30,31 and IL-2Rγ chain32 that have the ability to bind with IL-4.33 These published data prompted us to study the effect of IL-4 on PMNs functions.

When comparing the number of monocytes and PMNs required to induce T-cell proliferation, it was observed that 10 times more PMNs than monocytes were necessary to yield the same extent of T-cell proliferation. However, the cell preparation used in this work never contained more than 1% of contaminating cells and certainly not the 10% of monocytes that would be required to affect the results.30 The observation that ten times more PMNs than monocytes were required to induce a similar extent of T-cell proliferation has to be considered together with the observation that only a proportion of PMNs acquired HLA class II. Thus, when only fully equipped PMNs are considered, the ability to process and to present antigen is similar to that of monocytes. Whether HLA class II-positive PMNs participate in the immune defence or play a role in pathophysiological events, is a matter of speculation. The fact that only a minor proportion of PMNs acquire HLA class II might lead to the conclusion that a possible accessory function of PMNs would be rather weak. One has; however, to bear in mind that PMNs are numerous in the peripheral blood, and that even a low percentage of PMNs expressing HLA class II would exceed both circulating monocytes and dendritic cells in number.

Due to the notion that the presence of Staphylococcus entrotoxin coincides with relapses of Wegener's granulomatosis,34 we tested whether PMNs was able to also present Staphylococcus enterotoxin A as a superantigen, so-called because it binds outside of the peptide-binding groove of the HLA class II and the antigen-specific domain of the T-cell receptor, and consequently activates a large portion of T-cells, preferentially those with a V beta 2 domain.35 In accordance with previous studies,8,36 co-culture of PMNs with T-cells and SEA resulted in T-cell proliferation. Taken together, our data demonstrate that by synthesizing and expressing of HLA class II antigens, CD80 and CD86; PMNs acquire the capacity to present superantigens to T-cells.

Data showed that there is a clear increase in T-lymphocyte proliferation in the co-culture of stimulated PMNs+T-cells. Because there is no antigen present, this means that it is not caused by the co-stimulatory molecules on the surface of the PMNs but probably due to mediators secreted by the PMNs. Furthermore, unstimulated PMNs+T-cells+SEA give almost a 1000-fold increase of T-cell proliferation while only a few percent of PMNs express co-stimulatory molecules in a naive state. Probably the results obtained are both from released mediators and the co-stimulatory molecules. Mediators secreted by IL-4 stimulated PMNs will be investigated in our future research.

In conclusion, stimulated PMNs with IL-4 lead to expression of the antigen presenting molecules (HLA class II) and the co-stimulatory molecules (CD80 and CD86). These molecules play an important role in antigen presentation and consequently T-cell proliferation in the presence of SEA. This means that IL-4 stimulated PMNs might be involved indirectly in acquired immune response in addition to their role in innate immunity.

Conflict of interest

The authors have no conflict of interest to declare.

Acknowledgements

I thank Prof. Dr. El-Feki M.A. (Zoology Department, Faculty of Science, El-Minia University, El-Minia, Egypt) for revising the manuscript. I also thank Dr. Shaban H.A. (Zoology Department, Faculty of Science, El-Minia University, El-Minia, Egypt) for his efforts in data analysis.

References
[1]
L. Gasmi, A.G. McLennan, S.W. Edwards.
The diadenosine polyphosphates Ap3A and Ap4A and adenosine triphosphate interact with granulocyte-macrophage colony-stimulating factor to delay neutrophil apoptosis: implications for neutrophil platelet interactions during inflammation.
Blood, 87 (1996), pp. 3442-3449
[2]
C.F. Fortin, A. Larbi, G. Dupuis, O. Lesur, T. Fülöp Jr..
GM-CSF activates the Jak/STAT pathway to rescue polymorphonuclear neutrophils from spontaneous apoptosis in young but not elderly individuals.
Biogerontology, 8 (2007), pp. 173-187
[3]
M.F. Alves Rosa, M. Vulcano, F.S. Minnucci, P.D. Di Gianni, M.A. Isturiz.
Inhibition of Fc gamma R-dependent functions by N-formylmethionylleucylphenylalanine in human neutrophils.
Clin Immunol Immunopathol, 83 (1997), pp. 147-155
[4]
K.C. Petroni, L. Shen, P.M. Guyre.
Modulation of human polymorphonuclear leukocyte IgG Fc receptors and Fc receptor-mediated and glucocorticoids functions by IFN-γ.
J Immunol, 140 (1988), pp. 3467-3472
[5]
A.R. Lloyd, J.J. Oppenheim.
Poly's lament, the neglected role of the polymorphonuclear neutrophil in the afferent limb of the immune response.
Immunol Today, 13 (1992), pp. 169-172
[6]
C. Iking-konert, C. Wagner, B. Denefleh, F. Hug, M. Schneider, K. Andrassy, et al.
Up-regulation of the dendritic cell marker CD83 on polymorphonuclear neutrophils (PMNs): divergent expression in acute bacterial infections and chronic inflammatory disease.
Clinical Exp Immunol, 130 (2002), pp. 501-508
[7]
N. Vachiery, P. Totte, V. Balcer, D. Martinez, A. Bensaid.
Effect of isolation techniques, in vitro culture and IFN-γ treatment on the constitutive expression of HLA class I and class II molecules on goat neutrophils.
Vet Immunol Immunopathol, 70 (1999), pp. 19-32
[8]
M. Radsak, C. Iking-koner, S. Stegmaie, K. Andrass, G.M. Hänsch.
Polymorphonuclear neutrophils as accessory cells for T-cell activation: major histocompatibility complex class II restricted antigen-dependent induction of T cell proliferation.
Immunology, 101 (2000), pp. 521-530
[9]
C. Iking-Konert, S. Vogt, M. Radsak, C. Wagner, G.M. Hänsch, K. Andrassy.
Polymorphonuclear neutrophils in Wegener's granulomatosis acquire characteristics of antigen presenting cells.
Kidney Int, 60 (2001), pp. 2247-2262
[10]
A.W. Tyler, K.B. Terry, A.B. Lorne, J.G. Philip.
Bovine polymorphonuclear cells passively acquire membrane lipids and integral membrane proteins from apoptotic and necrotic cells.
J Leukoc Biol, 79 (2006), pp. 1226-1233
[11]
C. Shauna, R.M. Owain, M.B. James, B.M. Iain.
Murine neutrophils present class II restricted antigen.
Immunol Lett, 118 (2008), pp. 49-54
[12]
A. Lavoie-Lamoureux, K. Moran, G. Beauchamp, S. Mauel, F. Steinbach, J. Lefebvre-Lavoie, et al.
IL-4 activates equine neutrophils and induces a mixed inflammatory cytokine expression profile with enhanced neutrophil chemotactic mediator release ex vivo.
Am J Physiol Lung Cell Mol Physiol, 299 (2010), pp. 472-482
[13]
K.A. Bahaa, E. Hossam.
Up-regulation of major histocompatibility complex class II, CD83, CD64 and CD14 on polymorphonuclear neutrophils stimulated with interleukin-15.
J Microbiol Immunol Infect, 41 (2008), pp. 462-468
[14]
W. Holter.
Interleukin-4: structure and function.
Cytokines in health and disease, pp. 53
[15]
W.E. Paul.
Interleukin-4: a prototypic immunoregulatory lymphokine.
Blood, 77 (1991), pp. 1859-1870
[16]
R.L. Idzerda, C.J. March, B. Mosley, S.D. Lyman, T. Vanden Bos, S.D. Gimpel, et al.
Human interleukin-4 receptor confers biological responsiveness and defines a novel receptor superfamily.
J Exp Med, 171 (1990), pp. 861-873
[17]
G. Aversa, J. Punnonen, B.G. Cocks, R. de Waal Malefyt, F. Vega Jr, S.M. Zurawski, et al.
An interleukin 4 (IL-4) mutant protein inhibits both IL-4 and IL-13-induced human immunoglobulin G4 (IgG4) and IgE synthesis and B cell proliferation: support for a common component shared by IL-4 and IL-13 receptors.
J Exp Med, 178 (1993), pp. 2213-2218
[18]
J. Savill.
Apoptosis in resolution of inflammation.
J Leukoc Biol, 61 (1997), pp. 375-380
[19]
P.E. Newburger, B.K. Subrahmanyam, S.M. Weissman.
Global analysis of neutrophil gene expression.
Curr Opin Hematol, 7 (2000), pp. 16-20
[20]
F. Colotta, F. Re, N. Polentarutti, S. Sozanni, A. Mantovani.
Modulation of granulocyte survival and programmed cell death by cytokines and bacterial products.
Blood, 80 (1992), pp. 2012-2020
[21]
L.M. Biasucci, G. Liuzzo, S. Giubilato, B.R. Della, M. Leo, M. Pinnelli, et al.
Delayed neutrophil apoptosis in patients with unstable angina: relation to C-reactive protein and recurrence of instability.
Eur Heart J, 30 (2009), pp. 2220
[22]
A. Lee, M.B.K. Whyte, C. Haslett.
Inhibition of apoptosis and prolongation of neutrophil functional longevity by inflammatory mediators.
J Leukoc Biol, 54 (1993), pp. 283-288
[23]
W.L. Biffl, E.E. Moore, F.A. Moore, C.C. Barnett, V.S. Carl, V.M. Peterson.
Interleukin-6 delays neutrophil apoptosis.
Arch Surg, 131 (1996), pp. 24-30
[24]
L.L. Lanier, S. O’Fallon, C. Somoza, J.H. Phillips, P.S. Linsley, K. Okumura, et al.
CD80 (B7) and CD86 (B70) provide similar costimulatory signals for T-cell proliferation, cytokine production, and generation of CTL.
J Immunol, 154 (1995), pp. 97-105
[25]
W. Reinisch, W. Tillinger, C. Lichtenberger, A. Gangl, M. Willheim, O. Scheiner, et al.
In vivo induction of HLA-DR on human neutrophils in patients treated with interferon-γ.
Blood, 87 (1996), pp. 3067-3068
[26]
E.J. Gosselin, K. Wardwell, W.F. Rigby, P.M. Guyre.
Induction of HLA class II on human polymorphonuclear neutrophils by granulocyte/macrophage colony-stimulating factor, IFN-gamma, and IL-3.
J Immunol, 151 (1993), pp. 1482-1490
[27]
S.P. Mudzinski, T.P. Christian, E. Guo, E. Cirenza, K.R. Hazlett, E.J. Gosselin.
Expression of MHC-DR (major histocompatibility complex class II) on neutrophils from patients treated with granulocyte-macrophage colony-stimulating factor for mobilization of stem cells.
Blood, 86 (1995), pp. 2452-2453
[28]
W.B. Smith, L. Guida, Q. Sun, E.L. Korpelainen, C. van den Heuvel, D. Gillis, et al.
Neutrophils activation by granulocyte-macrophage colony-stimulating factor express receptors for interleukin-3 which mediate class II expression.
Blood, 86 (1995), pp. 3938-3944
[29]
J.Y. Djeu, K. Matshushima, J.J. Oppenheim, K. Shiotsuki, D.K. Blanchard.
Functional activation of human neutrophils by recombinant monocyte-derived neutrophil chemotactic factor IL-8.
J Immunol, 144 (1990), pp. 2205-2210
[30]
K.A. Bahaa.
T-cells proliferation by stimulated polymorphonuclear neutrophils in presence of superantigen.
Assuit Univ J Zool, 1 (2009), pp. 143-158
[31]
J.Y. Djeu, J.H. Liu, S. Wie, H. Rui, C.A. Pearson, W.J. Leonard, et al.
Function on human neutrophils: mechanism of activation associated with IL-2 receptor β of antifungal activity against Candida albicans by IL-2.
J Immunol, 150 (1993), pp. 960-970
[32]
J.H. Liu, S. Wei, D. Ussery, P.K. Epling-Burnette, W.J. Leonard, J.Y. Djeu.
Expression of interleukin-2 receptor gamma chain on human neutrophils.
Blood, 84 (1994), pp. 3870-3875
[33]
H.Y. Wang, W.E. Paul, A.D. Keegan.
IL-4 function can be transferred to the IL-2 receptor by tyrosine containing sequences found in the IL-4 receptor α chain.
Immunity, 4 (1996), pp. 113-121
[34]
J.W. Cohn-Terveart, E.R. Popa, N.A. Bos.
The role of superantigen in vasculitis.
Curr Opin Rheumatol, 11 (1999), pp. 24-33
[35]
I.J. Simpson, M.A. Skinner, A. Geursen.
Peripheral blood T-lymphocytes in systemic vasculitis: increased T-cell receptor V beta 2 gene usage in microscopic polyarteritis.
Clin Exp Immunol, 101 (1995), pp. 220-226
[36]
N.A. Fanger, C. Liu, P.M. Guyre, K. Wardwell, J. O’Neil, T.L. Guo, et al.
Activation of human T cells by major histocompatibility complex class II-expressing neutrophils: proliferation in the presence of superantigen, but not tetanus toxoid.
Blood, 89 (1997), pp. 4128-4135
Copyright © 2010. SEICAP
Download PDF
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Quizás le interese:
10.1016/j.aller.2020.01.003
No mostrar más