Hypertension. 1996;27:495-501
(Hypertension. 1996;27:495-501.)
© 1996 American Heart Association, Inc.
Strategies for Studying Cardiovascular Phenotypes in Genetically Manipulated Mice
K. David Becker;
Kim R. Gottshall;
Kenneth R. Chien
From the Department of Medicine, Center for Molecular Genetics and
American Heart Association Bugher Foundation Center for Molecular Biology,
University of California, San Diego, La Jolla.
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Abstract
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Abstract Unraveling the pathogenesis of complex
cardiovascular
diseases, such as hypertension, requires
the development of
in vivo animal model systems. Although
large-animal models have
long served as the gold standard, recent
advances in transgenic
and gene-targeting approaches, mouse
genetics, and microsurgical
technology are initiating a revolution that
has led to the unexpected
coupling of in vivo molecular physiology with
genetically engineered
mice. This article discusses the design of
strategies to study
complex cardiovascular
phenotypes in genetically modified mice,
including both
transgenic and gene-targeted animals. At this
time, a number of
strategies are used to address specific molecular
or
physiological questions, and examples are briefly
highlighted.
In addition, a number of potential problems in the
generation
and use of transgenic mice in the study of
cardiovascular biology
are presented.
Key Words: models, cardiovascular animals, transgenic mice, knockout gene targeting mice, inbred strains myocardium
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Introduction
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Most human disease is
polygenic, with several genes interacting
with environmental influences
leading to the clinical phenotype.
Diseases generated by a
single gene defect are often subject
to the influence of modifiers or
interacting genes that alter
the expression of the phenotype
and thus contribute to heterogeneity
of human disease.
Nowhere are multifactorial pressures more
evident than in
cardiovascular medicine. Hypertension and
atherosclerosis
clearly have a polygenic basis, and the
variability of phenotypic
expression in human hypertrophic
cardiomyopathy is of considerable
interest.
Preclinical diagnosis and therapy in such disease
has, until recently,
not been approached by addressing the underlying
molecular basis of the
phenotype. Models defining cardiovascular
physiology
have long relied on large animals, which have inherent
limitations
determined by genetic variance and inaccessibility to
molecular-genetic
manipulation. For these and other reasons,
several investigators
have turned to the mouse as a model system in
which to study
cardiovascular disease.
The powerful methods developed for the mouse model system allow an
attack on any defined biological question through several approaches
(for a review, see Reference 1). Many inbred strains of mice have been
produced, and within each strain, genetic variability is essentially
eliminated. Phenotypic analysis in conjunction with molecular
examination and/or genomic manipulation within inbred strains allows
precise determination of the role of specific gene products.
Studies using different genetic backgrounds in different inbred strains
have allowed identification of modifiers and isolation of genes that
encode interacting gene products.2 The determination
of the physical map of the mouse will soon produce molecular markers at
short intervals spanning the entire genome, providing an ideal
vertebrate system for molecular-genetic analysis of complex
traits.
Characterization of an allelic series at any particular locus is the
classic genetic method used to analyze gene function. Such
approaches encompass a range of mutations at a single locus, from a
complete loss of function (null alleles) to various levels of
reduced function (hypomorphic alleles) to new functions (neomorphic
alleles; eg, constitutively active gene). In the mouse, all types
of alleles can be produced by molecular manipulation of
endogenous loci as well as by overexpression of
wild-type or mutant transgenes in a systemic, tissue-specific,
or ectopic fashion. Recent reviews have described the broad use of
transgenic mice to study cardiovascular
biology.3 4 The purpose of this article is to
supplement
these reviews and briefly describe a few examples in which the power
and elegance of the mouse system have been used to address questions of
development and disease of the cardiovascular
system.
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Transgenesis and the Myocardium
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Analyses of the mechanisms producing particular
cardiovascular
phenotypes in the mouse have
recently relied on overexpression
of either wild-type or mutant
cDNAs to produce neomorphic alleles.
The optimal approach in the
production of a transgenic animal
is determined by the desired
effect, the target tissue, and
the availability of appropriate
regulatory sequences to drive
transgene expression. Systemic expression
(ie, throughout the
entire animal) is used when it produces the
preferred distribution,
when tissue specificity is not an option, or
when this pattern
of expression is not deleterious and/or will not
complicate
the outcome. Both broad-based (ie, expression limited to
several
tissues) and systemic transgene expression have been used to
elevate
the serum levels of the wild-type isoform of several
components
of lipoprotein transport metabolism (Table 1

).
Overexpression
of human apolipoprotein
AI
5 6 or rat apolipoprotein E
7 in
transgenic
mice
appears to provide protection against diet-induced formation
or
progression of atherosclerotic lesions. Species-specific
differences
in human and mouse lipoprotein metabolism argue
against acceptance
of absolute validity for such models,
yet these transgenics
provide direct evidence that increased HDL levels
protect against
atherosclerosis.
Systemic overexpression of transgenes may complicate the interpretation
of phenotypes within individual transgenic animals. It is
therefore necessary in many cases to limit transgene expression to
individual tissues or cell types. This approach was used to produce
high levels of cardiac-specific expression of the
ß2-adrenergic receptor,8 ß-ARK, or a
ß-ARK inhibitor.9 10 The resulting increased
density of ß2-receptors produces an increase in
myocardial contractility at rest, suggesting that
activated ß2-receptors can couple to G proteins
in the absence of agonist. Furthermore, Bond et al9 showed
the first in vivo evidence for the existence of inverse agonists (ie,
molecules that turn off precoupled receptors) with the potential to
elucidate clinically important therapeutic agents. Tissue-specific
overproduction of ß-ARK and ß-ARK inhibitor
also suggests that these molecules are important in regulating
myocardial contractility. Increased concentrations of
ß-ARK did not affect basal contractility, but they
caused a reduction in the isoproterenol-induced response, whereas
overexpression of a ß-ARK inhibitor increased basal as
well as isoproterenol-induced myocardial
contractility.
Expression of wild-type proteins in tissues in which they are not
normally found provides the means to assess the role that a factor may
have in the determination of the fate of a particular cell. It is well
known that the four members of the MyoD family of HLH transcription
factors are essential for skeletal muscle development. However, the
heart is apparently normal in mice that lack individual or pairs of the
HLH proteins.11 12 Although these genes are not
expressed
in wild-type murine heart (for a review, see Reference 13), Litvin
and coworkers14 reported the presence of an HLH protein in
the early heart primordia of the chick. In an attempt to show that MyoD
and Myf-5 can initiate skeletal myogenesis in vivo, each factor has
been ectopically expressed in the heart of transgenic mice.
Production of MyoD in the heart stimulates expression of some
skeletal musclespecific genes.15 Partial initiation
of skeletal myogenesis in the heart causes abnormal cardiac development
and fetal death. Expression of Myf-5 in the heart stimulates the genes
observed early in skeletal myogenesis and leads to myofiber
degeneration with cardiac dilatation,16 indicating that
these transcription factors can initiate some of the skeletal muscle
program in the cardiac context that is not compatible with proper heart
development.
Targeted expression of mutant proteins in the
cardiovascular system of the mouse has the potential to
elucidate the determinants of individual
physiological phenotypes in both the adult
and the developing animal. The production of oncogenic
ras in the ventricles of the mouse heart, for example,
stimulates hypertrophy in the adult with an impairment of
diastolic function17 similar to the clinical
phenotype of human hypertrophic
cardiomyopathy. During early embryonic development,
overexpression of a dominant negative form of the tyrosine receptor
kinase tek results in mid-gestational death, which could be due to
either severe disruption of endothelial tissue,
vascular leak and hemorrhage, or abnormal heart
development.18 Embryos deficient for tek produce
endothelial cells, but expansion of this cell
population fails to occur, suggesting the tek is required for the
maintenance of the endothelial cell fate. It
remains to be shown whether the myocardial defect derives from a
missing interaction with the developing endothelium or
is secondary to a defect in the endothelial cells.
 |
Regulation of Transgene Expression
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Potentially the most powerful as well as the most limiting
aspect
of generating transgenic animals is the promoter sequences used
to
regulate expression of the transgene. Production of
transgene
product in the preferred spatial pattern, at an
appropriate
time, and at effective concentrations is characteristic of
ideal
regulatory sequences.
17 The transgenic promoter
should limit
expression to the tissue, region, or cell type of
interest.
Very few tissue- or cell typespecific promoters target
expression
to the cardiovascular system (for a review,
see Reference 3).
In some cases, it may be possible to use a
subfragment of the
full-length promoter to drive tissue- and/or
time-specific expression.
For example, the endogenous
MLC2v protein is present in both
slow skeletal muscle and
ventricular myocardium
19 ; however,
a
small fragment of this promoter limits expression to the
ventricular
compartment in transgenic
mice.
20
The ideal promoter should provide appropriate developmental regulation.
The temporal regulation of a transgenic promoter can potentially limit
usefulness in addressing particular questions. The 5.5-kb
-myosin heavy-chain promoter has been used extensively to
produce expression throughout the entire myocardium in
adult animals (eg, ß2-receptor mice), yet during
development this gene is shut off in the ventricles,21
indicating that it would have limited use in experiments addressing
mid- to late-gestational ventricular development, the
time at which most cardiogenesis occurs. In fact, for some
cardiovascular questions the available
cardiac-specific promoters may not produce the desired temporal
pattern of expression. Most of the promoters currently used to limit
transgene expression to the heart are temporally expressed early in
development and continue throughout the life of the mouse. Transgene
expression throughout the life of the mouse could complicate the
observed phenotypefor example, leading to early developmental
defects or to compensatory effects in the adultand might not produce
the desired model intended for dissection of primary molecular
mechanisms of cardiovascular disease. Such limitations
have spawned the production of controllable promoters that
yield inducible transgene expression.
The ability to control gene expression facilitates analysis of
tissue-specific gene function and provides the means to generate
timed developmental defects or to determine the effects of transgene
expression limited to the adult. Promoters inducible via metal ions,
heat shock, or steroid hormones can drive low levels of transcription
even in the absence of inducers and therefore suffer from the lack of
stringent regulation. A system inducible by tetracycline or its
analogues has extremely low levels of basal transgene expression, which
can be stimulated up to 5000-fold and still retain tissue
specificity.22 This system holds great promise for
tissue-specific inducible transgene expression, yet
cardiac-specific inducible expression in vivo has yet to be
achieved.
Finally, promoter strength should be sufficient to produce active
amounts of the transgene product. Although 250 bp of the MLC2v
promoter produces ventricle-specific expression, RNA levels
produced from this fragment are low (J. Hunter and K. Gottshall,
unpublished data, 1995). This may be an advantage when high levels of
transgene expression may lead to a lethal phenotype. In most
cases, however, the desired level of transgene expression is at or near
levels of the endogenous counterpart of the transgenic
promoter being used. Both the human cardiac actin23 and
mouse
-myosin heavy-chain promoters24 can
produce high levels of transgene RNA in the heart. The human cardiac
actin promoter can produce amounts of RNA equivalent to the
endogenous mouse gene; however, this high expression
requires an enhancer element that is located 3' to the human actin
coding sequences. To further increase expression levels 10- to
100-fold, an intron can be added to the transgene construct between the
promoter and the cDNA.25 26 For any particular gene,
it
may be necessary to study several transgenic animals, each taking
advantage of the expression patterns of different promoter sequences to
address both developmental and adult-related questions.
 |
Manipulation of the Endogenous Locus
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Homologous recombination can be used to manipulate an
endogenous
locus in ways that may overcome several of the
concerns one
has when using transgenic promoters. Homologous
recombination
is used to replace sequences at the genomic locus with
DNA that
has been altered in vitro (for a review, see Reference 27).
This
process is accomplished in totipotent embryonic stem
cells
28 derived from the inner cell mass of a mouse
blastocyst. Under
the appropriate culture conditions, embryonic stem
cells remain
undifferentiated and subsequently can contribute to all
cells
of an adult when injected into the blastocele of a developing
embryo.
The resulting animal has an inbred genetic background harboring
a
single change at the targeted locus. This method makes it possible
to
eliminate or modify endogenous gene function creating
duplications,
deficiencies, or hypomorphic or neomorphic
alleles.
Hypertension is a polygenic disease in which both clinical and
physiological studies and genetic mapping have
implicated the involvement of the renin-angiotensin
system.29 30 The genes encoding
angiotensinogen and ACE have been analyzed by use
of gene targeting to produce both deficiencies and duplications at the
endogenous mouse loci. This approach does not alter the
regulatory elements of the locus, and analysis can be
accomplished in a homogenous genetic background.31 The
angiotensinogen locus was altered to produce a duplication
as well as a deficiency in separate strains of mice.32
Interbreeding allowed production of an allelic series of
animals with zero, one, two, three, or four copies of the wild-type
gene. Kim and colleagues32 show that blood pressure
changes directly in response to gene dose, establishing a causal
relation between angiotensinogen and blood pressure
regulation. Even though genetic studies provide conflicting reports as
to the linkage of the gene encoding ACE,29 33 Krege
et
al34 supply clear evidence that ACE has a role in the
regulation of blood pressure. Male mice hemizygous (+/-) or
deficient (-/-) for the ACE gene show decreases in blood
pressure commensurate with gene dose and have decreased fertility.
Female mice display normal fertility, and only the animals deficient
for ACE have decreased blood pressure. Both of these studies show
significant changes in blood pressure that are relatively easy to
detect. Mating these animals to mice of various genetic backgrounds
could lead to the discovery and analysis of interacting genes
involved in blood pressure regulation, making these useful models for
the study of essential hypertension.
For many genes, the knockout or complete removal of function throughout
the entire animal may produce an early lethal phenotype, thus
complicating subsequent analysis. Deletion of an individual
gene restricted to a tissue and/or time in the life of a mouse can be
created by use of the site-specific Cre recombinase of
bacteriophage P1.35 This system requires the generation of
two lines of mice. First, the gene of interest is manipulated in vitro
to include Cre recognition sequences (called loxP sites)
flanking functionally required exons. Subsequent homologous
recombination inserts this construct at the endogenous
locus. The other mouse line is a standard transgenic animal containing
the Cre recombinase cDNA under the control of a tissue-specific
promoter. Expression of Cre recombinase in a mouse homozygous for the
loxP targeted locus removes the genomic DNA internal to the
loxP sites, eliminating gene function. Regulating the
transgenic expression of Cre recombinase with a spatially and/or
temporally controlled promoter generates conditional, cell
typespecific gene knockout. Although this approach is yet to be
accomplished in the cardiovascular context, it has been
used to create a T-cellspecific deletion of the ubiquitous enzyme
DNA pol-ß, involved in DNA repair.35 loxP
sites were added to the pol-ß locus via recombinant DNA and
homologous recombination methods. Cre recombinase expression was
regulated by a T-cellspecific promoter in transgenic mice. In
animals heterozygous for the targeted pol-ß gene and hemizygous for
the Cre transgene, deletion of the pol-ß fragment was observed in
63% to 84% of the splenic T cells. These experiments appear to be
limited by the transient expression of the promoter producing Cre, and
in other situations it will be prudent to maximize recombinase
expression to achieve 100% deletion frequencies. This study brings
forth the very exciting possibility of circumventing a lethal
phenotype and being able to systematically examine lack of gene
function in any tissue or tissues of interest. One limitation of this
system occurs because most genes are expressed at some time during
embryonic development, and tissue-specific knockout will occur as
soon as the recombinase is produced. This may be overcome through
cis-acting control elements that confer inducible regulation
to the promoter driving Cre expression, such as the
tetracycline-controlled system mentioned above.
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Reporter Genes
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Nearly all of the experiments discussed so far rely on prior
knowledge
of the tissue and temporal patterns produced by the promoter
used
in each transgenic animal. In situ hybridization using antisense
RNA
probes in whole mount or tissue sections is the standard for
the
determination of such patterns. Although extremely informative,
this
technique is laborious, complex, and highly sensitive to
background
distortion. It has now become commonplace to use
reporter genes in
transgenic mice to explore the issues of promoter-generated
pattern
as well as to discover the
cis-acting elements responsible
for
transcriptional activity. The key elements in the usefulness
of any
reporter gene are the sensitivity and ease of detection
(Table
2

). Nearly any gene can be used as a reporter (for a
review,
see Reference 36), but detection may be limited to in situ
hybridization
with specific probes. The growth hormone genes are an
example
of a marker that can be detected only by in situ hybridization
with
nucleic acid probes
37 or by immunohistochemistry with
species-specific
antibodies.
38 The use of this
reporter is further complicated
by the biological activity that growth
hormone may have on the
target tissue. Single-cell detection of
firefly luciferase RNA
is also limited to hybridization or
immunohistochemical methods;
however, the ability to detect this marker
in cell extracts
makes it an extremely useful measure of gene
expression.
20 39 Similarly, the gene encoding CAT is
used
to analyze gene expression
in cell extracts from transgenic
animals or from cells in culture.
40 The luciferase assay,
a quantitative measurement of photon
emission, is considered more
sensitive than the CAT assay, which
depends on enzymatic
acetylation of substrate and subsequent
thin-layer
chromatography followed by
autoradiography. Recent
methods have been developed
to increase the sensitivity of the
CAT assay to rival that of
luciferase.
41 Furthermore, a histochemical
procedure
recently described allows in situ detection of CAT
protein by the
formation of a brown precipitate in cells expressing
the
transgene.
42
The most popular marker in the study of temporal and spatial gene
expression is LacZ. This enzyme catalyzes the hydrolysis of
5-bromo-4-chloro-indolyl-ß-D-galactoside (X-gal) to
form a blue precipitate that is visible at the single-cell
level43 44 and can be detected in a quantitative
assay
from cell extracts.45 The detection of this marker
consists of tissue-fixation and the addition of
chromogenic substrate, a simple process that generally
produces high-resolution results. However, LacZ is not
without its share of problems. Mammals have an endogenous
ß-galactosidase activity that can contribute to background
staining, although this is not present in the heart. There are pH
differences for optimum activity between the mammalian and bacterial
enzymes that can be used to reduce the level of background, yet even at
high pH, the mammalian protein may display residual function.
Differentiation of the endogenous and transgene staining
can be achieved by cloning a nuclear localization signal into
ß-galactosidase.46 47 48 Subsequent
tissue staining
will produce blue nuclei in cells expressing the transgene, whereas the
endogenous signal will be cytosolic. It has been observed
that sequences in the LacZ cDNA can produce unexpected
distribution of transgene expression. A cell typespecific neural
promoter driving expression of LacZ produces
ß-galactosidase in neurons that do not express the
endogenous gene.49 However, the same promoter
expresses a different marker in a pattern that matches the
endogenous gene. Finally, results of LacZ
expression postnatally and in adult tissues do not always produce
predictable expression patterns (for a review, see Reference 36), the
reasons for which are not understood.
Recently a new marker has come to light that allows identification and
analysis of living cells expressing this protein. The cDNA
encoding the GFP from the jellyfish Aequorea victoria has
been cloned.50 This small protein (26 900 kD) functions
as a monomer and emits green light in response to long-wave UV
stimulation in either living or formaldehyde-fixed tissue. GFP
functions as a fusion protein and has had no deleterious effects on the
function of the protein it is fused to.51 This marker can
be detected in Dictyostelium (for a review, see Reference
52), plants (for a review, see Reference 53), Caenorhabditis
elegans,54 Drosophila (for a review, see
Reference 55), mammalian cells (for a review, see Reference 56), and
transgenic mice.57 Mutations at the amino acids that
constitute the chromophore transform GFP into a brighter molecule with
absorption and emission spectra suited for standard filter sets used in
the detection of fluorescein isothiocyanate. Cells
transfected with GFP expression plasmids have been purified by
fluorescence-activated cell sorting.58
This should make it possible to purify any cell population from
transgenic mice, or any other organism, in which GFP is expressed in a
tissue-specific fashion. As was suggested for the choice of
transgene promoter, the choice of marker will depend on the
application, and any one reporter gene most likely will not
suffice.
 |
Troubleshooting
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The use of transgenic mice to study
cardiovascular biology has
relied on advances in rDNA
as well as the ability to make physiological
measurements
in small animals. Microsurgical approaches have been
developed
to produce models of either right or left
ventricular dysfunction
via pulmonary artery or
aortic constriction, respectively.
59 60 In these
models,
quantitative analysis of ventricular function
has
been measured by x-ray contrast microangiography. These
techniques
as well as methods for determination of respiratory
function are
impressive but are invasive, requiring anesthesia
to
produce high-resolution results, and may result in the death
of the
individual (for a review, see Reference 61). Noninvasive
techniques
such as echocardiography can be used to measure
chamber
size, wall thickness, and cardiac function (Reference 62;
Tanaka
N., M.D. et al, 1995, unpublished data); however, the level
of
resolution presently attainable must be improved if this
method is
to be of widespread use. Efforts to miniaturize technology
for
assessment of cardiac physiology must progress to achieve
full
advantage of the molecular genetics available in the mouse
system in
the study of cardiovascular biology.
The temporal and spatial patterns generated when promoter fragment is
used to drive expression of a transgene are of prime importance in
transgenic technology. Assuming that the transgene will be expressed in
exactly the same distribution as the endogenous gene may
lead to problems in the analysis of transgenics. Experiments
involving the atrial natriuretic peptide promoter show
differences between in vitro and in vivo regulation in response to
-adrenergic stimulation.63 Similarly, discordance
of transgene and endogenous gene expression patterns has
been described, for example, in the tek regulatory
sequences.64 The most likely explanation is that the
promoter fragment does not include all of the cis-acting
sequences necessary to mimic the endogenous distribution.
Alternatively, reporter gene analysis may bring to light
previously unrecognized patterns of endogenous gene
expression. The MLC 3f gene was thought to be expressed only
in skeletal muscle; however, Kelly et al65 discovered that
this promoter will produce ß-galactosidase in the heart.
Subsequent in situ hybridization with a probe to the
endogenous gene showed that this gene is active in the
heart.
Transgene regulation may be affected by the copy number and/or the site
of chromosomal integration. Transgene insertions can be complex events
consisting of one or many copies at any particular location and may
contain chromosomal translocations as well. It is common that only a
percentage of the transgenic animals generated (ie, founder lines) will
express the exogenous gene, even though all of these animals may
contain the intact gene. Bonnerot et al46 have shown
position-dependent effects on temporal and spatial distributions of
transgene expression in analysis of several different
transgenic lines harboring the same promoter/reporter construct.
Embryonic or neonatal death is the phenotype commonly observed
in many knockout lines and transgenic lines (eg, tek null and ectopic
expression of myogenic factors in the heart). If death is not the
result, then often it is difficult to discriminate between the
developmental and physiological effects.
Interpretation, for example, of the atrial natriuretic
peptide knockouts as well as the overexpression of
ß2-receptors may be confounded by systemic and/or
tissue-specific compensatory changes that occur in response to
chronic lack of function or overexpression, respectively. This problem
should be eliminated with the future use of controllable transgenes as
well as inducible time- and/or space-specific gene knockouts.
 |
Conclusions
|
|---|
Current technology in molecular genetics of the mouse
provides
a powerful system to explore the
physiological role of wild-type
and mutant
molecules. Mouse models of human disease allow access
to underlying
molecular mechanisms. Physiological differences
between
mice and humans do present some minor limitations. However,
even
if the mouse does not have the molecular counterpart of a human
protein,
valuable information regarding function in normal and/or
disease
processes can be obtained in transgenic mice. Proper use of
homogeneous
genetic background minimizes phenotypic
variability and enhances
the prospect of mapping genes encoding
proteins that interact
in the generation of disease. This opens the
mammalian genome
to a level of analysis previously
unprecedented in history.
 |
Selected Abbreviations and Acronyms
|
|---|
| ACE |
= |
angiotensin-converting enzyme |
| ß-ARK |
= |
ß-adrenergic receptor kinase |
| CAT |
= |
chloramphenicol acetyltransferase |
| GFP |
= |
green fluorescent protein |
| HLH |
= |
helixloop-helix |
| LacZ |
= |
bacterial ß-galactosidase |
| MLC2v |
= |
myosin light chain-2v |
| pol-ß |
= |
polymerase-ß |
|
 |
Acknowledgments
|
|---|
Dr Becker is supported by an individual National Research
Scholar
Award from the National Institutes of Health (NIH), Dr
Gottshall
is supported by a training grant from the NIH and National
Eye
Institute, and Dr Chien is supported by grants from the
NIH/National
Heart, Lung, and Blood Institute and American Heart
Association.
The authors would like to thank Dr Andrew Grace, Dr Peter
Gruber,
and Dr Howard Rockman for their critical comments and
discussions
during the preparation of this paper.
 |
Footnotes
|
|---|
Reprint requests to Kenneth R. Chien, MD, PhD, Professor of
Medicine,
Department of Medicine, 0613-C, University of California,
San Diego, 9500
Gilman Dr, La Jolla, CA 92093. E-mail kchien@ucsd.edu.
 |
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