Microvesicles derived from human Wharton’s Jelly mesenchymal stromal cells ameliorate renal ischemia-reperfusion injury in rats by suppressing CX3CL1
- Xiangyu Zou†1,
- Guangyuan Zhang†1,
- Zhongliang Cheng2,
- Deming Yin3,
- Tao Du1, 4,
- Guanqun Ju1,
- Shuai Miao1,
- Guohua Liu1,
- Mujun Lu5Email author and
- Yingjian Zhu1Email author
© Zou et al.; licensee BioMed Central Ltd. 2014
Received: 18 October 2013
Accepted: 12 March 2014
Published: 19 March 2014
Studies have demonstrated that mesenchymal stromal cells (MSCs) could reverse acute and chronic kidney injury by a paracrine or endocrine mechanism, and microvesicles (MVs) have been regarded as a crucial means of intercellular communication. In the current study, we focused on the therapeutic effects of human Wharton-Jelly MSCs derived microvesicles (hWJMSC-MVs) in renal ischemia/reperfusion injury and its potential mechanisms.
MVs isolated from conditioned medium were injected intravenously in rats immediately after ischemia of the left kidney for 60 minutes. The animals were sacrificed at 24 hours, 48 hours and 2 weeks after reperfusion. The infiltration of inflammatory cells was identified by the immunostaining of CD68+ cells. ELISA was employed to determine the inflammatory factors in the kidney and serum von Willebrand Factor (VWF). Tubular cell proliferation and apoptosis were identified by immunostaining. Renal fibrosis was assessed by Masson’s tri-chrome straining and alpha-smooth muscle actin (α-SMA) staining. The CX3CL1 expression in the kidney was measured by immunostaining and Western blot, respectively. In vitro, human umbilical vein endothelial cells were treated with or without MVs for 24 or 48 hours under hypoxia injury to test the CX3CL1 by immunostaining and Western blot.
After administration of hWJMSC-MVs in acute kidney injury (AKI) rats, renal cell apoptosis was mitigated and proliferation was enhanced, inflammation was also alleviated in the first 48 hours. MVs also could suppress the expression of CX3CL1 and decrease the number of CD68+ macrophages in the kidney. In the late period, improvement of renal function and abrogation of renal fibrosis were observed. In vitro, MVs could down-regulate the expression of CX3CL1 in human umbilical vein endothelial cells under hypoxia injury at 24 or 48 hours.
A single administration of MVs immediately after ischemic AKI could ameliorate renal injury in both the acute and chronic stage, and the anti-inflammatory property of MVs through suppression of CX3CL1 may be a potential mechanism. This establishes a substantial foundation for future research and treatment.
Ischemia/reperfusion (I/R) injury is a major cause of intrinsic acute kidney injury (AKI), which has emerged as the most common condition in hospitalized patients and continues to result in a high mortality rate . Ischemia/reperfusion injury (IRI)-induced AKI may result in proliferation of fibroblasts and excessive deposition of extracellular matrix  and has been recognized as a major contributor to end-stage kidney disease . Therefore, a potent therapeutic intervention for ischemic AKI is imperative.
Inflammation is now believed to play a major role in the pathophysiology of AKI . Various specific inflammatory cells and pro-inflammatory cytokines/chemokines are increased in the kidney in the early phase of injury after an ischemic AKI [4, 5]. Among these inflammatory cells, a macrophage is an important mediator in the initiation and extension of ischemic/reperfusion injury [6, 7]. The function of macrophages and inflammatory cytokines in tissue repair at different stages is still unclear. However, a previous publication showed that strategies which limit the initial macrophage infiltration or activation can be beneficial for ischemic AKI . SJ Yu et al. also found that macrophage depletion using clodronate could protect against ischemic AKI . Further studies indicated that knockout or neutralizing against adhesion molecule-1 in mice also prevents macrophage recruitment and the expression of inflammatory cytokines, which consequently induces less severe damage in renal disease models [10, 11]. The transmigration of macrophages across the vascular endothelium into tissues depends upon the influence of various factors, including adhesion molecules, chemokines and their receptors . CX3CL1, also called fractalkine, is found mainly expressed on endothelial cells and is a potent chemo-attractant factor for macrophages [13, 14]. It has been reported that the up-regulation of CX3CL1 was observed in I/R induced AKI, and CX3CL1/CX3CR1 could promote kidney interstitial fibrosis after IRI . Meanwhile, inhibition of CX3CR1 reduces the macrophages in the injured kidney and has the effects of therapy in AKI [14, 16]. These studies indicate that CX3CL1 is an important target molecule in anti-inflammation therapy for ischemic AKI.
Although the kidney has been thought to have a certain capacity for self-repair or regeneration after ischemic AKI, several strategies have been proposed to promote recovery from AKI. Among them, MSCs are thought of as a promising and effective strategy to contribute to kidney repair, although the mechanisms are not very clear now. MSCs display an immune-modulatory activity which is important in the response to tissue injury , and the inflammatory suppression role of MSCs in renal IRI was also reported . On the other hand, the paracrine or endocrine mechanisms of MSCs in tissue injury repair have also been proposed recently [19, 20]. Microvesicles (MVs) derived from MSCs are recently exploited in regenerative medicine to repair damaged tissues. These membranous structures delivering bioactive molecular contents, such as proteins, mRNAs and micro-RNAs sequences, are described as a novel pathway in cell-to-cell interaction. It has also been reported that MVs derived from MSCs could protect AKI in I/R animal models [21, 22]. However, the real mechanisms are unclear and whether the Wharton’s Jelly mesenchymal stromal cells derived microvesicles (hWJMSC-MVs) could play an immunomodulation role in ischemic AKI is unknown.
The objectives of the present study were to investigate the possible therapeutic potential of hWJMSC-MVs to rescue rats from AKI and to clarify the possible mechanism(s) by which hWJMSC-MVs may improve renal function in this ischemic AKI model.
Materials and methods
Fresh human umbilical cords that are usually discarded after delivery were obtained with the written consent of the parents. This experiment was approved by the Research Ethics Committee at Shanghai First People’s Hospital-affiliated Shanghai Jiao Tong University (Permit number: 2013KY018). Human umbilical cords were delivered and stored in cold Hank’s balanced salt solution (Sigma-Aldrich, St Louis, MO, USA) and then cellular isolation started within 4 h. The hWJMSCs were isolated and identified as described previously . Briefly, with the elimination of umbilical cord vessels, mesenchymal tissues were cut into 1 mm3 pieces and then stuck to the substrate of culture plates individually, followed by the addition of low-glucose Dulbecco, Modified Eagle’s Medium (DMEM, Gibco BRL Co., USA) containing 10% fetal bovine serum (FBS, Gibco BRL Co., USA) at 37°C in a humidified atmosphere with 5% CO2. The medium was changed every two days. After about two weeks’ culture, the adherent cells were harvested with 0.25% trypsin (Gibco BRL Co., USA) treatment and sub-cultured. Only cells from three to six passages were used for further experiments.
Human umbilical vein endothelial cells (HUVEC) were isolated from umbilical cord veins by collagenase digestion. In brief, the veins were washed twice with phosphate-buffered saline (PBS), and the HUVECs were flushed out after digestion with 0.1% collagenase (Gibco BRL Co., USA) for 30 minutes at room temperature. HUVECs were seeded onto dishes in EGM-2 medium at 37°C in a humidified atmosphere with 5% CO2. The medium was changed every two days. After one week’s culture, the adherent cells were harvested with 0.05% trypsin (Gibco BRL Co., USA) treatment and sub-cultured. Only cells from passages 2 to 4 were used for experiments. Phenotypic analysis of cultured cells was determined by immunofluorescence using CD31 (Abcam, Cambridge, UK) and VE- Cadherin (Abcam).
Isolation of MVs
MVs were obtained from supernatants of hWJMSCs as was previously described . Briefly, hWJMSCs were cultured in DMEM without FBS and with added 0.5% bovine serum album (BSA) (Sigma-Aldrich) overnight. The viability of the cell cultured overnight was >99% as detected by trypan blue exclusion and no apoptotic cells were detected by terminal transferase-mediated dUTP nick-end labeling (TUNEL) assay. The conditioned medium was collected and stored at -80°C. The medium was centrifuged at 2,000 g for 20 minutes to remove debris, and then ultracentrifuged at 100,000 g in a SW41 swing rotor (Beckman Coulter, Fullerton, CA, USA) for one hour at 4°C. MVs were washed once with serum-free M199 (Sigma-Aldrich) containing 25 mM HEPES (pH = 7.4) and submitted to a second ultracentrifugation in the same conditions. MVs were stored at -80°C for the experiments. To quantify the protein content, the Bradford protein assay kit (P0006, Beyotime Institute of Biotechnology, China) was used in the Bradford assay. We quantified it indirectly according to 5 × 105 MSCs releasing approximately 100 μg MVs overnight.
Transmission electron microscopy
MVs were fixed with 2.5% glutaraldehyde in PBS for 2 h, after being washed; MVs were ultra-centrifuged and suspended in 100 uL PBS. A total of 20 uL of MVs was loaded onto a formvar/carbon-coated grid, negatively stained with 3% aqueous phosphor-tungstic acid for one minute and observed by transmission electron microscopy (HITACHI, H-7650, Japan).
MVs surface marker analysis
Flow cytometry was used to characterize the isolated MVs. MVs were incubated for 30 minutes at room temperature, 5 ml of latex beads were added and incubated for another 30 minutes at 4°C, then washed in 0.5% BSA in PBS and incubated with different antibodies (CD9, CD34, CD44, CD45, CD63, CD73 or with appropriate isotype control IgG. After washing, MV-coated beads were immediately analyzed using a FACS Calibur flow cytometer (Becton Dickinson, FACS Calibur).
Animal models of unilateral renal IRI
All work involving animals was done in accordance with the animal use protocol enacted by the Institutional Animal Care and Use Committees of School of Medicine, Shanghai Jiao Tong University. All animals used were male SD rats (180 to 200 g), which were housed at a constant temperature and humidity, with a 12:12-h light-dark cycle. Animal models were performed in male SD rats (180 to 200 g) by left ischemia for 60 minutes, Sham-treated animals were treated in a similar manner, except that the renal vessels were not clamped. A total of 100 ug MVs in 1 mL of vehicle (M199, Gibco BRL Co., USA) or a total of 1 ml of vehicle only was administered via caudal vein immediately after reperfusion. The animals were separated into different groups according to different therapeutic procedures. We used at least six rats for each group at different time points: 1) sham-treated rats (n = 18); 2) vehicle-injected IRI rats (n = 18); MVs-injected IRI rats (n = 18). The rats were sacrificed at 24 h, 48 h and 2 weeks, respectively. Blood and kidney samples were collected and submitted for corresponding examination. To trace MVs in the kidneys, the PKH-26 dye (Sigma) kit was used to label the MVs. Then, 100 ug of PKH-26 labeled MVs were injected intravenously into AKI rats, and the unlabeled MVs were used as a control. Rats were sacrificed after 3 h and kidneys were acquired for frozen sectioning. The Cytokeratin 19 antibody (Abcam,) was used for staining the cytoplasm of tubular epithelial cells; Hoechst 33258 dye (Sigma) was added for nuclear staining.
After the right uninjured kidneys of the rats were removed on Day 12, blood samples were obtained for measurement of plasma BUN and creatinine on Day 14. Serum creatinine and BUN were measured by a Beckman Analyzer II (Beckman Instruments, Inc.).
ELISA analyses of vWF levels in serum and cytokine expression in injured kidneys
For analysis of the level of vWF in serum, samples were frozen at -80°C until analysis and we used a Rat vWF Elisa kit following the manufacturer’s instructions (Eiaab, Hubei, China), and for analysis of TNF-α and IL-10 in injured kidneys, samples were frozen at -80°C until analysis. We used a Rat TNF-α Elisa kit (R & D Systems Inc., USA) and an IL-10 Elisa kit (R & D Systems, Inc., USA) following the manufacturer’s instructions.
One portion of the renal tissue was fixed in 4% paraformaldehyde and embedded in paraffin. Sections 4 um-thick were labeled with mouse antibody to rat CD68 (dilution 1:100; Abcam), mouse antibody to rat α-SMA (dilution 1:500; Abcam), rat antibody to human CX3CL1 (dilution 1:250; Abcam), rat antibody to human Ki67 (dilution 1:250; Abcam) followed by horseradish peroxide (HRP)-conjugated secondary antibody using diaminobenzidine (DAB) reagents as substrates and then counterstained with hematoxylin. The numbers of CD68+ cells in the corticomedullary junctions and outer medullas of kidneys were randomly counted in an average of 30 high power fields (HPF). Under 400× magnification, scoring for Ki67-positive cells was carried out by counting the number of positive tubular cell nuclei in 30 random fields from randomly chosen kidney sections for each animal (n = 6 rats, each group). Tubular cell apoptosis was assessed by a TUNEL assay using an In Situ Cell Death Detection Kit (Roche, Mannheim, Germany). Kidney sections were screened for tubular cells of positive nuclei under 400× magnification. The apoptotic score was achieved by counting the number of positive nuclei in 30 random fields.
Hematoxylin and Eosin (H&E) staining
To detect the injury to the kidneys, they were fixed in 4% paraformaldehyde (pH 7.4), gradually dehydrated, embedded in paraffin, cut into 4-μM sections and stained with H&E stain. Histopathology scoring was applied based on a previous study in a blinded fashion . The score was given based on the grading of tubular necrosis, loss of brush border, cast formation and tubular dilatation in 10 randomly chosen, non-overlapping fields (200×) as follows: 0 (none), 1 (≤10%), 2 (11 to 25%), 3 (26 to 45%), 4 (46 to 75%), and 5 (≥76%).
Masson’s trichromatic staining
The degree of interstitial fibrosis was scored semi-quantitatively on a 0 to 3 scale (0, no lesion; 1, <33% of parenchyma affected by the lesion; 2, 33% to 67% of parenchyma affected by the lesion; 3, >67% of parenchyma affected by the lesion). The scores were assessed by a blinded observer in 100 HPFs (magnification 400×) of parenchyma for each rat (n = 6 rats, each group). The total score was obtained by the addition of all scores, with a maximum score of 300.
Protein concentration was measured with BCA Protein Assay, 30 ug of total protein were electrophoresed on an 8% to 10% SDS-PAGE gel and then transferred onto nitrocellulose membranes (Millipore, USA). Membranes were blocked in 5% non-fat milk in TBS containing 0.1% Tween 20 for 1 h at room temperature, and then each membrane was incubated with a rabbit antibody to rat CX3CL1 (dilution 1:1,000; Abcam), mouse antibody to α-SMA (dilution 1:1,000; Abcam) or a GAPDH antibody overnight at 4°C. After being washed in PBS, each membrane was incubated for one to two hours with a secondary antibody conjugated by peroxidase at room temperature, detected by ECL reagent (Millipore, USA). The density of each band was analyzed by Image-Pro Plus 6.0 software.
Immunochemistry staining for CX3CL1 expression in HUVECs
HUVECs injured by hypoxia were incubated on chamber slides and exposed to MVs or control medium for 48 hours. Subsequently, the slides were fixed in 4% paraformaldehyde and permeabilized with HEPES-250 Triton × 100 buffer (Sigma). Rat antibody to human CX3CL1 (dilution 1:1,000; Abcam) was used as the primary antibody. Harris hematoxylin was added for nuclear counterstaining.
RNA extraction and micro-RNA profiling by real-time quantitative PCR
Total RNA was isolated from hWJMSC-MVs by Trizol (Invitrogen, Carlsbad, CA, USA) extraction method. To increase the yield of small RNAs, the RNA was precipitated overnight. RNA concentration and RNA integrity were determined by capillary electrophoresis on an Agilent 2100 Bioanalyzer (Agilent Technologies, Palo Alto, CA, USA). At the time of the study, commercially available primers (designed and synthetized by BioTNT, Shanghai, China) were available for six mature human micro-RNAs (miR-15a, miR-15b, miR-16, miR-195, miR-424 and miR-497). We used these looped primers to profile six mature micro-RNAs by real-time PCR using an Applied Biosystems’ 7900HT real-time PCR instrument. RNA was converted to cDNA by priming with a mixture of looped primers (designed and synthetized by BioTNT, Shanghai, China) using previously published reverse transcription conditions . Each RT reaction contained 1 ug of total RNA, and real-time PCR was performed using standard conditions.
Results from at least three independent experiments are reported as the means ± standard deviation (SD). Statistical analyses were performed using SPSS v19.0. A value of P <0.05 was considered to be statistically significant.
Isolation and expansion of hWJMSCs
hWJMSCs were isolated and identified as our group previously showed . Briefly, the cells had a spindle-shaped morphology and adhered to plastic surfaces. With FACS analysis, we found that the expression of MSC markers (CD44, CD73, CD90 and CD105) was positive, whereas the expression of hematopoietic markers (CD45, CD34 and CD14) and an endothelial marker (CD31) was negative . In addition, these cells harbored the potential to differentiate toward chondrocytes and osteoblasts .
Isolation and characterization of HUVECs
HUVECs were isolated from umbilical cord vein by collagenase digestion successfully. Immunofluorescence analysis revealed the positive expression of CD31 and VE-Cadherin.
Extraction and characterization of hWJMSC-MVs
The alleviation of I/R-induced kidney injury by hWJMSC-MVs in early stages
To evaluate the tubular injury level, H&E staining was performed. Lesions were observed in rats at 48 h by H&E staining of kidney tissue slices. The slices showed that numerous necrotic areas of the proximal epithelium had appeared and abundant tubular protein casts had formed in the vehicle and MVs therapy groups. However, the tubular lesions obviously decreased in the MV group compared to the vehicle (Figure 1B). The representation of histological score suggested the same results (Figure 1C). Circulating vWF was measured as a marker of endothelial injury. The serum level of vWF was increased at 24 h and 48 h, compared with sham, after IRI (respectively, 42.13 ± 2.34 ng/ml versus 18.19 ± 1.06 ng/ml, P <0.05, and 56.25 ± 3.42 ng/ml versus 18.19 ± 1.06 ng/ml, P <0.05). Surprisingly, in the MV group there was a significant reduction of the vWF level at 24 h and 48 h compared with the vehicle group (respectively, 31.18 ± 0.95 ng/ml versus 42.13 ± 2.34 ng/ml P <0.05, and 37.70 ± 2.61 ng/ml versus 56.25 ± 3.42 ng/ml, P <0.05). Compared with the sham group, the MV group still had a high level (respectively, 31.18 ± 0.95 ng/ml versus 18.19 ± 1.06 ng/ml, P <0.05, and 37.70 ± 2.61 ng/ml versus 18.19 ± 1.06 ng/ml, P <0.05), which is shown in Figure 1D. Three hours after PKH-26-labeled MVs (red fluorescence) were injected intravenously, red fluorescence was observed in the kidneys of the AKI rats, while there was no red fluorescence detected in the control group (Additional file 1: Figure S1).
hWJMSC-MVs mitigated the apoptosis and enhanced the proliferation of renal cells
IRI-induced fibrosis is abrogated by MVs therapy, as well as improvement of renal function in late stage
The hWJMSC-MVs infusion reduced the infiltration of macrophages and attenuated inflammation in early stage
The down-regulated expression of CX3CL1 by MVs both in vivo and in vitro
Profiling of CX3CL1 related micro-RNAs in hWJMSC-MVs by real-time quantitative PCR
In the present study, we observed that a single administration of hWJMSC-MVs immediately after induction of IRI could decrease the expression of CX3CL1 in the kidney and lessen the infiltration of CD68+ macrophages at the 24 h and 48 h time points after the reperfusion. Meanwhile, the blood vWF level, a parameter reflecting the injury to endothelial cells, declined and the apoptosis of renal cells mitigated in the early stage of renal IRI. Furthermore, the renal function was ameliorated and kidney fibrosis was abrogated by MVs in the late stage.
In recent years, strategies for administration of stem cells from various sources, such as bone marrow, fetal membrane and adipose, for repairing kidney injury have been reported [26–28], but the potential mechanisms remain unclear. In previous studies, Caplan et al. have suggested that MSCs may provide a paracrine support for kidney repair . Consistently, Bi et al. demonstrated that the administration of conditioned medium from MSCs may also have beneficial effects on AKI , indicating that endocrine or paracrine mechanisms play an important role. Our group also found that hWJMSCs could alleviate acute and chronic kidney injury through an endocrine mechanism . MVs, which are contained in the condition medium of MSCs, are small vesicles released by cells bearing the surface antigens characteristic of the original cells. They can also enter the target cells through specific receptor ligand interactions and transfer micro-RNA, mRNA, proteins and other bioactive materials [21, 30–32]. Bruno et al. demonstrated a protective effect of bone marrow MSC-derived MVs on acute kidney injury and found that MVs could be detected in an injured kidney after intravenous administration . In the present study, we isolated MVs from hWJMSC-conditioned medium, characterized them successfully and found that hWJMSC-MVs have a crucial therapeutic effect in AKI.
To investigate the potential mechanisms of MVs in the IRI, we detected the CD68+ macrophages in the injured kidney. We found that the expression of CD68+ macrophages as well as the serum level of vWF in the MVs group declined at 24 h and 48 h after reperfusion. Macrophages’ effects on tissue repair depend on their phenotypes and the inflammatory milieu [33, 34]. Some strategies to block the initial inflammatory response, such as depleting macrophages or inhibiting the action of inflammatory cytokines, are protective against ischemic AKI [9, 33]. In our study we found CD68+ macrophages were reduced significantly by MVs in the early stage of AKI. Inflammatory cytokines are known to play an important role in ischemic AKI; the decreased expression of TNF-α and increased expression of IL-10 in the injured kidney was also observed. Moreover, the renal cell apoptosis was mitigated and proliferation was enhanced in the MV group. From the data above, we confirmed that hWJMSC-MVs play a therapeutic role in I/R-induced acute kidney injury through the regulation of inflammation.
To further study the potential mechanisms, we evaluated the expression of CX3CL1, which is a potent chemo-attractant protein for macrophages. We found that the expression of CX3CL1 was up-regulated obviously in the kidney after ischemic AKI, which is in accordance with the published data [13, 16]. Interestingly, in the MV group, the CX3CL1 was dramatically down-regulated in the injured kidney. Further, in in vitro studies, we also found that MVs could suppress the expression of CX3CL1 in cultured HUVECs under a hypoxia-oxygen injury model. On the other hand, previous studies show that CX3CL1 with its cognate receptor CX3CR1 could mediate the immune cell adhesion in the pathogenesis of vascular injury [35, 36]; the authors also found that the expression of CX3CL1 protein in the kidney increased markedly in ischemic AKI and that CX3CL1/CX3CR1 promotes kidney injury both in hypertensive and ischemic animal models [15, 16]. Meanwhile, inhibition of CX3CR1, the only known receptor of CX3CL1, could reduce the macrophages in an injured kidney and have therapeutic effects in AKI [14, 16]. Thus, we concluded that down-regulation of CX3CL1 by MVs might be a way to reduce the infiltration of macrophages in the kidney and MVs’ inflammation regulation property may be one of the underlying mechanisms of hWJMSC-MVs’ therapeutic effects.
It has also been shown that RNA, including mRNA and micro-RNA, contained in the MVs could be transferred into the target cells and may play an important role in the repair of I/R-induced AKI . Recently, some studies also found that different cell-derived MVs protect against acute kidney injury via a horizontal transfer of related mRNAs or micro-RNAs [21, 37]. Thus, we supposed that some secreted patterns of micro-RNAs, which can modulate the expression of CX3CL1, may be included in the hWJMSCs-MVs. Moreover, it has also been reported that some micro-RNAs predicted by the Targetscan Database for particular molecule was confirmed . So we paid more attention to miR-15a, miR-15b, miR-16, miR-195, miR-424 and miR-497, which are the targeted results for CX3CL1 in the Targetscan Database. This means these micro-RNAs are the biological target molecules and, by matching the CX3CL1 to the seed region, may have the potential effects of modulation of CX3CL1. Interestingly, the miR-16, miR-15b and miR-15a were profiled successfully both in hWJMSCs and hWJMSC-MVs by the real-time quantitative PCR method with a high concentration, and we think that these micro-RNAs contained in MVs may involve the modulation of CX3CL1 expression. However, how MVs modulate the expression of CX3CL1 and whether these micro-RNAs have functional effects are unknown. We plan to investigate the deeper mechanism in our next project.
A single administration of hWJMSC-MVs immediately after IRI could ameliorate kidney ischemia/reperfusion injury both in the acute and chronic stages, and it could also suppress the expression of CX3CL1 and mitigate the inflammation levels in injured kidneys in the early stage, which may be regarded as a novel mechanism for therapeutic effects on ischemic AKI.
alpha smooth muscle actin
acute kidney injury
bovine serum album
high power fields HUVECs, human umbilical vein endothelial cells
human Wharton’s Jelly mesenchymal stromal cells derived microvesicles
tumore necrosis factor alpha
terminal transferase-mediated dUTP nick-end labeling
von Willebrand Factor.
This study is supported by grants from the Research Program of Science and Technology Commission of Shanghai Municipality (10411967200) and the fund of Shanghai First People’s Hospital (12RC04) and National Natural Science Foundation of China (81170642, 81070605, 81370860) and Shanghai Shen Kang Plat-form Grant (SHDC12007206).
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