Skip to main content
Top
Published in: BMC Complementary Medicine and Therapies 1/2014

Open Access 01-12-2014 | Research article

Earthworm (Pheretima aspergillum) extract stimulates osteoblast activity and inhibits osteoclast differentiation

Authors: Yuan-Tsung Fu, Kuo-Yu Chen, Yueh-Sheng Chen, Chun-Hsu Yao

Published in: BMC Complementary Medicine and Therapies | Issue 1/2014

Login to get access

Abstract

Background

The potential benefits of earthworm (Pheretima aspergillum) for healing have received considerable attention recently. Osteoblast and osteoclast activities are very important in bone remodeling, which is crucial to repair bone injuries. This study investigated the effects of earthworm extract on bone cell activities.

Methods

Osteoblast-like MG-63 cells and RAW 264.7 macrophage cells were used for identifying the cellular effects of different concentrations of earthworm extract on osteoblasts and osteoclasts, respectively. The optimal concentration of earthworm extract was determined by mitochondrial colorimetric assay, alkaline phosphatase activity, matrix calcium deposition, Western blotting and tartrate-resistant acid phosphatase activity.

Results

Earthworm extract had a dose-dependent effect on bone cell activities. The most effective concentration of earthworm extract was 3 mg/ml, significantly increasing osteoblast proliferation and differentiation, matrix calcium deposition and the expression levels of alkaline phosphatase, osteopontin and osteocalcin. Conversely, 3 mg/ml earthworm extract significantly reduced the tartrate-resistant acid phosphatase activity of osteoclasts without altering cell viability.

Conclusions

Earthworm extract has beneficial effects on bone cell cultures, indicating that earthworm extract is a potential agent for use in bone regeneration.
Appendix
Available only for authorised users
Literature
1.
go back to reference Huang HF, You JS: The use of Chinese herbal medicine on experimental fracture healing. Am J Chin Med. 1997, 25: 351-356. 10.1142/S0192415X97000391.CrossRefPubMed Huang HF, You JS: The use of Chinese herbal medicine on experimental fracture healing. Am J Chin Med. 1997, 25: 351-356. 10.1142/S0192415X97000391.CrossRefPubMed
2.
go back to reference Wong RWK, Rabie ABM: Traditional Chinese medicines and bone formation-a review. J Oral Maxillofac Surg. 2006, 64: 828-837. 10.1016/j.joms.2006.01.017.CrossRefPubMed Wong RWK, Rabie ABM: Traditional Chinese medicines and bone formation-a review. J Oral Maxillofac Surg. 2006, 64: 828-837. 10.1016/j.joms.2006.01.017.CrossRefPubMed
3.
go back to reference Hori M, Kondon K, Yoshida T, Konishi E, Minami S: Studies of antipyretic components in the Japanese earthworm. Biochem Pharmacol. 1974, 23: 1582-1590.CrossRef Hori M, Kondon K, Yoshida T, Konishi E, Minami S: Studies of antipyretic components in the Japanese earthworm. Biochem Pharmacol. 1974, 23: 1582-1590.CrossRef
4.
go back to reference Liu CH, Lin YW, Tang NY, Liu HJ, Huang CY, Hsieh CL: Effect of oral administration of Pheretima aspergillum (earthworm) in rats with cerebral infarction induced by middle-cerebral artery occlusion. Afr J Tradit Complem Altern Med. 2013, 10: 66-82. Liu CH, Lin YW, Tang NY, Liu HJ, Huang CY, Hsieh CL: Effect of oral administration of Pheretima aspergillum (earthworm) in rats with cerebral infarction induced by middle-cerebral artery occlusion. Afr J Tradit Complem Altern Med. 2013, 10: 66-82.
5.
go back to reference Wojdani A, Stein EA, Alfred LJ, Cooper EL: Mitogenic effect of earthworm (Lumbricus terrestris) coelomic fluid on mouse and human lymphocytes. Immunobiol. 1984, 166: 167-176.CrossRef Wojdani A, Stein EA, Alfred LJ, Cooper EL: Mitogenic effect of earthworm (Lumbricus terrestris) coelomic fluid on mouse and human lymphocytes. Immunobiol. 1984, 166: 167-176.CrossRef
6.
go back to reference Vaillier J, Cadoret MA, Roch P, Valembois P: Protein analysis of earthworm coelomic fluid. III. isolation and characterization of several bacteriostatic molecules from Eisenia fetida Andrei. Develop Comp Immunol. 1985, 9: 11-20. 10.1016/0145-305X(85)90055-2.CrossRef Vaillier J, Cadoret MA, Roch P, Valembois P: Protein analysis of earthworm coelomic fluid. III. isolation and characterization of several bacteriostatic molecules from Eisenia fetida Andrei. Develop Comp Immunol. 1985, 9: 11-20. 10.1016/0145-305X(85)90055-2.CrossRef
7.
go back to reference Kauschke E, Mohring W: Comparative analysis of haemolytic and hemagglutinating activities in the coelomic fluid of Eisenia foetida and Lumbricus terrestris (Annelida, Lumbricidae). Dev Comp Immunol. 1987, 11: 331-343. 10.1016/0145-305X(87)90077-2.CrossRefPubMed Kauschke E, Mohring W: Comparative analysis of haemolytic and hemagglutinating activities in the coelomic fluid of Eisenia foetida and Lumbricus terrestris (Annelida, Lumbricidae). Dev Comp Immunol. 1987, 11: 331-343. 10.1016/0145-305X(87)90077-2.CrossRefPubMed
8.
go back to reference Hirigoyenberry F, Lasalle F, Lasseques M: Antibacterial activity of Eisenia fetida andrei coelomic fluid: transcription and translation regulation of lysozime and proteins evidence after bacterial infestation. Comp Biochem Physiol. 1990, 95B: 71-75. Hirigoyenberry F, Lasalle F, Lasseques M: Antibacterial activity of Eisenia fetida andrei coelomic fluid: transcription and translation regulation of lysozime and proteins evidence after bacterial infestation. Comp Biochem Physiol. 1990, 95B: 71-75.
9.
go back to reference Sekizawa Y, Hagiwara K, Nakajima T, Kobayashi H: A novel protein that causes contraction of the isolated rat aorta: its purification from the coelomic fluid of the earthworm. Eisenia foetida Biomed Res. 1996, 17: 197-203.CrossRef Sekizawa Y, Hagiwara K, Nakajima T, Kobayashi H: A novel protein that causes contraction of the isolated rat aorta: its purification from the coelomic fluid of the earthworm. Eisenia foetida Biomed Res. 1996, 17: 197-203.CrossRef
10.
go back to reference Mihara H, Maruyama M, Sumi H: Novel thrombolytic therapy discovered from traditional oriental medicine using the earthworm. Southeast Asian J Trop Med Public Health. 1992, 23: 131-140.PubMed Mihara H, Maruyama M, Sumi H: Novel thrombolytic therapy discovered from traditional oriental medicine using the earthworm. Southeast Asian J Trop Med Public Health. 1992, 23: 131-140.PubMed
11.
go back to reference Hrženjak T, Popović M, Božić T, Grdiša M, Kobrehel D, Tiška-Rudman L: Fibrinolytic and anticoagulative activities from the earthworm Eisenia foetida. Comp Biochem Physiol. 1998, 119B: 825-832.CrossRef Hrženjak T, Popović M, Božić T, Grdiša M, Kobrehel D, Tiška-Rudman L: Fibrinolytic and anticoagulative activities from the earthworm Eisenia foetida. Comp Biochem Physiol. 1998, 119B: 825-832.CrossRef
12.
go back to reference Grdiša M, Popović M, Hrženjak T: Glycolipoprotein extract (G-90) from earthworm Eisenia foetida exerts some antioxidative activity. Comp Biochem Physiol. 2001, 128A: 821-825.CrossRef Grdiša M, Popović M, Hrženjak T: Glycolipoprotein extract (G-90) from earthworm Eisenia foetida exerts some antioxidative activity. Comp Biochem Physiol. 2001, 128A: 821-825.CrossRef
13.
go back to reference Cooper EL, Hrzenjak TM, Grdiša M: Alternative sources of fibrinolytic, anticoagulative, antimicrobial and anticancer molecules. Int J Immunopathol Pharmacol. 2004, 17: 237-244.PubMed Cooper EL, Hrzenjak TM, Grdiša M: Alternative sources of fibrinolytic, anticoagulative, antimicrobial and anticancer molecules. Int J Immunopathol Pharmacol. 2004, 17: 237-244.PubMed
14.
go back to reference Balamurugan M, Parthasarathi K, Ranganathan LS, Cooper EL: Hypothetical mode of action of earthworm extract with hepatoprotective and antioxidant properties. J Zhejiang Univ Sci. 2008, 9B: 141-147.CrossRef Balamurugan M, Parthasarathi K, Ranganathan LS, Cooper EL: Hypothetical mode of action of earthworm extract with hepatoprotective and antioxidant properties. J Zhejiang Univ Sci. 2008, 9B: 141-147.CrossRef
15.
go back to reference Grdiša M, Popović M, Hrženjak T: Stimulation of growth factor synthesis in skin wounds using tissue extract (G-90) from the earthworm Eissenia foetida. Cell Biochem Funct. 2004, 22: 373-378. 10.1002/cbf.1121.CrossRefPubMed Grdiša M, Popović M, Hrženjak T: Stimulation of growth factor synthesis in skin wounds using tissue extract (G-90) from the earthworm Eissenia foetida. Cell Biochem Funct. 2004, 22: 373-378. 10.1002/cbf.1121.CrossRefPubMed
16.
go back to reference Zhang M, Li X, Liu Y, Ye F, Qiu G: Effects of extract of Dilong (Pheretima) on the scalded skin in rats. J Tradit Chin Med. 2006, 26: 68-71.PubMed Zhang M, Li X, Liu Y, Ye F, Qiu G: Effects of extract of Dilong (Pheretima) on the scalded skin in rats. J Tradit Chin Med. 2006, 26: 68-71.PubMed
17.
go back to reference Wei S, Yin X, Kou Y, Jiang B: Lumbricus extract promotes the regeneration of injured peripheral nerve in rats. J Ethnopharmacol. 2009, 123: 51-54. 10.1016/j.jep.2009.02.030.CrossRefPubMed Wei S, Yin X, Kou Y, Jiang B: Lumbricus extract promotes the regeneration of injured peripheral nerve in rats. J Ethnopharmacol. 2009, 123: 51-54. 10.1016/j.jep.2009.02.030.CrossRefPubMed
18.
go back to reference Chen CT, Lin JG, Lu TW, Tsai FJ, Huang CY, Yao CH, Chen YS: Earthworm extracts facilitate PC12 cell differentiation and promote axonal sprouting in peripheral nerve injury. Am J Chin Med. 2010, 38: 547-560. 10.1142/S0192415X10008044.CrossRefPubMed Chen CT, Lin JG, Lu TW, Tsai FJ, Huang CY, Yao CH, Chen YS: Earthworm extracts facilitate PC12 cell differentiation and promote axonal sprouting in peripheral nerve injury. Am J Chin Med. 2010, 38: 547-560. 10.1142/S0192415X10008044.CrossRefPubMed
19.
go back to reference Balamurugan M, Parthasarathi K, Cooper EL, Ranganathan LS: Earthworm paste (Lampito mauritii, Kinberg) alters inflammatory, oxidative, haematological and serum biochemical indices of inflamed rat. Eur Rev Med Pharmacol Sci. 2007, 11: 77-90.PubMed Balamurugan M, Parthasarathi K, Cooper EL, Ranganathan LS: Earthworm paste (Lampito mauritii, Kinberg) alters inflammatory, oxidative, haematological and serum biochemical indices of inflamed rat. Eur Rev Med Pharmacol Sci. 2007, 11: 77-90.PubMed
20.
go back to reference Chen KY, Lin KC, Chen YS, Yao CH: A novel porous gelatin composite containing naringin for bone repair. Evid Based Complement Alternat Med. 2013, 2013: 283941-PubMedPubMedCentral Chen KY, Lin KC, Chen YS, Yao CH: A novel porous gelatin composite containing naringin for bone repair. Evid Based Complement Alternat Med. 2013, 2013: 283941-PubMedPubMedCentral
21.
go back to reference Takahashi N, Akatsn T, Udagawa N, Sasaki T, Yamaguchi A, Moseley JM, Martin TJ, Suda T: Osteoblastic cells are involved in osteoclast formation. Endocrinology. 1988, 123: 2600-2602. 10.1210/endo-123-5-2600.CrossRefPubMed Takahashi N, Akatsn T, Udagawa N, Sasaki T, Yamaguchi A, Moseley JM, Martin TJ, Suda T: Osteoblastic cells are involved in osteoclast formation. Endocrinology. 1988, 123: 2600-2602. 10.1210/endo-123-5-2600.CrossRefPubMed
22.
go back to reference Hussein O, Tiedemann K, Komarova SV: Breast cancer cells inhibit spontaneous and bisphosphonate-induced osteoclast apoptosis. Bone. 2011, 48: 202-211. 10.1016/j.bone.2010.09.006.CrossRefPubMed Hussein O, Tiedemann K, Komarova SV: Breast cancer cells inhibit spontaneous and bisphosphonate-induced osteoclast apoptosis. Bone. 2011, 48: 202-211. 10.1016/j.bone.2010.09.006.CrossRefPubMed
23.
go back to reference Cheng CP, Sheu MJ, Sytwu HK, Chang DM: Decoy receptor 3 suppresses RANKL-induced osteoclastogenesis via down-regulating NFATc1 and enhancing cell apoptosis. Rheumatol. 2013, 52: 609-622. 10.1093/rheumatology/kes343.CrossRef Cheng CP, Sheu MJ, Sytwu HK, Chang DM: Decoy receptor 3 suppresses RANKL-induced osteoclastogenesis via down-regulating NFATc1 and enhancing cell apoptosis. Rheumatol. 2013, 52: 609-622. 10.1093/rheumatology/kes343.CrossRef
24.
go back to reference Yao CH, Liu BS, Hsu SH, Chen YS, Tsai CC: Biocompatibility and biodegradation of a bone composite containing tricalcium phosphate and genipin crosslinked gelatin. J Biomed Mater Res. 2004, 69A: 709-717. 10.1002/jbm.a.30045.CrossRef Yao CH, Liu BS, Hsu SH, Chen YS, Tsai CC: Biocompatibility and biodegradation of a bone composite containing tricalcium phosphate and genipin crosslinked gelatin. J Biomed Mater Res. 2004, 69A: 709-717. 10.1002/jbm.a.30045.CrossRef
25.
go back to reference Chen KY, Chung CM, Kuo SM, Chen YS, Yao CH: Influence of collagen I nanospheres on the growth and osteogenic difference of rat bone marrow stromal cells. J Med Biol Eng. 2009, 29: 284-289. Chen KY, Chung CM, Kuo SM, Chen YS, Yao CH: Influence of collagen I nanospheres on the growth and osteogenic difference of rat bone marrow stromal cells. J Med Biol Eng. 2009, 29: 284-289.
26.
go back to reference Tang CH, Hsu TL, Lin WW, Lai MZ, Yang RS, Hsieh SL, Fu WM: Attenuation of bone mass and increase of osteoclast formation in decoy receptor 3 transgenic mice. J Biol Chem. 2007, 282: 2346-2354. 10.1074/jbc.M603070200.CrossRefPubMed Tang CH, Hsu TL, Lin WW, Lai MZ, Yang RS, Hsieh SL, Fu WM: Attenuation of bone mass and increase of osteoclast formation in decoy receptor 3 transgenic mice. J Biol Chem. 2007, 282: 2346-2354. 10.1074/jbc.M603070200.CrossRefPubMed
27.
go back to reference Puchtler H, Meloan SN: Demonstration of phosphates in calcium deposits: a modification of von Kossa’s reaction. Histochem. 1978, 56: 177-185. 10.1007/BF00495978.CrossRef Puchtler H, Meloan SN: Demonstration of phosphates in calcium deposits: a modification of von Kossa’s reaction. Histochem. 1978, 56: 177-185. 10.1007/BF00495978.CrossRef
28.
go back to reference Quinn JMW, Elliott J, Gillespie MT, Martin TJ: A combination of osteoclast differentiation factor and macrophage-colony stimulating factor is sufficient for both human and mouse osteoclast formation in vitro. Endocrinology. 1998, 139: 4424-4427. 10.1210/endo.139.10.6331.CrossRefPubMed Quinn JMW, Elliott J, Gillespie MT, Martin TJ: A combination of osteoclast differentiation factor and macrophage-colony stimulating factor is sufficient for both human and mouse osteoclast formation in vitro. Endocrinology. 1998, 139: 4424-4427. 10.1210/endo.139.10.6331.CrossRefPubMed
29.
go back to reference Lin CY, Sun JS, Sheu SY, Lin FH, Wang YJ, Chen LT: The effect of Chinese medicine on bone cell activities. Am J Chin Med. 2002, 30: 271-285. 10.1142/S0192415X02000351.CrossRefPubMed Lin CY, Sun JS, Sheu SY, Lin FH, Wang YJ, Chen LT: The effect of Chinese medicine on bone cell activities. Am J Chin Med. 2002, 30: 271-285. 10.1142/S0192415X02000351.CrossRefPubMed
30.
go back to reference Sun JS, Lin CY, Dong GC, Sheu SY, Lin FH, Chen LT, Wang YJ: The effect of Gu-Sui-Bu (Drynaria fortunei J. Sm) on bone cell activities. Biomaterials. 2002, 23: 3377-3385. 10.1016/S0142-9612(02)00038-8.CrossRefPubMed Sun JS, Lin CY, Dong GC, Sheu SY, Lin FH, Chen LT, Wang YJ: The effect of Gu-Sui-Bu (Drynaria fortunei J. Sm) on bone cell activities. Biomaterials. 2002, 23: 3377-3385. 10.1016/S0142-9612(02)00038-8.CrossRefPubMed
31.
go back to reference Sun JS, Thériault BL, Anderson GI: The effect of Gu-Sui-Bu (Drynaria fortunei) on bone cell activity. Am J Chin Med. 2004, 32: 737-753. 10.1142/S0192415X0400234X.CrossRefPubMed Sun JS, Thériault BL, Anderson GI: The effect of Gu-Sui-Bu (Drynaria fortunei) on bone cell activity. Am J Chin Med. 2004, 32: 737-753. 10.1142/S0192415X0400234X.CrossRefPubMed
32.
go back to reference Yao CH, Tsai CC, Chen YS, Liu BS: Fabrication and evaluation of a new composite composed of tricalcium phosphate, gelatin and Chi-Li-Saan as a bone substitute. Am J Chin Med. 2002, 30: 471-482. 10.1142/S0192415X02000557.CrossRefPubMed Yao CH, Tsai CC, Chen YS, Liu BS: Fabrication and evaluation of a new composite composed of tricalcium phosphate, gelatin and Chi-Li-Saan as a bone substitute. Am J Chin Med. 2002, 30: 471-482. 10.1142/S0192415X02000557.CrossRefPubMed
33.
go back to reference Yao CH, Tsai HM, Chen YS, Liu BS: Fabrication and evaluation of a new composite composed of tricalcium phosphate, gelatin, and chinese medicine as a bone substitute. J Biomed Mater Res. 2005, 75B: 277-288. 10.1002/jbm.b.30294.CrossRef Yao CH, Tsai HM, Chen YS, Liu BS: Fabrication and evaluation of a new composite composed of tricalcium phosphate, gelatin, and chinese medicine as a bone substitute. J Biomed Mater Res. 2005, 75B: 277-288. 10.1002/jbm.b.30294.CrossRef
34.
go back to reference Chang YM, Kuo WH, Lai TY, Shih YT, Tsai FJ, Tsai CH, Shu WT, Chen YY, Chen YS, Kuo WW, Huang CY: RSC96 Schwann cell proliferation and survival induced by Dilong through PI3K/Akt signaling mediated by IGF-I. Evid Based Complement Alternat Med. 2011, 2011: 216148-PubMedPubMedCentral Chang YM, Kuo WH, Lai TY, Shih YT, Tsai FJ, Tsai CH, Shu WT, Chen YY, Chen YS, Kuo WW, Huang CY: RSC96 Schwann cell proliferation and survival induced by Dilong through PI3K/Akt signaling mediated by IGF-I. Evid Based Complement Alternat Med. 2011, 2011: 216148-PubMedPubMedCentral
35.
go back to reference Chang YM, Shih YT, Chen YS, Liu CL, Fang WK, Tsai CH, Tsai FJ, Kuo WW, Lai TY, Huang CY: Schwann cell migration induced by earthworm extract via activation of PAs and MMP2/9 mediated through ERK1/2 and p38. Evid Based Complement Alternat Med. 2011, 2011: 395458-PubMedPubMedCentral Chang YM, Shih YT, Chen YS, Liu CL, Fang WK, Tsai CH, Tsai FJ, Kuo WW, Lai TY, Huang CY: Schwann cell migration induced by earthworm extract via activation of PAs and MMP2/9 mediated through ERK1/2 and p38. Evid Based Complement Alternat Med. 2011, 2011: 395458-PubMedPubMedCentral
36.
go back to reference Cho IH, Choi ES, Lim HG, Lee HH: Purification and characterization of six fibrinolytic serine-proteases from Earthworm Lumbricus rubellus. J Biochem Mol Biol. 2004, 37: 199-205. 10.5483/BMBRep.2004.37.2.199.CrossRefPubMed Cho IH, Choi ES, Lim HG, Lee HH: Purification and characterization of six fibrinolytic serine-proteases from Earthworm Lumbricus rubellus. J Biochem Mol Biol. 2004, 37: 199-205. 10.5483/BMBRep.2004.37.2.199.CrossRefPubMed
37.
go back to reference Ji H, Wang L, Bi H, Sun L, Cai B, Wang Y, Zhao J, Du Z: Mechanisms of lumbrokinase in protection of cerebral ischemia. Eur J Pharmacol. 2008, 590: 281-289. 10.1016/j.ejphar.2008.05.037.CrossRefPubMed Ji H, Wang L, Bi H, Sun L, Cai B, Wang Y, Zhao J, Du Z: Mechanisms of lumbrokinase in protection of cerebral ischemia. Eur J Pharmacol. 2008, 590: 281-289. 10.1016/j.ejphar.2008.05.037.CrossRefPubMed
38.
go back to reference Sun H, Ge N, Shao M, Cheng X, Li Y, Li S, Shen J: Lumbrokinase attenuates diabetic nephropathy through regulating extracellular matrix degradation in streptozotocin-induced diabetic rats. Diabetes Res Clin Pract. 2013, 100: 85-95. 10.1016/j.diabres.2013.01.012.CrossRefPubMed Sun H, Ge N, Shao M, Cheng X, Li Y, Li S, Shen J: Lumbrokinase attenuates diabetic nephropathy through regulating extracellular matrix degradation in streptozotocin-induced diabetic rats. Diabetes Res Clin Pract. 2013, 100: 85-95. 10.1016/j.diabres.2013.01.012.CrossRefPubMed
39.
go back to reference Huang CY, Kuo WW, Liao HE, Lin YM, Kuo CH, Tsai FJ, Tsai CH, Chen JL, Lin JY: Lumbrokinase attenuates side-stream-smoke-induced apoptosis and autophagy in young hamster hippocampus: correlated with eNOS induction and NFκB/iNOS/COX-2 signaling suppression. Chem Res Toxicol. 2013, 26: 654-661. 10.1021/tx300429s.CrossRefPubMed Huang CY, Kuo WW, Liao HE, Lin YM, Kuo CH, Tsai FJ, Tsai CH, Chen JL, Lin JY: Lumbrokinase attenuates side-stream-smoke-induced apoptosis and autophagy in young hamster hippocampus: correlated with eNOS induction and NFκB/iNOS/COX-2 signaling suppression. Chem Res Toxicol. 2013, 26: 654-661. 10.1021/tx300429s.CrossRefPubMed
40.
go back to reference Weinreb M, Shinar D, Rodan GA: Different pattern of alkaline phosphatase, osteopontin, and osteocalcin expression in developing rat bone visualized by in situ hybridization. J Bone Min Res. 1990, 5: 831-842.CrossRef Weinreb M, Shinar D, Rodan GA: Different pattern of alkaline phosphatase, osteopontin, and osteocalcin expression in developing rat bone visualized by in situ hybridization. J Bone Min Res. 1990, 5: 831-842.CrossRef
Metadata
Title
Earthworm (Pheretima aspergillum) extract stimulates osteoblast activity and inhibits osteoclast differentiation
Authors
Yuan-Tsung Fu
Kuo-Yu Chen
Yueh-Sheng Chen
Chun-Hsu Yao
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2014
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/1472-6882-14-440

Other articles of this Issue 1/2014

BMC Complementary Medicine and Therapies 1/2014 Go to the issue