Abstract
Being the central metabolic organ of vertebrates, the liver possesses the largest repertoire of metabolic enzymes among all tissues and organs. Almost all metabolic pathways are resident in the parenchymal cell, hepatocyte, but the pathway capacities may largely differ depending on the localization of hepatocytes within the liver acinus-a phenomenon that is commonly referred to as metabolic zonation. Metabolic zonation is rather dynamic since gene expression patterns of metabolic enzymes may change in response to nutrition, drugs, hormones and pathological states of the liver (e.g., fibrosis and inflammation). This fact has to be ultimately taken into account in mathematical models aiming at the prediction of metabolic liver functions in different physiological and pathological settings. Here we present a spatially resolved kinetic tissue model of hepatic glucose metabolism which includes zone-specific temporal changes of enzyme abundances which are driven by concentration gradients of nutrients, hormones and oxygen along the hepatic sinusoids. As key modulators of enzyme expression we included oxygen, glucose and the hormones insulin and glucagon which also control enzyme activities by cAMP-dependent reversible phosphorylation. Starting with an initially non-zonated model using plasma profiles under fed, fasted and diabetic conditions, zonal patterns of glycolytic and gluconeogenetic enzymes as well as glucose uptake and release rates are created as an emergent property. We show that mechanisms controlling the adaptation of enzyme abundances to varying external conditions necessarily lead to the zonation of hepatic carbohydrate metabolism. To the best of our knowledge, this is the first kinetic tissue model which takes into account in a semi-mechanistic way all relevant levels of enzyme regulation.
Introduction
The tightly controlled switch between hepatic uptake and release of glucose keeps the plasma glucose concentrations within a range between 4 and 10 mM despite largely varying carbohydrate intake and utilization. This homeostatic function of the liver with respect to plasma glucose is achieved by several enzyme-regulatory mechanisms acting on different time scales. On the short term, hormone-dependent reversible enzyme phosphorylation and changes of reaction rates elicited by concentration changes of reaction substrates/products and allosteric modulators enable a metabolic response within seconds or minutes. Recurrent activation of these fast regulatory modes is typically accompanied by slow changes in the abundance of metabolic enzymes on a time scale of hours to days (Hopgood et al., ; Weinberg and Utter, ). Both the fast and slow mode of enzyme regulation are important for the regulation of the glucose exchange flux between hepatocytes and blood plasma (Bulik et al., ), Owing to concentration gradients of oxygen, metabolites, hormones, and morphogens along the hepatic capillaries (sinusoids) the expression of metabolic enzymes may differ in various zones of the liver acinus. For example, the oxygen pressure decreases by 50% along the porto-central axis of the acinus (Jungermann and Kietzmann, ). This goes in line with the number and structure of mitochondria (Schmucker et al., ) and glycolytic capacities in the periportal and pericentral zone (Braeuning et al., ). Hepatocytes close to the portal pole (zone 1) experiencing the highest concentration of oxygen pressure are predestined for strong ATP-demanding anabolic pathways like gluconeogenesis and urea synthesis. Contrary, hepatocytes close to the venous pole of the acinus (zone 3) experience the lowest oxygen concentrations and thus possess a high glycolytic capacity, a typical feature of cells working under conditions of permanent oxygen deprivation. The heterogeneous allocation of gluconeogenetic and glycolytic capacities to different hepatocytes along the porto-central axis may even result in a situation where a certain fraction of glucose produced by periportal cells is used to fuel the glycolysis of pericentral cells (Berndt et al., ).
Several blood-born factors have been identified as regulators of zone-dependent gene expression of metabolic enzymes. Oxygen, glucose, the hormones glucagon and insulin, the morphogens Wnt and hedgehog and the growth factor HGF belong to the best studied factors. The various factors appear to act in a hierarchical fashion whereby the gradients of morphogens and growth factors create a basic expression pattern that is further modulated by nutrition-related factors such as oxygen, glucose, fatty acids and the hormones insulin and glucagon. In this work, we will focus on the latter group of modifiers, i.e., we restrict our model to the metabolic response of the liver to nutritional challenges and oxygen availability.
Metabolic adaptation of hepatocytes to varying oxygen pressures is mainly controlled by hypoxia-inducible transcription factors (HIFs), heterodimeric complexes consisting of a constitutively expressed β-subunit and an oxygen-sensitive α-subunit. In the liver, HIF-1α regulates primarily glycolytic genes whereas HIF-2α is known to primarily regulate genes involved in cell proliferation and iron metabolism (Ramakrishnan and Shah, ). In line with the falling oxygen pressure along the porto-central axis, HIFαs were found with higher levels in the less aerobic pericentral zone (Kietzmann et al., ). Besides oxygen, the pancreatic hormones insulin and glucagon are important drivers of zone-dependent differences in enzyme activities. The regulatory role of these hormones is 2-fold. They control the cellular cAMP level in an antagonistic manner and thus exert opposite effects on the reversible phosphorylation of key regulatory enzymes of glycolysis and gluconeogenesis as PFK2, PK, and PEPCK. The hepatic clearance of the two hormones by endocytic uptake into hepatocytes creates a concentration gradient along the porto-central axis which entails zone-dependent differences in the phosphorylation level of interconvertible enzymes. With respect to gene expression of metabolic enzymes, insulin and glucagon also control the efficiency of several transcription factors as ChREBP, SREBP-1c, CREB, and Foxo (Han et al., ). Both actions of glucagon and insulin are tightly interrelated and function in part through the same mechanisms. For example, the cAMP-activated protein kinase A (PKA) is responsible for phosphorylation of interconvertible enzymes such as FBPFK2 and PK, as well as for the phosphorylation of the transcription factors ChREBP and CREP (Uyeda and Repa, ). cAMP is produced by glucagon-induced activation of the adenylate cyclase and degraded by insulin-stimulated cAMP phosphodiesterase. Consequently, the protein level of key regulatory enzymes reflects the integral hormone levels over longer time periods.
In this work we included dynamic changes in the abundance of metabolic enzymes into our previously developed multi-scale tissue model of hepatic glucose metabolism (Berndt et al., ). The rates of protein synthesis and degradation were modeled by phenomenological rate equations which were parameterized by using experimentally determined protein levels at varying concentrations of oxygen, glucose, insulin, and glucagon. The central aims of our work were (i) to provide a proof of principle for integrating in a self-consistent manner the temporal gene expression of enzymes into kinetic models of cellular metabolism, (ii) to lend further support to the concept of post-differentiation patterning according to which metabolic zonation is driven by gradients of oxygen, nutrients and hormones in the capillary blood and (iii) to present a modeling approach that obviates the requirement to measure the cellular abundance of metabolic enzymes (e.g., by quantitative proteomics) in different physical states of the liver, a procedure burdened with many problems as, for example, invasive tissue sampling and protein quantification in cells separated from different zones.
Model Description
The model combines a mathematical model of the sinusoidal tissue unit (STU) (Berndt et al., ) with a kinetic model of the protein turnover of key regulatory enzymes.
Compartment Model of Metabolite and Hormone Transport in the Sinusoidal Tissue Unit (STU)
Structurally, the STU is defined by a single sinusoid, the adjacent space of Disse and a monolayer of hepatocytes flanking the space of Disse (see Figure 1A). Functionally, the model describes the exchange of oxygen, metabolites and hormones between the sinusoidal blood, the space of Disse and the hepatocytes and the glucose metabolism within hepatocytes. The transport of metabolite and hormones within the STU is driven by diffusion and directional transport along the flow of water and blood. Lateral blood flow in the vessel is described by Hagen-Poiseuille law for fluid flow through a cylinder, water flow in the space of Disse is described by Hagen-Poiseuille law for fluid flow in a hollow cylinder. Exchange of water between the vessel and the space of Disse is driven by hydrostatic and oncotic pressure difference between the blood vessel and the space of Disse.
Figure 1
Conceptually, the STU was divided into NH zones, where NH is the number of hepatocytes along the porto-central axis. Each zone is made up of the sinusoid volume, the space of Disse and the hepatocyte (Figure 1A). Within one zone, the concentration of metabolites and hormones is given by a single value. The mathematical description of the STU model and a complete list of parameters used can be found in Berndt et al. (
Kinetic Model of Hepatocyte Glucose Metabolism
The reaction scheme for the glucose metabolism of a single hepatocyte is depicted in Figure 1B. It consists of the pathways for glycolysis, glyconeogenesis, glycogen synthesis and degradation. The time-dependent variation of metabolite concentrations is given by first-order differential equations. The liver specific enzymatic rate laws take into account substrate regulation, allosteric regulation and hormonal regulation by hormone-dependent reversible phosphorylation (Bulik et al.,
Kinetic Model of Hormonal Signaling
The pancreatic hormones glucagon and insulin are released into the portal vein in response to the plasma glucose concentration and are partially cleared during their passage through the liver. Hence, there is a difference between their plasma concentrations determined in peripheral blood samples and effective intra-hepatic concentrations. This difference was taken into account by setting the concentration values of insulin and glucagon in the periportal blood to the 2-fold of their plasma values (Balks and Jungermann,
Kinetic Model of Protein Turnover
The temporal change of the protein level PENZ of a metabolic enzyme (ENZ) is given by the difference between the rates of protein synthesis and protein degradation :
The right-hand side of equation (1), vENZ(E), represents the turnover rate of the enzyme protein. It is controlled by modulators affecting either the synthesis or the degradation or both. Note that the enzyme level PENZ scales linearly with the maximal rate of the enzyme. The rate equations of protein synthesis and degradation both depend on the momentary concentration of at least one of the four modulators Ei, i = 1 (insulin), i = 2 (glucagon), i = 3 (glucose), i = 4 (oxygen) considered in the model. The general structure of the rate equation for the protein synthesis of enzyme ENZ reads.
where is a constant determining the basal synthesis rate and fi is a nonlinear function of the i-th modulator. The “+” sign holds if Ei is an activator (inductor) of protein synthesis, the (–) sign holds If Ei is an inhibitor (repressor). If Ei has not been reported so far to exert an effect on the protein synthesis of enzyme ENZ it holds and Numerical values for the rate constants and were fixed in such a manner that for a normal 24 h plasma profile (see below) the zone- and time averaged protein levels coincided with the stationary protein levels as reported in Bulik et al. (
Table 1
| Enzyme name | References | ||
|---|---|---|---|
| Glucose transporter | k1 = 0.8 k2 = 6 Kglcext = 15 mM | Postic et al., | |
| Glucokinase | k1 = 2 k2 = 1 Ko2 = 80 mmHG n = 15 k3 = 10 Kins = 500 pM | Dice and Goldberg, | |
| Glucose-6-phosphatase | k1 = 1 k2 = 0.8 n1 = 3 Kglucagon = 100 pM k3 = 1 k4 = 15 keff = 0.3 Kglcext = 17 mM n2 = 20 | Leskes et al., | |
| Phosphofructokinase 1 | k2 = 80 hKins = 100 pMn = 1.5 | Dunaway and Weber, | |
| Fructosebis-phosphatase 1 | k1 = 0.25 k2 = 1 Kglu = 100 pM n = 3 | Dice and Goldberg, | |
| Phosphofructo-kinase 2/Fructosebis-phosphatase 2 | k1 = 2 k2 = 1 Ko2 = 75 mmHG n = 10 k3 = 1 k4 = 1 Kglu = 80 pM | Dunaway and Weber, | |
| Pyruvate kinase | k1 = 3.2 k2 = 1 Ko2 = 75 mmHG n = 10 k3 = 1 k4 = 0.5 Kglu = 150 pM k5 = 0.2 k6 = 1 Kins = 500 pM n2 = 2 | Hopkirk and Bloxham, | |
| Pyruvate carboxylase | k1 = 0.1 k2 = 1 Kglu = 150 pM | Weinberg and Utter, | |
| Phosphoenol-pyruvate Carboxykinase | k1 = 0.5 k2 = 2 Ko2 = 75 mmHG n1 = 10 k3 = 1 k4 = 3 n2 = 0.5 Kglu = 0.2 pM k5 = 1 k6 = 0.8 Kins = 100 pM | Nauck et al., |
Synthesis and degradation rates of the regulatory enzymes of hepatic carbohydrate.
In order to quantify the sensitivity of the turnover rate vENZ(E) of a protein against small changes of an modulator E, we used the sensitivity (elasticity) coefficient as defined in metabolic control analysis:
Figure 2 depicts the sensitivity coefficients for the turnover rates of the nine enzyme proteins with variable expression level as function of the four modulators oxygen (I), glucagon (II), insulin (III) and glucose (IV). Except for the sensitivities of the PEPCK and G6PP turnover with respect to glucagon and glucose, respectively, the extremum of all other sensitivity characteristics lies within the reported physiological range of the related modulators (green-shaded areas in Figure 2). The sensitivity of G6PP turnover with respect to glucose becomes important in the diabetic case, where glucose levels can exceed 20 mM (see below).
Figure 2

Sensitivity coefficients of protein turnover rates defined in equation (3) as function of modulator concentrations.
I Sensitivity of protein turnover rates with respect to oxygen of (A) GK, (B) FBPFK2, (C) PK, (D) PEPCK
II Sensitivity of protein turnover rates with respect to (E) G6PP, (F) FBP1, (G) FBPFK2, (H) PK, (I) PC, (J) PEPCK
III Sensitivity of protein turnover rates with respect to (K) GK, (L) PFK1, (M) PK, (N) PEPCK
IV Sensitivity of protein turnover rates with respect to (O) GlcT, (P) G6PP
The green-shades areas indicate the reported physiological concentration range of the respective modulator.
Results
Dynamic Metabolic Zonation in a Well-Fed State of the Rat
First, we used the model to simulate the temporal variation of enzyme abundances, metabolite concentrations and fluxes within the various zones along the porto-central axis of the STU. The simulation was initiated with identical abundance of enzymes along the sinusoid which we set to the stationary mean protein abundance used in Bulik et al. (
Even with identical enzyme abundances across all hepatocytes, there occurs a progressive decline of hormone plasma levels from the portal to the central pole due to the ongoing hormone uptake by hepatocytes in each zone. Moreover, oxygen uptake in one zone diminishes the available oxygen pressure seen by the cells in the adjacent zone toward the pericentral pole. As oxygen is not part of the model, we assumed a linear decrease in oxygen partial pressure from 90 mmHG in the periportal zone to 35 mm HG in the pericentral zone (Jungermann and Kietzmann,
Figure 3

Diurnal variations in the plasma levels of glucose (A), insulin (B), glucagon (C), cellular glycogen (D) and the glucose exchange flux (E) in different zones along the porto-central axis. The different curves refer to different spatial positions of hepatocytes, counted from periportal (red curve) to percentral (green curve). The bold blue line refers to the means values of the shown variable. Note that the red curves (= most portal cell) for the hormones and glucose are identical with their plasma profiles.
Figure 4

Diurnal variations in the relative abundance of glycolytic and gluconeogenetic enzymes within hepatocytes along the porto-central axis of a well-fed rat. The curves illustrate the relative deviation of protein abundances from the overall spatial and 24h- mean (= 24 h mean of the bold red curve). From the top to the bottom, the different curves refer to the spatial position of the hepatocyte counted from periportal to percentral. The bold red line refers to the average protein abundance across all cells. (A) GlcT, (B) G6PP, (C) GK, (D) PFK1, (E) FBPPFK1, (F) PFK2, (G) FBPPFK2, (H) PK, (I) PC, (J) PEPCK.
Figures 3A–C depicts the timely variation of glucose, insulin, glucagon in various sinusoidal compartments. Intriguingly, the highest glucose concentrations in the very portal zone (see red curve in Figure 3A) are paralleled by the lowest glucose concentrations in the very central zone (green curve). This seemingly paradoxical situation is due to the fact that the high level of insulin and low level of glucagon strongly increase the glucose uptake capacity of hepatocytes such that the otherwise strong zone-dependent differences in the glucose exchange flux (see Figure 3E) almost disappear. The simulation also reveals large zone-dependent differences in the cellular dynamics of glycogen (Figure 3D). The variation of the glycogen content in portal cells is much more pronounced than in central cells.
The time-dependent variation in the protein levels of key glycolytic and gluconeogenetic enzymes in different zones are depicted in Figure 4. The uniform overall shape of the curves reflects essentially the daily variation of the plasma glucose level. Generally, the daily fluctuations of enzyme levels around their 24 h mean hardly exceed 10%. Thus, as long as the liver is repeatedly confronted with the same 24 h plasma profile of metabolites and hormones, timely variations of protein levels should have only a marginal impact on the hepatic control of the plasma glucose level.
In contrast to the modest time-dependent variations of protein levels, the computed zone-dependent differences of enzyme levels display a large scatter. The maximal differences between the enzyme endowment of hepatocytes closest to the portal and central pole lie between 0.1 [e.g., glucose transporter (glcT) and phosphofructokinase 1 (pfk1)] and 4.5 [phosphoenolpyruvate kinase (pepck)]. For the validation of these computational predictions, we calculated the 24 h-average protein levels of the first (most portal) and last (most central) hepatocyte and compared the ratio of the computed average protein levels with experimental data (see first columns for each enzyme in Figure 5). We further compared the ratio of 24 h- and zone-averaged mean protein levels between a fed and fasted rat and a diabetic and normal rat.
Figure 5

Ratio of enzyme levels in hepatocytes. Red circles indicate the computed ratio of protein levels. Green circles and gray bars indicate the mean value and the range of variability of various experimentally determined ratios. First columns (pc): Portal-to-central ratios (= 24h-averaged protein levels between hepatocyte #1 and hepatocyte # 25) for the well-fed state of the rat. Experimental data were taken from (Sharma et al.,
This analysis provided a good concordance between theoretical and experimental results. The only exception is the pyruvate carboxylase, a key regulatory enzyme of gluconeogenesis, were portal to central gradients could not be univocally explained by the reported oxygen dependency. Oxygen dependency accounts only for about 35% percent of the observed zonation (see Table 1 and Supplement 1).
Dynamic Metabolic Zonation of the Liver During Adaptation to Fasting
Next, we studied how the zonation of metabolic enzymes is affected if the liver has to cope with a fundamentally different nutritional regime. To this end, we simulated the zone-dependent dynamic changes of protein levels and metabolites during the transition from a fed state of the rat to a fasting state. The simulation started with the stable 24 h zonated enzyme profile that is established if the liver experiences recurrently the same plasma profile of a fed rat (see above). At time t = 24 h, the plasma profile of the fed rate was replaced by plasma profile of a fasted rat (La Fleur et al.,
Figure 6

Diurnal variations in the relative abundance of glycolytic and gluconeogenetic enzymes within hepatocytes along the porto-central axis during the transition from a fed state (t = 0–24 h) to a fasted state (t > 24 h). The curves illustrate the relative deviation of protein abundances from the overall spatial and 24 h mean (= 24 h mean of the bold red curve). From the top to the bottom, the different curves refer to the spatial position of the hepatocyte counted from periportal to percentral. The bold red line refers to the average protein abundance across all cells. The vertical dotted line indicates onset of the starvation period. (A) GlcT, (B) G6PP, (C) GK, (D) PFK1, (E) FBPPFK1, (F) PFK2, (G) FBPPFK2, (H) PK, (I) PC, (J) PEPCK.
The computed changes of enzyme profiles toward a more gluconeogenetic phenotype are accompanied by significant alterations of the intra-sinusoidal glucose gradient and the zone-dependent differences in the glucose exchange rate (Figure 7). Compared with the fed state, the porto-venous glucose difference becomes much larger in the fasted state (Figure 7A). The same holds for the glucose exchange rate (Figure 7D).
Figure 7

Diurnal variations in the plasma levels of glucose (A), insulin (B), glucagon (C), cellular glycogen (D) and the glucose exchange flux (E) in different zones along the porto-central axis during the transition from a well-fed state (t = 0–24 h) to a fasted state (t > 24 h) of the rate. The different curves refer to different spatial positions of hepatocytes, counted from periportal (red curve) to percentral (green curve). The bold blue line refers to the means values of the shown variables. Note that the red curves (= most portal cell) for the hormones and glucose are identical with their plasma profiles.
In agreement with experimental data (Babcock and Cardell,
Figure 8 illustrates the importance of dynamic zonation for the adaptation of the porto-venous glucose difference (AVGD) to a specific nutritional regime. Regulation of interconvertible enzymes by hormone-dependent phosphorylation alone, i.e., at fixed protein levels of the fed state (blue line), would result in an AVGD of about 3.5 mM for the typical range of portal glucose concentrations in the fasted state (red shaded area). Dynamic adaption of protein levels enlarges the AVGD to about 7 mM (red line) thus rendering the liver to a strong glucose producer in the fasted state.
Figure 8

Hepatic porto-venous glucose difference (AVGD) for the well-fed and fasted nutritional state. The daily variations of plasma glucose in the fasted, fed and well-fed state are indicated by the red-, green- and blue-shaded areas. The solid lines represent the AVGD if in the fasted state (red), fed state (green) and the well-fed state (blue). Crosses depict experimentally measured AVGD (Huang and Veech,
Dynamic Metabolic Zonation of the Liver in Diabetes Type II (“Diabetic Liver”)
Late diabetes type 2 is characterized by long persistence of high postprandial plasma glucose levels, reduced insulin levels (hypo-insulinemia) and elevated glucagon levels (hyper-glucagonemia). It is mainly the shift in the insulin/glucagon ratio that renders the liver to a glucose producer which on top of the insulin-resistant muscle and adipose tissue contributes to high plasma glucose levels. We tested whether our model can also correctly describe this metabolic abnormality and the observed changes of protein abundances in different zones. To this end, we used the glucose-hormone transfer function constructed for the diabetic case (see Bulik et al.,
Figure 9

Diurnal variations in the plasma levels of glucose (A), insulin (B), glucagon (C), cellular glycogen (D), and the glucose exchange flux (E) in different zones along the porto-central axis of a diabetic rat.
Discussion
Metabolic Zonation of Hepatic Glucose Metabolism Is Driven by Concentration Gradients of Hormones and Metabolites
In this work we used a mathematical model to study the dynamic zonation of the hepatic glucose metabolism. To this end we extended our previously published multi-scale tissue model of the hepatic carbohydrate metabolism (Berndt et al.,
The Proposed Multi-Scale Model Encompasses All Levels of Metabolic Regulation
An important feature of the cellular metabolic network of the liver is the ability to adapt its functional output to varying external conditions such as changes in nutrient supply and varying hormone levels. These adaptive mechanisms operate at two different time scales. The short term adaptation occurs within seconds or minutes and is brought about by activity changes in the present metabolic enzymes by substrate availability, allosteric regulation and reversible phosphorylation. The second adaptive mechanism operates within hours or days and is brought about by changes in the enzyme abundances. It is already known for a long time that the total protein content of liver enzymes may largely vary owing to enhanced protein degradation during fasting (providing glucogenic amino acids as substrate for gluconeogenesis) mediated by the hormone glucagon or enhanced protein synthesis by the hormone insulin (Hopgood et al.,
Metabolic Response of the Liver to Varying Nutritional Regimes
Our simulations suggest that in the presence of a constant daily nutritional regime the diurnal variation of enzyme abundances should be fairly moderate in the range of 10–20% around the mean. This is a lot less than daily variations in the abundance of the key regulatory enzyme of cholesterol synthesis, ßHMG-CoA reductase (Kirkpatrick et al.,
Main Limitations of the Model and Outlook for Future Model Extensions
The used multiscale tissue model comprises a number of simplifications of the true anatomical structure of the liver which may impact on the simulated intra-sinusoidal concentration gradients of hormones and metabolites. For example, the blood flow rate within the pericentral zone of the sinusoid may vary if a sinusoid spreads out, forms anastomoses or merges with another sinusoid (Rappaport et al.,
The rate laws presented in this paper are effective transfer functions describing directly the relation between modulators (nutrients and hormones) and the turnover rate of a protein. Usage of effective transfer function raises the question which properties of the underlying regulatory network have to be captured. Obviously, not all known modulators of protein synthesis and degradation have been considered in the model. Ground-breaking experiments pointed initially to the oxygen gradient as the most important driving force of metabolic zonation (Jungermann and Kietzmann,
Conclusion
In summary, we propose a self-consistent model of liver carbohydrate metabolism that consistently takes into account variable gene expression of metabolic enzymes, regulation of metabolic pathways, exchange of metabolites and hormones between the blood and hepatocytes and microperfusion of the liver. Once the input of hormones and nutrients to the periportal region the liver acinus is known, the model allows to compute the metabolic phenotype of individual hepatocytes along the porto-central axis. The local hormone and metabolite concentrations determine the phosphorylation state of the interconvertible enzymes, hormonal clearance rates and expression level of metabolic enzymes. The metabolic phenotype in turn determines the functional output (here: glucose exchange rate) of each hepatocyte and this way the venous glucose output of the acinus. Integration across a representative set of acini yields finally the total glucose output of the liver.
Statements
Author contributions
NB developed the concept, implemented the model, carried out the simulation, wrote the manuscript. H-GH developed the concept, advised the implementation of the model, wrote the manuscript.
Funding
NB was funded by the German Systems Biology Program “LiSyM,” grant no. 31 L0057, sponsored by the German Federal Ministry of Education and Research (BMBF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fphys.2018.01786/full#supplementary-material
References
1
AllenJ. W.KhetaniS. R.BhatiaS. N. (2005). In vitro zonation and toxicity in a hepatocyte bioreactor. Toxicol. Sci. 84, 110–119. 10.1093/toxsci/kfi052
2
ArgaudD.ZhangQ.PanW.MaitraS.PilkisS. J.LangeA. J. (1996). Regulation of rat liver glucose-6-phosphatase gene expression in different nutritional and hormonal states: gene structure and 5'-flanking sequence. Diabetes45, 1563–1571. 10.2337/diab.45.11.1563
3
BabcockM. B.CardellR. R. (1974). Hepatic glycogen patterns in fasted and fed rats. Am. J. Anat.140, 299–337. 10.1002/aja.1001400302
4
BahnakB. R.GoldA. H. (1982). Effects of alloxan diabetes on the turnover of rat liver glycogen synthase. Comparison with liver phosphorylase. J. Biol. Chem.257, 8775–8780.
5
BalksH. J.JungermannK. (1984). Regulation of peripheral insulin/glucagon levels by rat liver. Eur. J. Biochem.141, 645–650. 10.1111/j.1432-1033.1984.tb08240.x
6
BallardF. J.HopgoodM. F. (1973). Phosphopyruvate carboxylase induction by L-tryptophan. Effects on synthesis and degradation of the enzyme. Biochem. J. 136, 259–264. 10.1042/bj1360259
7
BerndtN.HorgerM. S.BulikS.HolzhütterH. G. (2018). A multiscale modelling approach to assess the impact of metabolic zonation and microperfusion on the hepatic carbohydrate metabolism. PLoS Comput. Biol.14:e1006005. 10.1371/journal.pcbi.1006005
8
BockK. W.FröhlingW.RemmerH. (1973). Influence of fasting and hemin on microsomal cytochromes and enzymes. Biochem. Pharmacol.22, 1557–1564. 10.1016/0006-2952(73)90021-X
9
BraeuningA.IttrichC.KöhleC.HailfingerS.BoninM.BuchmannA.et al. (2006). Differential gene expression in periportal and perivenous mouse hepatocytes. FEBS J.273, 5051–5061. 10.1111/j.1742-4658.2006.05503.x
10
BulikS.HolzhütterH. G.BerndtN. (2016). The relative importance of kinetic mechanisms and variable enzyme abundances for the regulation of hepatic glucose metabolism-insights from mathematical modeling. BMC Biol.14:15. 10.1186/s12915-016-0237-6
11
BurkeZ. D.ReedK. R.PhesseT. J.SansomO. J.ClarkeA. R.ToshD. (2009). Liver zonation occurs through a beta-catenin-dependent, c-Myc-independent mechanism. Gastroenterology136, 2316–2324 e2311–2313. 10.1053/j.gastro.2009.02.063
12
ChangA. Y.SchneiderD. I. (1971). Hepatic enzyme activities in streptozotocin-diabetic rats before and after insulin treatment. Diabetes20, 71–77. 10.2337/diab.20.2.71
13
ChenK. S.KatzJ. (1988). Zonation of glycogen and glucose syntheses, but not glycolysis, in rat liver. Biochem. J. 255, 99–104. 10.1042/bj2550099
14
ChristB.NathA.BastianH.JungermannK. (1988). Regulation of the expression of the phosphoenolpyruvate carboxykinase gene in cultured rat hepatocytes by glucagon and insulin. Eur. J. Biochem.178, 373–379. 10.1111/j.1432-1033.1988.tb14460.x
15
CladarasC.CottamG. L. (1980). Turnover of Liver Pyruvate-Kinase. Arch. Biochem. Biophys.200, 426–433. 10.1016/0003-9861(80)90373-2
16
CollettiM.CicchiniC.ConigliaroA.SantangeloL.AlonziT.PasquiniE.et al. (2009). Convergence of Wnt signaling on the HNF4 alpha-driven transcription in controlling liver zonation. Gastroenterology137, 660–672. 10.1053/j.gastro.2009.05.038
17
ColosiaA. D.MarkerA. J.LangeA. J.el-MaghrabiM. R.GrannerD. K.TaulerA.et al. (1988). Induction of rat liver 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase mRNA by refeeding and insulin. J. Biol. Chem.263, 18669–18677.
18
CrepinK. M.DarvilleM. I.HueL.RousseauG. G. (1988). Starvation or diabetes decreases the content but not the mRNA of 6-phosphofructo-2-kinase in rat liver. Febs Lett.227, 136–140. 10.1016/0014-5793(88)80884-6
19
DiceJ. F.GoldbergA. L. (1975). Statistical-analysis of relationship between degradative rates and molecular-weights of proteins. Arch. Biochem. Biophys.170, 213–219. 10.1016/0003-9861(75)90112-5
20
DipietroD. L.WeinhouseS. (1960). Hepatic glucokinase in the fed, fasted, and alloxan-diabetic rat. J. Biol. Chem.235, 2542–2545.
21
DonofrioJ. C.ThompsonR. S.ReinhartG. D.VenezialeC. M. (1984). Quantification of liver and kidney phosphofructokinase by radioimmunoassay in fed, starved and alloxan-diabetic rats. Biochem. J. 224, 541–547. 10.1042/bj2240541
22
DunawayG. A.LeungG. L.ThrasherJ. R.CooperM. D. (1978). Turnover of hepatic phosphofructokinase in normal and diabetic rats-role of insulin and peptide stabilizing factor. J. Biol. Chem.253, 7460–7463.
23
DunawayG. A.WeberG. (1974). Effects of hormonal and nutritional changes on rates of synthesis and degradation of hepatic phosphofructokinase isozymes. Arch. Biochem. Biophys. 162, 629–637. 10.1016/0003-9861(74)90225-2
24
EkataksinW.KanedaK. (1999). Liver microvascular architecture: an insight into the pathophysiology of portal hypertension. Semin. Liver Dis.19, 359–382. 10.1055/s-2007-1007126
25
el-MaghrabiM. R.LangeA. J.KummelL.PilkisS. J. (1991). The rat fructose-1,6-bisphosphatase gene-structure and regulation of expression. J. Biol. Chem.266, 2115–2120.
26
EvansJ. L.QuistorffB.WittersL. A. (1989). Zonation of hepatic lipogenic enzymes identified by dual-digitonin-pulse perfusion. Biochem. J. 259, 821–829. 10.1042/bj2590821
27
ExtonJ. H.ParkC. R. (1965). Control of gluconeogenesis in the perfused liver of normal and adrenalectomized rats. J. Biol. Chem.240, 955–957.
28
FrederiksW. M.MarxF.van NoordenC. J. (1991). Homogeneous distribution of phosphofructokinase in the rat liver acinus: a quantitative histochemical study. Hepatology14, 634–639. 10.1002/hep.1840140410
29
GabbayR. A.SutherlandC.GnudiL.KahnB. B.O'BrienR. M.GrannerD. K.et al. (1996). Insulin regulation of phosphoenolpyruvate carboxykinase gene expression does not require activation of the Ras/mitogen-activated protein kinase signaling pathway. J. Biol. Chem.271, 1890–1897. 10.1074/jbc.271.4.1890
30
GannonM. C.NuttallF. Q. (1997). Effect of feeding, fasting, and diabetes on liver glycogen synthase activity, protein, and mRNA in rats. Diabetologia40, 758–763. 10.1007/s001250050746
31
GebhardtR.Matz-SojaM. (2014). Liver zonation: novel aspects of its regulation and its impact on homeostasis. World J. Gastroenterol.20, 8491–8504. 10.3748/wjg.v20.i26.8491
32
GiffinB. F.DrakeR. L.MorrisR. E.CardellR. R. (1993). Hepatic lobular patterns of phosphoenolpyruvate carboxykinase, glycogen synthase, and glycogen phosphorylase in fasted and fed rats. J. Histochem. Cytochem.41, 1849–1862. 10.1177/41.12.8245433
33
HanH. S.KangG.KimJ. S.ChoiB. H.KooS. H. (2016). Regulation of glucose metabolism from a liver-centric perspective. Exp. Mol. Med.48:e218. 10.1038/emm.2015.122
34
HoehmeS.FriebelA.HammadS.DrasdoD.HengstlerJ. G. (2017). Creation of three-dimensional liver tissue models from experimental images for systems medicine. Methods Mol. Biol.1506, 319–362. 10.1007/978-1-4939-6506-9_22
35
HopgoodM. F.BallardF. J.ReshefL.HansonR. W. (1973). Synthesis and degradation of phosphoenolpyruvate carboxylase in rat-liver and adipose-tissue-changes during a starvation-refeeding cycle. Biochem. J. 134, 445–453. 10.1042/bj1340445
36
HopgoodM. F.ClarkM. G.BallardF. J. (1980). Protein-degradation in hepatocyte monolayers-effects of glucagon, adenosine 3'-5'-cyclic monophosphate and insulin. Biochem. J. 186, 71–79. 10.1042/bj1860071
37
HopkirkT. J.BloxhamD. P. (1979). Studies on the biosynthesis of hepatic pyruvate-kinase and its correlation with enhanced hepatic lipogenesis in meal-trained rats. Biochem. J. 182, 383–397. 10.1042/bj1820383
38
HopkirkT. J.BloxhamD. P. (1980). Biosynthesis of rat-liver pyruvate-kinase-measurement of enzyme lifetime and the rate of synthesis at weaning. Biochem. J. 192, 507–516. 10.1042/bj1920507
39
HuangM. T.VeechR. L. (1988). Role of the direct and indirect pathways for glycogen synthesis in rat liver in the postprandial state. J. Clin. Invest.81, 872–878. 10.1172/JCI113397
40
IynedjianP. B.JotterandD.NouspikelT.AsfariM.PilotP. R. (1989). Transcriptional induction of glucokinase gene by insulin in cultured liver cells and its repression by the glucagon-cAMP system. J. Biol. Chem.264, 21824–21829.
41
JonesC. G.TitheradgeM. A. (1996). Measurement of metabolic fluxes through pyruvate kinase, phosphoenolpyruvate carboxykinase, pyruvate dehydrogenase, and pyruvate carboxylase in hepatocytes of different acinar origin. Arch. Biochem. Biophys.326, 202–206. 10.1006/abbi.1996.0066
42
JungermannK.KatzN. (1982). Functional hepatocellular heterogeneity. Hepatology2, 385–395. 10.1002/hep.1840020316
43
JungermannK.KatzN. (1989). Functional specialization of different hepatocyte populations. Physiol. Rev.69, 708–764. 10.1152/physrev.1989.69.3.708
44
JungermannK.KietzmannT. (1997). Role of oxygen in the zonation of carbohydrate metabolism and gene expression in liver. Kidney Int.51, 402–412. 10.1038/ki.1997.53
45
JungermannK.KietzmannT. (2000). Oxygen: modulator of metabolic zonation and disease of the liver. Hepatology31, 255–260. 10.1002/hep.510310201
46
KatzN.TeutschH. F.JungermannK.SasseD. (1977a). Heterogeneous reciprocal localization of fructose-1,6-bisphosphatase and of glucokinase in microdissected periportal and perivenous rat-liver tissue. FEBS Lett.83, 272–276. 10.1016/0014-5793(77)81021-1
47
KatzN.TeutschH. F.SasseD.JungermannK. (1977b). Heterogeneous distribution of glucose-6-phosphatase in microdissected periportal and perivenous rat-liver tissue. FEBS Lett.76, 226–230. 10.1016/0014-5793(77)80157-9
48
KietzmannT.CornesseY.BrechtelK.ModaressiS.JungermannK. (2001). Perivenous expression of the mRNA of the three hypoxia-inducible factor alpha-subunits, HIF1alpha, HIF2alpha and HIF3alpha, in rat liver. Biochem. J. 354, 531–537. 10.1042/bj3540531
49
KietzmannT.RothU.FreimannS.JungermannK. (1997). Arterial oxygen partial pressures reduce the insulin-dependent induction of the perivenously located glucokinase in rat hepatocyte cultures: mimicry of arterial oxygen pressures by H2O2. Biochem. J. 321(Pt 1),17–20.
50
KirkpatrickR. B.RobinsonS. F.KillenbergP. G. (1980). Diurnal-variation of rat-liver enzymes catalyzing bile-acid conjugation and sulfation. Biochim. Biophys. Acta. 620, 627–630. 10.1016/0005-2760(80)90154-X
51
KönigM.HolzhütterH. G. (2012). Kinetic modeling of human hepatic glucose metabolism in type 2 diabetes mellitus predicts higher risk of hypoglycemic events in rigorous insulin therapy. J. Biol. Chem.287, 36978–36989. 10.1074/jbc.M112.382069
52
La FleurS. E.KalsbeekA.WortelJ.BuijsR. M. (1999). A suprachiasmatic nucleus generated rhythm in basal glucose concentrations. J. Neuroendocrinol.11, 643–652. 10.1046/j.1365-2826.1999.00373.x
53
LeskesA.SiekevitzP.PaladeG. E. (1971). Differentiation of endoplasmic reticulum in hepatocytes : II. glucose-6-phosphatase in rough microsomes. J. Cell Biol.49, 288–302. 10.1083/jcb.49.2.288
54
MannaP.JainS. K. (2012). Decreased hepatic phosphatidylinositol-3,4,5-triphosphate (PIP3) levels and impaired glucose homeostasis in type 1 and type 2 diabetic rats. Cell. Physiol. Biochem.30, 1363–1370. 10.1159/000343325
55
MassillonD. (2001). Regulation of the glucose-6-phosphatase gene by glucose occurs by transcriptional and post-transcriptional mechanisms-Differential effect of glucose and xylitol. J. Biol. Chem.276, 4055–4062. 10.1074/jbc.M007939200
56
MiethkeH.WittigB.NathA.ZierzS.JungermannK. (1985). Metabolic zonation in liver of diabetic rats. Zonal distribution of phosphoenolpyruvate carboxykinase, pyruvate kinase, glucose-6-phosphatase and succinate dehydrogenase. Biol. Chem. Hoppe. Seyler.366, 493–501. 10.1515/bchm3.1985.366.1.493
57
MinchenkoO.OpentanovaI.CaroJ. (2003). Hypoxic regulation of the 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase gene family (PFKFB-1-4) expression in vivo. FEBS Lett.554, 264–270. 10.1016/S0014-5793(03)01179-7
58
MiralpeixM.CarballoE.BartronsR.CrepinK.HueL.RousseauG. G. (1992). Oral-administration of vanadate to diabetic rats restores liver 6-phosphofructo-2-kinase content and messenger-Rna. Diabetologia35, 243–248. 10.1007/BF00400924
59
MorseltA. F.FrederiksW. M.Copius Peereboom-StegemanJ. H.van VeenH. A. (1987). Mechanism of damage to liver cells after chronic exposure to low doses of cadmium chloride. Arch. Toxicol. Suppl.11, 213–215. 10.1007/978-3-642-72558-6_34
60
NauckM.WölfleD.KatzN.JungermannK. (1981). Modulation of the glucagon-dependent induction of phosphoenolpyruvate carboxykinase and tyrosine aminotransferase by arterial and venous oxygen concentrations in hepatocyte cultures. Eur. J. Biochem.119, 657–661. 10.1111/j.1432-1033.1981.tb05658.x
61
NeelyP.El-MaghrabiM. R.PilkisS. J.ClausT. H. (1981). Effect of diabetes, insulin, starvation, and refeeding on the level of rat hepatic fructose 2,6-bisphosphate. Diabetes30, 1062–1064. 10.2337/diab.30.12.1062
62
NoguchiT.InoueH.TanakaT. (1985). Transcriptional and post-transcriptional regulation of L-type pyruvate-kinase in diabetic rat-liver by insulin and dietary fructose. J. Biol. Chem.260, 4393–4397.
63
PosticC.BurcelinR.RencurelF.PegorierJ. P.LoizeauM.GirardJ.et al. (1993). Evidence for a transient inhibitory effect of insulin on GLUT2 expression in the liver: studies in vivo and in vitro. Biochem. J. 293(Pt 1), 119–124.
64
ProbstI.SchwartzP.JungermannK. (1982). Induction in primary culture of gluconeogenic and glycolytic hepatocytes resembling periportal and perivenous cells. Eur. J. Biochem.126, 271–278. 10.1111/j.1432-1033.1982.tb06775.x
65
QuistorffB. (1985). Gluconeogenesis in periportal and perivenous hepatocytes of rat liver, isolated by a new high-yield digitonin/collagenase perfusion technique. Biochem. J. 229, 221–226. 10.1042/bj2290221
66
RajuJ.GuptaD.RaoA. R.BaquerN. Z. (1999). Effect of antidiabetic compounds on glyoxalase I activity in experimental diabetic rat liver. Ind. J. Exp. Biol.37, 193–195.
67
RamakrishnanS. K.ShahY. M. (2017). A central role for hypoxia-inducible factor (HIF)-2alpha in hepatic glucose homeostasis. Nutr. Healthy Aging4, 207–216. 10.3233/NHA-170022
68
RappaportA. M.BorowyZ. J.LougheedW. M.LottoW. N. (1954). Subdivision of hexagonal liver lobules into a structural and functional unit - role in hepatic physiology and pathology. Anat. Rec.119, 11–33. 10.1002/ar.1091190103
69
RosaJ. L.VenturaF.TaulerA.BartronsR. (1993). Regulation of hepatic 6-phosphofructo-2-kinase fructose 2,6-bisphosphatase gene-expression by glucagon. J. Biol. Chem.268, 22540–22545.
70
SalasM.VinuelaE.SolsA. (1963). Insulin-dependent synthesis of liver glucokinase in the rat. J. Biol. Chem.238, 3535–3538.
71
SchmuckerD. L.MooneyJ. S.JonesA. L. (1978). Stereological analysis of hepatic fine structure in the Fischer 344 rat. Influence of sublobular location and animal age. J. Cell Biol. 78, 319–337. 10.1083/jcb.78.2.319
72
SharmaC.ManjeshwarR.WeinhouseS. (1964). Hormonal and dietary regulation of hepatic glucokinase. Adv. Enzyme Regul.2, 189–200. 10.1016/S0065-2571(64)80013-3
73
SibrowskiW.MüllerM. J.SeitzH. J. (1981). Effect of different thyroid states on rat-liver glucokinase synthesis and degradation Invivo. J. Biol. Chem.256, 9490–9494.
74
SibrowskiW.StaegemannU.SeitzH. J. (1982). Accelerated turnover of hepatic glucokinase in starved and streptozotocin-diabetic rat. Eur. J. Biochem.127, 571–574. 10.1111/j.1432-1033.1982.tb06910.x
75
SliekerL. J.SundellK. L.HeathW. F.OsborneH. E.BueJ.ManettaJ.et al. (1992). Glucose transporter levels in tissues of spontaneously diabetic Zucker fa/fa rat (ZDF/drt) and viable yellow mouse (Avy/a). Diabetes41, 187–193. 10.2337/diab.41.2.187
76
TeutschH. F.LowryO. H. (1982). Sex specific regional differences in hepatic glucokinase activity. Biochem. Biophys. Res. Commun.106, 533–538. 10.1016/0006-291X(82)91143-3
77
ThorensB.FlierJ. S.LodishH. F.KahnB. B. (1990). Differential regulation of two glucose transporters in rat liver by fasting and refeeding and by diabetes and insulin treatment. Diabetes39, 712–719. 10.2337/diab.39.6.712
78
TorreC.PerretC.ColnotS. (2010). Molecular determinants of liver zonation. Prog. Mol. Biol. Transl. Sci.97, 127–150. 10.1016/B978-0-12-385233-5.00005-2
79
TrusM.ZawalichK.GaynorD.MatschinskyF. (1980). Hexokinase and glucokinase distribution in the liver lobule. J. Histochem. Cytochem.28, 579–581. 10.1177/28.6.7391551
80
UyedaK.RepaJ. J. (2006). Carbohydrate response element binding protein, ChREBP, a transcription factor coupling hepatic glucose utilization and lipid synthesis. Cell Metab.4, 107–110. 10.1016/j.cmet.2006.06.008
81
Van SchaftingenE.HersH. G. (1983). The role of fructose 2,6-bisphosphate in the long-term control of phosphofructokinase in rat liver. Biochem. Biophys. Res. Commun.113, 548–554. 10.1016/0006-291X(83)91760-6
82
VasiljA.GentzelM.UeberhamE.GebhardtR.ShevchenkoA. (2012). Tissue proteomics by one-dimensional gel electrophoresis combined with label-free protein quantification. J. Proteome Res. 11, 3680–3689. 10.1021/pr300147z
83
WalsP. A.PalacinM.KatzJ. (1988). The zonation of liver and the distribution of fructose 2,6-bisphosphate in rat liver. J. Biol. Chem.263, 4876–4881.
84
WeinbergM. B.UtterM. F. (1979). Effect of thyroid-hormone on the turnover of rat-liver pyruvate-carboxylase and pyruvate-dehydrogenase. J. Biol. Chem.254, 9492–9499.
85
WeinbergM. B.UtterM. F. (1980). Effect of streptozotocin-induced diabetes mellitus on the turnover of rat liver pyruvate carboxylase and pyruvate dehydrogenase. Biochem. J. 188, 601–608. 10.1042/bj1880601
86
WeinsteinS. P.O'BoyleE.FisherM.HaberR. S. (1994). Regulation of GLUT2 glucose transporter expression in liver by thyroid hormone: evidence for hormonal regulation of the hepatic glucose transport system. Endocrinology135, 649–654. 10.1210/endo.135.2.8033812
87
WimhurstJ. M.ManchesterK. L. (1970a). A comparison of the effects of diabetes induced with either alloxan or streptozotocin and of starvation on the activities in rat liver of the key enzymes of gluconeogenesis. Biochem. J. 120, 95–103. 10.1042/bj1200095
88
WimhurstJ. M.ManchesterK. L. (1970b). Suppression of pyruvate carboxylase by glucose in perfused rat liver. Febs Lett. 8, 91–9410.1016/0014-5793(70)80232-0
89
WölfleD.JungermannK. (1985). Long-term effects of physiological oxygen concentrations on glycolysis and gluconeogenesis in hepatocyte cultures. Eur. J. Biochem.151, 299–303. 10.1111/j.1432-1033.1985.tb09100.x
90
WurtmanR. J. (1974). Daily rhythms in tyrosine-transaminase and other hepatic enzymes that metabolize amino-acids-mechanisms and possible consequences. Life Sci.15, 827–847. 10.1016/0024-3205(74)90001-0
91
YangJ.ReshefL.CassutoH.AlemanG.HansonR. W. (2009). Aspects of the control of phosphoenolpyruvate carboxykinase gene transcription. J. Biol. Chem.284, 27031–27035. 10.1074/jbc.R109.040535
92
ZalitisJ. G.PitotH. C. (1979). Synthesis and degradation of rat-liver and kidney fructose bisphosphatase Invivo.Arch. Biochem. Biophys.194, 620–631. 10.1016/0003-9861(79)90657-X
93
ZellerE.HammerK.KirschnickM.BraeuningA. (2013). Mechanisms of RAS/beta-catenin interactions. Arch. Toxicol. 87, 611–632. 10.1007/s00204-013-1035-3
Summary
Keywords
metabolism, metabolic zonation, kinetic model, multiscale model, gene expression
Citation
Berndt N and Holzhütter H-G (2018) Dynamic Metabolic Zonation of the Hepatic Glucose Metabolism Is Accomplished by Sinusoidal Plasma Gradients of Nutrients and Hormones. Front. Physiol. 9:1786. doi: 10.3389/fphys.2018.01786
Received
16 August 2018
Accepted
28 November 2018
Published
12 December 2018
Volume
9 - 2018
Edited by
Steven Dooley, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Germany
Reviewed by
Adil Mardinoglu, Chalmers University of Technology, Sweden; Rolf Gebhardt, Leipzig University, Germany
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© 2018 Berndt and Holzhütter.
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*Correspondence: Hermann-Georg Holzhütter hergo@charite.de
This article was submitted to Gastrointestinal Sciences, a section of the journal Frontiers in Physiology
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