1
|
Lu L, Kong WY, Zhang J, Firdaus F, Wells JW, Stephenson RJ, Toth I, Skwarczynski M, Cruz JLG. Utilizing murine dendritic cell line DC2.4 to evaluate the immunogenicity of subunit vaccines in vitro. Front Immunol 2024; 15:1298721. [PMID: 38469294 PMCID: PMC10925716 DOI: 10.3389/fimmu.2024.1298721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Subunit vaccines hold substantial promise in controlling infectious diseases, due to their superior safety profile, specific immunogenicity, simplified manufacturing processes, and well-defined chemical compositions. One of the most important end-targets of vaccines is a subset of lymphocytes originating from the thymus, known as T cells, which possess the ability to mount an antigen-specific immune response. Furthermore, vaccines confer long-term immunity through the generation of memory T cell pools. Dendritic cells are essential for the activation of T cells and the induction of adaptive immunity, making them key for the in vitro evaluation of vaccine efficacy. Upon internalization by dendritic cells, vaccine-bearing antigens are processed, and suitable fragments are presented to T cells by major histocompatibility complex (MHC) molecules. In addition, DCs can secrete various cytokines to crosstalk with T cells to coordinate subsequent immune responses. Here, we generated an in vitro model using the immortalized murine dendritic cell line, DC2.4, to recapitulate the process of antigen uptake and DC maturation, measured as the elevation of CD40, MHC-II, CD80 and CD86 on the cell surface. The levels of key DC cytokines, tumor necrosis alpha (TNF-α) and interleukin-10 (IL-10) were measured to better define DC activation. This information served as a cost-effective and rapid proxy for assessing the antigen presentation efficacy of various vaccine formulations, demonstrating a strong correlation with previously published in vivo study outcomes. Hence, our assay enables the selection of the lead vaccine candidates based on DC activation capacity prior to in vivo animal studies.
Collapse
Affiliation(s)
- Lantian Lu
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD, Australia
- Faculty of Medicine, Frazer Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Wei Yang Kong
- Faculty of Medicine, Frazer Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Jiahui Zhang
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD, Australia
- Faculty of Medicine, Frazer Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Farrhana Firdaus
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD, Australia
| | - James W. Wells
- Faculty of Medicine, Frazer Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Rachel J. Stephenson
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Istvan Toth
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD, Australia
- Institute of Molecular Bioscience, The University of Queensland, St. Lucia, QLD, Australia
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Mariusz Skwarczynski
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jazmina L. Gonzalez Cruz
- Faculty of Medicine, Frazer Institute, The University of Queensland, Woolloongabba, QLD, Australia
| |
Collapse
|
2
|
Lei L, Huang D, Gao H, He B, Cao J, Peppas NA. Hydrogel-guided strategies to stimulate an effective immune response for vaccine-based cancer immunotherapy. SCIENCE ADVANCES 2022; 8:eadc8738. [PMID: 36427310 PMCID: PMC9699680 DOI: 10.1126/sciadv.adc8738] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/07/2022] [Indexed: 05/25/2023]
Abstract
Cancer vaccines have attracted widespread interest in tumor therapy because of the potential to induce an effective antitumor immune response. However, many challenges including weak immunogenicity, off-target effects, and immunosuppressive microenvironments have prevented their broad clinical translation. To overcome these difficulties, effective delivery systems have been designed for cancer vaccines. As carriers in cancer vaccine delivery systems, hydrogels have gained substantial attention because they can encapsulate a variety of antigens/immunomodulators and protect them from degradation. This enables hydrogels to simultaneously reverse immunosuppression and stimulate the immune response. Meanwhile, the controlled release properties of hydrogels allow for precise temporal and spatial release of loads in situ to further enhance the immune response of cancer vaccines. Therefore, this review summarizes the classification of cancer vaccines, highlights the strategies of hydrogel-based cancer vaccines, and provides some insights into the future development of hydrogel-based cancer vaccines.
Collapse
Affiliation(s)
- Lei Lei
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, P. R. China
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, P. R. China
| | - Dennis Huang
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
- Institute for Biomaterials, Drug Delivery, and Regenerative Medicine, The University of Texas at Austin, Austin, TX 78712, USA
| | - Huile Gao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, P. R. China
| | - Bin He
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, P. R. China
| | - Jun Cao
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, P. R. China
| | - Nicholas A. Peppas
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
- Institute for Biomaterials, Drug Delivery, and Regenerative Medicine, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Chemical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- Departments of Pediatrics, Surgery, and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA
| |
Collapse
|
3
|
Kamaly N, Fredman G, Fojas JJR, Subramanian M, Choi W, Zepeda K, Vilos C, Yu M, Gadde S, Wu J, Milton J, Leitao RC, Fernandes LR, Hasan M, Gao H, Nguyen V, Harris J, Tabas I, Farokhzad OC. Targeted Interleukin-10 Nanotherapeutics Developed with a Microfluidic Chip Enhance Resolution of Inflammation in Advanced Atherosclerosis. ACS NANO 2016; 10:5280-92. [PMID: 27100066 PMCID: PMC5199136 DOI: 10.1021/acsnano.6b01114] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Inflammation is an essential protective biological response involving a coordinated cascade of signals between cytokines and immune signaling molecules that facilitate return to tissue homeostasis after acute injury or infection. However, inflammation is not effectively resolved in chronic inflammatory diseases such as atherosclerosis and can lead to tissue damage and exacerbation of the underlying condition. Therapeutics that dampen inflammation and enhance resolution are currently of considerable interest, in particular those that temper inflammation with minimal host collateral damage. Here we present the development and efficacy investigations of controlled-release polymeric nanoparticles incorporating the anti-inflammatory cytokine interleukin 10 (IL-10) for targeted delivery to atherosclerotic plaques. Nanoparticles were nanoengineered via self-assembly of biodegradable polyester polymers by nanoprecipitation using a rapid micromixer chip capable of producing nanoparticles with retained IL-10 bioactivity post-exposure to organic solvent. A systematic combinatorial approach was taken to screen nanoparticles, resulting in an optimal bioactive formulation from in vitro and ex vivo studies. The most potent nanoparticle termed Col-IV IL-10 NP22 significantly tempered acute inflammation in a self-limited peritonitis model and was shown to be more potent than native IL-10. Furthermore, the Col-IV IL-10 nanoparticles prevented vulnerable plaque formation by increasing fibrous cap thickness and decreasing necrotic cores in advanced lesions of high fat-fed LDLr(-/-) mice. These results demonstrate the efficacy and pro-resolving potential of this engineered nanoparticle for controlled delivery of the potent IL-10 cytokine for the treatment of atherosclerosis.
Collapse
Affiliation(s)
- Nazila Kamaly
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Gabrielle Fredman
- Departments of Medicine, Pathology and Cell Biology, and Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, United States
| | - Jhalique Jane R. Fojas
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Manikandan Subramanian
- Departments of Medicine, Pathology and Cell Biology, and Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, United States
| | - Won Choi
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
- Center for Convergence Bioceramic Materials, Convergence R&D Division, Korea Institute of Ceramic Engineering and Technology, 101, Soho-ro, Jinj-si, Gyeongsangnam-do 52851, Republic of Korea
| | - Katherine Zepeda
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Cristian Vilos
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
- Facultad de Medicina, Center for Integrative and Innovative Science, Universidad Andres Bello, Echaurren 183, Santiago 8370071, Chile
| | - Mikyung Yu
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Suresh Gadde
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Jun Wu
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Jaclyn Milton
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Renata Carvalho Leitao
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Livia Rosa Fernandes
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Moaraj Hasan
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Huayi Gao
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Vance Nguyen
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Jordan Harris
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Ira Tabas
- Departments of Medicine, Pathology and Cell Biology, and Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, United States
- Corresponding Authors: .
| | - Omid C. Farokhzad
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
- King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Corresponding Authors: .
| |
Collapse
|
4
|
Cui H, Zhang W, Hu W, Liu K, Wang T, Ma N, Liu X, Liu Y, Jiang Y. Recombinant mammaglobin A adenovirus-infected dendritic cells induce mammaglobin A-specific CD8+ cytotoxic T lymphocytes against breast cancer cells in vitro. PLoS One 2013; 8:e63055. [PMID: 23650543 PMCID: PMC3641140 DOI: 10.1371/journal.pone.0063055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 03/30/2013] [Indexed: 12/23/2022] Open
Abstract
Mammaglobin A (MGBA) is a novel breast cancer-associated antigen almost exclusively over-expressed in primary and metastatic human breast cancers, making it a potential therapeutic target for breast cancer. The development of dendritic cell (DC)-induced tumor antigen specific CD8+ cytotoxic T lymphocytes (CTLs) may hold promise in cancer immunotherapy. In this study we constructed recombinant replication-defective adenoviral (Ad) vectors encoding MGBA and evaluated their ability to trigger anti-tumor immunity in vitro. DCs were isolated from the human peripheral blood monocyte cells (PBMCs) of two HLA-A33+ healthy female volunteers, and infected with adenovirus carrying MGBA cDNA (Ad-MGBA). After that, the Ad-MGBA-infected DCs were used to stimulate CD8+ CTLs in vitro and the latter was used for co-culture with breast cancer cell lines. The data revealed that infection with Ad-MGBA improved DC maturation and up-regulated the expression of co-stimulatory molecules and the secretion of interleukin-12 (IL-12), but down-regulated interleukin-10 (IL-10) secretion from DCs. Ad-MGBA-infected DC-stimulated CD8+CTLs displayed the highest cytotoxicity towards HLA-A33+/MGBA+ breast cancer MDA-MB-415 cells compared with other CD8+CTL populations, and compared with the cytotoxicity towards HLA-A33−/MGBA+ breast cancer HBL-100 cells and HLA-A33−/MGBA− breast cancer MDA-MB 231 cells. In addition, Ad-MGBA-infected DC-stimulated CD8+ CTLs showed a high level of IFNγ secretion when stimulated with HLA-A33+/MGBA+ breast cancer MDA-MB-415 cells, but not when stimulated with HLA-A33−/MGBA+ HBL-100 and HLA-A33−/MGBA−MDA-MB-231 cells. In addition, killing of CD8+CTLs against breast cancer was in a major histocompability complex (MHC)-limited pattern. Finally, the data also determined the importance of TNF-α in activating DCs and T cells. These data together suggest that MGBA recombinant adenovirus-infected DCs could induce specific anti-tumor immunity against MGBA+ breast cancers, which could provide a novel strategy in the immunotherapy of breast cancer.
Collapse
Affiliation(s)
- Huixia Cui
- Cancer Research Institute, The First Hospital of China Medical University, Shenyang, China
- College of Nursing, Liaoning Medical University, Jinzhou, China
| | - Wenlu Zhang
- Department of Oncology, The First Hospital of Liaoning Medical University, Jinzhou, China
| | - Wei Hu
- Cancer Research Institute, The First Hospital of China Medical University, Shenyang, China
| | - Kun Liu
- College of Nursing, Liaoning Medical University, Jinzhou, China
| | - Tong Wang
- Cancer Research Institute, The First Hospital of China Medical University, Shenyang, China
| | - Nan Ma
- Cancer Research Institute, The First Hospital of China Medical University, Shenyang, China
| | - Xiaohui Liu
- Cancer Research Institute, The First Hospital of China Medical University, Shenyang, China
| | - Yunpeng Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Youhong Jiang
- Cancer Research Institute, The First Hospital of China Medical University, Shenyang, China
- * E-mail:
| |
Collapse
|
5
|
Qiu Y, Zhang J, Liu Y, Ma H, Cao F, Xu J, Hou Y, Xu L. The combination effects of acetaminophen and N-acetylcysteine on cytokines production and NF-κB activation of lipopolysaccharide-challenged piglet mononuclear phagocytes in vitro and in vivo. Vet Immunol Immunopathol 2013; 152:381-8. [DOI: 10.1016/j.vetimm.2013.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 01/18/2013] [Accepted: 01/22/2013] [Indexed: 01/19/2023]
|
6
|
Miyazaki H, Morishita J, Ueki M, Nishina K, Shiozawa S, Maekawa N. The effects of a selective inhibitor of c-Fos/activator protein-1 on endotoxin-induced acute kidney injury in mice. BMC Nephrol 2012; 13:153. [PMID: 23173923 PMCID: PMC3557146 DOI: 10.1186/1471-2369-13-153] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/18/2012] [Indexed: 12/17/2022] Open
Abstract
Background Sepsis has been identified as the most common cause of acute kidney injury (AKI) in intensive care units. Lipopolysaccharide (LPS) induces the production of several proinflammatory cytokines including tumor necrosis factor (TNF)-alpha, a major pathogenetic factor in septic AKI. c-Fos/activator protein (AP)-1 controls the expression of these cytokines by binding directly to AP-1 motifs in the cytokine promoter regions. T-5224 is a new drug developed by computer-aided drug design that selectively inhibits c-Fos/AP-1 binding to DNA. In this study, we tested whether T-5224 has a potential inhibitory effect against LPS-induced AKI, by suppressing the TNF-alpha inflammatory response and other downstream effectors. Methods To test this hypothesis, male C57BL/6 mice at 7 weeks old were divided into three groups (control, LPS and T-5224 groups). Mice in the control group received saline intraperitoneally and polyvinylpyrrolidone solution orally. Mice in the LPS group were injected intraperitoneally with a 6 mg/kg dose of LPS and were given polyvinylpyrrolidone solution immediately after LPS injection. In the T-5224 group, mice were administered T-5224 orally at a dose of 300 mg/kg immediately after LPS injection. Serum concentrations of TNF-alpha, interleukin (IL)-1beta, IL-6 and IL-10 were measured by ELISA. Moreover, the expression of intercellular adhesion molecule (ICAM)-1 mRNA in kidney was examined by quantitative real-time RT-PCR. Finally, we evaluated renal histological changes. Results LPS injection induced high serum levels of TNF-alpha, IL-1beta and IL-6. However, the administration of T-5224 inhibited the LPS-induced increase in these cytokine levels. The serum levels of IL-10 in the LPS group and T-5224 group were markedly elevated compared with the control group. T-5224 also inhibited LPS-induced ICAM-1 mRNA expression. Furthermore histological studies supported an anti-inflammatory role of T-5224. Conclusions In endotoxin-induced AKI, T-5224 inhibited the production of TNF-alpha and other downstream effectors. In contrast, T-5224 did not inhibit IL-10, an anti-inflammatory cytokine. These data support that the use of T-5224 is a promising new treatment for septic kidney injury.
Collapse
Affiliation(s)
- Hiroyuki Miyazaki
- Division of Anesthesiology and Perioperative Medicine, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | | | | | | | | | | |
Collapse
|
7
|
Walk RM, Elliott ST, Blanco FC, Snyder JA, Jacobi AM, Rose SD, Behlke MA, Salem AK, Vukmanovic S, Sandler AD. T-cell activation is enhanced by targeting IL-10 cytokine production in toll-like receptor-stimulated macrophages. Immunotargets Ther 2012; 1:13-23. [PMID: 27471682 PMCID: PMC4934151 DOI: 10.2147/itt.s32615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Toll-like receptor (TLR) agonists represent potentially useful cancer vaccine adjuvants in their ability to stimulate antigen-presenting cells (APCs) and subsequently amplify the cytotoxic T-cell response. The purpose of this study was to characterize APC responses to TLR activation and to determine the subsequent effect on lymphocyte activation. We exposed murine primary bone marrow-derived macrophages to increasing concentrations of agonists to TLRs 2, 3, 4, and 9. This resulted in a dose-dependent increase in production of not only tumor necrosis factor–alpha (TNF-α), a surrogate marker of the proinflammatory response, but also interleukin 10 (IL-10), a well-described inhibitory cytokine. Importantly, IL-10 secretion was not induced by low concentrations of TLR agonists that readily produced TNF-α. We subsequently stimulated lymphocytes with anti-CD3 antibody in the presence of media from macrophages activated with higher doses of TLR agonists and observed suppression of interferon gamma release. Use of both IL-10 knockout macrophages and IL-10 small-interfering RNA (siRNA) ablated this suppressive effect. Finally, IL-10 siRNA was successfully used to suppress CpG-induced IL-10 production in vivo. We conclude that TLR-mediated APC stimulation can induce a paradoxical inhibitory effect on T-cell activation mediated by IL-10.
Collapse
Affiliation(s)
- Ryan M Walk
- Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA; Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Steven T Elliott
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Felix C Blanco
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Jason A Snyder
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | | | - Scott D Rose
- Integrated DNA Technologies, Coralville, IA, USA
| | | | - Aliasger K Salem
- Division of Pharmaceutics, University of Iowa, Iowa City, IA, USA
| | - Stanislav Vukmanovic
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Anthony D Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| |
Collapse
|