PHYSIOLOGY AND MANAGEMENT Mammary-Derived Growth Inhibitor Protein and Messenger Ribonucleic Acid Concentrations in Different Physiological States of the Gland I. POLITIS and R. C. GOREWrr Department of Animal Science Cornell University Ithaca 14853

T. MUllER and R. GROSSE Department of Cellular Biochemistry Academy of SCiences Berlin-Buch, Germany 1115 ABSTRACT

Expression of manunary-derived growth inhibitor in tissue from lactating and involuting bovine mammary glands was investigated. Seventeen lactating, pregnant (220 to 272 d in gestation) cows were divided in two groups of 8 and 9 cows each. Cows of the first group were slaughtered while in lactation. Cows of the second group (9 involuting cows) were slaughtered at 13 to 52 d following sudden cessation of milking. Hi~ concentrations of mammarydenved growth inhibitor (.63% of the total protein) were detected in mammary tissue of lactating cows. Mammaryderived growth inhibitor «.10% of the total protein) was dramatically reduced during most of the involution period (13 to 45 d following cessation of milking). Mammary-derived growth inhibitor was ag~ detected (.28% of the total protein) dunng the last stage of the involution (46 to 53 d after cessation of milking), which coincided with colostrum formation. When steady state concentrations of mammary-derived growth inhibitor mRNA were examined, the results obtained mirrored those obtained at the protein concentration. These data suggest that regulation of manunary-derived growth inhibitor occurs via modulation of the steady state concentration of its mRNA. Furthermore, there is a strong

Received December 12, 1991. Accepted February 10, 1992. 1992 I Dairy Sci 75:1423-1429

correlation between mammary-derived growth inhibitor expression and lactation in dairy cows. (Key words: mammary-derived growth inhibitor, lactation, involution) Abbreviation key: MDGI derived growth inhibitor.

=

mammary-

INTRODUCTION

Mammary-derived growth inhibitor (MDGI) is a 13-kDa protein purified from the lactating bovine mammary gland (2, 9, 10). In situ hybridization and immunohistochemical analysis showed that MOOI is actually produced by mammary epithelial cells (9). Mammary-derived growth inhibitor inhibits proliferation of several normal and transformed mammary epithelial cell lines in a dosedependent and reversible manner (6). The MOOI protein and mRNA are higher in fully differentiated lactating glands than in rapidly developing glands of pregnant animals (9, 10). Mamm~-derived growth inhibitor may fulfill a role m the onset of differentiation coupled with inhibition of mammary epithelial cell proliferation (6). D~ cows require a nonlactating period of approXImately 60 d prior to lactation to achieve maximal milk. production in the subsequ~t lactation (8, 11, 15). The nonlactating penod of the dairy cow is divided into three distinct stages: 1) an initial period of active involution, which begins just after the cessation of milking and is completed by approximately 30 d in the dry period; 2) a period of steady state involution (31 to 45 d after cessation of milking); and 3) a period of colostrum formation prior to the initiation of lactation (46 1423

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POUTIS ET AL.

to 60 d following cessation of milking) (8, 14,

15). Politis et al. (12, 13) detected very low concentrations of MOOI in the mammary glands of dairy cows during the first two stages of mammary involution. It is not known whether MOOI is expressed in the bovine mammary gland during the last stage of involution, which coincides with colostrum fonnation. Furthermore, there is no published information on changes of MOOI mRNA between lactating and involuting animals. The objective of the present study was to investigate changes in MOOI mRNA and protein concentrations between lactating and involuting animals. Emphasis was placed on the last stage of involution, which coincided with colostrum formation. Our work provides more basic knowledge toward understanding the molecular events affecting MOOI expression during mammary growth and development. MATERIALS AND METHODS Animals

Seventeen lactating, pregnant (220 to 272 d in gestation) Holstein cows were used throughout this investigation. Eight cows were slaughtered while in lactation. The remaining 9 cows were slaughtered during the dry period according to the following schedule: 3 cows at 12 to 30 d, another set of 3 cows at 31 to 45 d, and the remaining 3 cows at 46 to 53 d following sudden cessation of milking. These days were chosen to correspond with the three distinct stages of the involution process: active involution, steady state involution, and colostrum formation (8, 14, 15). Cessation of milking occurred at approximately 300 DIM. At slaughter, the udder was removed quickly, and approximately 15 to 20 g of mammary tissue parenchyma were dissected, frozen in liquid nitrogen, and transported inunediately to our laboratory. Tissue Preparation for MDGI Protein Determination

Mammary tissue (10 g), obtained at the local slaughter house, was minced with scissors and homogenized using a Brinkman homogenizer (Kinematica GmbH, Steinhofbalde, Switzerland) in 25 ml of homogenization buffer (50 mM Tris·HCI, pH 7.5,25 mM KCl, Ioumal of Dairy Science Vol. 75, No.6, 1992

5 rnM MgCl2) supplemented with .25 M sucrose and protease inhibitors: pepstatin A (.5 J.1g/ml) and phenylmethylsulfonylsulfate (.5 mM). The homogenate was centrifuged at 1000 X g for 10 min. The supernatant was recovered and centrifuged at 100,000 x g for 30 min to obtain a pellet containing microsomes and mitochondria and a supernatant denoted as the cytoplasmic fraction. Detection of MDGI Antigen

Western blot analysis using anti-MOO! rabbit serum was employed to examine the presence or absence of MOOI in the cytoplasmic fraction of bovine mammary tissue (12, 13). The cytoplasmic fraction contains the majority of MOOI present in the mammary cells (10, 12, 13). Anti-MOOI rabbit IgO was produced by R. Grosse in the Central Institute of Molecular Biology, Academy of Sciences, BerlinBuch, Germany. All details regarding preparation and the specificity of this antibody have been described earlier (2, 10, 12, 13). The SDS-PAGE was carried out using 15% acrylamide-resolving gels and 4% acrylamidestacking gels as described by Bohmer et al. (2). Samples were electrophoresed in .02 M Tris, .15 M glycine buffer (pH 8.3) at 30 rnA for 5 h along with standards from 2.5 to 116 kDa (Sigma Chemical Co., St. Louis, MO) in adjacent lanes. Gel portions containing standards were cut, stained for 30 min in 1% (wt/ vol) Coomassie brilliant blue dye and 50% (wt/vol) trichloroacetic acid, and destained in 20% (voVvol) acetic acid. Portions of the gels containing fractionated proteins present in the cytoplasmic fraction of mammary tissue were further processed for Western blots. Western blots were prepared using immobiIon membranes (Millipore, Bedford, MA). Electrostatic transfer of samples previously fractionated by SDS-PAGE (30 V, 12 h, 4"C; Bio-Rad Transblot apparatus, Bio-Rad, Richmond, CA) was carried out in .02 M Tris, .15 M glycine (pH 8.3) containing 20% methanol. Initially, membranes were incubated at room temperature for 30 min in Tris-buffered saline (50 mM Tris, .9% NaCI, pH 7.5) containing 3% gelatin. Subsequently, all washes and incubations were carried out with Tris-buffered saline containing 1% gelatin. After washing, the membranes were incubated for 12 h with

MAMMARY-DERIVED GROwrn INHIBITOR

anti-MOOI rabbit IgG (2 J.lg/ml); they were then washed and incubated for 2 h with the secondary antibody, peroxidase-conjugated anti-rabbit IgG (1:1000 dilution; Sigma Chemical Co.). To ensure antibody specificity, a control lane was loaded with 1 J.lg of purified MOOI. The MOOI antigen was purified by R. Grosse in the Central Institute of Molecular Biology. All details of this purification procedure have been described earlier (6). All membranes were washed and stained with .003% hydrogen peroxide and 4-chloro-I-naphthol (.6 mg/ml; Bio-Rad). Determination of MDGI Protein Content

An ELISA methodology was developed to measure MOOI concentration in the cytoplasmic fraction of bovine mammary cells obtained from lactating and involuting glands. Briefly, test samples were initially incubated in .1% SDS at 37°C for 30 min. This step is necessary because MOOI has the tendency to precipitate. Samples were then diluted in .1 M sodium bicarbonate buffer (pH 9.6), incubated overnight at 4°C in a 96-well polystyrene microtiter plate, and then equilibrated for 1 h at 37°C with 100 J.ll of anti-MOOI rabbit IgG (.8 J.lg/ml). Wells were washed six times with PBS (.14 M NaCl, .01 M NaH2P04, pH 7.2) containing .05% Tween 80, incubated for 1 h at 37°C with 100 J.ll of anti-rabbit IgO-peroxidase conjugate (1 :2000 dilution), and washed again six times with PBS. One hundred microliters of .182 mM 2',2'-azineo-diethylbenzothiazoline sulfonate (Sigma Chemical Co.) in .1 M citrate buffer (pH 5.2) containing .003% hydrogen peroxide were then added to each well. Absorbance was measured at 405 om after 10 min. Controls included in the assays were 1) wells coated with bovine serum albumin without sample and 2) wells with the first antibody layer substituted by nonimmune serum. The sensitivity of this assay system was 1 ng/ml, and absOlbance was linear with MOOI concentration up to 10 ng/ml. Recovery of an added mass of MOOI was 91.8%, and intraassay and interassay coefficients of variation were less than 10%. The MOOI protein concentration was expressed as micrograms of MOOI per milligram of total protein. Total protein in cytoplasmic and microsomal fractions of mammary tissue

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was determined by the method of Bradford (3) using bovine serum albumin as a standard. Isolation of Total RNA from Mammary Tissue

Total cellular RNA from mammary tissue was isolated by the method of Chomczynski and Sacchi (4). Mammary tissue (1 g) was cut into small pieces, while frozen, with a sterile razor blade in a petri dish. Mammary gland pieces were lysed by the addition of 10 ml of RNAzoI (CINNA/BIOTECH, Frienswood, TX). The larger pieces of the tissue were homogenized by drawing the lysis buffer and tissue through a syringe fitted with an I8-gauge needle and subsequently were transferred to a fresh polypropylene tube. One milliliter of chloroform was then added, and the fmal suspension was mixed vigorously and then placed on ice for 15 min. Samples were centrifuged at 10,000 x g for 20 min at 4°C. After centrifugation, the upper aqueous phase containing RNA was transferred to a new tube, mixed with an equal volume of isopropanol, and then placed at -70°C for 1 h to precipitate RNA. Sedimentation at 10,000 x g for 20 min was then performed, the supernatant was discarded, and the RNA pellet was washed twice with 95% ethanol, sedimented, vacuum dried (15 min), and dissolved in .2 ml of H20. Northern Blot Analysis

Hybridization of immobilized RNA to radiolabeled cDNA probes was performed as described previously (l). Briefly, 8 J.lg of total RNA were separated by electrophoresis on a 1.2% agarose gel containing 6% formaldehyde. The gel was rinsed twice in 10 x SSC (.15 M NaCl, .015 M sodium citrate, pH 7.0) for 10 min at room temperature, and the RNA was transferred to zeta probe membranes (Bio-Rad) by capillary blotting with 20 x SSC for 20 h. Following transfer, the membrane was placed in a plastic bag containing 8 ml of prehybridization buffer [50% formamide, 4 x (.15 M NaCl, .01 M NaH2P04, 1 mM EDTA, pH 7.4), 1% SDS, 200 J.lg/ml of salmon sperm DNA, and 5 mg/ml of skim milk powder] for 20 h at 42°C. Membranes were hybridized in the same solution containing 4 x lOS cpm/ml of 32p-labeled MOOI cDNA, labeled using nicktranslation (1). The membranes were washed at 42°C for 20 min in approximately 300 ml of 2 10umal of Daily Science Vol. 75, No.6. 1992

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• a

b

13 kDa

c

Figure l. Western blot analysis of mammary tissue mammary-derived growth inhibitor (MOOI). Proteins from cytoplasmic fraction of mammary cens were separated by SDS-PAGE. blotted onto nitrocellulose, and detected with antiMOOI rabbit serum and anti-rabbit IgG-peroxidase conjugate. Lane a. IS J.l8 of cytoplasmic mammary cell extract obtained from involuting cows (4 to 53 d following cessation of milking); lane b, 5 ~g of cytoplasmic mammary cell extract obtained from lactating cows; lane c, .35 J.l8 of purifIed MOO!.

x SSC-.l% SOS, then with .5 x SSC-.l%

physiological stages. Figure 1 shows the presence of a 13-kDa immunoreactive MOOI antigen in mammary tissue obtained from involuting cows at 46 to 53 d after cessation of milking Oane a) and from lactating cows Oane b), which comigrated with purified MOOI (lane c). To gain more insight into the pattern of MOOI production, ELISA methodology was employed to measure MOOI protein concentrations in mammary tissue. Table 1 shows the presence of high concentrations of MOOI (6.3 Jlg/mg of total protein) in mammary tissue obtained from lactating cows. However, MOOI was present at very low concentrations «.8 Jlg/mg of total protein) in' mammary tissue Statistical Analysis obtained from mammary glands at the first All data were expressed as means and stan- stage Oess than 30 d after cessation of milldng) dard deviations. Differences between means or second stage (31 to 45 d after cessation of were evaluated using the Student's t test (P < milldng) of involution. The MOOI was again detected (2.8 Jlg/mg of total protein) during the .05). last stage of involution (46 to 53 d ?Jter cessation of milking), which coincided with colosRESULTS trum formation. Western blot analysis was performed to esTo investigate the level at which the exprestablish the presence of MOOI antigen in mam- sion of MOOI is regulated, the steady state mary tissue obtained from glands at different concentrations of MOOI mRNA concentraSOS, and then .1 x SSC-.l% SOS. The membranes were then exposed to Kodak XAR-S xray film (Eastman Kodak. Co., Rochester, NY) at _72°C for 24 h using two intensifying screens. Relative radioactivity was estimated from the autoradiograms by densitometry. Membranes were stripped with 50 roM NaOH at room temperature for 30 min and were probed for a second time with a mouse 18-S rRNA probe to estimate the amount of total RNA in each lane and, therefore, to normalize for variability in RNA loaded to each well and transfer efficiency.

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MAMMARY-DERIVED GROWTII INlllBITOR

.8 kb a

b

c

d

Figure 2. Mammary-derived growth inhibitor (MOO!) mRNA isolated from mammary tissue obtained from lactating and involuting glands. Total RNA (8 118) was electrophoresed on agarose gel and transferred to membrane, and the filter was probed with a nick-translated MOOI cDNA probe. Lanes a and b, total RNA isolated from lactating mammary glands; Lanes c and d, total RNA isolated from involuting mammary glands (46 to 53 d following cessation of milking).

tions were explored. Total RNA from bovine mammary tissue was hybridized with a bovine MOOI eDNA, and the results are presented in Figure 2. As shown, bovine MOOI was encoded by a single RNA species of approximately 800 nucleotides long, a size in agreement with that previously reported (6). Relative amounts of MOOI mRNA were initially determined by scanning the autoradiogram. Then, the blot was stripped, hybridized with a 18-S rRNA probe, and scanned for a second time to estimate the amount of total RNA in each lane. Values obtained for MOOI mRNA from the ftrst scanning were then divided by the corresponding 18-S rRNA values from the second scanning, therefore accounting for variability in the amount of RNA loaded to each lane and transfer efficiency. The normalized values were then expressed as percentage of the maximal stimulation; the maximally stimulated sample was arbitrarily assigned a value of 100%. The results are presented in Table 2. As shown, maximal stimulation of MOOI mRNA occurred in mammary tissue obtained from lactating animals. Lower (threefold) MOOI mRNA were detected in mammary tissue obtained from involuting animals at the last stage of involution (46 to 53 d following cessation of milking). This coincided with colostrum formation. We were unable to detect appreciable mRNA in mammary

glands of involuting cows (ftrst and second stages). DISCUSSION

The ftrst novel ftnding emerging from this study is the presence of MOOI in mammary tissue obtained from glands during the last stage of the involution, which coincided with colostrum formation. Western blot analysis, however, reflects the presence or absence of MOOI antigen. It does not address the possibility of quantitative differences in concentra-

TABLE 1. Mammary-derived growth inhibitor (MOGI)t antigen in mammary tissue obtained from lactating and involuting Holstein cows. MDGI Antigen

Source

{J18/mg of proteins)

Lactating Involution stage2 First Second Third

X

SD

6.3

1.2

.08

.04.28

.06 .03 .12

t The MOOI expression was determined by EliSA. 2First stage corresponds to 12 to 30 d, second stage to 31 to 45 d, and third stage to 46 to 53 d following sudden cessation of milking.

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POUTIS ET AL.

tiation of the secretory epithelium (9). The presence of high concentrations of MOOI during the prepartum period likely is consistent Relative amounts with a role for MOOI in differentiation rather of MOOI mRNA Source than proliferation of mammary epithelial cells. (%) The question of whether MDGI production in the third stage of involution is a consequence 100 Lactating Involution stage2 of initiation of colostrum production, or inND2 First volvement of MDGI in the regulation of these ND Second phenomena, or both cannot be answered at the 36 Third moment. IPirst stage corresponds to 12 to 30 d, second stage to The second major fmding of the present 31 to 45 d, and third stage to 46 to 53 d following sudden study was that the regulatory mechanism for cessation of milking. control of MOOI expression in mammary cells 2Not detected. in vivo is via modulation of the steady state concentration of its mRNA. This is because changes in MOOI mRNA concentrations were tions of MOOI expression. To address this almost identical to those observed at the proquestion, an ELISA used to measure MOOI tein level. The MDGI mRNA was highest in lactating glands; MOOI mRNA in involuting protein concentrations showed much higher glands (third stage) was still approximately MOOI in mammary tissue obtained from 36% of the fully induced concentrations obglands of lactating than from glands of involutserved in lactating glands. The MOOI mRNA ing cows (first and second stages). Again was not detected in involuting glands obtained MOOI was detected at lower, but still apduring the first and second periods. preciable, concentrations than those in lactatTwo mechanisms for MDGI mRNA regulaing glands during the last stage of involution tion are consistent with these observations: 1) (46 to 53 d after cessation of milking), which modulation of MOOI mRNA through changes coincided with colostrum formation. in transcriptional activity of the MDGI gene Relatively little is known about the specific and 2) modulation through stabilization of mechanism or mechanisms, including the role MOOI mRNA. Further experiments involving of growth factors or growth inhibitors in trig- measurements of transcription rates will more gering or initiating the process of active milk clearly define how the message levels are be(colostrum) secretion prior to parturition. Two ing modulated. weeks prior to parturition, mammary glands Based on the results obtained at the protein undergo several functional changes character- level, one should expect some, even though ized by colostrum formation (5, 7, 9). Colos- limited, MDGI mRNA in involuting cows trogenesis is favored by the hormonal environ- (first and second stages). These are two possiment at the end of pregnancy and occurs in ble explanations for this inconsistency. First, two stages: 1) the first stage, which comprises the MDGI protein may have been actually the prepartum period, is characterized by the produced at an earlier stage of lactation and appearance of precolostral fluid; 2) the second remained within the manunary gland in associstage, which begins immediately prior to partu- ation with milk fat. This explanation is consisrition, is characterized by the onset of active tent with earlier findings (6), suggesting that milk secretion (5, 7). What is the physiological MOOI is found in milk in strong association significance of the presence of high concentra- with milk fat globule membrane. Second, tions of MOOI during this period? In consider- MOOI mRNA was present at concentrations ing a reasonable explanation, we recall that lower than the detection limit of our system. It two roles have been proposed for MDGI: epi- is generally more difficult to detect mRNA thelial cell differentiation and inhibition of cell species in tissues from cells in culture, espeproliferation (6). Near parturition, two key cially when the particular mRNA species is phenomena occur: intense growth and differen- scarce.

TABLE 2. Mammary-derived growth inhibitor (MDGI) mRNA in mammary tissue obtained from lactating and involuting Holstein cows.

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MAMMARY-DERIVED GROWTII INHIBITOR

Considering the limited MOOI expression in mammary glands of involuting cows (first and second stages), two major possibilities can be envisaged: limited secretion from substantial loss of mammary epithelial cells or reduced synthetic activity per cell, alone or in combination. It is unlikely that the lack of MOOI mRNA is due to cell loss, because loss of mammary epithelial cells does not occur to a significant extent during involution in the bovine species (8, 15). We favor the second hypothesis, that the limited secretion is due to reduced synthetic ability per cell, based on several studies showing that inactive mammary epithelial cells prevail during the first and second stages of mammary involution (8, 11, 13). The question of whether lack of MOOI production is a consequence of these cellular events, or whether it is involved in the regulation of these events, or both cannot be answered at the moment. The presence of MOOI in lactating and involuting glands 2 wk prior to parturition, at the stage of colostrum formation, suggests that a relationship exists between the presence of MOOI and the functional state of the gland. These results and recent results of others (6) that MOOI can substitute for prolactin in inducing p-casein expression led us to hypothesize a role for MOOI in differentiation of epithelial cells along with inhibition of cell proliferation. In summary, the present observations document the presence of high concentrations of MOOI in lactating and involuting mammary glands at the time of colostrum formation. Our initial investigation of the molecular events that occur in mammary glands has led to the realization that regulation of MOOI production occurs at the level of the steady-state concentration of MOOI mRNA. Additional experiments should lead to a further clarification of the mechanism or mechanisms affecting MOOI expression and ultimately to a better understanding of the physiological significance of these events. ACKNOWLEDGMENTS

The research reported herein was supported by funds from the New York State Agriculture Research Station.

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REFERENCES 1 Ausubel, F. M, R. Brent, R. E. Kingston, D. P. Moore, J. E. Seidman, J. A. Smith, and K. Strabl. 1991. Current protocols in molecular biology. Vol. I. (Suppl. 8). Massachusetts General Hospital, Harvard Med. School, Cambridge, MA. 2Bohmer, F.-D., W. Lehmann, F. Noll, R. Samtleben, P. Langen, and R. Grosse. 1985. Specific neutralizing antiserum against a polypeptide growth inhibitor for mammary cells purified from bovine mammary gland. Biochim. Biophys. Acta 846:145. 3 Bradford, M. M. 1976. A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein dye-binding. Anal. Biochem. 72:248. 4 Chomczynski, P., and N. Sacchi. 1987. Single step method of RNA isolation by added guanididium thiocyanate-phenol chloroform extraction. Anal. Biochem. 162:56. 5 Fleet, I. R., J. H. Goode, M. H. Hamon, M. S. Laurie, J. L. Linzell, and M. Peaker. 1975. Secretory activity of the goat mammary glands during pregnancy and the onset of lactation. J. Physiol. 251 :763. 6 Grosse, R., and P. Langen. 1990. Mammary-derived growth inhibitor. Page 249 in Handbook of experimental pharmacology. Vol. 95/11. Peptide growth factors and their receptors n. M. B. Sporn and A. B. Roberts, ed. Springer-Verlag, New York, NY. 7 Hartmann, P. E. 1973. Changes in the composition and yield of mammary secretion of cows during the initiation of lactation. J. Endocrinol. 59:231. 8 Hurley, W. L. 1989. Mammary gland function during involution. J. Dairy Sci. 72:1637. 9 Kurtz, A., F. Vogel, K. Funa, C. H. Heldin, and R. Grosse. 1989. Developmental regulation of mammaryderived growth inhibitor expression in bovine mammary tissue. J. Cell BioI. 110:1779. 10 Muller, T., A. Kurtz, F. Vogel, H. Breter, F. Schneider, U. Angstrom, M. Mieth, F.-D. Bohmer, and R. Grosse. 1989. A mammary-derived growth inhibitor (MOOI) related to 70 kDa antigen identified in nuclei of mammary epithelial cells. J. Cell Physiol. 138:415. 11 Oliver, S. P., and L. M. Sordillo. 1989. Approaches to the manipulation ofmarnmary involution. J. Dairy Sci. 72:1647. 12 Politis, I., R. C. Gorewit, T. Muller, and R. Grosse. 1991. Mammary-derived growth inhibitor in lactation and involution. Domest. Anim. Endocrinol. 9:89. 13 Politis, I., R. C. Gorewit, T. Muller, and R. Grosse. 1992. Comparison of mammary-derived growth inhil>itor production in mammary tissue of lactating, pregnant versus nonlactating, pregnant Holstein cows. Can. J. Anim. Sci. 72(June). 14 Smith, K. L., and D. A. Todhunter. 1982. The physiology of mammary glands during the dry period and the relationship to infection. Page 87 in Proc. 21st Annu. Mtg. Natl. Mastitis Counc., Inc., Arlington. VA. 15 Sordillo, L. M., and S. C. Nickerson. 1988. Morphologic changes in the bovine mammary gland during involution and lactogenesis. Am. J. Vet. Res. 49:1112.

Journal of Dairy Science Vol. 75, No.6, 1992

Mammary-derived growth inhibitor protein and messenger ribonucleic acid concentrations in different physiological states of the gland.

Expression of mammary-derived growth inhibitor in tissue from lactating and involuting bovine mammary glands was investigated. Seventeen lactating, pr...
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