FUMARIC ACID

Details

Stereochemistry	ACHIRAL
Molecular Formula	C4H4O4
Molecular Weight	116.0723
Optical Activity	NONE
Defined Stereocenters	0 / 0
E/Z Centers	1
Charge	0

SHOW SMILES / InChI

Structure Search

SMILES

C(\[H])(=C(/[H])\C(=O)O)/C(=O)O

InChI

InChIKey=VZCYOOQTPOCHFL-OWOJBTEDSA-N

InChI=1S/C4H4O4/c5-3(6)1-2-4(7)8/h1-2H,(H,5,6)(H,7,8)/b2-1+

HIDE SMILES / InChI

Molecular Formula	C4H4O4
Molecular Weight	116.0723
Charge	0
Count

Stereochemistry	ACHIRAL
Additional Stereochemistry	No
Defined Stereocenters	0 / 0
E/Z Centers	1
Optical Activity	NONE

Description
Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/204063s014lbl.pdfhttp://onlinelibrary.wiley.com/doi/10.1002/047084289X.rd344/fullhttps://www.ncbi.nlm.nih.gov/pubmed/12522577 | https://www.ncbi.nlm.nih.gov/pubmed/27614618 | https://www.ncbi.nlm.nih.gov/pubmed/20664170 | https://multiplesclerosisnewstoday.com/alks-8700-multiple-sclerosis/https://www.ncbi.nlm.nih.gov/pubmed/28340950https://www.ncbi.nlm.nih.gov/pubmed/15987702 | https://www.ncbi.nlm.nih.gov/pubmed/17182618http://www.google.ru/patents/US3887480 | https://www.google.com/patents/US4668735
Curator's Comment:: description was created based on several sources, including https://www.ncbi.nlm.nih.gov/pubmed/20647102 | https://www.ncbi.nlm.nih.gov/pubmed/19595601

Maleic acid monosodium salt. Used in water soluble polymers preparation.

CNS Activity

Originator

Approval Year

Targets

Primary Target	Pharmacology	Potency
NADP-dependent malic enzyme, mitochondrial 12 Target ID: CHEMBL6182 Sources: https://www.ncbi.nlm.nih.gov/pubmed/19595601	Inhibitor 7728
Egl nine homolog 2 13 Target ID: Q96KS0 Gene ID: 112398.0 Gene Symbol: EGLN2 Target Organism: Homo sapiens (Human) Sources: https://www.ncbi.nlm.nih.gov/pubmed/17182618	Inhibitor 7728	120.0 µM [IC50]
Egl nine homolog 3 19 Target ID: Q9H6Z9 Gene ID: 112399.0 Gene Symbol: EGLN3 Target Organism: Homo sapiens (Human) Sources: https://www.ncbi.nlm.nih.gov/pubmed/17182618	Inhibitor 7728	60.0 µM [IC50]
Egl nine homolog 1 22 Target ID: Q9GZT9 Gene ID: 54583.0 Gene Symbol: EGLN1 Target Organism: Homo sapiens (Human) Sources: https://www.ncbi.nlm.nih.gov/pubmed/17182618	Inhibitor 7728	80.0 µM [IC50]
NRF2 pathway 13 Target ID: WP2884 Sources: https://www.ncbi.nlm.nih.gov/pubmed/27614618	Activator 1343
pyroptosis 12 Target ID: GO:0070269 Sources: https://www.ncbi.nlm.nih.gov/pubmed/26096886	Inhibitor 7728
Hydroxycarboxylic acid receptor 2 31 Target ID: CHEMBL4420 Sources: https://www.ncbi.nlm.nih.gov/pubmed/20664170 \| http://en.pharmacodia.com/web/drug/1_5666.html	Activator 1343
Nuclear factor erythroid 2-related factor 2 19 Target ID: Q16236 Gene ID: 4780.0 Gene Symbol: NFE2L2 Target Organism: Homo sapiens (Human) Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/204063s014lbl.pdf	Activator 1343
Target ID: Glutathione S-transferase Sources: https://www.ncbi.nlm.nih.gov/pubmed/1287182	Substrate 609

Conditions

Condition	Modality	Highest Phase	Product
Periapical diseases 12 Sources: https://www.ncbi.nlm.nih.gov/pubmed/19840650	Primary	Not Provided 492	Unknown Approved Use Unknown
Cancer 569 Sources: https://www.ncbi.nlm.nih.gov/pubmed/15987702	Diagnostic	Natural Metabolite	Unknown Approved Use Unknown
Unknown 2502
Relapsing forms of multiple sclerosis 12 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/204063s014lbl.pdf	Secondary	Approved 8043	TECFIDERA Approved Use Indicated for the treatment of patients with relapsing forms of multiple sclerosis Launch Date 1.36434234E12
Arthritis 86 Sources: https://www.ncbi.nlm.nih.gov/pubmed/28832396	Palliative	Preclinical	Unknown Approved Use Unknown
Multiple sclerosis 95 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2014/204063Orig1s010.pdf	Primary	Approved 8043	TECFIDERA Approved Use TECFIDERA, dimethyl fumarate undergoes rapid presystemic hydrolysis by esterases and is converted to its active metabolite, monomethyl fumarate (MMF). TECFIDERA is indicated for the treatment of patients with relapsing forms of multiple sclerosis. Launch Date 1.36425597E12
Ischemic stroke 41 Sources: https://www.ncbi.nlm.nih.gov/pubmed/27614618	Preventing	Preclinical	Unknown Approved Use Unknown
Unknown 2502

C_max

Value	Dose	Co-administered	Analyte	Population
1.87 mg/L DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/204063lbl.pdf	240 mg 2 times / day multiple, oral dose: 240 mg route of administration: Oral experiment type: MULTIPLE co-administered:		MONOMETHYL FUMARATE plasma	Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: FED

AUC

Value	Dose	Co-administered	Analyte	Population
8.21 mg × h/L DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/204063lbl.pdf	240 mg 2 times / day multiple, oral dose: 240 mg route of administration: Oral experiment type: MULTIPLE co-administered:		MONOMETHYL FUMARATE plasma	Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: FED

T_1/2

Value	Dose	Co-administered	Analyte	Population
1 h DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/204063lbl.pdf	240 mg 2 times / day multiple, oral dose: 240 mg route of administration: Oral experiment type: MULTIPLE co-administered:		MONOMETHYL FUMARATE plasma	Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: FED

F_unbound

Value	Dose	Co-administered	Analyte	Population
64% DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/204063lbl.pdf	240 mg 2 times / day multiple, oral dose: 240 mg route of administration: Oral experiment type: MULTIPLE co-administered:		MONOMETHYL FUMARATE plasma	Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: FED

Doses

Dose	Population	Adverse events
190 mg 2 times / day multiple, oral Highest studied dose Dose: 190 mg, 2 times / day Route: oral Route: multiple Dose: 190 mg, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210296s000lbl.pdf Page: 6.1	unhealthy, adult n = 769 Health Status: unhealthy Condition: multiple sclerosis Age Group: adult Sex: unknown Population Size: 769 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210296s000lbl.pdf Page: 6.1	Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210296s000lbl.pdf Page: 6.1
190 mg 2 times / day multiple, oral Highest studied dose Dose: 190 mg, 2 times / day Route: oral Route: multiple Dose: 190 mg, 2 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/32629403/	unhealthy, mean 37 years n = 105 Health Status: unhealthy Condition: multiple sclerosis Age Group: mean 37 years Sex: M+F Population Size: 105 Sources: https://pubmed.ncbi.nlm.nih.gov/32629403/	Other AEs: Gastrointestinal disturbance... Other AEs: Gastrointestinal disturbance (53%) Sources: https://pubmed.ncbi.nlm.nih.gov/32629403/

AEs

AE	Significance	Dose	Population
Gastrointestinal disturbance	53%	190 mg 2 times / day multiple, oral Highest studied dose Dose: 190 mg, 2 times / day Route: oral Route: multiple Dose: 190 mg, 2 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/32629403/	unhealthy, mean 37 years n = 105 Health Status: unhealthy Condition: multiple sclerosis Age Group: mean 37 years Sex: M+F Population Size: 105 Sources: https://pubmed.ncbi.nlm.nih.gov/32629403/

Overview

CYP3A4	CYP2C9	CYP2D6	hERG

OverviewOther

Other Inhibitor	Other Substrate	Other Inducer
CYP 98 P-gp 1330	CYP450 59	P-gp 248 CYP 70

Drug as perpetrator

Target	Modality	Activity
CYP 132	inducer 1440 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210296s000lbl.pdf#page=10 Page: 10.0	no
CYP 132	inhibitor 3045 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210296s000lbl.pdf#page=10 Page: 10.0	no
P-gp 1514	inducer 1440 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210296s000lbl.pdf#page=10 Page: 10.0	no
P-gp 1514	inhibitor 3045 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210296s000lbl.pdf#page=10 Page: 10.0	no

Drug as victim

Target	Modality	Activity	Metabolite	Clinical evidence
CYP450 59	substrate 3113 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/210296Orig1s000ClinPharmR.pdf#page=8 Page: 8.0	no

Sourcing

Vendor/Aggregator	ID	URL
3B Scientific (Wuhan) Corp	3B4-0303	http://www.3bsc.com/index/pro_info.php?id=18151
3B Scientific (Wuhan) Corp	3B4-2852	http://www.3bsc.com/index/pro_info.php?id=77486
AK Scientific, Inc. (AKSCI)	O997	http://www.aksci.com/item_detail.php?cat=O997
Aaron Chemicals	AR002URG	http://www.aaronchem.com/2756-87-8
Achemtek	0104-021727	http://www.achemtek.com/2756-87-8
Alfa Chemistry	AP2756878	https://reagents.alfa-chemistry.com/product/mono-methyl-fumarate-cas-2756-87-8-9093.html
Alichem	490019201	http://www.alichem.com/en/products/2756-87-8.html
Ambeed	A983659	https://www.ambeed.com/products/2756-87-8.html
Ambinter	Amb10071357	http://www.ambinter.com/reference/10071357
ApexBio Technology	B7674	http://www.apexbt.com/mmf.html
Aurora Fine Chemicals LLC	A01.295.615	http://online.aurorafinechemicals.com/info?ID=A01.295.615
Aurum Pharmatech LLC	M-3444	http://www.Aurumpharmatech.com/Product/ProductDetails/M_3444
Avantor Inc	TCM2413-5G	https://us.vwr.com/store/product/16813484/fumaric-acid-monomethyl-ester-98-0-by-gc
BLD Pharm	BD00941719	http://www.bldpharm.com/products/2756-87-8.html
BLD Pharm	BD140326	http://www.bldpharm.com/products/2756-87-8.html
BioChemPartner	BCP18454	http://www.biochempartner.com/2756-87-8-BCP18454
BioSynth	J-017996	https://www.biosynth.com/en/products/all-products/products/J-017996.html
BioSynth	J-522708	https://www.biosynth.com/en/products/all-products/products/J-522708.html
CSNpharm	CSN22981	https://www.csnpharm.com/products/mmf.html
Chem Scene	CS-0026484	http://www.chemscene.com/2756-87-8.html
ChemMol	99067199	http://www.chemmol.com/chemmol/99067199.html
Chemspace	CSSB00011216927	https://chem-space.com/CSSB00011216927
DC Chemicals	DC33842	http://www.dcchemicals.com//product_show-Monomethyl_Fumarate.html
Hairui	MOJB01402	http://www.hairuichem.com/en/product/2756-87-8.html
LGC Standards	MM0352.03-0025	https://www.lgcstandards.com/US/en/p/MM0352.03-0025
Lab Network	LN01310370	https://labnetwork.com/frontend-app/p/#!/moleculedetails/LN01310370
MedChem Express	HY-103252	https://www.medchemexpress.com/monomethyl-fumarate.html
MuseChem	R058046	https://www.musechem.com/product/R058046.html
OChem	4292	http://www.ocheminc.com/index.php?act=psearch&pid=56M878
Oakwood	102026	http://www.oakwoodchemical.com/ProductsList.aspx?CategoryID=-2&txtSearch=170495&ExtHyperLink=1
Oakwood	94823	http://www.oakwoodchemical.com/ProductsList.aspx?CategoryID=-2&txtSearch=79997&ExtHyperLink=1
Selleck Chemicals	S6889	http://www.selleckchem.com/products/monomethyl-fumarate.html
Sigma-Aldrich	651419_ALDRICH	https://www.sigmaaldrich.com/catalog/product/aldrich/651419?utm_source=pubchem&utm_campaign=pubchem_2017&utm_medium=referral
Sigma-Aldrich	92571_SIAL	https://www.sigmaaldrich.com/catalog/product/sial/92571?utm_source=pubchem&utm_campaign=pubchem_2017&utm_medium=referral
Smolecule	S536016	http://www.smolecule.com/products/s536016
Smolecule	S759551	https://www.smolecule.com/products/s759551
TCI (Tokyo Chemical Industry)	M2413	http://www.tcichemicals.com/eshop/en/us/commodity/M2413/index.html
THE BioTek	bt-275065	https://www.thebiotek.com/product/inhibitors/bt-275065
Tocris	4511	https://www.tocris.com/products/mmf_4511
VladaChem	VL278632-1G	https://www.vladachem.com/product.php?products=2756-87-8
abcr GmbH	AB503712	http://www.abcr.com/shop/en/AB503712
abcr GmbH	AB558870	http://www.abcr.com/shop/en/AB558870
eNovation Chemicals	D382932	http://www.enovationchem.com/productDetails.asp?productID=D382932
eNovation Chemicals	D533508	https://www.enovationchem.com/ProductDetails.asp?ProductID=D533508
eNovation Chemicals	D695687	https://www.enovationchem.com/ProductDetails.asp?ProductID=D695687
iChemical	EBD2637923	http://www.ichemical.com/products/2756-87-8.html?utm_source=PubChem&utm_medium=website&utm_campaign=product%20catalogs

PubMed

Title	Date	PubMed
Antifungal properties of 2-bromo-3-fluorosuccinic acid esters and related compounds.	1977 Apr	321785
The influence of long-term treatment with timolol on human tear lysozyme albumin content.	1982	7075967
Urinary loss of glucose, phosphate, and protein by diffusion into proximal straight tubules injured by D-serine and maleic acid.	1985 Jun	3925238
Microperfusion study of proximal tubule bicarbonate transport in maleic acid-induced renal tubular acidosis.	1986 Mar	3953825
Do contrast media aggravate Fanconi's syndrome in rats? A comparison of diatrizoate, iohexol, and ioxilan.	1988 Sep	3198337
Menstrual migraine and intermittent ergonovine therapy.	1989 Jun	2759844
Automated screening of urine samples for carbohydrates, organic and amino acids after treatment with urease.	1991 Jan 2	2026685
Antifungal activity of fumaric acid in mice infected with Candida albicans.	1991 Nov	1799950
Ocular surface alteration after long-term treatment with an antiglaucomatous drug.	1992 Jul	1495787
Physiology and pathophysiology of organic acids in cerebrospinal fluid.	1993	8412012
Disposition of [14C]velnacrine maleate in rats, dogs, and humans.	1993 Nov-Dec	7905382
Age-related reference values for urinary organic acids in a healthy Turkish pediatric population.	1994 Jun	8087979
[Studies on the mechanisms of renal damages induced by nephrotoxic compounds].	1995 Dec	8583688
Glycine attenuates Fanconi syndrome induced by maleate or ifosfamide in rats.	1996 Mar	8648909
A synthetic polycation, a copolymer of 1-vinyl-3-methylimidazole iodide with maleic acid diethyl ester, increases passive ionic permeability in erythrocyte membranes modified by fatty acids.	1998	10024972
Abnormal substrate levels that depend upon mitochondrial function in cerebrospinal fluid from Alzheimer patients.	1998	9693263
In vitro shear bond strength of adhesive to normal and fluoridated enamel under various contaminated conditions.	1999 Aug	10635272
Experience with intraarterial infusion of styrene maleic acid neocarzinostatin (SMANCS)-lipiodol in pancreatic cancer.	1999 Jul-Aug	10522050
Determination of trimebutine and desmethyl-trimebutine in human plasma by HPLC.	2000 Jul	10965422
Subcritical mineralization of sodium salt of dodecyl benzene sulfonate using sonication-wet oxidation (SONIWO) technique.	2001 Jun	11358311
Molecular mechanism for the regulation of human mitochondrial NAD(P)+-dependent malic enzyme by ATP and fumarate.	2002 Jul	12121650
An in vitro study on restoring bond strength of a GIC to saliva contaminated enamel under unrinse condition.	2002 Jul-Aug	12450709
The comparison of plasma deproteinization methods for the detection of low-molecular-weight metabolites by (1)H nuclear magnetic resonance spectroscopy.	2002 May 15	12009699
Neocortical neurons cultured from mice with expanded CAG repeats in the huntingtin gene: unaltered vulnerability to excitotoxins and other insults.	2003	12895502
Aqueous humour flow after a single oral dose of isosorbide-5-mononitrate in healthy volunteers.	2003 Aug	12859262
Molecular machinery for non-vesicular trafficking of ceramide.	2003 Dec 18	14685229
Identification of anti-inflammatory drugs according to their capacity to suppress type-1 and type-2 T cell profiles.	2004 Dec	15663561
Dynamic alterations of fibronectin layers on copolymer substrates with graded physicochemical characteristics.	2004 Mar 30	15835174
Effect of inducers of DT-diaphorase on the haemolytic activity and nephrotoxicity of 2-amino-1,4-naphthoquinone in rats.	2005 Aug 15	16045903
Enhanced cytotoxicity of bioreductive antitumor agents with dimethyl fumarate in human glioblastoma cells.	2005 Feb	15655414
Determination of ergometrine maleate by fluorescence detection.	2005 May-Jun	15924314
Tumor-necrosis-factor-related apoptosis-inducing-ligand (TRAIL)-mediated death of neurons in living human brain tissue is inhibited by flupirtine-maleate.	2005 Oct	16043230
Protein adsorption from flowing solutions on pure and maleic acid copolymer modified glass particles.	2006 Aug 1	16797943
Effects of antiglaucoma drugs on collagen gel contraction mediated by human corneal fibroblasts.	2006 Jun	16778650
Probing carboxylate Gibbs transfer energies via liquid\|liquid transfer at triple phase boundary electrodes: ion-transfer voltammetry versus COSMO-RS predictions.	2008 Jul 14	18688392
The psoriasis drug monomethylfumarate is a potent nicotinic acid receptor agonist.	2008 Oct 31	18722346
Molecular mechanisms of Nrf2-mediated antioxidant response.	2009 Feb	18618599
Quantitative morphometry of respiratory tract epithelial cells as a tool for testing chemopreventive agent efficacy.	2010 Mar	20392991
Integration of metabolomics and transcriptomics data to aid biomarker discovery in type 2 diabetes.	2010 May	20567778
DMF inhibits PDGF-BB induced airway smooth muscle cell proliferation through induction of heme-oxygenase-1.	2010 Oct 20	20961405
Structure-activity comparison of the cytotoxic properties of diethyl maleate and related molecules: identification of diethyl acetylenedicarboxylate as a thiol cross-linking agent.	2011 Jan 14	21105742
Fumaric acid attenuates the eotaxin-1 expression in TNF-α-stimulated fibroblasts by suppressing p38 MAPK-dependent NF-κB signaling.	2013 Aug	23707484
Evaluation of aggregating brain cell cultures for the detection of acute organ-specific toxicity.	2013 Jun	22954530
Small molecule activators of the Nrf2-HO-1 antioxidant axis modulate heme metabolism and inflammation in BV2 microglia cells.	2013 Oct	23942037
Curcumin prevents maleate-induced nephrotoxicity: relation to hemodynamic alterations, oxidative stress, mitochondrial oxygen consumption and activity of respiratory complex I.	2014 Nov	25119790
Role of Nuclear Factor (Erythroid-Derived 2)-Like 2 Signaling for Effects of Fumaric Acid Esters on Dendritic Cells.	2017	29312359
Recent advances in understanding NRF2 as a druggable target: development of pro-electrophilic and non-covalent NRF2 activators to overcome systemic side effects of electrophilic drugs like dimethyl fumarate.	2017	29263788
Dual action by fumaric acid esters synergistically reduces adhesion to human endothelium.	2018 Dec	28984166
Dimethyl fumarate treatment alters NK cell function in multiple sclerosis.	2018 Feb	29108094
Monomethyl fumarate treatment impairs maturation of human myeloid dendritic cells and their ability to activate T cells.	2019 Jan	29106333

Patents

Sample Use Guides

In Vivo Use Guide

The starting dose for TECFIDERA is 120 mg twice a day orally. After 7 days, the dose should be increased to the maintenance dose of 240 mg twice a day orally. Temporary dose reductions to 120 mg twice a day may be considered for individuals who do not tolerate the maintenance dose. Within 4 weeks, the recommended dose of 240 mg twice a day should be resumed. Discontinuation of TECFIDERA should be considered for patients unable to tolerate return to the maintenance dose. The incidence of flushing may be reduced by administration of TECFIDERA with food. Alternatively, administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to TECFIDERA dosing may reduce the incidence or severity of flushing.

Route of Administration: Oral

In Vitro Use Guide

MMF did not affect endothelial cell growth when tested at 200 uM.

Substance Class	Chemical Created by `admin` on `Sat Jun 26 01:11:40 UTC 2021` Edited by `admin` on `Sat Jun 26 01:11:40 UTC 2021`
Record UNII	88XHZ13131
Record Status	`Validated (UNII)`
Record Version

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Name

Type

Language

FUMARIC ACID

Official Name

English

TRANS-BUTENEDIOIC ACID

Systematic Name

English

MALIC ACID IMPURITY A [EP]

Common Name

English

2(TRANS)-BUTENEDIOIC ACID

Systematic Name

English

BOLETIC-ACID

Common Name

English

FUMARIC ACID [WHO-DD]

Common Name

English

FUMARATE

Systematic Name

English

INS NO.297

Code

English

FEMA NO. 2488

Code

English

FUMARIC ACID [MI]

Common Name

English

E-297

Code

English

2-BUTENEDIOIC ACID, (E)-

Common Name

English

FUMARIC ACID [USP]

Common Name

English

ETHYLENEDICARBOXYLIC ACID

Systematic Name

English

ALLOMALEIC-ACID

Common Name

English

(E)-BUTENEDIOIC ACID

Systematic Name

English

FUMARIC ACID [INCI]

Common Name

English

FUMARIC ACID [HSDB]

Common Name

English

FUMARICUM ACIDUM [HPUS]

Common Name

English

FUMARIC ACID [MART.]

Common Name

English

NSC-2752

Code

English

TRANS-1,2-ETHYLENEDICARBOXYLIC ACID

Common Name

English

FUMARICUM ACIDUM

Common Name

English

FUMARIC ACID [VANDF]

Common Name

English

FUMARIC ACID [USP-RS]

Common Name

English

FUMARIC ACID [FHFI]

Common Name

English

MONOSODIUM FUMARATE [JAN]

Common Name

English

FUMARIC ACID [II]

Common Name

English

INS-297

Code

English

FUMARIC ACID [FCC]

Common Name

English

Classification Tree Code System Code

LOINC

13743-0