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Published online before print November 1, 2007
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From the Divisions of Clinical Pharmacology,* and Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract |
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An imbalance in component processes underlying homeostasis may be one fundamental mechanism contributing to the development of colon cancer,4 the second leading cause of cancer-related mortality in developed countries.5 Thus, targeted inactivation of p21,6 which regulates cell cycle progression and differentiation, promotes APC mutation-dependent tumor formation by increasing proliferation and decreasing apoptosis and differentiation in intestine. Deletion of Muc2 in differentiated cells induces colorectal cancer by increasing proliferation and migration and decreasing apoptosis.7 Conversely, crypt hyperplasia associated with disrupted differentiation, without changes in proliferation or apoptosis, promotes intestinal tumorigenesis in mice exhibiting loss of imprinting of the insulin-like growth factor II gene.8
Guanylyl cyclase C (GC-C), the receptor for bacterial diarrheagenic heat-stable enterotoxins (STs) and the endogenous ligands guanylin and uroguanylin, is the primary endogenous source of cyclic guanosine 3',5' monophosphate (cGMP) in intestinal epithelial cells.9,10 Heretofore, GC-C and its downstream effector cGMP were considered principal regulators of intestinal fluid homeostasis. Intriguingly, GC-C has recently emerged as a key regulator of colon cancer cell dynamics. GC-C signaling through cyclic nucleotide gated channel disrupts tumor cell cycle progression and proliferation.11-13 In close agreement, induction of cGMP-dependent mechanisms produces enduring colon cancer cytostasis.13 Further, treatment of ApcMin/+ mice with oral uroguanylin suppresses intestinal tumor formation.14 However, although cGMP coordinates proliferation, differentiation, and apoptosis in many cell systems,15,16 a role for GC-C in regulating component processes underlying crypt-villus homeostasis remains elusive. That GC-C might regulate crypt-villus homeostasis is supported by the near-uniform loss of guanylin and uroguanylin expression early in intestinal tumorigenesis.17-19 Indeed, eliminating guanylin expression in mice induces expansion of the proliferating crypt compartment in colon,20 although this effect is ostensibly not mimicked by elimination of GC-C expression.21
These observations suggest that GC-C and its ligands may function as a paracrine system regulating component processes underlying intestinal mucosa homeostasis. Moreover, GC-C signaling may represent a novel homeostatic mechanism whose dysregulation through loss of ligand expression contributes to colon carcinogenesis. The present studies explored the role of GC-C in coordinating processes organizing the crypt-villus axis, including proliferation, cell cycle, migration, differentiation, and apoptosis.
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Materials and Methods |
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TopAbstractMaterials and MethodsResultsDiscussionReferences |
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NCM460 cells,22
which express GC-C mRNA (Figure 1A)
and functional GC-C protein (Figure 1, B–E)
, and their proprietary M3:10 medium were from In Cell (San Antonio, TX). T84 human colon carcinoma cells, used as a positive control for GC-C expression,23
were from American Type Culture Collection (Manassas, VA).
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and exhibited loss of GC-C ligand binding in their intestine (Figure 1G)
. GC-C–/– mice (I-129 background) were backcrossed with a C57BL/6 strain for seven or more generations, and GC-C–/– and GC-C+/+ littermates (males, 3 months old) were analyzed. Animals were maintained in a controlled environment (20°C, 12-hour dark/light cycle) with free access to food and water. For cell migration, three GC-C–/– and three GC-C+/+ mice per time point (2, 24, and 48 hours) were analyzed. These animals (nine GC-C–/– and nine GC-C+/+ mice) were also used for examining other morphometric or cytodynamic parameters. Two additional cohorts of six mice per genotype were used for calculations of cell cycle times. Finally, two additional cohorts of five mice per genotype were used for immunoblot analyses. Reagents used included native ST and the inactive analog ST(5–17)Ala,9,17Cys(Acm),5,106-14 disulfide (TJU 1-103) (Bachem, San Carlos, CA); [methyl-3H]thymidine (Amersham, Piscataway, NJ), and 3-isobutyl-1-methylxanthine, guanylin, 8-br-cGMP (Sigma, St. Louis, MO). Crypt Depth
Mouse intestines were isolated, cleaned, and divided into five segments: duodenum (the rostral, 5-cm-long small intestinal segment from the pyloric sphincter), jejunum (the rostral half of small intestine from the duodenum to the ileal-cecal junction), ileum (the caudal half of small intestine from the duodenum to the ileal-cecal junction), and proximal (the rostral half) and distal (the caudal half) colon (from the cecal-colonic junction to the anal sphincter). Intestinal samples, spanning 1 cm (small intestine) or 0.5 cm (colon) from the center of each segment, were fixed overnight (10% formalin), embedded in paraffin, sectioned (5 µm), and mounted (5 to 20 sections/slide) for hematoxylin and eosin (H&E) staining. Digital images were captured with a light microscope attached to a computer and recorded using Adobe Photoshop. Crypt length was measured (in 
10 crypts/intestinal segment/mouse) as the distance from the bottom to the opening of crypt with intact columnar epithelia using the NIH Image J analysis software.
In Vivo Cell Proliferation, Cell Differentiation, and Cell Death
Intestinal sections were deparaffinized and rehydrated with sequential washes of xylene, ethanol, and water, followed by heat-induced epitope retrieval (10 mmol/L citrate buffer, ph 6.0). Sections were incubated with primary antibodies (overnight, 4°C), followed by secondary antibodies and diaminobenzidine substrate (avidin-biotin kit; Vector Laboratories, Burlingame, CA). Stained cells were quantified (in 5 to 15 crypt-villus units/intestinal segment/mouse) using NIH Image J software. Proliferating cells were stained with the proliferating cell nuclear antigen (PCNA) immunohistochemistry (IHC) kit (Zymed, South San Francisco, CA) or the rat anti-mouse Ki-67 antibody (1:50 dilution; DAKO Cytomation, Carpinteria, CA). PCNA- and Ki-67-labeling indices were calculated by normalizing the number of PCNA- or Ki-67-positive cells to the total cell number in respective crypts. Paneth cells, enterocytes, and enteroendocrine cells were stained with rabbit anti-human/mouse lysozyme antibody (ready-to-use, DAKO Cytomation), goat anti-villin antibody [Villin(C-19), 1:25 dilution; Santa Cruz Biotechnology, Santa Cruz, CA], and rabbit anti-chromogranin A antibody (1:200 dilution, Zymed), respectively. Goblet cells were quantified using Alcian blue staining of mucin7 with fast nuclear red counterstaining. Finally, cell death was quantified by terminal deoxynucleotidyl transferase-mediated dNTP-biotin nick-end labeling (TUNEL) using the TACSXL blue label in situ apoptosis detection kit (Trevigen, Gaithersburg, MD).
In Vivo Cell Cycle and Cell Migration
Crypt cell cycles were examined by cumulative BrdU (15 mg/kg) injections (at 4- to 6-hour intervals for 24 hours) into the peritoneal cavity.25 Thirty minutes after each injection, a cohort of mice was sacrificed, and intestinal sections were stained for BrdU (IHC BrdU kit, Zymed Inc.). The relationship between the ratio of BrdU+ cells to PCNA+ cells and time was analyzed with a nonlinear mixed effects model, and cell cycle times (T) calculated from the slope (sl) of the proximal limb of biphasic curves,25 using the equation: sl = 1/T.
For cell migration, three mice per group were sacrificed at 2, 24, and 48 hours after a single intraperitoneal BrdU injection (15 mg/kg), and resulting intestinal sections were subjected to BrdU IHC. Migration rate (µm/hour) reflects the slope of the fitted line of the distance of the farthest labeled enterocyte from the crypt-bottom throughout time. The number (for cell cycle) or the distance (for cell migration) of BrdU-labeled cell(s)/crypt was quantified using NIH Image J software.
Immunoblot Analyses
Epithelia were dissected from normal intestinal mucosa from five individual animals in each group or NCM460 cells (
1,000,000/well in a six-well plate) were synchronized (48 hours) by serum starvation and restimulated with serum alone (control) or that containing 1 mmol/L 8br-cGMP for 3 hours. In each case, protein was extracted in Laemmli buffer containing protease and phosphatase inhibitor cocktails (Pierce, Rockford, IL) and stored at –20°C. Homogenized proteins were subjected to immunoblot analyses using antibodies to the following antigens where indicated: cyclin D1 and pRb from Santa Cruz Biotechnology (1:200 dilution) and cleaved caspase 3 and GAPDH from Cell Signaling (Danvers, MA; 1:1000 dilution). ITF (1:10,000) anti-serum was a gift from Dr. Daniel K. Podolsky (Massachusetts General Hospital and Harvard Medical School, Boston, MA). Bovine anti-goat and anti-rabbit secondary antibodies were from Santa Cruz Biotechnology (1:5000 dilution). Staining intensity of specific bands quantified by densitometry was normalized to that for GAPDH. Average relative intensity reflects the mean of five individual animals per genotype or three independent experiments with NCM460 cells.
In Vitro Cell Proliferation and Cell Cycle
For DNA synthesis, NCM460 cells (50,000/well in a 96-well plate) were synchronized (48 hours) by serum starvation and restimulated (24 hours) with 10% fetal bovine serum in the presence of the indicated treatments. Cells were labeled by adding, for the last 3 hours of incubations, [methyl-3H]thymidine (0.2 µCi/well), and [3H]thymidine incorporation into DNA was quantified.11,13
Also, growth curves were generated by treating NCM460 cells (50,000/well in a 24-well plate) in media and determining the DNA or protein content per well. After DNA extraction with ethanol in phenol/chloroform, DNA concentrations were measured by spectrophotometry (260 nm) and cell numbers extrapolated from linear standard curves (data not shown). Conversely, protein concentrations were determined using the BCA protein assay kit (Pierce). Cell doubling times (at the period of exponential growth) and cell cycle distributions by flow cytometry (after serum restimulation of synchronized cells) were calculated as described.11
Primary Cultures of Colon Mucosa
Colonic tissues were obtained from patients undergoing surgery under a protocol approved by the institutional review board (control no. 01.0823) as a part of the clinical trial NIH R01 CA75123 (S.A. Waldman, PI). Normal colonic mucosa dissected from the lamina propria were cut into 25-mm2 sheets and placed onto six-well plates in primary culture media.26 Colonic mucosal sheets incorporated thymidine into nuclear DNA for >21 hours (data not shown). Thus, after isolation and recovery (4 hours), treatments were performed 15 minutes before addition of [methyl-3H]thymidine (2 µCi/well) for 16 hours. Then, 3H-thymidine incorporation into DNA was quantified,11 and results were normalized to the wet weight of mucosa sheets.
GC-C and Cyclic GMP Analyses
GC-C mRNA was quantified by reverse transcriptase (RT)-PCR.27 Iodination of ST and GC-C ligand binding was assessed in membranes from NCM460 cells or mouse intestinal mucosa.23 Specific GC-C binding was calculated using Prism 3.0 software after subtraction of nonspecific binding (with unlabeled ST) from total binding (without unlabeled ST). Finally, cGMP was quantified by radioimmunoassay28 in NCM460 cells incubated (30 minutes) in serum-free media with the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine (1 mmol/L) before addition of treatments (for 15 minutes).
Statistics
Crypt depth, cell proliferation by PCNA or Ki-67 IHC, and cell migration were analyzed by fitting a linear mixed effects model.29 To estimate cell cycle times, a nonlinear mixed effects model29 was fitted to the crypt-specific proportion ratios of BrdU-labeled cells to PCNA+ cells with the fixed effects part as described.25 These models accounted for animal-to-animal variability and correlation between clustered measures from the same animal. All other comparisons used the Student’s t-test. Determinations in vitro were repeated at least three times. Where appropriate, analyses were done in triplicate and results reflect mean ± SEM of a representative experiment. In all analyses, P < 0.05 was considered statistically significant.
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Results |
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TopAbstractMaterials and MethodsResultsDiscussionReferences |
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Although the gross histological architecture of crypt and villus units were not obviously different in GC-C+/+ and GC-C–/– mice (Figure 1H)
, closer examination revealed that in the absence of GC-C signaling mice exhibited longer crypts (Figure 2A
, Table 1
; measured with the NIH Image J analysis software) associated with increased numbers of Ki-67+ (Figure 2, B–D
; quantified by Ki-67+ IHC) or PCNA+ (Figure 2, E and F
, and Table 1
; quantified by PCNA+ IHC) cells compared with GC-C+/+ mice. Crypt elongation reflected hyperplasia along a decreasing rostral-caudal gradient (P < 0.001), and the number of proliferating cells was the dominant predictor of hyperplasia in all intestinal segments (P < 0.001). Moreover, the fraction of proliferating cells in crypts (Ki-67- or PCNA-labeling index) increased in GC-C–/– mice compared with GC-C+/+ mice with the greatest effect in proximal colon (Figure 2, D and F)
, indicating that crypt hyperplasia principally reflects expansion of the proliferating, and not quiescent, compartment. Indeed, the colonic crypts of Lieberkuhn include the entire cell phenotypic spectrum along the crypt-villus axis, whereas shorter small intestinal crypts (Figure 1H)
, apically restricted by the crypt-villus junction (Figure 8)
, are predominantly populated by proliferating progenitor cells (Figure 2B)
. In agreement with the suggestion that GC-C critically regulates cell proliferative dynamics, induction of GC-C signaling using ST or 8-br-cGMP, a membrane-permeant cGMP analog,30
inhibited proliferation of normal epithelial cells in mucosal sheets isolated from intestines of patients, as assessed by 3H-thymidine incorporation into nuclear DNA (Figure 3A)
. Further, ST or the endogenous GC-C agonist guanylin, but not the inactive ST analog TJU 1-103, inhibited proliferation of NCM460 human intestinal crypt cells22
(Figure 3B)
, and this effect was mimicked by 8-br-cGMP (Figure 3C)
.
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To define further the proliferative crypt kinetics in GC-C–/– mice, cell cycle duration was quantified after serial peritoneal BrdU injections, with incorporation into DNA by cycling cells during S phase transition (Figure 4A)
.25
This model presumes that proliferating crypt cells reflect two populations, including stem cells with a uniform cell cycle that is twice the duration of progenitor cells.25,31
The nonlinear mixed effects model,29
used to analyze BrdU labeling curves, was fitted to the crypt-specific proportion ratios of BrdU-labeled cells to PCNA+ cells (Figure 4B)
. Only cell cycles of progenitor cells were considered, since the model and time (24 hours) used permit quantification of in vivo cell cycle rates of rapidly proliferating progenitor cells rather than slowly proliferating stem cells.3,31
Elimination of GC-C signaling accelerated the cell cycle in crypt progenitor cells of GC-C–/–, compared with GC-C+/+, mice along a rostro-caudal gradient, with significantly higher effects in proximal small intestine and modest effects in colon (Figure 4, B and C
; Table 2
). Acceleration of the cell cycle in GC-C–/– mice was associated with increases in critical intestinal cell cycle mediators by immunoblot analysis, including cyclin D1 and p-Rb (Figure 4, D and E)
.
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. Indeed, colonocytes treated with ST (Figure 5A)
or 8-br-cGMP (Figure 5B)
grew more slowly than control cells receiving PBS, as quantified by the DNA (top panels) or protein (bottom panels) content of cell cultures. Also, intestinal cells exposed to ST (Figure 5C)
or 8-br-cGMP (Figure 5D)
exhibited a longer doubling time (assessed at the period of exponential growth)11
associated with a delay in the G1/S phase transition (Figure 5E)
. Accordingly, in NCM460 cells cGMP reduced the protein levels of cyclin D1 and p-Rb (Figure 5, F and G)
, key promoters of the G1/S cell cycle transition that are regulated by in vivo GC-C signaling (Figure 4, D and E)
.
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Beyond proliferative kinetics, expansion of the crypt progenitor cell compartment in GC-C–/– mice could reflect reduced egress of cells from that compartment, mediated by changes in migration or apoptosis.2
Proliferating epithelial cells migrated more rapidly along the crypt-villus axis in GC-C–/– compared with GC-C+/+ mice (Figure 6, A and B
, and Table 3
; quantified by single intraperitoneal BrdU injection). Linear mixed effects modeling, which considered animal-average scores of PCNA+ cells and crypt depth, suggests that accelerated enterocyte migration was an adaptive response to, rather than the cause of, crypt hyperplasia (P < 0.001). Indeed, as observed for proliferative kinetics, GC-C-dependent regulation of cell migration exhibited a rostro-caudal gradient (Table 3)
. Similarly, elimination of GC-C increased apoptosis in intestinal crypts as assessed by TUNEL (Figure 6, C and D)
and immunoblot analysis for cleaved caspase 3 (Figure 6, E and F)
, also reflecting an adaptive response to crypt hyperplasia.
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Perturbations in cell maturation dynamics also could contribute to the expansion of crypt compartments in GC-C–/– mice.2
Indeed, elimination of GC-C signaling specifically altered cell-lineage differentiation, and GC-C–/– mice exhibited fewer goblet cells compared with wild-type mice, as assessed by counting intestinal cells stained for mucin with Alcian blue (Figure 7, A and B)
and by immunoblot analysis for intestine trefoil factor (Figure 7, C and D)
. In addition, GC-C–/– mice exhibited fewer Paneth cells than GC-C+/+ mice, as quantified by counting mucosal cells stained with anti-lysozyme antibody (Figure 7, E–G)
. However, there were no differences in enteroendocrine cells (Figure 7, H–L
; quantified by IHC for anti-chromogranin A) or absorptive enterocytes (Figure 8
; quantified by IHC for villin). Further, the ordered transition from the proliferating (Ki-67+) to the differentiated (villin+) cell compartment was maintained in GC-C–/– mice (Figure 8)
. Moreover, there were no differences in villus length in GC-C–/–, compared with GC-C+/+, mice (data not shown). Taken together, these data suggest that GC-C signaling critically affects the homeostasis of intestinal crypt compartment by coordinating processes underlying reciprocal regulation of proliferation and differentiation associated with adaptive responses in migration and apoptosis.
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Discussion |
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TopAbstractMaterials and MethodsResultsDiscussionReferences |
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In that context, GC-C signaling has emerged as a key modulator of the colon cancer cell phenotype. GC-C inhibits colon cancer cell proliferation11-13 and opposes colon carcinogenesis in ApcMin/+ mice.14,38 Also, although GC-C expression is highly conserved,23 expression of guanylin and uroguanylin is uniformly lost early in neoplastic transformation, suggesting that disruption of GC-C signaling may contribute to colon carcinogenesis.14,19 GC-C and cGMP inhibit tumor cell proliferation by inducing Ca2+ influx through cyclic nucleotide gated channels,12 suggesting that the anti-tumor effects of dietary Ca2+ 34,35 may be mediated, in part, by GC-C signaling. Moreover, activation of GC-C may oppose proproliferative Wnt/β-catenin/Tcf-4 signaling by promoting PKG1β-dependent degradation of β-catenin, inhibiting its nuclear translocation.39
Beyond colon cancer cell proliferation, the role of GC-C in mechanisms underlying normal intestinal epithelial cell dynamics remains undefined. Elimination of guanylin expression in mice produced colonic crypt hyperplasia, reflecting expansion of proliferative compartments associated with increased migration.20 Although reminiscent of observations in the present study, these effects were not replicated in GC-C–/– mice,21 suggesting that other receptors mediate the effects of guanylin on colon crypt dynamics. Indeed, receptors other than GC-C may mediate effects of GC-C ligands on fluid homeostasis.40 However, previous studies examining crypt dynamics in GC-C–/– mice did not present data and did not specify the anatomical segment along the rostro-caudal axis analyzed.21 As demonstrated herein, experimental measurements confined to the distal colon in GC-C–/– mice could have produced artifactually negative results.
Here, elimination of GC-C induced selective crypt hyperplasia along a decreasing rostro-caudal gradient, in the absence of changes in villus morphology. Crypt hyperplasia reflected, in part, increases in the number of proliferating cells and acceleration of their cell cycle. These changes were associated with adaptive increases in migration and apoptosis along the crypt-villus axis, which limited expansion of the proliferating compartment. Thus, GC-C signaling represents a previously unrecognized mechanism restricting the size and proliferative rate of the intestinal progenitor compartment. The rostral-caudal gradient of this effect likely reflects a recapitulation of the established gradient along that axis of proliferation, migration, and apoptosis41,42 and the quantitative and qualitative differences in downstream effector mechanisms mediating GC-C signaling.20,43-46 In the context of the present studies, crypt elongation associated with increases in proliferation and migration previously observed in guanylin–/– mice reflect elimination of GC-C signaling, rather than loss of signaling by another unidentified receptor.20
The present study reveals a previously unappreciated role for GC-C in mechanisms regulating proliferative indices of normal intestinal epithelial cells. Indeed, GC-C signaling inhibited DNA synthesis rates in normal colonocytes in human mucosa sheets and in human intestinal epithelial cells. Moreover, GC-C signaling prolonged the intestinal epithelial cell cycle by inducing a G1/S delay. Crypt hyperplasia associated with increased numbers of rapidly cycling progenitor cells in GC-C–/– mice reflects loss of physiological GC-C regulation of the cell cycle. In contrast, GC-C-induced cytostasis in colon cancer cells reflects a generalized slowing, without delay in any specific phase, of the cell cycle.11-13 In that context, GC-C-induced G1/S delay may represent a novel tumor-suppressor mechanism in normal cells whose interruption, through loss of ligand expression,17-19 contributes to colon tumorigenesis.
In addition, this study reveals a role for GC-C signaling in lineage-specific maturation of intestinal epithelial cells. In GC-C–/– mice, crypt hyperplasia reflected increases in proliferative dynamics and reciprocal restriction of differentiation along the secretory lineage, specifically of Paneth and goblet cells, without effects on enteroendocrine cells or absorptive enterocytes. The selective impairment of cell lineage commitment suggests that, rather than a passive consequence of dysregulated cell proliferation, these effects may reflect a previously unrecognized ability of GC-C to regulate discreet molecular mechanisms associated with intestinal cell programming.
Beyond fluid balance, GC-C has recently emerged as a critical signaling molecule suppressing colorectal tumorigenesis by regulating distinct, mutually reinforcing molecular mechanisms underlying crypt-villus homeostasis, including restriction of proliferation and maintenance of genomic integrity.38 Observations presented here further support the suggestion that GC-C is one of the integrated paracrine mechanisms regulating intestinal mucosa homeostasis. Thus, GC-C signaling restricts the size of crypt progenitor compartments, impeding cell cycle progression and proliferation, promoting lineage-specific maturation, limiting cell migration, and inhibiting apoptosis. The pathophysiological significance of GC-C as a paracrine mechanism restricting the size of the proliferating compartment is underscored by the centrality of this compartment in mechanisms underlying colon carcinogenesis. Indeed, overexpression of molecules like Wnt, β-catenin, and Tcf that promote the progenitor cell compartment in the crypt is associated with colonic tumorigenesis.32,33 Conversely, disruption of genes including APC, SMAD, and IHH, which restrict the proliferating crypt compartment and promote differentiation in the villus compartment, also is associated with colonic tumorigenesis.47-51 The prevailing model suggests that tumor initiation and progression in colon reflects accumulation of genetic mutations in proliferating crypt progenitor cells.52 Importantly, expression of guanylin and uroguanylin is invariably lost early during neoplastic transformation.17-19 In the context of the present studies, early loss of GC-C ligands and the associated physiological mechanisms restricting the cell cycle, number of proliferating cells and size of the progenitor compartment, and promoting cell differentiation will induce crypt hyperplasia, amplifying accumulation of stochastic genetic mutations underlying tumor initiation.4,6,8 Moreover, dysregulated GC-C signaling reflecting loss of ligands eliminates one important cytostatic mechanism inhibiting proliferation in transformed cells, potentiating tumor promotion.11-13,30 Of significance, loss of guanylin and uroguanylin expression in human tumors is associated with near-uniform overexpression of GC-C,23,27 suggesting paracrine hormone replacement therapy as a novel chemopreventive strategy to maintain crypt-villus homeostasis and suppress tumor initiation and promotion in intestine.38
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Footnotes |
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Supported by the National Institutes of Health (grants CA75123 and CA95026 to S.A.W.), Targeted Diagnostic and Therapeutics Inc. (to S.A.W.), and the Pennsylvania Department of Health (to G.M.P.).
The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations, or conclusions. S.A.W. is the Samuel M.V. Hamilton Endowed Professor.
S.A.W. and G.M.P. contributed equally to this study.
Accepted for publication August 23, 2007.
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References |
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A, Velic A, Basoglu C, Hirsch JR, Edemir B, Kuhn M, Schlatter E: Uroguanylin and guanylin regulate transport of mouse cortical collecting duct independent of guanylate cyclase C. Kidney Int 2005, 68:1008-1017[CrossRef][Medline]This article has been cited by other articles:
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  G. M. Pitari, J. E. Lin, F. J. Shah, W. J. Lubbe, D. S. Zuzga, P. Li, S. Schulz, and S. A. Waldman Enterotoxin preconditioning restores calcium-sensing receptor-mediated cytostasis in colon cancer cells Carcinogenesis, August 1, 2008; 29(8): 1601 - 1607. [Abstract] [Full Text] [PDF]
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