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Qin J, Qi X, Li Y, Tang Z, Zhang X, Ru S, Xiong JQ. Bisphenols can promote antibiotic resistance by inducing metabolic adaptations and natural transformation. JOURNAL OF HAZARDOUS MATERIALS 2024; 470:134149. [PMID: 38554512 DOI: 10.1016/j.jhazmat.2024.134149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/01/2024]
Abstract
Whether bisphenols, as plasticizers, can influence bacterial uptake of antibiotic resistance genes (ARGs) in natural environment, as well as the underlying mechanism remains largely unknown. Our results showed that four commonly used bisphenols (bisphenol A, S, F, and AF) at their environmental relative concentrations can significantly promote transmission of ARGs by 2.97-3.56 times in Acinetobacter baylyi ADP1. Intriguingly, we observed ADP1 acquired resistance by integrating plasmids uptake and cellular metabolic adaptations other than through reactive oxygen species mediated pathway. Metabolic adaptations including upregulation of capsules polysaccharide biosynthesis and intracellularly metabolic enzymes, which enabled formation of thicker capsules for capturing free plasmids, and degradation of accumulated compounds. Simultaneously, genes encoding DNA uptake and translocation machinery were incorporated to enhance natural transformation of antibiotic resistance carrying plasmids. We further exposed aquatic fish to bisphenols for 120 days to monitor their long-term effects in aquatic environment, which showed that intestinal bacteria communities were dominated by a drug resistant microbiome. Our study provides new insight into the mechanism of enhanced natural transformation of ARGs by bisphenols, and highlights the investigations for unexpectedly-elevated antibiotic-resistant risks by structurally related environmental chemicals.
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Affiliation(s)
- Jingyu Qin
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China; School of Life Sciences, Department of Immunology and Microbiology, Department of Chemical Biology, Southern University of Science and Technology, No. 1088, Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, China
| | - Xin Qi
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Yuejiao Li
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Zhuyun Tang
- School of Life Sciences, Department of Immunology and Microbiology, Department of Chemical Biology, Southern University of Science and Technology, No. 1088, Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, China
| | - Xiaona Zhang
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Shaoguo Ru
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China.
| | - Jiu-Qiang Xiong
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China.
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2
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Zhang J, Wang X, Wang HT, Qiao Z, Yao T, Xie M, Urbanowicz BR, Zeng W, Jawdy SS, Gunter LE, Yang X, Czarnecki O, Regan S, Seguin A, Rottmann W, Winkeler KA, Sykes R, Lipzen A, Daum C, Barry K, Lu MZ, Tuskan GA, Muchero W, Chen JG. Overexpression of REDUCED WALL ACETYLATION C increases xylan acetylation and biomass recalcitrance in Populus. PLANT PHYSIOLOGY 2023; 194:243-257. [PMID: 37399189 PMCID: PMC10762510 DOI: 10.1093/plphys/kiad377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/05/2023]
Abstract
Plant lignocellulosic biomass, i.e. secondary cell walls of plants, is a vital alternative source for bioenergy. However, the acetylation of xylan in secondary cell walls impedes the conversion of biomass to biofuels. Previous studies have shown that REDUCED WALL ACETYLATION (RWA) proteins are directly involved in the acetylation of xylan but the regulatory mechanism of RWAs is not fully understood. In this study, we demonstrate that overexpression of a Populus trichocarpa PtRWA-C gene increases the level of xylan acetylation and increases the lignin content and S/G ratio, ultimately yielding poplar woody biomass with reduced saccharification efficiency. Furthermore, through gene coexpression network and expression quantitative trait loci (eQTL) analysis, we found that PtRWA-C was regulated not only by the secondary cell wall hierarchical regulatory network but also by an AP2 family transcription factor HARDY (HRD). Specifically, HRD activates PtRWA-C expression by directly binding to the PtRWA-C promoter, which is also the cis-eQTL for PtRWA-C. Taken together, our findings provide insights into the functional roles of PtRWA-C in xylan acetylation and consequently saccharification and shed light on synthetic biology approaches to manipulate this gene and alter cell wall properties. These findings have substantial implications for genetic engineering of woody species, which could be used as a sustainable source of biofuels, valuable biochemicals, and biomaterials.
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Affiliation(s)
- Jin Zhang
- State Key Laboratory of Subtropical Silviculture, College of Forestry and Biotechnology, Zhejiang A&F University, Hangzhou, Zhejiang 311300, China
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Xiaqin Wang
- State Key Laboratory of Subtropical Silviculture, College of Forestry and Biotechnology, Zhejiang A&F University, Hangzhou, Zhejiang 311300, China
| | - Hsin-Tzu Wang
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
| | - Zhenzhen Qiao
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Tao Yao
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Meng Xie
- Biology Department, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - Breeanna R Urbanowicz
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, GA 30602, USA
| | - Wei Zeng
- State Key Laboratory of Subtropical Silviculture, College of Forestry and Biotechnology, Zhejiang A&F University, Hangzhou, Zhejiang 311300, China
| | - Sara S Jawdy
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Lee E Gunter
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Xiaohan Yang
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Olaf Czarnecki
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Sharon Regan
- Biology Department, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Armand Seguin
- Laurentian Forestry Center, Natural Resources Canada, Québec, Quebec G1V 4C7, Canada
| | | | | | - Robert Sykes
- Bioenergy Science and Technology, National Renewable Energy Laboratory, Golden, CO 80401, USA
| | - Anna Lipzen
- Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Chris Daum
- Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Kerrie Barry
- Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Meng-Zhu Lu
- State Key Laboratory of Subtropical Silviculture, College of Forestry and Biotechnology, Zhejiang A&F University, Hangzhou, Zhejiang 311300, China
| | - Gerald A Tuskan
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Wellington Muchero
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Jin-Gui Chen
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Center for Bioenergy Innovation, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
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Wu X, Pan D, Xia Q, Sun Y, Geng F, Cao J, Zhou C. The combination of high-throughput sequencing and LC-MS/MS reveals the mechanism of Staphylococcus inoculation on bacterial community succession and taste development during the processing of dry-cured bacon. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2023; 103:7187-7198. [PMID: 37351843 DOI: 10.1002/jsfa.12806] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND To understand the mechanism of co-inoculation of Staphylococcus vitulinus and Staphylococcus xylosus (SX&SV) on taste quality of dry-cured bacon, physicochemical parameters, microbial community, metabolite compositions and taste attributes were investigated during the processing of dry-cured bacon with Staphylococcus inoculation. The potential correlation between core bacteria and metabolites was evaluated, and the metabolic pathway of key metabolites was further explored. RESULTS The values of pH, water activity and adhesiveness were significantly lower in SX&SV, and more than 2.56- and 2.15-fold higher values in richness and overall acceptance were found in SX&SV bacon than in CK bacon. The overwhelming advantage of Staphylococcus was confirmed in SX&SV by high-throughput sequencing. Sixty-six metabolites were identified by liquid chromatography-tandem mass spectrometry, and oligopeptides, amino acid derivatives and organic acids were the key components. Pearson correlation demonstrated that the accumulation of oligopeptides, amino acid derivatives and organic acids were positively correlated with high abundance of Staphylococcus. The pathways of purine metabolism, glutathione metabolism and glutamate metabolism were mainly involved in developing the taste quality of SX&SV. CONCLUSION The co-inoculation of Staphylococcus vitulinus and Staphylococcus xylosus enhanced the taste attributes of dry-cured bacon. The present study provides the theoretical reference with respect to regulating the taste quality of fermented meat products by starter cultures of Staphylococcus during manufacture. © 2023 Society of Chemical Industry.
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Affiliation(s)
- Xueyi Wu
- Key Laboratory of Animal Protein Food Processing Technology of Zhejiang Province; college of food science and pharmaceutical sciences, Ningbo University, Ningbo, China
| | - Daodong Pan
- Key Laboratory of Animal Protein Food Processing Technology of Zhejiang Province; college of food science and pharmaceutical sciences, Ningbo University, Ningbo, China
| | - Qiang Xia
- Key Laboratory of Animal Protein Food Processing Technology of Zhejiang Province; college of food science and pharmaceutical sciences, Ningbo University, Ningbo, China
| | - Yangying Sun
- Key Laboratory of Animal Protein Food Processing Technology of Zhejiang Province; college of food science and pharmaceutical sciences, Ningbo University, Ningbo, China
| | - Fang Geng
- Meat Processing Key Laboratory of Sichuan Province, School of Food and Biological Engineering, Chengdu University, Chengdu, China
| | - Jinxuan Cao
- Key Laboratory of Animal Protein Food Processing Technology of Zhejiang Province; college of food science and pharmaceutical sciences, Ningbo University, Ningbo, China
- China Food Flavor and Nutrition Health Innovation Center, Beijing Technology and Business University, Beijing, China
| | - Changyu Zhou
- Key Laboratory of Animal Protein Food Processing Technology of Zhejiang Province; college of food science and pharmaceutical sciences, Ningbo University, Ningbo, China
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Schultz BJ, Snow ED, Walker S. Mechanism of D-alanine transfer to teichoic acids shows how bacteria acylate cell envelope polymers. Nat Microbiol 2023; 8:1318-1329. [PMID: 37308592 PMCID: PMC10664464 DOI: 10.1038/s41564-023-01411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/17/2023] [Indexed: 06/14/2023]
Abstract
Bacterial cell envelope polymers are often modified with acyl esters that modulate physiology, enhance pathogenesis and provide antibiotic resistance. Here, using the D-alanylation of lipoteichoic acid (Dlt) pathway as a paradigm, we have identified a widespread strategy for how acylation of cell envelope polymers occurs. In this strategy, a membrane-bound O-acyltransferase (MBOAT) protein transfers an acyl group from an intracellular thioester onto the tyrosine of an extracytoplasmic C-terminal hexapeptide motif. This motif shuttles the acyl group to a serine on a separate transferase that moves the cargo to its destination. In the Dlt pathway, here studied in Staphylococcus aureus and Streptococcus thermophilus, the C-terminal 'acyl shuttle' motif that forms the crucial pathway intermediate is found on a transmembrane microprotein that holds the MBOAT protein and the other transferase together in a complex. In other systems, found in both Gram-negative and Gram-positive bacteria as well as some archaea, the motif is fused to the MBOAT protein, which interacts directly with the other transferase. The conserved chemistry uncovered here is widely used for acylation throughout the prokaryotic world.
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Affiliation(s)
- Bailey J Schultz
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Eric D Snow
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Suzanne Walker
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.
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5
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Burnett AJN, Rodriguez E, Constable S, Lowrance B, Fish M, Weadge JT. WssI from the Gram-Negative Bacterial Cellulose Synthase is an O-acetyltransferase that Acts on Cello-oligomers with Several Acetyl Donor Substrates. J Biol Chem 2023:104849. [PMID: 37224964 PMCID: PMC10302187 DOI: 10.1016/j.jbc.2023.104849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
In microbial biofilms, bacterial cells are encased in a self-produced matrix of polymers (e.g., exopolysaccharides) that enable surface adherence and protect against environmental stressors. For example, the wrinkly spreader phenotype of Pseudomonas fluorescens colonizes food/water sources and human tissue to form robust biofilms that can spread across surfaces. This biofilm largely consists of bacterial cellulose produced by the cellulose synthase proteins encoded by the wss operon, which also occurs in other species, including pathogenic Achromobacter species. Although phenotypic mutant analysis of the wssFGHI genes has previously shown that they are responsible for acetylation of bacterial cellulose, their specific roles remain unknown and distinct from the recently identified cellulose phosphoethanolamine modification found in other species. Here we have purified the C-terminal soluble form of WssI from P. fluorescens and A. insuavis and demonstrated acetyl-esterase activity with chromogenic substrates. The kinetic parameters (kcat/KM values of 13 and 8.0 M-1∙ s-1, respectively) indicate that these enzymes are up to four times more catalytically efficient than the closest characterized homolog, AlgJ from the alginate synthase. Unlike AlgJ and its cognate alginate polymer, WssI also demonstrated acetyltransferase activity onto cellulose oligomers (e.g., cellotetraose to cellohexaose) with multiple acetyl-donor substrates (pNP-Ac, MU-Ac and acetyl-CoA). Finally, a high-throughput screen identified three low micromolar WssI inhibitors that may be useful for chemically interrogating cellulose acetylation and biofilm formation.
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Affiliation(s)
| | - Emily Rodriguez
- Department of Biology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Shirley Constable
- Department of Biology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Brian Lowrance
- Department of Biology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Michael Fish
- Department of Biology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Joel T Weadge
- Department of Biology, Wilfrid Laurier University, Waterloo, ON, Canada.
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Newman KE, Tindall SN, Mader SL, Khalid S, Thomas GH, Van Der Woude MW. A novel fold for acyltransferase-3 (AT3) proteins provides a framework for transmembrane acyl-group transfer. eLife 2023; 12:e81547. [PMID: 36630168 PMCID: PMC9833829 DOI: 10.7554/elife.81547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/04/2022] [Indexed: 01/12/2023] Open
Abstract
Acylation of diverse carbohydrates occurs across all domains of life and can be catalysed by proteins with a membrane bound acyltransferase-3 (AT3) domain (PF01757). In bacteria, these proteins are essential in processes including symbiosis, resistance to viruses and antimicrobials, and biosynthesis of antibiotics, yet their structure and mechanism are largely unknown. In this study, evolutionary co-variance analysis was used to build a computational model of the structure of a bacterial O-antigen modifying acetyltransferase, OafB. The resulting structure exhibited a novel fold for the AT3 domain, which molecular dynamics simulations demonstrated is stable in the membrane. The AT3 domain contains 10 transmembrane helices arranged to form a large cytoplasmic cavity lined by residues known to be essential for function. Further molecular dynamics simulations support a model where the acyl-coA donor spans the membrane through accessing a pore created by movement of an important loop capping the inner cavity, enabling OafB to present the acetyl group close to the likely catalytic resides on the extracytoplasmic surface. Limited but important interactions with the fused SGNH domain in OafB are identified, and modelling suggests this domain is mobile and can both accept acyl-groups from the AT3 and then reach beyond the membrane to reach acceptor substrates. Together this new general model of AT3 function provides a framework for the development of inhibitors that could abrogate critical functions of bacterial pathogens.
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Affiliation(s)
- Kahlan E Newman
- School of Chemistry, University of SouthamptonSouthamptonUnited Kingdom
| | - Sarah N Tindall
- Department of Biology and the York Biomedical Research Institute, University of YorkYorkUnited Kingdom
| | - Sophie L Mader
- Department of Biochemistry, University of OxfordOxfordUnited Kingdom
| | - Syma Khalid
- Department of Biochemistry, University of OxfordOxfordUnited Kingdom
| | - Gavin H Thomas
- Department of Biology and the York Biomedical Research Institute, University of YorkYorkUnited Kingdom
| | - Marjan W Van Der Woude
- Hull York Medical School and the York Biomedical Research Institute, University of YorkYorkUnited Kingdom
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Anderson AC, Stangherlin S, Pimentel KN, Weadge JT, Clarke AJ. The SGNH hydrolase family: a template for carbohydrate diversity. Glycobiology 2022; 32:826-848. [PMID: 35871440 PMCID: PMC9487903 DOI: 10.1093/glycob/cwac045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/20/2022] [Accepted: 07/05/2022] [Indexed: 11/14/2022] Open
Abstract
The substitution and de-substitution of carbohydrate materials are important steps in the biosynthesis and/or breakdown of a wide variety of biologically important polymers. The SGNH hydrolase superfamily is a group of related and well-studied proteins with a highly conserved catalytic fold and mechanism composed of 16 member families. SGNH hydrolases can be found in vertebrates, plants, fungi, bacteria, and archaea, and play a variety of important biological roles related to biomass conversion, pathogenesis, and cell signaling. The SGNH hydrolase superfamily is chiefly composed of a diverse range of carbohydrate-modifying enzymes, including but not limited to the carbohydrate esterase families 2, 3, 6, 12 and 17 under the carbohydrate-active enzyme classification system and database (CAZy.org). In this review, we summarize the structural and functional features that delineate these subfamilies of SGNH hydrolases, and which generate the wide variety of substrate preferences and enzymatic activities observed of these proteins to date.
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Affiliation(s)
- Alexander C Anderson
- Department of Molecular and Cellular Biology, University of Guelph, Guelph N1G2W1, Canada
| | - Stefen Stangherlin
- Department of Chemistry & Biochemistry, Wilfrid Laurier University, Waterloo N2L3C5, Canada
| | - Kyle N Pimentel
- Department of Molecular and Cellular Biology, University of Guelph, Guelph N1G2W1, Canada
| | - Joel T Weadge
- Department of Biology, Wilfrid Laurier University, Waterloo N2L3C5, Canada
| | - Anthony J Clarke
- Department of Molecular and Cellular Biology, University of Guelph, Guelph N1G2W1, Canada
- Department of Chemistry & Biochemistry, Wilfrid Laurier University, Waterloo N2L3C5, Canada
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Pearson C, Tindall S, Potts JR, Thomas GH, van der Woude MW. Diverse functions for acyltransferase-3 proteins in the modification of bacterial cell surfaces. Microbiology (Reading) 2022; 168. [PMID: 35253642 PMCID: PMC9558356 DOI: 10.1099/mic.0.001146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The acylation of sugars, most commonly via acetylation, is a widely used mechanism in bacteria that uses a simple chemical modification to confer useful traits. For structures like lipopolysaccharide, capsule and peptidoglycan, that function outside of the cytoplasm, their acylation during export or post-synthesis requires transport of an activated acyl group across the membrane. In bacteria this function is most commonly linked to a family of integral membrane proteins – acyltransferase-3 (AT3). Numerous studies examining production of diverse extracytoplasmic sugar-containing structures have identified roles for these proteins in O-acylation. Many of the phenotypes conferred by the action of AT3 proteins influence host colonisation and environmental survival, as well as controlling the properties of biotechnologically important polysaccharides and the modification of antibiotics and antitumour drugs by Actinobacteria. Herein we present the first systematic review, to our knowledge, of the functions of bacterial AT3 proteins, revealing an important protein family involved in a plethora of systems of importance to bacterial function that is still relatively poorly understood at the mechanistic level. By defining and comparing this set of functions we draw out common themes in the structure and mechanism of this fascinating family of membrane-bound enzymes, which, due to their role in host colonisation in many pathogens, could offer novel targets for the development of antimicrobials.
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Affiliation(s)
| | - Sarah Tindall
- Department of Biology, University of York, Heslington, UK
| | | | - Gavin H. Thomas
- Department of Biology, University of York, Heslington, UK
- York Biomedical Institute, University of York, Heslington, UK
| | - Marjan W. van der Woude
- Hull York Medical School, Heslington, UK
- York Biomedical Institute, University of York, Heslington, UK
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