Laboratory development of permethrin resistance and cross-resistance pattern of Culex quinquefasciatus to other insecticides

Eco-friendly bio-larvicidal and antimicrobial activity of isolated bioactive compound from Kurthia gibsonii (Bacillales)

The targeted organisms include mosquito vectors, bacterial pathogens and non-targeted organisms. Preliminary mosquito larvicidal activity was conducted using cell-free supernatants (CFSs) from 11 gut bacteria. Among them, the bacterium SS11 exhibited promising results and was identified as Kurthia gibsonii based on its 16S rRNA sequence (1350 bp). The diethyl ether extract (DEE) of K. gibsonii demonstrated significant larvicidal effects, with LC50 values of 5.59 µL/mL and 8.59 µL/mL for 3rd instar larvae of Aedes aegypti and 2nd instar larvae of Anopheles stephensi, respectively. Analysis of the DEE using FT-IR, and GC-MS revealed the presence of 16 functional groups, and 7 bioactive compounds, respectively. A molecular docking study identified GC-MS compounds against odorant receptors from A. aegypti and odorant-binding proteins from A. stephensi was performed to assess the interaction and binding affinity. Overall, these findings suggest that the bioactive compounds 2, 4, 6-tribromoaniline from the DEE of K. gibsonii hold potential as an environmentally compatible alternative for biocontrol purposes, and compounds 9-tricosene and didecyl phthalate can be used for mosquito traps.

Overexpression of cytochrome P450 and esterase genes involved in permethrin resistance in larvae and adults of Culex quinquefasciatus

Mosquitoes are important vectors of several arthropod-borne diseases, which remain a priority for epidemiological research. Mosquito vector control strategies have traditionally relied on chemical insecticides such as synthetic pyrethroids. However, the indiscriminate use of pesticides has resulted in the development of resistance in many mosquito species. In insects, resistance evolves primarily through the overexpression of one or more gene products from the cytochrome P450, carboxylesterase, and glutathione superfamilies. The current study examined the expression of cytochrome P450 CYP6M2, CYP6AA7, CYP6Z2, CYP9J34, α-Esterase, Esterase B1, and neuroactin genes in larvae and adults of a permethrin-resistant (PerRes) and susceptible (Sus) Culex quinquefasciatus strains. The results showed that the CYP6AA7 gene was overexpressed (10-fold) in larvae and adults with PerRes (p < 0.01) followed by CYPJ34 (9.0-fold) and CYP6Z2 (5.0-fold) compared to the Sus, whereas fewer changes in CYP6M gene expression were observed in PerRes adults (p < 0.05), and no expression was found in larvae. The esterase gene was overexpressed in PerRes larvae (9.0-fold) followed by adults (2.5-fold) compared to the susceptible strain. Based on data, the present study suggests that cytochrome P450, CYP6AA7, CYP6Z2, CYP9J34, α-Esterase, Esterase B1, and neuroactin genes were involved in permethrin resistance in larval and adult Cx. quinquefasciatus.

M. Moustafa M, Fónagy A, Farag SM. Co-application of entomopathogenic fungi with chemical insecticides against Culex pipiens

Culex pipiens (Diptera: Culicidae) is a vector of many human and animal diseases. Its control is regarded as a preventative approach that is focused on effectively managing such diseases. In this context, dose response assays of two insecticides, bendiocarb and diflubenzuron were performed with two entomopathogenic fungi, Beauveria bassiana and Metarhizium anisopliae against 3^rd instar C. pipiens larvae. The most effective agents, combination experiments as well as enzymatic activities of phenoloxidase (PO) and chitinase (CHI) were also assessed. The results showed that diflubenzuron was more effective at low concentrations (LC₅₀: 0.001 ppm) than bendiocarb (LC₅₀: 0.174 ppm), whereas M. anisopliae was more effective (LC₅₀: 5.2x10⁵ conidia/mL) than B. bassiana (LC₅₀: 7.5x10⁷ conidia/mL). Synergistic interactions were observed when diflubenzuron was applied at 2- and 4-days post- exposure to M. anisopliae, with the highest degree of synergism observed when diflubenzuron was applied 2 days post-fungal exposure (χ2 = 5.77). In contrast, additive interactions were recorded with all other insecticide-fungal combinations. PO activities significantly (p ≤ 0.05) increased during 24 h after a single diflubenzuron treatment as well as when diflubenzuron was applied prior to M. anisopliae, whereas suppressed after 24 h when M. anisopliae applied prior to diflubenzuron as well as after 48 h from single and combined treatments. CHI activity increased 24 h after both single and combined treatments, the activity remained elevated 48 h after a single diflubenzuron treatment and when diflubenzuron was applied after M. anisopliae. Histological study of the cuticle by transmission electron microscopy revealed abnormalities following single and combined treatments. Germination of the conidia and production of the mycelium that colonizes the lysing cuticle was obvious when diflubenzuron was applied 48 h after M. anisopliae exposure. Overall, these results demonstrate that M. anisopliae is compatible with diflubenzuron at lower concentrations and that combined applications can improve C. pipiens management.

Pretreatment of mosquito larvae with ultraviolet-B and nitropolycyclic aromatic hydrocarbons induces increased sensitivity to permethrin toxicity

Nitropolycyclic aromatic hydrocarbons (Nitro-PAH) are highly toxic PHA derivatives. Nitro-PHAs are emitted by carbonaceous materials and PHA post-emission transformation, which causes water and environmental pollution and also exists as carcinogenic and immunotoxic agents. UV light has been shown to cause DNA damage and improves the covalent binding of PAH to DNA significantly. Mosquito breeding grounds are pools of water that can be large open zones or encased ponds with varying levels of sunlight exposure. This research was performed to assess the combined effects of UV-B exposure and Nitro-PAH on the physiological function of Culex quinquefasciatus larvae. To assess the impact of UV-B irradiation and Nitro-PAH exposure on mosquito vectors, parameters were examined: (1) Nitro-PAH availability and its impact on cell fatalities; (2) the detoxifying abilities of cytochrome P450, glutathione-S-transferase, and esterase; (3) the reactions to Reactive Oxygen Species; and (4) The resistance of mosquito larvae to three synthetic pesticides (temephos, imidacloprid, and permethrin). UV-B and Nitro-PAH treatment caused cellular damage and increased major detoxification enzymes such as α & β-esterase, cytoP450, CAT, GST, and POX. The levels of oxidative stress, ROS and protein carbonyl content, nitrite, ascorbic acid and thiobarbituric acid were decreased significantly. Toxicology bioassays revealed that UV-B + Nitro-PAH exposure significantly increased larval susceptibility. The current study concludes that prior exposure to Nitro-PAHs and UV-B may make mosquito larvae more vulnerable to chemical insecticides.

Enhancement of Temephos and Deltamethrin Toxicity by Petroselinum crispum Oil and its Main Constituents Against Aedes aegypti (Diptera: Culicidae)

Previous work presented the profound antimosquito potential of Petroselinum crispum essential oil (PEO) against either the pyrethroid-susceptible or resistant strains of Aedes aegypti. This plant oil also inhibited the activity of acetylcholinesterase and mixed-function oxidases significantly, thus suggesting its potential as a synergist for improving mosquitocidal efficacy of insecticidal formulations. This study investigated the chemical composition, larvicidal activity, and potential synergism with synthetic insecticides of PEO and its main compounds for the purpose of interacting with insecticide resistance in mosquito vectors. The chemical profile of PEO, obtained by GC-MS analysis, showed a total of 17 bioactive compounds, accounting for 99.09% of the whole oil, with the most dominant constituents being thymol (74.57%), p-cymene (10.73%), and γ-terpinene (8.34%). All PEO constituents exhibited promising larvicidal effects, with LC50 values ranging from 19.47 to 59.75 ppm against Ae. aegypti, in both the pyrethroid-susceptible and resistant strains. Furthermore, combination-based bioassays revealed that PEO, thymol, p-cymene, and γ-terpinene enhanced the efficacy of temephos and deltamethrin significantly. The most effective synergist with temephos was PEO, which reduced LC50 values to 2.73, 4.94, and 3.28 ppb against MCM-S, PMD-R, and UPK-R, respectively, with synergism ratio (SR) values of 1.33, 1.38, and 2.12, respectively. The best synergist with deltamethrin also was PEO, which reduced LC50 values against MCM-S, PMD-R, and UPK-R to 0.008, 0.18, and 2.49 ppb, respectively, with SR values of 21.25, 9.00, and 4.06, respectively. This research promoted the potential for using essential oil and its principal constituents as not only alternative larvicides, but also attractive synergists for enhancing efficacy of existing conventional insecticides.

Genome mining and functional analysis of cytochrome P450 genes involved in insecticide resistance in Leucinodes orbonalis (Lepidoptera: Crambidae)

Genome-wide analysis of cytochrome P450 monooxygenase (CYP) genes from the advanced genome project of the Leucinodes orbonalis and the expression analysis provided significant information about the metabolism-mediated insecticide resistance. A total of 72 putative CYP genes were identified from the genome and transcriptome of L. orbonalis. The genes were classified under 30 families and 46 subfamilies based on the standard nomenclature. In the present study, a novel CYP gene, CYP324F1, was identified and it has not been reported from any other living system so far. Biochemical assays showed enhanced titers (5.81-18.5-fold) of O-demethylase of CYP in five field-collected populations. We selected 34 homologous CYP gene sequences, seemed to be involved in insecticide resistance for primer design and quantitative real-time PCR studies. Among the many overexpressed genes (>10 fold), the expression levels of CYP324F1 and CYP306A1 were prominent across all the field populations as compared with the susceptible iso-female line. Oral delivery of ds-CYP324F1 and ds-CYP306A1 directed against CYP324F1 and CYP306A1 to the larvae of one of the insecticide resistance populations caused reduced expression of these two transcripts in a dose-dependent manner (53.4%-85.0%). It appears that the increased titer of O-demethylase is the result of increased transcription level of CYP genes in resistant populations. The data provide insight for identifying the novel resistance management strategies against L. orbonalis.

Isolation and identification of entomopathogenic fungus from Eastern Ghats of South Indian forest soil and their efficacy as biopesticide for mosquito control

The repeated usage of chemical insecticides, responsible for insecticide resistance in mosquitoes and environmental toxicity. Currently effective and environmental-safe control strategies are needed for the control disease-vector mosquitoes. Entomopathogens can be an effective alternative to chemical insecticide. Herein we isolated and tested 46 soil-borne entomopathogenic fungi belonging to six genera, namely Beauveria sp., Metarhizium sp., Fusarium sp., Aspergillus sp., Trichoderma sp., and Verticillium sp., fungi conidia were tested on Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus larvae. Bioassays results show that M. anisopliae fungal isolate causes a 100%, 98.6% and 92% mortality within six days, on Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus, respectively. M. anisopliae treated three mosquito larvae have lower lifetime with LT₅₀ values in A. stephensi, 2.931 days; A. aegypti, 2.676 days and C. quinquefasciatus, 3.254 days. 18 s rDNA sequence analysis confirmed that the isolated fungus are belonging to the genus of M. anisopliae-VKKH3, B. bassiana-VKBb03, and V. lecanii-VKPH1. Our results clearly show that M. anisopliae has good potential, as a low-cost, environmentally safe tool for the control of A. aegypti, A. stephensi, and C. quinquefasciatus mosquitoes.

Chemical composition and larvicidal activity against Aedes mosquitoes of essential oils from Arisaema fargesii

BACKGROUND

Dengue fever is caused by the spread of dengue virus by Aedes mosquito vectors. Currently, the most effective way to control dengue is by preventing mosquitoes from spreading the disease. Arisaema fargesii is a Chinese herbal medicine commonly used to repel mosquitoes. In our laboratory, anti-mosquito chemical components were extracted from A. fargesii, and the effects of these substances on mosquito larvae were examined.

RESULTS

In total, 48 compounds corresponding to 98.79% of the total oil were identified and the major compounds identified were linalool (12.38%), carvacrol (8.27%), eugenol (5.21%), and β-selinene (5.36%). Essential oil had larvicidal activity against Ae. aegypti and Ae. albopictus with LC₅₀ values of 40.49 mg/L, 47.01 mg/L, respectively. The LC₅₀ values of carvacrol, eugenol, linalool and β-selinene were 32.78, 56.34, 70.56, 136.03 mg/L against Ae. aegypti larvae, and 39.08, 52.07, 82.34, 151.74 mg/L, respectively, against Ae. albopictus larvae. Biochemical assays of Aedes larvae showed that the activities of acetylcholinesterase (AChE), monooxygenases (MO), glutathione-S-transferase (GST), p-Nitrophenyl acetate (p-NPA) esterase, α-esterase and β-esterase were significantly affected by carvacrol. Essential oil induced the detoxification mechanism for the action of GST and MO.

CONCLUSION

The result indicates that essential oil of A. fargesii and its isolated constituent have good inhibitory effects on the defense enzymes of Aedes mosquito larvae. A. fargesii essential oil can be used to control Aedes mosquito larvae to prevent the spread of dengue fever. © 2019 Society of Chemical Industry.

Laboratory selection of Aedes aegypti field populations with the organophosphate malathion: Negative impacts on resistance to deltamethrin and to the organophosphate temephos

Background

Resistance to pyrethroids and to the organophosphate temephos is widespread in Brazilian populations of the dengue vector, Aedes aegypti. Thereof, since 2009 Insect Growth Regulators are employed as larvicides, and malathion is used against adults.

Methodology/Principal findings

We performed laboratory selection with malathion of two A. aegypti field populations initially susceptible to this organophosphate but resistant to temephos and deltamethrin. A fixed malathion dose inducing at least 80% mortality in the first generation, was used throughout the selection process, interrupted after five generations, when the threshold of 20% mortality was reached. For each population, three experimental and two control groups, not exposed to insecticides, were kept independently. For both populations, quantitative bioassays revealed, in the selected groups, acquisition of resistance to malathion and negative impact of malathion selection on deltamethrin and temephos resistance levels. In the control groups resistance to all evaluated insecticides decreased except, unexpectedly, to deltamethrin. Analysis of the main resistance mechanisms employed routine methodologies: biochemical and molecular assays for, respectively, metabolic resistance and quantification of the Na_V pyrethroid target main kdr mutations at positions 1016 and 1534. No diagnostic alteration could be specifically correlated with malathion selection, neither with the unusual deltamethrin increase in resistance levels observed in the control groups.

Conclusions/Significance

Our results confirm the multifactorial character of insecticide resistance and point to the need of high throughput methodologies and to the study of additional field vector populations in order to unravel resistance mechanisms.

Dengue, Zika and chikungunya viruses affect millions of people worldwide. Due to the lack of specific antivirals or to the limited supply of vaccines, focus remains on the control of the main vector, Aedes aegypti. Although the importance of social participation in the elimination of A. aegypti breeding sites is increasingly recognized, chemical control is still an important component of vector control. The exaggerated use of insecticides results in the spread of resistance and, consequently, in the loss of their effectiveness. In Brazil, malathion is the last adulticide available to the control of A. aegypti, due to the widespread resistance to pyrethroids. In order to anticipate what could occur in the field, we exposed two vector populations to selection with malathion. Both malathion and temephos, a larvicide largely employed, are organophosphates; however, they are structurally distinct molecules and seem to elicit different resistance mechanisms. We confirmed this issue: selection with malathion had a negative impact on temephos resistance compared to groups reared without any insecticide. Indeed, the variety of responses of both vector populations to the various insecticides points to the participation of multiple resistance mechanisms and confirms previous assumptions regarding the difficulty of identifying diagnostic insecticide resistance mechanisms.

Synergy in the adulticidal efficacy of essential oils for the improvement of permethrin toxicity against Aedes aegypti L. (Diptera: Culicidae)

BACKGROUND

In a previous screening program for mosquitocides from local edible plants in Thailand, essential oils (EOs) of Cyperus rotundus, Alpinia galanga and Cinnamomum verum, were found to possess promising adulticidal activity against Aedes aegypti. With the aim of reducing usage of conventional insecticides and improving the management of resistant mosquito populations, this study was designed to determine the potential synergism in the adulticidal efficacy of EOs on permethrin toxicity against Ae. aegypti, both pyrethroid-resistant and -susceptible strains.

METHODS

EOs extracted from rhizomes of C. rotundus and A. galanga as well as C. verum barks were evaluated for chemical compositions and adulticidal activity against Muang Chiang Mai-susceptible (MCM-S) and Pang Mai Dang-resistant (PMD-R) strains of Ae. aegypti. Adulticidal bioassays of EO-permethrin mixtures for synergistic activity were also performed on these Ae. aegypti strains.

RESULTS

Chemical characterization by the GC-MS analytical technique demonstrated that 48 compounds were identified from the EOs of C. rotundus, A. galanga and C. verum, representing 80.22%, 86.75% and 97.24%, respectively, of all compositions. Cyperene (14.04%), β-bisabolene (18.27%) and cinnamaldehyde (64.66%) were the main constituents of C. rotundus, A. galanga and C. verum oils, respectively. In adulticidal bioassays, EOs of C. rotundus, A. galanga and C. verum were effective in killing Ae. aegypti, both MCM-S and PMD-R strains, with LD50 values of 10.05 and 9.57 μg/mg female, 7.97 and 7.94 μg/mg female, and 3.30 and 3.22 μg/mg female, respectively. The adulticidal efficacy against MCM-S and PMD-R Ae. aegypti of these EOs was close to that of piperonyl butoxide (PBO, LD50 values = 6.30 and 4.79 μg/mg female, respectively) but less pronounced than that of permethrin (LD50 values = 0.44 and 3.70 ng/mg female, respectively). Nevertheless, combination-based bioassays discovered the accomplished synergism of EOs together with permethrin. Significant synergistic effects with permethrin against both the strains of Ae. aegypti were recorded in the EOs of C. rotundus and A. galanga. Addition of C. rotundus and A. galanga oils decreased the LD50 values of permethrin against MCM-S dramatically from 0.44 to 0.07 and 0.11 ng/mg female, respectively, with synergism ratio (SR) values of 6.28 and 4.00, respectively. Furthermore, EOs of C. rotundus and A. galanga also reduced the LD50 values of permethrin against PMD-R drastically from 3.70 to 0.42 and 0.003 ng/mg female, respectively, with SR values of 8.81 and 1233.33, respectively.

CONCLUSIONS

The synergy of enhanced adulticidal toxicity recorded from EO-permethrin combinations against both strains of Ae. aegypti presents a promising role of EOs as a synergist for improving mosquitocidal efficacy, particularly in situations where conventional compounds are ineffective or inappropriate.

Toxicity of Beauveria bassiana-28 Mycelial Extracts on Larvae of Culex quinquefasciatus Mosquito (Diptera: Culicidae)

Microbial-based pest control is an attractive alternative to chemical insecticides. The present study sought to evaluate the toxicity of the entomopathogenic fungus Beauveria bassiana-28 ethyl acetate extracts on different larval stages and pupae of Culex quinquefasciatus mosquitoes. B. bassiana-28 ethyl acetate mycelial extracts produced mosquitocidal activity against larvae and pupae which was comparable to that of the commercial insecticide B. bassiana-22 extract. The LC₅₀ (lethal concentration that kills 50% of the exposed larvae) values of B. bassiana-28 extracts for 1st to 4th instar larvae and pupae were 11.538, 6.953, 5.841, 3.581 and 9.041 mg/L respectively. Our results show that B. bassiana-28 ethyl acetate mycelial extract has strong insecticidal activity against larval and pupal stages of Cx. quinquefasciatus. Fourier transform infrared spectrum study of B. bassiana-28 extract shows peaks at 3226.91; 2927.94; 1593.13; 1404.18; 1224.18; 1247.94; 1078.21; 1018.41; 229.69; and 871.82 cm⁻¹. Major spectral peaks were observed at 3226.91 cm^−1, assigned to N–H stretching, 2927.94 cm⁻¹ assigned to C–H bonding and 1595.13 cm⁻¹ assigned to C–O stretching. Gas Chromatography-Mass Spectrometry studies of B. bassiana-28 ethyl acetate crude extract showed presence of six major compounds viz. N-hexadecanoic acids (13.6040%); Z,Z-9,12 octadecadienic acid (33.74%); 9-eicosyne (10.832%); heptacosane (5.148%); tetrateracontane (5.801%); and 7 hexyleicosane (5.723%). Histology of mosquito midgut tissue shows tissue lysis as a result of B.bassiana-28 extract exposure. The study shows that bioactive molecules obtained from B. bassiana-28 mycelial extract has insecticidal properties and can be used as alternative for mosquito control.

Comparative Analysis of Major Mosquito Vectors Response to Seed-Derived Essential Oil and Seed Pod-Derived Extract from Acacia nilotica

Botanical metabolites are increasingly realized as potential replacements to chemical insecticides. In the present study, Acacia nilotica seed essential oil and seed pod solvent extracts were tested for bioefficacy against three important types of mosquitoes. Mortality was recorded 24 h post-treatment, while smoke toxicity of adult mosquitoes was recorded at 10 min intervals for 40 min. Seed pod powder was extracted with different solvents and hydrodistilled seed oil chemical constituents were determined by using Gas chromatography mass spectroscopy (GC-MS) -. Larvicidal and adulticidal efficacy of seed hydrodistilled essential oil and solvent extracts were tested against larval and adult mosquitoes. The seed hydrodistilled oil provided strong larvicidal activity against Anopheles stephensi, (LC50 (lethal concentration that kills 50% of the exposed larvae) = 5.239, LC90 (lethal concentration that kills 90% of the exposed larvae) = 9.713 mg/L); Aedes aegypti, (LC50 = 3.174, LC90 = 11.739 mg/L); and Culex quinquefasciatus, (LC50 = 4.112, LC90 = 12.325 mg/L). Smoke toxicities were 82% in Cx. quinquefasciatus, 90% in Ae. aegypti, and 80% mortality in An. stephensi adults, whereas 100% mortality was recorded for commercial mosquito coil. The GC-MS profile of seed essential oil from A. nilotica showed the presence of hexadecane (18.440%) and heptacosane (15.914%), which are the main and active compounds, and which may be involved in insecticidal activity. Overall findings suggest that the seed oil showed strong mosquitocidal activity against mosquito vectors and therefore may provide an ecofriendly replacement to chemical insecticides.

Synergistic effect of entomopathogenic fungus Fusarium oxysporum extract in combination with temephos against three major mosquito vectors

Mosquito control using chemical insecticides is facing a major challenge due to development of insecticide resistance. Improving the efficiency of existing insecticides using synergistic secondary metabolites of biological origin is increasingly being researched. Herein, we evaluated the toxicity of Fusarium oxysporum extract alone and in binary combinations with temephos, on larvae and pupae of Anopheles stephensi, Aedes aegypti and Culex quinquefaciatus. F. oxysporum extract was characterized using TLC, FT-IR and GC-MS. After 24 h of exposure, the binary combination of temephos + F. oxysporum extract (1:1 ratio) was highly toxic to larvae of An. stephensi (LC50: 35.927 μg/ml), Ae. aegypti (LC50: 20.763 μg/ml) and Cx. quinquefasciatus, (LC50: 51.199 μg/ml). For pupae LC50 values were 38.668, 26.394, and 72.086 μg/ml, respectively. Histology studies of mosquitoes exposed to F. oxysporum extract showed vacuolation in epithelium, as well as in adipose, and muscle tissues of larval midgut. Overall, our results show that the synergistic combination of temephos and F. oxysporum extract is highly effective to control mosquito young instars.

Green synthesis of selenium nanoparticles conjugated Clausena dentata plant leaf extract and their insecticidal potential against mosquito vectors

Mosquitoes are major vectors for the transmission of many diseases like chikungunya, malaria, dengue, zika, etc. worldwide. In the present study, selenium nanoparticles (SeNPs) were synthesized from Clausena dentata and were tested for their larvicidal efficacy against the fourth-instar larvae of Anopheles stephensi, Aedes Aegypti, and Culex quinquefasciatus. The synthesized nanoparticles were characterized using UV-Vis spectroscopy, Fourier Transform Infrared Radiation (FTIR) spectroscopy, EDaX, and SEM. The results recorded from UV-Vis spectroscopy show the peak absorption spectrum at 420 nm. In FTIR, the maximum peak value is 2922.25 cm^-1 assigned to N-H group (amide group). In EDaX analysis shows peak around 72.64 which confirm the binding intensity of selenium. In SEM analysis, the synthesized SeNPs sizes were ranging from 46.32 nm to 78.88 nm. The synthesized SeNPs produced high mortality with very low concentration (LC₅₀) were 240.714 mg/L; 104.13 mg/L, and 99.602 mg/L for A. stephensi, A. Aegypti, and C. quinquefasciatus, respectively. These results suggest that the C. dentata leaf extract-mediated biosynthesis of SeNPs has the potential to be used as an ideal ecofriendly approach toward the control of mosquito vectors at early stages.