Pub Date : 2024-08-13Epub Date: 2024-06-14DOI: 10.1016/j.immuni.2024.05.021
Rebecca B Delconte, Mark Owyong, Endi K Santosa, Katja Srpan, Sam Sheppard, Tomi J McGuire, Aamna Abbasi, Carlos Diaz-Salazar, Jerold Chun, Inez Rogatsky, Katharine C Hsu, Stefan Jordan, Miriam Merad, Joseph C Sun
Fasting is associated with improved outcomes in cancer. Here, we investigated the impact of fasting on natural killer (NK) cell anti-tumor immunity. Cyclic fasting improved immunity against solid and metastatic tumors in an NK cell-dependent manner. During fasting, NK cells underwent redistribution from peripheral tissues to the bone marrow (BM). In humans, fasting also reduced circulating NK cell numbers. NK cells in the spleen of fasted mice were metabolically rewired by elevated concentrations of fatty acids and glucocorticoids, augmenting fatty acid metabolism via increased expression of the enzyme CPT1A, and Cpt1a deletion impaired NK cell survival and function in this setting. In parallel, redistribution of NK cells to the BM during fasting required the trafficking mediators S1PR5 and CXCR4. These cells were primed by an increased pool of interleukin (IL)-12-expressing BM myeloid cells, which improved IFN-γ production. Our findings identify a link between dietary restriction and optimized innate immune responses, with the potential to enhance immunotherapy strategies.
禁食与改善癌症预后有关。在这里,我们研究了禁食对自然杀伤(NK)细胞抗肿瘤免疫力的影响。周期性禁食以一种依赖 NK 细胞的方式提高了对实体瘤和转移性肿瘤的免疫力。禁食期间,NK细胞从外周组织重新分布到骨髓(BM)。在人体中,禁食也会减少循环中的NK细胞数量。禁食小鼠脾脏中的 NK 细胞在脂肪酸和糖皮质激素浓度升高的作用下发生了新陈代谢,通过增加 CPT1A 酶的表达增强了脂肪酸代谢,而 Cpt1a 基因缺失会损害 NK 细胞在这种情况下的存活和功能。与此同时,在禁食期间,NK细胞重新分布到BM需要转运介质S1PR5和CXCR4。白细胞介素(IL)-12表达的基质骨髓细胞池的增加为这些细胞提供了能量,从而改善了IFN-γ的产生。我们的研究结果确定了饮食限制与优化的先天性免疫反应之间的联系,有望加强免疫疗法策略。
{"title":"Fasting reshapes tissue-specific niches to improve NK cell-mediated anti-tumor immunity.","authors":"Rebecca B Delconte, Mark Owyong, Endi K Santosa, Katja Srpan, Sam Sheppard, Tomi J McGuire, Aamna Abbasi, Carlos Diaz-Salazar, Jerold Chun, Inez Rogatsky, Katharine C Hsu, Stefan Jordan, Miriam Merad, Joseph C Sun","doi":"10.1016/j.immuni.2024.05.021","DOIUrl":"10.1016/j.immuni.2024.05.021","url":null,"abstract":"<p><p>Fasting is associated with improved outcomes in cancer. Here, we investigated the impact of fasting on natural killer (NK) cell anti-tumor immunity. Cyclic fasting improved immunity against solid and metastatic tumors in an NK cell-dependent manner. During fasting, NK cells underwent redistribution from peripheral tissues to the bone marrow (BM). In humans, fasting also reduced circulating NK cell numbers. NK cells in the spleen of fasted mice were metabolically rewired by elevated concentrations of fatty acids and glucocorticoids, augmenting fatty acid metabolism via increased expression of the enzyme CPT1A, and Cpt1a deletion impaired NK cell survival and function in this setting. In parallel, redistribution of NK cells to the BM during fasting required the trafficking mediators S1PR5 and CXCR4. These cells were primed by an increased pool of interleukin (IL)-12-expressing BM myeloid cells, which improved IFN-γ production. Our findings identify a link between dietary restriction and optimized innate immune responses, with the potential to enhance immunotherapy strategies.</p>","PeriodicalId":13269,"journal":{"name":"Immunity","volume":" ","pages":"1923-1938.e7"},"PeriodicalIF":25.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.immuni.2024.06.017
Tissue-resident memory T (TRM) cells positively correlate with cancer survival, but the anti-tumor mechanisms underlying this relationship are not understood. This review reconciles these observations, summarizing concepts of T cell immunosurveillance, fundamental TRM cell biology, and clinical observations on the role of TRM cells in cancer and immunotherapy outcomes. We also discuss emerging strategies that utilize TRM-phenotype cells for patient diagnostics, staging, and therapy. Current challenges are highlighted, including a lack of standardized T cell nomenclature and our limited understanding of relationships between T cell markers and underlying tumor biology. Existing findings are integrated into a summary of the field while emphasizing opportunities for future research.
组织驻留记忆 T(TRM)细胞与癌症存活率呈正相关,但这种关系的抗肿瘤机制尚不清楚。本综述调和了这些观察结果,总结了 T 细胞免疫监视的概念、TRM 细胞的基本生物学特性以及有关 TRM 细胞在癌症和免疫治疗结果中作用的临床观察结果。我们还讨论了利用TRM表型细胞进行患者诊断、分期和治疗的新兴策略。我们强调了当前面临的挑战,包括缺乏标准化的 T 细胞命名法,以及我们对 T 细胞标记物与潜在肿瘤生物学之间关系的了解有限。在强调未来研究机遇的同时,还将现有研究成果纳入该领域的总结中。
{"title":"Resident memory T cells and cancer","authors":"","doi":"10.1016/j.immuni.2024.06.017","DOIUrl":"https://doi.org/10.1016/j.immuni.2024.06.017","url":null,"abstract":"<p>Tissue-resident memory T (T<sub>RM</sub>) cells positively correlate with cancer survival, but the anti-tumor mechanisms underlying this relationship are not understood. This review reconciles these observations, summarizing concepts of T cell immunosurveillance, fundamental T<sub>RM</sub> cell biology, and clinical observations on the role of T<sub>RM</sub> cells in cancer and immunotherapy outcomes. We also discuss emerging strategies that utilize T<sub>RM</sub>-phenotype cells for patient diagnostics, staging, and therapy. Current challenges are highlighted, including a lack of standardized T cell nomenclature and our limited understanding of relationships between T cell markers and underlying tumor biology. Existing findings are integrated into a summary of the field while emphasizing opportunities for future research.</p>","PeriodicalId":13269,"journal":{"name":"Immunity","volume":"56 1","pages":""},"PeriodicalIF":32.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.immuni.2024.07.018
The interferon-stimulated gene OAS1 has well-defined antiviral properties. In two recent issues of Immunity, Harioudh et al. describe a non-canonical function of OAS1 that selectively protects the translation of proteins involved in defense against viral or bacterial infections.
{"title":"A non-canonical function of OAS1 to combat viral and bacterial infections","authors":"","doi":"10.1016/j.immuni.2024.07.018","DOIUrl":"https://doi.org/10.1016/j.immuni.2024.07.018","url":null,"abstract":"<p>The interferon-stimulated gene OAS1 has well-defined antiviral properties. In two recent issues of <em>Immunity</em>, Harioudh et al. describe a non-canonical function of OAS1 that selectively protects the translation of proteins involved in defense against viral or bacterial infections.</p>","PeriodicalId":13269,"journal":{"name":"Immunity","volume":"16 1","pages":""},"PeriodicalIF":32.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.immuni.2024.07.009
Extracellular vesicles (EVs), such as ectosomes and exosomes, contain DNA, RNA, proteins and are encased in a phospholipid bilayer. EVs provide intralumenal cargo for delivery into the cytoplasm of recipient cells with an impact on the function of immune cells, in part because their biogenesis can also intersect with antigen processing and presentation. Motile EVs from activated immune cells may increase the frequency of immune synapses on recipient cells in a proximity-independent manner for local and long-distance modulation of systemic immunity in inflammation, autoimmunity, organ fibrosis, cancer, and infections. Natural and engineered EVs exhibit the ability to impact innate and adaptive immunity and are entering clinical trials. EVs are likely a component of an optimally functioning immune system, with the potential to serve as immunotherapeutics. Considering the evolving evidence, it is possible that EVs could be the original primordial organic units that preceded the creation of the first cell.
{"title":"The biology and function of extracellular vesicles in immune response and immunity","authors":"","doi":"10.1016/j.immuni.2024.07.009","DOIUrl":"https://doi.org/10.1016/j.immuni.2024.07.009","url":null,"abstract":"<p>Extracellular vesicles (EVs), such as ectosomes and exosomes, contain DNA, RNA, proteins and are encased in a phospholipid bilayer. EVs provide intralumenal cargo for delivery into the cytoplasm of recipient cells with an impact on the function of immune cells, in part because their biogenesis can also intersect with antigen processing and presentation. Motile EVs from activated immune cells may increase the frequency of immune synapses on recipient cells in a proximity-independent manner for local and long-distance modulation of systemic immunity in inflammation, autoimmunity, organ fibrosis, cancer, and infections. Natural and engineered EVs exhibit the ability to impact innate and adaptive immunity and are entering clinical trials. EVs are likely a component of an optimally functioning immune system, with the potential to serve as immunotherapeutics. Considering the evolving evidence, it is possible that EVs could be the original primordial organic units that preceded the creation of the first cell.</p>","PeriodicalId":13269,"journal":{"name":"Immunity","volume":"18 1","pages":""},"PeriodicalIF":32.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.immuni.2024.07.013
Response to immune checkpoint blockade is increased in obesity-related cancers, but the mechanisms remain unclear. In a recent issue of Nature, Bader et al. report that obesity in mice induces macrophage PD-1 upregulation to promote tumor growth while potentiating immunotherapy responses.
{"title":"Macrophages dig into the obesity paradox in cancer","authors":"","doi":"10.1016/j.immuni.2024.07.013","DOIUrl":"https://doi.org/10.1016/j.immuni.2024.07.013","url":null,"abstract":"<p>Response to immune checkpoint blockade is increased in obesity-related cancers, but the mechanisms remain unclear. In a recent issue of <em>Nature</em>, Bader et al. report that obesity in mice induces macrophage PD-1 upregulation to promote tumor growth while potentiating immunotherapy responses.</p>","PeriodicalId":13269,"journal":{"name":"Immunity","volume":"20 1","pages":""},"PeriodicalIF":32.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1016/j.immuni.2024.07.016
Due to its stimulatory potential for immunomodulatory CD4+ regulatory T (Treg) cells, low-dose interleukin-2 (IL-2) immunotherapy has gained considerable attention for the treatment of autoimmune diseases. In this investigator-initiated single-arm non-placebo-controlled phase-2 clinical trial of low-dose IL-2 immunotherapy in systemic lupus erythematosus (SLE) patients, we generated a comprehensive atlas of in vivo human immune responses to low-dose IL-2. We performed an in-depth study of circulating and cutaneous immune cells by imaging mass cytometry, high-parameter flow cytometry, transcriptomics, and targeted serum proteomics. Low-dose IL-2 stimulated various circulating immune cells, including Treg cells with a skin-homing phenotype that appeared in the skin of SLE patients in close interaction with endothelial cells. Analysis of surface proteins and transcriptomes revealed different IL-2-driven Treg cell activation programs, including gut-homing CD38+, skin-homing HLA-DR+, and highly proliferative inflammation-homing CD38+ HLA-DR+ Treg cells. Collectively, these data define the distinct human Treg cell subsets that are responsive to IL-2 immunotherapy.
{"title":"Interleukin-2 immunotherapy reveals human regulatory T cell subsets with distinct functional and tissue-homing characteristics","authors":"","doi":"10.1016/j.immuni.2024.07.016","DOIUrl":"https://doi.org/10.1016/j.immuni.2024.07.016","url":null,"abstract":"<p>Due to its stimulatory potential for immunomodulatory CD4<sup>+</sup> regulatory T (Treg) cells, low-dose interleukin-2 (IL-2) immunotherapy has gained considerable attention for the treatment of autoimmune diseases. In this investigator-initiated single-arm non-placebo-controlled phase-2 clinical trial of low-dose IL-2 immunotherapy in systemic lupus erythematosus (SLE) patients, we generated a comprehensive atlas of <em>in vivo</em> human immune responses to low-dose IL-2. We performed an in-depth study of circulating and cutaneous immune cells by imaging mass cytometry, high-parameter flow cytometry, transcriptomics, and targeted serum proteomics. Low-dose IL-2 stimulated various circulating immune cells, including Treg cells with a skin-homing phenotype that appeared in the skin of SLE patients in close interaction with endothelial cells. Analysis of surface proteins and transcriptomes revealed different IL-2-driven Treg cell activation programs, including gut-homing CD38<sup>+</sup>, skin-homing HLA-DR<sup>+</sup>, and highly proliferative inflammation-homing CD38<sup>+</sup> HLA-DR<sup>+</sup> Treg cells. Collectively, these data define the distinct human Treg cell subsets that are responsive to IL-2 immunotherapy.</p>","PeriodicalId":13269,"journal":{"name":"Immunity","volume":"191 1","pages":""},"PeriodicalIF":32.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-07DOI: 10.1016/j.immuni.2024.07.011
Hypertension is usually accompanied by elevated sympathetic tonicity, but how sympathetic hyperactivity is triggered is not clear. Recent advances revealed that microglia-centered neuroinflammation contributes to sympathetic excitation in hypertension. In this study, we performed a temporospatial analysis of microglia at both morphological and transcriptomic levels and found that microglia in the hypothalamic paraventricular nucleus (PVN), a sympathetic center, were early responders to hypertensive challenges. Vasculature analyses revealed that the PVN was characterized by high capillary density, thin vessel diameter, and complex vascular topology relative to other brain regions. As such, the PVN was susceptible to the penetration of ATP released from the vasculature in response to hemodynamic disturbance after blood pressure increase. Mechanistically, ATP ligation to microglial P2Y12 receptor was responsible for microglial inflammatory activation and the eventual sympathetic overflow. Together, these findings identified a distinct vasculature pattern rendering vulnerability of PVN pre-sympathetic neurons to hypertension-associated microglia-mediated inflammatory insults.
高血压通常伴有交感神经强直性增高,但交感神经亢进是如何引发的尚不清楚。最近的研究发现,以小胶质细胞为中心的神经炎症导致了高血压的交感神经兴奋。在这项研究中,我们从形态学和转录组水平对小胶质细胞进行了时空分析,发现交感中枢下丘脑室旁核(PVN)中的小胶质细胞是高血压挑战的早期响应者。血管分析表明,与其他脑区相比,下丘脑室旁核具有毛细血管密度高、血管直径细和血管拓扑结构复杂的特点。因此,当血压升高后血流动力学紊乱时,血管中释放的 ATP 很容易渗透到 PVN 中。从机理上讲,ATP 与小胶质细胞 P2Y12 受体的连接是导致小胶质细胞炎症激活和最终交感神经溢出的原因。总之,这些发现确定了一种独特的血管模式,它使 PVN 前交感神经元容易受到高血压相关的小胶质细胞介导的炎症损伤。
{"title":"Microglia in the hypothalamic paraventricular nucleus sense hemodynamic disturbance and promote sympathetic excitation in hypertension","authors":"","doi":"10.1016/j.immuni.2024.07.011","DOIUrl":"https://doi.org/10.1016/j.immuni.2024.07.011","url":null,"abstract":"<p>Hypertension is usually accompanied by elevated sympathetic tonicity, but how sympathetic hyperactivity is triggered is not clear. Recent advances revealed that microglia-centered neuroinflammation contributes to sympathetic excitation in hypertension. In this study, we performed a temporospatial analysis of microglia at both morphological and transcriptomic levels and found that microglia in the hypothalamic paraventricular nucleus (PVN), a sympathetic center, were early responders to hypertensive challenges. Vasculature analyses revealed that the PVN was characterized by high capillary density, thin vessel diameter, and complex vascular topology relative to other brain regions. As such, the PVN was susceptible to the penetration of ATP released from the vasculature in response to hemodynamic disturbance after blood pressure increase. Mechanistically, ATP ligation to microglial P2Y<sub>12</sub> receptor was responsible for microglial inflammatory activation and the eventual sympathetic overflow. Together, these findings identified a distinct vasculature pattern rendering vulnerability of PVN pre-sympathetic neurons to hypertension-associated microglia-mediated inflammatory insults.</p>","PeriodicalId":13269,"journal":{"name":"Immunity","volume":"37 1","pages":""},"PeriodicalIF":32.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1016/j.immuni.2024.07.003
Tumor-infiltrating lymphocyte (TIL) hypofunction contributes to the progression of advanced cancers and is a frequent target of immunotherapy. Emerging evidence indicates that metabolic insufficiency drives T cell hypofunction during tonic stimulation, but the signals that initiate metabolic reprogramming in this context are largely unknown. Here, we found that Meteorin-like (METRNL), a metabolically active cytokine secreted by immune cells in the tumor microenvironment (TME), induced bioenergetic failure of CD8+ T cells. METRNL was secreted by CD8+ T cells during repeated stimulation and acted via both autocrine and paracrine signaling. Mechanistically, METRNL increased E2F-peroxisome proliferator-activated receptor delta (PPARδ) activity, causing mitochondrial depolarization and decreased oxidative phosphorylation, which triggered a compensatory bioenergetic shift to glycolysis. Metrnl ablation or downregulation improved the metabolic fitness of CD8+ T cells and enhanced tumor control in several tumor models, demonstrating the translational potential of targeting the METRNL-E2F-PPARδ pathway to support bioenergetic fitness of CD8+ TILs.
肿瘤浸润淋巴细胞(TIL)功能低下是晚期癌症进展的一个因素,也是免疫疗法的一个常见靶点。新的证据表明,在强刺激过程中,新陈代谢不足会导致T细胞功能低下,但在这种情况下启动新陈代谢重编程的信号在很大程度上是未知的。在这里,我们发现肿瘤微环境(TME)中的免疫细胞分泌的代谢活性细胞因子 Meteorin-like (METRNL) 会诱导 CD8+ T 细胞的生物能衰竭。METRNL 由 CD8+ T 细胞在反复刺激过程中分泌,通过自分泌和旁分泌信号发挥作用。从机制上讲,METRNL增加了E2F-过氧化物酶体增殖激活受体δ(PPARδ)的活性,导致线粒体去极化和氧化磷酸化降低,从而引发生物能代偿性地转向糖酵解。METRNL的消减或下调改善了CD8+ T细胞的代谢能力,增强了几种肿瘤模型的肿瘤控制能力,证明了靶向METRNL-E2F-PPARδ途径支持CD8+ TILs生物能的转化潜力。
{"title":"The cytokine Meteorin-like inhibits anti-tumor CD8+ T cell responses by disrupting mitochondrial function","authors":"","doi":"10.1016/j.immuni.2024.07.003","DOIUrl":"https://doi.org/10.1016/j.immuni.2024.07.003","url":null,"abstract":"<p>Tumor-infiltrating lymphocyte (TIL) hypofunction contributes to the progression of advanced cancers and is a frequent target of immunotherapy. Emerging evidence indicates that metabolic insufficiency drives T cell hypofunction during tonic stimulation, but the signals that initiate metabolic reprogramming in this context are largely unknown. Here, we found that Meteorin-like (<em>METRNL</em>), a metabolically active cytokine secreted by immune cells in the tumor microenvironment (TME), induced bioenergetic failure of CD8<sup>+</sup> T cells. METRNL was secreted by CD8<sup>+</sup> T cells during repeated stimulation and acted via both autocrine and paracrine signaling. Mechanistically, METRNL increased E2F-peroxisome proliferator-activated receptor delta (PPARδ) activity, causing mitochondrial depolarization and decreased oxidative phosphorylation, which triggered a compensatory bioenergetic shift to glycolysis. <em>Metrnl</em> ablation or downregulation improved the metabolic fitness of CD8<sup>+</sup> T cells and enhanced tumor control in several tumor models, demonstrating the translational potential of targeting the METRNL-E2F-PPARδ pathway to support bioenergetic fitness of CD8<sup>+</sup> TILs.</p>","PeriodicalId":13269,"journal":{"name":"Immunity","volume":"76 1","pages":""},"PeriodicalIF":32.4,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}