Human Protein Z.
G J Broze Jr, J P Miletich
J Clin Invest.
1984;
73(4)
:933-938.
https://doi.org/10.1172/JCI111317
.
Protein Z was purified from human plasma by a four-step procedure which included barium
citrate adsorption, ammonium sulfate fractionation, DEAE-Sepharose chromatography, and
blue agarose chromatography with a yield of 20%. It is a 62,000 mol wt protein with an
extinction coefficient of 12.0. The concentration of Protein Z in pooled, citrated plasma is 2.2
micrograms/ml and its half-life in patients starting warfarin anticoagulation therapy is
estimated to be less than 2.5 d. The NH2-terminal sequence is
Ala-Gly-Ser-Tyr-Leu-Leu-(Gla)-(Gla)-Leu-Phe-(Gla)-Gly-Asn-Leu. Neither Protein Z nor its cleavage products, which
were obtained by treatment of Protein Z with thrombin or plasmin, incorporated
[3H]diisopropyl fluorophosphate. The physiological function of Protein Z remains unknown.
Research ArticleHuman
Protein Z
As
bstract.
Protein
Z was
purified
from human
plasma by
a
four-step
procedure
which included barium
citrate
adsorption, ammonium sulfate fractionation,
DEAE-Sepharose chromatography, and blue agarose
chromatography with a yield of 20%. It is a 62,000 mol
wt
protein with an extinction coefficient of 12.0. The
concentration of Protein Z in pooled, citrated plasma is
2.2 ug/ml and its half-life in patients starting warfarin
anticoagulation therapy is estimated to be <2.5 d. The
NH2-terminal sequence is
Ala-Gly-Ser-Tyr-Leu-Leu-(Gla)-(Gla)-Leu-Phe-(Gla)-Gly-Asn-Leu.
Neither Protein
Z
nor
its cleavage products, which were obtained by
treat-ment
of Protein
Z
with thrombin or plasmin, incorporated
[3H]diisopropyl fluorophosphate. The physiological
func-tion of
Protein Z remains unknown.
Introduction
Vitamin K is required for the posttranslational formation of a
unique
amino acid, gamma carboxyglutamic acid, which is present in a numberof plasma proteins, including Factors II, VII, IX, X, Protein C, and ProteinS,
all of which play a role in hemostasis (1, 2). The gamma carboxyglutamate residues appear to beessential to the functional properties of thesepro-teins, mediating their binding
tophospholipid surfaces viacal-cium bridges
(3). Recently Prowse andEsnouf
described another vitamin K-dependent protein in bovine plasma and they namedit
Protein Z (4).Initially
this protein was thought to representa
form of
Factor X(single chain),
but it waslateridentified
asadiscrete gamma carboxyglutamic acid-containing protein (5, 6). The
physiological function of
bovine Protein Z remains unknown. Herewedescribe
thepurification
andcharacterization
of
ahumanplasmaprotein
that appears to represent the human counterparttobovine
Protein Z.This work was doneduringthe tenureofaClinician-Scientist Award
fromtheAmericanHeartAssociation.
Receivedfor publication 11 October 1983 and in revisedform 23December 1983.
GeorgeJ. Broze, Jr. and Joseph P. Miletich
DivisionofHematology/Oncology and Laboratory Medicine, Washington University School of Medicine, The Jewish Hospital
ofSt. Louis, St. Louis, Missouri 63110
Materials
DEAESepharoseandcyanogenbromide-activated4BSepharosewere
purchased from Pharmacia Fine Chemicals,Inc.(Piscataway, NJ), and
blue agarose and lowmolecular weight standards for polyacrylamide gelelectrophoresis from Bio-Rad Laboratories (Richmond, CA).
Am-berlite CG-50wasobtained from Mallinckrodt, Inc.(Science Products
Div., St. Louis, MO). Soybeantrypsin inhibitor, bovineserumalbumin, Trizma base, acrylamide and bis-acrylamide, and benzamidine were bought from Sigma Chemical Co. (St. Louis, MO). [3H]Diisopropyl fluorophosphate (DFP)'waspurchased fromAmershamCorp.(Arlington Heights, IL). All otherchemicals wereofreagentgradeorbetter and
camefrom Fisher Scientific Co. (Pittsburgh, PA)orfrom Sigma Chem-icalCo.
Humanplasmas. Plasmasfrompatients withFactorsV/VIII defi-ciencyweregifts from Dr. Walter Kisiel(University of Washington, Seattle, WA-four patients) and Dr. Roger Edson (University of
Min-nesota,Minneapolis,MN-onepatient).
Plasmasdeficient in FactorsII,V, VII, VIII, IX, X, XI, XII, and
vonWillebrandsfactor, and Passavoytrait plasmawereobtained from GeorgeKing Biomedical (Overland Park, KS),as wasnormal control
plasmapooled from20 donors.
Individualnormalcontrolplasmaswereobtained from laboratory personnel. Samples fromeight patients startingwarfarin therapywere
takenfromspecimenssent tothe BarnesHospitalhemostasislaboratory
(St. Louis, MO).
Methods
Sodium dodecyl sulfate(SDS)polyacrylamidegelelectrophoresiswas
performedon10% gels (ratioacrylamide/bis,37.5:1) by the method of Laemmli(4%stacking gel) (7)orby the method ofWeberandOsborn (8). Gels were stained forprotein with Coomassie Brilliant Blue R. MolecularweightswereestimatedonWeber-Osbom gels byinterpolation
from linearsemilogarithmetic plots ofapparent molecularweightsvs.
migration distance usingthefollowing protein standards: phosphorylase b, 92,500; bovineserumalbumin, 66,200;ovalbumin, 45,000;carbonic anhydrase, 31,000; soybean trypsin inhibitor, 20,000;and lysozyme,
14,300.
Amino
acid composition and NHrterminal sequence
Asample ofpurified ProteinZwasdialyzedagainst0.1 Macetic acid for 48h.Portionsthatcontained 1.5-2.0nmolofproteinwereIyophilized
and thenhydrolyzedin 6 NHCIat 105°Cinsealed,evacuated tubes for24 h.Amino acidcompositionsweredeterminedinduplicate
using
a Beckman 119C amino acid analyzer (Beckman Instruments, Inc.,
Berkeley,CA)withamodifiedprogram(9).Theresultswerenotcorrected
1.Abbreviations usedinthispaper: DFP, diisopropyl
fluorophosphate;
4,
plasmin-cleaved ProteinZ;Zt, thrombin-cleaved ProteinZ. 933 Human Protein ZJ.Clin.Invest.
©The American Society for Clinical Investigation, Inc. 0021-9738/84/04/0933/05 $1.00
for lossesdue to hydrolysis. Half-cystine was determined as cysteic acid
bythe method of Hirs (10).
TheNH2-terminal sequence analysisofProtein Z was performed
on agas-phasesequenator(Applied Biosystems,FosterCity,CA);
phen-ylthiohydantoin derivatives were identified by high-performance liquid
chromatography (11, 12). Two separate analyses wereperformed using 1 nmol of ProteinZand gave identical results.
Extinction
coefficient
of
Protein
ZProteinZwasdialyzedextensively into 0.1 MNaCl, 0.05Tris,pH 7.5, anditsextinctioncoefficient wasdeterminedbythe methodofBabul andStellwagen(13).Nocorrectionwasmadefor light scattering.
Proteins
Humanprothrombin,Factor X, Factor IX,andFactor VII wereisolated
aspreviously described (14, 15). Protein Cwasfirstpurified from fresh-frozen plasma bybarium citrate adsorption, (NH4)2SO4 elution, and
affinity chromatography usingamurine monoclonalantibody, and then convertedtoactivated Protein C with thrombin (16, 17). Protein Swas
isolatedby a proceduresimilartothatof Dahlbach, with the exception thatDEAESepharose ratherthan DEAESephacel ion-exchange chro-matographywasused(18). Thrombin withaspecificactivityof 2.7NIH
units/agwaspreparedfrom prothrombin (19).
Human plasminogenwaspurified fromfresh-frozen plasma by affinity chromatographyonlysine-Sepharose;plasminwasprepared with
uro-kinaselinkedtoSepharose4B(20, 21).Toproduceplasmin-Sepharose,
1 mlof 0.1 MNaHCO3,pH8.3,containing2 mgplasminwasadded
to anequalvolume of CNBr-activated4B Sepharose and allowedto reactovernightat4VC. Unreacted siteswere thenblockedwith glycine ethylester, and thegelwaswashedextensively with 0.1 MNaCl, 0.05
M Tris, pH 7.5. The plasmin-Sepharose contained 1 mg protein/ml hydratedgel andithydrolyzed 2.8,umolof S225 1/minper mlof gelat roomtemperature.
Functional
assaysProthrombin, Factor VII, Factor IX, and Factor X were assayed as
previously described(14, 15).
Purification
of
Protein ZStarting material. Humancitrated plasma was kindly provided by the Missouri-Illinois Regional Red Cross Blood Program. 35 liters were thawed at 37°C, 137 gof benzamidine(25 mM) and350mgofsoybean
trypsin inhibitor (10 mg/liter)wereadded,andthe plasmawastransferred
tothe coldroom. Allsubsequentsteps wereperformedat4°C in plastic containers.
Bariumcitrateadsorptionandammoniumsulfatefractionation. 1.75
liters of 1.0MBaCl2wasadded dropwiseover 45 min and the mixture wasstirredan additional 15 min. The barium citrate precipitate was collected bycentrifugationat 3,000 gfor 15 minand thesupernatant plasma was decanted. The precipitate was washed once with 16 liters, and then twicewith 8liters, of0.15 MNaCl,0.01 MBaC12, 0.01 M
benzamidine,pH 7.0, andfinallyresuspended in 3.5 liters of 35% sat-urated
(NH4)SO4,
0.01 Mbenzamidine,0.02 MTris-HCl,pH 8.1 This wasstirredfor 30min,the precipitate was removed by centrifugation at3,000gfor20 min, and enough dry(NH4)2SO4was added to bring the supernatant to 65%saturation.Themixture was stirred for 30min, and theprotein precipitatewascollectedby centrifugation at 10,000 gfor20 min and resuspendedin350 mlof0.02 M sodium citrate,0.001
Mbenzamidine, pH6.0. The solution was dialyzed overnight against twochanges of40literseachof 0.02Msodiumcitrate, 0.001 M
ben-zamidine,pH 6.0.
DEAESepharose chromatography. The sample was then applied to
a5X95 cmcolumn ofDEAESepharose equilibrated in0.02 Msodium citrate, 0.001 Mbenzamidine,pH6.0,at aflowrateof 100 ml/h. The columnwaswashed with 200mlof the samebuffer and then eluted
with a lineargradientto 0.60 MNaCI,0.02 Msodiumcitrate, 0.001 M benzamidine, pH 6.0, over 9 liters. The ProteinZwaspooled as
indicated in Fig. 1,concentratedto 20 ml(PM-10 membrane,Amicon Corp.,Scientific Sys. Div.,Danvers, MA) anddialyzed against4liters of0.15 MNaCI, 0.02Msodium citrate, 0.001 Mbenzamidine,pH7.0. Blue agarosechromatography. The samplewasthenappliedto a 2 X 20 cm columnofblue agaroseequilibrated in 0.15MNaCI,0.02 M
sodium citrate, 0.001 M benzamidine, pH 7.0, at a flowrate of 10
ml/h andeluted with thesamebuffer. The protein that flowed through thecolumn undertheseconditions waspooled, concentrated (PM-I0
membrane) to 1-2mg/ml,and storedat-70°C.
Preparation
of
antisera
PurifiedProtein Z, Imgin1 ml0.1MNaCI,0.05MTris, pH7.5was
emulsified withanequal volume ofcomplete Freund's adjuvant and injectedsubcutaneously atmultiple sites into the back ofa2-kg male
New Zealandwhite rabbit.Abooster injection that contained thesame
doseofProtein Zinincomplete Freund'sadjuvantwasgivenat4wk,
and therabbitwasbledat 2-wk intervals. The bloodwasallowedto
clot andthe antiserawerecollectedaftercentrifugation.Whenanalyzed
by the Ouchterlony immunodiffusion technique (22), these antiseragave a precipitant band against Protein Z but failed to recognizehuman FactorsII,VII,IX,X,andProteins C and S.
Rocket
immunoelectrophoresis
Theconcentration of ProteinZin plasmaswasdeterminedbythe rocket immunoelectrophoresis method of Laurell(23).1% agarosegelsin0.024
MTris,0.075 Mbarbital,2 mMEDTA, pH8.7andcontainingrabbit anti-Z antisera at a 1:90 dilutionwere cast on GelBond film
(FMC
Corp., Marine ColloidsDiv., Springfield, NJ) (18ml agarosesolution for each 12.5 X 10cmslab). 15-,l sampleswereplacedin4-mmwellsand runovernightin ahorizontal slab
electrophoresis
apparatus withacold water(4°C) recirculatorat2V/cm.Thegelswerethen washed in0.145 MNaCl, 0.05 sodium phosphate, pH7.2,driedat65°C for
1 h, andstained with Coomassie Brilliant BlueR.
12
08 0 0
FRACTION NUMBER
Figure 1.ElutionofProtein Z from DEAE-Sepharose. Proteinwas
eluted from the column(5 X95 cm)withalineargradientfrom 0to
0.6 MNaClin0.02 M sodiumcitrate,0.001 Mbenzamidine, pH 6.0,over9 liters. Fractions(14 ml)werecollectedataflowrateof
180ml/h. ,OD280;---o---,conductivityinmmho;
-,expandedOD280.ThepersistentbaselineOD280(-0.5)is
duetothepresence of benzamidine.
Enzymatic
cleavage
of Protein ZThrombin-cleaved ProteinZ(Z)wasproducedbyincubating 1mg/ml ProteinZwith 200 U/mlthrombin in 0.1 MNaCl, 0.05 MTris,pH
8.0 for 3 h at 37°C. To removethrombin, the mixture was passed throughasmall columnof CG-50 inthesamebuffer.
Plasmin-cleaved Protein Z
(4)
wasproduced by incubating 1-2mg/mlProteinZwithanequal volumeof hydratedplasmin-Sepharose
in0.1 MNaCl, 0.05MTris, pH8.0for 20h at room temperature.The plasmin-Sepharosewas thenfilteredtoisolatethe
4.
For the purposesof this study,ZAand
Zp
wereassumed tohavethe sameextinction coefficientasnative Protein Z.Incorporation
of[3H]DFP
intoProteinZ,
Z., andZp
10 ul of1.14 mM[3HJDFP(I mCi/ml)in propylene glycolwasadded
to 10
Al
of Protein Z(1.0 mg/ml), ZA (1.0 mg/ml),4
(1.0 mg/ml), activated Protein C (1.0 mg/ml), orthrombin (0.07 mg/ml), in 0.1 M Tris,pH8.1. The sampleswereincubatedfor 20h at4°C,reducedwith5%2-mercaptoethanol,and, afterSDS-polyacrylamidegelelectrophoresis,
thegel waspreparedforfluorographyaspreviously described (24).Kodak XAR-5film(Eastman KodakCo., Rochester, NY)wasexposed for 1-8 wk at -70°C inacassette containingCronex intensifying screens
(DuPont Instruments, Wilmington, DE). Under these conditions
[3H]DFP
incorporation into the heavy chain of thrombin and both thea-andel-heavychains of activated Protein Ccouldbeeasilydetected.
Results
Purification
ofProteinZ.Based uponits concentration in plasmaasdetermined by
immunoelectrophoresis
(seebelow), we esti-mate that Protein Z was purified 35,000-fold by a four-step processwith a yield of 20% (16.8 mg Protein Z isolated from 35 liters citrated plasma). In this procedure, the vitamin K-dependentproteins are removed from plasma by adsorption to bariumcitrate,
andtheProtein Zis separated from the other adsorbed proteins by chromatography on DEAE Sepharose (Fig. 1). We found, as noted by others for bovine Protein Z (4, 6), that the use of an agarose- (as opposed to a dextran-) based ion-exchange support was required for optimal separation of the Protein Z. The bars in Fig. 1 represent the fractions that were pooled for Factor VII, Protein C, and Protein Z, respectively (left toright
infigure).
FactorXandProtein S eluted just before the large protein peak which contained Factor IX and pro-thrombin. As shown, the Protein Z occasionally eluted in at least twopartially separated peaks. The Protein Z pool following DEAE Sepharose chromatography was usually >95% pure asjudged
bySDS-polyacrylamide
gelelectrophoresis, but subse-quent blue agarosechromatography
was attimes required
to remove trace quantities of contaminants. Functional assay re-vealed no detectable prothrombin, Factor VII, Factor IX, or Factor X in the isolated Protein Z.Characterization.
The finalpreparation
ofProtein Z ap-peared to behomogeneous asjudged by SDS-polyacrylamide gel electrophoresis(Fig.
2).Inthe Laemmlidiscontinuous system (7), Protein Zfrequently
appeared asmultiple, tightly spaced bands, and it migrated withanapparent molecularweight greater than that found when the continuous system of Weber andOsborne
(8)
wasemployed.
When the latter methodwasused,
Protein Z migratedas asingle band withanapparentmolecular
weight
of 62,000, both before and after reduction. The extinction coefficient of Protein Z was estimated to be 12.0 using the method of Babul andStellwagen (13).
The aminoacid
composition
ofhuman Protein Z is shown in Table I,asisthat previously published for bovine Protein Z(6).
TheNH2-terminal
aminoacidsequenceis shown in Table II; forcomparison,
those of human Factors II,VII, IX,
X,
ProteinC,
ProteinS,
and bovine Protein Z (25-31) are also shown. No amino acids were detected incycles 7, 8,
and11,
and these residues were assumed to represent gamma
carboxy-glutamic acids.
Plasma levels ofProteinZ.Heterologous rabbit anti-Protein
Zantibodieswere usedto determine plasma levels of Protein Z
by
the rocketimmunoelectrophoresis technique
ofLaurell. Normal citrated plasma pooled from 20 donors, when testedon 12 occasions, gave a Protein Z level of 2.2±0.14
;g/ml
(mean±standard deviation). Themeanlevel of ProteinZ in 10 individual normal donors was 2.2±0.4 witha range of 1.6to2.95
jig/ml.
Protein Z immunoelectrophoresis rockets could notbe vi-sualized (<0.2 sg/ml) bythe third to fifthday after initiation of warfarin therapy in eight patients undergoing anticoagulant therapy for thromboembolic disease. Plasmas from five patients with FactorV/VIII deficiency and fromonepatientwith Pas-savoytrait had normal levels of Protein
Z,
asdid plasmasfrompatients with deficienciesof FactorII, V, VII, VIII, IX, X, XI, XII,or vonWillebrands factor.
Table I. Amino Acid Composition of Protein Z (Normalized to 35 LeucineResidues)
Human Bovine
Aspartic acid 28.2* 29.7
Threonine 25.9 21.1
Serine 24.7 21.5
Glutamine 49.5 45.0
Proline 15.8 29.7
Glycine 34.5 37.5
Alanine 17.0 31.4
Half-cystine 18.8 20.8
Valine 31.3 28.5
Methionine 4.0 3.9
Isoleucine 17.5 8.2
Leucine 35.0 35.0
Tyrosine 9.7 9.4
Phenylalanine 11.2 11.8
Histidine 13.9 10.4
Lysine 14.5 11.0
Arginine 20.3 28.5
Tryptophan ND 6.9
*Numberofresidues
ND,notdetermined
TableII. Comparisonof the NH-Terminal Sequences
of
HumanProthrombin,
FactorVII,
FactorIX,
FactorX,
ProteinC,
ProteinS, Protein Z, andBovine Protein ZSequencePosition
Factor 1 5 10 15
Humanprothrombin Ala Asn Thr - Phe Leu Gla Gla - Val
Arg
Lys
Gly
Asn LeuHumanFactor VII Ala Asn - Ala Phe Leu
(Gla)
(Gla)
Leu -Arg
ProHumanFactorIX Tyr Asn Ser Gly Lys Leu
(Gla)
(Gla)
Phe Val - GinGly
Asn LeuHumanFactorX Ala Asn Ser - Phe Leu Gla Gla - Met
Lys
Lys
Gly
His LeuHumanProtein C Ala Asn Ser - Phe Leu Gla Gla Leu
Arg
His Ser Ser LeuHumanProtein S Ala Asn Ser - Leu Leu
(Gla)
(Gla)
?Lys
Gln
Gly
Asn Leu HumanProteinZ Ala Gly Ser Tyr Leu Leu(Gla)
(Gla)
Leu Phe -(Gla)
Gly
Asn LeuBovine Protein Z Ala Gly Ser Tyr Leu Leu Gla Gla Leu Phe - Gla
Gly
His Leu Gla referstogammacarboxyglutamicacid. Parentheses surround Gla residues thataresuspected
butnotyetproven.Dashesrefertospaceswhich have been insertedtobringthesequencesinto
alignment
for betterhomology.
Cleavage
of
ProteinZby
thrombin andplasmin.
Treatment anapparent molecularweight
of56,000.
4
migrated
as asingle
of ProteinZwith
high
levelsof thrombinorplasmin produced
chain unreducedof
60,000 D,
andfollowing
reduction
wascleavage products
(seeMethods)
thatwehave calledZA
and4,
composed
ofaheavy
chainof
44,000
Dandalight
chain(not
respectively (Fig. 2).
ZA
wasasingle chain
protein
both reduced seenwell inFig. 2)
of
20,000
D.Neither Protein Z,
ZA,
nor4
and unreducedonSDS
polyacrylamide gel
electrophoresis
with
incorporated
[3H]DFP
underconditions
inwhich
[3H]DFP
in-F.
_
_ __
F
...
.- , w ?=-'X,-F"'
,;.R
.,...
w.x.A.
_
__
_
_-w
w
*z
sx.:
: _?
,,e
-.w
.
.
JX.
-*'
_..
_
...
,_..
:
_ _j
_
'! _ :
*:
:. .::
''''
...
',::
:
t'
""'',
.;.
_
.
..:
.
::.
...
......
_
.^W. :.8-!>: _
,: :.
*''
*t_.
'.
,,.:,&$t,,-:st.:.,.::
*s_.
3L:
.:
,:
::.:.
'::'>;e'':";;''..
.;X*
r::
#:.
:. w.Lz
Figure2.Sodiumdodecyl
sulfatepolyacrylamide
(10%) gelelectrophoresisof ProteinZ(7). On the left:
proteinstandards; Protein
Z(15
jg);
thrombin-treated ProteinZ(10Mg);
plasmin-treated ProteinZ(10
Ag);
andprotein standards,re-spectively.On theright:the
samesamplesafter
reduc-tion with 5%
2-mercapto-ethanol. Theprotein
stan-dardsarephosphorylaseb,
92,500; bovineserum
albu-min,66,200;ovalbumin,
45,000; carbonicanhydrase,
31,500;soybeantrypsin
in-hibitor, 20,000;and
lyso-zyme, 14,300.
U-936 GeorgeJ.Broze, Jr. and
Joseph
P.Miletich'"MMi4m.
corporation into thrombin and activated Protein C could be easilydetected.
Discussion
The human protein isolated here has been called Protein Z
because its molecular weight, amino acid composition, NH2-terminal sequence,andchromatographiccharacteristics are very
similar to those ofthe bovine protein ofthesame name.Protein
Zdoesnot appeartobe relatedtotherecently described Protein M,
since
itfailed
toactivate FactorXin the presence of human brainthromboplastin or to affect the activationofprothrombinin the presence of Factor Xa, Factor Va, phospholipids, and calcium. Both of these properties have been ascribed to
Protein M (32, 33, and Broze, G. J., Jr., and J. P. Miletich, unpublished observations).
The level ofProtein Z in human citrated plasma is -2.2
,gg/ml,
and from dataobtained from patients starting warfarin anticoagulation therapy, we estimate that the half-life of ProteinZis <2.5 d. Although the heterologous rabbit anti-Z antibody could no longer detect Protein Z in the plasmas of these patients treated with warfarin, it is not clear whether this is because of
an actual absence of Protein
Z,
orbecausethe rabbit antibody cannot detect gamma carboxyglutamate-deficient Protein Z.The physiological function of Protein Z remains obscure.
Inpreliminary experiments, neither the prothrombin time, par-tialthromboplastin time, nor euglobulin lysis time of normal plasma wasaffected by prior immunoadsorption of Protein Z fromthe plasma or by addition of
Z,
or4
(10 ,ug/ml)(Broze,G. J., Jr., and J. P.
Miletich, unpublished
observations). Although neitherProtein
Znorits cleavage products produced by treat-mentwith thrombin orplasmin could be demonstrated to in-corporate[3H]DFP,
it isstillpossible
thatProtein Zmaybe a serine protease zymogen.Acknowledaments
We wouldliketothankDr.Robert Mechamfor assistance in the amino acid
analysis,
Joseph Leykamfor assistance in theNHrterminalsequence,andGordon Holt, Dan Whithaus, andDarryl Higuchi for technical assistance.
This workwassupported, in part,by funds from the Missouri Affiliate of theAmerican HeartAssociation,andbyagrant from the Monsanto ChemicalCorporation.
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