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Mazzoni M, Dell'Orso G, Grossi A, Ceccherini I, Viola S, Terranova P, Micalizzi C, Guardo D, Massaccesi E, Palmisani E, Calvillo M, Fioredda F, Malattia C, Dufour C, Ravelli A, Miano M. Underlying CTLA4 Deficiency in a Patient With Juvenile Idiopathic Arthritis and Autoimmune Lymphoproliferative Syndrome Features Successfully Treated With Abatacept-A Case Report. J Pediatr Hematol Oncol 2021; 43:e1168-e1172. [PMID: 33625086 DOI: 10.1097/mph.0000000000002120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Functional variants of the cytotoxic T-lymphocyte antigen-4 (CTLA4) could contribute to the pathogenesis of disorders characterized by abnormal T-cell responses. CASE PRESENTATION We report a case of a 13-year-old girl who first presented with polyarticular juvenile idiopathic arthritis poorly responsive to treatment. During the following years the patient developed cytopenias, chronic lymphoproliferation, high values of T-cell receptor αβ+ CD4- CD8- double-negative T cells and defective Fas-mediated T cells apoptosis. Autoimmune lymphoproliferative syndrome was diagnosed and therapy with mycophenolate mofetil was started, with good hematological control. Due to the persistence of active polyarthritis, mycophenolate mofetil was replaced with sirolimus. In the following months the patient developed hypogammaglobulinemia and started having severe diarrhea. Histologically, duodenitis and chronic gastritis were present. Using the next generation sequencing-based gene panel screening, a CTLA4 mutation was detected (p.Cys58Serfs*13). At the age of 21 the patient developed acute autoimmune hemolytic anemia; steroid treatment in combination with abatacept were started with clinical remission of all symptoms, even arthritis. CONCLUSIONS Targeted immunologic screening and appropriate genetic tests could help in the diagnosis of a specific genetically mediated immune dysregulation syndrome, allowing to select those patients who can take advantage of target therapy, as in the case of abatacept in CTLA4 deficiency.
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Affiliation(s)
- Marta Mazzoni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic, and Maternal and Infant Health (DINOGMI), University of Genoa
| | | | | | | | - Stefania Viola
- Clinica Pediatrica e Reumatologia, IRCCS Istituto G. Gaslini, Genoa, Italy
| | | | | | | | | | | | | | | | - Clara Malattia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic, and Maternal and Infant Health (DINOGMI), University of Genoa
- Clinica Pediatrica e Reumatologia, IRCCS Istituto G. Gaslini, Genoa, Italy
| | | | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic, and Maternal and Infant Health (DINOGMI), University of Genoa
- Clinica Pediatrica e Reumatologia, IRCCS Istituto G. Gaslini, Genoa, Italy
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Ali MA, Abdelaziz A, Ali M, Abonar A, Hanafy M, Hussein H, Shabana H, Abd El-Hmid R, Kaddafy S. PADI4 (rs2240340), PDCD1 (rs10204525), and CTLA4 (231775) gene polymorphisms and polyarticular juvenile idiopathic arthritis. Br J Biomed Sci 2020; 77:123-128. [PMID: 32163016 DOI: 10.1080/09674845.2020.1730626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Certain single nucleotide polymorphisms (SNPs) in genes such as PADI4 (coding for peptidyl arginine deiminase 4), PDCD1 (coding for programmed cell death 1), and CTLA4 (coding for cytotoxic T-lymphocyte-associated protein 4) are linked to rheumatoid arthritis (RA). However, links between SNPs rs2240340, rs10204525 and rs231775 in PADI4, PDCD1 and CTLA4 respectively, and juvenile idiopathic arthritis (JIA), the commonest type of childhood arthritis, are unclear. We aimed to determine whether any of these SNPs are associated with JIA, and to clinical indices disease activity score (JADAS 71) and functional disability score (CHAQ). METHODS We genotyped the three SNPs in 150 children with polyarticular JIA and 160 healthy children, recording standard health questionnaires, clinical features and laboratory markers. RESULTS The TT genotype of PADI4 rs2240340 (aOR/95%CI 2.64: 1.31-5.30, P = 0.006) and CT genotype of PDCD1 rs10204525 (aOR/95%CI 4.99: 2.98-8.36, P < 0.0001) were associated with JIA. The AG+GG genotype of CTLA4 rs231175 was modestly linked to disease activity (aOR/95%CI 2.44 (1.19-5.04), p = 0.015). PADI4 rs2240340 was linked to CHAQ score (genotypes p = 0.013, alleles p = 0.006), whilst PDCD1 rs10204525 was linked to anti-CCP antibodies (genotypes p = 0.004), RF (genotypes p = 0.01), and the CHAQ score (genotypes p = 0.005, alleles p = 0.013). CONCLUSIONS There are various roles for these SNPs in PADI4, CTLA4 and PDCD1 in the diagnosis and, potentially, in the management of JIA.
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Affiliation(s)
- M A Ali
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University , Fayoum, Egypt
| | - A Abdelaziz
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Al Azhar University , Cairo, Egypt
| | - M Ali
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Al Azhar University , Cairo, Egypt
| | - A Abonar
- Department of Clinical Pathology, Faculty of Medicine, Al Azhar University , Cairo, Egypt
| | - M Hanafy
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Al Azhar University , Cairo, Egypt
| | - H Hussein
- Department of Internal Medicine, Faculty of Medicine, Fayoum University , Fayoum, Egypt
| | - H Shabana
- Department of Internal Medicine, Faculty of Medicine, Al Azhar University , Cairo, Egypt
| | - R Abd El-Hmid
- Department of Pediatrics, Faculty of Medicine, Fayoum University , Fayoum, Egypt
| | - S Kaddafy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University , Fayoum, Egypt
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Nazarova LS, Danilko KV, Malievsky VA, Bakirov AB, Viktorova TV. The role of the immune response mediator genes polymorphism in the predisposition to juvenile idiopathic arthritis. RUSSIAN OPEN MEDICAL JOURNAL 2019. [DOI: 10.15275/rusomj.2019.0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective ― The aim of the work was to study the contribution of the immune response mediator genes polymorphism (TNFA rs1800629, LTA rs909253, IL1B rs16944, IL2-IL21 rs6822844, IL2RA rs2104286, IL6 rs1800795, IL10 rs1800872, MIF rs755622, CTLA4 rs3087243, NFKB1 rs28362491, PTPN22 rs2476601, PADI4 rs2240336) to the formation of the predisposition to juvenile idiopathic arthritis (JIA) and its clinical variants. Material and Methods ― The JIA group included 330 patients and the control group – 342 volunteers without autoimmune diseases from the Republic of Bashkortostan, Russia. Genotyping was conducted by the real-time polymerase chain reaction. Results ― Taking into account the differences by sex, it was established, that the alleles/genotypes of the TNFA rs1800629, LTA rs909253, IL2-IL21 rs6822844, PTPN22 rs2476601 polymorphic loci and the TNFA rs1800629*G – LTA rs909253*G haplotype are associated with the development of JIA as a whole (p<0.05); alleles/genotypes of the LTA rs909253, IL1B rs16944, IL2-IL21 rs6822844, IL2RA rs2104286, IL6 rs1800795, IL10 rs1800872, MIF rs755622, CTLA4 rs3087243, NFKB1 rs28362491, PTPN22 rs2476601 polymorphic loci and the TNFA rs1800629*G – LTA rs909253*G haplotype – with some of JIA clinical variants (p<0.05). Conclusion ― In this work, the relationship of the alleles, genotypes and haplotypes of a number of the immune response mediator genes polymorphic loci with the risk of the development of JIA and its clinical variants was established. Specific associations were observed for girls and boys, which indicates the existence of sexual dimorphism in the JIA pathogenesis.
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Tejeda C, Broadaway AK, Ombrello MJ, Brown MR, Ponder LA, Pichavant MR, Wang G, Angeles-Han S, Hersh A, Bohnsack J, Conneely KN, Epstein M, Prahalad S. Case-control Association Study of Autoimmunity Associated Variants in PDCD1 and Juvenile Idiopathic Arthritis. Curr Rheumatol Rev 2018; 13:219-223. [PMID: 28056736 PMCID: PMC5759045 DOI: 10.2174/1573397113666170104123113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 08/24/2016] [Accepted: 12/27/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Variants in the gene encoding Programmed Cell Death-1 (PDCD1) have been associated with susceptibility to Systemic Lupus Erythematosus and other autoimmune diseases. Given that clinically distinct autoimmune phenotypes share common genetic susceptibility factors, variants in PDCD-1 were tested for a possible association with Juvenile Idiopathic Arthritis (JIA). METHODS Four Single Nucleotide Polymorphisms (SNPS) in the PDCD1 gene were genotyped and analyzed: rs7421861, rs11568821, rs10204525, and rs7568402 in 834 cases and 855 controls of Northern European ancestry. Each variant was examined for possible associations with JIA and then analyzed for association with JIA categories. RESULTS PDCD1 variants showed no association with JIA in the cohort overall (rs7421861 p=0.63, rs11568821 p=0.13, rs10204525 p=0.31, and rs7568402 p=0.45). Stratification by JIA categories indicated a significant association between systemic JIA and PDCD1 rs7568402 (OR=0.53, p=0.0027), which remained significant after 10,000 permutations, but was not replicated in an independent multi-ethnic systemic JIA cohort. A nominal association between enthesitis-related arthritis and rs115668821 was also observed (OR=0.22, p=0.012). CONCLUSION Unlike other multiple autoimmune disease associated genetic variants, there was no association between PDCD1 variants and JIA or JIA categories.
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Affiliation(s)
- Christina Tejeda
- Department of Pediatrics Emory University School of Medicine, Atlanta. United States
| | - Alaine K Broadaway
- Department of Human Genetics, Emory University School of Medicine, Atlanta. United States
| | - Michael J Ombrello
- Translational Genetics and Genomics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases. United States
| | - Milton R Brown
- Department of Pediatrics Emory University School of Medicine, Atlanta. United States
| | - Lori A Ponder
- Children's Health Care of Atlanta, Atlanta, GA. United States
| | - Mina Rohani Pichavant
- Department of Pediatrics Emory University School of Medicine, Atlanta. United States
| | - Gabriel Wang
- Department of Pediatrics Emory University School of Medicine, Atlanta. United States
| | | | - Aimee Hersh
- Division of Pediatric Immunology and Rheumatology, University of Utah, Salt Lake City. United States
| | - John Bohnsack
- Division of Pediatric Immunology and Rheumatology, University of Utah, Salt Lake City. United States
| | - Karen N Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta. United States
| | - Michael Epstein
- Department of Human Genetics, Emory University School of Medicine, Atlanta. United States
| | - Sampath Prahalad
- Department of Human Genetics, Emory University School of Medicine, Atlanta. United States
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Azevedo PM, Merriman TR, Topless RK, Wilson NJ, Crengle S, Lennon DR. Association study involving polymorphisms in IL-6, IL-1RA, and CTLA4 genes and rheumatic heart disease in New Zealand population of Māori and Pacific ancestry. Cytokine 2016; 85:201-6. [PMID: 27400406 DOI: 10.1016/j.cyto.2016.06.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Rheumatic fever (RF) incidence among New Zealand (NZ) individuals of Polynesian (Māori and Pacific) ancestry remains among the highest in the world. Polymorphisms in the IL-6, IL1RN, and CTLA4 genes have been associated with RF, and their products are modulated by new medications. Confirmation of these previous associations could help guide clinical approaches. We aimed to test IL-6, IL-1RA (IL1RN), and CTLA4 functional SNPs in 204 rheumatic heart disease (RHD) patients and 116 controls of Māori and Pacific ancestry. MATERIAL AND METHOD Self-reported ancestry of the eight great-grandparents defined ancestry of participants. Severity of carditis was classified according to the 2012 World Heart Federation guideline for the echocardiographic diagnosis of RHD. The IL-6 promoter rs1800797, IL1RN rs447713 and CTLA4 rs3087243 SNPs were genotyped by Taqman. Correlations were assessed by logistic regression analysis adjusting for gender and ancestry. RESULTS The IL-6 rs1800797 variant was significantly associated with RHD with carriers of the GG genotype 6.09 (CI 1.23; 30.23) times more likely to develop RHD than the carriers of the AA genotype (P=0.027). No significant associations with RHD were found for the IL1RN rs447713 and CTLA4 rs3087243 SNPs. Patients carrying the G allele (GG plus AG genotype) for the IL1RN rs447713 SNP had 2.36 times (CI 1.00; 5.56) more severe carditis than those without this allele (the AA genotype) (P=0.049). CONCLUSION The IL-6 promoter rs1800797 (-597G/A) SNP may influence susceptibility to RHD of people of Māori and Pacific ancestry living in NZ. The IL1RN rs447713 SNP may influence the severity of carditis in this population.
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Affiliation(s)
- Pedro M Azevedo
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
| | - Tony R Merriman
- Biochemistry Department, University of Otago, Dunedin, New Zealand
| | - Ruth K Topless
- Biochemistry Department, University of Otago, Dunedin, New Zealand
| | - Nigel J Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Sue Crengle
- University of Auckland, Tomaiora Māori Health Research Centre, Auckland, New Zealand
| | - Diana R Lennon
- Paediatrics, University of Auckland, Auckland, New Zealand
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Abstract
In recent years, there have been many new developments in the field of regulatory T cells (Treg), challenging the consensus on their behaviour, classification and role(s) in disease. The role Treg might play in autoimmune disease appears to be more complex than previously thought. Here, we discuss the current knowledge of regulatory T cells through animal and human research and illustrate the recent developments in childhood autoimmune arthritis (juvenile idiopathic arthritis (JIA)). Furthermore, this review summarises our understanding of the fields and assesses current and future implications for Treg in the treatment of JIA.
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Ellis JA, Chavez RA, Pezic A, Ponsonby AL, Akikusa JD, Allen RC, Munro JE. Independent replication analysis of genetic loci with previous evidence of association with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013; 11:12. [PMID: 23506417 PMCID: PMC3606368 DOI: 10.1186/1546-0096-11-12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 03/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last five years, there have been numerous reports of association of juvenile idiopathic arthritis with single nucleotide polymorphisms (SNPs) at various loci outside the major histocompatibility complex (MHC) region. However, the majority of these association findings have been generated using a limited number of international cohorts, and thus there is benefit in further independent replication. To address this, we examined a total of 56 SNPs in 42 non-MHC gene regions previously reported to be associated with JIA, in the ChiLdhood Arthritis Risk factor Identification sTudY (CLARITY), a new Australian collection of cases and healthy child controls. FINDINGS Genotyping was performed on a total of 324 JIA cases (mean age 9.7 years, 67.3% female) and 568 controls (mean age 7.8 years, 40.7% female). We demonstrated clear evidence for replication of association of JIA with SNPs in or around c12orf30, c3orf1, PTPN22, STAT4, and TRAF1-C5, confirming the involvement of these loci in disease risk. Further, we generated evidence supportive of replication of association of JIA with loci containing AFF3, CD226, MBL2, PSTPIP1, and RANTES (CCL5). These results were robust to sensitivity analyses for ethnicity. CONCLUSION We have provided valuable independent data as to the underlying genetic architecture of this understudied pediatric autoimmune disease, further confirming five loci outside the MHC, and supporting a role for a further five loci in determining disease risk.
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Affiliation(s)
- Justine A Ellis
- Genes, Environment & Complex Disease, Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, Vic, 3052, Australia.
| | - Raul A Chavez
- Genes, Environment & Complex Disease, Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, Vic, 3052, Australia
| | - Angela Pezic
- Environmental & Genetic Epidemiology Research, Murdoch Childrens Research Institute, Parkville, Vic, 3052, Australia
| | - Anne-Louise Ponsonby
- Environmental & Genetic Epidemiology Research, Murdoch Childrens Research Institute, Parkville, Vic, 3052, Australia
| | - Jonathan D Akikusa
- Arthritis & Rheumatology, Murdoch Childrens Research Institute, Parkville, Vic, 3052, Australia,Rheumatology Unit, Department of General Medicine, Royal Children’s Hospital, Parkville, Vic, 3052, Australia
| | - Roger C Allen
- Arthritis & Rheumatology, Murdoch Childrens Research Institute, Parkville, Vic, 3052, Australia,Rheumatology Unit, Department of General Medicine, Royal Children’s Hospital, Parkville, Vic, 3052, Australia
| | - Jane E Munro
- Arthritis & Rheumatology, Murdoch Childrens Research Institute, Parkville, Vic, 3052, Australia,Rheumatology Unit, Department of General Medicine, Royal Children’s Hospital, Parkville, Vic, 3052, Australia
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Hinks A, Eyre S, Ke X, Barton A, Martin P, Flynn E, Packham J, Worthington J, Thomson W. Association of the AFF3 gene and IL2/IL21 gene region with juvenile idiopathic arthritis. Genes Immun 2010; 11:194-8. [PMID: 20072139 PMCID: PMC2845517 DOI: 10.1038/gene.2009.105] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 10/15/2009] [Accepted: 10/19/2009] [Indexed: 11/09/2022]
Abstract
Recent genetic studies have led to identification of numerous loci that are associated with susceptibility to autoimmune diseases. The strategy of using information from these studies has facilitated the identification of novel juvenile idiopathic arthritis (JIA) susceptibility loci, specifically, PTPN22 and IL2RA. Several novel autoimmune susceptibility loci have recently been identified, and we hypothesise that single-nucleotide polymorphisms (SNPs) within these genes may also be JIA susceptibility loci. Five SNPs within the genes AFF3, IL2/IL21, IL7R, CTLA4 and CD226, previously associated with multiple autoimmune diseases were genotyped, in a large data set of Caucasian JIA patients and controls, and tested for association with JIA. We identified two susceptibility loci for JIA, AFF3 and the IL2/IL21 region and additional weak evidence supporting an association with the CTLA4 and IL7R genes, which warrant further investigation. All results require validation in independent JIA data sets. Further characterisation of the specific causal variants will be required before functional studies can be performed.
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Affiliation(s)
- A Hinks
- Arthritis Research Campaign-Epidemiology Unit (arc-EU), University of Manchester, Manchester, UK.
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Prahalad S, Glass DN. A comprehensive review of the genetics of juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2008; 6:11. [PMID: 18644131 PMCID: PMC2515830 DOI: 10.1186/1546-0096-6-11] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 07/21/2008] [Indexed: 12/29/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy of childhood which is believed to be influenced by both genetic and environmental factors. The progress in identifying genes underlying JIA susceptibility using candidate gene association studies has been slow. Several associations between JIA and variants in the genes encoding the human leukocyte antigens (HLA) have been confirmed and replicated in independent cohorts. However it is clear that genetic variants outside the HLA also influence susceptibility to JIA. While a large number of non-HLA candidate genes have been tested for associations, only a handful of reported associations such as PTPN22 have been validated. In this review we discuss the principles behind genetic studies of complex traits like JIA, and comprehensively catalogue non-HLA candidate-gene association studies performed in JIA to date and review several validated associations. Most candidate gene studies are underpowered and do not detect associations, and those that do are often not replicated. We also discuss the principles behind genome-wide association studies and discuss possible implications for identifying genes underlying JIA. Finally we discuss several genetic variants underlying multiple clinically distinct autoimmune phenotypes.
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Affiliation(s)
- Sampath Prahalad
- Assistant Professor of Pediatrics, Division of Immunology and Rheumatology, Department of Pediatrics, University of Utah School of Medicine, P.O Box 581289 Salt Lake City, UT 84158-1289, USA
| | - David N Glass
- Professor of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 7030, Cincinnati, OH 45229, USA
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