Skip to main content
Top
Published in: Respiratory Research 1/2011

Open Access 01-12-2011 | Research

IL-4 and IL-13 exposure during mucociliary differentiation of bronchial epithelial cells increases antimicrobial activity and expression of antimicrobial peptides

Authors: Suzanne Zuyderduyn, Dennis K Ninaber, Jasmijn A Schrumpf, Marianne AJA van Sterkenburg, Renate M Verhoosel, Frans A Prins, Sandra van Wetering, Klaus F Rabe, Pieter S Hiemstra

Published in: Respiratory Research | Issue 1/2011

Login to get access

Abstract

The airway epithelium forms a barrier against infection but also produces antimicrobial peptides (AMPs) and other inflammatory mediators to activate the immune system. It has been shown that in allergic disorders, Th2 cytokines may hamper the antimicrobial activity of the epithelium. However, the presence of Th2 cytokines also affects the composition of the epithelial layer which may alter its function. Therefore, we investigated whether exposure of human primary bronchial epithelial cells (PBEC) to Th2 cytokines during mucociliary differentiation affects expression of the human cathelicidin antimicrobial protein (hCAP18)/LL-37 and human beta defensins (hBD), and antimicrobial activity.
PBEC were cultured at an air-liquid interface (ALI) for two weeks in the presence of various concentrations of IL-4 or IL-13. Changes in differentiation and in expression of various AMPs and the antimicrobial proteinase inhibitors secretory leukocyte protease inhibitor (SLPI) and elafin were investigated as well as antimicrobial activity.
IL-4 and IL-13 increased mRNA expression of hCAP18/LL-37 and hBD-2. Dot blot analysis also showed an increase in hCAP18/LL-37 protein in apical washes of IL-4-treated ALI cultures, whereas Western Blot analysis showed expression of a protein of approximately 4.5 kDa in basal medium of IL-4-treated cultures. Using sandwich ELISA we found that also hBD-2 in apical washes was increased by both IL-4 and IL-13. SLPI and elafin levels were not affected by IL-4 or IL-13 at the mRNA or protein level. Apical wash obtained from IL-4- and IL-13-treated cultures displayed increased antimicrobial activity against Pseudomonas aeruginosa compared to medium-treated cultures. In addition, differentiation in the presence of Th2 cytokines resulted in increased MUC5AC production as has been shown previously.
These data suggest that prolonged exposure to Th2 cytokines during mucociliary differentiation contributes to antimicrobial defence by increasing the expression and release of selected antimicrobial peptides and mucus.
Appendix
Available only for authorised users
Literature
1.
go back to reference Van Wetering S, van der Linden AC, van Sterkenburg MA, de Boer WI, Kuijpers AL, Schalkwijk J, et al: Regulation of SLPI and elafin release from bronchial epithelial cells by neutrophil defensins. Am J Physiol Lung Cell Mol Physiol. 2000, 278: L51-L58.PubMed Van Wetering S, van der Linden AC, van Sterkenburg MA, de Boer WI, Kuijpers AL, Schalkwijk J, et al: Regulation of SLPI and elafin release from bronchial epithelial cells by neutrophil defensins. Am J Physiol Lung Cell Mol Physiol. 2000, 278: L51-L58.PubMed
2.
go back to reference Williams SE, Brown TI, Roghanian A, Sallenave JM: SLPI and elafin: one glove, many fingers. Clin Sci (Lond). 2006, 110: 21-35. 10.1042/CS20050115.CrossRef Williams SE, Brown TI, Roghanian A, Sallenave JM: SLPI and elafin: one glove, many fingers. Clin Sci (Lond). 2006, 110: 21-35. 10.1042/CS20050115.CrossRef
3.
go back to reference Hiemstra PS, Maassen RJ, Stolk J, Heinzel-Wieland R, Steffens GJ, Dijkman JH: Antibacterial activity of antileukoprotease. Infect Immun. 1996, 64: 4520-4524.PubMedPubMedCentral Hiemstra PS, Maassen RJ, Stolk J, Heinzel-Wieland R, Steffens GJ, Dijkman JH: Antibacterial activity of antileukoprotease. Infect Immun. 1996, 64: 4520-4524.PubMedPubMedCentral
4.
go back to reference Simpson AJ, Wallace WA, Marsden ME, Govan JR, Porteous DJ, Haslett C, et al: Adenoviral augmentation of elafin protects the lung against acute injury mediated by activated neutrophils and bacterial infection. J Immunol. 2001, 167: 1778-1786.CrossRefPubMed Simpson AJ, Wallace WA, Marsden ME, Govan JR, Porteous DJ, Haslett C, et al: Adenoviral augmentation of elafin protects the lung against acute injury mediated by activated neutrophils and bacterial infection. J Immunol. 2001, 167: 1778-1786.CrossRefPubMed
5.
6.
go back to reference McNeely TB, Shugars DC, Rosendahl M, Tucker C, Eisenberg SP, Wahl SM: Inhibition of human immunodeficiency virus type 1 infectivity by secretory leukocyte protease inhibitor occurs prior to viral reverse transcription. Blood. 1997, 90: 1141-1149.PubMed McNeely TB, Shugars DC, Rosendahl M, Tucker C, Eisenberg SP, Wahl SM: Inhibition of human immunodeficiency virus type 1 infectivity by secretory leukocyte protease inhibitor occurs prior to viral reverse transcription. Blood. 1997, 90: 1141-1149.PubMed
7.
go back to reference Del Prete GF, De Carli M, D'Elios MM, Maestrelli P, Ricci M, Fabbri L, et al: Allergen exposure induces the activation of allergen-specific Th2 cells in the airway mucosa of patients with allergic respiratory disorders. Eur J Immunol. 1993, 23: 1445-1449. 10.1002/eji.1830230707.CrossRefPubMed Del Prete GF, De Carli M, D'Elios MM, Maestrelli P, Ricci M, Fabbri L, et al: Allergen exposure induces the activation of allergen-specific Th2 cells in the airway mucosa of patients with allergic respiratory disorders. Eur J Immunol. 1993, 23: 1445-1449. 10.1002/eji.1830230707.CrossRefPubMed
8.
go back to reference Robinson DS, Hamid Q, Ying S, Tsicopoulos A, Barkans J, Bentley AM, et al: Predominant TH2-like bronchoalveolar T-lymphocyte population in atopic asthma. N Engl J Med. 1992, 326: 298-304. 10.1056/NEJM199201303260504.CrossRefPubMed Robinson DS, Hamid Q, Ying S, Tsicopoulos A, Barkans J, Bentley AM, et al: Predominant TH2-like bronchoalveolar T-lymphocyte population in atopic asthma. N Engl J Med. 1992, 326: 298-304. 10.1056/NEJM199201303260504.CrossRefPubMed
9.
go back to reference Van Wetering S, Zuyderduyn S, Ninaber DK, van Sterkenburg MA, Rabe KF, Hiemstra PS: Epithelial differentiation is a determinant in the production of eotaxin-2 and -3 by bronchial epithelial cells in response to IL-4 and IL-13. Mol Immunol. 2007, 44: 803-811. 10.1016/j.molimm.2006.04.008.CrossRefPubMed Van Wetering S, Zuyderduyn S, Ninaber DK, van Sterkenburg MA, Rabe KF, Hiemstra PS: Epithelial differentiation is a determinant in the production of eotaxin-2 and -3 by bronchial epithelial cells in response to IL-4 and IL-13. Mol Immunol. 2007, 44: 803-811. 10.1016/j.molimm.2006.04.008.CrossRefPubMed
10.
go back to reference Zhu Z, Homer RJ, Wang Z, Chen Q, Geba GP, Wang J, et al: Pulmonary expression of interleukin-13 causes inflammation, mucus hypersecretion, subepithelial fibrosis, physiologic abnormalities, and eotaxin production. J Clin Invest. 1999, 103: 779-788. 10.1172/JCI5909.CrossRefPubMedPubMedCentral Zhu Z, Homer RJ, Wang Z, Chen Q, Geba GP, Wang J, et al: Pulmonary expression of interleukin-13 causes inflammation, mucus hypersecretion, subepithelial fibrosis, physiologic abnormalities, and eotaxin production. J Clin Invest. 1999, 103: 779-788. 10.1172/JCI5909.CrossRefPubMedPubMedCentral
11.
go back to reference Laoukili J, Perret E, Willems T, Minty A, Parthoens E, Houcine O, et al: IL-13 alters mucociliary differentiation and ciliary beating of human respiratory epithelial cells. J Clin Invest. 2001, 108: 1817-1824.CrossRefPubMedPubMedCentral Laoukili J, Perret E, Willems T, Minty A, Parthoens E, Houcine O, et al: IL-13 alters mucociliary differentiation and ciliary beating of human respiratory epithelial cells. J Clin Invest. 2001, 108: 1817-1824.CrossRefPubMedPubMedCentral
12.
go back to reference Yoshisue H, Puddicombe SM, Wilson SJ, Haitchi HM, Powell RM, Wilson DI, et al: Characterization of ciliated bronchial epithelium 1, a ciliated cell-associated gene induced during mucociliary differentiation. Am J Respir Cell Mol Biol. 2004, 31: 491-500. 10.1165/rcmb.2004-0050OC.CrossRefPubMed Yoshisue H, Puddicombe SM, Wilson SJ, Haitchi HM, Powell RM, Wilson DI, et al: Characterization of ciliated bronchial epithelium 1, a ciliated cell-associated gene induced during mucociliary differentiation. Am J Respir Cell Mol Biol. 2004, 31: 491-500. 10.1165/rcmb.2004-0050OC.CrossRefPubMed
13.
go back to reference Atherton HC, Jones G, Danahay H: IL-13-induced changes in the goblet cell density of human bronchial epithelial cell cultures: MAP kinase and phosphatidylinositol 3-kinase regulation. Am J Physiol Lung Cell Mol Physiol. 2003, 285: L730-L739.CrossRefPubMed Atherton HC, Jones G, Danahay H: IL-13-induced changes in the goblet cell density of human bronchial epithelial cell cultures: MAP kinase and phosphatidylinositol 3-kinase regulation. Am J Physiol Lung Cell Mol Physiol. 2003, 285: L730-L739.CrossRefPubMed
14.
go back to reference Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T, et al: Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med. 2002, 347: 1151-1160. 10.1056/NEJMoa021481.CrossRefPubMed Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T, et al: Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med. 2002, 347: 1151-1160. 10.1056/NEJMoa021481.CrossRefPubMed
15.
go back to reference Nomura I, Goleva E, Howell MD, Hamid QA, Ong PY, Hall CF, et al: Cytokine milieu of atopic dermatitis, as compared to psoriasis, skin prevents induction of innate immune response genes. J Immunol. 2003, 171: 3262-3269.CrossRefPubMed Nomura I, Goleva E, Howell MD, Hamid QA, Ong PY, Hall CF, et al: Cytokine milieu of atopic dermatitis, as compared to psoriasis, skin prevents induction of innate immune response genes. J Immunol. 2003, 171: 3262-3269.CrossRefPubMed
16.
go back to reference Albanesi C, Fairchild HR, Madonna S, Scarponi C, De Pita O, Leung DY, et al: IL-4 and IL-13 negatively regulate TNF-alpha- and IFN-gamma-induced beta-defensin expression through STAT-6, suppressor of cytokine signaling (SOCS)-1, and SOCS-3. J Immunol. 2007, 179: 984-992.CrossRefPubMed Albanesi C, Fairchild HR, Madonna S, Scarponi C, De Pita O, Leung DY, et al: IL-4 and IL-13 negatively regulate TNF-alpha- and IFN-gamma-induced beta-defensin expression through STAT-6, suppressor of cytokine signaling (SOCS)-1, and SOCS-3. J Immunol. 2007, 179: 984-992.CrossRefPubMed
17.
go back to reference Howell MD, Gallo RL, Boguniewicz M, Jones JF, Wong C, Streib JE, et al: Cytokine milieu of atopic dermatitis skin subverts the innate immune response to vaccinia virus. Immunity. 2006, 24: 341-348. 10.1016/j.immuni.2006.02.006.CrossRefPubMed Howell MD, Gallo RL, Boguniewicz M, Jones JF, Wong C, Streib JE, et al: Cytokine milieu of atopic dermatitis skin subverts the innate immune response to vaccinia virus. Immunity. 2006, 24: 341-348. 10.1016/j.immuni.2006.02.006.CrossRefPubMed
18.
go back to reference Beisswenger C, Kandler K, Hess C, Garn H, Felgentreff K, Wegmann M, et al: Allergic airway inflammation inhibits pulmonary antibacterial host defense. J Immunol. 2006, 177: 1833-1837.CrossRefPubMed Beisswenger C, Kandler K, Hess C, Garn H, Felgentreff K, Wegmann M, et al: Allergic airway inflammation inhibits pulmonary antibacterial host defense. J Immunol. 2006, 177: 1833-1837.CrossRefPubMed
19.
go back to reference Van Wetering S, van der Linden AC, van Sterkenburg MA, Rabe KF, Schalkwijk J, Hiemstra PS: Regulation of secretory leukocyte proteinase inhibitor (SLPI) production by human bronchial epithelial cells: increase of cell-associated SLPI by neutrophil elastase. J Investig Med. 2000, 48: 359-366.PubMed Van Wetering S, van der Linden AC, van Sterkenburg MA, Rabe KF, Schalkwijk J, Hiemstra PS: Regulation of secretory leukocyte proteinase inhibitor (SLPI) production by human bronchial epithelial cells: increase of cell-associated SLPI by neutrophil elastase. J Investig Med. 2000, 48: 359-366.PubMed
20.
go back to reference Tjabringa GS, Vos JB, Olthuis D, Ninaber DK, Rabe KF, Schalkwijk J, et al: Host defense effector molecules in mucosal secretions. FEMS Immunol Med Microbiol. 2005, 45: 151-158. 10.1016/j.femsim.2005.03.004.CrossRefPubMed Tjabringa GS, Vos JB, Olthuis D, Ninaber DK, Rabe KF, Schalkwijk J, et al: Host defense effector molecules in mucosal secretions. FEMS Immunol Med Microbiol. 2005, 45: 151-158. 10.1016/j.femsim.2005.03.004.CrossRefPubMed
21.
go back to reference Wingens M, van Bergen BH, Hiemstra PS, Meis JF, Vlijmen-Willems IM, Zeeuwen PL, et al: Induction of SLPI (ALP/HUSI-I) in epidermal keratinocytes. J Invest Dermatol. 1998, 111: 996-1002. 10.1046/j.1523-1747.1998.00425.x.CrossRefPubMed Wingens M, van Bergen BH, Hiemstra PS, Meis JF, Vlijmen-Willems IM, Zeeuwen PL, et al: Induction of SLPI (ALP/HUSI-I) in epidermal keratinocytes. J Invest Dermatol. 1998, 111: 996-1002. 10.1046/j.1523-1747.1998.00425.x.CrossRefPubMed
22.
go back to reference Proud D, Sanders SP, Wiehler S: Human rhinovirus infection induces airway epithelial cell production of human beta-defensin 2 both in vitro and in vivo. J Immunol. 2004, 172: 4637-4645.CrossRefPubMed Proud D, Sanders SP, Wiehler S: Human rhinovirus infection induces airway epithelial cell production of human beta-defensin 2 both in vitro and in vivo. J Immunol. 2004, 172: 4637-4645.CrossRefPubMed
23.
go back to reference Diamond G, Yim S, Rigo I, McMahon L: Measuring antimicrobial peptide activity on epithelial surfaces in cell culture. Methods Mol Biol. 2010, 618: 371-382. 10.1007/978-1-60761-594-1_23.CrossRefPubMedPubMedCentral Diamond G, Yim S, Rigo I, McMahon L: Measuring antimicrobial peptide activity on epithelial surfaces in cell culture. Methods Mol Biol. 2010, 618: 371-382. 10.1007/978-1-60761-594-1_23.CrossRefPubMedPubMedCentral
24.
go back to reference Murakami M, Lopez-Garcia B, Braff M, Dorschner RA, Gallo RL: Postsecretory processing generates multiple cathelicidins for enhanced topical antimicrobial defense. J Immunol. 2004, 172: 3070-3077.CrossRefPubMed Murakami M, Lopez-Garcia B, Braff M, Dorschner RA, Gallo RL: Postsecretory processing generates multiple cathelicidins for enhanced topical antimicrobial defense. J Immunol. 2004, 172: 3070-3077.CrossRefPubMed
25.
go back to reference Peyret-Lacombe A, Duplan H, Watts M, Charveron M, Brunel G: Antimicrobial peptide modulation in a differentiated reconstructed gingival epithelium. Cell Tissue Res. 2007, 328: 85-95. 10.1007/s00441-006-0344-8.CrossRefPubMed Peyret-Lacombe A, Duplan H, Watts M, Charveron M, Brunel G: Antimicrobial peptide modulation in a differentiated reconstructed gingival epithelium. Cell Tissue Res. 2007, 328: 85-95. 10.1007/s00441-006-0344-8.CrossRefPubMed
26.
go back to reference Hase K, Eckmann L, Leopard JD, Varki N, Kagnoff MF: Cell differentiation is a key determinant of cathelicidin LL-37/human cationic antimicrobial protein 18 expression by human colon epithelium. Infect Immun. 2002, 70: 953-963. 10.1128/IAI.70.2.953-963.2002.CrossRefPubMedPubMedCentral Hase K, Eckmann L, Leopard JD, Varki N, Kagnoff MF: Cell differentiation is a key determinant of cathelicidin LL-37/human cationic antimicrobial protein 18 expression by human colon epithelium. Infect Immun. 2002, 70: 953-963. 10.1128/IAI.70.2.953-963.2002.CrossRefPubMedPubMedCentral
27.
go back to reference Kikuchi T, Shively JD, Foley JS, Drazen JM, Tschumperlin DJ: Differentiation-dependent responsiveness of bronchial epithelial cells to IL-4/13 stimulation. Am J Physiol Lung Cell Mol Physiol. 2004, 287: L119-L126. 10.1152/ajplung.00365.2003.CrossRefPubMed Kikuchi T, Shively JD, Foley JS, Drazen JM, Tschumperlin DJ: Differentiation-dependent responsiveness of bronchial epithelial cells to IL-4/13 stimulation. Am J Physiol Lung Cell Mol Physiol. 2004, 287: L119-L126. 10.1152/ajplung.00365.2003.CrossRefPubMed
28.
go back to reference Singh PK, Tack BF, McCray PB, Welsh MJ: Synergistic and additive killing by antimicrobial factors found in human airway surface liquid. Am J Physiol Lung Cell Mol Physiol. 2000, 279: L799-L805.PubMed Singh PK, Tack BF, McCray PB, Welsh MJ: Synergistic and additive killing by antimicrobial factors found in human airway surface liquid. Am J Physiol Lung Cell Mol Physiol. 2000, 279: L799-L805.PubMed
29.
go back to reference Harder J, Meyer-Hoffert U, Teran LM, Schwichtenberg L, Bartels J, Maune S, et al: Mucoid Pseudomonas aeruginosa, TNF-alpha, and IL-1beta, but Not IL-6, Induce Human beta -Defensin-2 in Respiratory Epithelia. Am J Respir Cell Mol Biol. 2000, 22: 714-721.CrossRefPubMed Harder J, Meyer-Hoffert U, Teran LM, Schwichtenberg L, Bartels J, Maune S, et al: Mucoid Pseudomonas aeruginosa, TNF-alpha, and IL-1beta, but Not IL-6, Induce Human beta -Defensin-2 in Respiratory Epithelia. Am J Respir Cell Mol Biol. 2000, 22: 714-721.CrossRefPubMed
30.
go back to reference Bals R, Wang X, Zasloff M, Wilson JM: The peptide antibiotic LL-37/hCAP-18 is expressed in epithelia of the human lung where it has broad antimicrobial activity at the airway surface. Proc Natl Acad Sci USA. 1998, 95: 9541-9546. 10.1073/pnas.95.16.9541.CrossRefPubMedPubMedCentral Bals R, Wang X, Zasloff M, Wilson JM: The peptide antibiotic LL-37/hCAP-18 is expressed in epithelia of the human lung where it has broad antimicrobial activity at the airway surface. Proc Natl Acad Sci USA. 1998, 95: 9541-9546. 10.1073/pnas.95.16.9541.CrossRefPubMedPubMedCentral
31.
go back to reference Gray TE, Guzman K, Davis CW, Abdullah LH, Nettesheim P: Mucociliary differentiation of serially passaged normal human tracheobronchial epithelial cells. Am J Respir Cell Mol Biol. 1996, 14: 104-112.CrossRefPubMed Gray TE, Guzman K, Davis CW, Abdullah LH, Nettesheim P: Mucociliary differentiation of serially passaged normal human tracheobronchial epithelial cells. Am J Respir Cell Mol Biol. 1996, 14: 104-112.CrossRefPubMed
32.
go back to reference Vermeer PD, Harson R, Einwalter LA, Moninger T, Zabner J: Interleukin-9 induces goblet cell hyperplasia during repair of human airway epithelia. Am J Respir Cell Mol Biol. 2003, 28: 286-295. 10.1165/rcmb.4887.CrossRefPubMed Vermeer PD, Harson R, Einwalter LA, Moninger T, Zabner J: Interleukin-9 induces goblet cell hyperplasia during repair of human airway epithelia. Am J Respir Cell Mol Biol. 2003, 28: 286-295. 10.1165/rcmb.4887.CrossRefPubMed
33.
go back to reference Felgentreff K, Beisswenger C, Griese M, Gulder T, Bringmann G, Bals R: The antimicrobial peptide cathelicidin interacts with airway mucus. Peptides. 2006, 27: 3100-3106. 10.1016/j.peptides.2006.07.018.CrossRefPubMed Felgentreff K, Beisswenger C, Griese M, Gulder T, Bringmann G, Bals R: The antimicrobial peptide cathelicidin interacts with airway mucus. Peptides. 2006, 27: 3100-3106. 10.1016/j.peptides.2006.07.018.CrossRefPubMed
34.
go back to reference Bucki R, Byfield FJ, Janmey PA: Release of the antimicrobial peptide LL-37 from DNA/F-actin bundles in cystic fibrosis sputum. Eur Respir J. 2007, 29: 624-632. 10.1183/09031936.00080806.CrossRefPubMed Bucki R, Byfield FJ, Janmey PA: Release of the antimicrobial peptide LL-37 from DNA/F-actin bundles in cystic fibrosis sputum. Eur Respir J. 2007, 29: 624-632. 10.1183/09031936.00080806.CrossRefPubMed
35.
go back to reference Davidson DJ, Currie AJ, Reid GS, Bowdish DM, MacDonald KL, Ma RC, et al: The cationic antimicrobial peptide LL-37 modulates dendritic cell differentiation and dendritic cell-induced T cell polarization. J Immunol. 2004, 172: 1146-1156.CrossRefPubMed Davidson DJ, Currie AJ, Reid GS, Bowdish DM, MacDonald KL, Ma RC, et al: The cationic antimicrobial peptide LL-37 modulates dendritic cell differentiation and dendritic cell-induced T cell polarization. J Immunol. 2004, 172: 1146-1156.CrossRefPubMed
Metadata
Title
IL-4 and IL-13 exposure during mucociliary differentiation of bronchial epithelial cells increases antimicrobial activity and expression of antimicrobial peptides
Authors
Suzanne Zuyderduyn
Dennis K Ninaber
Jasmijn A Schrumpf
Marianne AJA van Sterkenburg
Renate M Verhoosel
Frans A Prins
Sandra van Wetering
Klaus F Rabe
Pieter S Hiemstra
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2011
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/1465-9921-12-59

Other articles of this Issue 1/2011

Respiratory Research 1/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine