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BOR - Papers in Press, published online ahead of print October 1, 2003.
Biol Reprod 2003, 10.1095/biolreprod.103.021345
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BIOLOGY OF REPRODUCTION 70, 229–235 (2004)
DOI: 10.1095/biolreprod.103.021345
© 2004 by the Society for the Study of Reproduction, Inc.


Neuroendocrinology

Leptin Prevents Fasting-Mediated Reductions in Pulsatile Secretion of Luteinizing Hormone and Enhances Its Gonadotropin-Releasing Hormone-Mediated Release in Heifers1

M.N. Maciel, D.A. Zieba, M. Amstalden, D.H. Keisler, J.P. Neves, and G.L. Williams2

Animal Reproduction Laboratory,3 Texas A&M University Agricultural Research Station, Beeville, Texas 78102 Federal University of Santa Maria–CAPES,4 Santa Maria, RS, Brazil Department of Animal Science,5 Center for Animal Biotechnology and Genomics, Texas A&M University, College Station, Texas 77843 Department of Animal Science,6 University of Missouri, Columbia, Missouri 65211


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
We tested the hypothesis that leptin could prevent fasting-mediated reductions in pulsatile secretion and modify GnRH-mediated release of LH in heifers approaching puberty. Thirteen crossbred, prepubertal heifers (13.5–16 mo; 280–350 kg) exhibiting frequencies of pulses of LH between 0.67 and 1 pulse/h, were assigned randomly to two groups: 1) control (n = 6), fasted for 72 h with s.c. injections of saline at 12-h intervals, and 2) leptin (n = 7), fasted for 72 h with s.c. injections of oleptin (19.2 µg/kg) at 12-h intervals. Blood samples were collected intensively for 6 h on Days 0 and 3. This was followed on Day 3 with sequential administration of physiological (0.0011 µg/kg, i.v.) and pharmacological (0.22 µg/kg, i.v.) doses of GnRH and additional blood sampling. Leptin treatment increased (P = 0.0003) plasma concentrations of leptin 5–6-fold compared to controls. Fasting caused a marked decline (P = 0.01) between Days 0 and 3 in the frequency of LH pulses in controls; however, this effect was prevented in the leptin group, with pulse frequency increasing (P < 0.008) from Day 0 to 3. Leptin treatment increased GnRH-induced release of LH at both low (P = 0.04) and high (P = 0.02) doses. Plasma insulin and insulin-like growth factor-1 were reduced by fasting and unaffected by leptin. Leptin increased mean concentrations of growth hormone. Results indicate, for the first time, that exogenous leptin can prevent fasting-mediated reductions in the frequency of LH pulses and modify GnRH-mediated release of LH in intact, prepubertal heifers.

gonadotropin-releasing hormone, leptin, luteinizing hormone, neuroendocrinology, pituitary hormones


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Both acute and chronic undernutrition can negatively influence reproduction in domestic animals. In monogastrics, these effects occur to a large degree through suppressive effects on the frequency of LH pulses, which in turn is a reflection of a reduction in GnRH release [14]. Although similar effects are observed in ruminants in response to chronic undernutrition [5], the pulse generator in these species is less sensitive to short-term changes in dietary energy intake than in monogastrics, and the frequency of LH pulses is not reduced. Exceptions to this general rule include the pre/peripubertal heifer [6] and a unique model, the estradiol-implanted wether [7].

Recently, significant progress has been made in understanding how changes in nutrition are communicated to the hypothalamic-pituitary axis, thereby controlling gonadotropin secretion. At least part of this control involves the adipocyte-derived hormone leptin. In rodents, leptin normalizes body weight and restores fertility in leptin-deficient (ob/ob) mice [8], hastens the onset of puberty in normal mice [9], and stimulates hypothalamic GnRH and pituitary LH secretion in vitro [10, 11]. However, in cattle and sheep, the effects of leptin on gonadotropin secretion are observed mainly during states of acute or chronic feed restriction [12, 13]. Fasting hypersensitizes mature cows to leptin, with leptin treatment increasing mean circulating concentrations of LH and augmenting the size of individual pulses of LH [13], effects that appear to be mediated largely at the adenohypophyseal level [14]. Importantly, in castrated rams bearing estradiol implants, leptin prevented a fasting-mediated decline in the frequency of LH pulses [7]. To date, this effect has not been demonstrated in the intact, ruminant female. However, it suggests that in ruminant models in which fasting is capable of modulating frequency of LH pulses, leptin is acting at hypothalamic sites to influence the frequency of GnRH discharge [2, 5]. The present study examined this hypothesis in intact heifers approaching their first pubertal ovulation, an animal model known to respond to fasting with a decrease in the frequency of LH pulses [6]. Objectives were to determine if exogenous leptin could prevent a fasting-induced reduction in pulsatile secretion of LH, with corollary examinations of the effects of leptin on GnRH-mediated LH release and on growth hormone (GH) secretion.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
The Institutional Agricultural Animal Care and Use Committee (IAACUC) of the Texas A&M University System approved in advance all procedures used in these studies.

Animals and Procedures

Thirteen fall-born, prepubertal beef heifers (13.5–16 mo of age, 319.1 ± 9.12 kg) were used for this study. Before the beginning of the experiment, heifers were maintained in pens (25 x 9 m) where serum concentrations of progesterone were determined in twice-weekly blood samples collected by caudal venipuncture to monitor pubertal status. During this period, all heifers received diets formulated to promote a daily gain of approximately 0.45 kg/day [15].

Based on previous experience with heifers of this age, body weight, and breed type [6], we expected heifers to exhibit a frequency of LH pulses ranging from 0.50 to 1 pulse/h and to have their first pubertal ovulation within 30–90 days. Twenty-four hours before the start of the experiment, each heifer was fitted with a jugular catheter (Silastic tubing, 1.4 mm inside diameter, 1.9 mm outside diameter; Dow Corning Corporation, Midland, MI) for intensive and daily blood sampling. Heifers were assigned randomly to two groups: 1) control (n = 6) heifers were fasted for 72 h, with free access to water, and received s.c. injections of saline and 2) leptin (n = 7) heifers were fasted for 72 h (84.5 h including sampling period on Day 3), with free access to water, and received s.c. injections of recombinant ovine leptin (oleptin) in saline at a dose rate of 19.2 µg/kg per injection. Heifers were injected once on Day - 1 (1900 h); twice at 0700 and 1900 h on Days 0, 1, and 2; and once on Day 3 (0700 h) for a total of eight injections. The volume of each injection was approximately 2 ml, with volume varying slightly depending on individual body weight. Highly purified recombinant oleptin was provided by Dr. Arieh Gertler as reported previously [16]. The dose of leptin and treatment intervals were derived from both preliminary and published experiments [17] conducted in this laboratory with heifers (Fig. 1).



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FIG. 1. Time line for experimental procedures during the experiment. Fasting began on Day 0, 12 h after the onset of saline (S) or leptin (L) treatments on Day - 1. Treatments (S/L) were administered every 12 h, and single blood samples (not shown) were collected before each injection. Intensive blood sampling at 10-min intervals was conducted on Days 0 and 3 and at 15-min and 1-h intervals after the low (0.001 µg/kg) and high (0.22 µg/kg) doses of GnRH on Day 3. See text for additional details

Heifers were placed in indoor stanchions, and blood samples were collected at 10-min intervals for 6 h (0800–1400 h) on Days 0 and 3. At the end of the sixth hour on Day 3, all heifers received an i.v. injection of GnRH (0.001 µg/kg) intended to produce a physiological pulse of LH [18], with 10-min blood samples collected for an additional 90 min (1400–1530 h). At this time, a second GnRH injection (0.22 µg/kg) intended to stimulate release of all releasable pools [19] of LH was administered, and intensive bleeding continued for 4 h. During this period, samples were collected at 15-min intervals during the first hour (1530–1630 h) and at 1-h intervals during the last 3 h (1630–1930 h). Blood samples were also collected twice daily throughout the study, just before each saline or leptin injection. Blood samples (10 ml) were dispensed into tubes containing a solution of 150 µl heparin (10 000 IU/ml) and 5% EDTA and placed immediately on ice. During intensive blood sampling, the volume of blood collected (10 ml) was replaced with an equal volume of saline or heparanized (300 IU/ml) saline during catheter flushing. Serum (nonintensive, caudal blood samples) or plasma was obtained by centrifugation and stored at -20°C until hormone assays were conducted. After each intensive and daily blood sampling, heifers were returned to outside pens. A time line depicting the temporal sequence of animal procedures is shown in Figure 1.

Hormone and Biochemical Assays

Serum concentrations of progesterone were assayed in twice-weekly samples using the Coat-A-Count assay kit (Diagnostics Product Corporation, Los Angeles, CA) as reported previously from this laboratory [20]. Plasma concentrations of leptin were determined in samples collected during the week before the start of the experiment and in 12-h samples collected on Days 0, 1, 2, and 3 using a highly specific oleptin RIA validated for use in bovine serum or plasma [21]. Plasma concentrations of LH [22] and GH [23] were determined in samples collected at 10-min intervals for 6 h on Days 0 and 3, with all samples collected after GnRH injections on Day 3 assayed for LH.

To further assess metabolic status, circulating concentrations of insulin were determined in samples collected at 2-h intervals during the intensive sampling period on Day 0 and in samples collected at 10-min (0 and 10 min) and 30-min (30–360 min) intervals during intensive sampling on Day 3 using an assay reported previously [24]. Plasma concentrations of insulin-like growth factor-1 (IGF-1) were determined in samples collected every hour during intensive sampling on Days 0 and 3 [23]. Plasma concentrations of nonesterified fatty acids (NEFA) were analyzed using an enzymatic colorimetric assay kit (Wako Chemicals, Richmond, VA) in the first sample collected on Day 0 (0700 h) and in the last sample collected on Day 3 (1930 h). Intra- and interassay coefficients of variation ranged from 5% to 11% and 11% to 22%, respectively, for all assays reported.

Statistical Analysis

The frequency and amplitude of LH pulses were determined with the aid of a pulse-detection algorithm (Pulsefit 1.2) [25]. Pulse frequency data were analyzed using general linear mixed models for repeated measures using the mixed procedure (PROC MIXED) of the Statistical Analysis System (SAS) [26]. Because small but significant differences in LH pulse frequency existed between groups on Day 0, covariate analyses (ANCOVA) were used to test main effects on Day 3. Circulating concentration of LH, GH, IGF-1, insulin, NEFA, and leptin were analyzed as a repeated measure experiment using the PROC MIXED procedure of SAS. Sources of variation were treatment, day, and their interaction. Day was used as the repeated variable, and heifer (treatment) was used as the subject. When differences in circulating concentrations of hormones were detected between groups on Day 0, analysis of covariance (ANCOVA) was performed to compare treatment means on Day 3. The least squares means procedure was utilized to compare means.

To analyze GnRH-induced release of LH, samples collected before and after both the low and the high doses of GnRH were grouped into four periods (Fig. 1): period I, samples -10 to 0 (time of low-dose injection); period II, samples 1 to 4 after the low dose of GnRH; period III, samples 5 to 9 (sample 9 = time of high dose of GnRH) after the low dose of GnRH; and period IV, samples 10 to 16 after the high dose of GnRH. Because of differences noted in concentrations of LH among groups during period I, analyses of covariance were used to test main effects during periods II, III, and IV. When a significant difference was detected, the least squares procedure of SAS was used to compare means.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Plasma Leptin in Control and Leptin-Treated Heifers

Mean plasma concentrations of leptin decreased in five and increased in one heifer in the fasted control group between Days 0 and 3. Because of this variability, analysis of variance indicated that mean concentrations of leptin in this group did not differ over the 3-day experiment. However if data from the single heifer that increased were deleted from the analysis, a 12% reduction in mean concentrations of leptin was observed between Day 0 and Day 3 (5.0 vs. 4.4 ng/ml; P < 0.02) in this group. Recombinant oleptin markedly increased plasma concentrations of leptin in the fasted, leptin-treated group, with mean concentrations greater (P = 0.0003; Fig. 2) than in controls at all times after treatment onset.



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FIG. 2. Mean (±SEM) plasma concentrations of leptin during the week immediately preceding the onset of leptin or saline treatment on experimental Day -1 and for each subsequent day after the onset of treatment and fasting. Mean concentrations of leptin were greater (P < 0.0003) in the leptin than in the control group on all days of the experiment after the onset of treatments at -12 h (Day -1)

Effects of Leptin on Pulsatile Secretion of LH and GnRH-Mediated Release of LH

A marked decline (P = 0.01) in the frequency of LH pulses was observed in fasted, control heifers between Day 0 (4.01 ± 0.3 pulses/6 h) and Day 3 (2.18 ± 0.3 pulses/6 h) (Figs. 3 and 4). To the contrary, the frequency of LH pulses increased (4.98 vs. 3.69 ± 0.2 pulses/6 h; P = 0.008) in leptin-treated, fasted heifers during the same period and was greater (P < 0.005) than in controls on Day 3 (Figs. 3 and 5). Coincident with the decrease in frequency of LH pulses in saline-treated controls, the amplitude of LH pulses was greater (P = 0.04) in the control than in the leptin group on Day 3 (0.86 ± 0.12 vs. 0.63 ± 0.04 ng/ml).



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FIG. 3. Mean (±SEM) frequency of LH pulses in control and leptin-treated heifers on Days 0 and 3. A marked decline (a,bP = 0.01) in the frequency of LH pulses was observed in saline-treated controls during this period. To the contrary, the frequency of LH pulses increased (c,dP = 0.008) in leptin-treated, fasted heifers during the same period and were greater (a,bP < 0.01) than in controls on Day 3



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FIG. 4. Pulsatile patterns of LH release in three representative control heifers on Days 0 and 3 of fasting. Pulses are denoted by an asterisk and are enumerated in parentheses. Note the decline in the number of LH pulses between Days 0 and 3



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FIG. 5. Pulsatile patterns of LH release in three representative leptin-treated heifers on Days 0 and 3 of fasting. Pulses are denoted by an asterisk and are enumerated in parentheses. Note either no change or an increase in the number of pulses between Days 0 and 3

After adjusting for differences in individual animal baselines during period I, GnRH-mediated release of LH during both periods II and III (low dose of GnRH) and IV (high dose of GnRH) were greater (P = 0.04 and P = 0.02, respectively) in leptin-treated than in control-treated heifers (Fig. 6A). Mean concentrations of LH peaked between 20 and 30 min after both the low and high doses of GnRH, and mean maximal peaks did not differ between groups after either dose. Instead, the increase in LH release between leptin and control groups occurred as a result of enhanced duration of release after GnRH (Fig. 6B).



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FIG. 6. A) Mean (±SEM) concentrations of LH on Day 3 in leptin and control groups before and after GnRH treatments. Period I represents mean concentrations of LH at -10 min and immediately before (time 0) the low-dose injection of GnRH. Periods II (n = 4) and III (n = 5) represent 15-min samples collected after the low dose of GnRH and immediately before the high dose. Period IV represents 15-min (n = 4) and 1-h (n = 3) samples collected after the high dose of GnRH. After adjusting for differences in individual animal baselines during period I, GnRH-mediated release of LH during periods II and III (*P < 0.04) and IV (**P < 0.02) were greater in leptin-treated than in control-treated heifers. B) Temporal changes in LH release after the high dose of GnRH (period IV) in leptin and control groups. Note the increased duration of release of LH in leptin-treated heifers without a change in maximal peak concentrations

Metabolic Hormones and NEFA

Mean plasma concentrations of GH did not change throughout the fasting period in the control group, and neither the frequency nor the amplitude of GH pulses differed between groups. However, one heifer in each group had concentrations of GH that were greater than two standard deviations above the mean of all other heifers. With these heifers included in the analysis, leptin had no effect on GH concentrations. However, if data from these two animals were not included, mean concentrations of GH increased (P = 0.009) in the leptin group during the fasting period and were greater than in controls on Day 3 (P = 0.001; Fig. 7). Plasma concentrations of insulin and IGF-1 (P = 0.0001) decreased during the fasting period in both groups and did not differ because of treatment on any day (Fig. 8). In contrast, mean concentrations of NEFA increased markedly (P < 0.0001) between Days 0 and 3 in both groups but also were unaffected by treatment (Fig. 8). Serum concentrations of progesterone remained below 0.3 ng/ml throughout the study, indicative of a continuance of the prepubertal state.



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FIG. 7. Mean (±SEM) plasma concentrations of GH on Days 0 and 3 of the experiment, with one leptin-treated and one control heifer removed from the analysis because of circulating concentrations of GH greater than two standard deviations above the mean. With the two heifers removed, mean concentrations of GH in the leptin group were greater than the control group on Day 3 (*P = 0.001)



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FIG. 8. Mean (±SEM) plasma concentrations of insulin, IGF-1, and NEFA on Days 0 and 3 of the experiment. Plasma concentrations of insulin and IGF-1 decreased (P = 0.0001) during the fasting period in both groups and did not differ because of treatment on any day. In contrast, mean concentrations of NEFA increased markedly (P < 0.0001) between Days 0 and 3 in both groups but also were unaffected by treatment


    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
In previous studies reported from this laboratory, declines in leptin gene expression and plasma leptin concentrations in cattle during a 2–3-day fast have generally been in the range of 30%–40% [6, 13]. In this experiment, we observed a much smaller decline in plasma concentrations of leptin in fasted, saline-treated heifers during a 3-day fast, and one heifer did not exhibit a decrease. While an explanation for this less-than-expected effect on circulating leptin is not readily available, fasting did create the predicted array of other metabolic sequelae. These included marked reductions in plasma concentrations of insulin and IGF-1 and an increase in serum NEFA [6, 23, 24], responses that were evident in both groups and unaffected by leptin treatment.

Importantly, short-term fasting also caused a marked decline in the frequency of LH pulses in fasted, control heifers, similar to that observed in our previous reports [6], and this effect was prevented in the leptin group, with pulse frequency actually increasing in the latter. The noted increase in pulse amplitude that occurred coincident with a decrease in pulse frequency in controls is a commonly observed, reciprocal relationship for these two pulse parameters [27]. The ability of leptin to prevent fasting-mediated reductions in LH pulse frequency, demonstrated here for the first time in intact heifers, is in agreement with previous studies in rodents [28], monkeys [29], and estradiol-implanted wethers [7]. Consequently, our findings suggest that leptin was able to prevent a reduction in the frequency of GnRH pulses. In fact, leptin treatment appeared to increase GnRH pulse frequency based on the increase in the number of pulses of LH on Day 3 compared to Day 0. Both the expression of mRNA for the long form of the leptin receptor and leptin binding are increased in the arcuate nucleus during fasting in rats [30, 31]. Furthermore, undernutrition is associated with an increase in the number of leptin receptors in the ventromedial hypothalamus of ewes [32]. Therefore, although the decline in circulating leptin in the current study was not dramatic, the physiologic consequences of fasting that hypersensitized the hypothalamo-hypophyseal axis to leptin may have included an up-regulation of the leptin receptor. Currently, mechanisms through which leptin may stimulate GnRH secretion remain unclear. Leptin receptor signaling pathways most often involve successive activation of Janus tyrosine kinases and signal transducers and activators of transcription [33], but other direct or indirect pathways may also be operable [34]. For example, dietary energy restriction prolongs the period of inhibition of LH secretion by estradiol negative feedback in prepubertal heifers [35] and reduces LH secretion and up-regulates the number of estrogen receptors in the hypothalamus in female lambs [36]. Moreover, short-term fasting suppresses LH secretion in gonadectomized males receiving physiological doses of estradiol but not in gonadectomized females without estradiol replacement [7]. These observations accentuate the important contribution of estradiol in regulating GnRH neuronal activity and, ultimately, LH secretion [37]. Thus, it is possible that the ability of exogenous oleptin to prevent fasting-mediated reductions in LH pulse frequency in the current experiment also involves interactions among the leptin receptor, estradiol, and nutritional status.

In the current study, GnRH-mediated release of LH was greater in leptin-treated heifers compared with saline-treated controls, and this is in partial agreement with in vitro studies reported recently from this laboratory [14]. In those experiments, leptin-treated adenohypophyseal explants from fasted cows exhibited a marked increase in basal secretion of LH before GnRH treatments were applied. Therefore, only leptin-treated explants from normal-fed, mature cows (ovariectomized with an estradiol implant) exhibited an increased response to GnRH, as releasable pools of LH in tissues from fasted cows appeared to have been reduced because of enhanced secretion rates during the basal incubation period. The direct action of leptin at the pituitary level in other species is supported by the presence of leptin receptors on gonadotropes of ewes [38] and studies demonstrating increased release of LH from pituitary explants in rats [10]. One of the potential signaling pathways through which leptin could interact with GnRH in the exocytosis of secretory granules of LH is that involving inositol triphosphate (IP3). The latter, a second messenger for GnRH action at the level of the gonadotroph, activates IP3 via JAK2 [39].

As expected, mean concentrations of GH in saline-treated control heifers did not change throughout the study, confirming that short-term fasting does not affect the secretion of this hormone in prepubertal heifers [6]. However, our results (in the absence of data from two outlier heifers) provided evidence that leptin can stimulate GH secretion in heifers and supports a role for leptin in the regulation of the somatotropic axis in ruminants. Results are also consistent with data showing a stimulation of GH by leptin in fasted sheep [7] and in anterior pituitary explants from cows in the fasted state [40]. With one reported exception [12], leptin does not appear to consistently influence the secretion of GH in well-fed sheep [41, 42] or anterior pituitaries from well-fed cows [40]. Expression of leptin receptor mRNA is increased in the pituitary and hypothalamus of fasted rats [43]. Thus, it is possible that the increase in GH secretion observed in leptin-treated heifers was a result of leptin receptor interaction in somatotropes.

Fasting-mediated decreases in circulating concentrations of IGF-1 and insulin and increases in plasma NEFA observed in the current study are consistent with previous reports from this laboratory and others in sheep and cattle [6, 7, 13, 44]. Recent studies from this laboratory also demonstrated that intracerebroventricular or peripheral infusions of oleptin normalize fasting-mediated declines in circulating insulin and these effects were dependent on the metabolic status and the dose of leptin [13, 45]. In one of these studies, doses of 0.2 and 20 µg/kg of oleptin increased circulating insulin briefly, while the intermediate dose of oleptin (2.0 µg/kg) elevated insulin concentrations for at least 3 h [45].

In the current study, high doses of oleptin over a 3-day period of fasting were unable to prevent a reduction in circulating insulin, and these results are in agreement with others described previously in sheep [7]. The presence of leptin receptors in pancreatic islets [46] indicates that leptin can regulate directly the secretion of insulin. However, it has been reported that tissues exposed to relatively large concentrations of leptin accumulate excessive amounts of suppressors of leptin signaling, which can create a state of leptin resistance [33]. Thus, our failure to observe an effect of leptin on fasting-mediated decreases in circulating insulin may be a result of a state of leptin resistance created by the prolonged administration of high doses of leptin during the 3-day experiment. Increases in mean concentrations of NEFA are representative of the lipolytic state that animals typically undergo during fasting. Leptin treatment had no measurable effect on this process.

In summary, results of the current study demonstrate, for the first time in prepubertal, intact heifers, the ability of exogenous leptin to prevent fasting-mediated reductions in LH pulse frequency, to enhance responsiveness of the anterior pituitary to GnRH, and to increase basal GH secretion.


    ACKNOWLEDGMENTS
 
The authors thank Randle Franke, Melvin Davis, and Justin Kinnamon for animal care and Marsha Green for technical assistance.


    FOOTNOTES
 
1 Supported by USDA-NRI 00-35203-9132 and the Texas Agricultural Experiment Station. Back

2 Correspondence: G.L. Williams, Animal Reproduction Laboratory, Texas A&M University Agricultural Research Station, 3507 Highway 59E, Beeville, TX 78102-9410. FAX: 361 358 4930; glw{at}fnbnet.net Back

Received: 18 July 2003.

First decision: 18 August 2003.

Accepted: 12 September 2003.


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

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