73 resultados para niveaux de fusion
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OBJECTIVE: Interleukin-1 (IL-1) mediates ischemia-reperfusion injury and graft inflammation after heart transplantation. IL-1 affects target cells through two distinct types of transmembrane receptors, type-1 receptor (IL-1R1), which transduces the signal, and the non-signaling type-2 receptor (IL-1R2), which acts as a ligand sink that subtracts IL-1beta from IL-1R1. We analyzed the efficacy of adenovirus (Ad)-mediated gene transfer of a soluble IL-1R2-Ig fusion protein in delaying cardiac allograft rejection and the mechanisms underlying the protective effect. METHODS: IL-1 inhibition by IL-1R2-Ig was tested using an in vitro functional assay whereby endothelial cells preincubated with AdIL-1R2-Ig or control virus were stimulated with recombinant IL-1beta or tumor necrosis factor-alpha (TNF-alpha), and urokinase-type plasminogen activator (u-PA) induction was measured by zymography. AdIL-1R2-Ig was delivered to F344 rat donor hearts ex vivo, which were placed in the abdominal position in LEW hosts. Intragraft inflammatory cell infiltrates and proinflammatory cytokine expression were analyzed by immunohistochemistry and real-time reverse transcriptase-polymerase chain reaction (RT-PCR), respectively. RESULTS: IL-1R2-Ig specifically inhibited IL-1beta-induced u-PA responses in vitro. IL-1R2-Ig gene transfer reduced intragraft monocytes/macrophages and CD4(+) cell infiltrates (p<0.05), TNF-alpha and transforming growth factor-beta (TGF-beta) expression (p<0.05), and prolonged graft survival (15.6+/-5.7 vs 10.3+/-2.5 days with control vector and 10.1+/-2.1 days with buffer alone; p<0.01). AdIL-1R2-Ig combined with a subtherapeutic regimen of cyclosporin A (CsA) was superior to CsA alone (19.4+/-3.0 vs 15.9+/-1.8 days; p<0.05). CONCLUSIONS: Soluble IL-1 type-2 receptor gene transfer attenuates cardiac allograft rejection in a rat model. IL-1 inhibition may be useful as an adjuvant therapy in heart transplantation.
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Résumé pour le grand public L'île de Fuerteventura (Canaries) offre l'occasion rare d'observer les racines d'un volcan océanique édifié il y a 25 à 30 millions d'années et complètement érodé. On y voit de nombreux petits plutons de forme et composition variées, témoignant d'autant d'épisodes de l'activité magmatique. L'un de ces plutons, appelé PX1, présente une structure inhabituelle formée d'une alternance de bandes verticales d'épaisseur métrique à hectométrique de roches sombres de composition pyroxénilique ou gabbroïque. Les pyroxénites résultent clairement de l'accumulation de cristaux de pyroxènes et non de la simple solidification d'un magma? Se pose dès lors la question de la nature du processus qui a conduit à l'accumulation verticale de niveaux concentrés en pyroxènes. En effet, les litages pyroxénitiques classiques sont subhorizontaux, car ils résultent de l'accumulation gravitaire des cristaux séparés du magma dont ils cristalli¬sent par sédimentation. Cette étude vise à identifier et comprendre les mécanismes qui ont engendré ce Iitage minéralogique vertical et l'im¬portant volume de ces faciès cumulatifs. Nous nous sommes également intéressés aux conditions de pression et de température régnant au moment de la mise en place du pluton, ainsi qu'à sa durée de vie et à sa vitesse de refroidis¬sement. Enfin une approche géochimique nous a permis de préciser la nature de la source mantellique des magmas liés à cette activité magmatique. PX1 est en réalité un complexe filonien formé à des conditions de pression et de température de 1-2 kbar et 1050- 1100°C; sa construction a nécessité au moins 150 km3 de magma. L'alternance d'horizons gabbroïques et pyroxéniti¬ques représente des injections successives de magma sous la forme de filons verticaux, mis en place dans un contexte régional en extension. L'étude des orientations des minéraux dans ces faciès révèle que les horizons gabbroïques enregistrent l'extension régionale, alors que les pyroxénites sont générées par une compaction au sein du pluton. Ceci suggère que le régime des contraintes, qui était extensif lors de l'initiation de la mise en place de PX1, est pério¬diquement devenu compressif au sein même du pluton. Cette compression serait liée à des cycles de mise en place où la vitesse de croissance du pluton dépassait celle de l'extension régionale. La différenciation observée au sein de chaque horizon, depuis des pyroxénites riches en olivine jusqu'à des pyroxé¬nites à plagioclase interstitiel et des gabbros, ainsi que la composition géochimique des minéraux qui les constituent suggèrent que chaque filon vertical s'est mis en place à partir d'un magma de composition identique, puis a évolué indépendamment des autres en fonction du régime thermique et du régime des contraintes local. Lorsque le magma en train de cristalliser s'est trouvé en compression, le liquide résiduel a été séparé des cristaux déjà formés et extrait du système, laissant derrière lui une accumulation de cristaux dont la nature et les proportions dépendaient du stade de cristallisation atteint par le magma au moment de l'extraction. Ainsi, les niveaux de pyroxénites à olivine (premier minéral à cristalliser) ont été formés lorsque le magma correspondant était encore peu cristallisé; à l'inverse, les py¬roxénites riches en plagioclase (minéral plus tardif dans la séquence de cristallisation) et certains gabbros à caractère cumulatif résultent d'une compression tardive dans le processus de cristallisation du filon concerné. Les liquides résiduels extraits des niveaux pyroxénitiques sont rarement observés dans PX1, certaines poches et filonets de com¬position anorthositique pourraient en être les témoins. L'essentiel de ces liquides a probablement gagné des niveaux supérieurs du pluton, voire la surface du volcan. L'origine du régime compressif périodique affectant les filons en voie de cristallisation est attribuée aux injections suivantes de magma au sein du pluton, qui se sont succédées à un rythme plus rapide que la vitesse de consolidation des filons. Des datations U/Pb de haute précision sur des cristaux de zircon et de baddeleyite ainsi que40Ar/39Ar sur des cris¬taux d'amphibole révèlent une initiation de la mise en place de PX1 il y a 22.1 ± 0,7 Ma; celle-ci a duré quelque 0,48 ± 0,22 à 0,52 ± 0,29 Ma. Ce laps de temps est compatible avec celui nécessaire à la cristallisation des filons individuels, qui va de moins d'une année lors de l'initiation du magmatisme à 5 ans lors du maximum d'activité de PX1. La présence de cristaux résorbés enregistrant une cristallisation complexe suggère l'existence d'une chambre mag¬matique convective sous-jacente à PX1 et périodiquement rechargée. Les compositions isotopiques des roches étu¬diées révèlent une source mantellique profonde de type point chaud avec une contribution du manteau lithosphéri- que métasomatisé présent sous les îles Canaries. Résumé L'intrusion mafique Miocène PX1 fait partie du soubassement superficiel (0.15-0.2 GPa, 1100 °Q d'un volcan d'île océanique. La particularité de ce pluton est l'existence d'alternances d'unités de gabbros et de pyroxénites qui met¬tent en évidence un litage magmatique vertical (NNE-SSW). Les horizons gabbroiques et pyroxénitiques sont constitués d'unités de différenciation métriques qui suggèrent tine mise en place par injections périodiques de filons verticaux de magma formant un complexe filonien. Chaque filon vertical a subi une différenciation parallèle à un front de solidification sub-vertical parallèle aux bords du filon. Les pyroxénites résultent du fractionnement et de l'accumulation d'olivine ± clinopyroxene ± plagioclase à partir d'un magma basaltique faiblement alcalin et sont interprétées comme étant des imités de différenciation tronquées dont le liquide interstitiel a été extrait par compaction. L'orientation préférentielle des clinopyroxènes dans ces pyroxe- nites (obtenues par analyse EBSD et micro-tomographique) révèle une composante de cisaillement simple dans la genèse de ces roches, ce qui confirme cette interprétation. La compaction des pyroxénites est probablement causée par a mise en place de filons de magma suivants. Le liquide interstitiel expulsé est probablement par ces derniers. Les clinopyroxènes des gabbros, montrent une composante de cisaillement pure suggérant qu'ils sont affectés par une déformation syn-magmatique parallèle aux zones de cisaillement NNE-SSW observées autour de PX1 et liées au contexte tectonique Miocène d'extension régionale. Ceci suggère que les gabbros sont liés à des taux de mise en place faibles à la fin de cycles d'activité magmatique et sont peu ou pas affectés par la compaction. L'initiation et la géométrie de PX1 sont donc contrôlées par le contexte tectonique régional d'extension alors que les taux et les volumes de magma dépendent de facteurs liés à la source. Des taux d'injection élevés résultent probable¬ment en une croissance du pluton supérieure à la place crée par cette extension. Dans ce cas de figure, la propagation des nouveaux dykes et l'inaptitude du magma à circuler à travers les anciens dykes cristallisés pourrait causer une augmentation de la pression non-lithostatique sur ces derniers, exprimée par un cisaillement simple et l'expulsion du liquide interstitiel qu'ils contiennent (documenté par les zones de collecte anorthositiques). Les compositions en éléments majeurs et traces des gabbros et pyroxenites de PX1 sont globalement homogènes et dépendent de la nature cumulative des échantillons. Cependant, de petites variations des concentrations en éléments traces ainsi que les teneurs en éléments traces des bordures de clinopyroxenes suggèrent que ces derniers ont subi un processus de rééquilibrage et de cristallisation in situ. L'homogénéité des compositions chimiques des échantillons, ainsi que la présence de grains de clinopyroxene résorbés suggère que le complexe filonien PX1 s'est mis en place au dessus d'une chambre magmatique périodiquement rechargée dans laquelle la convection est efficace. Chaque filon est donc issu d'un même magma, mais a subi une différenciation par cristallisation in situ (jusqu'à 70% de fraction¬nement) indépendamment des autres. Dans ces filons cristallisés, les minéraux cumulatifs subissent un rééquilibrage partiel avec les liquide interstitiel avant que ce dernier ne soit expulsé lors de la compaction (mettant ainsi un terme à la différenciation). Ce modèle de mise en place signifie qu'un minimum de 150Km3 de magma est nécessaire à la genèse de PX1, une partie de ce volume ayant été émis par le 'Central Volcanic Complex' de Fuerteventura. Les rapports isotopiques radiogéniques mesurés révèlent la contribution de trois pôles mantelliques dans la genèse du magma formant PX1. Le mélange de ces pôles HIMU, DMM et EM1 refléterai l'interaction du point chaud Cana¬rien avec un manteau lithosphérique hétérogène métasomatisé. Les petites variations de ces rapports et des teneurs en éléments traces au sein des faciès pourrait refléter des taux de fusion partielle variable de la source, résultant en un échantillonnage variable du manteau lithosphérique métasomatisé lors de son interaction avec le point chaud. Des datations U/Pb de haute précision (TIMS) sur des cristaux de zircon et de baddeleyite extraits de gabbros de PX1 révèlent que l'initiation de la cristallisation du magma a eu lieu il y a 22.10±0.07 Ma et que l'activité magmatique a duré un minimum de 0.48 à 0.52 Ma. Des âges 40Ar/39Ar obtenus sur amphibole sont de 21.9 ± 0.6 à 21.8 ± 0.3 Ma, identiques aux âges U/Pb. La combinaison de ces méthodes de datations, suggère que le temps maximum nécessaire à PX1 pour se refroidir en dessous de la température de fermeture de l'amphibole est de 0.8Ma. Ceci signifie que la durée de vie de PX1 est de 520 000 à 800 000 ans. La coexistence de cristaux de baddeleyite et de zircon dans un gabbro est attribuée à son interaction avec un fluide riche en C02 relâché par les carbonatites encaissantes lors du métamorphisme de contact généré par la mise en place de PX1 environ 160 000 ans après le début de sa mise en place. Les durées de vie obtenue sont en accord avec le modèle de mise en place suggérant une durée de cristallisation poux chaque filon allant de 1 an à 5 ans. Abstract The Miocene PX1 gabbro-pyroxenite intrusion (Fuerteventura, Canary Islands), is interpreted as the shallow-level feeder-zone (0.15-0.2 GPa and 1100-1120°C), to an ocean island volcano. The particularity of PX1 is that it displays a NNE-SSW trending vertical magmatic banding expressed by alternating gabbro and pyroxeriite sequences. The gabbro and pyroxenite sequences consist of metre-thick differentiation units, which suggest emplacement by pe¬riodic injection of magma pulses as vertical dykes that amalgamated, similarly to a sub-volcanic sheeted dyke com¬plex. Individual dykes underwent internal differentiation following a solidification front (favoured by a significant lateral/horizontal thermal gradient) parallel to the dyke edges. Pyroxenitic layers result from the fractionation and accumulation of clinopyroxene ± olivine ± plagioclase crystals from a mildly alkaline basaltic liquid and are interpre¬ted as truncated differentiation sequences, from which residual melts were extracted by compaction. Clinopyroxene mineral orientation in pyroxenites (evidenced by EBSD and micro X-ray tomography analysis) display a marked pure shear component, supporting this interpretation. Compaction and squeezing of the crystal mush is ascribed to the incoming and inflating magma pulses. The resulting expelled interstitial liquid was likely collected and erupted along with the magma flowing through the newly injected dykes. Gabbro sequences represent crystallised coalesced magma batches, emplaced at lower rates at the end of eruptive cycles, and underwent minor melt extraction as evi¬denced by clinopyroxene orientations that record a simple shear component suggesting syn-magmatic deformation parallel to observed NNF.-SSW trending shear-zones induced by the regional tensional Miocene stress-field. The initiation and geometry of PX1 is controlled by the regional extensional tectonic regime whereas rates and vo¬lumes of magma depend on source-related factors. High injection rates are likely to induce intrusion growth rates larger than could be accommodated by the regional extension. In this case, dyke tip geometry and the inability of magma to circulate through previously emplaced and crystallised dykes could result in an increase of non-lithostatic pressure on previously emplaced mushy dyke walls; generating strong pure-shear compaction and interstitial melt expulsion within the feeder-zone as recorded by the cumulitic pyroxenite bands and anorthositic collection zones. The whole-rock major and trace-element chemistry of PX1 gabbros and pyroxenites is globally homogeneous and controlled by the cumulate nature of the samples (i.e. on the modal proportions of olivine, pyroxene, plagioclase and oxides). However, small variations of whole-rock trace-element contents as well as trace-element contents of clinopyroxene rims suggest that in-situ re-equilibration and crystallisation has occurred. Additionally, the global homogeneity and presence of complex zoning of rare resorbed clinopyroxene crystals suggest that the PX1 feeder- zone overlies a periodically replenished and efficiently mixed magma chamber. Each individual dyke of magma thus originated from a compositionally constant mildly alkaline magma and differentiated independently from the others reaching up to 70% fractionation. Following dyke arrest these are affected by interaction with the trapped interstitial liquid prior to its compaction-linked expulsion (thus stopping the differentiation process). This emplacement model implies that minimum amount of approximately 150 km3 of magma is needed to generate PX1, part of it having been erupted through the overlying Central Volcanic Complex of Fuerteventura. The radiogenic isotope ratios of PX1 samples reveal the contribution on three end-members during magma genesis. This mixing of the H1MU, EMI and DMM end-members could reflect the interaction of the deep-seated Canarian mantle plume with a heterogeneous metasomatic and sepentininsed lithospheric mantle. Additionally, the observed trace-element and isotopic variations within the same fades groups could reflect varying degrees of partial melting of the source region, thus tapping more or less large areas of the metasomatised lithospheric mantle during interac¬tion with the plume. High precision ID-TIMS U/Pb zircon and baddeleyite ages from the PX1 gabbro samples, indicate initiation of magma crystallisation at 22.10 ± 0.07 Ma. The magmatic activity lasted a minimum of 0.48 to 0.52 Ma. 40Ar/39Ar amphibole ages are of 21.9 ± 0.6 to 21.8 ± 0.3, identical within errors to the U/Pb ages. The combination of the 40Ar/39Ar and U/Pb datasets imply that the maximum amount of time PX1 took to cool below amphibole Tc is 0.8 Ma, suggesting PX1 lifetime of 520 000 to 800 000 years. On top of this, the coexistence of baddeleyite and zircon in a single sample is ascribed to the interaction of PX1 with C02-rich carbonatite-derived fluids released from the host-rock carbonatites during contact metamorphism 160 000 years after PX1 initiation. These ages are in agreement with the emplacement model, implying a crystallisation time of less than 1 to 5 years for individual dykes.
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PURPOSE: To improve the risk stratification of patients with rhabdomyosarcoma (RMS) through the use of clinical and molecular biologic data. PATIENTS AND METHODS: Two independent data sets of gene-expression profiling for 124 and 101 patients with RMS were used to derive prognostic gene signatures by using a meta-analysis. These and a previously published metagene signature were evaluated by using cross validation analyses. A combined clinical and molecular risk-stratification scheme that incorporated the PAX3/FOXO1 fusion gene status was derived from 287 patients with RMS and evaluated. RESULTS: We showed that our prognostic gene-expression signature and the one previously published performed well with reproducible and significant effects. However, their effect was reduced when cross validated or tested in independent data and did not add new prognostic information over the fusion gene status, which is simpler to assay. Among nonmetastatic patients, patients who were PAX3/FOXO1 positive had a significantly poorer outcome compared with both alveolar-negative and PAX7/FOXO1-positive patients. Furthermore, a new clinicomolecular risk score that incorporated fusion gene status (negative and PAX3/FOXO1 and PAX7/FOXO1 positive), Intergroup Rhabdomyosarcoma Study TNM stage, and age showed a significant increase in performance over the current risk-stratification scheme. CONCLUSION: Gene signatures can improve current stratification of patients with RMS but will require complex assays to be developed and extensive validation before clinical application. A significant majority of their prognostic value was encapsulated by the fusion gene status. A continuous risk score derived from the combination of clinical parameters with the presence or absence of PAX3/FOXO1 represents a robust approach to improving current risk-adapted therapy for RMS.
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Cell-cell fusion is essential for fertilization. For fusion of walled cells, the cell wall must be degraded at a precise location but maintained in surrounding regions to protect against lysis. In fission yeast cells, the formin Fus1, which nucleates linear actin filaments, is essential for this process. In this paper, we show that this formin organizes a specific actin structure-the actin fusion focus. Structured illumination microscopy and live-cell imaging of Fus1, actin, and type V myosins revealed an aster of actin filaments whose barbed ends are focalized near the plasma membrane. Focalization requires Fus1 and type V myosins and happens asynchronously always in the M cell first. Type V myosins are essential for fusion and concentrate cell wall hydrolases, but not cell wall synthases, at the fusion focus. Thus, the fusion focus focalizes cell wall dissolution within a broader cell wall synthesis zone to shift from cell growth to cell fusion.
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CONTEXT: The current standard for diagnosing prostate cancer in men at risk relies on a transrectal ultrasound-guided biopsy test that is blind to the location of the cancer. To increase the accuracy of this diagnostic pathway, a software-based magnetic resonance imaging-ultrasound (MRI-US) fusion targeted biopsy approach has been proposed. OBJECTIVE: Our main objective was to compare the detection rate of clinically significant prostate cancer with software-based MRI-US fusion targeted biopsy against standard biopsy. The two strategies were also compared in terms of detection of all cancers, sampling utility and efficiency, and rate of serious adverse events. The outcomes of different targeted approaches were also compared. EVIDENCE ACQUISITION: We performed a systematic review of PubMed/Medline, Embase (via Ovid), and Cochrane Review databases in December 2013 following the Preferred Reported Items for Systematic reviews and Meta-analysis statement. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. EVIDENCE SYNTHESIS: Fourteen papers reporting the outcomes of 15 studies (n=2293; range: 13-582) were included. We found that MRI-US fusion targeted biopsies detect more clinically significant cancers (median: 33.3% vs 23.6%; range: 13.2-50% vs 4.8-52%) using fewer cores (median: 9.2 vs 37.1) compared with standard biopsy techniques, respectively. Some studies showed a lower detection rate of all cancer (median: 50.5% vs 43.4%; range: 23.7-82.1% vs 14.3-59%). MRI-US fusion targeted biopsy was able to detect some clinically significant cancers that would have been missed by using only standard biopsy (median: 9.1%; range: 5-16.2%). It was not possible to determine which of the two biopsy approaches led most to serious adverse events because standard and targeted biopsies were performed in the same session. Software-based MRI-US fusion targeted biopsy detected more clinically significant disease than visual targeted biopsy in the only study reporting on this outcome (20.3% vs 15.1%). CONCLUSIONS: Software-based MRI-US fusion targeted biopsy seems to detect more clinically significant cancers deploying fewer cores than standard biopsy. Because there was significant study heterogeneity in patient inclusion, definition of significant cancer, and the protocol used to conduct the standard biopsy, these findings need to be confirmed by further large multicentre validating studies. PATIENT SUMMARY: We compared the ability of standard biopsy to diagnose prostate cancer against a novel approach using software to overlay the images from magnetic resonance imaging and ultrasound to guide biopsies towards the suspicious areas of the prostate. We found consistent findings showing the superiority of this novel targeted approach, although further high-quality evidence is needed to change current practice.
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The advent of multiparametric MRI has made it possible to change the way in which prostate biopsy is done, allowing to direct biopsies to suspicious lesions rather than randomly. The subject of this review relates to a computer-assisted strategy, the MRI/US fusion software-based targeted biopsy, and to its performance compared to the other sampling methods. Different devices with different methods to register MR images to live TRUS are currently in use to allow software-based targeted biopsy. Main clinical indications of MRI/US fusion software-based targeted biopsy are re-biopsy in men with persistent suspicious of prostate cancer after first negative standard biopsy and the follow-up of patients under active surveillance. Some studies have compared MRI/US fusion software-based targeted versus standard biopsy. In men at risk with MRI-suspicious lesion, targeted biopsy consistently detects more men with clinically significant disease as compared to standard biopsy; some studies have also shown decreased detection of insignificant disease. Only two studies directly compared MRI/US fusion software-based targeted biopsy with MRI/US fusion visual targeted biopsy, and the diagnostic ability seems to be in favor of the software approach. To date, no study comparing software-based targeted biopsy against in-bore MRI biopsy is available. The new software-based targeted approach seems to have the characteristics to be added in the standard pathway for achieving accurate risk stratification. Once reproducibility and cost-effectiveness will be verified, the actual issue will be to determine whether MRI/TRUS fusion software-based targeted biopsy represents anadd-on test or a replacement to standard TRUS biopsy.
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PURPOSE: Pediatric rhabdomyosarcoma (RMS) has two common histologic subtypes: embryonal (ERMS) and alveolar (ARMS). PAX-FOXO1 fusion gene status is a more reliable prognostic marker than alveolar histology, whereas fusion gene-negative (FN) ARMS patients are clinically similar to ERMS patients. A five-gene expression signature (MG5) previously identified two diverse risk groups within the fusion gene-negative RMS (FN-RMS) patients, but this has not been independently validated. The goal of this study was to test whether expression of the MG5 metagene, measured using a technical platform that can be applied to routine pathology material, would correlate with outcome in a new cohort of patients with FN-RMS. EXPERIMENTAL DESIGN: Cases were taken from the Children's Oncology Group (COG) D9803 study of children with intermediate-risk RMS, and gene expression profiling for the MG5 genes was performed using the nCounter assay. The MG5 score was correlated with clinical and pathologic characteristics as well as overall and event-free survival. RESULTS: MG5 standardized score showed no significant association with any of the available clinicopathologic variables. The MG5 signature score showed a significant correlation with overall (N = 57; HR, 7.3; 95% CI, 1.9-27.0; P = 0.003) and failure-free survival (N = 57; HR, 6.1; 95% CI, 1.9-19.7; P = 0.002). CONCLUSIONS: This represents the first, validated molecular prognostic signature for children with FN-RMS who otherwise have intermediate-risk disease. The capacity to measure the expression of a small number of genes in routine pathology material and apply a simple mathematical formula to calculate the MG5 metagene score provides a clear path toward better risk stratification in future prospective clinical trials. Clin Cancer Res; 21(20); 4733-9. ©2015 AACR.
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Expression of the SS18/SYT-SSX fusion protein is believed to underlie the pathogenesis of synovial sarcoma (SS). Recent evidence suggests that deregulation of the Wnt pathway may play an important role in SS but the mechanisms whereby SS18-SSX might affect Wnt signaling remain to be elucidated. Here, we show that SS18/SSX tightly regulates the elevated expression of the key Wnt target AXIN2 in primary SS. SS18-SSX is shown to interact with TCF/LEF, TLE and HDAC but not β-catenin in vivo and to induce Wnt target gene expression by forming a complex containing promoter-bound TCF/LEF and HDAC but lacking β-catenin. Our observations provide a tumor-specific mechanistic basis for Wnt target gene induction in SS that can occur in the absence of Wnt ligand stimulation.