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Molecular and Cellular Biology, February 2008, p. 949-957, Vol. 28, No. 3
0270-7306/08/$08.00+0 doi:10.1128/MCB.00354-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.
Primary Ciliary Dyskinesia in Mice Lacking the Novel Ciliary Protein Pcdp1
,
Lance Lee,1
Dean R. Campagna,1
Jack L. Pinkus,2
Howard Mulhern,1
Todd A. Wyatt,3
Joseph H. Sisson,3
Jacqueline A. Pavlik,3
Geraldine S. Pinkus,2 and
Mark D. Fleming1*
Department of Pathology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts 02115,1
Department of Pathology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115,2
Pulmonary and Critical Care Medicine Section, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 681983
Received 27 February 2007/
Returned for modification 11 May 2007/
Accepted 5 November 2007

ABSTRACT
Primary ciliary dyskinesia (PCD) results from ciliary dysfunction
and is commonly characterized by sinusitis, male infertility,
hydrocephalus, and situs inversus. Mice homozygous for the
nm1054 mutation develop phenotypes associated with PCD. On certain
genetic backgrounds, homozygous mutants die perinatally from
severe hydrocephalus, while mice on other backgrounds have an
accumulation of mucus in the sinus cavity and male infertility.
Mutant sperm lack mature flagella, while respiratory epithelial
cilia are present but beat at a slower frequency than wild-type
cilia. Transgenic rescue demonstrates that the PCD in
nm1054 mutants results from the loss of a single gene encoding the
novel primary ciliary dyskinesia protein 1 (Pcdp1). The
Pcdp1 gene is expressed in spermatogenic cells and motile ciliated
epithelial cells. Immunohistochemistry shows that Pcdp1 protein
localizes to sperm flagella and the cilia of respiratory epithelial
cells and brain ependymal cells in both mice and humans. This
study demonstrates that Pcdp1 plays an important role in ciliary
and flagellar biogenesis and motility, making the
nm1054 mutant
a useful model for studying the molecular genetics and pathogenesis
of PCD.

INTRODUCTION
Primary ciliary dyskinesia (PCD), which was previously known
as immotile cilia syndrome, affects approximately 1 in 16,000
newborn children worldwide and results from a defect in ciliary
and flagellar motility (
1,
2,
6,
13,
17,
66). Affected individuals
often suffer from bronchiectasis, chronic sinusitis, and neonatal
respiratory distress. In addition, males are infertile, and
many individuals have situs inversus, a complete reversal of
left-right asymmetry. The triad of sinusitis, bronchiectasis,
and situs inversus is commonly known as Kartagener's syndrome.
Some individuals with PCD also develop hydrocephalus (
3,
15,
18,
28,
32,
70), otitis media (
39,
40,
47), and retinitis pigmentosa
(
37,
65,
76).
Motile cilia are located on the surface of many types of eukaryotic cells and have a variety of functions (18, 22, 36, 46, 60, 63). For example, cilia on respiratory epithelial cells are responsible for movement of fluid and particles over the cell surface and are a critical component of host defense. Cilia on ependymal cells lining the ventricular surface of the brain facilitate cerebrospinal fluid flow, while those on the embryonic node play a critical role in left-right patterning during early development. The structurally related flagella are required for sperm motility.
Motile cilia elongate from the basal bodies of epithelial, ependymal, or nodal cells (1, 13, 17, 20, 22, 27, 36, 46, 60, 54). The core, or axoneme, of the cilia and flagella consists of a "9 + 2" microtubule structure with a ring of nine microtubule doublets surrounding a central pair of single microtubules. Several accessory proteins are associated with the microtubule pairs, including radial spokes and dynein arms, which generate the motor force required for ciliary motility. Although motile, nodal cilia have a 9 + 0 arrangement that lacks the central microtubule pair and resemble immotile cilia.
Human PCD linkage studies have demonstrated extensive genetic heterogeneity (7, 72). A number of genes have recently been implicated in human and mouse PCD. Predictably, human PCD mutations have been identified in three dynein chain genes: DNAI1 (19, 48, 71), DNAH11 (4), and DNAH5 (24, 44, 45). Similarly, loss of the mouse homolog of DNAH5 (Mdnah5) results in immotile cilia, chronic respiratory infections, hydrocephalus, and situs inversus (26), while loss of the dynein heavy chain gene Mdhc7 results in immotile cilia and male infertility (41). Additionally, mice lacking the gene encoding the axonemal filament protein Tektin-t also have immotile cilia due to impaired dynein arm function (64). PCD was also observed in mice lacking the genes encoding the transcription factor hepatocyte nuclear factor/forkhead homolog 4 (Hfh-4) (8, 10), DNA polymerase
(31), and the novel sperm-associated antigen 6 (Spag6) (53). Mutations in the human retinitis pigmentosa GTPase regulator gene have also been found to result in PCD (37, 76).
Although a diverse array of genes has already been implicated in PCD pathogenesis, relatively little is known about the biochemical and cellular processes that underlie ciliary and flagellar formation and function. In this paper, we identify a novel protein important for ciliary and flagellar function in the mouse. We demonstrate primary ciliary dyskinesia in mice homozygous for the nm1054 mutation, a recessive, pleiotropic mutation caused by an approximately 400-kb deletion on chromosome 1 that contains six genes (42, 43). Transgenic rescue demonstrated that deletion of the genes six-transmembrane epithelial antigen of the prostate (Steap3) and acyl-CoA binding protein (Acbp) result in the previously characterized anemia (42, 43) and cutaneous (35) phenotypes, respectively. Here, we show that the PCD phenotypes of hydrocephalus, male infertility, and respiratory ciliary dysfunction result from the loss of a single, novel gene named primary ciliary dyskinesia protein 1 (Pcdp1). We also demonstrate expression of the gene in spermatogenic and motile ciliated cell types and show protein localization in flagella and motile cilia in both mice and humans.

MATERIALS AND METHODS
Mice.
The
nm1054 mutation was maintained on both the C57BL/6J (B6)
and the 129S6/SvEvTac (129) backgrounds as previously described
(
42). Hydrocephalus was analyzed at 3 weeks in B6 mice expressing
RPCI-22 bacterial artificial chromosome (BAC) 11D19, which contains
the
Steap3 gene and rescues the anemia (
43). All other phenotypic
analyses were performed on (B6
x 129)F
1 (B6129F1) mice at 8
weeks. Animal procedures were approved by the Animal Care and
Use Committee at Children's Hospital Boston.
Transgenic rescue.
BAC transgenic animals were generated and identified as previously described (35, 43).
X-ray analysis.
Three-week-old mice were euthanized, and the heads were fixed in 4% paraformaldehyde. X-rays were taken at 55 KeV for 1 min using the Faxitron cabinet X-ray system 43855C (Faxitron).
Histology.
Testes from 8-week-old B6129F1 male mice were fixed in 10% buffered formalin and transferred to 70% ethanol after 24 h. Heads were fixed in Bouin's fixative until the bones were fully decalcified, and coronal sections were cut through the sinuses. Tissues were embedded in paraffin, sectioned, and stained with hematoxylin and eosin.
Electron microscopy.
Testes and heads from 8- and 24-week-old B6129F1 mice were fixed overnight in a modified Karnovsky's solution of 2.5% glutaraldehyde-2.0% paraformaldehyde, pH 7.4. After fixation, bony tissues in the heads were decalcified in 0.5 M EDTA. Testes and dissected respiratory mucosa were then rinsed in cold 0.1 M sodium cacodylate buffer, pH 7.4, and treated with cacodylate-buffered 2.0% osmium tetroxide for 1.5 h.
The tissue was rapidly dehydrated through increasing concentrations of ethanol and embedded in Polybed 812 (Polysciences Inc.). Thin sections were cut on a Leica EM UC-6 ultramicrotome and placed on uncoated copper grids. The grids were stained for 3 minutes with saturated uranyl acetate in a 1:1 mixture of 70% ethanol and 100% methanol (16) and for 3 min with Reynold's lead citrate (52). Stained sections were analyzed under a Phillips EM 208S electron microscope.
Ciliary beat frequency analysis.
Tracheae were isolated from 8-week-old B6129F1 mice in Dulbecco's modified Eagle medium supplemented with 1% penicillin-streptomycin. Ciliary beat frequency of tracheal rings was analyzed using the Sisson-Ammons video analysis system as previously described (57).
Northern analysis.
A 32P-labeled Pcdp1 probe was generated by PCR amplification of nucleotides 2184 to 2483 of the open reading frame from expressed sequence tag (EST) clone BF018525 (Invitrogen) with primers TGACCCCTCTATGGTGGAAG and GCTTTGCTTCGCAGATTCTT. A multitissue mouse Northern blot (OriGene Technologies, Inc.) was prehybridized, probed, washed, and viewed as previously described (35).
Reverse transcription-PCR (RT-PCR).
RNA was isolated from testes of 24-week-old B6129F1 mice using the RNAqueous kit (Ambion Inc.). First-strand cDNA was synthesized from 1 µg of wild-type or nm1054 testis RNA using the SuperScript II reverse transcriptase kit (Invitrogen). Pcdp1 was amplified by PCR using primers TGACCCCTCTATGGTGGAAG and GCTTTGCTTCGCAGATTCTT, which lie outside the deleted region.
In situ hybridization.
Nucleotides 1857 to 2484 of the Pcdp1 open reading frame were amplified from EST BF018525 and cloned into the pCRII-TOPO vector (Invitrogen). Ten micrograms of that plasmid was digested with BamHI and XhoI to generate antisense and sense probes, respectively. Riboprobes were labeled with 35S using an in vitro transcription kit (Roche Molecular Biochemicals). Wild-type and nm1054 testes were fixed in 4% paraformaldehyde. Heads were fixed in 0.5 M EDTA until fully decalcified, and coronal sections were cut through the sinuses. Radioactive in situ hybridization was performed on paraffin-embedded slides. After deparaffinization, the slides were fixed in 4% paraformaldehyde for 10 min and then treated with proteinase K for 10 min at 37°C. The slides were hybridized overnight at 60°C with labeled riboprobe diluted in hybridization buffer to 1 x 104 cpm/µl. The slides were washed at 65°C for 2 hours in 0.1x SSC (1x SSC is 0.15 M NaCl plus 0.015 M sodium citrate), immersed in Kodak NTB emulsion, and exposed for 2 to 4 weeks at 4°C. Following exposure, the slides were developed and counterstained with hematoxylin.
Immunohistochemistry.
Wild-type and nm1054 mouse tissues were isolated and fixed as described above for in situ hybridization. Human sections were from routine formalin-fixed, paraffin-embedded surgical and autopsy specimens. A rabbit polyclonal antiserum was raised to and affinity purified against the C-terminal 15 amino acids of Pcdp1 (KNLRSKALNTYLILD; Bethyl Laboratories, Inc.). Immunoperoxidase studies for Pcdp1 were performed manually on 5-µm paraffin sections. Following deparaffinization and quenching of endogenous peroxidase activity with aqueous 3% hydrogen peroxide for 5 min, Retrieve-All 2 (Signet Pathology Systems, Inc.) was used for heat-induced epitope retrieval in a Black & Decker HS80 steamer for 50 min. Slides were cooled at room temperature for 20 min, washed in water, and placed in 0.05 M Tris, pH 7.6, with 4% porcine serum. The slides were then incubated with anti-Pcdp1 antibody at a 1:2,000 dilution (0.5 µg/ml) for 2 hours, washed with a Tris-saline solution, and incubated with a horseradish peroxidase-labeled goat anti-rabbit secondary antibody (PowerVision, ImmunoVision Technologies Co.) for 30 min. Antibody localization was effected using the peroxidase reaction with 3,3'-diaminobenzidine tetrahydrochloride (DAB+; DakoCytomation) as the chromogen. Staining intensity was enhanced by brief immersion in DAB enhancer solution (Zymed Laboratories). Sections were counterstained with methyl green, dehydrated, and coverslipped.
Nucleotide sequence accession number.
The mouse Pcdp1 sequence was deposited and released under GenBank accession number EF632061.

RESULTS
nm1054 mice have primary ciliary dyskinesia.
Mice homozygous for the
nm1054 deletion have several phenotypes
commonly associated with primary ciliary dyskinesia, including
hydrocephalus, male infertility, and respiratory abnormalities.
Homozygous mutants on the B6 background develop severe hydrocephalus,
or dilatation of the ventricles of the brain, which results
in a dramatic increase in the size of the cranial vault (Fig.
1). Mutants on this background usually die within the first
week of life as a result of the hydrocephalus and severe anemia.
Mutant mice transgenic for the
Steap3 gene, which complements
the anemia (
43), occasionally live to 3 to 5 weeks of age before
dying from the hydrocephalus. Mutants on the 129 background
develop either mild or no hydrocephalus, indicating the presence
of genetic modifiers segregating in diverse mouse strains.
Mutant male mice on both the 129 and B6129F1 genetic backgrounds
are infertile. Wild-type female mice paired with
nm1054 mutant
mice for 2 weeks form vaginal plugs but do not become pregnant.
Histological analysis shows an absence of mature spermatozoa
in the seminiferous tubules of
nm1054 testes (Fig.
2A and B).
While sperm heads are present and appear normal, there are no
visible flagella. Transmission electron microscopy confirmed
the absence of mature sperm, although abortive tail structures
were occasionally visible (Fig.
2C to E). In addition, there
are no sperm in the
nm1054 epididymis (see Fig. S1A and B in
the supplemental material). Reverse transcription-PCR showed
that
Protamine 1 (
12,
30,
34),
Protamine 2 (
12,
11),
TP1 (
21,
69), and
TP2 (
55,
75), which are all markers of early to mid-spermiogenesis,
the final stage of spermatogenesis, are expressed in the
nm1054 testes (see Fig. S1C in the supplemental material). These data
suggest that there is a spermatogenic defect late in spermiogenesis.
In addition to the hydrocephalus and male infertility, there
is an accumulation of mucus in the sinuses of
nm1054 mutant
mice (Fig.
3A and B). Although there is no evidence of the inflammation
seen in sinusitis, excessive mucus in the nasal passage could
be indicative of the impaired epithelial clearance that predisposes
PCD patients to chronic infection and respiratory distress.
In dramatic contrast to the absence of sperm flagella,
nm1054 sinus and tracheal epithelial cells possess cilia with a normal
ultrastructure (Fig.
3C and D and data not shown). However,
the beat frequency of
nm1054 tracheal epithelial cilia is approximately
25% lower than that of wild-type cilia, with a difference of
more than 2 beats per second (Fig.
3E). This impaired ciliary
motility could account for the apparent defect in mucus clearance.
Presumably, the hydrocephalus in
nm1054 mice results from an
accumulation of cerebrospinal fluid due to a similar decrease
in motility of ependymal cilia. Situs inversus, otitis media,
and retinitis pigmentosa are not present in
nm1054 mutant mice
(data not shown).
Transgenic rescue of nm1054 PCD.
An overlapping BAC contig spanning the
nm1054 deletion was previously
developed (
43). The PCD in
nm1054 mice is rescued in a transgenic
line derived from CITB BAC clone 528N15 (Fig.
4) (
29), while
the anemia (
42,
43) and the cutaneous phenotype (
35) are not
affected. Transgenic mutant mice on the B6 background do not
develop hydrocephalus (data not shown). Additionally, transgenic
B6129F1
nm1054 males are fertile. Histology and electron microscopy
of transgenic mutant testes demonstrate the presence of mature
spermatozoa (Fig.
4A and data not shown), and there is no abnormal
accumulation of mucus in the sinuses from transgenic mutant
animals (Fig.
4B). None of the other transgenes spanning the
nm1054 deletion rescues any of the PCD phenotypes.
Characterization of Pcdp1, a novel ciliary protein.
BAC 528N15, which rescues the PCD in
nm1054 mutant mice, contains
a single, novel gene we have named
Pcdp1 (Fig.
4C). This strongly
suggests that the PCD observed in
nm1054 mutant mice results
solely from the loss of
Pcdp1. The
Pcdp1 gene was originally
defined by gene prediction tools in the Ensembl database (
5),
as well as partial testis ESTs with GenBank accession numbers
BB616643 (
9), BU937221, CF197896, BF018525, AV274480, and BF319649
and ensemble EST EMUST37840. We cloned the full-length
Pcdp1 open reading frame from reverse-transcribed B6129F1 testis cDNA
(data not shown) and determined that the 2,508-nucleotide gene
is comprised of 23 exons and encodes an 836-amino-acid protein.
This is consistent with a study identifying this gene by UniGene
ID number 297290 as one of 28 novel genes expressed during spermatogenesis
(
23).
The Pcdp1 protein has orthologs in species ranging from ciliated unicellular eukaryotes to humans, although no Chlamydomonas reinhardtii ortholog has been identified. The protein sequence is highly conserved among higher eukaryotes (Fig. 5A). Although there are no identifiable domains, signals, or structural motifs in the Pcdp1 protein, the high sequence similarity suggests that the protein has an important function. The region spanning amino acids 53 to 231 is 22% identical to Hydin, a large protein localized to the central microtubule pair of cilia and flagella (Fig. 5B) (33). Loss of Hydin results in immotile flagella in Chlamydomonas reinhardtii (33) and hydrocephalus in the hy3 mouse (14).
Expression of
Pcdp1 in mouse tissues was investigated by Northern
analysis, RT-PCR, and radioactive in situ hybridization. A multitissue
Northern blot assay showed weak expression of an approximately
2.5-kb transcript only in the testis (Fig.
6A).
Pcdp1 expression
in wild-type and
nm1054 testis was investigated by RT-PCR using
primers that lie outside the deleted region. Absence of
Pcdp1 expression in
nm1054 testes strongly suggests that the mutation
is a null (Fig.
6B). In situ hybridization showed
Pcdp1 expression
specifically in developing spermatocytes and spermatids but
not in immature spermatogonia (Fig.
6C), suggesting that it
is only expressed in cells undergoing spermatogenesis. Given
the multitissue phenotype, expression was also expected in other
specialized cell types possessing motile cilia. In situ hybridization
showed expression in the ciliated respiratory epithelial cells
lining the sinuses, trachea, and bronchi of wild-type mice (Fig.
6E and data not shown). In contrast, no
Pcdp1 expression was
detected in
nm1054 testis (Fig.
6D) or respiratory epithelial
cells (Fig.
6F) when we used a probe that lies outside the deleted
region. Additionally, no signal was observed from the sense
controls (data not shown).
We also investigated Pcdp1 protein expression by immunohistochemistry
using a rabbit polyclonal antibody raised to the C-terminal
15 amino acids. The antibody was validated by Western blotting
of N- and C-terminal FLAG-tagged Pcdp1 constructs overexpressed
in HEK293T cells (data not shown). Pcdp1 protein is expressed
in spermatocytes and spermatids and localizes to the flagella
of mature spermatozoa (Fig.
7A), the cilia of mouse (Fig.
7C)
and human (Fig.
7E) respiratory epithelial cells, and the cilia
of ependymal cells in human brain (Fig.
7F). Some cytoplasmic
staining is observed near the apical surface of the respiratory
epithelial and ependymal cells that may correspond to Pcdp1
protein in transit to the cilia. The Pcdp1 staining pattern
in mouse testis and respiratory epithelia is identical to that
of acetylated tubulin, a marker for motile cilia (data not shown).
Pcdp1 was not detected in
nm1054 sperm flagella (Fig.
7B) or
respiratory epithelial cilia (Fig.
7D). Some staining was observed
in the cytoplasm of
nm1054 epithelial cells. Although the C-terminal
antigenic region is not removed by the
nm1054 deletion, absence
of a transcript in
nm1054 animals using RT-PCR primers (Fig.
6B) and an in situ hybridization probe (Fig.
6D and F) that
lie outside the deleted region suggest that any staining observed
in mutant tissues is nonspecific.

DISCUSSION
In this study, we have demonstrated that loss of the novel gene
Pcdp1 results in primary ciliary dyskinesia in the
nm1054 mutant
mouse. Homozygous mutants develop hydrocephalus on the C57BL/6J
background, as well as male infertility and an accumulation
of mucus in the sinus cavity, likely due to impaired clearance
and slowed ciliary beat frequency. The
Pcdp1 gene is expressed
in spermatogenic cells and ciliated respiratory epithelial cells
and encodes a conserved protein that localizes to sperm flagella
and motile cilia in the respiratory system and the brain. Based
on the phenotype, this novel protein likely plays an important
role in ciliary biogenesis or function.
There is a striking difference between the spermatogenic and respiratory abnormalities in nm1054 mice. There is a complete absence of mature flagella in mutant testis and an absence of sperm in the epididymis. Presence of abortive tail structures and expression of spermiogenesis markers suggest that the block in spermatogenesis occurs late in spermiogenesis. In contrast, respiratory cilia are present and ultrastructurally normal, although the tracheal ciliary beat frequency is significantly lower than that of wild-type tracheal cilia. These findings suggest that Pcdp1 is essential for the biogenesis of flagella but is only required for the motility of respiratory epithelial cilia. Furthermore, this observation implies that although respiratory cilia and sperm flagella share a common axonemal structure, their formation and function are distinctly different. This hypothesis is supported by an identified mutation in the porcine KPL2 gene that results in truncated sperm tails but does not affect the axonemal structure of motile cilia (56).
Since the Pcdp1 protein is specifically localized along the length of cilia and flagella, it is not likely involved in initial elongation of the axoneme from the basal body. Such a function would likely require Pcdp1 in the cytoplasm rather than the full length of the cilia. This is supported by the apparent completion of ciliogenesis and the presence of flagellar structures that have likely passed the early stages of spermiogenesis. It is likely that Pcdp1 plays a role in ciliary and flagellar motility, as well as in flagellar axonemal assembly or stability late in spermiogenesis. However, biochemical data will be required to determine whether the role is structural or regulatory or if the protein is involved in another undefined pathway or process.
The absence of situs inversus in nm1054 deletion homozygotes suggests that Pcdp1 does not play an important role in nodal cilia and is not required for left-right patterning in the early embryo. Nodal cilia differ from other motile cilia in that they do not possess a central microtubule pair. Human mutations affecting the central microtubule pair have been shown to result in PCD without situs inversus (61). It is therefore possible that Pcdp1 function is associated with the central apparatus, which is composed of a microtubule pair and numerous accessory proteins and is thought to control and regulate the dynein motor force required for ciliary and flagellar motility (51, 58, 59). Disruption of central apparatus proteins in Chlamydomonas commonly results in immotile flagella (33, 51, 58, 59), while suppressor mutations in outer or inner dynein arm components restore motility by bypassing the inhibition (25, 49, 50). In the complete absence of the Chlamydomonas central apparatus, the flagella are paralyzed, but the microtubule doublets are still able to undergo the sliding motion that produces flagellar motility, albeit at a greatly reduced velocity (68). This suggests that the central apparatus plays a role in regulating the dynein motor force rather than generating it.
Even though the nm1054 ciliary ultrastructure is normal, the PCD in nm1054 mutants is similar to phenotypes observed in mice lacking dynein genes (26, 41). This suggests that Pcdp1 may directly or indirectly regulate dynein motor force. If Pcdp1 encodes a component of the central apparatus, loss of the gene in nm1054 mice could be disrupting ciliary motility by inhibiting microtubule sliding without destroying the axonemal ultrastructure. This effect has been observed when central apparatus components are mutated in the mouse. Male mice lacking the testis-specific isoform of the central apparatus protein sperm-associated antigen 16 (Spag16L) are infertile, and their sperm have flagella with a normal ultrastructure but decreased motility (73, 74). Amino acids 53 to 231 of Pcdp1 are 22% identical to the central apparatus protein Hydin. Loss of Hydin results in immotile flagella in Chlamydomonas and hydrocephalus in mice (33, 14), further supporting the possibility that Pcdp1 may encode a central pair protein. In addition, it is possible that Pcdp1 is also a key structural component in flagella, such that loss of the protein could cause flagellar instability during late spermiogenesis, resulting in the absence of mature sperm tails. Further experiments are required to decipher the differences between cilia and flagella to determine how the requirement for Pcdp1 may vary between these two organelles.
The nm1054 mutant is a useful model for studying PCD. To date, no mutations in the human ortholog of Pcdp1 have been identified that result in this disorder. However, given the PCD phenotype in nm1054 mice, understanding the function of the Pcdp1 protein may contribute greatly to the understanding of the molecular mechanisms perturbed in PCD, as well as to the diagnosis and treatment of the disorder.

ACKNOWLEDGMENTS
This work was supported by the National Institutes of Health
(HL074247 for M.D.F. and AA008769 for J.H.S.) and a Department
of Veteran's Affairs Merit Review Grant (T.A.W.). L.L. was supported
in part by an NIH postdoctoral NRSA training grant (HL007574.23).
We gratefully thank James Edwards and Tonora Archibald in the Children's Hospital Boston Pathology Department histology core facility, as well as Yu Yang in the Dana Farber—Partners Cancer Center in situ core facility, for their technical assistance and expertise. We thank Hannah Kinney and Robin Haynes for human brain sections. We also thank Steven Margossian for reading the manuscript, as well as Nancy Andrews and members of the Andrews and Fleming laboratories for unending discussion and suggestions.

FOOTNOTES
* Corresponding author. Mailing address: Department of Pathology, Enders 1116, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115. Phone: (617) 919-2664. Fax: (617) 730-0168. E-mail:
mark.fleming{at}childrens.harvard.edu 
Published ahead of print on 26 November 2007. 
Supplemental material for this article may be found at http://mcb.asm.org/. 

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