Journal of Fish Diseases 2012, 35, 563–568 doi:10.1111/j.1365-2761.2012.01397.x Enhancement of Hsp70 synthesis protects common carp, Cyprinus carpio L., against lethal ammonia toxicity Y Y Sung1,2, R J Roberts3 and P Bossier4 1 Department of Aquaculture Science, Faculty of Fisheries and Aqua-Industry, Universiti Malaysia Terengganu (UMT), Kuala Terengganu, Malaysia 2 Institute of Marine Biotechnology, Universiti Malaysia Terengganu (UMT), Kuala Terengganu, Malaysia 3 Hagerman Fish Culture Research Laboratory, Hagerman, ID, USA 4 Laboratory of Aquaculture & Artemia Reference Center, Faculty of Bioscience Engineering, Ghent University, Belgium Abstract Exposure to TEX-OE, a patented extract of the prickly pear cactus (Opuntia ficus indica) containing chaperone-stimulating factor, was shown to protect common carp, Cyprinus carpio L., fingerlings against acute ammonia stress. Survival was enhanced twofold from 50% to 95% after exposure to 5.92 mg L)1 NH3, a level determined in the ammonia challenge bioassay as the 1-h LD50 concentration for this species. Survival of TEX-OEpre-exposed fish was enhanced by 20% over non-exposed controls during lethal ammonia challenge (14.21 mg L)1 NH3). Increase in the levels of gill and muscle Hsp70 was evident in TEX-OEpre-exposed fish but not in the unexposed controls, indicating that application of TEX-OE accelerated carp endogenous Hsp70 synthesis during ammonia perturbation. Protection against ammonia was correlated with Hsp70 accretion. Keywords: Ammonia stress, carp, Cyprinus carpio, Heat shock proteins, TEX-OE. Introduction Prokaryotic and eukaryotic organisms, including humans, all possess a group of highly conserved proteins termed heat shock proteins (Hsps). As molecular chaperones, Hsps bind the exposed Correspondence Dr Y S Yeong, Department of Fisheries and Aquaculture, Faculty of Agrotechnology and Food Science, University Malaysia Terengganu (UMT), 21030, Kuala Terengganu, Malaysia (E-mail: [email protected]) 2012 Blackwell Publishing Ltd 563 hydrophobic surfaces of non-native proteins introduced into the body (Robert 2003) and of those not fully synthesized, folded, assembled or localized to the appropriate cellular compartment (Feder & Hoffman 1999; Mchaourab, Godar & Stewart 2009). They also maintain other proteins in folding-competent, folded or unfolded states, contribute to the folding of nascent and altered proteins, assist protein localization, import and/or export between cell organelles and target non-native or aggregated proteins for degradation and removal from cells. They are also known as stress proteins and are constitutively expressed, representing 5–10% of the total protein in healthy growing cells and two or three times that amount when induced by stressors such as heat, cold, nutritional deficiencies, oxygen deprivation and disease (Pockley 2003; Pockley, Muthana & Calderwood 2008; Roberts et al. 2010), all of which can affect protein conformation. Upon up-regulation of Hsps, cells are better able to adapt to gradual changes in their environment and to tolerate lethal conditions. In relation to aquatic organisms, the Hsp70 family of heat shock proteins is perhaps the most widely studied. Generally, interest has centred on its well-recognized role in enhancement of the thermal resistance response to heat stress. Examples include observations on Hsp70-induced thermotolerance generated in coho salmon, Oncorhynchus kisutch (Walbaum), as a result of a sublethal heat shock (Arkush, Cherr & Clegg 2008), and elevated Hsp70 promoted resistance to lethal temperature of the brine shrimp, Artemia franciscana (Kellogg) (Clegg Journal of Fish Diseases 2012, 35, 563–568 et al. 2000; Sung et al. 2008). Molluscs such as Pacific oyster, Crassostrea gigas (Thunberg) (Clegg et al. 1998), and California native oyster, Ostreola conchaphila (Carpenter) (Brown et al. 2004), are able to survive temperatures up to 39 C, a level well above their normal lethal temperature, when they are primed initially with a sublethal heat shock at 34 C. Hsps are also involved in cross-tolerance, a phenomenon whereby aquatic organisms acquire increased tolerance to physiological insult following an initial transient, albeit different, stress, a capability frequently occurring concomitantly with Hsp accretion (Sung et al. 2007). With respect to biotic stress tolerance, Hsp70 has also been shown to protect the brine shrimp (Sung et al. 2007, 2008, 2009a,b), the black tiger prawn, Penaeus monodon (Fabricius) (de la Vega et al. 2006), and platyfish, Xiphophorus maculatus (Günther) (Ryckaert et al. 2010), against pathogenic microbe challenge. In most of the above-cited examples, heat shock was used to enhance Hsp production. Whilst effective, this can in itself cause significant mortalities in aquatic organisms. A less traumatic means of enhancement of Hsp production would therefore have considerable practical value. Pro-Tex, the aquatic form of TEX-OE, is a patented extract of the prickly pear cactus (Opuntia ficus indica). It has been shown to accelerate and elevate Hsp synthesis in humans (Wiese et al. 2004) and fish (Sandilands, Drynan & Roberts 2009; Roberts et al. 2010), protecting them against a wide variety of stressors. The current study was carried out to investigate whether application of TEX-OE chaperone-stimulating factor could be shown to protect carp, Cyprinus carpio L. against toxic ammonia levels, a common cause of significant mortalities of fish in aquaculture and in aquarium fish, particularly during transportation. The correlation between enhanced tolerance and Hsp70 expression in muscle and gill during ammonia perturbation was determined. Materials and methods Preparation of Opuntia ficus indica extract solution Two microlitres of Pro-Tex [Bradan Limited, a soluble variant of TEX-OE (Batch no. J3TexET08066)] for use in fish culture was diluted with 50 L of dechlorinated freshwater following the manufacturerÕs recommendation, with the solution mixed well by gentle shaking. 2012 Blackwell Publishing Ltd 564 Y Y Sung et al. Hsp70 and ammonia toxicity Experimental animals and median lethal ammonia (1-h LC50) determination Carp juveniles measuring approximately 5 cm (0.54 g) were acclimatized with constant aeration at 28 C in the hatchery of University Malaysia Terengganu (UMT) 7 days prior to experiment. During acclimatization, fish were fed ad libitum on granular pellets consisting 60% crude protein. Faeces were removed, and 50% of the rearing water replaced daily to maintain optimal water quality. Short-term static toxicity tests without water replacement were performed to estimate the acute toxicity levels of ammonia under the experimental conditions. Groups of 20 fish were transferred to a 2-L test aquaria 12 h prior to exposure. The water pH and temperature were controlled to 7.0 and 28C, respectively. Fish were then subjected to 1-h incubation in 2.37, 4.74, 9.48, 11.84, 14.21, 16.58 and 18.95 mg L)1 NH3, with ammonium chloride stock solution added to each experimental aquarium and adjusted to compensate for water salinity, temperature and pH variation to reach the desired ammonia concentrations (Alcaraz et al. 1999; Schuler et al. 2010). Unexposed animals served as the controls. Aeration ceased during exposure to prevent ammonia evaporation. Mortality was determined after 1 h by counting dead animals, and the percentages calculated as Nt · 100/No, where Nt and No are final and initial numbers of fish, respectively (Sung et al. 2008). Morbid fish were considered dead. The concentration that causes 50% mortalities within 1 h, obtained from the mortality curve, is considered as the 1-h LD50. Lethal concentration refers to the concentration that causes total mortalities (LCT). Each bioassay was performed in triplicate. Ammonia challenge test To test whether TEX-OE confers enhanced ammonia tolerance, two groups of fish (one preexposed for 2 h with TEX-OE by immersion and another without TEX-OE immersion, each consisting of 20 fish) were challenged at LC50 (5.92 mg L)1) and LCT (14.21 mg L)1) NH3 for 1 h. Survivals were determined as above. Protein extraction, SDS–PAGE and Western immunoblotting Fish that survived after challenge at median lethal ammonia (LD50) concentration were killed by pithing prior to removing muscle and gill tissues by Journal of Fish Diseases 2012, 35, 563–568 dissection. Protein extraction was performed as described by Sung et al. (2007, 2008). About 20 mg of wet tissue was rinsed several times with sterile water prior to being homogenized in 100 lL of cold buffer K (150 mm sorbitol, 70 mm potassium gluconate, 5 mm MgCl2, 5 mm NaH2PO4, 40 mm HEPES, pH 7.4) (Clegg et al. 2000) supplemented with a protease inhibitor cocktail (Sigma-Aldrich Inc.-P8340) as recommended by the manufacturer. Aliquots of homogenate were combined with equal volumes of 2 times sodium dodecyl sulphate (SDS) sample buffer, vortexed, heated at 95 C for 5 min (Laemmli 1970), cooled and centrifuged at 4000 rpm for 10 min. Ten microlitres of protein samples was loaded to the lane of 10% poly-acrylamide gels and electrophoresed at 130 volts for 15 min and followed by 150 volts for 45 min. HeLa cell lysate (HC) (heat shocked, Bioreagent-LYC-HCL100) served as a positive control. Two gels were run simultaneously: one stained with Coomassie Biosafe (Bio-Rad Laboratories) and another transferred to a polyvinylidene fluoride transfer membrane (Bio-Rad Immun-Blot PVDF) for antibody probing. Membranes were incubated in blocking buffer (50 mL of phosphatebuffered saline containing 0.2% (v/v) Tween-20 and 5% (w/v) bovine serum albumin) for 60 min at 25 C. Hsp70 monoclonal antibody (1:5000 dilution, Thermo Scientific MA3-006) was used to detect both constitutive and inducible isoforms of the Hsp70. Goat anti-mouse IgG F(abÕ)2 polyclonal antibody, HRP (1:2000 dilution, Bioreagents-SAB100J), was used as secondary antibody. For detection, 0.7 mm diaminobenzidine tetrahydrochloride dihydrate (DAB) was used as a substrate in association with 0.01% (v/v) H2O2 in 0.1 m Tris-HCL (pH 7.6) (Sung et al. 2007, 2008). Y Y Sung et al. Hsp70 and ammonia toxicity as the 1-h LD50. Total mortalities first occurred at 14.21 g L)1 NH3, and this concentration was considered as the lethal ammonia concentration (LCT) (Fig. 1). Tex-OE enhances carp survival during acute ammonia stress Exposure to TEX-OE within the water column for 2 h before challenge significantly enhanced the tolerance of the carp to acute ammonia challenge. Survivals were boosted twofold from approximately 50% to 95% after exposure to the median LCT (LD50) (Fig. 2). When fish exposed to TEX-OE in the water column for 2 h were then exposed to acute ammonia challenge at the 100% lethal challenge level, the number of viable animals was also enhanced, with survival of 20% of fish challenged, whereas total mortality occurred in the controls (Fig. 3). Figure 1 Cumulative mortalities of Cyprinus carpio fingerlings after challenge for 1 h in different ammonia (NH3) concentrations. Data presented are mean standard deviations. Experiments were repeated once. Statistics Survival percentage (%) were ArcSin to satisfy normality and homocedasticity requirements whenever necessary. Significant differences were determined by performing one-way ANOVA with software SPSS version 11.5 for Windows. Results One-hour median and lethal ammonia concentration NH3 at 5.92 g L)1 killed 50% of the animals within 1 h; thus, this concentration was considered 2012 Blackwell Publishing Ltd 565 Figure 2 Survival of control carp and fish treated with TEXOE followed by exposure to 1-h LD50 (5.92 mg L)1 NH3). Data presented are mean standard deviations. *Statistical differences as against control treatment at P < 0.05. Experiments were repeated once, indicated as Exp 1 and Exp 2. Y Y Sung et al. Hsp70 and ammonia toxicity Journal of Fish Diseases 2012, 35, 563–568 Gill Muscle (a) 250 kDa 150 kDa 100 kDa 75 kDa 50 kDa Figure 3 Survival of TEX-OE pre-exposed carp after challenge with lethal ammonia concentration (LCT) (14.21 mg L)1 NH3). Total mortality occurred in the unexposed controls. Data presented are mean standard deviations. Experiments were repeated once, indicated as Exp 1 and Exp 2. 37 kDa M C T C T Muscle (b) Gill 250 kDa Tex-OE enhances muscle and gill Hsp70 The Coomassie-stained gels revealed induction of a 40-kDa protein, a 70-kDa protein and a 90-kDa protein in the muscles of carp pre-exposed to TEXOE. A single protein band of approximately 70 kDa was enhanced in the gill tissues (Fig. 4A). Hsp70 was detected in the HC, which served as the positive control in this study, revealing a single protein band at approximately 70 kDa. Muscle Hsp70 was slightly enhanced in fish pre-exposed to TEX-OE. Augmentation of Hsp70 was evident in the gill tissues (Fig. 4B). Discussion Ammonia is extremely harmful to fish, with the unionized form NH3, more toxic than NH4+. Ammonia accumulation in the rearing water may result from fish metabolic waste, assimilation process from uneaten feed and nitrogen-containing substances from agricultural effluent (Santhi et al. 1992). Total ammonia of more than 0.02 mg L)1 is not desired in aquaculture systems because it reduces fish survival, inhibits growth and causes a variety of physiological malfunctions (Israeli-Weinstein & Kimmel 1998). In this study, exposure to 5.92 mg L)1 NH3 for 1 h resulted in 50% mortalities, whereas 14.21 mg L)1 killed all experimental fish; thus, these concentrations were considered as the 1-h LD50 and LCT, respectively, for common carp under the experimental conditions extant. Reduced swimming activities, increased respiration as well as gill and tissue erosion occur, suggesting that mortality is caused by gill damage, a 2012 Blackwell Publishing Ltd 566 150 kDa 100 kDa 75 kDa 50 kDa M HC C T C T Figure 4 A The protein profiles of carp pre-exposed to TEXOE (T) and unexposed controls (C) during 1-h LD50 stress (5.92 mg L)1). Muscle and gill tissues were collected, and the extracted protein electrophoresed in 10% Coomassie-stained SDS polyacrylamide gel. Box, elevation of p40, p70 and p90 in muscles of fish exposed to TEX-OE. Arrow, induction of p70 in gills. M, molecular mass standards are on the left in kilodaltons (kDa). B Immunodetection of muscle and gill Hsp70. HC, HeLa cell lysates as a positive control. typical sign of ammonia toxicity in many fish species (Benli, Köksal & Özkul 2008). Ammonia, particularly NH3, diffuses easily across the gill membranes, causing severe gill damage that disrupts respiratory functions (Russo 1985; Bhakta 2006). Exposing carp to TEX-OE, however, enhanced tolerance towards the detrimental effect of ammonia, evidenced by a twofold increase in survival after the median lethal concentration challenge. Remarkably, 20% of those that were pre-exposed to TEX-OE also survived lethal ammonia challenge, a situation whereby total mortality of the experimental fish should occur. This protection may be explained by the high induction of gill and/or muscle Hsp70, outcomes similar to other aquatic organisms encountering ammonia stress (Roberts et al. 2010) or perturbation of a different nature (Brown et al. 1992; Sung Y Y Sung et al. Hsp70 and ammonia toxicity Journal of Fish Diseases 2012, 35, 563–568 et al. 2007, 2008). As one example, heat shock followed by 4- to 48-h recovery enhances the ability of tide pool sculpin to withstand osmotic and hypoxic stress, with survival increasing from 68% to 96% and 47% to 76%, respectively. The strongest association between increased Hsp70 and crosstolerance is observed in tide pool sculpin gills (Todgham, Schulte & Iwama 2005). The development of stress tolerance in fish following the exposure to TEX-OE is correlated with Hsps expression. This result is in agreement with the findings of Camilleri (2002) and Roberts et al. (2010), who reported that pretreatment with TEX-OE via immersion induced angelfish, Pterophyllum scalare (Schultze), gill Hsp70 expression and promoted a twofold survival increase when exposed to 1.1 mg L)1 free ammonia, which was the 24-h LC50 for this species. When TEX-OE was used to prestimulate fish before exposure to stressors, circulating Hsp levels were detectable after the first sign of stress. Hsps were rapidly induced, and the levels were higher than those normally occurring in unexposed fish subsequent to a heat stress (Balucci 2005; Roberts et al. 2010). The mechanism by which Hsps protect against stress has yet to be determined, but the increment of intracellular level of Hsp70 may mediate tolerance by preventing protein denaturation, refolding damaged proteins or ensuring degradation of irreversibly damaged proteins, thus preventing accumulation of abnormal proteins and their aggregates (Hartl & Hayer-Hartl 2009; Mchaourab et al. 2009). These processes are crucial in maintaining a normal cellular homoeostasis during stress. On a practical note, application of TEX-OE might also induce Hsps other than Hsp70. As revealed by SDS-PAGE, the expression of a 40- and 90-kDa protein was apparent in carp pre-exposed to TEX-OE during ammonia perturbation. Further studies are required to substantiate whether these proteins represent Hsp40 and 90. It is noteworthy that a multi-component chaperone complex is required to establish stress tolerance, a case seen in the thermotolerance acquisition of insects and aquatic organisms (Duncan 2005). Whatever the outcomes might be, the current investigation shows that Pro-Tex, the form of TEX-OE used in the study, induces Hsp70 and enhances carp tolerance against the deleterious effects of ammonia. Its usage is demonstrably a safe and effective means of induction of rapid Hsp synthesis during stress, with high levels of survival in circumstances where severe 2012 Blackwell Publishing Ltd 567 losses might be expected. The study suggests that Hsps play a crucial role in ammonia stress tolerance in carp. Acknowledgements This work was supported by the E-Science Fund Project No. 05-01-12-SF1006 from the Ministry of Agriculture (MOA), Malaysia to YYS. We thank Dr Hii Yii Siang, Mr Chou Ching Chung and Mr Chan Huan Hui for their assistance in the preparation of the manuscript. References Alcaraz G., Chiappa-Carrara X., And V.E. & Vanegas C. (1999) Acute toxicity of ammonia and nitrite to white shrimp Penaeus setiferus. Journal of the World Aquaculture Society 30, 90–97. Arkush K.D., Cherr G.N. & Clegg J.S. (2008) Induced thermotolerance and tissue Hsc70 in juvenile Coho salmon, Oncorhynchus kisutch. Acta Zoologica 89, 331–338. Balucci C.A. (2005) Studies on the properties of an extract of Opuntia ficus indica. Ph.D thesis, University of Malta, 376 pp. Benli A.Ç.K., Köksal G. & Özkul A. (2008) Sublethal ammonia exposure of Nile tilapia (Oreochromis niloticus L.): effects on gill, liver and kidney histology. Chemosphere 72, 1355–1358. Bhakta J.N. (2006) Ammonia toxicity to four freshwater fish species: Catla catla, Labeo bata, Cyprinus carpio and Oreochromis mossambica. Electronic Journal of Biology 2, 39–41. Brown M.A., Upender R.P., Hightower L.E. & Renfro J.L. (1992) Thermoprotection of a functional epithelium: heat stress effects on transepithelial transport by flounder renal tubule in primary monolayer culture. Proceedings of the National Academy of Sciences USA 89, 3246–8250. Brown H.M., Briden A., Stokell T., Griffin F.J. & Cherr G.N. (2004) Thermotolerance and Hsp70 profiles in adult and embryonic California native oysters, Ostreola conchaphila (Carpenter, 1857). Journal of Shellfish Research 23, 135–141. Camilleri T. (2002) The prophylactic effect of TEX-OE in angelfish (Pterophyllum scalare) against stress caused by ammonia, nitrite and chlorine. B.Sc Hons thesis, University of Malta, 124 pp. Clegg J.S., Uhlinger K.R., Jackson S.A., Cherr G.N., Rifkin E. & Friedman C.S. (1998) Induced thermotolerance and the heat shock protein-70 family in the Pacific oyster Crassostrea gigas. Molecular Marine Biology and Biotechnology 7, 21–30. Clegg J.S., Jackson S.A., Hoa N.V. & Sorgeloos P. (2000) Thermal resistance, developmental rate and heat shock proteins in Artemia franciscana, from San Francisco Bay and Southern Vietnam. Journal of Experimental Marine Biology and Ecology 252, 85–96. de la Vega E., Hall M.R., Degnan B.M. & Wilson K.J. (2006) Short-term hyperthermic treatment of Penaeus monodon increases expression of heat shock protein 70 (HSP70) and Journal of Fish Diseases 2012, 35, 563–568 reduces replication of gill associated virus (GAV). Aquaculture 253, 1–4. Duncan R.F. (2005) Inhibition of Hsp90 function delays and impairs recovery from heat shock. FEBS Journal 272, 5244– 5256. Sandilands J., Drynan K.D. & Roberts R.J. (2009) Preliminary studies on the enhancement of storage time of chilled milt of Atlantic salmon, Salmo salar L., using an extender containing the TEX-OE heat shock-stimulating factor. Aquaculture Research 40, 402–409. Feder M.E. & Hoffman G.E. (1999) Heat shock proteins, molecular chaperones, and the stress response: evolutionary and ecological physiology. Annual Review of Physiology 61, 243–282. Santhi K., Gunasekhar K., Babu C.S., Reddy K.P.O. & Neeraja P. (1992) Changes in the dehydrogenase levels of fish Oreochromis mossambicus under chronic ammonia stress. Journal of Inland Fisheries Society of India 24, 71–73. Hartl F.U. & Hayer-Hartl M. (2009) Converging concepts of protein folding in vitro and in vivo. Nature Structural and Molecular Biology 16, 574–581. Schuler D.J., Boardman G.D., Kuhn D.D. & Flick G.J. (2010) Acute toxicity of ammonia and nitrite to Pacific white shrimp, Litopenaeus vannamei, at low salinities. Journal of the World Aquaculture Society 41, 438–441. Israeli-Weinstein D. & Kimmel E. (1998) Behavioral response of carp (Cyprinus carpio) to ammonia stress. Aquaculture 165, 81–93. Laemmli U.K. (1970) Cleavage of structural proteins during assembly of the head of bacteriophage T4. Nature, 227, 680– 685. Mchaourab H.S., Godar J.A. & Stewart P.L. (2009) Structure and mechanism of protein stability sensors: chaperone activity of small heat shock proteins. Biochemistry 48, 3828–3837. Pockley A.G. (2003) Heat shock proteins as regulators of the immune response. Lancet 362, 469–476. Pockley A.G., Muthana M. & Calderwood S.K. (2008) The dual immunoregulatory roles of stress proteins. Trends in Biochemical Sciences 33, 71–79. Robert J. (2003) Evolution of heat shock protein and immunity. Developmental and Comparative Immunology 27, 449–464. Roberts R.J., Agius C., Saliba C., Bossier P. & Sung Y.Y. (2010) Heat shock proteins (chaperones) in fish and shellfish and their potential role in relation to fish health: a review. Journal of Fish Diseases 33, 789–801. Russo R.C. 1985. Ammonia, nitrite, and nitrate. In: Fundamentals of Aquatic Toxicology (ed. by G.M. Rand & S.R. Petrocelli), pp. 455–474. Hemisphere Publishing, Washington DC. Ryckaert J., Pasmans F., Tobback E., Duchateau L., Decostere A., Haesebrouck F., Sorgeloos P. & Bossier P. (2010) Heat shock proteins protect platyfish (Xiphophorus maculatus) from Yersinia ruckeri induced mortality. Fish and Shellfish Immunology 28, 228–231. 2012 Blackwell Publishing Ltd Y Y Sung et al. Hsp70 and ammonia toxicity 568 Sung Y.Y., Van Damme E.J.M., Sorgeloos P. & Bossier P. (2007) Non-lethal heat shock protects gnotobiotic Artemia franciscana larvae against virulent vibrios. Fish and Shellfish Immunology 22, 318–326. Sung Y.Y., Pineda C., MacRae T.H., Sorgeloos P. & Bossier P. (2008) Exposure of gnotobiotic Artemia franciscana larvae to abiotic stress promotes heat shock protein 70 synthesis and enhances resistance to pathogenic Vibrio campbellii. Cell Stress and Chaperones 13, 59–66. Sung Y.Y., Ashame M.F., Chen S.J., MacRae T.H., Sorgeloos P. & Bossier P. (2009a) Feeding Artemia franciscana (Kellogg) larvae with bacterial heat shock protein, protects from Vibrio campbellii (Baumann) infection. Journal of Fish Diseases 32, 675–685. Sung Y.Y., Dhaene T., Defoirdt T., Boon N., MacRae T.H., Sorgeloos P. & Bossier P. (2009b) Ingestion of bacteria overproducing DnaK attenuates Vibrio infection of gnotobiotic Artemia franciscana larvae. Cell Stress and Chaperones 14, 603–609. Todgham A.E., Schulte P.M. & Iwama G.K. (2005) Cross-tolerance in the tidepool sculpin: the role of heat shock proteins. Physiological and Biochemical Zoology 78, 133–144. Wiese J., McPherson S., Odden M.C. & Shlipak M.G. (2004) Effect of Opuntia ficus indica on symptoms of the alcohol hangover. Archive of Internal Medicine 164, 1334–1340. Received: 4 January 2011 Revision received: 11 March 2011 Accepted: 7 July 2011
© Copyright 2026 Paperzz