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Free Radical Tissue Damage and Protective Role of Antioxidant Nutrients Brodv Memorial Lecture XX Dr. Lawrence J. Machlin Head, Clinical Nutrition Roche Vitamins and Fine Chemicals H Nutley, New Jersey Special Report'41 November 17, 19£ -^Agricultural Experiment Station University of Missouri-Columblf'^f^ The Board of Curators established the Samuel Brody Lectureship Fund in April, 1959. Lectures have been held asoften assufficient income from theendowment fund provided expenses and a small honorarium for a distinguished lecturer. The committee will welcome additional contributions from any individual or group. Such funds will be applied to the principal or endowment fund of the Brody Memorial Lectureship Fund. Any increases in the endowment fund, of course, will allowlecturesto be held more frequently. The present Brody Memorial Lectureship Committee was appointed by Dean Roger Mitchell. Committee members are: Dr. Harold D. Johnson, Brody Lecture Chairman Dr. Ralph Anderson, Gamma Sigma Delta Representative Dr. Warren Zahler, Sigma Xi Representative. Previous Brody Lectures I. II. III. IV. V. VI. Max Kleiber, Dept. Animal Science, Univ. ofCalif.-Berkeley, Dec. 5 1960. Knut Schmidt-Nielsen, Dept. of Zoology, Duke University, Dec. 7, 1961. F.W. Went, Director, Missouri Botanical Garden, April 2, 1963. K.L. Blaxter, Dept. of Nutrition, Hannah Dairy Research Institute, Jan. 27, 1964. C. Ladd Prosser, Dept. of Physiology, University of Illinois, Feb. 25, 1965. H.T. Hammel, Physiology Group, John B. Pierce Foundation Laboratory, Feb. 17, 1966. VII. H.N. Munro, Dept. Physiological Chemistry, Massachusetts Institute ofTechnolo gy, Feb. 6, 1967. VIII. James D. Hardy, Dept. of Physiology, Yale University, April 30, 1968. IX. Loren D. Carlson, Dept. of Physiology, University ofCalif.-Davis, May 10, 1969. X. R.L. Baldwin, Dept. of Animal Science, University of Calif.-Davis, Feb. 5, 1971. XI. John R. Brobeck, Dept. of Physiology, The School of Medicine, University of Pennsylvania, Oct. 5, 1972. XII. Bruce A. Young, Dept. of Animal Science, University of Alberta, Edmonton, Canada, April 22, 1974. XIII. D.E. Johnson, Dept. ofAnimal Science, Colorado State University, Fort Collins, Oct. 23, 1975. XIV. Albert L. Lehninger, Dept. ofPhysiological Chemistry, The Johns Hopkins School of Medicine, Baltimore, October 7, 1976. XV. Henry A. Lardy, Dept. of Biological Science, University of Wisconsin, Madison, Feb. 8, 1979. XVI. H. Allen Tucker, Dept. of Dairy Sci. & Dept. of Physiology, Michigan State University, East Lansing, April 2, 1981. XVII. H. Russell Conrad, Dept. ofDairy Science, Ohio State University, Oct. 15, 1982. XVIII. David Robertshaw, Dept. of Physiology and Biophysics, Colorado State University, Fort Collins, Nov. 15, 1984. XIX. Allen Munck, Professor of Physiology, Dartmouth Medical School - Oct. 28, 1986. Free Radical Tissue Damage and the Protective Role of Antioxidant Nutrients By: Dr. Lawrence J. Machlin Director of Clinical Nutrition Vitamins and Fine Chemicals Division Hoffmann-La Roche Inc. Introduction I'm deeply honored to be invited to present the Brody Lecture. I have fond memories of the 17 years I spent in Missouri and of the many rewarding relationships I had with members of the faculty here at Columbia, particularly, HaroldJohnson, Boyd O'Delland Jimmy Savage. The subject of free radical tissue damage and the protective role of antioxidant nutrients has its origins in work of Olcott and Matill almost 50 years ago. They proposed that vitamin E functioned as an in vivo antioxidant, i.e., it scavenged free radicals in tissues. It took many decades to provide adequate proof of this hypothesis. When I was at Monsanto over25yearsago, I contributedto this subject by showing that a wide variety of synthetic antioxidants can prevent vitamin E deficiency symptoms in the chicken. The entire subject of free radical biology has expanded considerably in the last 10-15 years triggered by studies on antioxidant enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GPX), obser vations on ischemia reperfusion injury and a host of other discoveries. Several journals are now devoted to the subjectand scientific conferences abound. Although there are many scientific issues to be resolved, it is clear that free radicals are involved in many disease processes and nutrition plays an important role in protecting the body against the consequences of free radical tissue damage. In the following I will discuss what free radicals are, where they come from, how they damagetissuesand then briefly describe the antioxidant defense system of the body and the role of nutrition in maintaining this system and finally give two examples of health conditions influenced by antioxidant nutrients. Sources of Free Radicals If a reactive molecule contains one or more unpaired electrons, the molecule is termed a free radical. Most of the biological free radicals contain oxygen (Table 1). Active forms of oxygen such as singlet oxygen (1O2) and H2O2 although not radicals themselves lead to free radical formation and can also cause damage. Endogenous The formation of highly reactive, oxygen-containing molecular spe cies is a normal consequence of a variety of essential biochemical reactions. Endogenous sources of free radicals include those that are generated and act intracellularly, as well as those that are formed within the cell and are released into the surrounding area. Intracellular free radicals are generated from the autoxidation and consequent inactivation TABLE 1 Potentially Cytotoxic Species of Oxygen Superoxide anion radical 02H02. Hydroperoxyl radical H202 Hydrogen peroxide •OH Hydroxyl radical ROO- Peroxide radical (R = lipid) ^02 Singlet oxygen of small molecules such as reduced flavms and thiols, catecholamines, and from the activity of certain oxidases, cyclooxygenases, lipoxygenases, dehydrogenases, and peroxidases. Oxidases and electron trans port systems are prime, continuous sources of intracellular, reactive oxygenated free radicals. Electron transfer from transitionmetals such as iron to oxygen-containing molecules can initiate free radical reactions. The sites of free radical generation encompass all cellular constituents including mitochondria, lysosomes, peroxisomes, and nuclear, endoplasmic reticular, and plasma membranes as well as sites within the cytosol. (Fig. 1) FIGURE 1 Cellular Sources of Free Radicals electron transport system cytochromes P450 and 65 hemoglobif^ xanthine oxidose oxidative burst m^LEUS ENDOPLASMIC RETICULUM, myeloperoxidase enzyme system DNA (phagocytes) LYSOSOMES oxidases PEROXISOMES O flavoproteins O CYTOPLASM MTOCHONDRON reduced flavins transition metals electron transport system LIPID BILAYER OF ALL CELLULAR MEMBRANES lipid peroxidatlon lipoxygenoses prostoglandin synthetase NADPH oxidase (phagocytes) Adopted from Freeman, B. A. eta!., 1982 5 Exogenous Exogenous sources of free radicals include tobacco smoke, certain pollutants and organic solvents, anesthetics, hyperoxic environments, and pesticides. Some of these compounds as well as certain medications are metabolized to free radical intermediate products that have been shown to cause oxidative damage to the target tissues. Exposure to radiation results in the formation of free radicals within the exposed tissues. Consequences of free radical damage (Fig. 2) Free radicals can damage DNA, resulting in cell injury and mutagenesis, and protein, resulting in denaturation and, decreased enzyme activity. The amino acids histidine, tryptophan, methionine and cysteine are particularly prone to attack. Damage to carbohydrate particularly as glycoproteins can result in alteration of receptors and depolymerization of substances such as hyaluronic acid. Free radical - induced lipid oxidation can cause damage to the membrane directly by causing alterations in the PUFA and indirectly by formation of secondary products such as reactive aldehydes {E.g., malondialdehyde, hydroxyalkenals) Figs. 3-4. FIGURE 2 Transport Receptor disturbances alterations Increased turnover ofprotein Damage to cartiohydrates REACTIVE FHEE RADICAL -SH dsturfaences Secondary products SH-oxidation Enzyme changes DNA-damage, ceoinpry mutation upxl perondation Membrane fi*icti6n enzyme •amage to protens Membrane damage FIGURE 3 COOH 0H« /v^Y^w Initiation PUFA A/=V=Vn/ 1a/=vw COOH r /VVvV\cQOH (conjugated diene] (R*) Propagation VVV^NAcooh — ' COOH 0* WV^A COOH 8* /V=V^W Lipid hydroperoxyl radical (RO,* 1 '' V|W\ * A/'V^vV H Lipid hydraperoxide 2R*-»Rfl 2 RO,*—0, + ROOR RO," + R*-»ROOR RO,* + VitE-^ROOH + VitE* Termination FIGURE 4 TRANSMEMBRANE GLYCOPROTEIN MEMBRANE SURFACE PROTEINS CH,-S FREE RADICAL DAMAGE DISULFIDE CROSSUNKING ^ PROTEIN STRAND SCJSSION FIGURE 5 UPIO-PROTBN CROSSUNKING PROTBN-PROTEIN CROSSUNKING LIPID-LIPID CROSSUNKING AMINO ACID OXIDATION 0 MALONDIALDEHYDE COOH RELEASED FROM OXIDIZED FATTY ACIDS FATTY ACID OXIDATION COOH Antioxidant function of nutrients Lipid peroxidation is a chain reaction (Fig. 3) which can be terminated when two radicals react with each other or when a chain-breaking antioxidant such as vitamin E reacts with a radical to form a less reactive radical (tocopheroxy radical). Tocopheroxy radical can be reduced to tocopherol by ascorbic acid (vitamin C) or reduced glutathione. Nutrients with antioxidant functions Vitamin E (alpha tocopherol), the major lipid-soluble antioxidant in all cellular membranes, not only reacts with the peroxy radical (ROO*) but with the hydroxyl radical (HO'), superoxide radical (©2"), and also quench singlet oxygen (^02). It is clear that vitamin E does function as an in vivo antioxidant as evidenced by the increased concentration of aldehyde, peroxides, and lipofuscin in the tissues of vitamin E deficient animals. Furthermore pentane, a product of peroxidation of n-6 fatty acids, is significantly increased in the exhaled air of vitamin E deficient animals and humans. Other vitamins and minerals also have protectiverolesagainst radical damage either by direct antioxidant activities or as precursors of "antioxi dant" enzymes. (Table 2) TABLE 2 Antioxidant micronutrients Activity Nutrient Vitamin C (ascorbic acid) Importantwater-soluble cytosolicchain-breaking an tioxidant; reacts directly with superoxide, singlet oxygen; regenerates tocopherol from tocopheroxy radical Vitamin E (alpha-tocopherol) B-Carotene Major membrane-bound, lipid-soluble chain-break ing antioxidant; reacts directly with superoxide, sin glet oxygen Most potent singlet oxygen quencher, antioxidant properties particularly at low oxygen pressure, lipid soluble Zinc Constituent of cytosolic superoxide dismutase and metallothionein, membrane stabilizer Selenium Copper Constituent of glutathione peroxidase Constituent of cytosolic superoxide dismutase and ceruloplasmin Iron Constituent of catalase Maganese Constituent of mitochondrial superoxide dismutase Ascorbic acid is water soluble and has been shown to react directly with the 02~, HO- and ^©2 and can also regenerate the reduced antioxidant form of vitamin E from the vitamin E radical. In the presence of transition metals ascorbic acid can provoke the formation of free radicals. However, there is no evidence that this pro-oxidant effectoccurs in vivo. Beta carotene, a pigment found in all plants, is the most efficient quencher of singlet oxygen known in nature and can also function as an antioxidant. Beta carotene is the major carotenoid precursor of vitamin A. Vitamin A, however, cannot quench singlet oxygen and has only a limited capacity to scavenge free radicals. Following its reaction with 1O2, beta carotene dissipates the energy taken up in the molecule, and returns to its ground state. One molecule of beta carotene can deactivate many 1O2 molecules (about 1000). Several essential minerals are constituents of protective antioxidant enzymes. Zinc and copper, are required for synthesis of cytosolic superoxide dismutase (SOD) and manganese for the mitochondrial SOD. However, dietary deficiencies of copper and manganese have been shown to lower tissue SOD, whereas a zinc deficiency has had littleeffect on tissue levels of the enzyme. In fact, high levels of zinc have been found to lower SOD presumably by inducing a copper deficit. On the other hand, zinc may be important as a membrane stabilizer and as a precursor of metallothionein, a protein with antioxidant properties. Selenium as an essential component of glutathione peroxidase (GPX), an enzyme important in the decomposition of both hydrogen peroxide and lipid peroxides. Catalase, a heme protein (iron), catalyzes the decomposi tion of hydrogen peroxide. The sulfur amino acids, methionine and cysteine may be important as precursors of the cysteine-containing peptide, glutathione an important component of the antioxidant defense system (Figure 5). It is important to note that the antioxidant enzymes are primarily intracellular and thus extracellular free radicals, either endogenously produced or from the environment, must be inactivated by the circulating antioxidants such as the antioxidant vitamins discussed above as well as by ceruloplasmin. The level of dietary intake of all the antioxidant micronutrients directly affects the circulating level of these nutrients and the activity of the antioxidant metalloenzymes. Thus, low intakes of one or more of these antioxidant nutrients could reduce the body's defenses against free radical damage and increase susceptibility to health prob lems associatedwith free radical damage. Eachtissue or cellhas a unique composition in regard to antioxidant protection, pro-oxidant compo nents, and exposure to free radicals. Health or pathology depends upon the balance of these three factors. Some examples of the special condi tions that exist in certain tissues and the possible consequences are given in Table 3. FIGURE 5 Antioxidant Protection Within The Cell Vitamin E /3-carotene NUCLEUS Vitamins C and E ENDOPLASMtC RETICULUM ^-carotene LYSOSOMES Catalase PEROXISOMES Ki O GSH CYTOPLASM y' Glutathione MITOCHONDRION Peroxidase Cu/Zn SOD / 'Vitamin C LIPID BILAYER OF ALL CELLULAR MEMBRANES Vitamin E Vitamin E + (3 carotene SOD + Glutathione Peroxidase + GSH TABLE 3 Example of special conditions which can predispose specific tissues to free radical damage Special Possible conditions consequences Tissue Lung High exposure to O2, O3, Emphysema, cancer NO2, smoke Synovial fluid No SOD, GSH peroxidase, catalase Exposure to inflammatory Arthritis cells Retina High PUFA, High O2 Exposure to light Retinal degeneration Lens Exposure to light Low protein turnover Cataract High PUFA, autoxidation Parkinson's Brain of catecholamines, low turnover 10 Antioxidant Interactions In addition to direct quenching of reactive, damaging free radicals, vitamin C has been clearly shown to interact with the tocopheroxyl radical and to regenerate the reduced tocopherol. Thus, vitamin C can have a "sparing effect" on vitamin E. Vitamin E can protect the conjugated double bonds of beta carotene from oxidation and thus have a sparingeffect on this vitamin. Vitamin E can protect against many of the symptoms of selenium deficiency and vice versa. These sparing as well as synergistic actions are thought to result from the ability of both tocopherol and selenium-dependent GPX to decrease the production of lipid autoxidation products. Studies in animals and man suggest that both vitamin E and selenium are neces sary for maximum protection against cancer. As a result of these interactions, there may be other health conditions where combinations of vitamin E, C, betacarotene and selenium may be more effective than any single nutrient. Health implications of free radical damage The range of antioxidant defenses available within the cell and extracellularly are generally adequate to protect against oxidative dam age. However, the balance can be lost because of overproduction of free radicals, by exposure to sources that overwhelm the antioxidant de fenses, or by inadequate intakeof nutrients that contribute to the defense system. Two examples of health effects of free radical damage where there is considerable evidence that antioxidant nutrients can protect, are lung cancer and cataracts. There is considerable evidence that smoking increases the risk of lung cancerand recently evidence has accumulated that consumption of foods high in beta carotene reduces the risk oflung cancer (and some other cancers as well) Fig. 6 & 7. There is considerable chemical evidence to support the hypothesis that cataracts are the result of the accumulation of free radical insults over a course of many years (Table 4). Furthermore, studies in animals have shown that vitamin E and C both slow the onset of cataracts in animal models, and that human subjects taking vitamin C or E supplements have a reduced relative risk of cataracts (Table 5). There are many other examples of free radical-mediated disease processes where nutritional intervention could possibly play an impor tant role. In addition to the diseases mentioned earlier is this report, cardiovascular disease, arthritis diabetes, macular degeneration photodermatoses, and the aging process itselfare worth continuedexploration. Of course there are many scientific issues remaining. We need less equivocal methodologies which would permit us to detect and quantify free radical injury particularly in vivo. In most cases more information is 11 BETA CAROTENE AND CANCER 19-Year Inodence of Bronchiogenic Carcenoma (%j 30-h 0.12.2 ' Duration of 2.3- 3.0Carotene Index Cigarette Smcriung (yps) 4.019.2- mg/day Bnranate association of carotene ndex and duration of agarette smoking with 19-year lungcancer ^idence. SchekeDe et al..(19ai] FIGURE 7 PROTECTIVE EFFECT OF CAROTENES ON CANCER EPIDEMIOLOGIC STUDIES No Effect Reduced Risk Cervix Esophagus Or(^arynx/head/neck Stomach Bladder Colon/rectum I I 11 p I Number of Studies r TABLE 4 Evidence for Oxidative Damage to the Lens (Human Studies) o Incidence related to exposure to ultraviolet and near ultra violet light o In cataracts find increased: - H2O2, Malondialdehyde (MDA) - Disulfides, dityrosine, methionione sulfone In cataracts find decreased: o Superoxide dismutase (SOD), glutathione peroxidase and cataiase 0 Reduced glutathione early in development TABLE 5 Effect of Vitamins E & C Supplements on Cataracts* People Over 55 Years Old Supplement Relative risk None 1.00 Vitamin E 0.40 (P = .003) Vitamin C 0.25 (P = .04) Vitamins E & C 0.32 (P = .05) ^Robertson (1987) GCR N-122113, L J. Machlin still necessary to establish the casualty between free radical injuries and eventual pathologies. Finally, there is an enormous opportunity to better define the role of nutrition in helping prevent or at least delay the onset of a host of slowly developing chronic health problems. Summary In summary, it is clear that the area of free radical biology is emerging quite rapidly. Free radical injury to tissues is certainly not responsible for all of the health problems of the world. However, there is already considerable evidence that a free radical etiology at least partially 13 underlies many pathological processes and that nutrition plays an important protective role against such processes and their subsequent health effects. It will take considerably more effort to completely comprehend and utilize this emerging science, but in view of the potential rewards in terms of enhanced public health, the effort is certainly warranted. References Armstrong, D., Sohal, S., Cutler, R.G., Slater, XE, (1984) Free radicals in molecular biology, aging, and disease. Raven Press, New York. Bendich, A., Machlin, L.J., Scandurra, O., Burton, G.W., Wayner, D.D.M., (1986) Adv. in Free Radical Biology and Medical 2; 419-444. Chow, C.K., (1988) Cellular antioxidant defense mechanisms Volumes I, II, & III. CRC Press, Boca Raton, Florida. Halliwell, B., Gutteridge, J.M.C., (1985) Free radicals in biology and medicine. Clarendon Press, Oxford. Freeman, B.A., (1987) Crapo, J.Q, (1982) Biology of disease: free radicals and tissue injury. Lab Invest. 47; 412-426. Machlin, L.J., Bendich, A., (1987) Free radical tissue damage: protective role of antioxidant nutrients. FASEB J. 1:441-445. Machlin, L.J., (1987) Protective role of vitamins against free radical damage. Nutrition pp 51-54. Slater, T.F., (1987) Free radical mediated tissue damage. Nutrition pp 46-50. Southom, PA., Powis, A., (1988) Free radicals in medicine. 1. Chemical nature and biologic reactions. II Involvementin human disease Mayo Clin. Proc. 63: 381-389, 390-408. Figure Legends Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Cellular sources of free radicals (Machlin and Bendich 1987) Consequences of free radical damage (Adapted from Slater, 1987) Lipid peroxidation (Southern & Powis 1988) Free radical damage to membrane (Freeman & Crapo 1982) Antioxidant protection within the cell (Machlin and Bendich 1987) Beta-carotene intake and risk of lung cancer. (From Shekelle et. al 1981) Fig. 7 Beta-carotene and risk of cancer. Summary of epidemiological studies. Bibliography of Dr. Lawrence J. Machlin, Ph.D. LAWRENCE J. MACHLIN, Director Clinical Nutrition, Roche Vitamins and Fine Chemicals (Hoffman-LaRoche, Inc.). Bom 1927;Married, 3 sons; B.S. Degree, Cornell University, 1948; M.N.S. Cornell University,1949,Nutrition; Ph.D. Georgetown University,1954,Biochemis14 try, 1984-Present, Director, Clinical Nutrition, Hoffman-LaRoche, Inc.; 1973-1984, Senior Research Group Chief,Vitaminsand Clinical Nutrition, Hoffman-LaRoche, Inc.; 1963-1974, Senior Group Leader, Monsanto Company; 1960-1963, Scientist, Monsanto Company; 1956-1960, Biochemist, Monsanto Company; 1950-1956, Biochemist, U.S.D.A.-Atomic Ener gy Commission; 1949-1950, Nutritionist, U.S.D.A., Beltsville, MD. Professional Activities: Organized and co-chaired international conference on Vitamin E, 1982 and 1988 and Vitamin C in 1986; Participant, White House Conference on Food, Nutrition and Health, 1969. Professional Memberships: American Institute of Nutrition; American Society of Clinical Nutrition; American College of Nutrition (Fellow); Society for Experimental Biology and Medicine; New York Academy of Science; New York Lipid Club; and International Association of Vitamin and Nutritional Oncology. Scientific Achievements: Established nutritional requirement for sulfate sulfur. Oneoffirst to describe theimportant interrelationship between linoleic acid and vitamin E. Clarified the etiology of vitamin E deficiencies in the chicken. Discovered that vitamin E will inhibit prostaglandin synthesis and platelet aggregation. Established that subjects with sickle-cell anemia are deficientin vitamin E and that number of irreversibly sickled cells would decrease with vitamin E treatment. Developed a unique, sensitive and reliable bioassay for vitamin E bioactivity. Helped demonstrate the specific need for vitamin E for maximal immune response. Pioneered development of assays for insulin and growth hormone in farm animals. One of first to unequivocably demonstrate the effects of growth hormone in improving milk production in dairy cows and lean meat production in the pig. Publications: Author and/or Co-author of over 110 scientific papers, including 4 patents and 5 book chapters. Editor of 4 books, two on "Vitamin E", a "Handbook of Vitamins" and Conference on Vitamin C. Books: Machlin, L.J. (Ed.)1980. Vitamin E,a Comprehensive Treatise. Marcel Dekker, Inc., New York, N.Y Lubin, B. and Machlin, L.J. (Eds.) 1982. Vitamin E: Biochemical, Hemalological, and Clinical Aspects. Ann. N.Y Acad. Sci., Vol. 393. Machlin, L.J. (Ed.) 1984. Handbook of Vitamins, Nutritional, Biochemical and Clinical Aspects. Marcel Dekker, New York, N.Y. Burns, J.J., J.M. Rivers and L.J. Machlin (Eds.) 1987. Third Conference on Vitamin C. Ann. N.Y. Acad. Sci., Vol. 498. Book Chapters: Machlin, L.J. 1962, Role of antioxidants in the biological fate of lipids. IN: Lipids and Their Oxidation. H.W. Schults, E.A. Dayand R.W. Sinnhuker (Eds.), The AVI Publishing Co., Inc., Westport, CT, pp. 255-268. Machlin, L.J. 1973. Phosphorus in human nutrition. IN: Environmental Phosphorus Handbook. E.J. Griffith, A. Beeton, J.M. Spence and D.J. Mitchell (Eds.), John Wiley & Sons, Inc., New York, pp. 413-423. Machlin, L.J. 1976. Role of growth hormone in improving farm animal production. IN: Anabolic Agents in Animal Production. EC. Lu and J. Rendel (Eds.), FAOAVHO Symposium, Rome, March 1975, Environmental Qualityand Safety, Suppl. Vol. V Georg Thieme Publishing, Stuttgart, pp. 43-54. Machlin, L.J. and M. Brin. 1980. Vitamin E. IN: Human Nutrition - A Comprehensive Treatise, Vol. 3B, Nutrition and the Adult. R. Alfin-Slater and D. Kritchevsky (Eds.), Plenum Publishing Corp., New York, pp. 245-266. Machlin, L.J. 1984. Vitamin E. IN: Handbook on Vitamins. L.J. Machlin (Ed.), Marcel Dekker, Inc., New York, pp. 99-145. 15