Loading…

Tissue-Infiltrating Neutrophils Constitute the Major In Vivo Source of Angiogenesis-Inducing MMP-9 in the Tumor Microenvironment

Abstract According to established notion, one of the major angiogenesis-inducing factors, pro-matrix metalloproteinase-9 (proMMP-9), is supplied to the tumor microenvironment by tumor-associated macrophages (TAMs). Accumulated evidence, however, indicates that tumor-associated neutrophils (TANs) are...

Full description

Saved in:
Bibliographic Details
Published in:Neoplasia (New York, N.Y.) N.Y.), 2014-10, Vol.16 (10), p.771-788
Main Authors: Deryugina, Elena I, Zajac, Ewa, Juncker-Jensen, Anna, Kupriyanova, Tatyana A, Welter, Lisa, Quigley, James P
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c734t-918df9cf0a0360e96845d90b43e52268fc6e7f5b7bbc4af225ba9369d3a79df33
cites cdi_FETCH-LOGICAL-c734t-918df9cf0a0360e96845d90b43e52268fc6e7f5b7bbc4af225ba9369d3a79df33
container_end_page 788
container_issue 10
container_start_page 771
container_title Neoplasia (New York, N.Y.)
container_volume 16
creator Deryugina, Elena I
Zajac, Ewa
Juncker-Jensen, Anna
Kupriyanova, Tatyana A
Welter, Lisa
Quigley, James P
description Abstract According to established notion, one of the major angiogenesis-inducing factors, pro-matrix metalloproteinase-9 (proMMP-9), is supplied to the tumor microenvironment by tumor-associated macrophages (TAMs). Accumulated evidence, however, indicates that tumor-associated neutrophils (TANs) are also critically important for proMMP-9 delivery, especially at early stages of tumor development. To clarify how much angiogenic proMMP-9 is actually contributed by TAMs and TANs, we quantitatively evaluated TAMs and TANs from different tumor types, including human xenografts and syngeneic murine tumors grown in wild-type and Mmp9 -knockout mice. Whereas host MMP-9 competence was required for full angiogenic potential of both normal and tumor-associated leukocytes, direct comparisons of neutrophils versus macrophages and TANs versus TAMs demonstrated that macrophages and TAMs secrete 40- to 50-fold less proMMP-9 than the same numbers of neutrophils or TANs. Correspondingly, the levels of MMP-9–mediated in vivo angiogenesis induced by neutrophils and TANs substantially exceeded those induced by macrophages and TAMs. MMP-9–delivering TANs were also required for development of metastasis-supporting intratumoral vasculature, characterized by ≥ 11-μm size lumens and partial coverage with stabilizing pericytes. Importantly, MMP-9–producing TAMs exhibit M2-skewed phenotype but do not express tissue inhibitor of metalloproteinases-1 (TIMP-1), a novel characteristic allowing them to secrete TIMP-1–free, neutrophil-like MMP-9 zymogen unencumbered by its natural inhibitor. Together, our findings support the notion whereby TANs, capable of immediate release of their pre-stored cargo, are the major contributors of highly angiogenic MMP-9, whereas tumor-influxing precursors of macrophages require time to differentiate, polarize into M2-skewed TAMs, shut down their TIMP-1 expression, and only then, initiate relatively low-level production of TIMP-free MMP-9 zymogen.
doi_str_mv 10.1016/j.neo.2014.08.013
format article
fullrecord <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_5aaad31b20c04e9490bc014aa3de1a37</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1476558614001195</els_id><doaj_id>oai_doaj_org_article_5aaad31b20c04e9490bc014aa3de1a37</doaj_id><sourcerecordid>1776667666</sourcerecordid><originalsourceid>FETCH-LOGICAL-c734t-918df9cf0a0360e96845d90b43e52268fc6e7f5b7bbc4af225ba9369d3a79df33</originalsourceid><addsrcrecordid>eNqFkl-L1DAUxYso7jr6AXyRPvrSMWmatEEQlsE_Azsq7OhrSNPb2Vs7yWySDuybH910Z13EB30ICeX8Tppzbpa9pGRJCRVvhqUFtywJrZakWRLKHmXntKpFwXkjHv9xPsuehTCQxNC6fpqdlZzVklB-nv3cYggTFGvb4xi9jmh3-WeYoneHaxxDvnI2RIxThDxeQ77Rg_P52ubf8ejyKzd5A7nr8wu7Q7cDCwFDMusmMxttNl8LmaO9Q7fTPqEbNN6BPaJ3dg82Ps-e9HoM8OJ-X2TfPrzfrj4Vl18-rlcXl4WpWRULSZuul6YnmjBBQIqm4p0kbcWAl6VoeiOg7nlbt62pdF-WvNWSCdkxXcuuZ2yRrU--ndODOnjca3-rnEZ198H5ndI-ohlBca11x2hbEkMqkFW6xqSMtWYdUM3q5PX65HXw7maCENUeg4Fx1KmPKagUshBiXv-XirIkgrNU3iKjJ2kKKAQP_cNfUqLmvtWgEqTmvhVpVEIS8-refmr30D0QvwtOgrcnAaRsjwheBYNgDXTowcT0ePyn_bu_aDOiRaPHH3ALYUj121SaoiqUiqireeDmeaNVmjUqOfsF1fjQ0Q</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1622065301</pqid></control><display><type>article</type><title>Tissue-Infiltrating Neutrophils Constitute the Major In Vivo Source of Angiogenesis-Inducing MMP-9 in the Tumor Microenvironment</title><source>PubMed Central Free</source><source>Elsevier ScienceDirect Journals</source><creator>Deryugina, Elena I ; Zajac, Ewa ; Juncker-Jensen, Anna ; Kupriyanova, Tatyana A ; Welter, Lisa ; Quigley, James P</creator><creatorcontrib>Deryugina, Elena I ; Zajac, Ewa ; Juncker-Jensen, Anna ; Kupriyanova, Tatyana A ; Welter, Lisa ; Quigley, James P</creatorcontrib><description>Abstract According to established notion, one of the major angiogenesis-inducing factors, pro-matrix metalloproteinase-9 (proMMP-9), is supplied to the tumor microenvironment by tumor-associated macrophages (TAMs). Accumulated evidence, however, indicates that tumor-associated neutrophils (TANs) are also critically important for proMMP-9 delivery, especially at early stages of tumor development. To clarify how much angiogenic proMMP-9 is actually contributed by TAMs and TANs, we quantitatively evaluated TAMs and TANs from different tumor types, including human xenografts and syngeneic murine tumors grown in wild-type and Mmp9 -knockout mice. Whereas host MMP-9 competence was required for full angiogenic potential of both normal and tumor-associated leukocytes, direct comparisons of neutrophils versus macrophages and TANs versus TAMs demonstrated that macrophages and TAMs secrete 40- to 50-fold less proMMP-9 than the same numbers of neutrophils or TANs. Correspondingly, the levels of MMP-9–mediated in vivo angiogenesis induced by neutrophils and TANs substantially exceeded those induced by macrophages and TAMs. MMP-9–delivering TANs were also required for development of metastasis-supporting intratumoral vasculature, characterized by ≥ 11-μm size lumens and partial coverage with stabilizing pericytes. Importantly, MMP-9–producing TAMs exhibit M2-skewed phenotype but do not express tissue inhibitor of metalloproteinases-1 (TIMP-1), a novel characteristic allowing them to secrete TIMP-1–free, neutrophil-like MMP-9 zymogen unencumbered by its natural inhibitor. Together, our findings support the notion whereby TANs, capable of immediate release of their pre-stored cargo, are the major contributors of highly angiogenic MMP-9, whereas tumor-influxing precursors of macrophages require time to differentiate, polarize into M2-skewed TAMs, shut down their TIMP-1 expression, and only then, initiate relatively low-level production of TIMP-free MMP-9 zymogen.</description><identifier>ISSN: 1476-5586</identifier><identifier>ISSN: 1522-8002</identifier><identifier>EISSN: 1476-5586</identifier><identifier>EISSN: 1522-8002</identifier><identifier>DOI: 10.1016/j.neo.2014.08.013</identifier><identifier>PMID: 25379015</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Angiogenesis Inducing Agents - metabolism ; Animals ; Cell Line, Tumor ; Humans ; Macrophages - enzymology ; Macrophages - pathology ; Male ; Matrix Metalloproteinase 9 - genetics ; Matrix Metalloproteinase 9 - metabolism ; Mice, Inbred C57BL ; Mice, Knockout ; Neovascularization, Pathologic ; Neutrophils - metabolism ; Neutrophils - pathology ; Oncology ; Prostatic Neoplasms - blood supply ; Prostatic Neoplasms - enzymology ; Prostatic Neoplasms - pathology ; Tissue Inhibitor of Metalloproteinase-1 - metabolism ; Tumor Microenvironment - physiology ; Xenograft Model Antitumor Assays</subject><ispartof>Neoplasia (New York, N.Y.), 2014-10, Vol.16 (10), p.771-788</ispartof><rights>Neoplasia Press, Inc.</rights><rights>2014 Neoplasia Press, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c734t-918df9cf0a0360e96845d90b43e52268fc6e7f5b7bbc4af225ba9369d3a79df33</citedby><cites>FETCH-LOGICAL-c734t-918df9cf0a0360e96845d90b43e52268fc6e7f5b7bbc4af225ba9369d3a79df33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1476558614001195$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3549,27924,27925,45780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25379015$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Deryugina, Elena I</creatorcontrib><creatorcontrib>Zajac, Ewa</creatorcontrib><creatorcontrib>Juncker-Jensen, Anna</creatorcontrib><creatorcontrib>Kupriyanova, Tatyana A</creatorcontrib><creatorcontrib>Welter, Lisa</creatorcontrib><creatorcontrib>Quigley, James P</creatorcontrib><title>Tissue-Infiltrating Neutrophils Constitute the Major In Vivo Source of Angiogenesis-Inducing MMP-9 in the Tumor Microenvironment</title><title>Neoplasia (New York, N.Y.)</title><addtitle>Neoplasia</addtitle><description>Abstract According to established notion, one of the major angiogenesis-inducing factors, pro-matrix metalloproteinase-9 (proMMP-9), is supplied to the tumor microenvironment by tumor-associated macrophages (TAMs). Accumulated evidence, however, indicates that tumor-associated neutrophils (TANs) are also critically important for proMMP-9 delivery, especially at early stages of tumor development. To clarify how much angiogenic proMMP-9 is actually contributed by TAMs and TANs, we quantitatively evaluated TAMs and TANs from different tumor types, including human xenografts and syngeneic murine tumors grown in wild-type and Mmp9 -knockout mice. Whereas host MMP-9 competence was required for full angiogenic potential of both normal and tumor-associated leukocytes, direct comparisons of neutrophils versus macrophages and TANs versus TAMs demonstrated that macrophages and TAMs secrete 40- to 50-fold less proMMP-9 than the same numbers of neutrophils or TANs. Correspondingly, the levels of MMP-9–mediated in vivo angiogenesis induced by neutrophils and TANs substantially exceeded those induced by macrophages and TAMs. MMP-9–delivering TANs were also required for development of metastasis-supporting intratumoral vasculature, characterized by ≥ 11-μm size lumens and partial coverage with stabilizing pericytes. Importantly, MMP-9–producing TAMs exhibit M2-skewed phenotype but do not express tissue inhibitor of metalloproteinases-1 (TIMP-1), a novel characteristic allowing them to secrete TIMP-1–free, neutrophil-like MMP-9 zymogen unencumbered by its natural inhibitor. Together, our findings support the notion whereby TANs, capable of immediate release of their pre-stored cargo, are the major contributors of highly angiogenic MMP-9, whereas tumor-influxing precursors of macrophages require time to differentiate, polarize into M2-skewed TAMs, shut down their TIMP-1 expression, and only then, initiate relatively low-level production of TIMP-free MMP-9 zymogen.</description><subject>Angiogenesis Inducing Agents - metabolism</subject><subject>Animals</subject><subject>Cell Line, Tumor</subject><subject>Humans</subject><subject>Macrophages - enzymology</subject><subject>Macrophages - pathology</subject><subject>Male</subject><subject>Matrix Metalloproteinase 9 - genetics</subject><subject>Matrix Metalloproteinase 9 - metabolism</subject><subject>Mice, Inbred C57BL</subject><subject>Mice, Knockout</subject><subject>Neovascularization, Pathologic</subject><subject>Neutrophils - metabolism</subject><subject>Neutrophils - pathology</subject><subject>Oncology</subject><subject>Prostatic Neoplasms - blood supply</subject><subject>Prostatic Neoplasms - enzymology</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Tissue Inhibitor of Metalloproteinase-1 - metabolism</subject><subject>Tumor Microenvironment - physiology</subject><subject>Xenograft Model Antitumor Assays</subject><issn>1476-5586</issn><issn>1522-8002</issn><issn>1476-5586</issn><issn>1522-8002</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNqFkl-L1DAUxYso7jr6AXyRPvrSMWmatEEQlsE_Azsq7OhrSNPb2Vs7yWySDuybH910Z13EB30ICeX8Tppzbpa9pGRJCRVvhqUFtywJrZakWRLKHmXntKpFwXkjHv9xPsuehTCQxNC6fpqdlZzVklB-nv3cYggTFGvb4xi9jmh3-WeYoneHaxxDvnI2RIxThDxeQ77Rg_P52ubf8ejyKzd5A7nr8wu7Q7cDCwFDMusmMxttNl8LmaO9Q7fTPqEbNN6BPaJ3dg82Ps-e9HoM8OJ-X2TfPrzfrj4Vl18-rlcXl4WpWRULSZuul6YnmjBBQIqm4p0kbcWAl6VoeiOg7nlbt62pdF-WvNWSCdkxXcuuZ2yRrU--ndODOnjca3-rnEZ198H5ndI-ohlBca11x2hbEkMqkFW6xqSMtWYdUM3q5PX65HXw7maCENUeg4Fx1KmPKagUshBiXv-XirIkgrNU3iKjJ2kKKAQP_cNfUqLmvtWgEqTmvhVpVEIS8-refmr30D0QvwtOgrcnAaRsjwheBYNgDXTowcT0ePyn_bu_aDOiRaPHH3ALYUj121SaoiqUiqireeDmeaNVmjUqOfsF1fjQ0Q</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Deryugina, Elena I</creator><creator>Zajac, Ewa</creator><creator>Juncker-Jensen, Anna</creator><creator>Kupriyanova, Tatyana A</creator><creator>Welter, Lisa</creator><creator>Quigley, James P</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T5</scope><scope>7TO</scope><scope>H94</scope><scope>DOA</scope></search><sort><creationdate>20141001</creationdate><title>Tissue-Infiltrating Neutrophils Constitute the Major In Vivo Source of Angiogenesis-Inducing MMP-9 in the Tumor Microenvironment</title><author>Deryugina, Elena I ; Zajac, Ewa ; Juncker-Jensen, Anna ; Kupriyanova, Tatyana A ; Welter, Lisa ; Quigley, James P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c734t-918df9cf0a0360e96845d90b43e52268fc6e7f5b7bbc4af225ba9369d3a79df33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Angiogenesis Inducing Agents - metabolism</topic><topic>Animals</topic><topic>Cell Line, Tumor</topic><topic>Humans</topic><topic>Macrophages - enzymology</topic><topic>Macrophages - pathology</topic><topic>Male</topic><topic>Matrix Metalloproteinase 9 - genetics</topic><topic>Matrix Metalloproteinase 9 - metabolism</topic><topic>Mice, Inbred C57BL</topic><topic>Mice, Knockout</topic><topic>Neovascularization, Pathologic</topic><topic>Neutrophils - metabolism</topic><topic>Neutrophils - pathology</topic><topic>Oncology</topic><topic>Prostatic Neoplasms - blood supply</topic><topic>Prostatic Neoplasms - enzymology</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Tissue Inhibitor of Metalloproteinase-1 - metabolism</topic><topic>Tumor Microenvironment - physiology</topic><topic>Xenograft Model Antitumor Assays</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Deryugina, Elena I</creatorcontrib><creatorcontrib>Zajac, Ewa</creatorcontrib><creatorcontrib>Juncker-Jensen, Anna</creatorcontrib><creatorcontrib>Kupriyanova, Tatyana A</creatorcontrib><creatorcontrib>Welter, Lisa</creatorcontrib><creatorcontrib>Quigley, James P</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Neoplasia (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Deryugina, Elena I</au><au>Zajac, Ewa</au><au>Juncker-Jensen, Anna</au><au>Kupriyanova, Tatyana A</au><au>Welter, Lisa</au><au>Quigley, James P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tissue-Infiltrating Neutrophils Constitute the Major In Vivo Source of Angiogenesis-Inducing MMP-9 in the Tumor Microenvironment</atitle><jtitle>Neoplasia (New York, N.Y.)</jtitle><addtitle>Neoplasia</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>16</volume><issue>10</issue><spage>771</spage><epage>788</epage><pages>771-788</pages><issn>1476-5586</issn><issn>1522-8002</issn><eissn>1476-5586</eissn><eissn>1522-8002</eissn><abstract>Abstract According to established notion, one of the major angiogenesis-inducing factors, pro-matrix metalloproteinase-9 (proMMP-9), is supplied to the tumor microenvironment by tumor-associated macrophages (TAMs). Accumulated evidence, however, indicates that tumor-associated neutrophils (TANs) are also critically important for proMMP-9 delivery, especially at early stages of tumor development. To clarify how much angiogenic proMMP-9 is actually contributed by TAMs and TANs, we quantitatively evaluated TAMs and TANs from different tumor types, including human xenografts and syngeneic murine tumors grown in wild-type and Mmp9 -knockout mice. Whereas host MMP-9 competence was required for full angiogenic potential of both normal and tumor-associated leukocytes, direct comparisons of neutrophils versus macrophages and TANs versus TAMs demonstrated that macrophages and TAMs secrete 40- to 50-fold less proMMP-9 than the same numbers of neutrophils or TANs. Correspondingly, the levels of MMP-9–mediated in vivo angiogenesis induced by neutrophils and TANs substantially exceeded those induced by macrophages and TAMs. MMP-9–delivering TANs were also required for development of metastasis-supporting intratumoral vasculature, characterized by ≥ 11-μm size lumens and partial coverage with stabilizing pericytes. Importantly, MMP-9–producing TAMs exhibit M2-skewed phenotype but do not express tissue inhibitor of metalloproteinases-1 (TIMP-1), a novel characteristic allowing them to secrete TIMP-1–free, neutrophil-like MMP-9 zymogen unencumbered by its natural inhibitor. Together, our findings support the notion whereby TANs, capable of immediate release of their pre-stored cargo, are the major contributors of highly angiogenic MMP-9, whereas tumor-influxing precursors of macrophages require time to differentiate, polarize into M2-skewed TAMs, shut down their TIMP-1 expression, and only then, initiate relatively low-level production of TIMP-free MMP-9 zymogen.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25379015</pmid><doi>10.1016/j.neo.2014.08.013</doi><tpages>18</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1476-5586
ispartof Neoplasia (New York, N.Y.), 2014-10, Vol.16 (10), p.771-788
issn 1476-5586
1522-8002
1476-5586
1522-8002
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_5aaad31b20c04e9490bc014aa3de1a37
source PubMed Central Free; Elsevier ScienceDirect Journals
subjects Angiogenesis Inducing Agents - metabolism
Animals
Cell Line, Tumor
Humans
Macrophages - enzymology
Macrophages - pathology
Male
Matrix Metalloproteinase 9 - genetics
Matrix Metalloproteinase 9 - metabolism
Mice, Inbred C57BL
Mice, Knockout
Neovascularization, Pathologic
Neutrophils - metabolism
Neutrophils - pathology
Oncology
Prostatic Neoplasms - blood supply
Prostatic Neoplasms - enzymology
Prostatic Neoplasms - pathology
Tissue Inhibitor of Metalloproteinase-1 - metabolism
Tumor Microenvironment - physiology
Xenograft Model Antitumor Assays
title Tissue-Infiltrating Neutrophils Constitute the Major In Vivo Source of Angiogenesis-Inducing MMP-9 in the Tumor Microenvironment
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T06%3A17%3A30IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Tissue-Infiltrating%20Neutrophils%20Constitute%20the%20Major%20In%20Vivo%20Source%20of%20Angiogenesis-Inducing%20MMP-9%20in%20the%20Tumor%20Microenvironment&rft.jtitle=Neoplasia%20(New%20York,%20N.Y.)&rft.au=Deryugina,%20Elena%20I&rft.date=2014-10-01&rft.volume=16&rft.issue=10&rft.spage=771&rft.epage=788&rft.pages=771-788&rft.issn=1476-5586&rft.eissn=1476-5586&rft_id=info:doi/10.1016/j.neo.2014.08.013&rft_dat=%3Cproquest_doaj_%3E1776667666%3C/proquest_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c734t-918df9cf0a0360e96845d90b43e52268fc6e7f5b7bbc4af225ba9369d3a79df33%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1622065301&rft_id=info:pmid/25379015&rfr_iscdi=true