Loading…

GDF15 mediates the metabolic effects of PPARβ/δ by activating AMPK

Peroxisome proliferator-activated receptor β/δ (PPARβ/δ) activates AMP-activated protein kinase (AMPK) and plays a crucial role in glucose and lipid metabolism. Here, we examine whether PPARβ/δ activation effects depend on growth differentiation factor 15 (GDF15), a stress response cytokine that reg...

Full description

Saved in:
Bibliographic Details
Published in:Cell reports (Cambridge) 2021-08, Vol.36 (6), p.109501, Article 109501
Main Authors: Aguilar-Recarte, David, Barroso, Emma, Gumà, Anna, Pizarro-Delgado, Javier, Peña, Lucía, Ruart, Maria, Palomer, Xavier, Wahli, Walter, Vázquez-Carrera, Manuel
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-c559t-88d75ccb1ff50a56987ba0f2bd7c2ea167a9df38765ca5b2ddeeb34c5d1965923
cites cdi_FETCH-LOGICAL-c559t-88d75ccb1ff50a56987ba0f2bd7c2ea167a9df38765ca5b2ddeeb34c5d1965923
container_end_page
container_issue 6
container_start_page 109501
container_title Cell reports (Cambridge)
container_volume 36
creator Aguilar-Recarte, David
Barroso, Emma
Gumà, Anna
Pizarro-Delgado, Javier
Peña, Lucía
Ruart, Maria
Palomer, Xavier
Wahli, Walter
Vázquez-Carrera, Manuel
description Peroxisome proliferator-activated receptor β/δ (PPARβ/δ) activates AMP-activated protein kinase (AMPK) and plays a crucial role in glucose and lipid metabolism. Here, we examine whether PPARβ/δ activation effects depend on growth differentiation factor 15 (GDF15), a stress response cytokine that regulates energy metabolism. Pharmacological PPARβ/δ activation increases GDF15 levels and ameliorates glucose intolerance, fatty acid oxidation, endoplasmic reticulum stress, and inflammation, and activates AMPK in HFD-fed mice, whereas these effects are abrogated by the injection of a GDF15 neutralizing antibody and in Gdf15−/− mice. The AMPK-p53 pathway is involved in the PPARβ/δ-mediated increase in GDF15, which in turn activates again AMPK. Consistently, Gdf15−/− mice show reduced AMPK activation in skeletal muscle, whereas GDF15 administration results in AMPK activation in this organ. Collectively, these data reveal a mechanism by which PPARβ/δ activation increases GDF15 levels via AMPK and p53, which in turn mediates the metabolic effects of PPARβ/δ by sustaining AMPK activation. [Display omitted] •Activation of the AMPK-p53 pathway by PPARβ/δ agonists increases GDF15•Many metabolic effects mediated by PPARβ/δ activation are abrogated in Gdf15−/− mice•GDF15 is required for the activation of AMPK by ligand-activated PPARβ/δ•In skeletal muscle, GDF15 activates AMPK in the absence of the GDF15 receptor GFRAL GDF15 is a stress response cytokine that regulates energy metabolism. Aguilar-Recarte et al. show that PPARβ/δ activation increases GDF15 levels, which contributes to the metabolic effect of this receptor and activates AMPK in skeletal muscle independently of GDF15 receptor GFRAL.
doi_str_mv 10.1016/j.celrep.2021.109501
format article
fullrecord <record><control><sourceid>hal_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_b6f0fb8048d340e8be15dc85700ffd26</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S2211124721009293</els_id><doaj_id>oai_doaj_org_article_b6f0fb8048d340e8be15dc85700ffd26</doaj_id><sourcerecordid>oai_HAL_hal_03321289v1</sourcerecordid><originalsourceid>FETCH-LOGICAL-c559t-88d75ccb1ff50a56987ba0f2bd7c2ea167a9df38765ca5b2ddeeb34c5d1965923</originalsourceid><addsrcrecordid>eNp9UctO5DAQtFaLALH8AUK57mFmup04cS5II95iVowQnC0_2uBRICMnjMRvIb5jvgkPYdHuBV_aLlWV1VWMHSCMEbCcLMaWmkjLMQeOCaoF4A-2yzniCHlR_fznvsP2u24B6ZSAWBfbbCcvcgnAq112cn5yhiJ7JBd0T13WP1B69Nq0TbAZeU-277LWZ_P59Gb9Olm_ZeYl07YPK92Hp_ts-md-9Ytted10tP8599jd2ent8cVodn1-eTydjawQdT-S0lXCWoPeC9CirGVlNHhuXGU5aSwrXTufy6oUVgvDnSMyeWGFw7oUNc_32OXg61q9UMsYHnV8Ua0O6gNo473SsQ-2IWVKD95IKKTLCyBpCIWzUlQA3jteJq_fg9eDbv6zupjO1AaDPOfIZb3CxC0Gro1t10XyXwIEtelDLdTQh9r0oYY-kuxwkC2fTQr4S_Q3_UQ4GgiUQlsFiqqzgZ5sKiOm3NNW4fsf3gFW0Ju1</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>GDF15 mediates the metabolic effects of PPARβ/δ by activating AMPK</title><source>BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS</source><creator>Aguilar-Recarte, David ; Barroso, Emma ; Gumà, Anna ; Pizarro-Delgado, Javier ; Peña, Lucía ; Ruart, Maria ; Palomer, Xavier ; Wahli, Walter ; Vázquez-Carrera, Manuel</creator><creatorcontrib>Aguilar-Recarte, David ; Barroso, Emma ; Gumà, Anna ; Pizarro-Delgado, Javier ; Peña, Lucía ; Ruart, Maria ; Palomer, Xavier ; Wahli, Walter ; Vázquez-Carrera, Manuel</creatorcontrib><description>Peroxisome proliferator-activated receptor β/δ (PPARβ/δ) activates AMP-activated protein kinase (AMPK) and plays a crucial role in glucose and lipid metabolism. Here, we examine whether PPARβ/δ activation effects depend on growth differentiation factor 15 (GDF15), a stress response cytokine that regulates energy metabolism. Pharmacological PPARβ/δ activation increases GDF15 levels and ameliorates glucose intolerance, fatty acid oxidation, endoplasmic reticulum stress, and inflammation, and activates AMPK in HFD-fed mice, whereas these effects are abrogated by the injection of a GDF15 neutralizing antibody and in Gdf15−/− mice. The AMPK-p53 pathway is involved in the PPARβ/δ-mediated increase in GDF15, which in turn activates again AMPK. Consistently, Gdf15−/− mice show reduced AMPK activation in skeletal muscle, whereas GDF15 administration results in AMPK activation in this organ. Collectively, these data reveal a mechanism by which PPARβ/δ activation increases GDF15 levels via AMPK and p53, which in turn mediates the metabolic effects of PPARβ/δ by sustaining AMPK activation. [Display omitted] •Activation of the AMPK-p53 pathway by PPARβ/δ agonists increases GDF15•Many metabolic effects mediated by PPARβ/δ activation are abrogated in Gdf15−/− mice•GDF15 is required for the activation of AMPK by ligand-activated PPARβ/δ•In skeletal muscle, GDF15 activates AMPK in the absence of the GDF15 receptor GFRAL GDF15 is a stress response cytokine that regulates energy metabolism. Aguilar-Recarte et al. show that PPARβ/δ activation increases GDF15 levels, which contributes to the metabolic effect of this receptor and activates AMPK in skeletal muscle independently of GDF15 receptor GFRAL.</description><identifier>ISSN: 2211-1247</identifier><identifier>EISSN: 2211-1247</identifier><identifier>DOI: 10.1016/j.celrep.2021.109501</identifier><identifier>PMID: 34380027</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adenylate Kinase - metabolism ; AMP-Activated Protein Kinases - metabolism ; AMPK ; Animals ; Cell Line ; Endoplasmic Reticulum Stress ; Enzyme Activation ; GDF15 ; glucose tolerance ; Growth Differentiation Factor 15 - deficiency ; Growth Differentiation Factor 15 - metabolism ; Inflammation - pathology ; Insulin - metabolism ; Life Sciences ; Lipid Metabolism ; Liver - metabolism ; Liver - pathology ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Muscle, Skeletal - metabolism ; p53 ; PPAR delta - metabolism ; PPAR-beta - metabolism ; PPARβ/δ ; Signal Transduction ; Tumor Suppressor Protein p53 - metabolism</subject><ispartof>Cell reports (Cambridge), 2021-08, Vol.36 (6), p.109501, Article 109501</ispartof><rights>2021 The Authors</rights><rights>Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c559t-88d75ccb1ff50a56987ba0f2bd7c2ea167a9df38765ca5b2ddeeb34c5d1965923</citedby><cites>FETCH-LOGICAL-c559t-88d75ccb1ff50a56987ba0f2bd7c2ea167a9df38765ca5b2ddeeb34c5d1965923</cites><orcidid>0000-0001-7138-8207 ; 0000-0002-5966-9089</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34380027$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.inrae.fr/hal-03321289$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Aguilar-Recarte, David</creatorcontrib><creatorcontrib>Barroso, Emma</creatorcontrib><creatorcontrib>Gumà, Anna</creatorcontrib><creatorcontrib>Pizarro-Delgado, Javier</creatorcontrib><creatorcontrib>Peña, Lucía</creatorcontrib><creatorcontrib>Ruart, Maria</creatorcontrib><creatorcontrib>Palomer, Xavier</creatorcontrib><creatorcontrib>Wahli, Walter</creatorcontrib><creatorcontrib>Vázquez-Carrera, Manuel</creatorcontrib><title>GDF15 mediates the metabolic effects of PPARβ/δ by activating AMPK</title><title>Cell reports (Cambridge)</title><addtitle>Cell Rep</addtitle><description>Peroxisome proliferator-activated receptor β/δ (PPARβ/δ) activates AMP-activated protein kinase (AMPK) and plays a crucial role in glucose and lipid metabolism. Here, we examine whether PPARβ/δ activation effects depend on growth differentiation factor 15 (GDF15), a stress response cytokine that regulates energy metabolism. Pharmacological PPARβ/δ activation increases GDF15 levels and ameliorates glucose intolerance, fatty acid oxidation, endoplasmic reticulum stress, and inflammation, and activates AMPK in HFD-fed mice, whereas these effects are abrogated by the injection of a GDF15 neutralizing antibody and in Gdf15−/− mice. The AMPK-p53 pathway is involved in the PPARβ/δ-mediated increase in GDF15, which in turn activates again AMPK. Consistently, Gdf15−/− mice show reduced AMPK activation in skeletal muscle, whereas GDF15 administration results in AMPK activation in this organ. Collectively, these data reveal a mechanism by which PPARβ/δ activation increases GDF15 levels via AMPK and p53, which in turn mediates the metabolic effects of PPARβ/δ by sustaining AMPK activation. [Display omitted] •Activation of the AMPK-p53 pathway by PPARβ/δ agonists increases GDF15•Many metabolic effects mediated by PPARβ/δ activation are abrogated in Gdf15−/− mice•GDF15 is required for the activation of AMPK by ligand-activated PPARβ/δ•In skeletal muscle, GDF15 activates AMPK in the absence of the GDF15 receptor GFRAL GDF15 is a stress response cytokine that regulates energy metabolism. Aguilar-Recarte et al. show that PPARβ/δ activation increases GDF15 levels, which contributes to the metabolic effect of this receptor and activates AMPK in skeletal muscle independently of GDF15 receptor GFRAL.</description><subject>Adenylate Kinase - metabolism</subject><subject>AMP-Activated Protein Kinases - metabolism</subject><subject>AMPK</subject><subject>Animals</subject><subject>Cell Line</subject><subject>Endoplasmic Reticulum Stress</subject><subject>Enzyme Activation</subject><subject>GDF15</subject><subject>glucose tolerance</subject><subject>Growth Differentiation Factor 15 - deficiency</subject><subject>Growth Differentiation Factor 15 - metabolism</subject><subject>Inflammation - pathology</subject><subject>Insulin - metabolism</subject><subject>Life Sciences</subject><subject>Lipid Metabolism</subject><subject>Liver - metabolism</subject><subject>Liver - pathology</subject><subject>Mice</subject><subject>Mice, Inbred C57BL</subject><subject>Mice, Knockout</subject><subject>Muscle, Skeletal - metabolism</subject><subject>p53</subject><subject>PPAR delta - metabolism</subject><subject>PPAR-beta - metabolism</subject><subject>PPARβ/δ</subject><subject>Signal Transduction</subject><subject>Tumor Suppressor Protein p53 - metabolism</subject><issn>2211-1247</issn><issn>2211-1247</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNp9UctO5DAQtFaLALH8AUK57mFmup04cS5II95iVowQnC0_2uBRICMnjMRvIb5jvgkPYdHuBV_aLlWV1VWMHSCMEbCcLMaWmkjLMQeOCaoF4A-2yzniCHlR_fznvsP2u24B6ZSAWBfbbCcvcgnAq112cn5yhiJ7JBd0T13WP1B69Nq0TbAZeU-277LWZ_P59Gb9Olm_ZeYl07YPK92Hp_ts-md-9Ytted10tP8599jd2ent8cVodn1-eTydjawQdT-S0lXCWoPeC9CirGVlNHhuXGU5aSwrXTufy6oUVgvDnSMyeWGFw7oUNc_32OXg61q9UMsYHnV8Ua0O6gNo473SsQ-2IWVKD95IKKTLCyBpCIWzUlQA3jteJq_fg9eDbv6zupjO1AaDPOfIZb3CxC0Gro1t10XyXwIEtelDLdTQh9r0oYY-kuxwkC2fTQr4S_Q3_UQ4GgiUQlsFiqqzgZ5sKiOm3NNW4fsf3gFW0Ju1</recordid><startdate>20210810</startdate><enddate>20210810</enddate><creator>Aguilar-Recarte, David</creator><creator>Barroso, Emma</creator><creator>Gumà, Anna</creator><creator>Pizarro-Delgado, Javier</creator><creator>Peña, Lucía</creator><creator>Ruart, Maria</creator><creator>Palomer, Xavier</creator><creator>Wahli, Walter</creator><creator>Vázquez-Carrera, Manuel</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>1XC</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-7138-8207</orcidid><orcidid>https://orcid.org/0000-0002-5966-9089</orcidid></search><sort><creationdate>20210810</creationdate><title>GDF15 mediates the metabolic effects of PPARβ/δ by activating AMPK</title><author>Aguilar-Recarte, David ; Barroso, Emma ; Gumà, Anna ; Pizarro-Delgado, Javier ; Peña, Lucía ; Ruart, Maria ; Palomer, Xavier ; Wahli, Walter ; Vázquez-Carrera, Manuel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c559t-88d75ccb1ff50a56987ba0f2bd7c2ea167a9df38765ca5b2ddeeb34c5d1965923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenylate Kinase - metabolism</topic><topic>AMP-Activated Protein Kinases - metabolism</topic><topic>AMPK</topic><topic>Animals</topic><topic>Cell Line</topic><topic>Endoplasmic Reticulum Stress</topic><topic>Enzyme Activation</topic><topic>GDF15</topic><topic>glucose tolerance</topic><topic>Growth Differentiation Factor 15 - deficiency</topic><topic>Growth Differentiation Factor 15 - metabolism</topic><topic>Inflammation - pathology</topic><topic>Insulin - metabolism</topic><topic>Life Sciences</topic><topic>Lipid Metabolism</topic><topic>Liver - metabolism</topic><topic>Liver - pathology</topic><topic>Mice</topic><topic>Mice, Inbred C57BL</topic><topic>Mice, Knockout</topic><topic>Muscle, Skeletal - metabolism</topic><topic>p53</topic><topic>PPAR delta - metabolism</topic><topic>PPAR-beta - metabolism</topic><topic>PPARβ/δ</topic><topic>Signal Transduction</topic><topic>Tumor Suppressor Protein p53 - metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aguilar-Recarte, David</creatorcontrib><creatorcontrib>Barroso, Emma</creatorcontrib><creatorcontrib>Gumà, Anna</creatorcontrib><creatorcontrib>Pizarro-Delgado, Javier</creatorcontrib><creatorcontrib>Peña, Lucía</creatorcontrib><creatorcontrib>Ruart, Maria</creatorcontrib><creatorcontrib>Palomer, Xavier</creatorcontrib><creatorcontrib>Wahli, Walter</creatorcontrib><creatorcontrib>Vázquez-Carrera, Manuel</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>Hyper Article en Ligne (HAL)</collection><collection>Directory of Open Access Journals</collection><jtitle>Cell reports (Cambridge)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aguilar-Recarte, David</au><au>Barroso, Emma</au><au>Gumà, Anna</au><au>Pizarro-Delgado, Javier</au><au>Peña, Lucía</au><au>Ruart, Maria</au><au>Palomer, Xavier</au><au>Wahli, Walter</au><au>Vázquez-Carrera, Manuel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>GDF15 mediates the metabolic effects of PPARβ/δ by activating AMPK</atitle><jtitle>Cell reports (Cambridge)</jtitle><addtitle>Cell Rep</addtitle><date>2021-08-10</date><risdate>2021</risdate><volume>36</volume><issue>6</issue><spage>109501</spage><pages>109501-</pages><artnum>109501</artnum><issn>2211-1247</issn><eissn>2211-1247</eissn><abstract>Peroxisome proliferator-activated receptor β/δ (PPARβ/δ) activates AMP-activated protein kinase (AMPK) and plays a crucial role in glucose and lipid metabolism. Here, we examine whether PPARβ/δ activation effects depend on growth differentiation factor 15 (GDF15), a stress response cytokine that regulates energy metabolism. Pharmacological PPARβ/δ activation increases GDF15 levels and ameliorates glucose intolerance, fatty acid oxidation, endoplasmic reticulum stress, and inflammation, and activates AMPK in HFD-fed mice, whereas these effects are abrogated by the injection of a GDF15 neutralizing antibody and in Gdf15−/− mice. The AMPK-p53 pathway is involved in the PPARβ/δ-mediated increase in GDF15, which in turn activates again AMPK. Consistently, Gdf15−/− mice show reduced AMPK activation in skeletal muscle, whereas GDF15 administration results in AMPK activation in this organ. Collectively, these data reveal a mechanism by which PPARβ/δ activation increases GDF15 levels via AMPK and p53, which in turn mediates the metabolic effects of PPARβ/δ by sustaining AMPK activation. [Display omitted] •Activation of the AMPK-p53 pathway by PPARβ/δ agonists increases GDF15•Many metabolic effects mediated by PPARβ/δ activation are abrogated in Gdf15−/− mice•GDF15 is required for the activation of AMPK by ligand-activated PPARβ/δ•In skeletal muscle, GDF15 activates AMPK in the absence of the GDF15 receptor GFRAL GDF15 is a stress response cytokine that regulates energy metabolism. Aguilar-Recarte et al. show that PPARβ/δ activation increases GDF15 levels, which contributes to the metabolic effect of this receptor and activates AMPK in skeletal muscle independently of GDF15 receptor GFRAL.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34380027</pmid><doi>10.1016/j.celrep.2021.109501</doi><orcidid>https://orcid.org/0000-0001-7138-8207</orcidid><orcidid>https://orcid.org/0000-0002-5966-9089</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2211-1247
ispartof Cell reports (Cambridge), 2021-08, Vol.36 (6), p.109501, Article 109501
issn 2211-1247
2211-1247
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_b6f0fb8048d340e8be15dc85700ffd26
source BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS
subjects Adenylate Kinase - metabolism
AMP-Activated Protein Kinases - metabolism
AMPK
Animals
Cell Line
Endoplasmic Reticulum Stress
Enzyme Activation
GDF15
glucose tolerance
Growth Differentiation Factor 15 - deficiency
Growth Differentiation Factor 15 - metabolism
Inflammation - pathology
Insulin - metabolism
Life Sciences
Lipid Metabolism
Liver - metabolism
Liver - pathology
Mice
Mice, Inbred C57BL
Mice, Knockout
Muscle, Skeletal - metabolism
p53
PPAR delta - metabolism
PPAR-beta - metabolism
PPARβ/δ
Signal Transduction
Tumor Suppressor Protein p53 - metabolism
title GDF15 mediates the metabolic effects of PPARβ/δ by activating AMPK
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-01T11%3A42%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-hal_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=GDF15%20mediates%20the%20metabolic%20effects%20of%20PPAR%CE%B2/%CE%B4%20by%20activating%20AMPK&rft.jtitle=Cell%20reports%20(Cambridge)&rft.au=Aguilar-Recarte,%20David&rft.date=2021-08-10&rft.volume=36&rft.issue=6&rft.spage=109501&rft.pages=109501-&rft.artnum=109501&rft.issn=2211-1247&rft.eissn=2211-1247&rft_id=info:doi/10.1016/j.celrep.2021.109501&rft_dat=%3Chal_doaj_%3Eoai_HAL_hal_03321289v1%3C/hal_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c559t-88d75ccb1ff50a56987ba0f2bd7c2ea167a9df38765ca5b2ddeeb34c5d1965923%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_id=info:pmid/34380027&rfr_iscdi=true