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Wang X, Yang J, Huang P, Wang D, Zhang Z, Zhou Z, Liang L, Yao R, Yang L. Cytisine: State of the art in pharmacological activities and pharmacokinetics. Biomed Pharmacother 2024; 171:116210. [PMID: 38271893 DOI: 10.1016/j.biopha.2024.116210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024] Open
Abstract
Cytisine is a naturally occurring bioactive compound, an alkaloid mainly isolated from legume plants. In recent years, various biological activities of cytisine have been explored, showing certain effects in smoking cessation, reducing drinking behavior, anti-tumor, cardiovascular protection, blood sugar regulation, neuroprotection, osteoporosis prevention and treatment, etc. At the same time, cytisine has the advantages of high efficiency, safety, and low cost, has broad development prospects, and is a drug of great application value. However, a summary of cytisine's biological activities is currently lacking. Therefore, this paper summarizes the pharmacological action, mechanism, and pharmacokinetics of cytisine by referring to numerous databases, and analyzes the new and core targets of cytisine with the help of computer simulation technology, to provide reference for doctors.
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Affiliation(s)
- Xuezhen Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Jiaming Yang
- Research Center for Infectious Diseases, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Peifeng Huang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Dong Wang
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Zhibin Zhang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Zehua Zhou
- Research Center for Infectious Diseases, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Leiqin Liang
- Research Center for Infectious Diseases, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Rongmei Yao
- Research Center for Infectious Diseases, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Long Yang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Research Center for Infectious Diseases, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
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Tavakoli-Ardakani M, Gholamzadeh Sani Z, Beyraghi N, Najarimoghadam S, Kheradmand A. Comparison between cytisine and Nicotine Replacement Therapy in smoking cessation among inpatient psychiatric patients. J Addict Dis 2023:1-8. [PMID: 37565489 DOI: 10.1080/10550887.2023.2237395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Introduction: Smoking is more common among people with mental disorders and is associated with adverse effects. Some compounds, including nicotine and cytisine, have been used in many individuals to increase success in smoking cessation. In this study, the effect of cytisine on the smoking status of patients hospitalized in the psychiatry department was investigated.Method: Forty-seven patients, hospitalized in the psychiatry ward, motivated to quit smoking, participated in this open-label randomized trial. Thirty patients used nicotine gums 2 mg (Nicolife®) for eight weeks, and the remaining took cytisine pills (Tabex®) according to the manufacturer's instructions for 25 days. All patients were followed up for six months. The primary outcome was smoking cessation, measured by the mood and physical symptoms scale (MPSS), the AUDIT alcohol consumption questions (AUDIT-C), confirmatory factor analyses, and reliability of the modified cigarette evaluation questionnaire at the end of the 1st week and at 1st, 2nd and 6th months after quit day.Findings: Only two out of 30 patients (6.66%) in the group taking Nicotine Replacement Therapy (NRT) could quit smoking entirely (no cigarettes after six months). In contrast, three out of 17 patients (17.64%) managed to do so in the cytisine group. The number of cigarettes smoked by the patients in both groups decreased, but the reduction was significant in the cytisine group.Conclusion: Cytisine is an effective and suitable agent for smoking cessation in patients with psychological problems, with fewer adverse effects and more success rate compared to NRT.
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Affiliation(s)
- Maria Tavakoli-Ardakani
- Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Gholamzadeh Sani
- Student Research Committee, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Beyraghi
- Center for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Shadi Najarimoghadam
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kheradmand
- Department of Psychiatry, Taleghani Hospital Research Development Committee, Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pastorino U, Ladisa V, Trussardo S, Sabia F, Rolli L, Valsecchi C, Ledda RE, Milanese G, Suatoni P, Boeri M, Sozzi G, Marchianò A, Munarini E, Boffi R, Gallus S, Apolone G. Cytisine Therapy Improved Smoking Cessation in the Randomized Screening and Multiple Intervention on Lung Epidemics Lung Cancer Screening Trial. J Thorac Oncol 2022; 17:1276-1286. [PMID: 35908731 DOI: 10.1016/j.jtho.2022.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Cytisine, a partial agonist-binding nicotine acetylcholine receptor, is a promising cessation intervention. We conducted a single-center, randomized, controlled trial (RCT) in Italy to assess the efficacy and tolerability of cytisine as a smoking cessation therapy among lung cancer screening participants. METHODS From July 2019 to March 2020, the Screening and Multiple Intervention on Lung Epidemics RCT enrolled 869 current heavy tobacco users in a low-dose computed tomography screening program, with a randomized comparison of pharmacologic intervention with cytisine plus counseling (N = 470) versus counseling alone (N = 399). The primary outcome was continuous smoking abstinence at 12 months, biochemically verified through carbon monoxide measurement. RESULTS At the 12-month follow-up, the quit rate was 32.1% (151 participants) in the intervention arm and 7.3% (29 participants) in the control arm. The adjusted OR of continuous abstinence was 7.2 (95% confidence interval: 4.6-11.2). Self-reported adverse events occurred more frequently in the intervention arm (399 events among 196 participants) than in the control arm (230 events among 133 participants, p < 0.01). The most common adverse events were gastrointestinal symptoms, comprising abdominal swelling, gastritis, and constipation. CONCLUSIONS The efficacy and safety observed in the Screening and Multiple Intervention on Lung Epidemics RCT indicate that cytisine, a very low-cost medication, is a useful treatment option for smoking cessation and a feasible strategy to improve low-dose computed tomography screening outcomes with a potential benefit for all-cause mortality.
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Affiliation(s)
- Ugo Pastorino
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.
| | - Vito Ladisa
- Division of Pharmacy, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Trussardo
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Sabia
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Rolli
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Camilla Valsecchi
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta E Ledda
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy; Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Paola Suatoni
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Mattia Boeri
- Division of Tumour Genomics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Division of Tumour Genomics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Alfonso Marchianò
- Division of Radiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Munarini
- Division of Pneumology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Boffi
- Division of Pneumology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
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Phusahat P, Dilokthornsakul P, Boonsawat W, Zaeoue U, Hansuri N, Tawinkan N, Theeranut A, Lertsinudom S. Efficacy and Safety of Cytisine in Combination with a Community Pharmacists' Counselling for Smoking Cessation in Thailand: A Randomized Double-Blinded Placebo-Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13358. [PMID: 36293938 PMCID: PMC9603285 DOI: 10.3390/ijerph192013358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cytisine is a prospective pharmacological alternative for community pharmacy smoking cessation services. However, it has not yet been licensed because of a lack of efficacy and safety information in Thailand. OBJECTIVE The aim of this study was to evaluate the efficacy of cytisine in combination with community pharmacists' counselling on smoking cessation in a community pharmacy in ThailandDesign. Setting, participants, and interventions: A double-blinded randomized placebo-controlled trials was carried out. Participants aged >18 years old who smoked >10 tobaccos/day were randomly assigned to receive cytisine or placebo and five sessions of counselling by a community pharmacist. The primary outcome was a continuous abstinence rate (CAR) at week 48. The CAR was also measured at weeks 2, 4, 12, and 24. Adverse events were monitored. RESULTS A total of 132 participants were included, with 67 receiving cytisine and 65 receiving a placebo. Approximately 95% of participants were male. The CARs were determined to be 14.93% and 6.15% for cytisine and placebo, respectively, at week 48. The relative risk (RR) was 2.41 (95% confidence interval (CI); 0.80-7.35, p = 0.102). The RRs for CAR at weeks 2, 4, 12, and 24 were 2.43, 2.91, 2.50, and 1.78, respectively. Only the RRs for weeks 2, 4, and 12 were statistically significant. Common and non-serious gastrointestinal and neurological adverse events were observed. CONCLUSION Cytisine, when combined with community pharmacists' counselling, did not statistically improve the CAR at week 48, although it did improve the CAR at weeks 2, 4, and 12. Adverse events of cytisine were common and non-serious (registration number: TCTR20180312001).
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Affiliation(s)
- Pum Phusahat
- Division of Pharmacy, Somdej Phra Yupparat Sa Kaeo Hospital, Sa Kaeo 27000, Thailand
| | - Piyameth Dilokthornsakul
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand
| | - Watchara Boonsawat
- Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Uraiwan Zaeoue
- Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Nadthatida Hansuri
- Community Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Nirachara Tawinkan
- Community Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | | | - Sunee Lertsinudom
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
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Courtney RJ, Tutka P, Farrell M. The Effect of Cytisine vs Varenicline on Smoking Cessation-Reply. JAMA 2021; 326:1872-1873. [PMID: 34751713 DOI: 10.1001/jama.2021.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ryan J Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Piotr Tutka
- Department of Experimental and Clinical Pharmacology, University of Rzeszow, Rzeszow, Poland
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Tutka P, Vinnikov D, Courtney RJ, Benowitz NL. Cytisine for nicotine addiction treatment: a review of pharmacology, therapeutics and an update of clinical trial evidence for smoking cessation. Addiction 2019; 114:1951-1969. [PMID: 31240783 DOI: 10.1111/add.14721] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/08/2019] [Accepted: 06/18/2019] [Indexed: 01/30/2023]
Abstract
AIMS To review cytisine's history of use, pre-clinical evidence, clinical pharmacokinetics, efficacy, adverse reactions (ARs) and safety for smoking cessation. METHODS A synoptic review of the use of cytisine as a smoking cessation medication, mechanism of action, pharmacokinetics and safety. Relevant literature on data included in these sections were identified through a search of 11 databases with additional literature obtained from reports and monographs. Three databases (PubMed, EMBASE and www.elibrary.ru) were systematically searched for studies published from 2012 to August 2018 in any language to provide an updated meta-analysis of cytisine's efficacy and ARs for smoking cessation compared with placebo. We pooled the relative risks (RR) of abstinence in the efficacy analysis and RR of ARs, either reported by the authors or calculated from the reports. RESULTS Cytisine has been in use since 1964 and is currently marketed in 18 countries. Systemic bioavailability from oral ingestion is high and clearance is primarily renal, with minimal or no metabolism. Brain uptake in animal models is moderate. The plasma half-life averages 4.8 hours. Eight studies were included for meta-analysis of efficacy. With heterogeneous results, the overall RR versus placebo of successful continuous abstinence at the longest follow-up was 1.74 [95% confidence interval (CI) = 1.38-2.19]. Nausea, vomiting, dyspepsia, upper abdominal pain and dry mouth that were mild or moderate were the most common ARs, with RR versus placebo 1.10 (95% CI = 0.95-1.28). The cost of cytisine in eastern and central Europe is several-fold less than that of other smoking cessation medications. CONCLUSIONS Cytisine is a low-cost medication found to increase the likelihood of smoking cessation. The most frequently reported ARs of cytisine involve gastrointestinal symptoms that are mostly reported as either mild or moderate in severity.
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Affiliation(s)
- Piotr Tutka
- Department of Experimental and Clinical Pharmacology, University of Rzeszów, Rzeszów, Poland.,Laboratory for Innovative Research in Pharmacology, University of Rzeszów, Rzeszów, Poland.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Denis Vinnikov
- School of Public Health, Al-Farabi Kazakh National University, Almaty, Kazakhstan.,Biological Institute, National Research Tomsk State University, Tomsk, Russia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
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Chaim CH, Siu ER, Carvalho CFC, Frallonardo FP, Ismael F, de Andrade AG, Ventriglio A, Torales J, Bhugra D, Castaldelli-Maia JM. Experimentation with tobacco during adolescence as a factor influencing treatment of smoking in adulthood. A retrospective cohort. SAO PAULO MED J 2019; 137:234-240. [PMID: 31365599 PMCID: PMC9743999 DOI: 10.1590/1516-3180.2018.0504140319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There are still few studies on predictors of smoking cessation in Brazilian samples. Experimentation with tobacco during adolescence (ETA) may be one of the important predictors. OBJECTIVE This study aimed, within the context of a treatment-seeking group of subjects, to test the hypothesis that ETA negatively affects the outcome of smoking cessation during adulthood. DESIGN AND SETTING Retrospective (historic) cohort study conducted at a psychosocial care center in São Paulo, Brazil, between 2007 and 2010. METHODS Data on sociodemographics, smoking and medical profiles were obtained through self-report questionnaires that were completed at the baseline and at any follow-up appointment. Logistic regression models were constructed to describe factors associated with the outcome of smoking cessation, measured according to the self-reported four-week success rate among 367 outpatient smokers. RESULTS ETA was found to be associated with not quitting smoking through the treatment (odds ratio = 0.57; 95% confidence interval = 0.33-0.96; P < 0.05), even after adjustment for dependence level, sociodemographics, nicotine patch use and number of years of smoking. CONCLUSIONS Early exposure to nicotine may lead to higher risk of continuing smoking after treatment, in adulthood.
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Affiliation(s)
- Carolina Hanna Chaim
- MD. Research Associate, Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.
| | - Erica Rosanna Siu
- PhD. Research Associate, Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.
| | | | - Fernanda Piotto Frallonardo
- MD. Research Associate, ABC Center for Mental Health Studies, Department of Neuroscience, Faculdade de Medicina do ABC (FMABC), Fundação ABC, Santo André (SP), Brazil.
| | - Flavia Ismael
- MD, PhD. Vice-President, ABC Center for Mental Health Studies, Department of Neuroscience, Faculdade de Medicina do ABC (FMABC), Fundação ABC, Santo André (SP), Brazil. Auxiliary Professor of Medicine, Universidade de São Caetano do Sul (USCS), São Caetano do Sul (SP), Brazil.
| | - Arthur Guerra de Andrade
- MD, PhD. Associate Professor, Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), and Full Professor, ABC Center for Mental Health Studies, Department of Neuroscience, Faculdade de Medicina do ABC (FMABC), Fundação ABC, Santo André (SP), Brazil.
| | - Antonio Ventriglio
- MD, PhD. Honorary Researcher, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
| | - Julio Torales
- MD, PhD. Assistant Professor, Department of Psychiatry, Medical School, National University of Asunción, San Lorenzo, Central, Paraguay.
| | - Dinesh Bhugra
- MA, MSc, MBBS, FRCP, FRCPsych, FFPH, PhD, FACP, FAMS. Emeritus Professor, Institute of Psychiatry, Psychology & Neuroscience, King’s College, London, United Kingdom.
| | - João Mauricio Castaldelli-Maia
- MD, PhD. Research Associate, Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), and Auxiliary Professor, ABC Center for Mental Health Studies, Department of Neuroscience, Faculdade de Medicina do ABC (FMABC), Fundação ABC, Santo André (SP), Brazil.
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