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Zhang C, D'Angelo D, Buttini F, Yang M. Long-acting inhaled medicines: Present and future. Adv Drug Deliv Rev 2024; 204:115146. [PMID: 38040120 DOI: 10.1016/j.addr.2023.115146] [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: 06/05/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Inhaled medicines continue to be an essential part of treatment for respiratory diseases such as asthma, chronic obstructive pulmonary disease, and cystic fibrosis. In addition, inhalation technology, which is an active area of research and innovation to deliver medications via the lung to the bloodstream, offers potential advantages such as rapid onset of action, enhanced bioavailability, and reduced side effects for local treatments. Certain inhaled macromolecules and particles can also end up in different organs via lymphatic transport from the respiratory epithelium. While the majority of research on inhaled medicines is focused on the delivery technology, particle engineering, combination therapies, innovations in inhaler devices, and digital health technologies, researchers are also exploring new pharmaceutical technologies and strategies to prolong the duration of action of inhaled drugs. This is because, in contrast to most inhaled medicines that exert a rapid onset and short duration of action, long-acting inhaled medicines (LAIM) improve not only the patient compliance by reducing the dosing frequency, but also the effectiveness and convenience of inhaled therapies to better manage patients' conditions. This paper reviews the advances in LAIM, the pharmaceutical technologies and strategies for developing LAIM, and emerging new inhaled modalities that possess a long-acting nature and potential in the treatment and prevention of various diseases. The challenges in the development of the future LAIM are also discussed where active research and innovations are taking place.
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Affiliation(s)
- Chengqian Zhang
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark
| | - Davide D'Angelo
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark; Food and Drug Department, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
| | - Francesca Buttini
- Food and Drug Department, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
| | - Mingshi Yang
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark; Wuya College of Innovation, Shenyang Pharmaceutical University, Wenhua Road No. 103, 110016, Shenyang, China.
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Li F, Li X, Jiang M, Wang C, Liu G, Yang Z, Wu Y. Research progress into the application of Mycobacterium phlei in veterinary medicine. Vet Med Sci 2023; 9:2617-2624. [PMID: 37723902 PMCID: PMC10650220 DOI: 10.1002/vms3.1262] [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: 04/04/2023] [Revised: 08/21/2023] [Accepted: 09/03/2023] [Indexed: 09/20/2023] Open
Abstract
Mycobacterium phlei is a gram-positive acid-fast mycobacterium from the family Mycobacteriaceae. It is a valuable resource for both natural drugs and microecological preparations. It has been widely used in the field of human medicine; however, in the field of animal husbandry and veterinary medicine, the research and application of M. phlei is still in the preliminary exploration stage. This study aims to summarize the research progress of M. phlei in the field of veterinary medicine and provide a valuable reference for future research. Key words, such as 'M. phlei', 'veterinary field', 'immune balancer', 'genome' and other relevant words to this study, were used to search through PubMed, Web of Science, SciELO, Science Direct and Google Scholar databases. The results showed that the culture conditions of M. phlei were relatively simple, but its bacterial composition and genome sequence were relatively complex, and various components in the cell wall may have immunoregulatory effects. Therefore, the inactivated preparation made from M. phlei can have various applications in the veterinary field, such as growth regulation, immune regulation, antitumour, anti-parasite and asthma treatment. The literature review indicates that M. phlei preparation is an efficient and convenient immune system balance agent. Despite the challenges associated with the use of M. phlei preparations, it has a strong potential for application in veterinary medicine.
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Affiliation(s)
- Fan Li
- College of Veterinary MedicineHunan Agricultural UniversityChangshaHunanChina
| | - Xiang Li
- Hunan Canzoho Biological Technology Co., Ltd.LiuyangHunanChina
| | - Meng‐Lin Jiang
- College of Veterinary MedicineHunan Agricultural UniversityChangshaHunanChina
| | - Chun‐Hua Wang
- College of Veterinary MedicineHunan Agricultural UniversityChangshaHunanChina
| | - Gao‐Feng Liu
- Hunan Canzoho Biological Technology Co., Ltd.LiuyangHunanChina
| | - Zi Yang
- Academician WorkstationChangsha Medical UniversityChangshaHunanChina
| | - Yong Wu
- College of Veterinary MedicineHunan Agricultural UniversityChangshaHunanChina
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Xiao H, Zhang QN, Sun QX, Li LD, Xu SY, Li CQ. Effects of Mycobacterium vaccae Aerosol Inhalation on Airway Inflammation in Asthma Mouse Model. J Aerosol Med Pulm Drug Deliv 2021; 34:374-382. [PMID: 33945334 DOI: 10.1089/jamp.2021.0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Mycobacterium vaccae vaccine, a composition of Mycobacterium proteins, has been known to have bidirectional immunomodulatory functions. Recent studies have shown that M. vaccae has a therapeutic potential for treating asthma. However, little is known regarding the effect of M. vaccae aerosol inhalation during allergen sensitization or challenge on asthma. The purpose of this study was to explore the effect and the underlying mechanism of M. vaccae aerosol inhalation during allergen sensitization or challenge on airway inflammation in an asthma mouse model. Methods: Asthma mouse models were established. Mice received aerosol inhalation with M. vaccae once daily during allergen sensitization or challenge for 5 days successively. Airway responsiveness, bronchoalveolar lavage fluid (BALF) cell count, histology, and cytokine concentrations (IL-4, IFN-γ, IL-10, and IL-17) were measured. The relative mRNA expression of ASC, caspase-1, TNF-α, and IL-1β was also determined. Expression of pulmonary NLRP3 and nuclear factor kappa B (NF-κB) protein was measured using immunohistochemistry and Western blot. Results: M. vaccae aerosol inhalation suppressed airway hyperresponsiveness and inflammation, reduced levels of IL-4, upregulated expression of IFN-γ and IL-10 in BALF, inhibited mRNA expression of pulmonary ASC, caspase-1, TNF-α, and IL-1β, and also inhibited expression of pulmonary NLRP3 and NF-κB protein during allergen sensitization or challenge. Conclusion: M. vaccae aerosol inhalation can suppress airway hyperresponsiveness and inflammation during allergen sensitization or challenge, and may be a promising approach for asthma therapy.
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Affiliation(s)
- Huan Xiao
- Department of Emergency and The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qian-Nan Zhang
- Department of Emergency and The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qi-Xiang Sun
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lao-Dong Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Si-Yue Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chao-Qian Li
- Department of Emergency and The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Lin YR, Wu FY, Xiao H, Huang JL, Gong BB, Li YL, Lu N, Jiang XH, Sun QX, Zhang JF, Hu JT, Zhao YX, Li CQ. Mycobacterium vaccae Nebulization in the Treatment of COVID-19: A Randomized, Double-Blind, Placebo-Controlled Trial. J Aerosol Med Pulm Drug Deliv 2021; 34:108-114. [PMID: 33691499 DOI: 10.1089/jamp.2020.1628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 infection is associated with strong infectiousness and has no effective therapy. We aimed to explore the efficacy and safety of Mycobacterium vaccae nebulization in the treatment of Coronavirus Disease 2019 (COVID-19). Methods: In this randomized, double-blind, placebo-controlled clinical trial, we included 31 adult patients with moderate COVID-19 who were admitted to the Fourth People's Hospital of Nanning (Nanning, China) between January 22, 2020 and February 17, 2020. Patients were randomly divided into two groups: group A (standard care group) and group B (M. vaccae in combination with standard care group). The primary outcome was the time interval from admission to viral RNA negative conversion (oropharyngeal swabs were used in this study). Secondary outcomes included chest computed tomography (CT), mortality, length of hospital stay, complications during treatment, and so on. Patients were followed up to 4 weeks after discharge (reexamination of viral RNA, chest CT, etc.). Results: Nucleic acid test negative conversion time in group B was shorter than that in group A (2.9 days [2.7-8.7] vs. 6.8 days [3.3-13.8]; p = 0.045). No death and no conversion to severe or critical cases were observed in both groups. Two weeks after discharge, neither "relapse" nor "return to positive" cases were found. Four weeks after discharge, it was found that there was no case of " relapse " or "return to positive" in group B, and 1 patient in group A showed "return to positive", but there was no clinical manifestation and imaging progression. No adverse reactions related to M. vaccae were found during observation period. Conclusion: M. vaccae treatment might shorten the time interval from admission to viral RNA negative conversion, which might be beneficial to the prevention and treatment of COVID-19. Clinical Trial Registration: ChiCTR2000030016.
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Affiliation(s)
- Yan-Rong Lin
- Department of Respiratory and Critical Care Medicine, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
| | - Feng-Yao Wu
- Department of Respiratory and Critical Care Medicine, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
| | - Huan Xiao
- Department of Respiratory Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Jian-Lin Huang
- Department of Respiratory Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Bei-Bei Gong
- Department of Respiratory and Critical Care Medicine, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
| | - You-Ling Li
- Department of Respiratory and Critical Care Medicine, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
| | - Ning Lu
- Department of Respiratory and Critical Care Medicine, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
| | - Xiao-Hong Jiang
- Department of Respiratory Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Qi-Xiang Sun
- Department of Respiratory Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Jian-Feng Zhang
- Department of Emergency, Guangxi Medical University, Nanning, Guangxi, China
| | - Jun-Tao Hu
- Department of Respiratory Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Yong-Xiang Zhao
- Collaborative Innovation Center for Targeting Tumor Theranostics, Guangxi Medical University, Nanning, Guangxi, China
| | - Chao-Qian Li
- Department of Respiratory Medicine, Guangxi Medical University, Nanning, Guangxi, China
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Jiang XH, Li CQ, Feng GY, Luo MJ, Sun QX. Inhalation of nebulized Mycobacterium vaccae can protect against allergic bronchial asthma in mice by regulating the TGF-β/Smad signal transduction pathway. Allergy Asthma Clin Immunol 2020; 16:59. [PMID: 32834825 PMCID: PMC7386169 DOI: 10.1186/s13223-020-00456-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background Mycobacterium vaccae nebulization imparted protective effect against allergic asthma in a mouse model. The TGF-β/Smad signal transduction pathway plays an important role in allergic bronchial asthma. However, the effect of M. vaccae nebulization on the TGF-β/Smad signal transduction pathway in mouse models of allergic asthma remains unclear. This study investigated the preventive effect of M. vaccae nebulization during bronchial asthma in a mouse model and elucidate the implication of TGF-β/Smad signal transduction pathway in the process. Methods In total, 24 female Balb/c mice were randomized to normal control (group A), asthma control (group B), and M. vaccae nebulization (group C) groups. Both groups B and C were sensitized using ovalbumin for establishment of the asthmatic model; group A received phosphate-buffered solution. Prior to the establishment of asthma, Group C was nebulized with M. vaccae. Airway responsiveness was measured in all the groups, using a noninvasive lung function machine before and 24 h after establishment of the asthmatic model. The animals were then harvested, and bronchoalveolar lavage fluid (BALF) and lung tissue were collected. The total cell counts in BALF was estimated. Protein expression of TGF-β1, TβR1, Smad1, and Smad7 was detected by immunohistochemistry. The population of CD3+γδT, IL-13+CD3+T, TGF-β+CD3+T, IL-13+CD3+γδT, and TGF-β+ CD3+ γδT cells were detected by flow cytometry. One-way analysis of variance for within-group comparisons, the least significant difference t-test or Student–Newman–Keuls test for intergroup comparisons, and the nonparametric rank sum test for analysis of airway inflammation scores were used in the study. Results The eosinophil count; protein expression of TGF-β1, TβR1, and Smad1; and percentages of CD3+γδT and IL-13+CD3+T cells were significantly lower in the M. vaccae nebulization group than in the asthma control group (P < 0.01). There were significant intergroup differences in the percentages of TGF-β+CD3+T and IL-13+CD3+γδT cells (P < 0.05). Conclusions Mycobacterium vaccae nebulization could confer protection against allergic bronchial asthma by reducing airway responsiveness and alleviating airway inflammation in mice. The underlying mechanism might be attributed its effect on the deregulated expression of TGF-β1, TβR1, Smad1, and Smad7 of the TGF-β/Smad signal transduction pathway.
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Affiliation(s)
- Xiao-Hong Jiang
- Department of Geriatric Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Chao-Qian Li
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Guang-Yi Feng
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Ming-Jie Luo
- Department of Respiratory Medicine, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 530021 Guangxi China
| | - Qi-Xiang Sun
- The Graduate School of Guangxi Medical University, Nanning, 530021 Guangxi China
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Mustafa AS. Vaccine Potential of Mycobacterial Antigens against Asthma. Med Princ Pract 2020; 29:404-411. [PMID: 32422630 PMCID: PMC7511680 DOI: 10.1159/000508719] [Citation(s) in RCA: 3] [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: 03/10/2020] [Accepted: 05/17/2020] [Indexed: 12/16/2022] Open
Abstract
Asthma is a cause of substantial burden of disease in the world, including both premature deaths and reduced quality of life. A leading hypothesis to explain the worldwide increase of asthma is the "hygiene hypothesis," which suggests that the increase in the prevalence of asthma is due to the reduction in exposure to infections/microbial antigens. In allergic asthma, the most common type of asthma, antigen-specific T helper (Th)2 and Th17 cells and their cytokines are primary mediators of the pathological consequences. In contrast, Th1 and T regulatory (Treg) cells and their cytokines play a protective role. This article aims to review the information on the effect of mycobacteria and their antigens in modulating Th2/Th17 responses towards Th1/Treg responses and protection against asthma in humans and animal models.
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Affiliation(s)
- Abu Salim Mustafa
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait,
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Ming M, Li C, Luo Z, Lv S, Sun Q. The effect of inhaled inactived Mycobacterium phlei as a treatment for asthma. Mol Med Rep 2016; 15:777-783. [PMID: 28035388 PMCID: PMC5364862 DOI: 10.3892/mmr.2016.6087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/21/2016] [Indexed: 01/06/2023] Open
Abstract
Allergic asthma is a chronic airway disorder characterized by airway inflammation, mucus hypersecretion, and airway hyperresponsiveness (AHR). A murine model of asthma was used to examine the antiasthmatic effect of inhaled inactived Mycobacterium phlei (M. phlei). AHR, neutrophil levels, eosinophil levels and levels of interleukin (IL)-17 and IL-23 receptor (IL-23R) were monitored. The results demonstrated that inactivated M. phlei alleviates the IL-17+γδT cell-mediated immune response and attenuates airway inflammation and airway hyperresponsiveness in the asthmatic murine lung, partially through inhibiting the expression of IL-23R. In conclusion, inactivated M. phlei may be an effective antiasthmatic treatment, regulating IL-17-producing γδT (IL-17+γδT) cell-mediated airway inflammation and airway hyperresponsiveness to relieve the symptoms of mice with asthma.
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Affiliation(s)
- Moyu Ming
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Chaoqian Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Zhixi Luo
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Shengqiu Lv
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Qixiang Sun
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
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Marangu D, Kovacs S, Walson J, Bonhoeffer J, Ortiz JR, John-Stewart G, Horne DJ. Wheeze as an adverse event in pediatric vaccine and drug randomized controlled trials: A systematic review. Vaccine 2015; 33:5333-5341. [PMID: 26319071 PMCID: PMC4743983 DOI: 10.1016/j.vaccine.2015.08.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/08/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Wheeze is an important sign indicating a potentially severe adverse event in vaccine and drug trials, particularly in children. However, there are currently no consensus definitions of wheeze or associated respiratory compromise in randomized controlled trials (RCTs). OBJECTIVE To identify definitions and severity grading scales of wheeze as an adverse event in vaccine and drug RCTs enrolling children <5 years and to determine their diagnostic performance based on sensitivity, specificity and inter-observer agreement. METHODS We performed a systematic review of electronic databases and reference lists with restrictions for trial settings, English language and publication date ≥1970. Wheeze definitions and severity grading were abstracted and ranked by a diagnostic certainty score based on sensitivity, specificity and inter-observer agreement. RESULTS Of 1205 articles identified using our broad search terms, we identified 58 eligible trials conducted in 38 countries, mainly in high-income settings. Vaccines made up the majority (90%) of interventions, particularly influenza vaccines (65%). Only 15 trials provided explicit definitions of wheeze. Of 24 studies that described severity, 11 described wheeze severity in the context of an explicit wheeze definition. The remaining 13 studies described wheeze severity where wheeze was defined as part of a respiratory illness or a wheeze equivalent. Wheeze descriptions were elicited from caregiver reports (14%), physical examination by a health worker (45%) or a combination (41%). There were 21/58 studies in which wheeze definitions included combined caregiver report and healthcare worker assessment. The use of these two methods appeared to have the highest combined sensitivity and specificity. CONCLUSION Standardized wheeze definitions and severity grading scales for use in pediatric vaccine or drug trials are lacking. Standardized definitions of wheeze are needed for assessment of possible adverse events as new vaccines and drugs are evaluated.
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Affiliation(s)
- Diana Marangu
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Stephanie Kovacs
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Judd Walson
- Department of Epidemiology, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States; Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jan Bonhoeffer
- Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland
| | - Justin R Ortiz
- Initiative for Vaccine Research (IVR), World Health Organization, Geneva, Switzerland
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States
| | - David J Horne
- Department of Medicine, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States
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