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Departments of Molecular Biology and Molecular and Experimental Medicine, The Scripps Research Institute, San Diego, California 92037,1 Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 16/10 ul. Miklukho-Maklaya, 117997 Moscow, Russia,2 Institute for Biological Sciences, National Research Council, Ottawa, Ontario K1A OR6, Canada,3 Division of Cell Biology and Immunology, The Wellcome Trust Biocentre, School of Life Sciences, University of Dundee, Dow Street, Dundee DD1 5EH, United Kingdom4
Received 2 March 2007/ Returned for modification 15 April 2007/ Accepted 1 June 2007
| ABSTRACT |
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| INTRODUCTION |
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Many of the siglec proteins contain one or more immunoreceptor tyrosine-based inhibitory motifs (ITIMs), (I/L/V)XYXX(L/V), suggesting that they play important roles as inhibitory receptors of cell signaling (25, 78), as exemplified by CD22, which is well documented as a regulator of B-cell receptor (BCR) signaling. Upon antigen binding to the BCR, the ITIMs of CD22 are quickly tyrosine phosphorylated and recruit protein tyrosine phosphatase SHP-1, which dephosphorylates the BCR and dampens the B-cell response, setting a threshold for B-cell activation (27, 73).
CD22 is also known to undergo endocytosis following ligation by anti-CD22 antibody (38, 64) or high-affinity multivalent-sialoside ligands (22). The tyrosine-based ITIMs of CD22 also fit the sorting signal YXXØ (where Ø is a hydrophobic residue) for association with the adaptor complex 2 (AP2), which directs recruitment of receptors into clathrin-coated pits (13). John et al. reported that CD22 associates with the AP50 subunit of AP2 through these tyrosine-based motifs and that they are required for endocytosis (37). Consistent with this observation, CD22 is predominantly localized in clathrin-rich domains (23, 34). Antigen ligation of the BCR results in mobilization of the BCR to "activation rafts," which subsequently fuse with clathrin domains prior to endocytosis (69, 70). Since CD22 is specifically excluded from activation rafts (54), the negative regulatory effect of CD22 on BCR signaling has been proposed to occur following its movement to clathrin domains (23), linking the endocytic activity of CD22 to its role in regulation of BCR signaling.
Sn and most CD33-related siglec proteins are expressed on cells of the innate immune system, including monocytes, macrophages, neutrophils, eosinophils, and dendritic cells (25, 43, 50, 85), focusing investigations into their precise functions on the known activities of these cells. Like CD22, ligation of CD33-related siglec proteins (CD33 and Siglec-5, -7, and -9) also induces recruitment of SHP-1 via phosphorylated ITIMs (6, 7, 53, 72). Antibody ligation of the same siglec proteins initiates their endocytosis, suggesting that endocytic activity is also a general property of this subfamily (9, 38, 50, 81, 84). Over 20 pathogenic microorganisms express sialic acid-containing glycans on their surface (25). Recent demonstration of the binding or uptake of several sialylated pathogens, including Neisseria meningitidis, Trypanosoma cruzi, Campylobacter jejuni, and group B Streptococcus, by Sn and Siglec-5, -7, and -9 has suggested various roles of these siglec proteins in the immune responses to these organisms (8, 18, 25, 30, 38, 45). Since mechanisms of pathogen entry and engulfment are increasingly recognized to involve the host cells' endocytic machinery (12), the endocytic functions of the siglec proteins are also relevant to their roles in pathogen recognition and uptake.
In this report, we contrast the mechanisms of endocytosis of CD22 and a CD33-related siglec, murine Siglec-F, predominately expressed on eosinophils (85). Eosinophils are best known for their role in allergic diseases (62). In this regard, a recent report analyzing Siglec-F null mice revealed enhanced eosinophil infiltration and blood eosinophilia in response to allergen challenge, suggesting that Siglec-F is a negative regulator of eosinophil response to allergens (86). Eosinophils also contribute to an immune response against foreign pathogens, including binding, engulfment, and killing of microbes (1, 15, 19, 32, 36, 83). While investigating the endocytic activity of Siglec-F, we observed efficient endocytosis of anti-Siglec antibody, high-affinity sialoside ligand probes, and Neisseria meningitidis bearing sialylated glycans. Like CD22, endocytosis was dependent on its cytoplasmic ITIM and ITIM-like motifs. Surprisingly, however, Siglec-F exhibited no colocalization with clathrin, raising doubt that it was endocytosed by a clathrin-mediated mechanism, as proposed for CD22. More detailed investigations showed that while endocytosis of CD22 is indeed mediated by a clathrin-dependent mechanism and is sorted to early endosome and recycling compartments, Siglec-F endocytosis is directed to lysosomal compartments and is mediated by a mechanism that is independent of clathrin and dynamin. The results suggest that siglec proteins have evolved different mechanisms of endocytosis consistent with roles in regulation of cell signaling and innate immunity.
| MATERIALS AND METHODS |
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Synthesis of high-molecular-mass sialoside-PAA probe.
Biotinylated low-molecular-mass (30 kDa) sialoside-polyacrylamide (PAA) conjugates bearing Neu5Ac
2-3[6-SO4]Galß1-4[Fuc
1-3]GlcNAc (6'-sulfo-sLeX) or 9-biphenylcarbonyl (BPC)-Neu5Ac
2-6Galß1-4GlcNAc were synthesized by coupling spacered oligosaccharides and spacered biotin to poly (4-nitrophenyl acrylate) as described previously (16) Biotinylated high-molecular-mass (1,000 kDa) PAA conjugates were synthesized by coupling spacered oligosaccharides and spacered biotin to poly (N-oxysuccinimide acrylate) as described previously (67); the 1,000-kDa lactose conjugate was obtained from The Consortium for Functional Glycomics.
Mice. The IL5 transgenic (IL5-Tg) mouse line NJ.1638 was the generous gift of James J. Lee (Mayo Clinic, Scottsdale, AZ) (41). C57BL/6 mice were obtained from the Scripps Research Institute. Protocols were conducted in accordance with the National Institutes of Health and the Scripps Research Institute.
Plasmids. The full-length cDNA fragment of Siglec-F and human CD22 was amplified by PCR and cloned into pcDNA5/FRT/V5-His vector (Invitrogen) (71). Site-directed mutagenesis was performed using a Genetailor site-directed mutagenesis system (Invitrogen). The primers used for construction of Siglec-F mutants were as follows: for T535F, 5'-GGATGAGCCTGAACTCCACTTTGCCTCCCTC-3' (sense) and 5'-GGATGAGCCTGAACTCCACTTTGCCTCCCTC-3' (antisense); for T568F, 5'-GGAGGCTATGAAATCTGTATTCACAGACATC-3' (sense) and 5'-TACAGATTTCATAGCCTCCGTGTTCTGAG-3' (antisense); and for the cytoplasmic tail deletion, dC, 5'-TTTTCACAGTGAAGGTCCTCTGATAGAAATCAGCCC-3' (sense) and 5'-GAGGACCTTCACTGTGAAAAAGATGAGGCA-3' (antisense). Dynamin-1 cDNA constructs (wild type [WT] and K44A) were obtained from Sandra L. Schmid (The Scripps Research Institute, San Diego, CA). ADP ribosylation factor 6 (ARF6)-enhanced green fluorescent protein (EGFP) cDNA constructs (WT, T27N, and Q67L) were obtained from Julie G. Donaldson (National Institutes of Health, Bethesda, MD). Cells were grown to 70 to 80% confluence on coverslips and transiently transfected with plasmid using Lipofectamine 2000 (Invitrogen).
Cell culture. CHO cells were cultured in Ham's F-12 medium, respectively, supplemented with 10% fetal calf serum, penicillin (100 U/ml), and streptomycin (100 µg/ml). Stable clones of CHO cells expressing Siglec-F, Siglec-F mutants, and human CD22 were generated by Lipofectamine 2000 (Invitrogen) and selection in 0.5 mg/ml hygromycin B (Roche Molecular Biochemicals).
Agent treatments. Cells were preincubated for 30 min at 37°C in Ham's F-12-10% fetal calf serum medium containing 10 mM methyl-ß-cyclodextrin (CD) (Sigma-Aldrich), 5 µM latrunculin A (Sigma-Aldrich), 1 µM jasplakinolide (EMD Biosciences, CA), 100 µM genistein (Sigma-Aldrich), 100 µM PP2 (EMD Biosciences), 100 µM sodium pervanadate, 1 µM nocodazole (Sigma-Aldrich), 10 µM amiloride (Sigma-Aldrich), 50 µM nystatin (Sigma-Aldrich), or 10 µM brefeldin A (Sigma-Aldrich). Cells were then incubated with PE-anti-Siglec-F in the continued presence of the agents at 37°C for 1 h. Agent treatment did not affect cell viability.
Flow cytometry. Cells (5 x 105) suspended in PBS/BSA (10 mM phosphate-buffered saline [pH 7.0] containing 10 mg/ml bovine serum albumin) were incubated with 10 µg/ml of primary antibody or sialoside-PAA probe for 30 min on ice. After washing with PBS/BSA, cells were incubated with 10 µg/ml of FITC-secondary antibody or streptavidin-Cy5-PE for 30 min on ice. For sialidase pretreatment, cells in PBS/BSA were incubated with 25 mU of A. ureafaciens sialidase (Roche Molecular Biochemicals) for 30 min at 37°C. Flow cytometry data were acquired on a FACS Calibur flow cytometer (BD Biosciences, San Jose, CA) and analyzed using the CellQuest software.
Immunofluorescence microscopy. For the internalization assay, CHO cells cultured on coverslips for 2 days were labeled with fluorescence-conjugated antibody (10 µg/ml) in PBS/BSA for 30 min on ice. Cells were then incubated at 37°C for various times, and internalization was stopped by transferring the cells to ice. After washing, cells were fixed with 4% paraformaldehyde (PFA; Electron Microscopy Services) for 15 min at room temperature. For colocalization experiments, cells were further permeabilized with 0.1% saponin in PBS for 20 min at room temperature and then incubated with the desired antibody for 1 h at room temperature or 4°C overnight.
For eosinophil staining, eosinophils from IL5-Tg mice at 107/ml in PBS/BSA were fixed with 2% PFA for 10 min at 4°C before staining with the desired antibodies for 30 min at 4°C. After cell surface staining, cells were cytospun onto glass slides and fixed with 4% PFA for 20 min at room temperature. Cells were further permeabilized with 0.1% saponin in PBS for 20 min at room temperature and then incubated with anticlathrin antibody (clone x22). Cells were mounted with Prolong gold antifade reagent (Invitrogen) and examined using a Zeiss Axiovert S100TV microscope equipped with a Bio-Rad MRC 1024 confocal laser scanner. Images were collected with Bio-Rad LaserSharp 2000 software and analyzed with Image J (v. 1.33), Zeiss LSM image, and Adobe Photoshop.
Bacteria. Cells of Neisseria meningitidis MC58 (NRCC 6200 Cap+ and NRCC 4728 Cap–) were grown on chocolate agar in the presence of 20 µg/ml CMP-NeuAc to increase the level of sialylation of the lipooligosaccharide (LOS). The cells were killed by heat treatment at 68°C for 1 h. The killed cells were labeled with FITC by resuspending them first in PBS and then mixing them with 1 mg/ml FITC in sodium bicarbonate buffer at pH 9. Cells were reacted with the dye for 15 min and then washed extensively. Cells were observed by phase-contrast microscopy to ensure they were intact and to estimate the cell number.
| RESULTS |
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60% internalization relative to time zero after 30 min.
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The endocytosis of Siglec-F was also assessed by monitoring the internalization of fluorescently labeled anti-Siglec-F MAb. Eosinophils or SigF-CHO cells were stained with PE-anti-Siglec-F MAb at 4°C and warmed to 37°C for up to 60 min. Cell-associated antibody was monitored by flow cytometry before (total) or after removing residual cell surface antibody by a brief low-pH wash. After incubation at 37°C for 60 min, the level of intracellular PE-anti-Siglec-F MAb increased gradually over time (Fig. 1b and c). The combined results demonstrate that antibody ligation initiates efficient endocytosis of Siglec-F on both mouse eosinophils and SigF-CHO cells.
Mutation of tyrosines 538 and 561 abrogates endocytosis of Siglec-F.
Siglec-F carries two potential cytoplasmic tyrosine-based sorting motifs (YxxL/I) at amino acids Tyr 538 and 561. To assess whether the intact motifs are required for internalization, we designed mutant constructs substituting phenylalanine for tyrosine 538 and 561, either individually or in combination, and a cytoplasmic deletion mutant (Fig. 2a). The internalization of the mutant Siglec-F constructs was compared to that of WT Siglec-F by flow cytometry. Although PE-anti-Siglec-F MAb was efficiently internalized in CHO cells expressing WT Siglec-F, the level of internalized antibody was significantly decreased in CHO cells expressing the double-tyrosine mutant Y538/561F (Fig. 2b). Mutation of both tyrosines to phenylalanine reduced internalization by nearly 80% (Fig. 2c). The inhibitory effect of the cytoplasmic deletion mutant is similar to that of the double-tyrosine mutant Y538/561F (85% inhibition), suggesting that the tyrosine-based motifs are dominant sorting signals. Since mutation of either Tyr538 or Tyr561 also inhibited (66 to
69%) endocytosis of Siglec-F, we conclude that both tyrosine-based motifs are required for optimal endocytosis of Siglec-F. In contrast to the mutations in the cytoplasmic domain, an Arg-to-Ala mutation of the conserved arginine residue required for sialoside binding (3) showed no effect on internalization of Siglec-F, suggesting that ligand-binding activity is not directly involved in the endocytosis of Siglec-F (data not shown), as reported previously for endocytosis of CD22 (87).
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The effect of tyrosine-based motifs on endocytosis of Siglec-F was confirmed by confocal fluorescence microscopy. While anti-Siglec-F showed predominantly intracellular punctate staining in CHO cells expressing WT Siglec-F, cells expressing the double-tyrosine mutant (Y538/561F) showed only diffuse surface staining that was removed with a brief low-pH wash (not shown).
A high-affinity sialoside probe competes with cis ligands and binds to Siglec-F on native cells.
Recently, Collins et al. showed that high-affinity sialoside ligands could compete with cis ligands, bind to CD22 on native B cells, and serve as a ligand-based marker of CD22 endocytosis (22). The ligand was comprised of a high-affinity synthetic ligand of CD22, 9-biphenylcarboxyl-NeuAc
2-6Galß1-4GlcNAc (BPC-NeuAc-LN), attached to a 1,000-kDa PAA (74) backbone. To determine if CD22 and Siglec-F carry sialoside ligands to the same compartments as their respective anti-siglec antibodies, we sought to prepare an analogous sialoside ligand for Siglec-F. We previously reported that the preferred glycan ligand for Siglec-F is 6'-sulfo-sLeX (Neu5Ac
2-3[6-SO4]Galß1-4[Fuc
1-3]GlcNAc) (71). However, Siglec-F appears to be masked to synthetic 30-kDa PAA probes containing this sequence unless the cells are treated with sialidase to destroy cis ligands, a general property of the siglec family (25, 47, 58, 59, 78). To create high-avidity probes for Siglec-F, 6'-sulfo-sLeX was attached to the 1,000-kDa-molecular-mass PAA along with 5% biotin to allow detection with streptavidin (74). A standard enzyme-linked immunosorbent assay using immobilized Siglec-F-Fc chimera showed that the resulting 1,000-kDa 6'-sulfo-sLeX-PAA probe bound with much higher binding avidity than did the standard 30-kDa 6'-sulfo-sLeX-PAA probe (data not shown), indicating that the increased multivalency did increase binding avidity for Siglec-F. The 6'-sulfo-sLeX-PAA probes (30 kDa and 1,000 kDa) were then compared for their abilities to compete with cis ligands and bind to native eosinophils and SigF-CHO cells, as illustrated in Fig. 5a. As found earlier, the 30-kDa probe failed to bind to native cells but bound only to the sialidase-treated (asialo) cells (71). In contrast, the 1,000-kDa probe bound to native cells as well, demonstrating that the 1,000-kDa 6'-sulfo-sLeX-PAA probe can effectively compete with cis ligands on both mouse eosinophils and SigF-CHO cells. Blocking with anti-Siglec-F MAb inhibited binding of the sialoside probe to the cells (Fig. 5b), indicating that the binding is not due to a nonspecific interaction (71). No binding of a control 1,000-kDa lactose-PAA probe was observed.
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Endocytosis of Siglec-F is dynamin-1 independent. To further investigate the mechanism of endocytosis, we evaluated the dependence on dynamin-1. Dynamin-1 is a large GTPase that regulates vesiculation events at the plasma membrane for several clathrin-dependent and clathrin-independent endocytic pathways (24). Expression of a dominant-negative dynamin-1 mutant (Dyn1-K44A) inhibits both clathrin- and caveolin-mediated endocytic pathways (28, 35, 40, 51). Internalization of Tf and anti-CD22 was virtually inhibited by Dyn1-K44A, but not by WT dynamin-1 (Dyn1-WT), whereas that of anti-Siglec-F was not inhibited by the expression of either Dyn1-K44A or Dyn1-WT (Fig. 7). These results indicate that endocytosis of CD22 is dynamin dependent, characteristic of a clathrin-mediated pathway, whereas endocytosis of Siglec-F is dynamin independent.
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2-3Galß1-4GlcNAc sequence, whereas MC58cap+ expresses, in addition to the LOS, a polysialic acid capsule [(NeuAc
2-8NeuAc)n] (80). The former sequence is recognized as a weak ligand by Siglec-F, while the latter is not recognized (3, 71). SigF-CHO cells pretreated with or without sialidase were incubated with fixed FITC-labeled bacteria on ice for 30 min and allowed to internalize at 37°C for 60 min. Noninternalized bacteria were removed with PBS/BSA wash and were confirmed to be internalized by resistance to ethidium bromide quenching of fluorescence (not shown). While neither the MC58cap– or MC58cap+ bacteria were internalized in untreated SigF-CHO cells (Fig. 10), MC58cap– was selectively internalized by cells treated with sialidase treatment to destroy cis interactions of Siglec-F with the NeuAc
2-3Gal linkages known to be expressed by CHO cells. No internalization of N. meningitidis was observed in control CHO cells. These results indicate that endocytic machinery of Siglec-F is capable of internalizing bacteria containing a terminal sialoside sequence on a cell surface glycolipid that is recognized as a ligand.
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| DISCUSSION |
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Anti-CD22 antibody and sialoside ligands endocytosed by CD22 colocalize to early endosomes and recycling compartments with the Tf receptor, well documented to be an internalized clathrin-dependent mechanism (46). Moreover, endocytosis is dependent on the dynamin-1 GTPase required for clathrin-mediated vesicle formation (24). Clathrin-dependent endocytosis of CD22 is consistent with its activity as a regulator of BCR signaling since the endocytosis of the BCR is also predominantly clathrin dependent and required for dampening of BCR signaling (70). It is of interest that the CD22 ITIMs involved in recruitment of SHP-1 are the same tyrosine motifs that mediate binding of the clathrin adaptor protein AP2 (37). However, while tyrosine phosphorylation is required for SHP-1 binding, phosphorylation blocks binding of AP2, suggesting an inverse regulation of these two activities (37).
Rapid mobilization of CD22 to the cell surface following BCR ligation is consistent with redistribution of an intracellular pool of CD22 localized in the para-Golgi recycling compartment shared by other recycling receptors (82). Conversely, CD22 antibody induces rapid endocytosis of CD22 to the same compartment, reaching a plateau of 60 to 70% internalized. This redistribution is achieved without increased degradation (64, 87) and has been suggested to be consistent with redistribution of CD22 to an intracellular recycling pool (73). Elegant studies by Shan and Press (64) earlier suggested that the constitutive endocytosis of CD22 was terminal, leading to degradation with a half-life of
8 h without recycling to the cell surface. However, given the slower kinetics of CD22 endocytosis relative to the Tf receptor (Fig. 4a), recycling of CD22 from the intracellular pool might also be slower, and it is possible that recycling was not observed over the time course sufficient to demonstrate recycling of the Tf receptor.
In contrast to CD22, Siglec-F endocytosis traffics to lysosomal compartments by a mechanism that is clathrin, caveolin, and dynamin-1 independent. The endocytic pathway utilized by Siglec-F appears to be similar to that utilized by major histocompatibility complex class 1 (MHC-1), and several other leukocyte receptors including interleukin-2 receptor
subunit (Tac), E-cadherin, integrins, and CD59 (2, 4, 17, 48, 49, 56). In this pathway, receptors are first sorted to ARF6-positive endosomes, which then fuse with early endosomes derived from clathrin-cargo, before being sorted to late endosomes and lysosomes. As shown for Siglec-F (Fig. 6), expression of the ARF6-Q67L mutant, which blocks fusion of ARF6-positive endosomes with early endosomes, results in the accumulation of receptors in vacuole-like structures (49). The requirement for tyrosine-dependent endocytosis of Siglec-F has also been demonstrated for MHC-1 (42, 63), although the exact role of this sequence in the endocytic mechanism remains to be defined.
As recently shown by Zhang et al. (86), Siglec-F negatively regulates eosinophil responses to allergens. The endocytic pathway utilized by Siglec-F is also suggestive of receptors whose function is to deliver cargo to lysosomes for degradation and thus may also function as an innate immune receptor related to bacterial clearance or antigen presentation, as proposed for Siglec-H, another CD33-related siglec expressed on plasmacytoid dendritic cell precursors (84). Clinical and experimental investigations have shown that eosinophils can function as antigen-presenting cells that can process microbial, viral, and parasitic antigens and migrate to lymph nodes to present antigens to CD4+ T cells, thereby promoting T-cell proliferation and polarization (29, 44, 65, 66). It was reported recently that Siglec-F is highly expressed on CD11c+ lung macrophages (52). We also found that Siglec-F is expressed on alveolar macrophages, bone marrow-derived dendritic cells, and bone marrow-derived macrophages (data not shown).
Recent reports on other members of the siglec family also suggest that they may function as receptors for clearance of pathogens as part of the innate immune response. For example, Sn and Siglec-5 bind to and internalize the invasive human pathogen Neisseria meningitidis, expressing sialylated lipopolysaccharides containing the NeuAc
2-3Gal linkage in a sialic acid-dependent manner even in the presence of cis ligands (38). As shown in this report, Siglec-F can also mediate uptake of Neisseria meningitidis expressing sialylated lipooligosaccharides containing the NeuAc
2-3Gal linkage recognized as a ligand by Siglec-F (3, 71). Sn was also found to mediate association of macrophages with Trypanosoma cruzi, a parasite expressing cell surface sialic acids (45), and porcine Sn was shown to mediate the entry of porcine reproductive and respiratory viruses into porcine alveolar macrophages (30, 77). Thus, bacteria, parasites, and viruses expressing sialic acids on their cell surfaces are likely to be natural trans ligands of siglec proteins (20, 79). The diversity of interactions of siglec proteins with sialylated pathogens suggests that they may play multiple roles in their interactions with immune cells (8, 18, 30, 38, 45).
The roles emerging for the rapidly evolving siglec family reflect diverse functions resulting from their varied specificity for sialylated ligands by the N-terminal Ig domain and regulatory motifs in their cytoplasmic domains that regulate cell signaling receptors and endocytosis. As documented in this report, two siglec proteins of unrelated function, CD22 and Siglec-F, exhibit clathrin-dependent and clathrin-independent mechanisms of endocytosis, both of which require intact cytoplasmic tyrosine-based motifs.
Since Siglec-F is a typical CD33-related siglec that shares highly conserved cytoplasmic tyrosine-based motifs, we predict that other CD33-related siglec proteins show similar endocytic properties to Siglec-F. While there is no clear human ortholog of Siglec-F, human Siglec-8 is considered a functionally convergent paralog due to its restricted expression on eosinophils and unique specificity for the sialoside ligand 6'-sulfo-sLeX (11, 71). Thus, it will be of particular interest to see if the functional convergence of Siglec-F and Siglec-8 extends to their mechanisms of endocytosis. However, it is premature to generalize the mechanisms of endocytosis for the siglec family. For example, some CD33-related siglec proteins such as Siglec-H and Siglec-14 lack cytoplasmic tyrosine-based motifs, but they associate with the DAP12 coreceptor that contains a cytoplasmic immunoreceptor tyrosine-based activation motif (ITAM) (10, 84). Thus, siglec proteins may undergo endocytosis by yet other mechanisms than those of CD22 and Siglec-F described here. It is likely that a better understanding of the endocytic mechanisms of the siglec proteins will provide insights into their biological roles.
| ACKNOWLEDGMENTS |
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This work was supported by grants GM60938 and AI050143 from the National Institutes of Health, by a Wellcome Trust Senior Fellowship awarded to P.R.C., by Presidium RAS "Molecular and Cell Biology" to N.V.B., and by a JSPS Postdoctoral Fellowship for Research Abroad awarded to H.T.
| FOOTNOTES |
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Published ahead of print on 11 June 2007. ![]()
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