(American Journal of Pathology. 2000;156:813-819.)
© 2000 American Society for Investigative Pathology
Telomere Shortening Is an in Vivo Marker of Myocyte Replication and Aging
Jan Kajstura,
Barbara Pertoldi,
Annarosa Leri,
Carlo-Alberto Beltrami,
Andrzej Deptala,
Zbigniew Darzynkiewicz and
Piero Anversa
From the Department of Medicine, New York Medical College,
Valhalla, New York
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Abstract
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To determine whether adult cardiac myocytes are capable of multiple
divisions and whether this form of growth is restricted to a
subpopulation of cells that retain this capacity with age,
telomere lengths were measured in myocyte nuclei isolated from the left
ventricle of fetal and neonatal Fischer 344 rats and rats at 4,
12, and 27 months after birth. Two independent methodologies
were used for this analysis: laser scanning cytometer and
confocal microscopy. In each case, fluorescence intensity of a
peptide nucleic acid probe specific for telomeric sequence was
evaluated. The two techniques yielded comparable results. Telomeric
shortening increased with age in a subgroup of myocytes that
constituted 16% of the entire cell population. In the remaining
nondividing cells, progressive accumulation of a senescent
associated nuclear protein, p16INK4, was
evidenced. In conclusion, a significant fraction of myocytes
divides repeatedly from birth to senescence, counteracting the
continuous death of cells in the aging mammalian rat
heart.
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Introduction
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The recognition that cellular aging may occur in vitro
and in vivo has been discussed in recent
reviews.1-3
A characteristic of replicating cells is
shortening of telomeres, which may trigger growth arrest and
senescence.4-6
Erosion of telomeres may be interpreted as
DNA damage, activating p53, p53-inducible genes, and programmed cell
death.7-9
This condition is operative only in cells that
are not terminally differentiated and experience multiple divisions
during their lifespan. Telomere shortening should not be considered a
molecular trait of cardiac myocyte aging, because this cell population
is believed to be permanent and irreplaceable.10,11
According to the dogma, the number of muscle cells in the mammalian
heart is defined at birth, and in the absence of cardiac diseases,
these myocytes persist throughout the life of an individual or animal.
However, recent observations suggest that the heart is characterized by
ongoing cell death and cell regeneration during the entire life of a
human being or an animal.12,13
On this basis, the
assessment of the length distribution of telomeres in myocytes with
aging may provide information concerning the capacity of adult myocytes
of undergoing multiple mitotic divisions. Additionally, whether cell
regeneration affects all or a subgroup of myocytes and whether cellular
aging involves in a uniform manner cardiac myocytes in vivo
may be identified by this analysis. For this purpose, laser scanning
cytometer and confocal microscopy were
used to measure telomere lengths in cardiac myocytes from fetal,
neonatal, adult, and senescent Fischer 344 rats. Specifically, animals
at 4, 12, 16, and 27 months after birth were studied, because these
rats are considered to be young adults at 4 to 6 months, fully mature
adults at 10 to 12 months, aged at 16 to 18 months, and senescent at 22
to 27 months. Moreover, to establish whether the age of the entire
parenchymal cell population of the heart corresponded to the age of the
animals, the expression of p16INK4, a marker of
cellular aging,14-18
was examined. p16 is a member of the
INK4 family of proteins which inhibits cdk4 and cdk6, maintaining Rb in
its hypophosphorylated form.19,20
Changes in the quantity
of this protein in myocytes as a function of age were evaluated by
immunoprecipitation, whereas changes in p16INK4
distribution in the cells were determined by confocal microscopy.
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Materials and Methods
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Myocyte Isolation
Myocytes were enzymatically dissociated from the left ventricle of
Fischer 344 rats at gestational day 19 and at 1 day after birth, and at
4, 12, 16, and 27 months of age. In each isolation of fetal and
neonatal myocytes, an entire litter in each case had to be used. A
total of 10 litters, 5 for fetal and 5 for neonatal myocytes, were
used. Rats were decapitated and their hearts were quickly removed and
placed in calcium- and magnesium-free Hanks balanced salt solution
(HBSS). Atria and right ventricle were dissected free and left
ventricular tissue was cut in small pieces, which were transferred into
10 ml of dissociation medium (0.1% trypsin, 1:250, and 0.01%
deoxyribonuclease I in HBSS) and stirred (approximately 60 rpm) at
37°C. The material dissociated from the tissue during first 15
minutes of trypsinization was discarded. An aliquot of dissociation
medium (10 ml) was added to the remaining fragments of myocardium, and
after 10 minutes of gentle stirring at 37°C the supernatant was
collected. The cells contained in this fraction were centrifuged at
300 x g for 4 minutes, resuspended in Eagles minimal
essential medium (MEM) supplemented with 10% fetal calf serum, and
stored on ice. The procedure was repeated 4 to 6 times. Isolated cells
were preplated in a 150-mm petri dish (Corning) for 1 hour at 37°C,
and myocytes which did not attach to the dish during this time were
collected.21,22
A different approach was followed for the collection of myocytes from
rats at 4 (n = 5), 12 (n
= 5), 16 (n = 5), and 27
(n = 5) months. Hearts were placed on a plastic
cannula for retrograde perfusion through the aorta. The solutions were
supplements of modified commercial MEM Eagle Joklik. HEPES-MEM
contained (in mmol/L) NaCl 117, KCl 5.7, NaHCO3
4.4, KH2PO4 1.5,
MgCl2 17, HEPES 21.1, and glucose 11.7, with
amino acids and vitamins, 2 mmol/L L-glutamine, and 21 mu/ml insulin;
pH was adjusted to 7.2 with NaOH. Osmolarity of this solution is 292
mOsm. Washing solution was HEPES-MEM with the addition of 0.5 mmol/L
EGTA. Resuspension medium was HEPES-MEM supplemented with 0.5% bovine
serum albumin, 0.3 mmol/L calcium chloride, adjusted to 292 mOsm. The
cell isolation procedure consisted of three main steps. Low calcium
perfusion: blood washout in the presence of EGTA for about 10 minutes,
and collagenase (selected Type I, Worthington Biochemical Corp.,
Freehold, NJ) perfusion of the myocardium was carried out at 37°C
with HEPES-MEM gassed with 85% O2/15%
N2. Mechanical tissue dissociation: after
removing the myocardium from the cannula, the left ventricle was cut
into small pieces and subsequently shaken in resuspension medium at
37°C. Supernatant cell suspensions were washed and resuspended in
resuspension medium. Separation of intact cells: intact cells were
enriched by centrifugation through Percoll (Sigma, St. Louis,
MO). Approximately 106
cells were
suspended in 10 ml of isotonic Percoll (final concentration, 41% in
resuspension medium) and centrifuged for 10 minutes at 34 x
g. Intact cells were recovered from the pellet and washed.
Rectangular, trypan blue-excluding cells constituted nearly 80% of all
myocytes. The extent of non-myocytes present in each preparation was
determined by preparing smears of the isolated myocytes and staining
them with
-sarcomeric actin and propidium iodide
(PI).23-25
Telomere Length
Myocytes were fixed in methanol/acetic acid (3/1) and resuspended
in 50% acetic acid. Smears of nuclei were fixed in 4% formaldehyde
and digested with pepsin. Ten microliters of hybridization solution
containing 7 µl formamide, 3 ng fluorescein isothiocyanate
(FITC)-labeled
(C3TA2)3
peptide nucleic acid (PNA) probe (PE Biosystems, Foster City,
CA), 0.5 mg blocking reagent (Boehringer Mannheim, Indianapolis,
IN), and 3 µl 10 mmol/L Tris, pH 7.5, were added, DNA
denatured, and hybridization performed.26
Subsequently,
slides were washed with 70% formamide and 10 mmol/L Tris, pH 7.5, and
with 150 mmol/L NaCl and 50 mmol/L Tris, pH 7.5. Slides were then
incubated with PI (10 µg/ml phosphate buffered saline) and RNase A (1
mg/ml). Total fluorescence of FITC-PNA probe, which corresponded to the
content of telomeric sequences per nucleus, was determined by laser
scanning Compucyte cytometer (CompuCyte Corp., Cambridge, MA)
and confocal microscopy (BioRad 1000, Hercules, CA). In laser
scanning cytometer, fluorescence excitation was provided by a 488 nm
laser line. The green fluorescence of FITC-PNA probe was measured using
a combination of dichroic mirrors and filters transmitting light at
530 ± 20 nm wavelength. The red fluorescence of PI was measured
by long pass filters transmitting at >610 nm. Software of the
cytometer was used to deconvolute histograms and estimate cells with
specific telomeric lengths.27,28
Approximately 5000 nuclei
were measured by the Compucyte cytometer in each left ventricle. By
confocal microscopy, FITC-PNA fluorescence was assessed by optically
sectioning the entire thickness of each nucleus and recording the
intensity of fluorescence in each section. Total fluorescence in each
myocyte was calculated. In each animal, approximately 300 nuclei were
measured.
Immunoprecipitation and Western Blot
Nuclear extracts were prepared by incubation of myocytes with
hypotonic buffer. Lysates were mixed with 0.5% NP-40, centrifuged, and
the nuclear pellets incubated in high-salt buffer; 300 µg protein
were incubated with 3 µg of mouse monoclonal
p16INK4 (F-12, Santa Cruz Biotechnology, Santa
Cruz, CA) and 250 µl of HNTG buffer (20 mmol/L Hepes, pH 7.5,
150 mmol/L NaCl, 0.1% Triton X-100, 10% glycerol), containing
protease inhibitors 0.2 mmol/L PMSF, 2 µg/µL aprotinin, and 0.2
mmol/L Na3VO4 overnight at
4°C. Subsequently, 50 µl of protein A-Agarose (Pierce, Rockford,
IL) was added to each sample.29
After several
washings with a buffer containing 20 mmol/L Tris-HCl, pH 7.4, 300
mmol/L NaCl, 2 mmol/L EDTA, and 2 mmol/L EGTA, samples were centrifuged
at 14,000 rpm and proteins were separated by 15% sodium dodecyl
sulfate-polyacrylamide gel electrophoresis, transferred onto
nitrocellulose filters, and exposed to mouse monoclonal
p16INK4 antibody, 1 µg/ml of Tris-buffered
saline/Tween 20 (TBST).
p16INK4 Distribution
Five hearts each from 1-day-old neonatal rats and rats at 4, 12,
and 27 months of age were excised and the left ventricle frozen at
-70°C. Cryostat sections were fixed in 2% paraformaldehyde for 10
minutes and incubated with p16INK4 antibody
(F-12, Santa Cruz), diluted 1:30 in phosphate buffered saline for 1
hour at 37°C. FITC-labeled anti-mouse IgG was used as secondary
antibody. Nuclei were stained with PI and the cytoplasm with
-sarcomeric actin (clone 5C5, Sigma). Myocyte nuclei labeled by
p16INK4 were evaluated by confocal microscopy. A
total of 500 myocyte nuclei was examined in each heart.
Data Analysis
Results are presented as mean ± SD. Statistical significance
in multiple comparisons in which analysis of variance and the Fisher
test indicated the presence of significant differences, was
determined by the Bonferroni method.30
P values
<0.05 were considered to be significant.
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Results
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The average yield of left ventricular myocytes in the fetal and
neonatal heart was 0.5 x 106
and 0.8
x 106
cells, respectively. Corresponding values
in rats at 4, 12, 16, and 27 months were 7.6 x
10,6
7.2 x 10,6
6.5 x 106, and 4.0 x
106
myocytes. Fibroblasts accounted for 3 to 4%
of cells in fetal and neonatal myocytes, and 1 to 2% of cells in young
adult, adult, aged, and senescent myocyte preparations (Figure 1A)
. After enzymatic dissociation of
cardiac muscle cells and Percoll treatment, nuclei were isolated
(Figure 1B)
and stained by in situ hybridization with a
fluorescent PNA probe. This probe, which is specific for telomeric
sequence, was labeled with FITC (Figure 1C)
. During this procedure, 25
to 30% of myocytes were lost, resulting in the preservation of nearly
70 to 75% of myocyte nuclei. Total nuclear DNA was assessed by PI (red
fluorescence) and distinguished from the amount of fluorescence emitted
by the PNA probe (green fluorescence). The latter corresponded to the
total telomeric length present in each nucleus.26
These
parameters were used to obtain a bivariate distribution of telomeric
length versus DNA in each nucleus; nearly 5000 nuclei were
examined in each left ventricle by laser scanning cytometer. Length of
telomeres was rather uniform in fetal and neonatal myocytes, but
telomere shortening was evident in myocyte nuclei at 4 and 12 months
and was even more apparent at 27 months (Figure 2)
. Additionally, 300 nuclei were
evaluated in each left ventricle by confocal microscopy. This consisted
in the assessment of the aggregate fluorescence of the PNA probe
(Figure 1C)
in each nucleus. The results collected with these two
independent methodologies are described below.

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Figure 1. Percoll-treated myocytes
(A). Nuclei
are stained by PI (yellow
fluorescence) and the cytoplasm by
-sarcomeric actin (red
fluorescence). Isolated myocyte nuclei are
depicted by red fluorescence of PI
(B). Nuclei
(blue fluorescence) after
in situ hybridization with a PNA probe specific for
telomeric sequence
(C). Red
fluorescent dots correspond to individual telomeres. Confocal
microscopy; original magnifications, x150
(A), x300
(B), x1500
(C).
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Figure 2. Bivariate distribution of DNA content and telomere length in myocyte
nuclei from the left ventricle of fetal
(F) and 1-day-old
neonatal (N) rats, and
rats at 4 (4M), 12
(12M), and 27
(27M) months of age.
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The telomeric length frequency histograms obtained by laser scanning
Compucyte cytometer and confocal microscopy were analyzed, and the
fraction of nuclei with shorter telomeres was calculated. This was
achieved by using fetal myocyte nuclei as baseline; telomeres shorter
than the average telomeric length in the fetal heart, minus two
standard deviations, were considered to have experienced loss of repeat
sequences. By laser scanning cytometer and confocal microscopy,
telomere shortening was detectable in a small group of fetal
(0.50.7%) and neonatal (1.21.7%) myocytes (Figure 3)
. However, nuclei with shorter
telomeres increased at 4 and 12 months, involving 5 to 7% of the
entire myocyte population. This value reached approximately
16% at 27 months. Additionally, telomere shortening in senescent
myocytes was 2.3- to 2.5-fold greater than in cells at 12 months, and
this difference was significant (Figure 3)
.

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Figure 3. Measurements of the percentage of myocyte nuclei with shorter telomeres
by laser scanning cytometer and confocal microscopy
(see Figure 2
for
symbols). Asterisks indicate
statistical differences (P
< 0.05) from F
(*), N
(**), 4M
(***), and 12M
(****) values;
n = 5 in each group.
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Telomere shortening was restricted to a subgroup of myocytes,
indicating that this marker of cellular aging was applicable to a
limited number of cells in the heart. This observation suggested that
16% of myocytes reentered the cell cycle and underwent mitotic
division. To characterize the process of myocyte aging in nondividing
cells, changes in the expression of p16INK4 in
myocyte nuclear proteins were evaluated by immunoprecipitation and
Western blot. p16INK4 optical density (OD)
increased in myocytes as a function of age (Figure 4)
. This protein was barely detectable in
neonatal myocytes (OD, 0.04 ± 0.03, n = 5),
becoming more apparent at 4 months (OD, 0.29 ± 0.09,
n = 5). However, this difference did not reach
statistical significance. Conversely, the quantity of
p16INK4 increased markedly at 12 months (OD,
0.71 ± 0.21, n = 5). In comparison with neonatal
myocytes a 19-fold upregulation of this protein was measured, and this
change was significant (P < 0.002). Even
greater were the increases in p16INK4 at 16 (OD,
1.01 ± 0.26, n = 5) and 27 (OD, 1.27 ±
0.31, n = 5) months. From 4 to 16 months,
p16INK4 increased 3.5-fold
(P < 0.002), and from 4 to 27 months, it
increased 4.4-fold (P < 0.0001).

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Figure 4. Detection of p16INK4 in myocyte nuclear proteins by
immunoprecipitation and Western blot. See Figure 2
for symbols.
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Measurements of the amount of p16INK4 by
immunoprecipitation did not provide information on the relative
distribution of this protein at the cellular level. Thus, the
biochemical determinations were complemented with the quantitative
estimation of the percentage of myocyte nuclei labeled by
p16INK4 antibody. This analysis was performed by
confocal microscopy (Figure 5)
. The
fraction of p16INK4-positive myocytes was low at
birth, averaging 9 ± 3% (n = 5) of the
cells. This parameter increased significantly with age. Values of
25 ± 7% (n = 5), 51 ± 12%
(n = 5), and 82 ± 5%
(n = 5) were found at 4, 12, and 27 months,
respectively. These morphometric data paralleled the changes detected
by immunoprecipitation, documenting that the increases in p16 quantity
reflected the progressive involvement of a larger number of cells with
age.

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Figure 5. Localization of p16INK4 in myocyte nuclei by confocal
microscopy in a rat heart at 27 months. A illustrates by red
fluorescence nuclei stained by propidium iodide and B shows
by green fluorescence p16INK4 labeling of the majority of
nuclei. In C, red fluorescence corresponds to -sarcomeric
actin antibody staining of the myocyte cytoplasm and yellow
fluorescence reflects the combination of PI and p16INK4
labeling of nuclei. Arrows, p16-positive myocyte nuclei;
arrowheads, p16-positive nonmyocyte nuclei. Original
magnifications, x1200.
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Discussion
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The results of the current study indicate that, from birth to
senescence, the mammalian rat heart is composed of nondividing and
dividing myocytes. This distinction is suggested by the length of
telomeres, which remains constant in a large fraction of myocyte nuclei
from 1 day to 27 months of age. Loss of telomeric DNA is minimal in
fetal and neonatal myocytes, suggesting that cell division during
gestation and in the immediate postnatal period may be characterized by
an almost complete reconstitution of telomeric repeat sequences by
telomerase.31
This is consistent with the high level of
bromodeoxyuridine labeling of myocytes in the fetal and 1-day-old rat
heart.22
Conversely, telomeric shortening in this early
phase of active cardiac growth may be below the sensitivity of the
methodology used. Loss of telomeric DNA per cell division is
approximately 50100 bp32
and a few population doublings
may not produce an appreciable decrease in fluorescence intensity of
the PNA probe.
Telomeric shortening occurred in 5 to 7% of adult myocytes, and a
value of 16% was found in senescent hearts; 16% of myocytes
experienced multiple divisions, and this percentage may reflect the
maximum number of cells that can replicate in life. The formation of
new myocytes by dividing cells and the development of aging-associated
events in nondividing cells complicate the understanding of the time
required for cellular senescence to occur. However,
p16INK4, a marker of cellular senescence, was
detected in 9% of 1-day-old myocytes, indicating that this condition
can be reached in approximately 1 month in nonreplicating cells of the
rat heart. Gestation lasts 3 weeks in rats. A postnatal rate of
cellular senescence of 2.7% myocytes per month
(r = 0.98; P < 0.001) could be
computed from the immunocytochemistry data obtained at various age
intervals. p16 quantity, measured by immunoprecipitation, increased
progressively with age, at a rate of 3.6% per month
(r = 0.96; P < 0.001),
confirming the quantitative results. There are some apparent
inconsistencies concerning p16INK4 localization
in myocytes. This member of the INK4 family of proteins is a marker of
replicative senescence.16
However,
p16INK4 was detected in more than 80% of
myocytes in the old heart, when telomere shortening involved 16% of
this cell population. The concomitant presence of intact telomeres and
p16INK4 staining suggests that this nuclear
protein may be involved in senescence of differentiated myocytes.
p16INK4 and its mRNA are extremely
stable,19
and they may accumulate in nonreplicating cells.
Understanding the high percentage of myocytes labeled by
p16INK4 late in life is complex. Because they
increase by 2.7% per month, senescent myocytes may have a long life
span, accumulating with age. Apoptosis and necrosis affect the aging
heart33
and extensive areas of myocardial damage,
involving death of large groups of myocytes, are commonly observed
across the ventricular wall.23
The age-dependent increase
in massive cell loss contrasts with the orderly appearance of
p16INK4-positive cardiac muscle cells. Although
this phenomenon remains unclear and cellular aging is particularly
evident in the old heart, animals do not have to be old to possess
senescent myocytes.
Shortening of telomeres in myocyte nuclei in vivo has
provided critical information against the dogma that the mammalian
heart is composed of terminally differentiated myocytes only and tissue
regeneration occurs exclusively by hypertrophy of existing
cells.34,35
Loss of telomeric repeat sequences strengthens
documentation that cardiac myocytes synthesize DNA36
and
undergo karyokinesis12,36,37
and
cytokinesis.13
Myocyte nuclei with constant PNA
fluorescence intensity vary from 98% to 84% of the cells from birth
to senescence. This indicates that the majority of myocytes exits the
cell cycle permanently in the early postnatal period34
and
the regenerative reserve is restricted to a small group of muscle
cells. Results favoring12,13
and opposing38
this possibility have been published.
Culture studies have proposed that telomere shortening may be used as a
marker of cellular aging.4-6
When cells have reached
their limit in population doublings, telomeres shorten, growth arrest
occurs, and senescence is reached.1,2,39
Telomeres may
continue to shorten and cells may activate their suicide program,
undergoing apoptosis.8
A decrease in length of telomeres
with age has been observed in vivo in peripheral blood
mononuclear cells.40
Short telomeres have been detected in
fibroblasts from patients with Hutchinson-Gilford
progeria41
and in lymphocytes from subjects with Downs
syndrome.42
Both diseases are characterized by premature
aging. Telomeric repeat sequences are lost in a small fraction of
myocytes and the predominant number maintains the initial telomeric
length. However, the majority of cells is characterized by
p16INK4 labeling, and this larger population may
be more susceptible to other age-associated events, including the
accumulation of lipofuscin43,44
and gene products
promoting apoptosis, such as p53 and Bax.45,46
The consequence of fibroblast contamination in the preparation must be
acknowledged and discussed. As indicated in Results, 1 to 2% of
nonmyocytes were present in the isolated cells. Five thousand nuclei
were measured by laser scanning Compucyte cytometer in each case.
Because nearly 90% of myocytes are binucleated and 10% are
mononucleated,23,33
5000 nuclei reflected 2250 binucleated
myocytes and 500 mononucleated myocytes. A 2% fraction of fibroblasts
would imply that 55 nuclei of the 5000 measured belonged to
nonmyocytes. This level of contamination corresponds to 1% of the
total population of nuclei. This value is well within the SD of the
16% of cells experiencing telomeric shortening. Identical results are
obtained when this computation is applied to nuclei measured by
confocal microscopy. An additional issue to be addressed concerns
nuclear division without cytokinesis, which would lead to an increased
number of nuclei per cell and telomeric shortening in the absence of
formation of new myocytes. However, this possibility can be excluded
because the proportion of mononucleated cells and binucleated cells is
minimally affected by age in Fischer 344 rats from 4 to 29
months after birth.23,33
The percentage of mononucleated
cells increases from 5% at 4 months to 11% at 29 months, while
binucleated cells decrease from 95 to 88%.23
These data
strongly suggest that karyokinesis without cytokinesis was, at most, a
rare event.
 |
Footnotes
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Address reprint requests to Jan Kajstura, Ph.D., Department of Medicine, Vosburgh Pavilion, Room 302, New York Medical College, Valhalla, NY 10595. E-mail: jan_kajstura{at}nymc.edu
Supported by grants HL-38132, HL-39902, NCI-28704, HL-43023, AG-15746, and AG-17042 from the National Institutes of Health.
Accepted for publication October 26, 1999.
 |
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