Role of DNA binding in the regulation and function of ribosomal S6 kinase 2

Lead Research Organisation: University College London
Department Name: Structural Molecular Biology

Abstract

Ribosomal protein S6 kinase (S6K) is a member of the AGC family of Ser Thr kinases which also includes PKA, PKB (Akt), PKCs etc. Biochemical and genetic studies in cell-based and animal models have provided evidence that S6K is a principal player in the regulation of cell growth, size and energy metabolism. Two major signal transduction pathways, phosphatidylinositide 3-kinases (PI3K) and mammalian target of rapamycin (mTOR), coordinate the activity of S6Ks in response to extracellular and intracellular stimuli, such as growth factors, mitogens, metabolites and nutrients. In an activate state, S6Ks translocate to discrete cellular compartments/multienzyme complexes, where they interact with and phosphorylate diverse substrates implicated in the regulation of translation, RNA processing, cytoskeletal rearrangement, cell growth and survival. A growing body of evidence links S6K signalling to various human pathologies, including diabetes, ageing and cancer.
In mammalian cells, there are two isoforms of S6K, termed S6K1 and S6K2. Nucleocytoplasmic shuttling has been reported for both isoforms of S6Ks, but their nuclear functions are not well understood. This grant application is based on our novel findings which imply the role of S6K2 in the regulation of transcription. We provide the evidence that S6K2 possesses an AT-hook DNA-binding domain at the C-terminal autoinhibitory domain, which mediates specific interaction with DNA. We also found that the activity of S6K2 is induced by direct interaction with DNA in a dose-dependent manner. Furthermore, mutational studies of the AT-hook motif revealed its importance in the regulation of S6K2 pro-survival signalling.
To further advance these original findings, we propose to study molecular mechanisms of S6K2-DNA interaction and an alternative model of S6K2 activation upon DNA binding by employing a range of biophysical, biochemical and cellular approaches. Our efforts will be also focused on exploring a cooperative mode of interaction between S6K2 and transcription factors in targeting promoter and enhancer regions of a specific set of genes, implicated in the regulation of S6K2-mediated cellular processes. Mammalian cell models and xenograft studies in nude mice will be employed to study the role of the S6K2 AT-hook motif in the regulation of transcription, ribosome biogenesis, cell survival and growth. It is expected that the proposed study will give deeper insight into nuclear functions of S6K2 and its implication in the regulation of transcription. Unique features of the S6K2-DNA interaction are not only of academic interest, but may also provide novel insights applicable to drug development.

Technical Summary

Ribosomal protein S6 kinase (S6K) is implicated in the regulation of cell growth, survival and glucose metabolism in response to extracellular stimuli and stresses. Deregulation of S6K signaling has been linked to various human pathologies, including obesity, diabetes and cancer. To date, nuclear functions of S6Ks are not well understood. We have recently discovered a novel feature of S6K2 regulation involving specific interaction with DNA via the AT-hook motif and the activation of its kinase activity. These original findings are fur-ther supported by mutational studies which reveal the importance of the AT-hook motif in S6K2 pro-survival signalling. We hypothesize that S6K2 has a potential to form regulatory complexes with transcription factors which may deliver the kinase at promoter regions of target genes in a sequence-specific manner. At DNA, the AT-hook motif can interact with the minor groove of AT-rich sequences, leading to a conformational change and activation of S6K2. In an activated state, S6K2 may modulate gene expression through phosphoryla-tion of transcription factors and/or protein-protein interactions. In the proposed study, we will focus to: a) investigate the molecular basis of the S6K2/DNA interaction; b) test an al-ternative model of S6K2 activation by DNA binding; c) explore a cooperation between S6K2 and transcription factors in targeting prompter/enhancer regions of a specific set of genes; d) investigate physiological relevance of the DNA binding activity of S6K2, focusing in particular on the regulation of transcription, ribosome biogenesis, cell growth and sur-vival. The proposed study may uncover a second member of a protein kinase family, in addition to DNA-PK, with a potential to be activated upon direct bindsing to DNA. It might also establish a platform for the development of small molecule compounds capable to block S6K2/DNA interaction and relevant S6K2-mediated functions.

Planned Impact

The primary benefit of the proposed research relates to increased knowledge of the regulation and function of S6K2, which we will intend to disseminate through peer-reviewed journals, national and international conferences, and free-to-access websites. We will also make S6K reagents and technical expertise freely available and will attempt to stimulate research in this field. Considering the current gap in knowledge relating to S6K2 regulation and function and our novel findings that the activity of S6K2 can be regulated by DNA binding, we believe the proposed research has the potential to significantly contribute to a better understanding of the roles of S6K2 in health and disease, and in the long-term, development of better treatment for diseases in which S6K2 is implicated. In particular, the study of the mechanism of S6K2 activation by DNA binding may present an opportunity for developing a novel way to modulate the activity of S6K2 and its downstream effects. We have an on-going S6K drug discovery programme which is primarily focused on developing small molecule inhibitors for S6K1. Where possible, we will feed findings from the proposed study into our ongoing drug discovery project and stimulate the development of a HTP screen for the identification of small molecule compounds capable to specifically inhibit the S6K2/DNA interaction. The proposed work therefore has the potential to initiate the development of novel therapeutic drugs in the long-term, as well as fostering positive economic outcomes, considering the rapidly growing global pharmaceutical market for protein kinase inhibitors. Another potential benefit of this research relates to the experience and skills gained by the staff involved in this project, which includes undergraduate and internship students who will work on the project. The proposed research offers a diverse range of techniques including biochemical and molecular biology techniques, bacterial and baculoviral expression of recombinant proteins, lentiviral overexpression and downregulation, mammalian cell biology, in vitro kinase assays and SPR analysis. Effective time-management, co-ordination and communication skills will therefore be critical for successful completion of this highly multidisciplinary project.

Publications

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Bakovic J (2021) Regulation of the CoA Biosynthetic Complex Assembly in Mammalian Cells. in International journal of molecular sciences

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Bakovic J (2021) Redox Regulation of the Quorum-sensing Transcription Factor AgrA by Coenzyme A. in Antioxidants (Basel, Switzerland)

 
Description The following progress has been made on the project: a) using colony formation assay and a xenograft model, we demonstrated for the first time that wild type S6K2 possesses an oncogenic potential and the DNA binding AT-hook motif contributes to this function; b) we found that the overexpression of wild type S6K2 promotes proliferation of NIH3T3 cells in medium with low foetal bovine serum (1%), while the effect of the S6K2 AT-hook mutants is significantly reduced; c) we have identified the site in S6K2 whose phosphorylation is induced upon binding to DNA in vitro and generated phosphomimetic and phosphorylation-dead mutants; d) the work is currently in progress on studying the importance of DNA-induced phosphorylation in vitro and in vivo; the 3D structure of S6K2 has not been solved so far and we have built a model of the S6K2 kinase domain based on available S6K1 kinase domain structures; e) we have identified a novel spicing isoform of S6K2, which has a dominant negative effect on the TORC1 signalling pathway; f) a significant progress on this project allowed us to secure a proof of concept funding from UCL Business/ Johnson&Johnson to develop novel S6K2 inhibitors targeting lung cancer; g) in addition, we also received a grant from the Therapeutic Innovation Fund (UCL) to solve the structure of the S6K2 kinase domain alone and in complex with developed inhibitors (in collaboration with Evotec Ltd);
Exploitation Route A good progress has been made on the project and we are currently in the process of preparing two manuscripts for publication. The publication of these novel findings can advance our understanding on: a) the role of S6K2 in the regulation of cell proliferation and survival in normal and cancer cells; b) the mechanism of S6K2 activation by DNA binding; c) the development of novel small molecule inhibitors/anti-cancer drugs targeting S6K2.
Sectors Pharmaceuticals and Medical Biotechnology

 
Description Member, International Expert Council, State Fund for Fundamental Research in Ukraine
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description BBSRC Project grant, Title: "Role of DNA binding in the regulation and function of ribosomal S6 kinase 2"
Amount £507,000 (GBP)
Funding ID BB/L010410/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 01/2015 
End 01/2018
 
Description Investigating the molecular mechanisms of protein deCoAlation
Amount £473,705 (GBP)
Funding ID BB/S009027/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 06/2019 
End 12/2023
 
Description MRC Infrastructure Grant, "Centre for Image-guided therapy - a theranostic approach to patients with cancer", Co-applicant
Amount £6,000,000 (GBP)
Funding ID MR/M009092/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 01/2015 
End 01/2019
 
Description Therapeutic Innovation Fund
Amount £69,700 (GBP)
Funding ID ISSF2/H17RCO/008 and BRC269/Hl/lG,l 101 440 
Organisation University College London 
Sector Academic/University
Country United Kingdom
Start 09/2015 
End 09/2016
 
Description Validation studies on newly discovered S6 kinase inhibitors
Amount £10,000 (GBP)
Funding ID M239-F1 
Organisation Rosetrees Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 05/2014 
End 05/2015
 
Title Development of S6K1 and S6K2 specific monoclonal antibodies 
Description We have developed a panel of highly specific S6K1 and S6K2 monoclonal antibodies which work efficiently in a diverse range of immunological assays, including Western blotting, immunoprecipitation and ELISA and immunohistochemistry. 
Type Of Material Antibody 
Year Produced 2014 
Provided To Others? Yes  
Impact Collaborative interactions have been established in the field of mTOR/S6K signalling with research teams from academia and industry. 
 
Title Development of anti-coenzyme A monoclonal antibodies 
Description We have developed anti-CoA monoclonal antibodies, which work very efficiently in various immunological assays, including IP, IF, IHC and Western blotting. To date, no commercially available anti-CoA antibodies are available on the market. 
Type Of Material Antibody 
Year Produced 2012 
Provided To Others? Yes  
Impact The availability of anti-CoA antibody allowed us to discover a novel posttranslational modification in cellular response to oxidative and metabolic stress, which we termed protein CoAlation. We also showed that CoA can function in cell as an endogenous antioxidant, when cells are exposed to oxidative or metabolic stress. 
 
Title In vitro CoAlation assay 
Description We have established a reliable in vitro CoAlation assay, which allows the analysis of CoA-modified proteins (CoAlation). 
Type Of Material Model of mechanisms or symptoms - in vitro 
Year Produced 2018 
Provided To Others? Yes  
Impact This methodology allows researchers to test whether their proteins of interst are CoAlated (covalent modification) in vitro and to study its effect on the function of CoA-modified proteins. 
 
Title Large-scale expression of recombinant S6Ks in insect and HEK293F cells 
Description We have developed a protocol for large-scale expression of recombinant EE-tagged S6K1 and S6K2 in HEK293F cells cultured in suspension. By suing EE-tag affinity chromatography, we can produce 2-3mg/L of highly pure and active preparations of EE-S6K1/2 suitable for biochemical and structural studies. 
Type Of Material Biological samples 
Provided To Others? No  
Impact Recombinant preparations of EE-S6K1 and EE-S6K2 can be used for structure/function studies and the development of HTP drug discovery assays. 
 
Title S6K2 kinase-dead conditional knock-in mouse model 
Description We have recently developed S6K2 kinase-dead conditional knock-in mouse model. At present, we are studying the phenotype of produced mice under various experimental condtions. 
Type Of Material Physiological assessment or outcome measure 
Provided To Others? No  
Impact The S6K2 kinase-dead conditional knock-in mouse model and generated mouse embryo fibroblasts (MEFs) will be useful for studying the efficacy of the in-house developed S6K inhibitors. 
 
Title Generation of S6K2 kinase-dead knock-in mouse model 
Description We have generated a conditional S6K2 kinase-dead knock-in mouse model (wt/conKI, wt/Flp) in order to elucidate the function of S6 kinase under various experimental conditions. 
Type Of Material Data analysis technique 
Year Produced 2019 
Provided To Others? No  
Impact conKI S6K2 mice were generated by Ozgene in Australia and transferred to the UCL Biological facility. Comparative analysis of wild type and conKI S6K2 mice under various experimental conditions revealed no specific phenotype. We also produced MEF (mouse embryonic fibroblasts) from wild type and conKI S6K2 mice and compared their response to various extracelluar stimuli and stresses. However, no significant differences were observed. Therefore, the decision was made to cryopreserve embryos from generated conKI S6K2 mice. 
URL https://www.ucl.ac.uk/biosciences/departments/smb/people/iris-profiles/gout-ivan
 
Description Elucidation of S6K signalling in normal and cancer cells 
Organisation Shanghai Institute of Materia Medica, China
Country China 
Sector Academic/University 
PI Contribution The interaction between both teams was initiated in March 2013, when I attended the 5th National Forum on New Technologies in Drug Discovery, which took place in Shanghai (11-13 March 2013). After my presentation, I was approached by Prof. L. Meng, who has a long-term interest in targeting the PI3K/mTOR pathway for drug discovery and identifying novel biomarkers. On LM's invitation, I visited the Shanghai Institute of Materia Medica after the meeting and had the opportunity to see centralized research facilities and to learn more about the research on the PI3K/mTOR pathway in the Division of Antitumor Pharmacology. I had a stimulating discussion with the Institute's Director Prof. D. Jing, who heads a State Key Laboratory of Drug Research affiliated to SIMM which focuses on developing novel anti-cancer drugs by targeting topoisomerases, microtubules, tyrosine kinases, heparanases and the PI3K/mTOR pathway. Discussions with LM and DJ allowed to identify the prospects for collaborative interactions on two closely linked projects: a) investigation of molecular mechanisms of S6K activation under physiological conditions and their deregulation in cancer and other human pathologies; and b) further development of novel S6K inhibitors identified in the frame of the ongoing drug discovery program at UCL. In the middle of 2013, the Material transfer and collaboration agreement on the S6K project was signed between UCL and SIMM. Soon after, a panel of plasmids directing the expression of wtS6K1, wtS6K2, S6K2-S2 splicing isoform and several mutant forms of S6K2 was then shipped to Prof. Meng's laboratory. During my second visit to SIMM in the beginning of 2014, the progress on the initiated collaborative project was discussed in details and the prospects for preparing joint publications and grant applications.
Collaborator Contribution A substantial amount of research has been carried out in Prof. Meng's laboratory on the collaborative project. The research was mainly conducted by Dr. X. Wang (XW), who has recently completed a PhD study on elucidating the function of the mTOR pathway in LM laboratory. XW was successful in establishing NIH3T3 and A549 cell lines with stable expression of wtS6K1 and wtS6K2 proteins from provided constructs. Moreover, XW compared the rate of proliferation of generated cell lines under various experimental conditions. These studies revealed that wtS6K2, but not wtS6K1, induces the proliferation of NIH3T3 cells under serum-starved condition (1% FCS). Interestingly, this effect was not observed when cells were cultured with 10% FCS. This is a very interesting observation and we plan to explore it further. In addition, LM team compared the growth of tumors from xenografts of A549 cells, overexpressing wtS6K1, wtS6K2 and vector alone. We have recently received the first set of experimental results, which indicate that overexpression of wtS6K2, but not wtS6K1 in A549 cells, promotes the growth of tumors. Moreover, testing the growth of A549 cells overexpressing mutant forms of S6K2 in xenograft studies is currently in progress.
Impact 1. NIH3T3 and A549 cell lines with stable expression of wtS6K1 and wtS6K2 was established. 2. The rate of proliferation of generated cell lines was analysed under various experimental conditions. We found that wtS6K2, but not wtS6K1, induces the proliferation of NIH3T3 cells under serum-starved condition (1% FCS). 3. Xenografts studies in nude mice revealed that overexpression of wtS6K2 in A549 cells, but not wtS6K1 in A549 cells, promotes the growth of tumors.
Start Year 2014
 
Description Enhancing structural information to aid design of novel irreversible inhibitors of S6K2 for the treatment of lung cancer 
Organisation Evotec
Country Germany 
Sector Private 
PI Contribution The development of S6K2 inhibitors has lagged behind S6K1 and other members of the AGC family of protein kinases. In the frame of this collaborative project, our efforts are focused on solving the crystal structure of the S6K2-KD alone and in complex with developed inhibitors. To do so, we designed and produced several expression constructs of the S6K2 kinase domain to generate recombinant proteins using baculoviral system.
Collaborator Contribution Evotec was involved in the design of expression constructs and the advice was also provided at various stages of their purification and quality control. They are now setting up crystallization trials with two generated constructs (alone and in complex with developed inhibitors).
Impact multi-disciplinary
Start Year 2015
 
Description Evotec Ltd 
Organisation Evotec
Country Germany 
Sector Private 
PI Contribution Design and generation of S6K2 baculoviral and bacterial expression constructs for crystallization studies. We have produced 4 expression constructs for the expression of S6K2 kinase domain in insect cells and 7 constructs for bacterial expression. Recombinant baculoviruses were produced and the expression and solubility of recombinant proteins tested. One construct was found to be highly expressed and soluble. We have produced several preparations of this construct for crystallization studies.
Collaborator Contribution Design and generation of S6K2 baculoviral and bacterial expression constructs for crystallization studies. Testing the quality of purified proteins and their suitability for setting up crystallization trials. One construct was used for crystallization studies, but no crystals have been produced so far (precipitation problems).
Impact Crystal structure of the full length S6K2 or its kinase domain has not been solved so far. In the frame of this collaboration we have experience the problem with producing highly concentrated preparations of recombinant S6K2 which would be suitable for crystallization studies. Homology modelling of S6K2 based on the crystal structure of S6K1 revealed hydrophobic areas on the surface of the S6K2, which most likely contribute to the precipitation of recombinant S6K2 kinase domain during the concentration stage. Site-directed mutagenesis will be employed to reduce the S6K2 surface hydrophobicity.
Start Year 2015
 
Description Identification of S6K2 phosphoryaltion sites induced by DNA binding by mass spectrometry 
Organisation University College London
Department MRC Laboratory for Molecular Cell Biology
Country United Kingdom 
Sector Academic/University 
PI Contribution We were the first to report DNA-induced activation of S6K2 which is associated with the increase of S6K2 autophosphorylation. We have an established collaborative link with Dr. M. Skehel and in the frame of this collaboration, we sent samples of recombinant S6K2 incubated in the presence of absence of DNA for the identification by MS-MS the sites of phosphorylation induced by DNA binding.
Collaborator Contribution The sites of phosphorylation were mapped to the catalytic and C-terminal regulatory domains in S6K2 and we are currently investigating their physiological relevance
Impact The sites of phosphoryaltion were mapped to the catalytic and C-terminal regulatory domains in S6K2 and we are currently investigating their physiological relevance
Start Year 2016
 
Description Regulation of S6Ks by CoAlation (covalent modification by coenzyme A) 
Organisation University of Cambridge
Country United Kingdom 
Sector Academic/University 
PI Contribution Dr. O. Pardo and Prof. M. Seckl, Imperial College London We examined the regulation of S6Ks in cellular response to oxidative and metabolic stress. These studies revealed the role of coenzyme A in the regulation of S6K under oxidative stress, mediated by covalent modification of the cysteine residue in the catalytic pocket of S6K by CoA.
Collaborator Contribution The site of S6K CoAlation (covalent modification by CoA) was mapped to Cys216 and Cys217 in S6K2 and S6K1 respectively. We showed that CoAlation occurs in vitro and in vivo, inhibits the activity of S6Ks.
Impact This is a multidisciplinary collaborative interaction, involving biochemistry, biophysics and cell biology. We are currently investigating the role of CoAlation in the function of S6Ks in vitro and in vivo.
Start Year 2019
 
Description Targeting S6K2 for anti-cancer drug discovery 
Organisation Johnson & Johnson
Country United States 
Sector Private 
PI Contribution The main focus of this collaborative project was to use an iterative process involving design, molecular docking/dynamics, synthesis and in vitro/in vivo testing to drive the development of irreversible S6K2 inhibitors. We expressed His-S6K1 and His-S6K2 using baculoviral expression system; Several milligrams of recombinant S6K1 and S6K2 were purified and their activities tested; Recombinant preparations of S6K1 and S6K2 were used to set up the Alphascreen and LANCE screen, specifically designed for testing S6K1/2 activities; A panel of small molecule compounds, designed and synthesised by the UCL Drug Discovery Group was tested in my laboratory using developed the Alphascreen and LANCE assays.
Collaborator Contribution In the frame of this project, we collaborated with the UCL Drug Discovery Group. The 3D structure of S6K2 kinase domain has not been solved so far. Therefore, a 3D homology model of the S6K2 kinase domain was built on the crystal structures of the S6K1 kinase domain; The model revealed a distinctive cysteine (Cys150) in the hinge region of the ATP-binding pocket of S6K2, but not S6K1. There are only four other kinases in the Kinome (over 500 protein kinases) with Cys at this position (FGFR4, TTK, MAPKAPK2 & MAPKAPK3). Based on these findings, a panel of small molecule compounds were designed to target the S6K2 ATP binding pocket and Cys150 for irreversible inhibition. The expertize on the design of irreversible S6K2 inhibitors and the development of S6K screening platforms was provided by researchers from J&J.
Impact This was a multidisciplinary collaborative project, involving researchers with the expertize in: a) bioinformatics (developing 3D homology models, molecular docking studies etc) b) medicinal chemistry c) biochemical studies and cell-based assays
Start Year 2015
 
Description UCL Drug Discovery Group 
Organisation University College London
Department UCL Cancer Institute
Country United Kingdom 
Sector Academic/University 
PI Contribution Molecular modelling, design and synthesis of irreversible inhibitors targeting S6K2
Collaborator Contribution More than 30 inhibitors have been designed and synthesised by the UCL Drug Discovery Group. Testing and optimization of synthesised compounds is currently in progress.
Impact To date, over 30 inhibitors have been designed and synthesised by the UCL Drug Discovery Group. Testing and optimization of synthesised compounds is currently in progress.
Start Year 2016
 
Description 7th international symposium on NBIA & related disorders 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact It was a virtual symposium which took place from 30th Sep until 3rd Oct 2020.
I gave a lecture at this meeting on the topic of our research.
Year(s) Of Engagement Activity 2021
URL https://nbiascientificsymposium.org/
 
Description Biochemical Society Focused Meeting "Neglected Thiols: Redox Biology and Signalling", online, 7-9 Dec 2020 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact More than 80 researchers particiapted in the Biochemical Society Focused Meeting "Neglected Thiols: Redox Biology and Signalling".
Prof. B. Halliwell and me organised this meeting.
I also presented our research on protein CoAlation and the antioxidant function of CoA at this meeting.
Year(s) Of Engagement Activity 2020
URL https://www.google.co.uk/search?q=Biochemical+Society+Focused+Meeting+Neglected+Thiols:+Redox+Biolog...
 
Description Biochemical Society Focused meeting "Coenzyme A and its derivatives in cellular metabolism and disease", London, 2014 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The organizer of the Focused meeting, expert panel discussion group
Year(s) Of Engagement Activity 2014
 
Description World Congress of Molecular & Cell Biology, Dalian, China, 2014 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited speaker and a panel discussion member on targeting signalling pathways for drug discovery
Year(s) Of Engagement Activity 2014
URL http://www.bitlifesciences.com/CMCB2014
 
Description World Congress on Cancer and Prevention Methods (Oncology- 2015), Dubai, August 27-29, 2015. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited Speaker and a Chairman of the session
Year(s) Of Engagement Activity 2015
URL http://scientificfuture.com/oncology-2015/abstract.php
 
Description XII International Congress of Polish Neuroscience Society, Gdansk, Poland, 2015 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited Speaker and a panel discussion session
Year(s) Of Engagement Activity 2015
URL https://www.facebook.com/GdanskiUniwersytetMedyczny