Skip to main content

Live Attenuated Plasmodium falciparum Sporozoite (PfSPZ) Vaccines

  • Living reference work entry
  • First Online:
Encyclopedia of Malaria

Synonyms

Malaria vaccines; PfSPZ vaccines; Preerythrocytic stage malaria vaccines; Whole organism malaria vaccines

Background

Malaria sickened 247,000,000 people in 2021 and killed 619,000, mostly children and pregnant women in sub-Saharan Africa, despite the availability of effective antimalarial drugs, long-lasting insecticide-impregnated bednets, and vector control measures (World Health Organization 2022a). These stark numbers have varied little in recent years, notwithstanding the expenditure of US$3.0–$4.0B per annum to combat malaria. In fact, there were more deaths from malaria in 2020 and 2021 than in any year since 2012, and in sub-Saharan Africa, there were four times as many deaths from malaria than from COVID-19 during these years. A highly effective vaccine is urgently needed, especially for Plasmodium falciparum(Pf), which is responsible for more than 98% of all deaths from malaria. Recognizing this requirement, in September 2022, the World Health Organization (WHO)...

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Ballou WR, Hoffman SL, Sherwood JA, Hollingdale MR, Neva FA, Hockmeyer WT, Gordon DM, Schneider I, Wirtz RA, Young JF, Wasserman GF, Reeve P, Diggs CL, Chulay JD. Safety and efficacy of a recombinant DNA Plasmodium falciparum sporozoite vaccine. Lancet. 1987;1:1277–81.

    Article  CAS  PubMed  Google Scholar 

  • Bastiaens GJ, Van Meer MP, Scholzen A, Obiero JM, Vatanshenassan M, Van Grinsven T, Sim BK, Billingsley PF, James ER, Gunasekera A, Bijker EM, Van Gemert GJ, Van De Vegte-Bolmer M, Graumans W, Hermsen CC, De Mast Q, Van Der Ven AJ, Hoffman SL, Sauerwein RW. Safety, immunogenicity, and protective efficacy of intradermal immunization with aseptic, purified, cryopreserved Plasmodium falciparum sporozoites in volunteers under chloroquine prophylaxis: a randomized controlled trial. Am J Trop Med Hyg. 2016;94:663–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Beaudoin RL, Strome CPA, Mitchell F, Tubergen TA. Plasmodium berghei: immunization of mice against the ANKA strain using the unaltered sporozoite as an antigen. Exp Parasitol. 1977;42:1–5.

    Article  CAS  PubMed  Google Scholar 

  • Clyde DF, Most H, Mccarthy VC, Vanderberg JP. Immunization of man against sporozoite-induced falciparum malaria. Am J Med Sci. 1973;266:169–77.

    Article  CAS  PubMed  Google Scholar 

  • Diawara H. ‘Pre-conception PfSPZ vaccine: safety and efficacy during subsequent pregnancy in Ouélessébougou, Mali’ annual meeting of the American Society of Tropical Medicine and Hygiene. Oral presentation Wednesday, November 2, 2022. 2022.

    Google Scholar 

  • Eappen AG, Li T, Marquette M, Chakravarty S, Kc N, Zanghi G, Hoffman BU, Hettiarachchi H, Patil A, Abebe Y, Tran C, Yossef A, Mcwilliams I, Morrison RD, Rathakrishnan A, Inbar E, Aly ASI, De La Vega P, Belmonte M, Sedegah M, Wai T, Campo JJ, King H, Kappe SHI, Li M, Billingsley PF, Sim BKL, Hoffman SL. In vitro production of infectious Plasmodium falciparum sporozoites. Nature. 2022;612:534–9.

    Article  CAS  PubMed  Google Scholar 

  • Epstein JE, Tewari K, Lyke KE, Sim BK, Billingsley PF, Laurens MB, Gunasekera A, Chakravarty S, James ER, Sedegah M, Richman A, Velmurugan S, Reyes S, Li M, Tucker K, Ahumada A, Ruben AJ, Li T, Stafford R, Eappen AG, Tamminga C, Bennett JW, Ockenhouse CF, Murphy JR, Komisar J, Thomas N, Loyevsky M, Birkett A, Plowe CV, Loucq C, Edelman R, Richie TL, Seder RA, Hoffman SL. Live attenuated malaria vaccine designed to protect through hepatic CD8+T cell immunity. Science. 2011;334:475–80.

    Article  CAS  PubMed  Google Scholar 

  • Epstein JE, Paolino KM, Richie TL, Sedegah M, Singer A, Ruben AJ, Chakravarty S, Stafford A, Ruck RC, Eappen AG, Li T, Billingsley PF, Manoj A, Silva JC, Moser K, Nielsen R, Tosh D, Cicatelli S, Ganeshan H, Case J, Padilla D, Davidson S, Garver L, Saverino E, Murshedkar T, Gunasekera A, Twomey PS, Reyes S, Moon JE, James ER, Kc N, Li M, Abot E, Belmonte A, Hauns K, Belmonte M, Huang J, Vasquez C, Remich S, Carrington M, Abebe Y, Tillman A, Hickey B, Regules J, Villasante E, Sim BK, Hoffman SL. Protection against Plasmodium falciparum malaria by PfSPZ vaccine. JCI Insight. 2017;2:e89154.

    Article  PubMed  PubMed Central  Google Scholar 

  • Franke-Fayard B. Development and clinical evaluation of genetically attenuated parasite that arrests late in the liver. Oral presentation Tues, Nov 1, 10:45 am, 2022 annual meeting of the American Society for Tropical Medicine and Hygiene. 2022.

    Google Scholar 

  • Goswami D, Betz W, Locham NK, Parthiban C, Brager C, Schäfer C, Camargo N, Nguyen T, Kennedy SY, Murphy SC, Vaughan AM, Kappe SHI. A replication-competent late liver stage–attenuated human malaria parasite. JCI Insight. 2020;5:e135589.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hoffman SL, Isenbarger D, Long GW, Sedegah M, Szarfman A, Waters L, Hollingdale MR, Van Der Meide PH, Finbloom DS, Ballou WR. Sporozoite vaccine induces genetically restricted T cell elimination of malaria from hepatocytes. Science. 1989;244:1078–81.

    Article  CAS  PubMed  Google Scholar 

  • Hoffman SL, Goh LM, Luke TC, Schneider I, Le TP, Doolan DL, Sacci J, De La Vega P, Dowler M, Paul C, Gordon DM, Stoute JA, Church LW, Sedegah M, Heppner DG, Ballou WR, Richie TL. Protection of humans against malaria by immunization with radiation-attenuated Plasmodium falciparum sporozoites. J Infect Dis. 2002;185:1155–64.

    Article  PubMed  Google Scholar 

  • Hoffman SL, Billingsley PF, James E, Richman A, Loyevsky M, Li T, Chakravarty S, Gunasekera A, Li M, Stafford R, Ahumada A, Epstein JE, Sedegah M, Reyes S, Richie TL, Lyke KE, Edelman R, Laurens M, Plowe CV, Sim BK. Development of a metabolically active, non-replicating sporozoite vaccine to prevent Plasmodium falciparum malaria. Hum Vaccin. 2010;6:97–106.

    Article  CAS  PubMed  Google Scholar 

  • Ishizuka AS, Lyke KE, Dezure A, Berry AA, Richie TL, Mendoza FH, Enama ME, Gordon IJ, Chang LJ, Sarwar UN, Zephir KL, Holman LA, James ER, Billingsley PF, Gunasekera A, Chakravarty S, Manoj A, Li M, Ruben AJ, Li T, Eappen AG, Stafford RE, CN K, Murshedkar T, Decederfelt H, Plummer SH, Hendel CS, Novik L, Costner PJ, Saunders JG, Laurens MB, Plowe CV, Flynn B, Whalen WR, Todd JP, Noor J, Rao S, Sierra-Davidson K, Lynn GM, Epstein JE, Kemp MA, Fahle GA, Mikolajczak SA, Fishbaugher M, Sack BK, Kappe SH, Davidson SA, Garver LS, Bjorkstrom NK, Nason MC, Graham BS, Roederer M, Sim BK, Hoffman SL, Ledgerwood JE, Seder RA. Protection against malaria at 1 year and immune correlates following PfSPZ vaccination. Nat Med. 2016;22:614–23.

    Article  CAS  PubMed  Google Scholar 

  • Jongo SA, Church LWP, Mtoro AT, Chakravarty S, Ruben AJ, Swanson PA, Kassim KR, Mpina M, Tumbo AM, Milando FA, Qassim M, Juma OA, Bakari BM, Simon B, James ER, Abebe Y, Kc N, Saverino E, Gondwe L, Studer F, Fink M, Cosi G, El-Khorazaty J, Styers D, Seder RA, Schindler T, Billingsley PF, Daubenberger C, Sim BKL, Tanner M, Richie TL, Abdulla S, Hoffman SL. Safety and differential antibody and t-cell responses to the Plasmodium falciparum sporozoite malaria vaccine, PfSPZ vaccine, by age in Tanzanian adults, adolescents, children, and infants. Am J Trop Med Hyg. 2019;100:1433–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jongo SA, Church LWP, Mtoro AT, Schindler T, Chakravarty S, Ruben AJ, Swanson PA, Kassim KR, Mpina M, Tumbo A-M, Milando FA, Qassim M, Juma OA, Bakari BM, Simon B, James ER, Abebe Y, Kc N, Saverino E, Fink M, Cosi G, Gondwe L, Studer F, Styers D, Seder RA, Schindler T, Billingsley PF, Daubenberger C, Sim BKL, Tanner M, Richie TL, Abdulla S, Hoffman SL. Increase of dose associated with decrease in protection against controlled human malaria infection by PfSPZ vaccine in Tanzanian adults. Clin Infect Dis. 2020;71:2849–57.

    Article  CAS  PubMed  Google Scholar 

  • Jongo SA, Urbano V, Church LWP, Olotu A, Manock SR, Schindler T, Mtoro A, Kc N, Hamad A, Nyakarungu E, Mpina M, Deal A, Bijeri JR, Ondo Mangue ME, Ntutumu Pasialo BE, Nguema GN, Owono SN, Rivas MR, Chemba M, Kassim KR, James ER, Stabler TC, Abebe Y, Saverino E, Sax J, Hosch S, Tumbo AM, Gondwe L, Segura JL, Falla CC, Phiri WP, Hergott DEB, García GA, Schwabe C, Maas CD, Murshedkar T, Billingsley PF, Tanner M, Ayekaba MO, Sim BKL, Daubenberger C, Richie TL, Abdulla S, Hoffman SL. Immunogenicity and protective efficacy of radiation-attenuated and chemo-attenuated PfSPZ vaccines in Equatoguinean adults. Am J Trop Med Hyg. 2021;104:283–93.

    Article  CAS  PubMed  Google Scholar 

  • Kublin JG, Mikolajczak SA, Sack BK, Fishbaugher ME, Seilie A, Shelton L, Vongoedert T, Firat M, Magee S, Fritzen E, Betz W, Kain HS, Dankwa DA, Steel RW, Vaughan AM, Noah Sather D, Murphy SC, Kappe SH. Complete attenuation of genetically engineered Plasmodium falciparum sporozoites in human subjects. Sci Transl Med. 2017;9:eaad9099.

    Article  PubMed  Google Scholar 

  • Luke TC, Hoffman SL. Rationale and plans for developing a non-replicating, metabolically active, radiation-attenuated Plasmodium falciparum sporozoite vaccine. J Exp Biol. 2003;206:3803–8.

    Article  PubMed  Google Scholar 

  • Lyke KE, Ishizuka AS, Berry AA, Chakravarty S, Dezure A, Enama ME, James ER, Billingsley PF, Gunasekera A, Manoj A, Li M, Ruben AJ, Li T, Eappen AG, Stafford RE, Kc N, Murshedkar T, Mendoza FH, Gordon IJ, Zephir KL, Holman LA, Plummer SH, Hendel CS, Novik L, Costner PJ, Saunders JG, Berkowitz NM, Flynn BJ, Nason MC, Garver LS, Laurens MB, Plowe CV, Richie TL, Graham BS, Roederer M, Sim BK, Ledgerwood JE, Hoffman SL, Seder RA. Attenuated PfSPZ vaccine induces strain-transcending t cells and durable protection against heterologous controlled human malaria infection. Proc Natl Acad Sci U S A. 2017;114:2711–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mordmüller B, Surat G, Lagler H, Chakravarty S, Ishizuka AS, Lalremruata A, Gmeiner M, Campo JJ, Esen M, Ruben AJ, Held J, Calle CL, Mengue JB, Gebru T, Ibanez J, Sulyok M, James ER, Billingsley PF, Natasha KC, Manoj A, Murshedkar T, Gunasekera A, Eappen AG, Li T, Stafford RE, Li M, Felgner PL, Seder RA, Richie TL, Sim BK, Hoffman SL, Kremsner PG. Sterile protection against human malaria by chemoattenuated PfSPZ vaccine. Nature. 2017;542:445–9.

    Google Scholar 

  • Mordmüller B, Sulyok Z, Sulyok M, Molnar Z, Lalremruata A, Calle CL, Bayon PG, Esen M, Gmeiner M, Held J, Heimann HL, Woldearegai TG, Ibanez J, Flugge J, Fendel R, Kreidenweiss A, Kc N, Murshedkar T, Chakravarty S, Riyahi P, Billingsley PF, Church LWP, Richie TL, Sim BKL, Hoffman SL, Kremsner PG. A pfspz vaccine immunization regimen equally protective against homologous and heterologous controlled human malaria infection. NPJ Vaccines. 2022;7:100.

    Google Scholar 

  • Mwakingwe-Omari A, Healy SA, Lane J, Cook DM, Kalhori S, Wyatt C, Kolluri A, Marte-Salcedo O, Imeru A, Nason M, Ding LK, Decederfelt H, Duan J, Neal J, Raiten J, Lee G, Hume JCC, Jeon JE, Ikpeama I, Kc N, Chakravarty S, Murshedkar T, Church LWP, Manoj A, Gunasekera A, Anderson C, Murphy SC, March S, Bhatia SN, James ER, Billingsley PF, Sim BKL, Richie TL, Zaidi I, Hoffman SL, Duffy PE. Two chemoattenuated PfSPZ malaria vaccines induce sterile hepatic immunity. Nature. 2021;595:289–94.

    Article  CAS  PubMed  Google Scholar 

  • Nussenzweig RS, Vanderberg J, Most H, Orton C. Protective immunity produced by the injection of x-irradiated sporozoites of Plasmodium berghei. Nature. 1967;216:160–2.

    Article  CAS  PubMed  Google Scholar 

  • Oneko M, Steinhardt LC, Yego R, Wiegand RE, Swanson PA, Kc N, Akach D, Sang T, Gutman JR, Nzuu EL, Dungani A, Kim Lee Sim B, Oloo PN, Otieno K, Bii DK, Billingsley PF, James ER, Kariuki S, Samuels AM, Jongo S, Chebore W, Abdulla S, Daubenberger C, Mpina M, Styers D, Potter GE, Abarbanell G, Richie TL, Hoffman SL, Seder RA. Safety, immunogenicity and efficacy of PfSPZ Vaccine against malaria in infants in western Kenya: a double-blind, randomized, placebo-controlled phase 2 trial. Nat Med. 2021;27:1636–45.

    Google Scholar 

  • Pradel G, Garapaty S, Frevert U. Kupffer and stellate cell proteoglycans mediate malaria sporozoite targeting to the liver. Comp Hepatol. 2004;3(Suppl 1):S47.

    Google Scholar 

  • Reuling IJ, Mendes AM, De Jong GM, Fabra-García A, Nunes-Cabaço H, Van Gemert GJ, Graumans W, Coffeng LE, De Vlas SJ, Yang ASP, Lee C, Wu Y, Birkett AJ, Ockenhouse CF, Koelewijn R, Van Hellemond JJ, Van Genderen PJJ, Sauerwein RW, Prudêncio M. An open-label phase 1/2a trial of a genetically modified rodent malaria parasite for immunization against Plasmodium falciparum malaria. Sci Transl Med. 2020;12(544):2578.

    Google Scholar 

  • Richie TL, Church LWP, Murshedkar T, Billingsley PF, James ER, Chen M-C, Abebe Y, Kc N, Healy SA, Diawara H, Sissoko MS, Sagara I, Cook DM, Epstein JE, Mordmüller B, Chakravarty S, Kapulu MC, Kreidenweiss A, Franke-Fayard B, Agnandji ST, Mccall MBB, Vaughan AM, Kublin JG, Murphy SC, Jongo S, Tanner M, Sirima SB, Laurens MB, Daubenberger C, Silva JC, Lyke KE, Janse CJ, Roestenberg M, Abdulla S, Dicko A, Kappe SHI, Sim BKL, Duffy PE, Kremsner PG, Hoffman SL. Sporozoite immunization: innovative translational science to support the fight against malaria. Expert Rev Vaccines. 2023 (in press).

    Google Scholar 

  • Rieckmann KH, Carson PE, Beaudoin RL, Cassells JS, Sell KW. Sporozoite induced immunity in man against an Ethiopian strain of Plasmodium falciparum. Trans R Soc Trop Med Hyg. 1974;68:258–9.

    Article  CAS  PubMed  Google Scholar 

  • Roestenberg M, Mccall M, Hopman J, Wiersma J, Luty AJ, Van Gemert GJ, Van De Vegte-Bolmer M, Van Schaijk B, Teelen K, Arens T, Spaarman L, De Mast Q, Roeffen W, Snounou G, Renia L, Van Der Ven A, Hermsen CC, Sauerwein R. Protection against a malaria challenge by sporozoite inoculation. N Engl J Med. 2009;361:468–77.

    Article  CAS  PubMed  Google Scholar 

  • Roestenberg M, Teirlinck AC, Mccall MB, Teelen K, Makamdop KN, Wiersma J, Arens T, Beckers P, Van Gemert G, Van De Vegte-Bolmer M, Van Der Ven AJ, Luty AJ, Hermsen CC, Sauerwein RW. Long-term protection against malaria after experimental sporozoite inoculation: an open-label follow-up study. Lancet. 2011;377:1770–6.

    Article  CAS  PubMed  Google Scholar 

  • Roestenberg M, Walk J, Van Der Boor SC, Langenberg MCC, Hoogerwerf MA, Janse JJ, Manurung M, Yap XZ, García AF, Koopman JPR, Meij P, Wessels E, Teelen K, Van Waardenburg YM, Van De Vegte-Bolmer M, Van Gemert GJ, Visser LG, Van Der Ven A, De Mast Q, Natasha KC, Abebe Y, Murshedkar T, Billingsley PF, Richie TL, Sim BKL, Janse CJ, Hoffman SL, Khan SM, Sauerwein RW. A double-blind, placebo-controlled phase 1/2a trial of the genetically attenuated malaria vaccine PfSPZ-GA1. Sci Transl Med. 2020;12:eaaz5629.

    Article  CAS  PubMed  Google Scholar 

  • Schofield L, Villaquiran J, Ferreira A, Schellekens H, Nussenzweig RS, Nussenzweig V. Gamma-interferon, CD8+ T cells and antibodies required for immunity to malaria sporozoites. Nature. 1987;330:664–6.

    Article  CAS  PubMed  Google Scholar 

  • Seder RA, Chang LJ, Enama ME, Zephir KL, Sarwar UN, Gordon IJ, Holman LA, James ER, Billingsley PF, Gunasekera A, Richman A, Chakravarty S, Manoj A, Velmurugan S, Li M, Ruben AJ, Li T, Eappen AG, Stafford RE, Plummer SH, Hendel CS, Novik L, Costner PJ, Mendoza FH, Saunders JG, Nason MC, Richardson JH, Murphy J, Davidson SA, Richie TL, Sedegah M, Sutamihardja A, Fahle GA, Lyke KE, Laurens MB, Roederer M, Tewari K, Epstein JE, Sim BK, Ledgerwood JE, Graham BS, Hoffman SL, For the Vrc 312 Study Team. Protection against malaria by intravenous immunization with a nonreplicating sporozoite vaccine. Science. 2013;341:1359–65.

    Article  CAS  PubMed  Google Scholar 

  • Sirima SB, Ouédraogo A, Tiono AB, Kaboré JM, Bougouma EC, Ouattara MS, Kargougou D, Diarra A, Henry N, Ouédraogo IN, Billingsley PF, Manoj A, Abebe Y, Kc N, Reuben A, Richie TL, James ER, Joshi S, Shrestha B, Strauss K, Lyke KE, Plowe CV, Potter GE, Cox C, Jones W, Sim BKL, Hoffman SL, Laurens MB. A randomized controlled trial showing safety and durable efficacy of a whole sporozoite vaccine against endemic malaria. Sci Transl Med. 2022;14:eabj3776.

    Article  CAS  PubMed  Google Scholar 

  • Sissoko MS, Healy SA, Katile A, Omaswa F, Zaidi I, Gabriel EE, Kamate B, Samake Y, Guindo MA, Dolo A, Niangaly A, Niare K, Zeguime A, Sissoko K, Diallo H, Thera I, Ding K, Fay MP, O’connell EM, Nutman TB, Wong-Madden S, Murshedkar T, Ruben AJ, Li M, Abebe Y, Manoj A, Gunasekera A, Chakravarty S, Sim BK, Billingsley PF, James ER, Walther M, Richie TL, Hoffman SL, Doumbo O, Duffy PE. Safety and efficacy of PfSPZ vaccine against Plasmodium falciparum via direct venous inoculation in healthy malaria-exposed adults in Mali: a randomised, double-blind phase 1 trial. Lancet Infect Dis. 2017;17:498–509.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sissoko MS, Healy SA, Katile A, Zaidi I, Hu Z, Kamate B, Samake Y, Sissoko K, Mwakingwe-Omari A, Lane J, Imeru A, Mohan R, Thera I, Guindo CO, Dolo A, Niare K, Koïta F, Niangaly A, Rausch KM, Zeguime A, Guindo MA, Bah A, Abebe Y, James ER, Manoj A, Murshedkar T, Kc N, Sim BKL, Billingsley PF, Richie TL, Hoffman SL, Doumbo O, Duffy PE. Safety and efficacy of a three-dose regimen of Plasmodium falciparum sporozoite vaccine in adults during an intense malaria transmission season in Mali: a randomised, controlled phase 1 trial. Lancet Infect Dis. 2022;22:377–89.

    Article  CAS  PubMed  Google Scholar 

  • Wang R, Doolan DL, Le TP, Hedstrom RC, Coonan KM, Charoenvit Y, Jones TR, Hobart P, Margalith M, Ng J, Weiss WR, Sedegah M, De Taisne C, Norman JA, Hoffman SL. Induction of antigen-specific cytotoxic T lymphocytes in humans by a malaria DNA vaccine. Science. 1998;282:476–80.

    Article  CAS  PubMed  Google Scholar 

  • Weiss WR, Sedegah M, Beaudoin RL, Miller LH, Good MF. Cd8+ T cells (cytotoxic/suppressors) are required for protection in mice immunized with malaria sporozoites. Proc Natl Acad Sci U S A. 1988;85:573–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Weiss WR, Mellouk S, Houghten RA, Sedegah M, Kumar S, Good MF, Berzofsky JA, Miller LH, Hoffman SL. Cytotoxic t cells recognize a peptide from the circumsporozoite protein on malaria-infected hepatocytes. J Exp Med. 1990;171:763–73.

    Article  CAS  PubMed  Google Scholar 

  • World Health Organization. Malaria vaccines: preferred product characteristics and clinical development considerations. Geneva: World Health Organization; 2022a. Licence: CC BY-NC-SA 3.0 IGO.

    Google Scholar 

  • World Health Organization. World malaria report 2022. Geneva: World Health Organization; 2022b. Licence: CC BY-NC-SA 3.0 IGO.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas L. Richie .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Science+Business Media, LLC, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Richie, T.L., Hoffman, S.L. (2023). Live Attenuated Plasmodium falciparum Sporozoite (PfSPZ) Vaccines. In: Kremsner, P.G., Krishna, S. (eds) Encyclopedia of Malaria. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8757-9_129-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8757-9_129-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8757-9

  • Online ISBN: 978-1-4614-8757-9

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics