Skip to main content
Top
Published in: Journal of Translational Medicine 1/2014

Open Access 01-12-2014 | Research

Metallothionein III (MT3) is a putative tumor suppressor gene that is frequently inactivated in pediatric acute myeloid leukemia by promoter hypermethylation

Authors: Yan-Fang Tao, Li-Xiao Xu, Jun Lu, Lan Cao, Zhi-Heng Li, Shao-Yan Hu, Na-Na Wang, Xiao-Juan Du, Li-Chao Sun, Wen-Li Zhao, Pei-Fang Xiao, Fang Fang, Yan-Hong Li, Gang Li, He Zhao, Yi-Ping Li, Yun-Yun Xu, Jian Ni, Jian Wang, Xing Feng, Jian Pan

Published in: Journal of Translational Medicine | Issue 1/2014

Login to get access

Abstract

Background

Acute myeloid leukemia (AML) is the second most common form of leukemia in children. Aberrant DNA methylation patterns are a characteristic feature in various tumors, including AML. Metallothionein III (MT3) is a tumor suppresser reported to show promoter hypermethylated in various cancers. However, the expression and molecular function of MT3 in pediatric AML is unclear.

Methods

Eleven human leukemia cell lines and 41 pediatric AML samples and 20 NBM/ITP (Norma bone marrow/Idiopathic thrombocytopenic purpura) control samples were analyzed. Transcription levels of MT3 were evaluated by semi-quantitative and real-time PCR. MT3 methylation status was determined by methylation specific PCR (MSP) and bisulfite genomic sequencing (BSG). The molecular mechanism of MT3 was investigated by apoptosis assays and PCR array analysis.

Results

The MT3 promoter was hypermethylated in leukemia cell lines. More CpG’s methylated of MT3 was observed 39.0% pediatric AML samples compared to 10.0% NBM controls. Transcription of MT3 was also significantly decreased in AML samples compared to NBM/ITP controls (P < 0.001); patients with methylated MT3 exhibited lower levels of MT3 expression compared to those with unmethylated MT3 (P = 0.049). After transfection with MT3 lentivirus, proliferation was significantly inhibited in AML cells in a dose-dependent manner (P < 0.05). Annexin V assay showed that apoptosis was significantly upregulated MT3-overexpressing AML cells compared to controls. Real-time PCR array analysis revealed 34 dysregulated genes that may be implicated in MT3 overexpression and apoptosis in AML, including FOXO1.

Conclusion

MT3 may be a putative tumor suppressor gene in pediatric AML. Epigenetic inactivation of MT3 via promoter hypermethylation was observed in both AML cell lines and pediatric AML samples. Overexpression of MT3 may inhibit proliferation and induce apoptosis in AML cells. FOXO1 was dysregulated in MT3-overexpressing cells, offering an insight into the mechanism of MT3-induced apoptosis. However, further research is required to determine the underlying molecular details.
Appendix
Available only for authorised users
Literature
1.
go back to reference Appelbaum FR, Baer MR, Carabasi MH, Coutre SE, Erba HP, Estey E, Glenn MJ, Kraut EH, Maslak P, Millenson M, Miller CB, Saba HI, Stone R, Tallman MS: NCCN practice guidelines for Acute Myelogenous Leukemia. Oncology (Williston Park). 2000, 14: 53-61. Appelbaum FR, Baer MR, Carabasi MH, Coutre SE, Erba HP, Estey E, Glenn MJ, Kraut EH, Maslak P, Millenson M, Miller CB, Saba HI, Stone R, Tallman MS: NCCN practice guidelines for Acute Myelogenous Leukemia. Oncology (Williston Park). 2000, 14: 53-61.
2.
go back to reference Sanz GF, Sanz MA, Vallespi T, Canizo MC, Torrabadella M, Garcia S, Irriguible D, San Miguel JF: Two regression models and a scoring system for predicting survival and planning treatment in myelodysplastic syndromes: a multivariate analysis of prognostic factors in 370 patients. Blood. 1989, 74: 395-408.PubMed Sanz GF, Sanz MA, Vallespi T, Canizo MC, Torrabadella M, Garcia S, Irriguible D, San Miguel JF: Two regression models and a scoring system for predicting survival and planning treatment in myelodysplastic syndromes: a multivariate analysis of prognostic factors in 370 patients. Blood. 1989, 74: 395-408.PubMed
3.
go back to reference Basu I, Cordovano G, Das I, Belbin TJ, Guha C, Schramm VL: A transition state analogue of 5′-methylthioadenosine phosphorylase induces apoptosis in head and neck cancers. J Biol Chem. 2007, 282: 21477-21486.CrossRefPubMed Basu I, Cordovano G, Das I, Belbin TJ, Guha C, Schramm VL: A transition state analogue of 5′-methylthioadenosine phosphorylase induces apoptosis in head and neck cancers. J Biol Chem. 2007, 282: 21477-21486.CrossRefPubMed
4.
go back to reference Mann MR, Bartolomei MS: Epigenetic reprogramming in the mammalian embryo: struggle of the clones. Genome Biol. 2002, 3: 2-REVIEWS1003CrossRef Mann MR, Bartolomei MS: Epigenetic reprogramming in the mammalian embryo: struggle of the clones. Genome Biol. 2002, 3: 2-REVIEWS1003CrossRef
5.
go back to reference Agrawal S, Unterberg M, Koschmieder S, ZurStadt U, Brunnberg U, Verbeek W, Buchner T, Berdel WE, Serve H, Muller-Tidow C: DNA methylation of tumor suppressor genes in clinical remission predicts the relapse risk in acute myeloid leukemia. Cancer Res. 2007, 67: 1370-1377.CrossRefPubMed Agrawal S, Unterberg M, Koschmieder S, ZurStadt U, Brunnberg U, Verbeek W, Buchner T, Berdel WE, Serve H, Muller-Tidow C: DNA methylation of tumor suppressor genes in clinical remission predicts the relapse risk in acute myeloid leukemia. Cancer Res. 2007, 67: 1370-1377.CrossRefPubMed
6.
go back to reference Akhavan-Niaki H, Samadani AA: DNA methylation and cancer development: molecular mechanism. Cell Biochem Biophys. 2013, 67: 501-513.CrossRefPubMed Akhavan-Niaki H, Samadani AA: DNA methylation and cancer development: molecular mechanism. Cell Biochem Biophys. 2013, 67: 501-513.CrossRefPubMed
7.
go back to reference Gaudet F, Hodgson JG, Eden A, Jackson-Grusby L, Dausman J, Gray JW, Leonhardt H, Jaenisch R: Induction of tumors in mice by genomic hypomethylation. Science. 2003, 300: 489-492.CrossRefPubMed Gaudet F, Hodgson JG, Eden A, Jackson-Grusby L, Dausman J, Gray JW, Leonhardt H, Jaenisch R: Induction of tumors in mice by genomic hypomethylation. Science. 2003, 300: 489-492.CrossRefPubMed
8.
go back to reference Chen RZ, Pettersson U, Beard C, Jackson-Grusby L, Jaenisch R: DNA hypomethylation leads to elevated mutation rates. Nature. 1998, 395: 89-93.CrossRefPubMed Chen RZ, Pettersson U, Beard C, Jackson-Grusby L, Jaenisch R: DNA hypomethylation leads to elevated mutation rates. Nature. 1998, 395: 89-93.CrossRefPubMed
9.
go back to reference Worm J, Aggerholm A, Guldberg P: In-tube DNA methylation profiling by fluorescence melting curve analysis. Clin Chem. 2001, 47: 1183-1189.PubMed Worm J, Aggerholm A, Guldberg P: In-tube DNA methylation profiling by fluorescence melting curve analysis. Clin Chem. 2001, 47: 1183-1189.PubMed
10.
go back to reference Willman CL: Targeted AML therapy: new biologic paradigms and therapeutic opportunities. Leukemia. 2001, 15: 690-694.CrossRefPubMed Willman CL: Targeted AML therapy: new biologic paradigms and therapeutic opportunities. Leukemia. 2001, 15: 690-694.CrossRefPubMed
11.
go back to reference Toyota M, Kopecky KJ, Toyota MO, Jair KW, Willman CL, Issa JP: Methylation profiling in acute myeloid leukemia. Blood. 2001, 97: 2823-2829.CrossRefPubMed Toyota M, Kopecky KJ, Toyota MO, Jair KW, Willman CL, Issa JP: Methylation profiling in acute myeloid leukemia. Blood. 2001, 97: 2823-2829.CrossRefPubMed
12.
go back to reference Miftakhova R, Sandberg T, Hedblom A, Nevzorova T, Persson JL, Bredberg A: DNA methylation in ATRA-treated leukemia cell lines lacking a PML-RAR chromosome translocation. Anticancer Res. 2012, 32: 4715-4722.PubMed Miftakhova R, Sandberg T, Hedblom A, Nevzorova T, Persson JL, Bredberg A: DNA methylation in ATRA-treated leukemia cell lines lacking a PML-RAR chromosome translocation. Anticancer Res. 2012, 32: 4715-4722.PubMed
13.
go back to reference Fu L, Huang W, Jing Y, Jiang M, Zhao Y, Shi J, Huang S, Xue X, Zhang Q, Tang J, Dou L, Wang L, Nervi C, Li Y, Yu L: AML1-ETO triggers epigenetic activation of early growth response gene l, inducing apoptosis in t (8;21) acute myeloid leukemia. Febs J. 2013, 281: 1123-1131.CrossRef Fu L, Huang W, Jing Y, Jiang M, Zhao Y, Shi J, Huang S, Xue X, Zhang Q, Tang J, Dou L, Wang L, Nervi C, Li Y, Yu L: AML1-ETO triggers epigenetic activation of early growth response gene l, inducing apoptosis in t (8;21) acute myeloid leukemia. Febs J. 2013, 281: 1123-1131.CrossRef
14.
15.
go back to reference Bernt KM, Armstrong SA: Targeting epigenetic programs in MLL-rearranged leukemias. Hematology Am Soc Hematol Educ Program. 2011, 2011: 354-360.CrossRefPubMed Bernt KM, Armstrong SA: Targeting epigenetic programs in MLL-rearranged leukemias. Hematology Am Soc Hematol Educ Program. 2011, 2011: 354-360.CrossRefPubMed
16.
go back to reference Tabe Y, Konopleva M, Kondo Y, Contractor R, Jin L, Ruvolo V, Tsutsumi-Ishii Y, Miyake K, Miyake N, Ohsaka A, Nagaoka I, Issa JP, Andreeff M: PML-RARalpha and AML1-ETO translocations are rarely associated with methylation of the RARbeta2 promoter. Ann Hematol. 2006, 85: 689-704.CrossRefPubMed Tabe Y, Konopleva M, Kondo Y, Contractor R, Jin L, Ruvolo V, Tsutsumi-Ishii Y, Miyake K, Miyake N, Ohsaka A, Nagaoka I, Issa JP, Andreeff M: PML-RARalpha and AML1-ETO translocations are rarely associated with methylation of the RARbeta2 promoter. Ann Hematol. 2006, 85: 689-704.CrossRefPubMed
17.
go back to reference Haferlach T, Nagata Y, Grossmann V, Okuno Y, Bacher U, Nagae G, Schnittger S, Sanada M, Kon A, Alpermann T, Yoshida K, Roller A, Nadarajah N, Shiraishi Y, Shiozawa Y, Chiba K, Tanaka H, Koeffler HP, Klein HU, Dugas M, Aburatani H, Kohlmann A, Miyano S, Haferlach C, Kern W, Ogawa S: Landscape of genetic lesions in 944 patients with myelodysplastic syndromes. Leukemia. 2014, 28: 241-247.PubMedCentralCrossRefPubMed Haferlach T, Nagata Y, Grossmann V, Okuno Y, Bacher U, Nagae G, Schnittger S, Sanada M, Kon A, Alpermann T, Yoshida K, Roller A, Nadarajah N, Shiraishi Y, Shiozawa Y, Chiba K, Tanaka H, Koeffler HP, Klein HU, Dugas M, Aburatani H, Kohlmann A, Miyano S, Haferlach C, Kern W, Ogawa S: Landscape of genetic lesions in 944 patients with myelodysplastic syndromes. Leukemia. 2014, 28: 241-247.PubMedCentralCrossRefPubMed
18.
go back to reference Weissmann S, Alpermann T, Grossmann V, Kowarsch A, Nadarajah N, Eder C, Dicker F, Fasan A, Haferlach C, Haferlach T, Kern W, Schnittger S, Kohlmann A: Landscape of TET2 mutations in acute myeloid leukemia. Leukemia. 2012, 26: 934-942.CrossRefPubMed Weissmann S, Alpermann T, Grossmann V, Kowarsch A, Nadarajah N, Eder C, Dicker F, Fasan A, Haferlach C, Haferlach T, Kern W, Schnittger S, Kohlmann A: Landscape of TET2 mutations in acute myeloid leukemia. Leukemia. 2012, 26: 934-942.CrossRefPubMed
19.
go back to reference Ajjimaporn A, Swinscoe J, Shavali S, Govitrapong P, Ebadi M: Metallothionein provides zinc-mediated protective effects against methamphetamine toxicity in SK-N-SH cells. Brain Res Bull. 2005, 67: 466-475.CrossRefPubMed Ajjimaporn A, Swinscoe J, Shavali S, Govitrapong P, Ebadi M: Metallothionein provides zinc-mediated protective effects against methamphetamine toxicity in SK-N-SH cells. Brain Res Bull. 2005, 67: 466-475.CrossRefPubMed
20.
go back to reference Howells C, West AK, Chung RS: Neuronal growth-inhibitory factor (metallothionein-3): evaluation of the biological function of growth-inhibitory factor in the injured and neurodegenerative brain. Febs J. 2010, 277: 2931-2939.CrossRefPubMed Howells C, West AK, Chung RS: Neuronal growth-inhibitory factor (metallothionein-3): evaluation of the biological function of growth-inhibitory factor in the injured and neurodegenerative brain. Febs J. 2010, 277: 2931-2939.CrossRefPubMed
21.
go back to reference Ma F, Wang H, Chen B, Wang F, Xu H: Metallothionein 3 attenuated the apoptosis of neurons in the CA1 region of the hippocampus in the senescence-accelerated mouse/PRONE8 (SAMP8). Arq Neuropsiquiatr. 2011, 69: 105-111.CrossRefPubMed Ma F, Wang H, Chen B, Wang F, Xu H: Metallothionein 3 attenuated the apoptosis of neurons in the CA1 region of the hippocampus in the senescence-accelerated mouse/PRONE8 (SAMP8). Arq Neuropsiquiatr. 2011, 69: 105-111.CrossRefPubMed
22.
go back to reference Carrasco J, Penkowa M, Giralt M, Camats J, Molinero A, Campbell IL, Palmiter RD, Hidalgo J: Role of metallothionein-III following central nervous system damage. Neurobiol Dis. 2003, 13: 22-36.CrossRefPubMed Carrasco J, Penkowa M, Giralt M, Camats J, Molinero A, Campbell IL, Palmiter RD, Hidalgo J: Role of metallothionein-III following central nervous system damage. Neurobiol Dis. 2003, 13: 22-36.CrossRefPubMed
23.
go back to reference Lee SJ, Koh JY: Roles of zinc and metallothionein-3 in oxidative stress-induced lysosomal dysfunction, cell death, and autophagy in neurons and astrocytes. Mol Brain. 2010, 3: 30-PubMedCentralCrossRefPubMed Lee SJ, Koh JY: Roles of zinc and metallothionein-3 in oxidative stress-induced lysosomal dysfunction, cell death, and autophagy in neurons and astrocytes. Mol Brain. 2010, 3: 30-PubMedCentralCrossRefPubMed
24.
go back to reference Lowy AM, Clements WM, Bishop J, Kong L, Bonney T, Sisco K, Aronow B, Fenoglio-Preiser C, Groden J: beta-Catenin/Wnt signaling regulates expression of the membrane type 3 matrix metalloproteinase in gastric cancer. Cancer Res. 2006, 66: 4734-4741.CrossRefPubMed Lowy AM, Clements WM, Bishop J, Kong L, Bonney T, Sisco K, Aronow B, Fenoglio-Preiser C, Groden J: beta-Catenin/Wnt signaling regulates expression of the membrane type 3 matrix metalloproteinase in gastric cancer. Cancer Res. 2006, 66: 4734-4741.CrossRefPubMed
25.
go back to reference Smith E, Drew PA, Tian ZQ, De Young NJ, Liu JF, Mayne GC, Ruszkiewicz AR, Watson DI, Jamieson GG: Metallothionien 3 expression is frequently down-regulated in oesophageal squamous cell carcinoma by DNA methylation. Mol Cancer. 2005, 4: 42-PubMedCentralCrossRefPubMed Smith E, Drew PA, Tian ZQ, De Young NJ, Liu JF, Mayne GC, Ruszkiewicz AR, Watson DI, Jamieson GG: Metallothionien 3 expression is frequently down-regulated in oesophageal squamous cell carcinoma by DNA methylation. Mol Cancer. 2005, 4: 42-PubMedCentralCrossRefPubMed
26.
go back to reference Deng D, El-Rifai W, Ji J, Zhu B, Trampont P, Li J, Smith MF, Powel SM: Hypermethylation of metallothionein-3 CpG island in gastric carcinoma. Carcinogenesis. 2003, 24: 25-29.CrossRefPubMed Deng D, El-Rifai W, Ji J, Zhu B, Trampont P, Li J, Smith MF, Powel SM: Hypermethylation of metallothionein-3 CpG island in gastric carcinoma. Carcinogenesis. 2003, 24: 25-29.CrossRefPubMed
27.
28.
go back to reference Cheng Y, Geng H, Cheng SH, Liang P, Bai Y, Li J, Srivastava G, Ng MH, Fukagawa T, Wu X, Chan AT, Tao Q: KRAB zinc finger protein ZNF382 is a proapoptotic tumor suppressor that represses multiple oncogenes and is commonly silenced in multiple carcinomas. Cancer Res. 2010, 70: 6516-6526.CrossRefPubMed Cheng Y, Geng H, Cheng SH, Liang P, Bai Y, Li J, Srivastava G, Ng MH, Fukagawa T, Wu X, Chan AT, Tao Q: KRAB zinc finger protein ZNF382 is a proapoptotic tumor suppressor that represses multiple oncogenes and is commonly silenced in multiple carcinomas. Cancer Res. 2010, 70: 6516-6526.CrossRefPubMed
29.
go back to reference Yan-Fang T, Jian N, Jun L, Na W, Pei-Fang X, Wen-Li Z, Dong W, Li P, Jian W, Xing F, Jian P: The promoter of miR-663 is hypermethylated in Chinese pediatric acute myeloid leukemia (AML). BMC medical genetics. 2013, 14: 74-PubMedCentralCrossRefPubMed Yan-Fang T, Jian N, Jun L, Na W, Pei-Fang X, Wen-Li Z, Dong W, Li P, Jian W, Xing F, Jian P: The promoter of miR-663 is hypermethylated in Chinese pediatric acute myeloid leukemia (AML). BMC medical genetics. 2013, 14: 74-PubMedCentralCrossRefPubMed
30.
go back to reference Jian P, Li ZW, Fang TY, Jian W, Zhuan Z, Mei LX, Yan WS, Jian N: Retinoic acid induces HL-60 cell differentiation via the upregulation of miR-663. J Hematol Oncol. 2011, 4: 20-PubMedCentralCrossRefPubMed Jian P, Li ZW, Fang TY, Jian W, Zhuan Z, Mei LX, Yan WS, Jian N: Retinoic acid induces HL-60 cell differentiation via the upregulation of miR-663. J Hematol Oncol. 2011, 4: 20-PubMedCentralCrossRefPubMed
31.
go back to reference Juang HH, Chung LC, Sung HC, Feng TH, Lee YH, Chang PL, Tsui KH: Metallothionein 3: an androgen-upregulated gene enhances cell invasion and tumorigenesis of prostate carcinoma cells. Prostate. 2013, 73: 1495-1506.CrossRefPubMed Juang HH, Chung LC, Sung HC, Feng TH, Lee YH, Chang PL, Tsui KH: Metallothionein 3: an androgen-upregulated gene enhances cell invasion and tumorigenesis of prostate carcinoma cells. Prostate. 2013, 73: 1495-1506.CrossRefPubMed
32.
go back to reference Yan-Fang T, Dong W, Li P, Wen-Li Z, Jun L, Na W, Jian W, Xing F, Yan-Hong L, Jian N, Jian P: Analyzing the gene expression profile of pediatric acute myeloid leukemia with real-time PCR arrays. Cancer Cell Int. 2012, 12: 40-PubMedCentralCrossRefPubMed Yan-Fang T, Dong W, Li P, Wen-Li Z, Jun L, Na W, Jian W, Xing F, Yan-Hong L, Jian N, Jian P: Analyzing the gene expression profile of pediatric acute myeloid leukemia with real-time PCR arrays. Cancer Cell Int. 2012, 12: 40-PubMedCentralCrossRefPubMed
33.
go back to reference Tao YF, Lu J, Du XJ, Sun LC, Zhao X, Peng L, Cao L, Xiao PF, Pang L, Wu D, Wang N, Feng X, Li YH, Ni J, Wang J, Pan J: Survivin selective inhibitor YM155 induce apoptosis in SK-NEP-1 Wilms tumor cells. BMC Cancer. 2012, 12: 619-PubMedCentralCrossRefPubMed Tao YF, Lu J, Du XJ, Sun LC, Zhao X, Peng L, Cao L, Xiao PF, Pang L, Wu D, Wang N, Feng X, Li YH, Ni J, Wang J, Pan J: Survivin selective inhibitor YM155 induce apoptosis in SK-NEP-1 Wilms tumor cells. BMC Cancer. 2012, 12: 619-PubMedCentralCrossRefPubMed
34.
go back to reference Zhang X, Tang N, Hadden TJ, Rishi AK: Akt, FoxO and regulation of apoptosis. Biochim Biophys Acta. 1813, 2011: 1978-1986. Zhang X, Tang N, Hadden TJ, Rishi AK: Akt, FoxO and regulation of apoptosis. Biochim Biophys Acta. 1813, 2011: 1978-1986.
36.
38.
go back to reference Modur V, Nagarajan R, Evers BM, Milbrandt J: FOXO proteins regulate tumor necrosis factor-related apoptosis inducing ligand expression. Implications for PTEN mutation in prostate cancer. J Biol Chem. 2002, 277: 47928-47937.CrossRefPubMed Modur V, Nagarajan R, Evers BM, Milbrandt J: FOXO proteins regulate tumor necrosis factor-related apoptosis inducing ligand expression. Implications for PTEN mutation in prostate cancer. J Biol Chem. 2002, 277: 47928-47937.CrossRefPubMed
39.
go back to reference Nakamura N, Ramaswamy S, Vazquez F, Signoretti S, Loda M, Sellers WR: Forkhead transcription factors are critical effectors of cell death and cell cycle arrest downstream of PTEN. Mol Cell Biol. 2000, 20: 8969-8982.PubMedCentralCrossRefPubMed Nakamura N, Ramaswamy S, Vazquez F, Signoretti S, Loda M, Sellers WR: Forkhead transcription factors are critical effectors of cell death and cell cycle arrest downstream of PTEN. Mol Cell Biol. 2000, 20: 8969-8982.PubMedCentralCrossRefPubMed
Metadata
Title
Metallothionein III (MT3) is a putative tumor suppressor gene that is frequently inactivated in pediatric acute myeloid leukemia by promoter hypermethylation
Authors
Yan-Fang Tao
Li-Xiao Xu
Jun Lu
Lan Cao
Zhi-Heng Li
Shao-Yan Hu
Na-Na Wang
Xiao-Juan Du
Li-Chao Sun
Wen-Li Zhao
Pei-Fang Xiao
Fang Fang
Yan-Hong Li
Gang Li
He Zhao
Yi-Ping Li
Yun-Yun Xu
Jian Ni
Jian Wang
Xing Feng
Jian Pan
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Translational Medicine / Issue 1/2014
Electronic ISSN: 1479-5876
DOI
https://doi.org/10.1186/1479-5876-12-182

Other articles of this Issue 1/2014

Journal of Translational Medicine 1/2014 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