Loading…

The unfolded protein response mediates reversible tau phosphorylation induced by metabolic stress

The unfolded protein response (UPR) is activated in neurodegenerative tauopathies such as Alzheimer’s disease (AD) in close connection with early stages of tau pathology. Metabolic disturbances are strongly associated with increased risk for AD and are a potent inducer of the UPR. Here, we demonstra...

Full description

Saved in:
Bibliographic Details
Published in:Cell death & disease 2014-08, Vol.5 (8), p.e1393-e1393
Main Authors: van der Harg, J M, Nölle, A, Zwart, R, Boerema, A S, van Haastert, E S, Strijkstra, A M, Hoozemans, J JM, Scheper, W
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-c491t-d7fba1dddff1da8eb3331ddaf23fe50249e66def112f38d6c87bcf2750932323
cites cdi_FETCH-LOGICAL-c491t-d7fba1dddff1da8eb3331ddaf23fe50249e66def112f38d6c87bcf2750932323
container_end_page e1393
container_issue 8
container_start_page e1393
container_title Cell death & disease
container_volume 5
creator van der Harg, J M
Nölle, A
Zwart, R
Boerema, A S
van Haastert, E S
Strijkstra, A M
Hoozemans, J JM
Scheper, W
description The unfolded protein response (UPR) is activated in neurodegenerative tauopathies such as Alzheimer’s disease (AD) in close connection with early stages of tau pathology. Metabolic disturbances are strongly associated with increased risk for AD and are a potent inducer of the UPR. Here, we demonstrate that metabolic stress induces the phosphorylation of endogenous tau via activation of the UPR. Strikingly, upon restoration of the metabolic homeostasis, not only the levels of the UPR markers pPERK, pIRE1 α and BiP, but also tau phosphorylation are reversed both in cell models as well as in torpor, a physiological hypometabolic model in vivo . Intervention in the UPR using the global UPR inhibitor TUDCA or a specific small-molecule inhibitor of the PERK signaling pathway, inhibits the metabolic stress-induced phosphorylation of tau. These data support a role for UPR-mediated tau phosphorylation as part of an adaptive response to metabolic stress. Failure to restore the metabolic homeostasis will lead to prolonged UPR activation and tau phosphorylation, and may thus contribute to AD pathogenesis. We demonstrate that the UPR is functionally involved in the early stages of tau pathology. Our data indicate that targeting of the UPR may be employed for early intervention in tau-related neurodegenerative diseases.
doi_str_mv 10.1038/cddis.2014.354
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4454326</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1790933628</sourcerecordid><originalsourceid>FETCH-LOGICAL-c491t-d7fba1dddff1da8eb3331ddaf23fe50249e66def112f38d6c87bcf2750932323</originalsourceid><addsrcrecordid>eNptkU1r3DAQhkVoSUKaa4_B0Esvu9GXbflSKKFNCoFe9i5kaZRV8EqOJAf233fSTcO2VELoY555NcNLyEdG14wKdW2dC2XNKZNr0coTcs6pZCup1PDu6HxGLkt5pDiEoLztTskZb1nXqn44J2azhWaJPk0OXDPnVCHEJkOZUyzQ7MAFU6HgyzPkEsYJmmqWZt6mgivvJ1NDik2IbrEoMO4xpZoxTcE2paJO-UDeezMVuHzdL8jm-7fNzd3q_uftj5uv9ysrB1ZXrvejYc4575kzCkYhBF6N58JDS7kcoOsceMa4F8p1VvWj9bxv6SA4zgvy5SA7LyNWbSHWbCY957Azea-TCfrvSAxb_ZCetZStFLxDgc-vAjk9LVCq3oViYZpMhLQUzfoBvxIdV4h--gd9TEuO2B1SquOSoR1IrQ-UzamUDP6tGEb1i3_6t3_6xT99SLg6buEN_-MWAtcHoGAoPkA--vf_kr8Af0eqFg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1786241354</pqid></control><display><type>article</type><title>The unfolded protein response mediates reversible tau phosphorylation induced by metabolic stress</title><source>PubMed (Medline)</source><source>Publicly Available Content Database</source><source>Springer Nature - nature.com Journals - Fully Open Access</source><creator>van der Harg, J M ; Nölle, A ; Zwart, R ; Boerema, A S ; van Haastert, E S ; Strijkstra, A M ; Hoozemans, J JM ; Scheper, W</creator><creatorcontrib>van der Harg, J M ; Nölle, A ; Zwart, R ; Boerema, A S ; van Haastert, E S ; Strijkstra, A M ; Hoozemans, J JM ; Scheper, W</creatorcontrib><description>The unfolded protein response (UPR) is activated in neurodegenerative tauopathies such as Alzheimer’s disease (AD) in close connection with early stages of tau pathology. Metabolic disturbances are strongly associated with increased risk for AD and are a potent inducer of the UPR. Here, we demonstrate that metabolic stress induces the phosphorylation of endogenous tau via activation of the UPR. Strikingly, upon restoration of the metabolic homeostasis, not only the levels of the UPR markers pPERK, pIRE1 α and BiP, but also tau phosphorylation are reversed both in cell models as well as in torpor, a physiological hypometabolic model in vivo . Intervention in the UPR using the global UPR inhibitor TUDCA or a specific small-molecule inhibitor of the PERK signaling pathway, inhibits the metabolic stress-induced phosphorylation of tau. These data support a role for UPR-mediated tau phosphorylation as part of an adaptive response to metabolic stress. Failure to restore the metabolic homeostasis will lead to prolonged UPR activation and tau phosphorylation, and may thus contribute to AD pathogenesis. We demonstrate that the UPR is functionally involved in the early stages of tau pathology. Our data indicate that targeting of the UPR may be employed for early intervention in tau-related neurodegenerative diseases.</description><identifier>ISSN: 2041-4889</identifier><identifier>EISSN: 2041-4889</identifier><identifier>DOI: 10.1038/cddis.2014.354</identifier><identifier>PMID: 25165879</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>631/80/86 ; 692/420 ; 692/699/317 ; 692/699/375/365 ; Alzheimer Disease - metabolism ; Alzheimer Disease - pathology ; Animals ; Antibodies ; Biochemistry ; Biomedical and Life Sciences ; Cell Biology ; Cell Culture ; Cell Line, Tumor ; Cerebral Cortex - metabolism ; Cold Temperature ; Corpus Striatum - metabolism ; Cricetinae ; Deoxyglucose - toxicity ; eIF-2 Kinase - antagonists &amp; inhibitors ; eIF-2 Kinase - metabolism ; Endoribonucleases - metabolism ; Hippocampus - metabolism ; Humans ; Immunology ; Life Sciences ; Original ; original-article ; Phosphorylation ; Protein-Serine-Threonine Kinases - metabolism ; Signal Transduction - drug effects ; Stress, Physiological ; tau Proteins - metabolism ; Taurochenodeoxycholic Acid - toxicity ; Tunicamycin - toxicity ; Unfolded Protein Response - drug effects</subject><ispartof>Cell death &amp; disease, 2014-08, Vol.5 (8), p.e1393-e1393</ispartof><rights>The Author(s) 2014</rights><rights>Copyright Nature Publishing Group Aug 2014</rights><rights>Copyright © 2014 Macmillan Publishers Limited 2014 Macmillan Publishers Limited</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c491t-d7fba1dddff1da8eb3331ddaf23fe50249e66def112f38d6c87bcf2750932323</citedby><cites>FETCH-LOGICAL-c491t-d7fba1dddff1da8eb3331ddaf23fe50249e66def112f38d6c87bcf2750932323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1786241354/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1786241354?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25752,27923,27924,37011,37012,44589,53790,53792,74897</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25165879$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Harg, J M</creatorcontrib><creatorcontrib>Nölle, A</creatorcontrib><creatorcontrib>Zwart, R</creatorcontrib><creatorcontrib>Boerema, A S</creatorcontrib><creatorcontrib>van Haastert, E S</creatorcontrib><creatorcontrib>Strijkstra, A M</creatorcontrib><creatorcontrib>Hoozemans, J JM</creatorcontrib><creatorcontrib>Scheper, W</creatorcontrib><title>The unfolded protein response mediates reversible tau phosphorylation induced by metabolic stress</title><title>Cell death &amp; disease</title><addtitle>Cell Death Dis</addtitle><addtitle>Cell Death Dis</addtitle><description>The unfolded protein response (UPR) is activated in neurodegenerative tauopathies such as Alzheimer’s disease (AD) in close connection with early stages of tau pathology. Metabolic disturbances are strongly associated with increased risk for AD and are a potent inducer of the UPR. Here, we demonstrate that metabolic stress induces the phosphorylation of endogenous tau via activation of the UPR. Strikingly, upon restoration of the metabolic homeostasis, not only the levels of the UPR markers pPERK, pIRE1 α and BiP, but also tau phosphorylation are reversed both in cell models as well as in torpor, a physiological hypometabolic model in vivo . Intervention in the UPR using the global UPR inhibitor TUDCA or a specific small-molecule inhibitor of the PERK signaling pathway, inhibits the metabolic stress-induced phosphorylation of tau. These data support a role for UPR-mediated tau phosphorylation as part of an adaptive response to metabolic stress. Failure to restore the metabolic homeostasis will lead to prolonged UPR activation and tau phosphorylation, and may thus contribute to AD pathogenesis. We demonstrate that the UPR is functionally involved in the early stages of tau pathology. Our data indicate that targeting of the UPR may be employed for early intervention in tau-related neurodegenerative diseases.</description><subject>631/80/86</subject><subject>692/420</subject><subject>692/699/317</subject><subject>692/699/375/365</subject><subject>Alzheimer Disease - metabolism</subject><subject>Alzheimer Disease - pathology</subject><subject>Animals</subject><subject>Antibodies</subject><subject>Biochemistry</subject><subject>Biomedical and Life Sciences</subject><subject>Cell Biology</subject><subject>Cell Culture</subject><subject>Cell Line, Tumor</subject><subject>Cerebral Cortex - metabolism</subject><subject>Cold Temperature</subject><subject>Corpus Striatum - metabolism</subject><subject>Cricetinae</subject><subject>Deoxyglucose - toxicity</subject><subject>eIF-2 Kinase - antagonists &amp; inhibitors</subject><subject>eIF-2 Kinase - metabolism</subject><subject>Endoribonucleases - metabolism</subject><subject>Hippocampus - metabolism</subject><subject>Humans</subject><subject>Immunology</subject><subject>Life Sciences</subject><subject>Original</subject><subject>original-article</subject><subject>Phosphorylation</subject><subject>Protein-Serine-Threonine Kinases - metabolism</subject><subject>Signal Transduction - drug effects</subject><subject>Stress, Physiological</subject><subject>tau Proteins - metabolism</subject><subject>Taurochenodeoxycholic Acid - toxicity</subject><subject>Tunicamycin - toxicity</subject><subject>Unfolded Protein Response - drug effects</subject><issn>2041-4889</issn><issn>2041-4889</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNptkU1r3DAQhkVoSUKaa4_B0Esvu9GXbflSKKFNCoFe9i5kaZRV8EqOJAf233fSTcO2VELoY555NcNLyEdG14wKdW2dC2XNKZNr0coTcs6pZCup1PDu6HxGLkt5pDiEoLztTskZb1nXqn44J2azhWaJPk0OXDPnVCHEJkOZUyzQ7MAFU6HgyzPkEsYJmmqWZt6mgivvJ1NDik2IbrEoMO4xpZoxTcE2paJO-UDeezMVuHzdL8jm-7fNzd3q_uftj5uv9ysrB1ZXrvejYc4575kzCkYhBF6N58JDS7kcoOsceMa4F8p1VvWj9bxv6SA4zgvy5SA7LyNWbSHWbCY957Azea-TCfrvSAxb_ZCetZStFLxDgc-vAjk9LVCq3oViYZpMhLQUzfoBvxIdV4h--gd9TEuO2B1SquOSoR1IrQ-UzamUDP6tGEb1i3_6t3_6xT99SLg6buEN_-MWAtcHoGAoPkA--vf_kr8Af0eqFg</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>van der Harg, J M</creator><creator>Nölle, A</creator><creator>Zwart, R</creator><creator>Boerema, A S</creator><creator>van Haastert, E S</creator><creator>Strijkstra, A M</creator><creator>Hoozemans, J JM</creator><creator>Scheper, W</creator><general>Nature Publishing Group UK</general><general>Springer Nature B.V</general><general>Nature Publishing Group</general><scope>C6C</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>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88I</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M2P</scope><scope>M7P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7TO</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>20140801</creationdate><title>The unfolded protein response mediates reversible tau phosphorylation induced by metabolic stress</title><author>van der Harg, J M ; Nölle, A ; Zwart, R ; Boerema, A S ; van Haastert, E S ; Strijkstra, A M ; Hoozemans, J JM ; Scheper, W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c491t-d7fba1dddff1da8eb3331ddaf23fe50249e66def112f38d6c87bcf2750932323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>631/80/86</topic><topic>692/420</topic><topic>692/699/317</topic><topic>692/699/375/365</topic><topic>Alzheimer Disease - metabolism</topic><topic>Alzheimer Disease - pathology</topic><topic>Animals</topic><topic>Antibodies</topic><topic>Biochemistry</topic><topic>Biomedical and Life Sciences</topic><topic>Cell Biology</topic><topic>Cell Culture</topic><topic>Cell Line, Tumor</topic><topic>Cerebral Cortex - metabolism</topic><topic>Cold Temperature</topic><topic>Corpus Striatum - metabolism</topic><topic>Cricetinae</topic><topic>Deoxyglucose - toxicity</topic><topic>eIF-2 Kinase - antagonists &amp; inhibitors</topic><topic>eIF-2 Kinase - metabolism</topic><topic>Endoribonucleases - metabolism</topic><topic>Hippocampus - metabolism</topic><topic>Humans</topic><topic>Immunology</topic><topic>Life Sciences</topic><topic>Original</topic><topic>original-article</topic><topic>Phosphorylation</topic><topic>Protein-Serine-Threonine Kinases - metabolism</topic><topic>Signal Transduction - drug effects</topic><topic>Stress, Physiological</topic><topic>tau Proteins - metabolism</topic><topic>Taurochenodeoxycholic Acid - toxicity</topic><topic>Tunicamycin - toxicity</topic><topic>Unfolded Protein Response - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van der Harg, J M</creatorcontrib><creatorcontrib>Nölle, A</creatorcontrib><creatorcontrib>Zwart, R</creatorcontrib><creatorcontrib>Boerema, A S</creatorcontrib><creatorcontrib>van Haastert, E S</creatorcontrib><creatorcontrib>Strijkstra, A M</creatorcontrib><creatorcontrib>Hoozemans, J JM</creatorcontrib><creatorcontrib>Scheper, W</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Science Database (ProQuest)</collection><collection>Biological Science Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cell death &amp; disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Harg, J M</au><au>Nölle, A</au><au>Zwart, R</au><au>Boerema, A S</au><au>van Haastert, E S</au><au>Strijkstra, A M</au><au>Hoozemans, J JM</au><au>Scheper, W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The unfolded protein response mediates reversible tau phosphorylation induced by metabolic stress</atitle><jtitle>Cell death &amp; disease</jtitle><stitle>Cell Death Dis</stitle><addtitle>Cell Death Dis</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>5</volume><issue>8</issue><spage>e1393</spage><epage>e1393</epage><pages>e1393-e1393</pages><issn>2041-4889</issn><eissn>2041-4889</eissn><abstract>The unfolded protein response (UPR) is activated in neurodegenerative tauopathies such as Alzheimer’s disease (AD) in close connection with early stages of tau pathology. Metabolic disturbances are strongly associated with increased risk for AD and are a potent inducer of the UPR. Here, we demonstrate that metabolic stress induces the phosphorylation of endogenous tau via activation of the UPR. Strikingly, upon restoration of the metabolic homeostasis, not only the levels of the UPR markers pPERK, pIRE1 α and BiP, but also tau phosphorylation are reversed both in cell models as well as in torpor, a physiological hypometabolic model in vivo . Intervention in the UPR using the global UPR inhibitor TUDCA or a specific small-molecule inhibitor of the PERK signaling pathway, inhibits the metabolic stress-induced phosphorylation of tau. These data support a role for UPR-mediated tau phosphorylation as part of an adaptive response to metabolic stress. Failure to restore the metabolic homeostasis will lead to prolonged UPR activation and tau phosphorylation, and may thus contribute to AD pathogenesis. We demonstrate that the UPR is functionally involved in the early stages of tau pathology. Our data indicate that targeting of the UPR may be employed for early intervention in tau-related neurodegenerative diseases.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>25165879</pmid><doi>10.1038/cddis.2014.354</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2041-4889
ispartof Cell death & disease, 2014-08, Vol.5 (8), p.e1393-e1393
issn 2041-4889
2041-4889
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4454326
source PubMed (Medline); Publicly Available Content Database; Springer Nature - nature.com Journals - Fully Open Access
subjects 631/80/86
692/420
692/699/317
692/699/375/365
Alzheimer Disease - metabolism
Alzheimer Disease - pathology
Animals
Antibodies
Biochemistry
Biomedical and Life Sciences
Cell Biology
Cell Culture
Cell Line, Tumor
Cerebral Cortex - metabolism
Cold Temperature
Corpus Striatum - metabolism
Cricetinae
Deoxyglucose - toxicity
eIF-2 Kinase - antagonists & inhibitors
eIF-2 Kinase - metabolism
Endoribonucleases - metabolism
Hippocampus - metabolism
Humans
Immunology
Life Sciences
Original
original-article
Phosphorylation
Protein-Serine-Threonine Kinases - metabolism
Signal Transduction - drug effects
Stress, Physiological
tau Proteins - metabolism
Taurochenodeoxycholic Acid - toxicity
Tunicamycin - toxicity
Unfolded Protein Response - drug effects
title The unfolded protein response mediates reversible tau phosphorylation induced by metabolic stress
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-10T13%3A05%3A17IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20unfolded%20protein%20response%20mediates%20reversible%20tau%20phosphorylation%20induced%20by%20metabolic%20stress&rft.jtitle=Cell%20death%20&%20disease&rft.au=van%20der%20Harg,%20J%20M&rft.date=2014-08-01&rft.volume=5&rft.issue=8&rft.spage=e1393&rft.epage=e1393&rft.pages=e1393-e1393&rft.issn=2041-4889&rft.eissn=2041-4889&rft_id=info:doi/10.1038/cddis.2014.354&rft_dat=%3Cproquest_pubme%3E1790933628%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c491t-d7fba1dddff1da8eb3331ddaf23fe50249e66def112f38d6c87bcf2750932323%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1786241354&rft_id=info:pmid/25165879&rfr_iscdi=true