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Antimicrobial Agents and Chemotherapy, March 1998, p. 612-617, Vol. 42, No. 3
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Anti-Human Immunodeficiency Virus Activity and
Cellular Metabolism of a Potential Prodrug of the Acyclic Nucleoside
Phosphonate 9-R-(2-Phosphonomethoxypropyl)adenine
(PMPA), Bis(isopropyloxymethylcarbonyl)PMPA
Brian L.
Robbins,1
Ranga V.
Srinivas,1
Choung
Kim,2
Norbert
Bischofberger,2 and
Arnold
Fridland1,3,*
Department of Infectious Diseases, St. Jude
Children's Research Hospital,1 and
Department of Pharmacology, University of
Tennessee,3 Memphis, Tennessee, and
Gilead Sciences, Foster City, California2
Received 8 September 1997/Returned for modification 19 November
1997/Accepted 19 December 1997
 |
ABSTRACT |
Bis(isopropyloxymethylcarbonyl)
9-R-(2-phosphonomethoxypropyl)adenine [bis(POC)PMPA] has
been identified as a novel prodrug of PMPA. The anti-human
immunodeficiency virus activity of bis(POC)PMPA was >100-fold greater
than that of PMPA in both an established T-cell line and primary
peripheral blood lymphocytes. This improved efficacy was shown to be
due to a rapid intracellular uptake of the prodrug resulting in an
increased intracellular accumulation of PMPA diphosphate (PMPApp), the
pharmacologically active metabolite. PMPApp levels in
bis(POC)PMPA-treated cells exceeded by >1,000-fold the levels seen in
cells treated with unmodified PMPA in both resting and activated
peripheral blood lymphocytes. Significant differences in the
intracellular catabolism of PMPA metabolites were noted between the
resting and activated lymphocytes. The half-life for the disappearance
of PMPApp, derived from either bis(POC)PMPA or PMPA, was 12 to 15 h in the activated lymphocytes and 33 to 50 h in the resting
lymphocytes. This long persistence of PMPApp, particularly in resting
lymphocytes, may be unique to the nucleoside phosphonate analogs and
indicates that effective levels of the active metabolite can be
achieved and maintained with relatively infrequent administration of
the parent drug.
 |
INTRODUCTION |
PMPA
[9-R-(2-phosphonomethoxypropyl)adenine], a prototype agent
of the class of acyclic nucleoside phosphonates, is a potent inhibitor
of both hepadnaviruses and retroviruses, including the human
immunodeficiency virus (HIV), the etiologic agent of AIDS (3-5,
11). Its antiviral activity is related to the preferential inhibition of the viral-specified DNA polymerases (3). PMPA possesses attributes which are desirable for an anti-HIV agent. It
shows a lack of cross-resistance with most of the known clinically nucleoside-resistant HIV strains in vitro and remarkable efficacy in
vivo in animal models of HIV infection (3, 14, 25, 26). Recently, it has been shown that PMPA is able to prevent the
establishment of simian immunodeficiency virus (SIV) infection in
macaques when treatment was started 48 h before or 24 h after
virus inoculation (25). In addition to this prophylactic
activity, PMPA shows efficacy against both chronic SIV infection in
macaques and feline immune deficiency virus infection in cats (14,
26). Due to its efficacy and limited toxicity PMPA is currently
undergoing phase I and II clinical trials for the treatment of HIV
infection in AIDS patients. Preliminary results have shown that PMPA
given intravenously appears safe and well tolerated and caused a 1.1 log reduction of HIV RNA levels after only eight doses (7).
Despite its demonstrated antiviral potency, PMPA has limited oral
bioavailability in animals, presumably resulting from the presence of
two negative charges on the phosphonyl group. This low oral
bioavailability may require high dosages to maintain therapeutic drug
levels; current clinical trials with PMPA employ daily infusions.
Acyloxyalkyl esters of carboxylic acids, e.g., ampicillin and
foscarnet, are known to increase the oral bioavailability of these
compounds over that of the free parental drugs (8, 12, 21).
In the case of 9-(2-phosphonomethoxyethyl)adenine (PMEA), the
bis(pivaloyloxymethyl) [bis(POM)] group has been introduced (15,
19), and this prodrug (now known as adefovir dipivoxil) is
currently in phase II and III clinical trials for the treatment of HIV
and hepatitis B infection. However, pivaloyl-containing compounds
generate pivalic acid during the release of the parent drug and can
cause increased urinary carnitine loss (1, 13). We have
sought to overcome this limitation of the pivaloyl esters by the
development of a more suitable prodrug for PMPA. To this end, a novel
series of alkyl methyl carbonate esters were synthesized (2). We describe here the cellular uptake, metabolism, and antiviral activities of one of the analogs,
bis(isopropyloxymethylcarbonyl)PMPA [bis(POC)PMPA].
(Preliminary results of these studies have been presented previously
[9].)
 |
MATERIALS AND METHODS |
Cells and viruses.
Residual blood collected from rings after
separation of platelets from the blood of healthy, HIV-negative donors
was used as a source of lymphocytes. The peripheral blood mononuclear
cells (PBMC) were separated over Ficoll-Hypaque gradient
centrifugation. The cells were centrifuged at low speed to remove
platelets, while contaminating erythrocytes were lysed by a brief
exposure to hypotonic solution. H9 cells persistently infected with HIV
type 1IIIB (H9/HIV-1IIIB) and MT-2 cells, a
human T-cell lymphotropic-transformed CD4+ T-lymphocytic
cell line, were obtained from the NIH AIDS Research and Reference
Reagent Program. The virus 96-250, a primary isolate from a pediatric
patient attending the St. Jude AIDS clinic, was isolated and propagated
by PBMC coculture.
Compounds.
The structures of PMPA and bis(POC)PMPA are
depicted in Fig. 1. The synthesis of the
different phosphonates has been described elsewhere (2). The
radiolabelled analogs [8-3H-adenine]bis(POC)PMPA
([3H]bis(POC)PMPA; specific activity, 28 Ci/mmol)
and [2,8-3H-adenine]PMPA ([3H]PMPA;
specific activity, 54 Ci/mmol) were obtained from Moravek Biochemicals
(Brea, Calif.). The radiochemicals were verified by high-performance
liquid chromatography (HPLC) before use and were estimated to be >95%
pure.
Antiretroviral assays.
The anti-HIV activities of PMPA and
its prodrugs were determined in MT-2 cells and PBMC according to
previously described procedures (23). Briefly, MT-2 cells or
PBMC were infected with HIV-1 at a multiplicity of infection of 0.01, and the virus-infected cells were seeded at a concentration of 0.2 × 106 cells/ml in medium containing various concentrations
of the drugs. After 5 days of incubation, the p24 antigen levels in the
culture supernatants were determined by an in-house p24 antigen capture assay (22). A nonlinear curve-fitting program (Enzfitter;
Elsevier-BioSoft, Evanston, Ill.) was used to calculate the drug
concentrations yielding half-maximal inhibitions in p24 antigen
production activity compared to that of the drug-free controls. Cell
viability was monitored in replicate cultures by the XTT assay
[2,3-bis-2-methoxy-4-nitro-5-sulfophenyl-5-(5-phenylamino)carbonyl-2H-tetrazolium hydroxide].
Metabolism of [3H]bis(POC)PMPA and
[3H]PMPA.
Untreated PBMC were used as resting
lymphocytes (R-PMBC). PBMC cultured for 72 h in an activation
medium (RPMI medium containing 20% fetal calf serum, 5 µg of
phytohemagglutinin-P/ml, and 5% interleukin-2) were used as activated
cells (phytohemagglutinin-activated PBMC [PHA-PBMC]). Resting or
activated PBMC (106 cells per ml, 10-ml volume) were
incubated in culture medium containing the indicated concentration of
[3H]bis(POC)PMPA or [3H]PMPA. The
activities of the intracellular metabolites PMPA diphosphate (PMPApp)
and PMPA monophosphate (PMPAp) were analyzed as described previously
(18, 23, 24). At different intervals, cells were centrifuged
(1,000 × g for 10 min) and were washed with cold
phosphate-buffered saline. The cell pellet was suspended in ~1 ml of
the incubation medium, layered onto 150 µl of Nyosil oil, and spun
through the oil with an Eppendorf microcentrifuge. The supernatant was
removed, and the cells were extracted with 200 µl of 70% ice-cold
methanol-15 mM Tris buffer (pH 7.4). After standing on ice for 15 min,
cell extracts were centrifuged with an Eppendorf centrifuge and
analyzed by HPLC using a 250-mm Whatman Partisil-SAX anion exchange
column. A linear gradient of 5 mM ammonium dihydrogen phosphate (pH
4.0) (buffer A) to 0.6 M ammonium dihydrogen phosphate buffer (pH 3.5) (buffer B) was used as follows (concentrations given for buffer B
only): 0 to 30% buffer B for 15 min, 30 to 40% buffer B for 10 min,
and 40 to 100% buffer B for 25 min, followed by 100% buffer B for 30 min. The column was run at a flow rate of 1.5 ml/min, fractions were
collected at 40-s intervals, and the different fractions were assayed
for radioactivity in a toluene-based scintillation fluid. A Whatman
Partisil-5 reverse phase column was used to resolve bis(POC)PMPA from
PMPA and its metabolites PMPAp and PMPApp; the column was eluted with a
linear gradient of ammonium dihydrogen phosphate buffer (0.05 M), pH
6.0, to 60% acetonitrile. The identities of the metabolites were
established by comparison to the elution profiles of authentic cold
standards. The retention times for the different standards were as
follows: PMPA, 14 min; PMPAp, 48 min; and PMPApp, 89 min. Cell numbers
and cell volumes at each sampling interval were determined with a
Coulter ZM 256-particle counter equipped with a Channelyzer (Coulter
Electronics, Miami, Fla.). The mean single-cell volumes for resting and
PHA-PBMC were 200 and 900 to 1,000 fl, respectively.
Intracellular retention of [3H]bis(POC)PMPA and
[3H]PMPA in PBMC.
Ten-milliliter aliquots of R-PBMC
and PHA-PBMC suspensions were incubated with 1 µM
[3H]bis(POC)PMPA or 10 µM [3H]PMPA for
24 h. Cells were then washed and resuspended in drug-free medium,
and aliquots were removed at different intervals over the next 48 h. Intracellular concentrations of PMPAp and PMPApp were determined as
described in the previous section. PHA-PBMC were maintained in medium
containing PHA and interleukin-2 throughout the study.
 |
RESULTS |
Anti-HIV activity of bis(POC)PMPA, bis(POM)PMPA, and PMPA.
The
activities of the different phosphonates were evaluated against
HIV-1IIIB and a clinical isolate, 96-250, in the lymphocyte cell line MT-2 and in PHA-stimulated PBMC. The EC50s (50%
effective concentrations) of bis(POC)PMPA against HIV-1IIIB
were 0.007 µM and 0.005 µM in MT-2 cells and PBMC, respectively
(Table 1). These values are comparable to
the EC50 of zidovudine, one of the most potent nucleoside
inhibitors of HIV-1, and ~100-fold lower than that for the unmodified
PMPA. Interestingly, bis(POC)PMPA showed a more than threefold greater
antiviral potency than a related prodrug, bis(POM)PMPA. PMPA and the
prodrugs all showed greater antiviral effects against the primary
clinical isolate 96-250 than against laboratory-adapted
HIV-1IIIB.
These compounds were also evaluated for their cytotoxicity to quiescent
or proliferating PBMC as well as MT-2 cells. As shown
in Table
1,
bis(POC)PMPA inhibited the growth of MT-2 and PHA-PBMC
with 50%
inhibitory concentrations (IC
50s) of 24 and 29 µM,
respectively.
These concentrations were well above the levels that
provided
the anti-HIV activities in these cells and gave selectivity
indices
(IC
50/EC
50 ratios) for bis(POC)PMPA of
~3,000 and 6,000 in MT-2
cells and PBMC, respectively. These values
were comparable to
the selectivity index values of free PMPA, which
were ~2,000 and
~7,000 in MT-2 cells and PBMC, respectively.
Interestingly, bis(POM)PMPA
was much more cytotoxic and showed lower
selectivity than PMPA
in these assays. None of these compounds,
however, exerted any
detectable toxicity against the quiescent PBMC up
to concentrations
well above 100 µM (as determined by dye exclusion).
Intracellular metabolism of [3H]bis(POC)PMPA and
[3H]PMPA.
Other structurally related acyclic
nucleoside analogs, e.g., PMEA and HPMPC, are internalized by
endocytosis (6, 17). It is likely that PMPA is also
internalized via endocytosis. PMPA is then phosphorylated by cellular
nucleotide kinases to PMPApp, the putative active intracellular
inhibitor of HIV reverse transcriptase. We investigated the metabolism
of bis(POC)PMPA in R-PBMC and PHA-PBMC to establish the cellular
pharmacokinetics of this compound. The time course of intracellular
metabolism of [3H]bis(POC)PMPA in PBMC is depicted in
Fig. 2. Both R-PBMC and PHA-PBMC showed a
rapid accumulation of PMPA in the millimolar range within 1 h of
incubation with 1 µM [3H]bis(POC)PMPA. Surprisingly,
neither bis(POC)PMPA nor its monoester derivative were detected within
the cell extracts at any of the time points examined (0.5 to 24 h), suggesting that bis(POC)PMPA is rapidly converted to PMPA within
the cells. PMPAp and PMPApp accumulated steadily for 8 h, reaching
a plateau at a total concentration of 2.8 and ~2 mM in R-PBMC and
PHA-PBMC, respectively. It is noteworthy that the accumulation of PMPA
and its metabolites was dose dependent when PBMC were incubated with
100 nM to 10 µM of the drug (data not shown).

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FIG. 2.
Intracellular metabolism of bis(POC)PMPA in PBMC. R-PBMC
(A) and PHA-PBMC (B) were incubated with 1 µM
[3H]bis(POC)PMPA. At different intervals, the
concentrations of PMPA and its metabolites in cell extracts were
analyzed by HPLC as described in Materials and Methods. ,
[3H]PMPA; , [3H]PMPAp; ,
[3H]PMPApp.
|
|
In parallel experiments with 10 µM [
3H]PMPA, the
cellular uptake and intracellular metabolism of PMPA was quite slow in
both
R-PBMC and PHA-PBMC. The accumulation of PMPA, and its
biologically
active metabolites, was barely detectable during the first
6 h
of incubation. Unlike cells treated with 1 µM bis(POC)PMPA,
which
accumulated PMPA metabolites in the millimolar range, the
intracellular
concentrations of PMPA, PMPAp, and PMPApp were only
~1.7, 0.4,
and 1.2 µM in R-PBMC, and 1.0, 0.2, and 0.4 µM in
PHA-PBMC, respectively,
after 24 h of incubation with 10 µM PMPA
(Table
2).
Intracellular decay of PMPA metabolites in PHA-PBMC and
R-PBMC.
An important characteristic of any drug is the amount of
time that the active drug metabolite persists in the cells. To
investigate the intracellular decay of PMPA metabolites, PBMC were
loaded with 1 µM [3H]bis(POC)PMPA or 10 µM
[3H]PMPA for 24 h, and the intracellular levels of
the drug metabolites were determined at different intervals after
drug removal. As shown in Fig. 3, the
intracellular clearance of PMPA metabolites was linear in PBMC.
PMPAp and PMPApp decayed with half-lives
(t1/2s) of 15 and 11 h, respectively, in
PHA-PBMC preloaded with either bis(POC)PMPA or PMPA. These values are
similar to results previously obtained in human T-lymphocytic cell
lines (19). In marked contrast, the intracellular
t1/2s of PMPAp and PMPApp were much longer (33 and 49 h, respectively) in R-PBMC preloaded with PMPA. In
bis(POC)PMPA-treated R-PBMC, there was very little clearance, and
t1/2s could not be estimated. The high cellular
concentration of PMPA that accumulates from bis(POC)PMPA during the
loading period is likely to be a factor and may serve as a reservoir
for continued phosphorylation of PMPA during the chase period.

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FIG. 3.
Catabolism of PMPAp and PMPApp from R-PBMC (A) and
PHA-PBMC (B) incubated with 1 µM [3H]bis(POC)PMPA ( ,
) or 10 µM [3H]PMPA ( , ) for 24 h. At
different intervals thereafter, cells were analyzed for PMPA
metabolites as described in Materials and Methods. The measured
t1/2 were calculated from the slopes of the
weighted lines generated by linear analysis.
|
|
 |
DISCUSSION |
We present here a preclinical evaluation of bis(POC)PMPA as a
potential prodrug of PMPA. Bis(POC)PMPA is very stable in buffer at
acidic pH (pH 2.0) and 37°C, exhibiting a t1/2
of over 150 h. Thus, it is likely that bis(POC)PMPA may stay
virtually intact in the gastric environment, when administered by the
oral route. In preliminary studies, bis(POC)PMPA has demonstrated an
oral bioavailability of 20 to 36% in mice and dogs, while PMPA, the parent compound, is poorly absorbed following oral administration (9, 16).
Bis(POC)PMPA exhibited increased activity against both
laboratory-adapted and primary clinical isolates of HIV strains in different cell culture systems. The inhibition of HIV in PHA-PBMC was
increased >100-fold over that of the unmodified parental drug and was
accompanied with a proportional increase in cytotoxicity. The
observation that the prodrug retained the same selectivity (~6,000)
as the parent drug shows that the protective group on the phosphonate
was not toxic to the cells. Thus, the observed increases in the
antiviral and cytotoxic activities of bis(POC)PMPA, without any loss of
selectivity, are more likely the result of increased accumulation of
PMPApp, which is both the active and cytotoxic form of the drug.
Surprisingly, bis(POC)PMPA was three- to fourfold more potent against
HIV and ~threefold less cytotoxic than its bis(POM) counterpart. The
reason for the difference in the activities of the two prodrugs is
unclear. Stimulated PBMC incubated with 1 µM bis(POC) for 16 h
accumulated 16.3 and 48.8 mmol of PMPAp and PMPApp/106
cells, respectively, compared to 12.2 and 24.5 mmol of PMPAp and
PMPApp/106 cells, respectively, accumulated by PBMC after
bis(POM)PMPA treatment. Thus, it is possible that the greater
PMPApp levels in bis(POC)PMPA-treated cells account for the slightly
greater antiviral activity compared to that of bis(POM)PMPA. The
increased toxicity, and concomitant reduction in selectivity, of
bis(POM)PMPA relative to bis(POC)PMPA cannot be attributed to these
anabolite differences. Both prodrugs are hydrolyzed to formaldehyde,
carbon dioxide, and PMPA. Bis(POM)PMPA also generates pivalic acid,
whereas the carbamate prodrug releases isopropanol. It is possible that
the accumulation of pivalic acid contributes to the increased
cytotoxicity of bis(POM)PMPA, although further studies are required to
establish this point.
A major advantage of bis(POC)PMPA is its increased bioavailability
after oral administration, thus obviating the need for intravenous
infusions. In previous studies Bis(POC)PMPA had oral bioavailabilities
of ~20 and 40% in monkeys and in humans, respectively (7,
16). A peak level of PMPA in plasma of ~0.3 µg/ml
(t1/2, 8 h; area under the
concentration-time curve, 4.7 to 5.7 mg/h/liter) was achieved after a
single oral administration of bis(POC)PMPA (equivalent to 27 mg of
PMPA/kg of body weight) in monkeys. Bis(POC)PMPA is highly susceptible
to serum esterases. This limits the persistence of the prodrug in
plasma and its availability to interact directly with target cells.
Nevertheless, our results show that bis(POC)PMPA is taken by cells
within minutes and provides significantly greater intracellular levels
of PMPA and active metabolites. Thus, enhanced antiviral activity of
the drug may be expected if even a minute fraction (<0.001%) of the
orally administered bis(POC)PMPA can enter the circulation in its
native form. It is also not clear whether the benefits of improved drug
delivery can be realized by direct intravenous inoculation of
bis(POC)PMPA. In vivo pharmacological studies need to be pursued to
test this possibility.
Significant differences were noted in the metabolism of PMPA and
bis(POC)PMPA in R-PBMC and PHA-PBMC. The amounts of PMPA and its
metabolites, derived from either prodrug or PMPA, were two- to
threefold higher in R-PBMC than in PHA-PBMC. This situation is quite
the opposite of what is seen with the dideoxynucleosides such as
zidovidine or 2', 3'-didehydro-3'-deoxythymidine (d4T), which are
highly dependent on the activated state of the PBMC for their
phosphorylation to the triphosphate (10). Several factors
control the pool size of intracellular nucleotide analogs, and these
include membrane transport, phosphorylation, and degradation of the
triphosphates. PMPA is probably internalized by endocytosis like other
structurally related acyclic nucleoside phosponates (e.g., PMEA and
HPMPC) and accumulates rather slowly within cells (6, 17).
Intracellular PMPA levels were ~twofold greater in R-PBMC than in
PHA-PBMC (Table 2 and Fig. 1). It is possible that endocytosis of PMPA
in R-PBMC is more efficient than in PHA-PBMC. Alternatively, the
relatively smaller size and cytosolic volume of R-PBMC, relative to
PHA-PBMC, may translate to higher drug concentrations.
Several factors may explain the differences in the metabolic profile of
PMPA, relative to that of other dideoxynucleosides. PMPA (and other
nucleoside phosphonates) circumvent the initial phosphorylation
required for most nucleosides, which phosphorylation is often a
limiting factor in resting cells. We showed previously that PMPA and
PMEA are phosphorylated to the mono- and diphosphate derivatives by the
actions of adenylate kinase, a ubiquitous enzyme that is localized
primarily to the mitochondria in human lymphocytes, and nucleoside
diphosphate kinase, respectively (19, 20). Both are
ubiquitous enzymes that show high levels of activity throughout the
cell cycle. One may, therefore, expect that PMPA and related compounds
are phosphorylated to similar extents in resting and dividing cells.
The identity of the enzymes involved in the intracellular catabolism of
these nucleoside analogs is currently not known. Surprisingly, we found
a significant difference between R-PBMC and PHA-PBMC in their clearance
of PMPA metabolites. The t1/2 of clearance of
PMPA metabolites ranged from 33 to 50 h in R-PBMC compared to 12 to 15 h in PHA-PBMC. These results clearly show that PMPApp catabolism is significantly slower in resting PBMC than in PHA-PBMC, and further studies are in progress to elucidate the mechanisms underlying this process. This is the first observation of such a
difference in nucleotide catabolism between resting and replicating cells. This increased retention of PMPA metabolites in resting cells is
likely to result in better antiviral activity, compared to other
nucleoside analogs, in cells which have limited proliferative capacity
(e.g., monocytes/macrophages and dendritic cells). Consistent with this
idea, Balzarini et al. (4) showed that PMEA is more effective in inhibiting HIV replication in primary macrophages than in
lymphocytes. Thus, the long persistence of PMPA metabolites in resting
cells may be a highly desirable property of this drug, and it may
translate into an improved therapeutic potential. Such persistence
suggests that PMPA has the potential to be effective in suppressing HIV
replication in dividing cells and to reduce the establishment of
latently infected quiescent cells.
In summary, bis(POC)PMPA is a novel prodrug highly active against HIV
in vitro in both established and primary peripheral blood lymphocytes.
This improved efficacy was due to rapid intracellular uptake of the
prodrug followed by anabolic phosphorylation to the pharmacologically
active metabolites. The PMPApp levels in bis(POC)PMPA-treated cells
exceeded the levels obtained in cells incubated with unmodified PMPA by
>1,000-fold. Metabolic studies also showed that PMPApp accumulated to
high levels in both resting and activated PBMC, and it persisted for a
considerably longer period in resting cells. These results may explain
the superior efficacy of PMPA in the SIV model. While these studies
were being completed, studies in animal systems and with humans have
shown that bis(POC)PMPA achieves pharmacologically active systemic
concentrations of PMPA. The low toxicity and favorable pharmacokinetics
of bis(POC)PMPA warrant further evaluation of this compound in
HIV-infected individuals.
 |
ACKNOWLEDGMENTS |
This research was supported in part by PHS grants RO1 AI27652 and
U01-AI32908 (Pediatric ACTU 065), Cancer Center Core Grant P30 CA21765
from the National Institutes of Health, and by the American Lebanese
Syrian Associated Charities.
H9/HIV-1IIIB and MT-2 cells were obtained from the NIH AIDS
Research and Reference Reagent Program (Rockville, Md.) through the
generosity of different contributors. We thank Jack Greenhaw for
excellent technical assistance.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Department of
Infectious Diseases, SJCRH, 332 N. Lauderdale, Memphis, TN 38105. Phone: (901) 495-3459. Fax: (901) 495-3099. E-mail:
arnold.fridland{at}stjude.org.
 |
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