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Beelen NA, Molenbroeck SJJ, Groeneveld L, Voorter CE, Bos GMJ, Wieten L. HLA class I NK-epitopes and KIR diversities in patients with multiple myeloma. Immunogenetics 2024; 76:155-164. [PMID: 38478091 PMCID: PMC11087314 DOI: 10.1007/s00251-024-01336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 05/12/2024]
Abstract
Multiple myeloma (MM) is a hematological malignancy caused by the clonal expansion of malignant plasma cells in the bone marrow. Myeloma cells are susceptible to killing by natural killer (NK) cells, but NK cells fail to control disease progression, suggesting immunosuppression. The activation threshold of NK-effector function is regulated by interaction between KIRs and self-HLA class I, during a process called "education" to ensure self-tolerance. NK cells can respond to diseased cells based on the absence of HLA class I expression ("Missing-self" hypothesis). The HLA and KIR repertoire is extremely diverse; thus, the present study aimed to characterize potential variances in genotypic composition of HLA Class I NK-epitopes and KIRs between MM patients and healthy controls. Genotypic expression of KIR and HLA (HLA-C group-C1/C2 and Bw4 motifs (including HLA-A*23, A*24, A*32) were analyzed in 172 MM patients and 195 healthy controls. Compared to healthy controls, we did not observe specific KIR genes or genotypes, or HLA NK-epitopes with higher prevalence among MM patients. The presence of all three HLA NK-epitopes (C1+C2+Bw4+) was not associated with MM occurrence. However, MM patients were more likely to be C1-/C2+/Bw4+ (p = 0.049, OR 1.996). In line with this, there was a trend of increased genetic co-occurrence of Bw4 and KIR3DL1 in MM patients (p = 0.05, OR 1.557). Furthermore, MM patients were more likely to genetically express both C2/KIR2DL1 and Bw4/KIR3DL1 (p = 0.019, OR 2.453). Our results reveal an HLA NK-epitope combination that is associated with the occurrence of MM. No specific KIR genotypes were associated with MM.
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Affiliation(s)
- Nicky A Beelen
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Stefan J J Molenbroeck
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Lisette Groeneveld
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Christien E Voorter
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gerard M J Bos
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Lotte Wieten
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands.
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2
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Al Hadra B, Lukanov T, Mihaylova A, Naumova E. High-resolution characterization of KIR genes polymorphism in healthy subjects from the Bulgarian population-A pilot study. HLA 2024; 103:e15341. [PMID: 38180282 DOI: 10.1111/tan.15341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/14/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Abstract
Although killer-cell immunoglobulin-like receptor (KIR) gene content has been widely studied in health and disease, with the advancement of next-generation sequencing (NGS) technology the high-resolution characterization of this complex gene region has become achievable. KIR allele-level diversity has lately been described across human populations. The present study aimed to analyze for the first time the allele-level polymorphism of nine KIR genes in 155 healthy, unrelated individuals from the Bulgarian population by applying NGS. The highest degree of polymorphism was detected for the KIR3DL3 gene with 40 observed alleles at five-digit resolution in total, 22 of which were common. On the other hand, the KIR3DS1 gene was found to have the lowest degree of polymorphism among the studied KIR genes with one common allele: KIR3DS1*01301 (31.6%). To better understand KIR allelic associations and patterns in Bulgarians, we have estimated the pairwise linkage disequilibrium (LD) for the 10 KIR loci, where KIR2DL3*00501 allele was found in strong LD with KIR2DL1*00101 (D' = 1.00, R2 = 0.742). This is the first study investigating KIR polymorphism at the allele level in a population from the South-East European region. Considering the effect of the populationally shaped KIR allelic polymorphism on NK cell function, this data could lead to a better understanding of the genetic heterogeneity of this region and can be carried into clinical practice by improvement of the strategies taken for NK-mediated diseases.
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Affiliation(s)
- Bushra Al Hadra
- Clinic of Clinical Immunology and Stem Cell Bank, Alexandrovska University Hospital, Sofia, Bulgaria
- Department of Clinical Immunology, Medical University, Sofia, Bulgaria
| | - Tsvetelin Lukanov
- Clinic of Clinical Immunology and Stem Cell Bank, Alexandrovska University Hospital, Sofia, Bulgaria
- Department of Clinical Immunology, Medical University, Sofia, Bulgaria
| | - Anastasiya Mihaylova
- Clinic of Clinical Immunology and Stem Cell Bank, Alexandrovska University Hospital, Sofia, Bulgaria
| | - Elissaveta Naumova
- Clinic of Clinical Immunology and Stem Cell Bank, Alexandrovska University Hospital, Sofia, Bulgaria
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3
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Ivanova M, Ormandjieva A, Dodova R, Kaneva R, Shivarov V. Possible impact of HLA class I and class II on malignancies driven by a single germ-line BRCA1 mutation. Int J Immunogenet 2023; 50:243-248. [PMID: 37505908 DOI: 10.1111/iji.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
This study provides the first immunogenetic preliminary evidence that specific human leucocyte antigen (HLA) class I and class II alleles and haplotypes may be relevant for BRCA1 c.5263_5264insC driven oncogenesis. Observed HLA associations might have practical implications for establishment of predictive markers for the response to immunotherapies in malignancies driven by this germ-line mutation.
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Affiliation(s)
- Milena Ivanova
- Department of Clinical Immunology, University Hospital Alexandrovska, Medical University Sofia, Sofia, Bulgaria
| | - Anastasia Ormandjieva
- Department of Clinical Immunology, University Hospital Alexandrovska, Medical University Sofia, Sofia, Bulgaria
| | - Rumyana Dodova
- Center for Molecular Medicine, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University Sofia, Sofia, Bulgaria
| | - Radka Kaneva
- Center for Molecular Medicine, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University Sofia, Sofia, Bulgaria
| | - Velizar Shivarov
- Department of Experimental Research, Medical University Pleven, Pleven, Bulgaria
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4
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Grygiel-Górniak B, Ziółkowska-Suchanek I, Szymkowiak L, Rozwadowska N, Kaczmarek E. The Influence of FAM13A and PPAR-γ2 Gene Polymorphisms on the Metabolic State of Postmenopausal Women. Genes (Basel) 2023; 14:genes14040914. [PMID: 37107672 PMCID: PMC10137345 DOI: 10.3390/genes14040914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Recently, we have observed two significant pandemics caused by communicable (COVID-19) and non-communicable factors (obesity). Obesity is related to a specific genetic background and characterized by immunogenetic features, such as low-grade systemic inflammation. The specific genetic variants include the presence of polymorphism of the Peroxisome Proliferator-Activated Receptors gene (PPAR-γ2; Pro12Ala, rs1801282, and C1431T, rs3856806 polymorphisms), β-adrenergic receptor gene (3β-AR; Trp64Arg, rs4994), and Family With Sequence Similarity 13 Member A gene (FAM13A; rs1903003, rs7671167, rs2869967). This study aimed to analyze the genetic background, body fat distribution, and hypertension risk in obese metabolically healthy postmenopausal women (n = 229, including 105 lean and 124 obese subjects). Each patient underwent anthropometric and genetic evaluations. The study has shown that the highest value of BMI was associated with visceral fat distribution. The analysis of particular genotypes has revealed no differences between lean and obese women except for FAM13A rs1903003 (CC), which was more prevalent in lean patients. The co-existence of the PPAR-γ2 C1431C variant with other FAM13A gene polymorphisms [rs1903003(TT) or rs7671167(TT), or rs2869967(CC)] was related to higher BMI values and visceral fat distribution (WHR > 0.85). The co-association of FAM13A rs1903003 (CC) and 3β-AR Trp64Arg was associated with higher values of systolic (SBP) and diastolic blood pressure (DBP). We conclude that the co-existence of FAM13A variants with C1413C polymorphism of the PPAR-γ2 gene is responsible for body fat amount and distribution.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | | | - Lidia Szymkowiak
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland
| | - Natalia Rozwadowska
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland
| | - Elżbieta Kaczmarek
- Department of Bioinformatics and Computational Biology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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Ivanova M, Tsvetkova G, Lessichkova S, Gesheva N, Hadjiev E, Shivarov V. Exploration of the role of
NKG2D
ligands
MICA
and
MICB
in
JAK2 V617F
‐positive myeloproliferative neoplasms. HLA 2023. [DOI: 10.1111/tan.15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Milena Ivanova
- Department of Clinical Immunology University Hospital Alexandrovska, Medical University Sofia Bulgaria
| | - Gergana Tsvetkova
- Department of Clinical Hematology University Hospital Alexandrovska, Medical University Sofia Bulgaria
| | - Spaska Lessichkova
- Department of Clinical Immunology University Hospital Alexandrovska, Medical University Sofia Bulgaria
| | - Nevena Gesheva
- Department of Clinical Immunology University Hospital Alexandrovska, Medical University Sofia Bulgaria
| | - Evgueniy Hadjiev
- Department of Clinical Hematology University Hospital Alexandrovska, Medical University Sofia Bulgaria
| | - Velizar Shivarov
- Department of Experimental Research Medical University Pleven Bulgaria
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Kanzaki G, Tsuboi N, Yokoo T, Uesugi N, Furuichi K, Shimizu A, Sugiyama H, Sato H, Yokoyama H. Seasonal variations in renal biopsy numbers and primary glomerular disease features based on the Japan renal biopsy registry. Sci Rep 2023; 13:5123. [PMID: 36991090 PMCID: PMC10060207 DOI: 10.1038/s41598-023-32182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
We analyzed the seasonal variations in the number of renal biopsies and clinical characteristics of primary glomerular disease in Japan using the Japan Renal Biopsy Registry (J-RBR). We retrospectively collected clinical and pathological data of patients with primary glomerular disease who were registered in the J-RBR between 2007 and 2018. Immunoglobulin A nephropathy (IgAN), minimal change nephrotic syndrome (MCNS), membranous nephropathy (MN), and postinfectious acute glomerulonephritis (PIAGN) constituted the four major glomerular disorders included in this study (total, 13,989; IgAN, 9121; MCNS, 2298; MN, 2447; and PIAGN, 123). The number of patients with IgAN or MCNS was higher during summer. However, no overt seasonal variations were observed in patients with MN or PIAGN. Subgroup analyses suggested that in the patients with IgAN, more renal biopsies of severe cases were performed during winter, probably owing to age and blood pressure. Furthermore, more renal biopsies of severe cases were performed during spring and winter in patients with MCNS even after adjusting for the abovementioned host factors. This study suggests that seasonal factors influence the decision to perform renal biopsy as well as the pathogenesis of primary glomerular disease. Thus, our findings may provide important insights regarding the pathophysiology of primary glomerular disease.
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Affiliation(s)
- Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan.
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan
| | - Noriko Uesugi
- Department of Pathology, Fukuoka University, Fukuoka, Japan
| | - Kengo Furuichi
- Division of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Sato
- Department of Internal Medicine, Sendai Hospital of East Japan Railway Company, Sendai, Japan
| | - Hitoshi Yokoyama
- Division of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
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7
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The relevance of HLA class II genes in JAK2 V617F-positive myeloproliferative neoplasms. Hum Immunol 2023; 84:199-207. [PMID: 36707384 DOI: 10.1016/j.humimm.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/29/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
In the present study we analyzed the relevance of HLA class II in JAK2 V617F-positive (JAK2 V617F+) myeloproliferative neoplasms (MPNs) focusing on genotype diversity, associations with specific alleles and haplotypes and the level of gene expression. One hundred and thirty-nine JAK2 V617F+ MPN patients and 1083 healthy controls, typed by Next generation sequencing (NGS) were included in the study. Multivariate generalized linear models with age as a covariate were applied for analysis of HLA-II allele and haplotype associations. Publicly available gene expression datasets were used to analyze HLA-II pathway genes expression in CD34+ stem cells (SCs) from MPN patients and healthy controls. We did not observe differences in HLA evolutionary divergence (HED) between JAK2 V617F+ MPNs and healthy controls. Two alleles: HLA-DPB1*03:01, DQB1*04:02 and 4 haplotypes: DPB1*02:01-DQA1*05:05-DQB1*03:01-DRB1*11:01, DPB1*04:02-DQA1*05:05-DQB1*03:01-DRB1*11:03, DPB1*02:01-DQA1*01:04-DQB1*05:03-DRB1*14:04, and DPB1*04:01-DQA1*03:01-DQB1*03:02-DRB1*04:01 had significantly lower frequency in MPN patients compared to controls. Additionally, we observed HLA-II alleles and haplotypes with statistically higher frequencies in JAK2 V617F+ patients. Differential gene expression analysis showed down-regulation of HLA-DRB1, -DRA, -DMA, -DMB, -DOA,-DRB4, CIITA, and CD74 genes in JAK2 V617F+ MPN CD34+ SCs as compared to normal CD34 + SCs. In conclusion, this study provides evidence for the pleiotropic effects of HLA-II genes in JAK2 V617F-driven MPNs.
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8
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Al Hadra B, Lukanov TI, Ivanova MI. HLA class I chain-related MICA and MICB genes polymorphism in healthy individuals from the Bulgarian population. Hum Immunol 2022; 83:551-555. [PMID: 35525711 DOI: 10.1016/j.humimm.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
Abstract
Although human leukocyte antigen (HLA) gene polymorphism has been investigated in many populations around the world, the data on MHC class I chain-related (MIC) genes are still limited. The present study is aimed to analyze the allelic polymorphism of MICA and MICB genes and haplotype associations with HLA-B locus in 132 healthy, unrelated individuals from the Bulgarian population by next generation sequencing (NGS). A total of 36 MICA and 16 MICB alleles were observed with the highest frequency detected for MICA*008:01 (17.1%) and MICB*005:02 (32.4%). Further, two and three-loci haplotype frequencies and pairwise linkage disequilibrium were estimated. Highly significant global linkage disequilibrium was found between either HLA-B and MICA and MICB genes. This is the first study on MICA and MICB allelic polymorphism, linkage disequilibrium, and haplotype polymorphism in the Bulgarian population. These results will allow for better characterization of the genetic heterogeneity of the Bulgarian population and could contribute to further analyses on MICA and MICB clinical significance.
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Affiliation(s)
- Bushra Al Hadra
- Department of Clinical Immunology, Medical University, Sofia, Bulgaria; Department of Clinical Immunology and Stem Cell Bank, Alexandrovska University Hospital, Sofia, Bulgaria.
| | - Tsvetelin I Lukanov
- Department of Clinical Immunology, Medical University, Sofia, Bulgaria; Department of Clinical Immunology and Stem Cell Bank, Alexandrovska University Hospital, Sofia, Bulgaria
| | - Milena I Ivanova
- Department of Clinical Immunology, Medical University, Sofia, Bulgaria; Department of Clinical Immunology and Stem Cell Bank, Alexandrovska University Hospital, Sofia, Bulgaria
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9
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Stangou MJ, Fylaktou A, Ivanova-Shivarova MI, Theodorou I. Editorial: Immunosenescence and Immunoexhaustion in Chronic Kidney Disease and Renal Transplantation. Front Med (Lausanne) 2022; 9:874581. [PMID: 35479944 PMCID: PMC9037092 DOI: 10.3389/fmed.2022.874581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/01/2022] [Indexed: 12/21/2022] Open
Affiliation(s)
- Maria J Stangou
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asimina Fylaktou
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration Hospital, Thessaloniki, Greece
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Guerini FR, Cesari M, Arosio B. Hypothetical COVID-19 protection mechanism: hints from centenarians. IMMUNITY & AGEING 2021; 18:15. [PMID: 33785044 PMCID: PMC8008020 DOI: 10.1186/s12979-021-00226-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/15/2021] [Indexed: 01/06/2023]
Abstract
The risk of serious complications and the fatality rate due to COVID-19 pandemic have proven particularly higher in older persons, putting a further strain in healthcare system as we dramatically observed. COVID-19 is not exclusively gerophile (géro “old” and philia “love”) as young people can be infected, even if older people experience more severe symptoms and mortality due to their greater frailty. Indeed, frailty could complicate the course of COVID-19, much more than the number of years lived. As demonstration, there are centenarians showing remarkable capacity to recover after coronavirus infection. We hypothesize that centenarian’s portfolio could help in identifying protective biological mechanisms underlying the coronavirus infection. The human leukocyte antigen (HLA) is one of the major genetic regions associated with human longevity, due to its central role in the development of adaptive immune response and modulation of the individual’s response to life threatening diseases. The HLA locus seems to be crucial in influencing susceptibility and severity of COVID-19. In this hypothesis, we assume that the biological process in which HLA are involved may explain some aspects of coronavirus infection in centenarians, although we cannot rule out other biological mechanisms that these extraordinary persons are able to adopt to cope with the infection.
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Affiliation(s)
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Beatrice Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. .,Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Ivanova M, Tsvetkova G, Lukanov T, Stoimenov A, Hadjiev E, Shivarov V. Probable HLA-mediated immunoediting of JAK2 V617F-driven oncogenesis. Exp Hematol 2020; 92:75-88.e10. [DOI: 10.1016/j.exphem.2020.09.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/13/2022]
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12
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Vayntrub TA, Mack SJ, Fernandez-Viña MA. Preface: 17th International HLA and Immunogenetics Workshop. Hum Immunol 2020; 81:52-58. [PMID: 32051104 DOI: 10.1016/j.humimm.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Tamara A Vayntrub
- Histocompatibility, Immunogenetics, and Disease Profiling Laboratory, Stanford Blood Center, Palo Alto, CA, USA.
| | - Steven J Mack
- Center for Genetics, Children's Hospital Oakland Research Institute, Oakland, CA, USA.
| | - Marcelo A Fernandez-Viña
- Histocompatibility, Immunogenetics, and Disease Profiling Laboratory, Stanford Blood Center, Palo Alto, CA, USA; Department of Pathology, Stanford University Medical Center, Stanford, CA, USA.
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