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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Evoluce pohlavních chromozomů a karyotypů u leguánů (Squamata: Pleurodonta) / Evolution of sex chromosomes and karyotypes in iguanas (Squamata: Pleurodonta)

Altmanová, Marie January 2017 (has links)
Evolution of sex chromosomes and karyotypes in iguanas (Squamata: Pleurodonta) PhD Thesis Marie Altmanová Abstract This PhD thesis is composed of five published articles and one manuscript, and is focused on the evolution of the sex chromosomes and karyotype of the iguanas (Pleurodonta). Based on our primary research of available data, only male heterogamety (XX/XY) with ancestral karyotype 2n = 36 chromosomes was recorded in iguanas. However, in many species sex chromosomes have not been uncovered by classical cytogenetics, probably due to their homomorphy. The partially-known X chromosome content of Anolis carolinensis allowed us to compare the relative gene doses of X-specific genes between male and female of representatives of all iguana families, and to reveal homologous and well-differentiated sex chromosomes across all iguanas, with the exception of basilisks. Thus, due to the comparable age with sex chromosomes of mammals and birds, the results put into question the importance of endothermy for the formation of stable sex chromosomes. The striking feature of the iguanas is the relatively frequent occurrence of multiple sex chromosomes in their karyotypes. Using the ancestral state analysis of the type of sex chromosomes, it has been found that these multiple sex chromosomes developed at least twelve...
32

Scouring genomes and evolutionary trees for the origins of sex-biased germline mutation

Wu, Felix January 2022 (has links)
Mammals receive more germline mutations from fathers than mothers. While the paternal bias in mutation has historically been attributed to errors in DNA replication during spermatogenesis, evidence suggests that in humans mutational mechanisms independent from cell division may play a more prominent role. Understanding how the ratio of paternal-to-maternal mutations, 𝛼, varies across animals differing in their gametogenic development, physiologies, and habitats can provide unique insights into the processes by which mutation arises in male and female germlines. To these ends, this thesis examines features of paternal mutation bias in dozens of amniote species using a combination of sequencing and evolutionary approaches. A direct way of measuring the strength of paternal mutation bias involves sequencing pedigrees of related individuals and detecting mutations arising in a single generation. In Chapter 2, we applied this approach to measure 𝛼 in olive baboons (Papio anubis) and humans. Strikingly, we estimated that in baboons 𝛼 = 4.5, similar to humans, despite baboons experiencing far fewer spermatogenic cell divisions than humans. A model of mutation based on cell division differences in the two species failed to explain this observation. Our results provide added evidence for non-replicative processes driving paternal bias in mutation and suggest that these causes are likely shared across mammals. In Chapter 3, we expanded our analysis to survey 𝛼 across 42 amniote species. We estimated 𝛼 from putatively neutral substitution rates of sex chromosomes and autosomes and found that in mammals, 𝛼 ranges up to 4 and correlates with generation times. In contrast, birds and snakes harbor a stable 𝛼 of roughly 2. These results are well predicted by modeling sex bias in mutation as a product of an early developmental phase when mutation occurs equally in both parents and a late phase after sexual differentiation when the male germline is more mutagenic. That the paternal mutation bias is widespread and occupies a narrow range of values suggests that it is caused by endogenous damage sources that are similar across species. Through a combination of pedigree sequencing and evolutionary techniques, this work demonstrates how a comparative approach across diverse taxa can shed light on the origins of sex-bias in germline mutation.
33

Epigenetic Regulation of the Sex Chromosomes and 3D Chromatin Organization in Male Germ Cells

Alavattam, Kris G. 01 October 2019 (has links)
No description available.
34

Cytogenetics of Bisexual/Unisexual Species of Poecilia. IV. Sex Chromosomes, Sex Chromatin Composition and Ag-nor Polymorphisms in Poecilia Iatipinna: A Population From Mexico

Sola, Luciana, Bressanello, Simona, Rasch, Ellen M., Monaco, Paul J. 01 January 1993 (has links)
Cytogenetic analysis using C-banding, silver staining and fluorescent staining was carried out on a population sample of Poecilia Iatipinna derived from Tampico, Mexico, to verify the presence of sex chromosomes in individuals from the southern areas of this species range and to investigate the extent of C-band and Ag-NOR polymorphisms. Females were found to have W heteromorphic chromosomes, with large amounts of heterochromatin-rich in AT nucleotide sequences. C-banding corresponded to the pattern proposed as typical for the genus. Specimens share one of the Ag- NOR locations previously described in populations from the U.S.A. and show additional ones as well.
35

Evoluce karyotypů a určování pohlaví u leguánů (Squamata: Pleurodonta) / Evolution of karyotype and sex determination in iguanas (Squamata: Pleurodonta)

Altmanová, Marie January 2013 (has links)
Squamate reptiles in general possess an unusual variability in karyotype and sex determining mechanisms. However, in these two aspects, iguanas (Pleurodonts) are considered as a relatively conservative group of lizards. So far only genotypic sex determination with male heterogamety has been detected in this lineage. However, the sex chromosomes have not been revealed in many species by classical cytogenetics, probably due to their homomorphy. Significant variability in karyotype was observed only in the species-rich genera Anolis, Sceloporus and Liolaemus. The aim of this thesis was to investigate the genome of available species from the main iguanid lineages using classical and molecular cytogenetic methods. As well as finding the karyotype characteristics, which may represent synapomorphies of main iguanid lineages, the other aim was to try to identify sex chromosomes. This study confirmed previously published karyotypes of 13 species and established new descriptions of karyotype for eight species. The chromosomes of all studied specimens were examined by methods of classical and molecular cytogenetics, 21 species covering eight iguanid families were analysed in this thesis. The majority of studied species shared the apparently ancestral karyotype of the group, with diploid chromosome number...
36

Evoluce vybraných karyotypových znaků u tetrapulmonátních pavoukovců / Evolution of selected karyotype characters in tetrapulmonate arachnids

Jílková, Klára January 2013 (has links)
The class Arachnida is not thoroughly explored from the cytogenetic point of view. Previous studies suggest a high diversity of karyotypes and sex determination in arachnids. This study deals with the evolution of sex chomosomes, nucleolar organizer regions (NOR), and telomeric repeats in the tetrapulmonate clade of arachnids, particularly in groups of ancient origin. Sex chromosomes were detected in two orders. Detection of NORs in a large set of species supports the hypothesis that the ancestral karyotype of arachnids contained NOR on one pair of autosomes only. The number of NORs has increased during the evolution of some groups of Pedipalpi. The NORs are located in terminal or subterminal chromosomal regions in most tetrapulmonates. The occurrence of the "insect" telomeric motif was confirmed in majority of tetrapulmonates. Interstitital telomeric repeats were not detected with the exception of one species. Keywords: arachnids, meiosis, sex chromosomes, telomeres, nucleolar organizer, heterochromatin
37

Comment le X vient-il à la rescousse du Y ? : évolution de la compensation de dosage des XY humains et autres questions sur l'évolution des chromosomes sexuels eucaryotes / The Y rescued by the X ? : evolution of dosage compensation in humans and other questions on sex chromosome evolution in eukaryotes

Pessia, Eugénie 12 December 2013 (has links)
Un premier pan de ma thèse concerne deux différents mécanismes de sauvetage du Y par le X. Premièrement, j'ai participé à une controverse sur la compensation de dosage chez les mammifères. Une hypothèse avait été proposée dans les années 60 par Susumo Ohno, proposant un mécanisme de compensation en deux temps. Chez les mâles, la perte de nombreux gènes sur le Y entraîne un déséquilibre de dosage car ces gènes qui étaient précédemment présents en deux copies sont devenus unicopie, soit une division d'expression par deux. Selon l'hypothèse d'Ohno, chez les mammifères en réponse à cela le X aurait doublé son expression, mais dans les deux sexes menant ainsi à une expression trop élevée chez les femelles. Ce deuxième problème de dosage aurait alors été résolu par la mise en place d'une inactivation aléatoire de l'un des deux X chez les femelles. Tandis que la deuxième partie de l'hypothèse d'Ohno, l'inactivation du X, a été très étudiée, la première partie est restée spéculative jusqu'aux années 2000. En étudiant des données d'expression du X humain j'ai pu montrer, de manière concomitante avec d'autres auteurs, que la première partie de l'hypothèse d'Ohno n'est pas totalement vraie car seule une partie des gènes sont sur-exprimés. J'ai ensuite participé à l'écriture d'une revue visant à donner une explication alternative à la compensation de dosage pour l'évolution de l'inactivation du X chez les femelles mammifères. Deuxièmement, j'ai étudié la présence de conversion génique X-Y dans plusieurs gènes, au sein de nombreuses espèces de primates. Mes travaux me mènent à discuter le fait que ce type d'évènement soit effectivement favorisé par la sélection. Je pose l'hypothèse que ces conversions géniques ont été maintenues de manière neutre. Ces deux travaux ne vont pas dans le sens d'un chromosome X sauvant le Y avec beaucoup de zèle. Dans un dernier temps, m'éloignant des espèces modèles, j'ai étudié les chromosomes sexuels particuliers d'une algue brune : Ectocarpus siliculosus. Cela m'a permis de vérifier si le scénario évolutif actuel des chromosomes sexuels est toujours valide dans un groupe d'eucaryotes séparé des animaux depuis plus d'un milliard d'années / The first part of my thesis concerns two different mechanisms of the Y being rescued by the X. Firstly, I contributed to a controversy on mammalian dosage compensation. During the 60s Susumo Ohno hypothesized a two-step dosage compensation mechanism. In males, the high loss of Y-linked genes led to a dosage imbalance: these genes were previously present in two allelic copies and became unicopy, meaning that their expression has been halved. According to Ohno’s hypothesis, in response to this imbalance the mammalian X would have doubled its expression in the two sexes, resulting in a to high expression in females. This second dosage imbalance would have been resolved by the random inactivation of one of the two Xs in females. Whereas the second part of Ohno’s hypothesis, the X-chromosome inactivation, has been well studied, the first part remained speculative until the 2000s. I studied human X-linked expression data and was able to show, concomitantly with other authors, that the first part of Ohno’s hypothesis is not totally true as only some of the X-linked genes are hyperexpressed. I later participated in the writing of a review aiming to give an alternative hypothesis for the evolution of X-chromosome inactivation in mammalian females than dosage compensation. Secondly, I studied signatures of X-Y gene conversion in several genes within numerous primate species. Myresults led me to discuss if these events were indeed selected for. I hypothesize that these gene conversion events occurred in a neutral manner. These two different studies suggest that the X chromosome may not be as much a help for the Y as has been suggested. Lastly, moving away from model species, I studied the peculiar sex chromosomes of a brown alga: Ectocarpus siliculosus. This work allowed me to test if the current hypotheses on sex chromosome evolution still hold in a eukaryotic group that diverged from animals more than one billion years ago
38

Étude de SLY et de la régulation (épi)génétique des chromosomes sexuels pendant la spermiogenèse / Study of SLY and the (epi)genetic regulation of sex chromosomes during spermiogenesis

Moretti, Charlotte 28 November 2016 (has links)
Globalement réprimés à la méiose (MSCI), les chromosomes sexuels sont partiellement réactivés dans les spermatides rondes avant l’arrêt général de la transcription dans les spermatozoïdes. Alors qu’il est clairement démontré que le MSCI est essentiel pour la poursuite de la spermatogenèse, la proportion de gènes réactivés ainsi que le mécanisme de régulation des chromosomes sexuels après la méiose demeurent un sujet de recherche et de débats. Chez la souris, la délétion du bras long du chromosome Y (MSYq) provoque la surexpression de plusieurs centaines de gènes, dont la majorité est portée par les chromosomes sexuels, associée à des modifications de la chromatine; ceci aboutit à la production de spermatozoïdes malformés et non-fécondants, présentant notamment une compaction anormale de leur chromatine. Sly est un des cinq gènes multicopies du MSYq et l’abolition de son expression chez la souris (souris Sly-KD) a récemment démontré qu’il est à la base de la dérégulation épigénétique des chromosomes sexuels et des problèmes de compaction de la chromatine des mâles MSYq-. De plus, les mâles avec délétion partielle de MSYq ainsi que les mâles Sly-KD produisent une descendance avec un excès de femelles, ce qui suggère l’existence d’un conflit intragénomique avec Slx, un gène multicopie homologue de Sly et porté par le chromosome X. Quel rôle pour SLY pendant la spermiogenèse ? Afin de répondre à cette question nous avons étudié les gènes cibles et les partenaires de SLY. Nous avons montré que SLY interagit avec TBL1XR1, membre inhérent au complexe répressif Ncor. De plus, localisée au niveau des promoteurs de gènes exprimés dans les spermatides et liés aux chromosomes sexuels et autosomaux, SLY contrôle des gènes impliqués dans la régulation génique et chromatinienne (e.g, variants H2A et DOT1L). Nous avons également détecté une baisse significative de la marque H3K79me2 accompagnée d’une rétention anormale des histones dans les spermatozoïdes des souris Sly-KD et proposons que DOT1L, la seule H3K79 méthyltransférase identifiée à ce jour, est essentielle au remodelage de la chromatine. Quels sont les mécanismes moléculaires du conflit intragénomique entre SLY et SLX ? Des expériences de co-immunoprécipitations ont démontré que SSTY, codée comme SLY par un gène multicopies du MSYq, interagit préférentiellement avec SLX in vivo. En outre, SLX et SLY sont capables toutes deux d’interagir avec SPIN1, homologue de SSTY et capable de se lier à H3K4me3. Ces différentes interactions entre SLX/SLY et SPIN1/SSTY pourraient participer au conflit intragénomique. Par la réévaluation de plusieurs jeux de données (RNA-Seq et ChIP-Seq) nous avons démontré que la répression des chromosomes sexuels ne persiste pas au-delà de la méiose et que le conflit intragénomique entre SLY et SLX représente une pression de sélection considérable, en partie responsable du paysage épigénétique spécifique des chromosomes sexuels et de leur enrichissement en gènes multicopies exprimés après la méiose. En conclusion, nos travaux ont permis de caractériser le mode d’action de SLX/SLY et d’identifier de nouveaux facteurs impliqués dans la régulation (épi)génétique pendant la spermiogenèse qui sont conservés chez l’homme. / Sex chromosomes in mammals are globally repressed during meiosis (MSCI ) and then partially reactivated in round spermatids prior to the transcriptional activity shut down occurring in spermatozoa. Whereas the MSCI is essential for spermatogenesis, the proportion of reactivated genes and the underlying mechanisms of the sex chromosomes regulation after meiosis is still a conundrum. In mice, deletions of the long arm of the Y chromosome (MSYq-) are responsible for the overexpression of more than hundred sex chromosome genes associated with epigenetic modifications that leads to impaired sperm functions and abnormal chromatin compaction. Sly is one of the five multicopy genes present on MSYq and Sly deficiency (Sly-KD) has recently been showed to be at the basis of the gene deregulation and sperm defects obrserved in MSYq- mice. Additionally, partially deleted MSYq males and Sly-KD mice produce offspring with a sex ratio distortion in favor of females; these observations suggest a postmeiotic intragenomic conflict involving Sly and its homolog Slx, an X-linked multicopy gene. What role for SLY during spermiogenesis? In order to decipher SLY mechanisms of action, we sought to study SLY target genes and partners. We showed that SLY interacts with TBL1XR1, an inherent member of the repressive Ncor complex. Meanwhile, we found that SLY is enriched at the promoter of spermatid expressed genes encoded both by sex chromosomes and autosomes. Additionally, SLY controls genes involved in genetic and chromatin regulation (e.g, H2A variants and DOT1L). We also observed a significant reduction of H3K79me2 levels associated with abnormal histone retention in Sly-KD spermatozoa. We propose that DOT1L, the principal H3K79 methyltransferase identified to date, is essential for chromatin remodeling in spermatids. What are the molecular mechanisms involved in the ongoing intragenomic conflict between SLY and SLX? We showed by co-immunoprecipitation that SSTY, another Y-linked multicopy gene, preferentially interacts with SLX in vivo. Furthermore, both SLX and SLY interact with SPIN1, a homolog of SSTY which is able to recognize H3K4me3. The interactions between SLX/SLY and SPIN1/SSTY could be part of the intragenomic conflict. By re-evaluating several RNA-Seq and ChIP-Seq datasets we demonstrated that MSCI does not persist beyond meiosis. We proposed that the intragenomic conflict between SLY and SLX constitutes a considerable selection pressure, partly responsible for the specific epigenetic landscape of sex chromosomes and their enrichment in multicopy genes expressed after meiosis. In conclusion, our work allowed a better understanding of the mode of action of SLX/SLY and the identification of new factors involved in the (epi)genetic regulation during spermiogenesis that are conserved in humans.
39

Organização genômica de sequências repetitivas em Pica-paus (aves piciformes)

Oliveira, Thays Duarte de 05 April 2017 (has links)
Submitted by Ana Damasceno (ana.damasceno@unipampa.edu.br) on 2017-06-01T21:04:14Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Organização genômica de sequências repetitivas em Pica-paus (aves piciformes).pdf: 2128434 bytes, checksum: 8afa26cc3c248da9e51696791e1dadc1 (MD5) / Made available in DSpace on 2017-06-01T21:04:15Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Organização genômica de sequências repetitivas em Pica-paus (aves piciformes).pdf: 2128434 bytes, checksum: 8afa26cc3c248da9e51696791e1dadc1 (MD5) Previous issue date: 2017-04-05 / A caracterização da quantidade e distribuição da fração de DNA repetitivo em genomas auxilia no entendimento de sua organização cromossômica. As Aves são conhecidas por apresentar uma baixa proporção de DNA repetitivo quando comparada a outras classes de Vertebrados. Entretanto, a ordem Piciformes se destaca por apresentar uma quantidade percentual superior dessas sequências comparado com as outras aves. Com isso, o objetivo deste estudo foi determinar a distribuição de diferentes tipos de sequências repetitivas no genoma de três espécies da família Picidae, Colaptes melanochloros (2n=84), Colaptes campestris (2n=84) e Melanerpes candidus (2n=64), por meio de hibridização in situ fluorescente (FISH) com sondas de rDNA 18S, teloméricas (TTAGGG)n e microssatélites. Os resultados mostraram, nessas três espécies, o cromossomo sexual Z como o maior do complemento, esse fato deve-se ao acúmulo de diferentes sequências de microssatélites. Entretanto o cromossomo W de C. Melanochloros, que é totalmente heterocromático, não apresentou acúmulo destas sequências. Os sítios ribossomais estão organizados em um par de cromossomos com uma constrição secundária e este teve o acúmulo da sequência (CGG)10 nas três espécies. As sondas teloméricas apresentaram marcações nas regiões terminais dos cromossomos e marcações intersticiais em alguns macrocromossomos. As marcações intersticiais indicam fusões entre cromossomos ou acúmulo de sequências repetitivas similares as teloméricas. Com as sondas de microssatélites identificou-se o mesmo padrão de hibridização nas espécies de Colaptes e padrão distinto entre Colaptes e M. candidus. As nossas análises de FISH mostraram várias sequências de microssatélites amplificadas no cromossomo Z nas três espécies analisadas, o que pode explicar o fato deste ser o maior elemento do cariótipo e desta família conter maior quantidade de sequências repetitivas comparadas com outros grupos de aves. Curiosamente, nenhuma das sequências foi encontrada acumulada no cromoss omo W, apesar de desempenharem um papel importante na diferenciação de cromossomos sexuais. Estes resultados evidenciam que, apesar da origem comum proposta para o sistema sexual ZW em aves, esses cromossomos seguiram diferentes trajetórias evolutivas em cada espécie, indicando uma alta plasticidade para a diferenciação cromossômica sexual neste grupo. Este trabalho é o primeiro passo para esclarecer o papel das sequências satélites e microssatélites na diferenciação de cromossomos sexuais. / The characterization of the amount and distribution of the repetitive DNA fractions in genomes assists in the understanding of their chromosomal organization. The Birds are characterized by presenting a low proportion of repetitive DNA when compared to other classes of Vertebrates. However, the order Piciformes stands out for having a higher percentage of these sequences compared to other birds. The objective of this study was to determine the distribution of different types of repetitive sequences in the genome of three species of the family Picidae, Colaptes melanochloros (2n = 84), Colaptes campestris (2n = 84) and Melanerpes candidus (2n = 64) by fluorescence in situ hybridization (FISH) with 18S, telomeric (TTAGGG) and microsatellite rDNA probes. The results showed, in these three species, the sexual chromosome Z as the largest of the complement, this fact is due to the accumulation of different sequences of microsatellites. However, the W chromosome of C. melanochloros, which is totally heterochromatic, did not show accumulation of these sequences. The ribosomal sites are organized on a pair of chromosomes with a secondary constriction and this had the accumulation of the sequence (CGG)10 in the three species. The telomeric probes showed markings in the terminal regions of the chromosomes and interstitial markings on some macrochromosomes. Interstitial markings indicate fusions between chromosomes or the accumulation of repetitive sequences similar to the telomeric ones. With the microsatellite probes the same pattern of hybridization was identified in the Colaptes species, distinct pattern between Colaptes and M. candidus. Our FISH analyzes showed several amplified microsatellite sequences on the Z chromosome in the three species analyzed, which may explain the fact that this is the largest element of the karyotype and that its genome contains the largest number of repetitive sequences compared to other groups of Birds. Interestingly, none of the sequences were found to be accumulated on the W chromosome, although they play an important role in the differentiation of sex chromosomes. These results show that, despite the common origin proposed for the ZW sexual system in birds, these chromosomes followed different evolutionary trajectories in each species, indicating a high plasticity for the sexual chromosome differentiation in this group. This work is the first step to clarify the role of satellites and microsatellite sequences in the differentiation of sex chromosomes.
40

ROLE OF SEX CHROMOSOMES IN SEXUAL DIMORPHISM OF ANGII-INDUCED ABDOMINAL AORTIC ANEURYSMS

Alsiraj, Yasir 01 January 2018 (has links)
Abdominal aortic aneurysms (AAAs), a permanent dilation in the abdominal region of the aorta, is a highly sexually dimorphic disease. AAAs prevalence is ranging from 4-10 fold higher in males than females. Defining the mechanistic basis for reduced (in females) or increased (in males) AAA formation and progression may uncover potential therapeutic targets. The majority of studies examining sexual dimorphism focus on the role of sex hormones. However, genes residing on sex chromosomes, in addition to sex hormones, may contribute to sexual dimorphism of AAAs. For example, the X chromosome contains about 5% of the whole genome, but the role of sex chromosomes genes to sexual dimorphism of cardiovascular diseases such as AAAs is largely unknown. The purpose of this study was to determine the role of sex chromosomes as mediators of sex differences for angiotensin II (AngII)-induced AAAs in hypercholesterolemic mice. We used the four core genotype murine model, which enables the creation of phenotypically normal male and female mice with an XX versus XY sex chromosome complement, to test the hypothesis that an XY sex chromosome complement promotes AngII-induced AAAs. Transgenic male mice expressing the Sry gene on an autosome, but not on the Y-chromosome, were bred to female low-density lipoprotein receptor deficient mice to create male and female mice with an XX or an XY sex chromosome complement. In females, an XY sex chromosome complement doubled the incidence and markedly increased the severity of AngII-induced AAAs. To define mechanisms, we examined gene expression patterns in abdominal aortas and demonstrated elevated expression of inflammatory genes that were linked to increased MMP activity and oxidative stress in aortas from XY females. Moreover, administration of testosterone to XY females, to mimic males, resulted in a striking level of aneurysm rupture. In males, transcriptional profiling of abdominal aortas revealed 450 genes that were influenced by sex chromosomes. Infusion of AngII to XY males resulted in diffuse pathology along the length of the aorta, while XX males developed focal AAAs, with pathology reduced by orchiectomy in both genotypes. Thoracic aortas of XY males exhibited adventitial thickening which was not exist in thoracic aortas from XX males. Following a prolonged period (3 months) of AngII infusions XY males had AAAs with expanded aortic walls, while XX males had thin walled dilated AAAs. In summary, our findings demonstrate a remarkable effect of sex chromosome complement to regulate aortic vasculature and disease development. Aside from demonstrating mechanisms of sexual dimorphism of aortic diseases, these findings indicate that chronic sex hormone therapy in the aging and transgender population may have cardiovascular ramifications. Moreover, identification of targets influenced by sex chromosomes and/or sex hormones in a manner that predicts disease development may identify sex-specific approaches to cardiovascular therapy.

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