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Shetty SV, Mazzucco MR, Winokur P, Haigh SV, Rumah KR, Fischetti VA, Vartanian T, Linden JR. Clostridium perfringens Epsilon Toxin Binds to and Kills Primary Human Lymphocytes. Toxins (Basel) 2023; 15:423. [PMID: 37505692 PMCID: PMC10467094 DOI: 10.3390/toxins15070423] [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: 03/31/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 07/29/2023] Open
Abstract
Clostridium perfringens epsilon toxin (ETX) is the third most lethal bacterial toxin and has been suggested to be an environmental trigger of multiple sclerosis, an immune-mediated disease of the human central nervous system. However, ETX cytotoxicity on primary human cells has not been investigated. In this article, we demonstrate that ETX preferentially binds to and kills human lymphocytes expressing increased levels of the myelin and lymphocyte protein MAL. Using flow cytometry, ETX binding was determined to be time and dose dependent and was highest for CD4+ cells, followed by CD8+ and then CD19+ cells. Similar results were seen with ETX-induced cytotoxicity. To determine if ETX preference for CD4+ cells was related to MAL expression, MAL gene expression was determined by RT-qPCR. CD4+ cells had the highest amount of Mal gene expression followed by CD8+ and CD19+ cells. These data indicate that primary human cells are susceptible to ETX and support the hypothesis that MAL is a main receptor for ETX. Interestingly, ETX bindings to human lymphocytes suggest that ETX may influence immune response in multiple sclerosis.
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Affiliation(s)
- Samantha V. Shetty
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA (T.V.)
| | - Michael R. Mazzucco
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA (T.V.)
| | - Paige Winokur
- Harold and Margaret Milliken Hatch Laboratory of Neuro-Endocrinology Rockefeller University, New York, NY 10065, USA
| | - Sylvia V. Haigh
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA (T.V.)
| | - Kareem Rashid Rumah
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, NY 10065, USA
| | - Vincent A. Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, NY 10065, USA
| | - Timothy Vartanian
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA (T.V.)
| | - Jennifer R. Linden
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA (T.V.)
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Ma Y, Sannino D, Linden JR, Haigh S, Zhao B, Grigg JB, Zumbo P, Dündar F, Butler D, Profaci CP, Telesford K, Winokur PN, Rumah KR, Gauthier SA, Fischetti VA, McClane BA, Uzal FA, Zexter L, Mazzucco M, Rudick R, Danko D, Balmuth E, Nealon N, Perumal J, Kaunzner U, Brito IL, Chen Z, Xiang JZ, Betel D, Daneman R, Sonnenberg GF, Mason CE, Vartanian T. Epsilon toxin-producing Clostridium perfringens colonize the multiple sclerosis gut microbiome overcoming CNS immune privilege. J Clin Invest 2023; 133:e163239. [PMID: 36853799 PMCID: PMC10145940 DOI: 10.1172/jci163239] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/23/2023] [Indexed: 03/01/2023] Open
Abstract
Multiple sclerosis (MS) is a complex disease of the CNS thought to require an environmental trigger. Gut dysbiosis is common in MS, but specific causative species are unknown. To address this knowledge gap, we used sensitive and quantitative PCR detection to show that people with MS were more likely to harbor and show a greater abundance of epsilon toxin-producing (ETX-producing) strains of C. perfringens within their gut microbiomes compared with individuals who are healthy controls (HCs). Isolates derived from patients with MS produced functional ETX and had a genetic architecture typical of highly conjugative plasmids. In the active immunization model of experimental autoimmune encephalomyelitis (EAE), where pertussis toxin (PTX) is used to overcome CNS immune privilege, ETX can substitute for PTX. In contrast to PTX-induced EAE, where inflammatory demyelination is largely restricted to the spinal cord, ETX-induced EAE caused demyelination in the corpus callosum, thalamus, cerebellum, brainstem, and spinal cord, more akin to the neuroanatomical lesion distribution seen in MS. CNS endothelial cell transcriptional profiles revealed ETX-induced genes that are known to play a role in overcoming CNS immune privilege. Together, these findings suggest that ETX-producing C. perfringens strains are biologically plausible pathogens in MS that trigger inflammatory demyelination in the context of circulating myelin autoreactive lymphocytes.
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Affiliation(s)
- Yinghua Ma
- Feil Family Brain and Mind Research Institute
| | | | | | | | - Baohua Zhao
- Feil Family Brain and Mind Research Institute
| | - John B. Grigg
- Jill Roberts Institute for Research in Inflammatory Bowel Disease
- Joan and Sanford I. Weill Department of Medicine, and
- Department of Microbiology and Immunology, Weill Cornell Medical College, Cornell University, New York, New York, USA
- Immunology and Microbial Pathogenesis Program and
| | - Paul Zumbo
- Applied Bioinformatics Core, Division of Hematology/Oncology, Department of Medicine, Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Friederike Dündar
- Applied Bioinformatics Core, Division of Hematology/Oncology, Department of Medicine, Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Daniel Butler
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Caterina P. Profaci
- Departments of Pharmacology and Neurosciences, UCSD, San Diego, California, USA
| | | | - Paige N. Winokur
- Harold and Margaret Milliken Hatch Laboratory of Neuro-endocrinology and
| | - Kareem R. Rumah
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, New York, USA
| | - Susan A. Gauthier
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Vincent A. Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, New York, USA
| | - Bruce A. McClane
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Francisco A. Uzal
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, UCD, Davis, California, USA
| | - Lily Zexter
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | | | | | - David Danko
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | | | - Nancy Nealon
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Jai Perumal
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Ulrike Kaunzner
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Ilana L. Brito
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, USA
| | - Zhengming Chen
- Division of Biostatistics, Department of Population Health Sciences, and
| | - Jenny Z. Xiang
- Genomics Resources Core Facility, Core Laboratories Center, Weill Cornell Medicine, New York, New York, USA
| | - Doron Betel
- Applied Bioinformatics Core, Division of Hematology/Oncology, Department of Medicine, Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Richard Daneman
- Departments of Pharmacology and Neurosciences, UCSD, San Diego, California, USA
| | - Gregory F. Sonnenberg
- Jill Roberts Institute for Research in Inflammatory Bowel Disease
- Joan and Sanford I. Weill Department of Medicine, and
- Department of Microbiology and Immunology, Weill Cornell Medical College, Cornell University, New York, New York, USA
- Immunology and Microbial Pathogenesis Program and
| | - Christopher E. Mason
- Feil Family Brain and Mind Research Institute
- Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Timothy Vartanian
- Feil Family Brain and Mind Research Institute
- Immunology and Microbial Pathogenesis Program and
- Department of Neurology, Weill Cornell Medical College, Cornell University, New York, New York, USA
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Abstract
Clostridium perfringens, a prevalent Gram-positive bacterium, causes necrotic diseases associated with abundant life loss and economic burdens of billions of USD. The mechanism of C. perfringens-induced necrotic diseases remains largely unknown, in part, because of the lack of effective animal models and the presence of a large array of exotoxins and diverse disease manifestations from the skin and deep tissues to the gastrointestinal tract. In the light of the advancement of medical and veterinary research, a large body of knowledge is accumulating on the factors influencing C. perfringens-induced necrotic disease onset, development, and outcomes. Here, we present an overview of the key virulence factors of C. perfringens exotoxins. Subsequently, we focus on comprehensively reviewing C. perfringens-induced necrotic diseases such as myonecrosis, acute watery diarrhea, enteritis necroticans, preterm infant necrotizing enterocolitis, and chicken necrotic enteritis. We then review the current understanding on the mechanisms of myonecrosis and enteritis in relation to the immune system and intestinal microbiome. Based on these discussions, we then review current preventions and treatments of the necrotic diseases and propose potential new intervention options. The purpose of this review is to provide an updated and comprehensive knowledge on the role of the host–microbe interaction to develop new interventions against C. perfringens-induced necrotic diseases.
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Mazzucco M, Mannheim W, Shetty SV, Linden JR. CNS endothelial derived extracellular vesicles are biomarkers of active disease in multiple sclerosis. Fluids Barriers CNS 2022; 19:13. [PMID: 35135557 PMCID: PMC8822708 DOI: 10.1186/s12987-021-00299-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/20/2021] [Indexed: 12/13/2022] Open
Abstract
Background Multiple sclerosis (MS) is a complex, heterogenous disease characterized by inflammation, demyelination, and blood–brain barrier (BBB) permeability. Currently, active disease is determined by physician confirmed relapse or detection of contrast enhancing lesions via MRI indicative of BBB permeability. However, clinical confirmation of active disease can be cumbersome. As such, disease monitoring in MS could benefit from identification of an easily accessible biomarker of active disease. We believe extracellular vesicles (EV) isolated from plasma are excellent candidates to fulfill this need. Because of the critical role BBB permeability plays in MS pathogenesis and identification of active disease, we sought to identify EV originating from central nervous system (CNS) endothelial as biomarkers of active MS. Because endothelial cells secrete more EV when stimulated or injured, we hypothesized that circulating concentrations of CNS endothelial derived EV will be increased in MS patients with active disease. Methods To test this, we developed a novel method to identify EV originating from CNS endothelial cells isolated from patient plasma using flow cytometry. Endothelial derived EV were identified by the absence of lymphocyte or platelet markers CD3 and CD41, respectively, and positive expression of pan-endothelial markers CD31, CD105, or CD144. To determine if endothelial derived EV originated from CNS endothelial cells, EV expressing CD31, CD105, or CD144 were evaluated for expression of the myelin and lymphocyte protein MAL, a protein specifically expressed by CNS endothelial cells compared to endothelial cells of peripheral organs. Results Quality control experiments indicate that EV detected using our flow cytometry method are 0.2 to 1 micron in size. Flow cytometry analysis of EV isolated from 20 healthy controls, 16 relapsing–remitting MS (RRMS) patients with active disease not receiving disease modifying therapy, 14 RRMS patients with stable disease not receiving disease modifying therapy, 17 relapsing-RRMS patients with stable disease receiving natalizumab, and 14 RRMS patients with stable disease receiving ocrelizumab revealed a significant increase in the plasma concentration of CNS endothelial derived EV in patients with active disease compared to all other groups (p = 0.001). Conclusions: For the first time, we have identified a method to identify CNS endothelial derived EV in circulation from human blood samples. Results from our pilot study indicate that increased levels of CNS endothelial derived EV may be a biomarker of BBB permeability and active disease in MS. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00299-4.
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Affiliation(s)
- Michael Mazzucco
- The Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - William Mannheim
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Samantha V Shetty
- The Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Jennifer R Linden
- The Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA.
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Mazzucco MR, Vartanain T, Linden JR. In vivo Blood-brain Barrier Permeability Assays Using Clostridium perfringens Epsilon Toxin. Bio Protoc 2020; 10:e3709. [PMID: 33659373 DOI: 10.21769/bioprotoc.3709] [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] [Received: 03/16/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 11/02/2022] Open
Abstract
In order for the brain to function properly, a carefully orchestrated homeostasis must be maintained. To help regulate this delicate balance, the brain has developed a highly selective blood-brain barrier (BBB). Under normal conditions, the BBB excludes harmful blood-borne material from the brain parenchyma. However, numerous neuropathological conditions can disrupt this barrier, causing BBB permeability and subsequent CNS dysfunction. Understanding the mechanisms involved in BBB permeability are essential to elucidating the pathology of various neurological disorders as well as identifying methods for drug delivery to the CNS. Here, we describe several in vivo methods to measure BBB permeability in mice using an array of diverse sized tracers including exogenous 376 Da fluorescein salt, 66.5 kDa bovine serum albumin, and 70 kDa dextran as well as endogenous 160 kDa mouse IgG. When administered intravenously, these substances are excluded from a healthy brain by the BBB. However, BBB dysfunction can allow entry of these tracers into the brain and this accumulation can be measured using spectrophotometry, fluorescent microscopy, and immunohistochemistry. We also describe a method to induce BBB permeability using Clostridium perfringens epsilon toxin. Finally, we include a short discussion about the advantages and disadvantages of each method and their appropriate downstream applications.
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Affiliation(s)
- Michael R Mazzucco
- Brain and Mind Institute, Weill Cornell Medical College, New York City, New York, 10065, USA
| | - Timothy Vartanain
- Brain and Mind Institute, Weill Cornell Medical College, New York City, New York, 10065, USA
| | - Jennifer R Linden
- Brain and Mind Institute, Weill Cornell Medical College, New York City, New York, 10065, USA
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Linden JR, Flores C, Schmidt EF, Uzal FA, Michel AO, Valenzuela M, Dobrow S, Vartanian T. Clostridium perfringens epsilon toxin induces blood brain barrier permeability via caveolae-dependent transcytosis and requires expression of MAL. PLoS Pathog 2019; 15:e1008014. [PMID: 31703116 PMCID: PMC6867657 DOI: 10.1371/journal.ppat.1008014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 11/20/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
Clostridium perfringens epsilon toxin (ETX) is responsible for causing the economically devastating disease, enterotoxaemia, in livestock. It is well accepted that ETX causes blood brain barrier (BBB) permeability, however the mechanisms involved in this process are not well understood. Using in vivo and in vitro methods, we determined that ETX causes BBB permeability in mice by increasing caveolae-dependent transcytosis in brain endothelial cells. When mice are intravenously injected with ETX, robust ETX binding is observed in the microvasculature of the central nervous system (CNS) with limited to no binding observed in the vasculature of peripheral organs, indicating that ETX specifically targets CNS endothelial cells. ETX binding to CNS microvasculature is dependent on MAL expression, as ETX binding to CNS microvasculature of MAL-deficient mice was not detected. ETX treatment also induces extravasation of molecular tracers including 376Da fluorescein salt, 60kDA serum albumin, 70kDa dextran, and 155kDA IgG. Importantly, ETX-induced BBB permeability requires expression of both MAL and caveolin-1, as mice deficient in MAL or caveolin-1 did not exhibit ETX-induced BBB permeability. Examination of primary murine brain endothelial cells revealed an increase in caveolae in ETX-treated cells, resulting in dynamin and lipid raft-dependent vacuolation without cell death. ETX-treatment also results in a rapid loss of EEA1 positive early endosomes and accumulation of large, RAB7-positive late endosomes and multivesicular bodies. Based on these results, we hypothesize that ETX binds to MAL on the apical surface of brain endothelial cells, causing recruitment of caveolin-1, triggering caveolae formation and internalization. Internalized caveolae fuse with early endosomes which traffic to late endosomes and multivesicular bodies. We believe that these multivesicular bodies fuse basally, releasing their contents into the brain parenchyma. Clostridium perfringens epsilon toxin (ETX) is an extremely lethal bacterial toxin known to cause a devastating disease in livestock animals and may be a possible cause of multiple sclerosis in humans. ETX is well known to cause disruption of the blood-brain barrier (BBB), a critical structure necessary for proper brain function. Deterioration of this barrier allows entry of toxic blood-borne material to enter the brain. Although ETX-induced BBB dysfunction is well accepted, how this happens is unknown. Here, we demonstrate that ETX causes BBB permeability by inducing formation of cell-surface invaginations called caveolae in endothelial cells, the cells that line blood vessels. Importantly, only endothelial cells from the brain and other central nervous system organs appear to be a target of ETX, as the toxin only binds to blood vessels in these organs and not blood vessels from other organs. These ETX-induced caveolae fuse with other caveolae and specialized intracellular vesicles called endosomes. We predict that these endosomes engulf blood-borne material during their internalization, allowing material to travel from the blood, through the cell, and into brain tissue. We also show that expression of the protein MAL and caveolin-1 is necessary for ETX-induced BBB permeability.
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Affiliation(s)
- Jennifer R. Linden
- The Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, New York, New York, United States of America
| | - Claudia Flores
- The Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, New York, New York, United States of America
| | - Eric F. Schmidt
- Laboratory of Molecular Biology, The Rockefeller University, New York, New York, United States of America
| | - Francisco A. Uzal
- California Animal Health & Food Safety Laboratory System, San Bernardino Branch, University of California, Davis, San Bernardino, California, United States of America
| | - Adam O. Michel
- Laboratory of Comparative Pathology, Center of Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center, The Rockefeller University, Weill Cornell Medicine, New York, New York, United States of America
| | - Marissa Valenzuela
- The Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, New York, New York, United States of America
| | - Sebastian Dobrow
- The Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, New York, New York, United States of America
| | - Timothy Vartanian
- The Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
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7
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Adler D, Linden JR, Shetty SV, Ma Y, Bokori-Brown M, Titball RW, Vartanian T. Clostridium perfringens Epsilon Toxin Compromises the Blood-Brain Barrier in a Humanized Zebrafish Model. iScience 2019; 15:39-54. [PMID: 31030181 PMCID: PMC6487375 DOI: 10.1016/j.isci.2019.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/29/2018] [Accepted: 04/08/2019] [Indexed: 12/22/2022] Open
Abstract
Clostridium perfringens epsilon toxin (ETX) is hypothesized to mediate blood-brain barrier (BBB) permeability by binding to the myelin and lymphocyte protein (MAL) on the luminal surface of endothelial cells (ECs). However, the kinetics of this interaction and a general understanding of ETX's behavior in a live organism have yet to be appreciated. Here we investigate ETX binding and BBB breakdown in living Danio rerio (zebrafish). Wild-type zebrafish ECs do not bind ETX. When zebrafish ECs are engineered to express human MAL (hMAL), proETX binding occurs in a time-dependent manner. Injection of activated toxin in hMAL zebrafish initiates BBB leakage, hMAL downregulation, blood vessel stenosis, perivascular edema, and blood stasis. We propose a kinetic model of MAL-dependent ETX binding and neurovascular pathology. By generating a humanized zebrafish BBB model, this study contributes to our understanding of ETX-induced BBB permeability and strengthens the proposal that MAL is the ETX receptor.
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Affiliation(s)
- Drew Adler
- Brain and Mind Research Institute, Weill Cornell Medical College of Cornell University, New York, NY 10065, USA; Department of Neurobiology and Behavior, Cornell University, Ithaca, NY 14850, USA
| | - Jennifer R Linden
- Brain and Mind Research Institute, Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Samantha V Shetty
- Brain and Mind Research Institute, Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Yinghua Ma
- Brain and Mind Research Institute, Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | | | - Richard W Titball
- Department of Biosciences, University of Exeter, Exeter, Devon EX4 4SB, UK
| | - Timothy Vartanian
- Brain and Mind Research Institute, Weill Cornell Medical College of Cornell University, New York, NY 10065, USA.
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