1
|
Papp KA, Hong CH, Lansang MP, Turchin I, Adam DN, Beecker JR, Bissonnette R, Gooderham MJ, Jack C, Joseph M, Lynde CW, Shear NH. Practical Management of Patients with Atopic Dermatitis on Dupilumab. Dermatol Ther (Heidelb) 2021; 11:1805-1828. [PMID: 34510403 PMCID: PMC8435113 DOI: 10.1007/s13555-021-00586-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Dupilumab is approved to treat moderate-to-severe atopic dermatitis (AD) in several countries in patients as young as 6 years of age. Since its approval, practical issues related to the use of dupilumab for AD have arisen, with particular interest in transitioning from current therapies and managing medication overlap, considerations for special populations of patients with AD, and management of potential adverse events. METHODS This article aims to review the literature addressing several practical management issues related to dupilumab use for AD and to provide a framework for clinical decision-making in these circumstances and sub-populations. Each statement was reviewed, revised and voted on by authors to provide their level of agreement and degree of uncertainty for each statement. RESULTS An agreement level > 80% was achieved for all of the statements. CONCLUSION The expert panel provides statements considering the practical management of patients with AD taking dupilumab to inform clinical decision-making in specific but frequently encountered clinical situations.
Collapse
Affiliation(s)
- Kim A Papp
- Probity Medical Research, Waterloo, ON, Canada.
- K. Papp Clinical Research, 135 Union St E, Waterloo, ON, N2J 1C4, Canada.
| | - Chih-Ho Hong
- Probity Medical Research, Waterloo, ON, Canada
- Dr. Chih-ho Hong Medical, Inc, Surrey, BC, Canada
| | - M Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Irina Turchin
- Probity Medical Research, Waterloo, ON, Canada
- Brunswick Dermatology Centre, Fredericton, NB, Canada
| | - David N Adam
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- CCA Medical Research, Ajax, ON, Canada
| | - Jennifer R Beecker
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | | | - Melinda J Gooderham
- Probity Medical Research, Waterloo, ON, Canada
- SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Carolyn Jack
- Division of Dermatology, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marissa Joseph
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Charles W Lynde
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Lynderm Research, Markham, ON, Canada
| | - Neil H Shear
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
2
|
Mollanazar N, Qiu C, Aldrich J, Tedaldi E, Valdes‐ Rodriguez R, Savage K, Hsu S. Use of dupilumab in patients who are HIV‐positive: report of four cases. Br J Dermatol 2019; 181:1311-1312. [DOI: 10.1111/bjd.18222] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- N.K. Mollanazar
- Department of Dermatology Lewis Katz School of Medicine at Temple University Philadelphia PA U.S.A
| | - C.C. Qiu
- Lewis Katz School of Medicine at Temple University Philadelphia PA U.S.A
| | - J.L. Aldrich
- Department of Medicine Lewis Katz School of Medicine at Temple University Philadelphia PA U.S.A
| | - E. Tedaldi
- Department of Medicine Lewis Katz School of Medicine at Temple University Philadelphia PA U.S.A
| | - R. Valdes‐ Rodriguez
- Department of Dermatology Lewis Katz School of Medicine at Temple University Philadelphia PA U.S.A
| | - K.T. Savage
- Drexel University College of Medicine Philadelphia PA U.S.A
| | - S. Hsu
- Department of Dermatology Lewis Katz School of Medicine at Temple University Philadelphia PA U.S.A
| |
Collapse
|
3
|
Singh P, Rajput R, Mehra NK, Vajpayee M, Sarin R. Cytokine gene polymorphisms among North Indians: Implications for genetic predisposition? INFECTION GENETICS AND EVOLUTION 2019; 73:450-459. [PMID: 31173933 DOI: 10.1016/j.meegid.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/01/2019] [Accepted: 06/03/2019] [Indexed: 11/25/2022]
Abstract
Variations in the production and activity of cytokines influence the susceptibility and/or resistance to various infectious agents, autoimmune diseases, as well as the post-transplant engraftment/ rejection. Differences in the production of cytokines between individuals have been correlated to single nucleotide polymorphisms (SNPs) in the promoter, coding or non-coding regions of cytokine genes. The present study aimed at understanding distribution of cytokine gene variants among HIV seropositive subjects including HIV + TB+ subjects of Indian origin. Our findings indicate significant association of pro-inflammatory (IL2, IFN-γ, TNF-α) and anti-inflammatory cytokine gene variants (IL4, IL10) with the risk to acquire the HIV infection and development of AIDS related illness in Indian population. Since distribution of genetic polymorphisms varies significantly across different populations, different genotypes might exhibit different disease-modifying effects. An understanding of the immunogenetic factors or AIDS restriction genes is important not only for elucidating the mechanisms of disease pathogenesis but also for vaccine design and its application.
Collapse
Affiliation(s)
- Paras Singh
- Department of Molecular Medicine, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India.
| | - Roopali Rajput
- Department of Molecular Medicine, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Narinder K Mehra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Madhu Vajpayee
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rohit Sarin
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| |
Collapse
|
4
|
Acting locally: innate mucosal immunity in resistance to HIV-1 infection in Kenyan commercial sex workers. Mucosal Immunol 2014; 7:268-79. [PMID: 23801306 DOI: 10.1038/mi.2013.44] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/20/2013] [Indexed: 02/04/2023]
Abstract
Cohort studies of female commercial sex workers (CSWs) in Kenya were among the first to identify highly HIV-1-exposed seronegative (HESN) individuals. As natural resistance is usually mediated by innate immune mechanisms, we focused on determining whether expression and function of innate signaling pathways were altered locally in the genital mucosa of HESN CSWs. Our results demonstrated that selected pattern-recognition receptors (PRRs) were significantly reduced in expression in cervical mononuclear cells (CMCs) from HESN compared with the new HIV-negative (HIV-N) and HIV-positive (HIV-P) groups. Although baseline levels of secreted cytokines were reduced in CMCs of HESN, they were highly stimulated following exposure to ssRNA40 in vitro. Importantly, cervical epithelial cells from HESN also expressed reduced levels of PRRs, but Toll-like receptor 3 (TLR3) and TLR7 as well as nuclear factor-κB and activator protein 1 were highly expressed and activated. Lastly, inflammatory cytokines interleukin (IL)-1β, IL-8, and RANTES (regulated and normal T cell expressed and secreted) were detected at lower levels in cervicovaginal lavage of HESN compared with the HIV-N and HIV-P groups. Overall, our study reveals a local microenvironment of HIV resistance in the genital mucosa consisting of a finely controlled balance of basal immune quiescence with a focused and potent innate anti-viral response critical to resistance to sexual transmission of HIV-1.
Collapse
|
5
|
A genetic polymorphism of FREM1 is associated with resistance against HIV infection in the Pumwani sex worker cohort. J Virol 2012; 86:11899-905. [PMID: 22915813 DOI: 10.1128/jvi.01499-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A subgroup of women enrolled in the Pumwani sex worker cohort remain seronegative and PCR negative for human immunodeficiency virus type 1 despite repeated exposure through high-risk sex work. Studies have shown that polymorphisms of genes involved in antigen presentation and viral restriction factors are associated with resistance to HIV infection. To discover other possible genetic factors underlying this HIV-resistant phenotype, we conducted an exploratory nonbiased, low-resolution, genome-wide single-nucleotide polymorphism (SNP) analysis comparing 60 HIV-resistant women to 48 HIV-infected controls. The SNP minor allele rs1552896, in an intron of FREM1, was significantly associated with the resistant phenotype (P = 1.68 × 10(-5); adjusted P = 2.37 × 10(-4); odds ratio [OR], 9.51; 95% confidence interval [CI], 2.82 to 32.05). We expanded the sample size by genotyping rs1552896 in the Pumwani cohort and comparing 114 HIV-resistant women to 609 HIV-infected controls and confirmed the association (P = 1.7 × 10(-4); OR, 2.67; 95% CI, 1.47 to 4.84). To validate the association in a second cohort, we genotyped 783 women enrolled in a mother-child health study and observed the minor allele of rs1552896 enriched in HIV-uninfected women (n = 488) compared to HIV-infected enrollees (n = 295) (P = 0.036; OR, 1.69; 95% CI, 0.98 to 2.93). Quantitative reverse transcription-PCR showed that FREM1 mRNA was highly expressed in tissues relevant for HIV-1 infection, and immunohistochemical analysis revealed that FREM1 protein is expressed in the ectocervical mucosa of HIV-resistant women. The significant association of rs1552896 with an HIV-resistant phenotype, together with the expression profile of FREM1 in tissues relevant to HIV infection, suggests that FREM1 is a potentially novel candidate gene for resistance to HIV infection.
Collapse
|
6
|
Ji H, Ball TB, Ao Z, Kimani J, Yao X, Plummer FA. Reduced HIV-1 long terminal repeat transcription in subjects with protective interferon regulatory factor-1 genotype: a potential mechanism mediating resistance to infection by HIV-1. ACTA ACUST UNITED AC 2010; 42:389-94. [PMID: 20100115 DOI: 10.3109/00365540903496536] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We previously described the polymorphism in the interferon regulatory factor-1 (IRF-1) gene as a novel correlate of resistance to HIV-1 infection in a Kenyan female sex worker cohort. However, the underlying mechanisms likely mediating this association remained to be elucidated. The initiation of HIV-1 long terminal repeat (LTR) transcription in peripheral blood mononuclear cells (PBMCs) from subjects with different IRF-1 haplotypes, representing protective, intermediate and the least protective IRF-1 allele combinations, were investigated here. A single-cycle pseudovirus construct expressing vesicular stomatitis virus envelop G-protein (VSV-G) and having an HIV-1 pNL4.3 backbone with luciferase insert was used to infect PBMCs with different IRF-1 haplotypes. The efficiency of early HIV-1 LTR transcription was monitored using a luciferase assay. IRF-1 protein levels induced by the infection were measured by quantitative Western blot. Our results showed that PBMCs with the protective IRF-1 genotype demonstrated significantly lower HIV-1 LTR transcription during the initial stages of infection compared to PBMCs with other haplotypes, which correlated with the kinetics of IRF-1 responsiveness to HIV-1 infection in the cells. It suggests that IRF-1 genotypes alter the efficiency of early HIV-1 LTR transcription, likely via modulating expression of IRF-1. This may represent one mechanism mediating the association between IRF-1 polymorphisms and resistance to HIV-1 infection.
Collapse
Affiliation(s)
- Hezhao Ji
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | | | | | | | |
Collapse
|
7
|
Becker Y. The molecular mechanism of human resistance to HIV-1 infection in persistently infected individuals--a review, hypothesis and implications. Virus Genes 2009; 31:113-9. [PMID: 15965616 DOI: 10.1007/s11262-005-2503-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 03/03/2005] [Accepted: 03/03/2005] [Indexed: 11/29/2022]
Abstract
Resistance to HIV-1 infection in Europeans is associated with a mutation in the gene that codes for the CCR5 protein that is present in Th2 cells and serves as a coreceptor for HIV-1 R5 strain. A deletion of 32 amino acids from the cytokine receptor prevents infection. This mutation prevails in Europeans and is absent in Africans. However, duplication of a gene that codes for a chemokine that binds to the CCR5 was discovered in Africans (mean gene copy 6 while in non-Africans the mean gene copy is 3). Higher expression of these genes protects T cells against HIV-1 infection in vitro. It should be noted that resistance to HIV-1 R5 variant does not protect against HIV-1 R4 variant. It was reported that a minority of highly HIV-1 exposed African professional sex workers (APSW) were resistant to the virus infection during a 10 years period. Recently, the analysis of the cytokines in the serum of the persistently infected seronegative women revealed that the latter hypo-expresses the cytokine IL-4. Since the molecular events during HIV-1 infection are associated with a marked increase in the levels of IL-4 and IgE in the sera of the infected individuals, it suggests that AIDS is an allergy. Thus, a very low level of IL-4 production may abrogate the virus infection. Studies on the human IL-4 gene revealed that together with the IL-4 mRNA a spliced variant with a deletion of exon 2 is synthesized. The latter is a natural antagonist of IL-4 and when expressed in an individual at a level higher than IL-4, the person will resist a microbial infection (e.g. Mycobacterium tuberculosis) or asthma. The present hypothesis suggests that the HIV-1 resistant APSWs produce more IL-4 delta 2 molecules than IL-4 molecules. The binding of IL-4 delta 2 to IL-4 receptors on T and B cells prevents their functions and the infection by HIV-1. The implications of these studies are that treatment of HIV-1 infected people with drugs that will block the IL-4 receptors will stop HIV-1 infections and the determination of the levels of IL-4 and IL-4 delta 2 in the sera of HIV-1+ patients will enable to identify the individuals that have a natural resistance to HIV-l/AIDS and those who need treatments.
Collapse
Affiliation(s)
- Yechiel Becker
- Department of Molecular Virology, Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
| |
Collapse
|
8
|
Ball TB, Ji H, Kimani J, McLaren P, Marlin C, Hill AVS, Plummer FA. Polymorphisms in IRF-1 associated with resistance to HIV-1 infection in highly exposed uninfected Kenyan sex workers. AIDS 2007; 21:1091-101. [PMID: 17502719 DOI: 10.1097/qad.0b013e3280ef6ae1] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the correlation between polymorphisms in the IL-4 gene cluster and resistance to HIV-1 infection. DESIGN : A cross-sectional genetic analysis of polymorphisms within the IL-4 gene cluster was conducted in a well-described female sex worker cohort from Nairobi, Kenya, known to exhibit differential susceptibility to HIV-1 infection. METHODS Microsatellite genotyping was used to screen six microsatellite markers in the IL-4 gene cluster for associations with HIV-1 resistance. Further analysis of the interferon regulatory factor 1 (IRF-1) gene was conducted by genomic sequencing. Associations between IRF-1 gene polymorphisms and the HIV-1 resistance phenotype were determined using the chi-square test and Kaplan-Meier survival analysis. The functional consequence of IRF-1 polymorphism was conducted by quantitative Western blot. RESULTS Three polymorphisms in IRF-1, located at 619, the microsatellite region and 6516 of the gene, showed associations with resistance to HIV-1 infection. The 619A, 179 at IRF-1 microsatellite and 6516G alleles were associated with the HIV-1-resistant phenotype and a reduced likelihood of seroconversion. Peripheral blood mononuclear cells from patients with protective IRF-1 genotypes exhibited significantly lower basal IRF-1 expression and reduced responsiveness to exogenous IFN-gamma stimulation. CONCLUSION Polymorphisms in the IRF-1 gene are associated with resistance to infection by HIV-1 and a lowered level of IRF-1 protein expression. This study adds IRF-1, a transcriptional immunoregulatory gene, to the list of genetic correlates of altered susceptibility to HIV-1. This is the first report suggesting that a viral transcriptional regulator might contribute to resistance to HIV-1. Further functional analysis on the role of IRF-1 polymorphisms and HIV-1 resistance is underway.
Collapse
Affiliation(s)
- Terry Blake Ball
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, 730 William Avenue, Winnipeg, Manitoba, Canada.
| | | | | | | | | | | | | |
Collapse
|
9
|
Bégaud E, Chartier L, Marechal V, Ipero J, Léal J, Versmisse P, Breton G, Fontanet A, Capoulade-Metay C, Fleury H, Barré-Sinoussi F, Scott-Algara D, Pancino G. Reduced CD4 T cell activation and in vitro susceptibility to HIV-1 infection in exposed uninfected Central Africans. Retrovirology 2006; 3:35. [PMID: 16792805 PMCID: PMC1524799 DOI: 10.1186/1742-4690-3-35] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 06/22/2006] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Environmentally driven immune activation was suggested to contribute to high rates of HIV-1 infection in Africa. We report here a study of immune activation markers and susceptibility to HIV-1 infection in vitro of forty-five highly exposed uninfected partners (EUs) of HIV-1 infected individuals in Central African Republic, in comparison with forty-four low-risk blood donors (UCs). RESULTS Analysis of T lymphocyte subsets and activation markers in whole blood showed that the absolute values and the percentage of HLA-DR+CD4 T cells and of CCR5+CD4 T cells were lower in the EUs than in the UCs (p = 0.0001). Mutations in the CCR5 coding region were not found in either group. Susceptibility to in vitro infection of unstimulated peripheral blood mononuclear cells, prior of PHA activation, was decreased in EUs compared to UCs, either using a CXCR4-tropic or a CCR5-tropic HIV-1 strain (p = 0.02 and p = 0.05, respectively). Levels of MIP-1beta, but not of MIP-1alpha or RANTES, in the supernatants of PHA-activated PBMC, were higher in the EUs than in the UCs (p = 0.007). CONCLUSION We found low levels of CD4 T cell activation and reduced PBMC susceptibility to HIV-1 infection in Central African EUs, indicating that both may contribute to the resistance to HIV-1 infection.
Collapse
Affiliation(s)
- Evélyne Bégaud
- Institut Pasteur, Bangui, CAR
- Centre de Ressources Biologiques de l'Institut Pasteur, Institut Pasteur, Paris, France
| | - Loïc Chartier
- Unité de Recherche et d'Expertise Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Valéry Marechal
- Institut Pasteur, Bangui, CAR
- Unité Postulante Interactions Moléculaires Flavivirus-Hôtes
| | | | | | - Pierre Versmisse
- Unité de Régulation des Infections Rétrovirales, Institut Pasteur, Paris, France
| | - Guillaume Breton
- Service de Médecine Interne, Groupe Hospitalier Pitié-Salpétrière, Paris, France
| | - Arnaud Fontanet
- Unité de Recherche et d'Expertise Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | | | | | | | - Daniel Scott-Algara
- Unité de Régulation des Infections Rétrovirales, Institut Pasteur, Paris, France
| | - Gianfranco Pancino
- Unité de Régulation des Infections Rétrovirales, Institut Pasteur, Paris, France
| |
Collapse
|
10
|
Ji H, Ball TB, Kimani J, Plummer FA. Novel interferon regulatory factor-1 polymorphisms in a Kenyan population revealed by complete gene sequencing. J Hum Genet 2004; 49:528-535. [PMID: 15378396 DOI: 10.1007/s10038-004-0185-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Accepted: 07/02/2004] [Indexed: 10/26/2022]
Abstract
Variation in susceptibility to HIV-1 infection depends on numerous factors, and host genetic variation has been well-described as an important component. As a transcriptional regulator, interferon regulatory factor 1 (IRF-1) plays a key role in both innate and adaptive immunity against viral infection. IRF-1 has also been shown to directly interact with HIV-1 5' LTR and efficiently initiate or amplify HIV-1 replication. By complete gene sequencing, we investigated genetic polymorphism of the IRF-1 gene in an HIV-1-endemic Kenyan population. This population displayed extensive genetic diversity at the IRF-1 locus. Fifty-three single nucleotide polymorphisms (SNPs) were identified in this population, including 26 novel SNPs. Two insertion and one deletion polymorphisms in IRF-1 were also identified. Linkage disequilibrium (LD) among these genetic variations was shown to be common in IRF-1. The functional consequences of these mutations in the context of HIV-1/AIDS remain to be determined. We also identified 35 consistent discrepancies between IRF-1 GenBank sequences and our population based sequencing data, suggesting that the previously submitted GenBank data were not representative of the majority of human IRF-1 sequences.
Collapse
Affiliation(s)
- Hezhao Ji
- Department of Medical Microbiology, University of Manitoba, Room 514, 730 William Avenue, Winnipeg, MB, Canada, R3E 0W3
| | - Terry Blake Ball
- Department of Medical Microbiology, University of Manitoba, Room 514, 730 William Avenue, Winnipeg, MB, Canada, R3E 0W3
| | - Joshua Kimani
- Department of Microbiology, University of Nairobi, Nairobi, Kenya
| | - Francis Allan Plummer
- Department of Medical Microbiology, University of Manitoba, Room 514, 730 William Avenue, Winnipeg, MB, Canada, R3E 0W3.
- National Microbiology Laboratory, Canadian Science Center for Human and Animal Health, Winnipeg, MB, Canada.
| |
Collapse
|