Allicin prevents H2O2-induced apoptosis of HUVECs by inhibiting an oxidative stress pathway
- Sisi Chen†1,
- Yuye Tang†2,
- Ying Qian1,
- Ruyi Chen1,
- Lin Zhang1Email author,
- Like Wo3Email author and
- Hui Chai1Email author
© Chen et al.; licensee BioMed Central Ltd. 2014
Received: 17 July 2014
Accepted: 27 August 2014
Published: 30 August 2014
Allicin, a primary ingredient of garlic, has been proposed to possess cardioprotective properties, which are commonly mediated by improved endothelial function.
To investigate the effect and mechanism of allicin on the apoptosis of human umbilical vein endothelial cells (HUVECs), we used Propidium iodide (PI) staining and Annexin V/ PI staining assays to establish a model of oxidative stress apoptosis induced by H2O2. MTT, RT-PCR and western-blot assays were used to detect the effects and mechanism of allicin on the model.
PI staining, Annexin V/ PI staining assays and morphological assessment suggest that the cell death induced by 0.5 mM H2O2 is primarily apoptotic. Conversely, allicin reverses the effect of H2O2 on cell death, suggesting a role in protecting HUVECs from apoptosis. We demonstrated that H2O2 activates PARP cleavage, reduces pro-Caspase-3 levels and activates Bax expression; however, allicin inhibits each of these apoptotic signaling indicators. Allicin also reduces the levels of malondialdehyde and increases the levels of superoxide dismutase, nitric oxide release and endothelial nitric oxide synthase mRNA, but has no significant effect on inducible nitric oxide synthase mRNA levels.
These results demonstrate that allicin has powerful effects in protecting HUVECs from apoptosis and suggest that protection occurs via a mechanism involving the protection from H2O2-mediated oxidative stress.
KeywordsAllicin Human umbilical vein endothelial cell (HUVEC) Anti-apoptosis H2O2
Cardiovascular diseases (CVDs) are a category of chronic noncommunicable diseases causing high global mortality and have been a heavy social burden in many countries [1, 2]. Atherosclerosis - a progressive disease characterized by the accumulation of lipids and fibrous elements in the large arteries - constitutes the single most important contributor to this growing burden of cardiovascular disease . Endothelial dysfunction is considered an early indicator of atherosclerosis, preceding angiographic or ultrasonic evidence of atherosclerotic plaques . In addition to managing anabolism and exchange of blood and tissue fluids, endothelial cells also act as an endocrine gland. Endothelial cells produce and secrete multiple biologically active substances that help to maintain normal angiostasis and balance of blood. Considerable evidence indicates that oxidized low-density lipoprotein (ox-LDL) can cause the apoptosis of vascular endothelial cells through multiple pathways . However the production process of ox-LDL is complicated, and it is stable for only 1 month at 4°C. Conversely, H2O2 is economical, simple and practical, so it is commonly used in injury models to replicate the effects of ox-LDL [6, 7].
Natural antioxidants are important for the prevention and treatment of atherosclerosis. Garlic has been studied extensively for its cardioprotective properties with very promising results . Its primary active ingredient, 2-propene-1-sulfinothioic acid S-2-propenyl ester (also known as allicin), has been shown to alter the composition of fatty acids in mice or rats fed a high fatty acid diet [9, 10]. The aim of present study was to use H2O2 instead of ox-LDL to establish a model of oxidative stress and apoptosis in which to observe the intervention effect of allicin on endothelial cell apoptosis. The characterization of a new antioxidant drug may be beneficial as a novel strategy for the treatment of atherosclerosis.
HUVECs were obtained from Cambrex (Shanghai Biological Technology Co., Ltd., China) and were grown in Dulbecco's modified eagle medium (DMEM) supplemented with 10% heat-inactivated FBS (Hangzhou Sijiqing biological engineering materials Co., Ltd., China) at 37°C in a humidified atmosphere of 5% CO2. Cells were used at passage 4–6 for all experiments.
Propidium iodide (PI) staining
HUVECs were cultured in 6 well plates (BD Falcon, USA) at a density of 2.0 × 105 cells/well in DMEM supplemented with 10% FBS. One day after plating, the cells were washed and incubated in serum-free medium for 12 hours. The cells were then washed again and incubated with medium containing various concentrations of H2O2 (0.1, 0.5, 1.0 mM) for 12 hours. The cells were trypsinized, washed with PBS, and centrifuged at 1000 rpm/min for 5 min. The cells were then resuspended at a density of 1 × 106 cells/ml, and the suspensions were fixed with 70% precooled ethanol at 4°C for 1 h. Next, the cells were centrifuged at 1000 rpm/min for 5 min, resuspended in 1 ml diluted PI (Shanghai Biological Technology Co., Ltd., China) and incubated in the dark at 4°C for 30 min. Flow cytometry was performed using a FACSCalibur (Backmancoulter, USA). Data were analyzed using CellQuest software (Becton–Dickinson). The amount of necrosis was determined as the percentage of PI-positive cells.
Annexin-V/PI assays were performed using a commercial apoptosis assay kit (Roche, Switzerland) according to the manufacturer's instructions. Briefly, HUVECs were cultured in 6 well plates (BD Falcon, USA) at a density of 2.0 × 105 cells/well and incubated in DMEM supplemented with 10% FBS. One day later, the cells were washed and incubated in serum-free medium for 12 hours. The cells were then washed again and incubated in medium with various concentrations of H2O2 (0.1, 0.5, 1.0 mM) for 12 hours. After incubation, the cells were trypsinized and washed with PBS. After centrifugation at 1000 rpm/min for 5 min, the cells were resuspended in 500 μL binding buffer at a concentration of 1 × 106 cells/ml. The suspensions were transferred to 1.5-mL tubes, and 5 μL of Annexin V and 10 μL of PI solution were added. The cells were incubated in the dark at room temperature for 20 min, and flow cytometry was performed using a FACSCalibur (Beckmancoulter, USA). Data were analyzed using CellQuest software (Becton–Dickinson). The amount of apoptosis was determined as the percentage of annexin V-positive cells/PI-negative cells.
As a measure of overall levels of cell death, HUVECs were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. HUVECs were plated onto 96-well plates and incubated in DMEM supplemented with 10% FBS. One day later, the cells were washed and incubated in serum-free medium for 12 hours. The cells were then were randomly divided into 6 groups: the normal control group (untreated cells), the model control group (H2O2 only), and the H2O2 plus allicin (98% purity, Shaanxi Ciyuan Biotech Co., Ltd, China) groups (1 μg/mL, 10 μg/mL, 20 μg/mL or 40 μg/mL allicin). These concentrations of allicin were selected to reflect a range of biological activities of the drug in HUVECs. Thirty minutes prior to the end of the incubation period, MTT was diluted 1:500 in 0.5% FBS DMEM culture medium and 200 μl was administered to each well. The plates were wrapped in aluminum foil to protect them from light and read using an enzyme-labeled instrument (Biotek ELX 800/FLX800).
Western blot assay
For the extraction of proteins, cells were placed in RIPA Lysis Buffer (Beyotime Institute of Biotechnology, China) and centrifuged at 13000 rpm/min for 30 min at 4°C. Protein concentrations were assayed with a NanoDrop instrument, and 40 μg of protein from each sample were run on a 15% SDS-PAGE gels. The separated proteins were transferred onto PVDF membranes. After blocking with 5% nonfat dry milk in double-distilled water at room temperature for 1 h, membranes were washed 3 times with PBS containing 0.05% Tween (PBS-T) and incubated overnight at 4°C with primary mouse monoclonal antibody (anti-PARP, anti-pro-Caspase-3, anti-Bax or anti-β-actin) (Santa Cruz Biotechnology, USA) at a 1:500 dilution. The membranes were washed 3 times with PBS-T, followed by 1 h incubation at room temperature in a 1:5000 dilution of goat anti-mouse-IgG-HRP (Santa Cruz Biotechnology, USA). After incubation, membranes were washed 3 times in PBS-T. Antigen-antibody complexes were analyzed by ECL, and protein levels were quantified by densitometry. Data were normalized to the β-actin content of the same sample.
Measurement of oxidative activity
The concentrations of malondialdehyde (MDA), sodium oxide dismutase (SOD) and nitric oxide (NO) were assessed using dedicated kits (Nanjing Jiancheng Biological Engineering Institute, China) according to the manufacturer’s protocols.
Reverse transcription PCR (RT-PCR) assay
Total cellular RNA was extracted from HUVECs by the Trizol method (Bio Basic Inc., Canada). PCR amplification was performed in a 20 μL reaction volume. The primer sequences were as follows: eNOS forward, 5’-CCAGCTAGCCAAAGTCACCAT-3’, eNOS reverse, 5’-GTCTCGGAGCCATACAGGATT-3’; iNOS forward, 5’-AGCGGTAACAAAGGAGATAG-3’, iNOS reverse, 5’-CCCGAAACCACTCGTATT-3’; GAPDH forward, 5’-GTCATCCATGACAACTTTGG-3’, GAPDH reverse, 5’-GAGCTTGACAAAGTGGTCGT-3’. After an initial denaturation at 95°C for 5 min, the PCR conditions were as follows: 35 cycles of denaturation at 95°C for 30 s, annealing at 55°C for 30 s, and extension at 72°C for 30s. The PCR products were electrophoresed on a 1% agarose, and stained with ethidium bromide solution.
Real-time quantitative PCR assay
Levels of endothelial nitric oxide (eNOS) mRNA expression were determined by real-time quantitative PCR. Triplicate reactions were run in a volume of 20 μL, containing 2 μL cDNA, 10 μL 2 × SYBR Green mix, 6 μL ddH2O, 1 μL PCR forward primer (10 μM), and 1 μL PCR reverse primer (10 μM). After an initial denaturation at 95°C for 5 min, the PCR conditions were as follows: 35 cycles of denaturation at 95°C for 30 s, annealing at 55°C for 30 s, and extension at 72°C for 30s.
The ΔΔCt (threshold cycle) method was used to calculate eNOS mRNA expression levels for each sample, with GAPDH as the reference gene.
All data are expressed as mean ± SEM. Statistical analysis was performed using the Student’s t-test and ANOVA. Significance was accepted at p <0.05.
H2O2 promotes apoptotic cell death of HUVECs
To characterize the effects of H2O2 in inducing cell death of HUVECs, we assessed morphological changes 12 h after exposure to a range of doses of H2O2 (0.1 mM, 0.5 mM and 1.0 mM). H2O2 promoted clear morphological changes to the cells, including cell shrinkage, karyopyknosis, and irregular nuclei. These results suggest that H2O2 induces programmed cell death in HUVECs.
The positive rate of PI of HUVEC cells in each group
Group (n = 3)
Necrosis rate (%)
2.5 ± 1.7
0.1 mmol/L H2O2
7.9 ± 1.0*
0.5 mmol/L H2O2
8.1 ± 2.1*
1.0 mmol/L H2O2
25.7 ± 2.5**
On the basis of the data in the PI staining and Annexin V/PI staining assays, we selected 0.5 mM H2O2 as a model dose that primarily causes apoptosis over necrosis for subsequent studies of apoptotic cell death.
Allicin inhibits H2O2-induced HUVEC cell death
Allicin inhibits the activation of an apoptotic cell death pathway by H2O2
Allicin decreases oxidative activity in HUVECS by H2O2
To determine whether the effects on oxidative stress may be mediated by SOD, an enzyme that regulates oxidative stress , we measured SOD levels in HUVECs following H2O2 and allicin exposure. H2O2 significant decreased in SOD levels, and these levels were increased by concomitant allicin exposure (Figure 4B).
The effects of allicin on oxidative activity were further verified by assessing levels of NO, a free radical signaling mediator . NO levels were significantly decreased in H2O2-induced HUVECs, and this decrease was reversed in a dose-dependent manner by allicin (Figure 4C).
Apoptosis, a form of programmed cell death, is directly or indirectly regulated at the genetic level, as opposed to necrosis, which is based on extrinsic factors and for which the cell has no active role . Apoptosis plays an important role in tissue remodeling, aging and response, and irreversible damage; and abnormal apoptosis may be the cause of many diseases.
Allium sativum (Liliaceae), whose common name is garlic, is an ancient spice and a medicine used for centuries around the world. Allicin (2-propene-1-sulfinothioic acid S-2-propenyl ester) is a key molecule of garlic and is responsible for the pungent smell of garlic . A role for allicin has been widely demonstrated in cardiovascular prevention [21–27], but the specific role of allicin as the compound corresponding to this effect and its mechanisms have not been elucidated.
H2O2 has the same oxidation resistance as ox-LDL, is easier to produce, and is well established as a common model for oxidative injury [6, 7]. Consequently, we established a HUVEC oxidative stress model by using H2O2 instead of ox-LDL to induce HUVEC apoptosis. We determined the effect and mechanism of allicin on apoptosis of HUVECs induced by H2O2 at 0.1 - 0.5 mM. PI staining and Annexin-V/PI assay demonstrated that the apoptosis rate was increased, but an increase in the secondary mortality was not obvious. When the concentration of H2O2 was increased to 1 mM, the apoptosis rate was increased, but secondary mortality was also increased significantly. For this reason, we selected 0.5 mM H2O2 as an appropriate concentration for inducing optimal apoptosis, with minimal amounts of secondary necrosis.
MTT assay demonstrated that allicin effectively reduces the apoptosis of HUVECs induced by H2O2 in a dose-dependent manner. These results were verified by Western blotting, which suggests that allicin stabilizes pro-Caspase-3 protein expression and reduces PARP and Bax protein expression. Caspases are a well-characterized group of cysteine proteases, which are related in structure and reside in the cytosol. A common feature of caspases is the ability to disconnect the aspartic acid residue peptide bond. Of the 11 caspases, Caspase-3 is considered the main terminal cleavage enzyme in the apoptosis process . Furthermore, Caspase-3 is responsible for the cleavage of the DNA repair enzyme PARP, which is another hallmark of apoptosis . Therefore, our findings that allicin reduces the cleavage of Caspase-3 and PARP are consistent with a role for allicin in preventing apoptosis. Furthermore, Bax is a member of the Bcl-2 family that regulates apoptosis by controlling mitochondrial membrane channels. Bax was the first pro-apoptotic member of this family that was identified, and its expression is increased by a variety of well-characterized apoptotic agents, including H2O2. Therefore, the ability of allicin to reduce Bax activation also supports the idea that allicin protects HUVECs from apoptosis caused by H2O2.
We also demonstrated that allicin effectively reduces levels of MDA, a biomarker of oxidative stress, while simultaneously increasing the activity of SOD, an antioxidant enzyme. MDA levels indirectly reflect the severity of attack in cells by free radicals, and SOD activity levels indirectly reflect the capability of scavenging oxygen free radicals [14, 15]. Therefore, these findings suggest that allicin protects HUVECs by preventing oxidative stress. In addition to increasing antioxidant activity, allicin may be involved in the scavenging of oxygen free radicals, prevention of lipid peroxidation, and stabilization of the cell membrane.
Our results further show that H2O2 dramatically decreases nitric oxide (NO) levels in HUVEC culture medium, while allicin leads to increased NO. NO is an endogenous vascular relaxing factor that is produced in endothelial cells. It serves as a ubiquitin signaling molecule and regulates angiostasis in blood vessels and apoptosis in many cells . H2O2 also up-regulates the expression of cell adhesion molecules. Activation of neutrophils induces the formation of non-ion-dependent NOS, and consumes a large amount of L-Arg. H2O2 also prompts an increase in calcium, which generates a large amount of O2− to directly inactivate NO by activating the xanthine/xanthine oxidase system . Therefore, the increased release of NO by allicin may serve to reverse the effects of H2O2 and protect cells through its antioxidant activity. H2O2 may also decrease NO release through its effects on the expression of eNOS, an enzyme that activates NO production . We have shown by both reverse transcription PCR and real-time quantitative PCR that allicin reverses this decrease in eNOS mRNA expression, which suggests an additional mechanism that may regulate its ability to increase the release of NO and decrease the apoptosis rate. These results demonstrate that allicin protects HUVECs from apoptosis and elucidate a pathway by which protection is mediated via the reduction in oxidative stress.
Allicin has powerful effects in protecting HUVECs from apoptosis. The protection occurs via a mechanism involving the reduction in oxidative stress, as measured by increased SOD and reduced MDA, NO and eNOS. There finding suggest that allicin functions as a powerful antioxidant. Further studies will be necessary to determine the direct effects of allicin on atherosclerosis.
This work was supported by Zhejiang Provincial Natural Science Foundation of China (LQ13H310003, LY13H020007, LY14H290003), the Research Foundation of Education Bureau of Zhejiang Province, China (Y20096333, Y200906336), and the fund of Zhejiang province for medical sciences (2009B114).
- Chan JY, Yuen AC, Chan RY, Chan SW: A review of the cardiovascular benefits and antioxidant properties of allicin. Phytother Res. 2013, 27 (5): 637-646. 10.1002/ptr.4796.View ArticlePubMedGoogle Scholar
- Lusis AJ: Atherosclerosis. Nature. 2000, 407 (6801): 233-241. 10.1038/35025203.View ArticlePubMedPubMed CentralGoogle Scholar
- Libby P: Inflammation in atherosclerosis. Nature. 2002, 420 (6917): 868-874. 10.1038/nature01323.View ArticlePubMedGoogle Scholar
- Herman AG, Moncada S: Therapeutic potential of nitric oxide donors in the prevention and treatment of atherosclerosis. Eur Heart J. 2005, 26 (19): 1945-1955. 10.1093/eurheartj/ehi333.View ArticlePubMedGoogle Scholar
- Osterud B, Bjorklid E: Role of monocytes in atherogenesis. Physiol Rev. 2003, 83 (4): 1069-1112.View ArticlePubMedGoogle Scholar
- Wang YK, Hong YJ, Wei M, Wu Y, Huang ZQ, Chen RZ, Chen HZ: Curculigoside attenuates human umbilical vein endothelial cell injury induced by H2O2. J Ethnopharmacol. 2010, 132 (1): 233-239. 10.1016/j.jep.2010.08.008.View ArticlePubMedGoogle Scholar
- Roberto D, Micucci P, Sebastian T, Graciela F, Anesini C: Antioxidant activity of limonene on normal murine lymphocytes: relation to H2O2 modulation and cell proliferation. Basic Clin Pharmacol Toxicol. 2010, 106 (1): 38-44.PubMedGoogle Scholar
- Arzanlou M, Bohlooli S, Jannati E, Mirzanejad-Asl H: Allicin from garlic neutralizes the hemolytic activity of intra- and extra-cellular pneumolysin O in vitro. Toxicon. 2011, 57 (4): 540-545. 10.1016/j.toxicon.2010.12.009.View ArticlePubMedGoogle Scholar
- Eilat S, Oestraicher Y, Rabinkov A, Ohad D, Mirelman D, Battler A, Eldar M, Vered Z: Alteration of lipid profile in hyperlipidemic rabbits by allicin, an active constituent of garlic. Coron Artery Dis. 1995, 6 (12): 985-990.PubMedGoogle Scholar
- Abramovitz D, Gavri S, Harats D, Levkovitz H, Mirelman D, Miron T, Eilat-Adar S, Rabinkov A, Wilchek M, Eldar M, Vered Z: Allicin-induced decrease in formation of fatty streaks (atherosclerosis) in mice fed a cholesterol-rich diet. Coron Artery Dis. 1999, 10 (7): 515-519. 10.1097/00019501-199910000-00012.View ArticlePubMedGoogle Scholar
- Oliver FJ, de la Rubia G, Rolli V, Ruiz-Ruiz MC, De Murcia G, Murcia JM: Importance of poly (ADP-ribose) polymerase and its cleavage in apoptosis. Lesson from an uncleavable mutant. J Biol Chem. 1998, 273 (50): 33533-33539. 10.1074/jbc.273.50.33533.View ArticlePubMedGoogle Scholar
- Boulares AH, Yakovlev AG, Ivanova V, Stoica BA, Wang G, Iyer S, Smulson M: Role of poly (ADP-ribose) polymerase (PARP) cleavage in apoptosis. Caspase 3-resistant PARP mutant increases rates of apoptosis in transfected cells. J Biol Chem. 1999, 274 (33): 22932-22940. 10.1074/jbc.274.33.22932.View ArticlePubMedGoogle Scholar
- Hoetelmans R, Van Slooten HJ, Keijzer R, Erkeland S, van de Velde CJ, Dierendonck JH: Bcl-2 and Bax proteins are present in interphase nuclei of mammalian cells. Cell Death Differ. 2000, 7 (4): 384-392. 10.1038/sj.cdd.4400664.View ArticlePubMedGoogle Scholar
- Liu YZ TB, Zheng YL, Ma KJ, Xu SZ, Qiu FZ: Screening methods for waterlogging tolerance at maize (Zea mays L. ) seedling stage. Agric Sci. 2010, 9 (3): 362-369.Google Scholar
- Du XMYW, Zhang H: The progress of super oxide dismutase. J China Biotechnol. 2002, 23 (1): 77-79.Google Scholar
- Liao JK, Shin WS, Lee WY, Clark SL: Oxidized low-density lipoprotein decreases the expression of endothelial nitric oxide synthase. J Biol Chem. 1995, 270 (1): 319-324. 10.1074/jbc.270.1.319.View ArticlePubMedGoogle Scholar
- Chen CA, Wang TY, Varadharaj S, Reyes LA, Hemann C, Talukder MA, Chen YR, Druhan LJ, Zweier JL: S-glutathionylation uncouples eNOS and regulates its cellular and vascular function. Nature. 2010, 468 (7327): 1115-1118. 10.1038/nature09599.View ArticlePubMedPubMed CentralGoogle Scholar
- Knowles RG, Moncada S: Nitric oxide synthases in mammals. Biochem J. 1994, 298 (Pt 2): 249-258.View ArticlePubMedPubMed CentralGoogle Scholar
- Lockshin RA, Zakeri Z: Programmed cell death and apoptosis: origins of the theory. Nat Rev Mol Cell Biol. 2001, 2 (7): 545-550. 10.1038/35080097.View ArticlePubMedGoogle Scholar
- Chu YL, Ho CT, Chung JG, Rajasekaran R, Sheen LY: Allicin induces p53-mediated autophagy in Hep G2 human liver cancer cells. J Agric Food Chem. 2012, 60 (34): 8363-8371. 10.1021/jf301298y.View ArticlePubMedGoogle Scholar
- Al-Qattan KK, Alnaqeeb MA, Ali M: The antihypertensive effect of garlic (Allium sativum) in the rat two-kidney–one-clip Goldblatt model. J Ethnopharmacol. 1999, 66 (2): 217-222. 10.1016/S0378-8741(98)00173-1.View ArticlePubMedGoogle Scholar
- Yin MCCW: Antioxidant activity of several Allium members. J Agric Food Chem. 1998, 46 (10): 4097-4101. 10.1021/jf980344x.View ArticleGoogle Scholar
- Gardner CD, Chatterjee LM, Carlson JJ: The effect of a garlic preparation on plasma lipid levels in moderately hypercholesterolemic adults. Atherosclerosis. 2001, 154 (1): 213-220. 10.1016/S0021-9150(00)00466-4.View ArticlePubMedGoogle Scholar
- Vimal V, Devaki T: Hepatoprotective effect of allicin on tissue defense system in galactosamine/endotoxin challenged rats. J Ethnopharmacol. 2004, 90 (1): 151-154. 10.1016/j.jep.2003.09.027.View ArticlePubMedGoogle Scholar
- Prasad K, Laxdal VA, Yu M, Raney BL: Evaluation of hydroxyl radical-scavenging property of garlic. Mol Cell Biochem. 1996, 154 (1): 55-63.View ArticlePubMedGoogle Scholar
- Rabinkov A, Miron T, Mirelman D, Wilchek M, Glozman S, Yavin E, Weiner L: S-Allylmercaptoglutathione: the reaction product of allicin with glutathione possesses SH-modifying and antioxidant properties. Biochim Biophys Acta. 2000, 1499 (1–2): 144-153.View ArticlePubMedGoogle Scholar
- Agarwal KC: Therapeutic actions of garlic constituents. Med Res Rev. 1996, 16 (1): 111-124. 10.1002/(SICI)1098-1128(199601)16:1<111::AID-MED4>3.0.CO;2-5.View ArticlePubMedGoogle Scholar
- Wang J, Lenardo MJ: Roles of caspases in apoptosis, development, and cytokine maturation revealed by homozygous gene deficiencies. J Cell Sci. 2000, 113 (Pt 5): 753-757.PubMedGoogle Scholar
- Spears JR, Prcevski P, Xu R, Li L, Brereton G, DiCarli M, Spanta A, Crilly R, Lavine S, Vander Heide R: Aqueous oxygen attenuation of reperfusion microvascular ischemia in a canine model of myocardial infarction. ASAIO J. 2003, 49 (6): 716-720. 10.1097/01.MAT.0000094665.72503.3C.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6882/14/321/prepub
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.