KA HOʻOHOLO IA M. TRAISH
Mai ke Keʻena o ka Biochemistry a me nā Urology, Ke Kulanui o ka Haumāna Kulanuiʻo Boston, Boston, Massachusetts.
| ʻO Dr Abdulmaged M. Traish, Professor of Biochemistry and Urology, Director, Laboratories for Medicine Sexual Institute, Institute for Medicine Sex, University of Medicine University, Center for Advanced Biomedical Research, 700 Albany St, W607, Boston, MA 02118 ( e mail: [pale ʻia ka leka uila]). |
| Loaʻaʻia no ka paʻiʻana i ka lāʻo Iune 13, 2008; i'āponoʻia no ka hoʻopukaʻana i ka lā XXUMX, 17. |
Hōʻuluʻulu Manaʻo
A he mea nui no ka hoʻouluʻana, ka uluʻana, a me ka mālamaʻana i ka pilina penile, a me ka hoʻoponoponoʻana i ka physiology o ka honua. Maʻaneʻi, hoʻolako mākou i kahi māhele māhele o nā'ikeahana no ka hoʻololi a me ka hoʻohālike o ka architecture a me ka physiology. Aia kekahi mauʻikeʻike nui e kuhikuhi nei i kahi koʻikoʻi koʻikoʻi o nā toikua ma ka paepaeilepili. Hōʻike nā haʻawina i nāʻano holoholona holoholona i kaʻike kūikawā i ka hana a nā androgens i ka hoʻololiʻana i nā mea e pili ana i ka pilina a me ke kamepiula, ka mole, a me nā hana physiological. ʻO kaʻikepili kumuhana mai kā mākou papa hoʻokolohua a me nā mea i hōʻikeʻia e nā poʻe'ē aʻe, he mea nui i ka mālamaʻana i ka hoʻolālā a me ka hanaʻana o ka pūnaewele nerve penile e pili ana, ka pono kūlohelohe o ka corvern cavernosa, ka tunicaalbuginea, a me ka endothelium o ke kauhale. Eia kekahi, he mea koʻikoʻi ka hana a me nā torogens i ka hoʻoponoponoʻana i ka hoʻokaʻawaleʻana o nā pūkuʻi mua i loko o ka muscle laneau. Ma kēia hōʻike, e hoʻohuli mākou i kā mākou kūkākūkā i nāʻike e pili ana i ke kanola o androgens i ka hoʻoponoponoʻana i nā mea'enekala penile i ka hoʻololiʻana i ka hana penile. Hiki i kēiaʻike ke hoʻoikaika koʻikoʻi i ka hoʻohana ponoʻana o nā androgens i loko o ka hōʻiliʻiliʻana e hana i nā maʻi me ka hanaʻole o nā erectile.
Nā hua'ōlelo koʻikoʻi: Andropause, meaʻole e like me ka erectile, hormone, penis, adipogenesis, androgen deficiency, corpus cavernosum, ponoʻole o ka wahine, ka puʻupuʻu keʻokeʻo
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ʻO ka hanaʻeha o ke kino e like me ke kino, he kumu nui ia o ka hanaʻole o erectile waiwai a uaʻikeʻia e ka pono no ka hoʻonuiʻia o nā kahe e hoʻomau i ka hale i ka wā o ke kaulikeʻana o ke kūkuluʻia e ka palapona saline (Hatzichristouet al, 1995, 1999; Nehra et al, 1996, 1998; Udelson et al, 1998; Mulhall et al, 2004). ʻO ke kino o ke kino me ka maʻi maʻamau aʻo ka hui pūʻia me ka maʻi o nā maʻi kūlohelohe,ʻo ia ka hemodynamicabnormality maʻamau e hāʻuleʻole ai ka paneʻana i ka pharmacotherapy intracavernous (Rajfer et al, 1988; Mulhall et al, 1997; Aversa et al, 2003;Wespes et al, 2005; Hwang et al, 2006). ʻO ka nohoʻana o ka concomitoryterial a me kaʻalima maikaʻi ke maʻi maʻi puʻupuʻu i ka paʻakikī i nā mea paʻakikī keʻike a mālama.
ʻOiai ua ho'āʻoʻia nā hana e kekahi o nā laborathesto e wehewehe a hoʻomaopopo i keʻano o ka hana a me nā mea e hoʻoholo ai i keʻano o ka cellular a me ka mole mole o kaʻoihana erectile a ua hanaʻia kekahi hanaʻole, e mau ana nā hapa. ʻO kēia mauʻano he mahele o ka androgens i ka hoʻolālā a me ka hana pono o nā nerves cavernosal a me ka'ēheu, ka uluʻana a me ka hana o ka mīkī māmā, a me ka hana o ka hopena a me ka hoʻomauʻana o ke kaʻina o ka halihali a me ke kahe o ka fibrosis. Maanei, ke hōʻike nei mākou i kahi hana hoʻolālā o ka hana hoʻohālike o ka androgen actionin (Hōʻike 2). Ke hoʻohana nei i kēia kumumanaʻo,ʻo ka wānana i ke kuleana o nā hōʻailona e pili ana i nā koina penile, me ka 1) kohu āpau, 2) kaʻokoʻa o nā puʻupuʻu lahilahi, 3) vasothelium vascular, a me 4) keʻano albuginea a me ke kikowaena.
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Hoʻoponoponoʻo Androgens i keʻano a me ka hana o pelvic ganglia (ʻO Meusburger aʻo Keast, 2001; Keast et al, 2002). Giuliano et al (2004) ua manaʻoʻia ka lawelaweʻana o ka'ōnaehana'ōnaehana e like me ka hanaʻana ma ka hanaʻana i nā neurons parasympatic paraga. 'Alakila al (2007) hōʻike i ka hoʻonāʻai'enerogene me ka hoʻololiʻana i ka hale o ke aʻalolo. Keʻike nei kēia mea nānā i nā hana a Baba et al (2000a,b) ma ka hoʻonāukiukiʻana i ho'ēmi i ka NADPH i loko o nā cavernosal a me nā dorsalnerves a me ka hoʻoponopono testosterone i hoʻihoʻiʻia i kēia mauʻanoʻoihana pale pūnaewele. Rogers et al (2003) ua hōʻike pūʻia hoʻi ka hoʻololiʻiaʻana o ka hanaʻana o ke aʻalolo ākea a ka hopena o ka lekageʻino. ʻO ka'ōlelo Testosterone ma hope koke iho o ka hoʻokahuliʻana e pale i ka lūlūʻino a hoihoi hou i nā pūnaewele i nā waiwai likeʻole me nā holoholona i paʻaʻole. ʻO ka mea e mahalo ai,ʻo ka mālamaʻana i nā holoholona i hoʻohemoʻia me ka hānaiʻana o ka endothelial vascular (VEGF) ua hoʻoulu houʻia ka hanana nerve a me kaʻoihana veno.No ka mea ua hōʻikeʻia nā torogens e hoʻoponopono i ka'ōlelo VEGF (Haggestrom et al, 1999), hiki ke hiki i ka VEGF synthéni ka cavernosum kino ke hoʻoholoʻia i loko o nā holoholona i hoʻokaheʻia a me ka hoʻoponopono testosterone i ka VEGF hōʻaho, no laila ka mediatingthe effects effects of androgeneuses on corpus cavernosum.
Orchiectomy i hoʻonui i ka hoʻonui nui o ka home intanchovernalpress e hoʻopukaʻia e ka hoʻolālā elela o ka pelvicnerve. Ua hoʻohuliʻia kēia ma muli o ke pani o ka testosterone, e hōʻike ana he mea nui ka testosterone i ka pūnaewele peripheralnerve e hoʻoponopono ana i ke kūkuluʻana o penile (Simpson a me Marshal, 1908; Müller et al, 1988; Heaton a me Varrin, 1994; Mills et al, 1994; Bivalacqua et al, 1998; ʻO Traish et al, 1999; Palese et al, 2003; Suzuki et al, 2007). Eia kekahi, Suzuki et al (2007) me ka hoʻohālikelike i ka hoʻohālikeʻana i nā pane mai o kaʻeleʻele i hoʻopiliʻia e ka hiliʻana o ka nerve cavernosal, i hoʻemiʻia i ka hoʻohemoʻoleʻia i nā holoholona i hoʻohemoʻia, ua hoʻopauʻia e ka mea hiku o ka medial preoptic i ka hemo ma hope o ka hoʻokahuliʻana a ua hoʻopau pihaʻia ka paopao testosterone.
A me nā mea hōʻailonaʻo Maintain Penile Trabecular Smooth MuscleʻOho a me ka Hana
Aia nāʻike nui e hōʻike ana he māhele koʻikoʻi kaʻiʻo o ka trachelularsmooth penile i ka hoʻoponoponoʻana i ka paepaeilefunction (Saenz de Tejada, 2002). ʻO ka maʻamau maoli o nā hoʻololi a me ka hoʻohālikelike i ka hopena o kaʻenehana ma hope o ka androgen deficiency, uaʻikeʻoleʻia.
Hoʻohālikeʻia ka hoʻohālikeʻana o ka hoʻohālikeʻana i nā mea hoʻohālike holoholona, ma o ke kālaiʻana a iʻole ka lapaʻauʻana, i ka hoʻoemi nuiʻana o ka content smoothbecual trabecular, a me ka hoʻonuiʻana i ka waihoʻana o ka matana connectivetissue (extracellular)ʻO Traish et al, 1999). ʻO kēia hoʻololi o ka tissuearchitecture e pili ana me ka ho'ēmiʻana o ka pēpena intracavernosal i ka paneʻana i ka hoʻokalakupua o ke pelvic (Simpson a me Marshal, 1908; Müller et al, 1988; Takahashi et al, 1991; Heaton a me Varrin, 1994; Mills et al, 1994; Bivalacqua et al, 1998; ʻO Traish et al,1999, 2003; Palese et al, 2003; Suzuki et al, 2007). Eia kekahi, o ka hoʻonaʻauao kūpono i nāʻokoʻa mai nā holoholona i hoʻohemoʻia i kākauʻia e like me ka mea i hoʻoponoponoʻoleʻia me ka mīkini paʻakikī, me ka nui o nā cytoplasmic vacuoles a hoʻemiʻia ka nui o nā myofilaments cytoplasmic (Persson et al, 1989; ʻO Traish a me Kim, 2005;ʻO Traish a me Guay, 2006; ʻO Traish et al, 2007). ʻO ka pauʻana o ka momona momona ka hopena o kaʻai'enerogeneke e pili ana i ka nui o ka makeʻana o ka cell cell, ka waihoʻana o nā kikowaena pūnaewele, a me ka hoʻokaʻawale adipocyte mai nā pūnaewele mua (Shabsigh et al, 1998; ʻO Traish et al, 2005). ʻO kekahi o nā hoʻololi hou i loko o nā hanana i hanaʻia i penile i hōʻikeʻia i nā poʻe maʻi me ka nonctilepal erectile i ke atrophy muscle maʻemaʻe a me ka hōʻiliʻiliʻana o extracellularmatrix, i komo i nā fibril collagen.
ʻO ka momona maʻemaʻe o ka corpora cavernosa e pili ana i ka pilina e pili ana i ka moʻaukala me ka weheweheʻana, ua maopopo keʻano o ka mīkini paʻalua i ka tissuratio connective. ʻO ka emiʻana o ka mīkini trabecular lōkahi me ka hoʻonuiʻana i ka waihoʻana o ka pilina o ka pilina pili i ka mea i manaʻoʻia e lawe i nā fibrosis kiko a me ka hopena o ka hanaʻole. Ua hoʻohuiʻia kaʻino o nā maʻi a me nā hopena o ke kino i nā kānaka me ka palakaʻole i ka maʻi o ka corporalsmooth (Nehra et al, 1996, 1998; Wespes et al, 1997, 1998). I loko o nāʻokoʻa mai nā kānaka me ED, uaʻikeʻia ka mīkini paʻakikī i kaʻike maʻamau e like me nā'āpana glycogen a me ka mitochondria i hōʻuluʻuluʻia i loko o nā pūnaewele. Ua hōʻike ka nuclei i ka'ōhinuhinuhinu a ua ho'ēmiʻia a hoʻopauʻia paha ka hulina pū cell-cell. Ua hōʻikeʻia kēia mau haʻawina e hoʻonuiʻia ka'enela collagen (e like me keʻano o nā mea pili) me ka hāʻuleʻana o ka hoʻopaʻi i loko o nāʻenehana puʻupuʻu manuale penile fibroelastic, e hoʻoemi ana i ka mālamaʻana, a me ka hopena o ka holoʻana o ke koko penile,Persson et al, 1989; Mersdorf et al, 1991).
Hoʻoponopono i nāʻokoʻa a me nā meaʻokoʻa i ka hoʻokaʻawaleʻana i nā pūnaewele mua o ka'ōpiko i kahi o Trabecular Smooth Muscle
ʻO ka hoʻohālike'Anetene i keʻano holoholona hoʻoholo i ka hoʻolakoʻana i nā adipocytes ma nā penile tissues, ma loko o ke subtunregregion (ʻO Traish et al, 2005). Ke kuhi o Testosterone ma hope o ka hoʻouka houʻana o ka hale. ʻO nā mea i hanaʻia e pili ana i ka emiʻana o ka pelvic i ke kino o ka pulupulu o ka pelvic. Uaʻike mākou a me nā poʻe'ē aʻe i ka hōʻuluʻuluʻana o adipocytes i loko o ka maʻi penile o ka maʻi diabetic (ʻO Traish a me Kim 2005; Kovanecz et al, 2006). Ma muli o ka piliʻana o ka maʻi me ka hoʻolālāʻana o ka androgeneke, hiki i ka uluʻana o ka adipocytes ka hopena o ke kaʻina o androgen o ke kelepaʻi pūnaewele. Pēlā nō, ka mālamaʻana i nā holoholona kāne me ka bisphenol A,ʻo ia hoʻi kaʻike i loaʻa i ka hana estrogenic, a ua uluʻia hoʻi nā adipocytes i loko o ka cavernosa corpora (Moon et al, 2001, 2004) Ke hōʻike nei kēia i nā'enerogenero a me ka hawewe e like me ka hawewe a me ka hawewe i ka capososum corpus a loaʻa i kaʻokoʻa o nā kinipiki i mua o ke adipocytes. ʻO Goyal et al (2005a,b; 2007a,b) ua hōʻike i keʻano o ka mālamaʻana i nā holoholona o 2 me nā'ōnerogeneʻe ma muli o ka hoʻemiʻia o nā kumu testosterone plasma a me ka hoʻonuiʻiaʻana o adipocytes i loko o ka cavernosa corpora o nā holoholona kahiko. Bhasin et al (2003) ua'ōleloʻia e ka hoʻohālike i ka hoʻokaʻawaleʻana o nā pūnaewele pluripotent i loko o ka muscle maʻemaʻe a pale i ka hoʻokaʻawaleʻana i nā adipocytes. Ua kākoʻo nuiʻia kēia kuhiakau e nā hopena o Singh et al (2003, 2006), ka mea i hōʻike i keʻano likeʻole o nā pluripotentcells i loko o ka muscle maʻemaʻe a me ka hanaʻoleʻana o ka adodigenesis isendrogen-dependent. Hoʻopuka mākou i kēlā hōʻiliʻiliʻana o adipocytesin ke ala waena ma waena o ka tunica albuginea a me nā kino cavernosal e hiki ke kōkua i ka pilikiaʻole o ke kino.
Hoʻoponopono i nāʻaeʻa a me nā hana
Ua hoʻokūpaʻa ponoʻia e like me ka hopena mumua o ke aho endothelium modulatescorpus cavernosum ma o ka hanaʻana o nā mea NO nā pīpīpoko, e like me prostaglandins, endothelin, kumuhana huahua pālua, a me ka hoʻololi i ka mea ulu nui β1 [TGF-β1] ((Moreland, 2000; Bivalacqua et al, 2003, 2005; Solomon et al, 2003ʻO Guay 2005, 2007; Musicki a me Burnett, 2007; Watts et al, 2007) .I ka hōʻino i ke kumuhana (e like me ka'ischemia, hypoxia, a me arteriosclerosis) hiki ke hoʻoulu i ka hoʻonui a hoʻemi paha o nā mea paracrine,Moreland, 2000). Ke aʻo hou nei aLu et al (2007) e hōʻike ana i ka hoʻoneʻe kumu o Androgene ma ka hoʻonaninui 5
hana i nā mea hoʻopilikia i nā mea hanaʻino i ka hopena o ka lāʻau, e like me ka mea i hoʻoholoʻia e ka microscopy electron. ʻO nā meaola o ka hopena o nā holoholona i nā holoholona i hōʻikeʻia i nā meaʻoluʻolu me nā hiʻohiʻonaʻokoʻa. ʻO ka hopenaolaum mai nā holoholona i hoʻouluʻia he holoholona nui a me nā mea kūpono, a uaʻikeʻia he kūponoʻole. Ua hoʻololiʻia nā mea loli pū-pūnaewele a ua hoʻomauʻia ke kāpiliʻana i nā koko koko koko ma kaʻala o ka hopeneola. ʻO ka hoʻoponopono o ka testosterone i loko o nā holoholona i hoʻokaheʻia i ka hapa o ka pono i loaʻa i ka pono o ka loiloi hope loa, me nā hapa liʻiliʻi iʻikeʻoleʻia. Ua hōʻikeʻia nāʻikepili mai kēia papahana e hoʻohohoʻiʻia ka hoʻohālike endroghelial āpau e ka androgen deficiency. Akishitaet al (2007) i hōʻikeʻia, ma ka 187 a me ka male outpatientswho iʻike i ka hanaʻana i ka vasodilation i ka lolopalapala (FMD) o ke kekona brachial e hoʻohana ana i ke ultrasonography, ka nui a me ka freetestosterone i hoʻopili ponoʻia me ka hapa o ka FMD. Ua hoʻokaʻawaleʻia kēia hoʻohuiʻana mai ka makahiki, ka nui o ka heluna kanaka, ka kiʻekiʻe, hyperlipidemia, ka maʻi diabetes, a me ka puhiʻana, e'ōlelo ana i ka hopena palekana o ka testosterone pili i ka endothelium.
ʻO ka hoihoi houʻana a me ka hoʻoponoponoʻana o kaʻeha endothelial,ʻo ia hoʻi, ma kahi o ka wai o nā lāpuni o ke kōpikipiki e pili ana i nā pūnaewele (PC) a me nā māmā o ke kahe o nā cell progenitor (EPC) .Foresta et al (2006, 2008) i nеnе i ka hopena o ka longedterstesterone therapy i loko o känaka me ka hypogonadotropic hypogonadismon PC a me nä mea e pono ai. Ua'ōlelo nā mea kākau i nā patienta hypogonadal i hoʻemiʻia nā pae o nā PC a me nā'Elepili a me nā testosterone i ho'ālaʻia ma ka hopena nui o kēia mau pūnaewele. Ua'ōleloʻia ka mea kākau e pili ana i ka hypogonadism me nā helu liʻiliʻi e pili ana i nā PC a me nā pono pūnaewele. ʻO ka ulu o ka hoʻonuiʻana, ka neʻeʻana, a me ka hana hoʻonohonohoʻana o nā koina o nā'EPC i hoʻokomoʻia e nā androgens,Foresta et al, 2008).
Paipai mākou e hoʻoneʻe i ka'enerogenelo toendothelial i nā pūpū o ka penis enlaressynthesis a me ka hoʻokuʻuʻana o ka TGF-β1, ka limu, a me ka nonproductive acid, akā e emi iho ana ka NO. ʻO ka hopena o kēlāʻano biologicalultsults i ka endothelium e lawe mai i nā loli o ka hōʻailona puʻupuʻu puʻupuʻu, e alakaʻi i ka hoʻonuiʻana i ka extracellularmatrix deposition (fibrosis), atrophy cell, a me ka uluʻana o ka ulu (hypoplasia). No laila, hiki i ka'ōpiko ke hoʻololi i ka laulima a me ka hōʻemi i ka kūpaʻa (e like me ka hopena), e hiki ai i ka maʻi vasculogenic erectile.
Androgens Maintain Tunica Albuginea Nā hana kūlohelohe a me nā mea pili pono i nā mea e pono ai ka pono.
ʻO Shen et al (2003) hōʻike, ma nā holoholona i hoʻohuiʻia, kahi hana nui ma ka mānoanoa o ka tunica albuginea i ka wā e hoʻohālikeʻia me nā holoholona i paʻaʻole. I loko o nā holoholona kūlohelohe, ua lako ka tunica i nā lālā e lapalapa ai, a me ka hoʻohālikelikeʻana o ia mau pale i nā papa hana maʻamau. I ka hoʻokaʻawaleʻana, ua hōʻikeʻia i nā holoholona i hoʻokaheʻia nā kinikini i nā mea i hoʻohālikeʻia i ka liʻiliʻi o nā huapalapala e hoʻopiliʻia ana o kēia mau hua me ka pilina. ʻO nā mea kākau i kāpaeʻole i kēlā mau hua'ōlelo he mea nui ia e mālama ai i ka laulā maʻamau o penile tunica albuginea.
Ma ka hoʻohālikeʻana o ka hoʻohālike e like me ka hoʻohālikeʻana i nā mea holoholona, ua hoʻonuiʻia ka hoʻonuiʻiaʻana o ka hua'ōlelo extracellular, me ka concomitantreduction i ka muscle laulā i ka ratio lāpili pili like e like me MaxNUMX-fold (Takahashi et al, 1991; ʻO Traish et al, 1999, 2003) Ke hoʻoemi nei i nā mea fibroelastic i loko o ke kino i hōʻoleʻia i ka mālama ponoʻana o kaʻiʻo a hoʻokaho i nā hemodynamics penile, me ka hopena o ka wili honua (Wespes et al, 1990, 1991; Ievtich, 1991; Nehra et al, 1996). Uaʻikeʻia kekahi mau noiʻiʻana i ka hoʻohālikeʻana o nā hua'ōlelo i ka hua'ōlelo extracellular ma o kaʻike o nā mea ulu (Natoli et al, 2005). Akā naʻe, pono eʻimi houʻia kēia mea ma ka penile. ʻO ka emiʻana o nā lālā a me ka hoʻololiʻana i nā hiʻohiʻona microscopic e hiki i ka waihona waiwai hoʻopiʻi o nāʻeleʻele ma o ka hanaʻole i ka hana o ka tunica albuginea (Gentile et al, 1996; Akkus et al, 1997) Ua hoʻopukaʻia e nā haʻawina hoʻonaʻauao i ka hoʻihoʻi houʻana o ka hana i nā kānaka me ka hana'elepilepile i piliʻia i ka venenleakage ma hope o ke kaʻinaʻana o ka haʻalina (Yassin et al, 2006; Kurbatov et al, 2008a,b). Ke hōʻike nei kēia mau'ōlelo he mea nui ka hana a me ka hana i ka mālamaʻana i ka pilina o nā mea e pono ai.
Ka hopena a me nā hopena
Aia kekahiʻano koʻikoʻi o nā hōʻike, e hōʻike ana e hoʻopili i ka'enela a me ka hana o nā aʻalolo penile, ka vascularendothelium, ka muscle laulā, ka pilina pilikino pili, a me ka tunica albuginea. Hoʻoponopono hou i ka hoʻokaʻawaleʻana i nā pūʻokoʻa mua i loko o ka mīkini paʻakikoki trabecular a hoʻonele i ka piliʻole i adipocytes. I loko o ke kanaka, hoʻohālike ka'eneʻeneʻeneʻo i nā maʻi o ka maʻi, e like me 1) ka hana kūponoʻole o ka penisene a me ka 2) kaʻole o nā hana e hoʻokau i ka maʻi me ka maʻi hānai a me nā maʻi hānai kūpilikiʻi me ka hoʻokele a me ka hoʻoikaika maʻi a me ke antiandrogentherapy. Hoʻoponoponoʻia ka hoʻohālikelike e hoʻohālike ai i ka hana male. ʻO kēia mauʻike iʻikeʻia, me nāʻike pololei,'ōleloʻia e hōʻike ka testosterone i nā mea hana o kaʻilima a hoʻomaikaʻi i nā hemodynamics penile.
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I ka hōʻuluʻuluʻana, he mea nui ke koʻikoʻi o ka mālamaʻana i ka hoʻolālā kūpono (Hōʻike 3), a me ka physiology māmā e pili ana i ka penile neural mahi a me ka hoʻolālā i ka pono o ka mīkī maʻemaʻe, endothelium, a me keʻano o ka momona o nā mea e pili ana, a me nā ala me ke alapili.
mau hoomaikai ana
Nā kumu lalo
Hoʻokumu ʻia kēia pepa i kahi hōʻike ma kahi Symposiumon Special April 12, 2008, "Strategies Therapeutic for Male Sexualand Hormonal Health," i hui pū ʻia me ka American Societyof Andrology Makahiki Makahiki, kahi i loaʻa ai ka mea e hōʻike nei i kahi honorarium.
He kūkākūkā a Dr. Traish a me ka pili kālā pū me Bayer AG.
E hoʻomaopopo '
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