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Wang Z, Wang X, Xu W, Li Y, Lai R, Qiu X, Chen X, Chen Z, Mi B, Wu M, Wang J. Translational Challenges and Prospective Solutions in the Implementation of Biomimetic Delivery Systems. Pharmaceutics 2023; 15:2623. [PMID: 38004601 PMCID: PMC10674763 DOI: 10.3390/pharmaceutics15112623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Biomimetic delivery systems (BDSs), inspired by the intricate designs of biological systems, have emerged as a groundbreaking paradigm in nanomedicine, offering unparalleled advantages in therapeutic delivery. These systems, encompassing platforms such as liposomes, protein-based nanoparticles, extracellular vesicles, and polysaccharides, are lauded for their targeted delivery, minimized side effects, and enhanced therapeutic outcomes. However, the translation of BDSs from research settings to clinical applications is fraught with challenges, including reproducibility concerns, physiological stability, and rigorous efficacy and safety evaluations. Furthermore, the innovative nature of BDSs demands the reevaluation and evolution of existing regulatory and ethical frameworks. This review provides an overview of BDSs and delves into the multifaceted translational challenges and present emerging solutions, underscored by real-world case studies. Emphasizing the potential of BDSs to redefine healthcare, we advocate for sustained interdisciplinary collaboration and research. As our understanding of biological systems deepens, the future of BDSs in clinical translation appears promising, with a focus on personalized medicine and refined patient-specific delivery systems.
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Affiliation(s)
- Zhe Wang
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China; (Z.W.); (R.L.)
| | - Xinpei Wang
- School of Pharmaceutical Sciences, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (X.W.); (W.X.); (Y.L.); (X.Q.); (X.C.); (Z.C.)
| | - Wanting Xu
- School of Pharmaceutical Sciences, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (X.W.); (W.X.); (Y.L.); (X.Q.); (X.C.); (Z.C.)
| | - Yongxiao Li
- School of Pharmaceutical Sciences, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (X.W.); (W.X.); (Y.L.); (X.Q.); (X.C.); (Z.C.)
| | - Ruizhi Lai
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China; (Z.W.); (R.L.)
| | - Xiaohui Qiu
- School of Pharmaceutical Sciences, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (X.W.); (W.X.); (Y.L.); (X.Q.); (X.C.); (Z.C.)
| | - Xu Chen
- School of Pharmaceutical Sciences, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (X.W.); (W.X.); (Y.L.); (X.Q.); (X.C.); (Z.C.)
| | - Zhidong Chen
- School of Pharmaceutical Sciences, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (X.W.); (W.X.); (Y.L.); (X.Q.); (X.C.); (Z.C.)
| | - Bobin Mi
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China
| | - Meiying Wu
- School of Pharmaceutical Sciences, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (X.W.); (W.X.); (Y.L.); (X.Q.); (X.C.); (Z.C.)
| | - Junqing Wang
- School of Pharmaceutical Sciences, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (X.W.); (W.X.); (Y.L.); (X.Q.); (X.C.); (Z.C.)
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Yap C, Solovyeva O, de Bono J, Rekowski J, Patel D, Jaki T, Mander A, Evans TRJ, Peck R, Hayward KS, Hopewell S, Ursino M, Rantell KR, Calvert M, Lee S, Kightley A, Ashby D, Chan AW, Garrett-Mayer E, Isaacs JD, Golub R, Kholmanskikh O, Richards D, Boix O, Matcham J, Seymour L, Ivy SP, Marshall LV, Hommais A, Liu R, Tanaka Y, Berlin J, Espinasse A, Dimairo M, Weir CJ. Enhancing reporting quality and impact of early phase dose-finding clinical trials: CONSORT Dose-finding Extension (CONSORT-DEFINE) guidance. BMJ 2023; 383:e076387. [PMID: 37863501 PMCID: PMC10583500 DOI: 10.1136/bmj-2023-076387] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 10/22/2023]
Affiliation(s)
| | | | - Johann de Bono
- Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Jan Rekowski
- Institute of Cancer Research, London SM2 5NG, UK
| | | | - Thomas Jaki
- MRC Biostatistics Unit, Cambridge University, Cambridge, UK
- Computational Statistics Group, University of Regensburg, Regensburg, Germany
| | - Adrian Mander
- Centre For Trials Research, Cardiff University, Heath Park, Cardiff, UK
| | - Thomas R Jeffry Evans
- Institute of Cancer Sciences, CR-UK Beatson Institute, University of Glasgow, Glasgow, UK
| | - Richard Peck
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Hoffmann-La Roche, Basel, Switzerland
| | - Kathryn S Hayward
- Departments of Physiotherapy, and Medicine (Royal Melbourne Hospital), University of Melbourne, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sally Hopewell
- Oxford Clinical Research Unit, NDORMS, University of Oxford, Oxford, UK
| | - Moreno Ursino
- ReCAP/F CRIN, INSERM, Paris, France
- Unit of Clinical Epidemiology, CHU Robert Debré, APHP, URC, INSERM CIC-EC 1426, Reims, France
- INSERM Centre de Recherche des Cordeliers, Sorbonne University, Paris Cité University, Paris, France
- Health data and model driven approaches for Knowledge Acquisition team, Centre Inria, Paris, France
| | | | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
- NIHR Research Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Edgbaston, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, University Hospital NHS Foundation Trust, Birmingham, UK
| | - Shing Lee
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Deborah Ashby
- School of Public Health, Imperial College London, London, UK
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Garrett-Mayer
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Robert Golub
- Department of Medicine, Northwestern University Feinberg School of Medicine, 633 Clark Street, Evanston, IL, USA
| | - Olga Kholmanskikh
- Federal Agency for Medicines and Health Products, Brussels, Belgium
- European Medicines Agency, Amsterdam, Netherlands
| | - Dawn Richards
- Clinical Trials Ontario, MaRS Centre, Toronto, ON, Canada
| | | | - James Matcham
- Strategic Consulting, Cytel (Australia), Perth, WA, Australia
| | - Lesley Seymour
- Investigational New Drug Programme, Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - S Percy Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Institute of Health, Bethesda, MD, USA
| | - Lynley V Marshall
- Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Antoine Hommais
- Department of Clinical Research, National Cancer Institute, Boulogne-Billancourt, France
| | - Rong Liu
- Bristol Myers Squibb, New York, NY, USA
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | - Munyaradzi Dimairo
- Division of Population Health, Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
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Yap C, Rekowski J, Ursino M, Solovyeva O, Patel D, Dimairo M, Weir CJ, Chan AW, Jaki T, Mander A, Evans TRJ, Peck R, Hayward KS, Calvert M, Rantell KR, Lee S, Kightley A, Hopewell S, Ashby D, Garrett-Mayer E, Isaacs J, Golub R, Kholmanskikh O, Richards DP, Boix O, Matcham J, Seymour L, Ivy SP, Marshall LV, Hommais A, Liu R, Tanaka Y, Berlin J, Espinasse A, de Bono J. Enhancing quality and impact of early phase dose-finding clinical trial protocols: SPIRIT Dose-finding Extension (SPIRIT-DEFINE) guidance. BMJ 2023; 383:e076386. [PMID: 37863491 DOI: 10.1136/bmj-2023-076386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
| | - Jan Rekowski
- Institute of Cancer Research, London SM2 5NG, UK
| | - Moreno Ursino
- ReCAP/F CRIN, INSERM, Paris, France
- Unit of Clinical Epidemiology, University Hospital Centre Robert Debré, Reims, France
- INSERM Centre de Recherche des Cordeliers, Sorbonne University, Paris, France
- Health data and model driven approaches for Knowledge Acquisition team, Centre Inria, Paris, France
| | | | | | - Munyaradzi Dimairo
- Division of Population Health, Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Canada
| | - Thomas Jaki
- MRC Biostatistics Unit, Cambridge University, Cambridge, UK
- Computational Statistics Group, University of Regensburg, Regensburg, Germany
| | - Adrian Mander
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | - Thomas R Jeffry Evans
- Institute of Cancer Sciences, CR-UK Beatson Institute, University of Glasgow, Glasgow, UK
| | - Richard Peck
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Hoffmann-La Roche, Basel, Switzerland
| | - Kathryn S Hayward
- Departments of Physiotherapy, and Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, University Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Shing Lee
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Sally Hopewell
- Oxford Clinical Research Unit, NDORMS, University of Oxford, Oxford, UK
| | - Deborah Ashby
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Elizabeth Garrett-Mayer
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - John Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Robert Golub
- Department of Medicine, Northwestern University Feinberg School of Medicine, Evanston, IL, USA
| | | | | | | | - James Matcham
- Strategic Consulting, Cytel (Australia), Perth, WA, Australia
| | - Lesley Seymour
- Investigational New Drug Programme, Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - S Percy Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Institute of Health, Bethesda, MD, USA
| | - Lynley V Marshall
- Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Antoine Hommais
- Department of Clinical Research, National Cancer Institute, Boulogne-Billancourt, France
| | - Rong Liu
- Bristol Myers Squibb, New York, NY, USA
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | - Johann de Bono
- Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
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Kassimu K, Milando F, Omolo J, Mdemu A, Nyaulingo G, Mbarak H, Mohamed L, Rashid R, Ahmed S, Rashid M, Msami H, Damiano D, Simon B, Mbaga T, Issa F, Lweno O, Balige N, Hassan O, Mwalimu B, Hamad A, Olotu A, Mårtensson A, Machumi F, Jongo S, Ngasala B, Abdulla S. Safety and Tolerability of an Antimalarial Herbal Remedy in Healthy Volunteers: An Open-Label, Single-Arm, Dose-Escalation Study on Maytenus senegalensis in Tanzania. Trop Med Infect Dis 2022; 7:tropicalmed7120396. [PMID: 36548651 PMCID: PMC9787516 DOI: 10.3390/tropicalmed7120396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Though Maytenus senegalensis is one of the medicinal plants widely used in traditional medicine to treat infectious and inflammatory diseases in Africa, there is a lack of safety data regarding its use. Therefore, the study aimed to asselss the safety and tolerability of the antimalarial herbal remedy M. senegalensis. MATERIAL AND METHODS The study design was an open-label, single-arm, dose-escalation. Twelve eligible male healthy Tanzanians aged 18 to 45 years were enrolled in four study dose groups. Volunteers' safety and tolerability post-investigational-product administration were monitored on days 0 to 7,14, and 56. RESULTS There were no deaths or serious adverse events in any of the study groups, nor any adverse events that resulted in premature discontinuation. The significant mean changes observed in WBC (p = 0.003), Neutrophils (p = 0.02), Lymphocytes (p = 0.001), Eosinophils (p = 0.009), Alanine aminotransferase (p = 0.002), Creatinine (p = 0.03) and Total bilirubin (p = 0.004) laboratory parameters were not associated with any signs of toxicity or clinical symptoms. CONCLUSIONS M. senegalensis was demonstrated to be safe and tolerable when administered at a dose of 800 mg every eight hours a day for four days. This study design may be adapted to evaluate other herbal remedies.
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Affiliation(s)
- Kamaka Kassimu
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
- Correspondence: or ; Tel.: +255-713-488-238
| | - Florence Milando
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Justin Omolo
- Department of Traditional Medicine, National Institute for Medical Research, Dar es Salaam P.O. Box 9653, Tanzania
| | - Abel Mdemu
- Department of Traditional Medicine, National Institute for Medical Research, Dar es Salaam P.O. Box 9653, Tanzania
| | - Gloria Nyaulingo
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Hussein Mbarak
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Latipha Mohamed
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Ramla Rashid
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Saumu Ahmed
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Mohammed Rashid
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Hania Msami
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - David Damiano
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Beatus Simon
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Thabit Mbaga
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Fatuma Issa
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Omar Lweno
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Neema Balige
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Omary Hassan
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Bakari Mwalimu
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Ali Hamad
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Ally Olotu
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Andreas Mårtensson
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, S-751 85 Uppsala, Sweden
| | - Francis Machumi
- Institute of Traditional Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Said Jongo
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
| | - Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, S-751 85 Uppsala, Sweden
| | - Salim Abdulla
- Bagamoyo Clinical Trial Facility, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania
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Determining drug dose in the era of targeted therapies: playing it (un)safe? Blood Cancer J 2022; 12:123. [PMID: 35999205 PMCID: PMC9399108 DOI: 10.1038/s41408-022-00720-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
Targeted therapies against phosphatidylinositol 3-kinase (PI3K), Bruton’s tyrosine kinase (BTK), and B-cell lymphoma-2 (BCL-2) are approved for chronic lymphocytic leukemia (CLL). Since approval of the first-in-class drugs, next-generation agents have become available and are continuously under development. While these therapies act on well-characterized molecular targets, this knowledge is only to some extent taken into consideration when determining their dose in phase I trials. For example, BTK occupancy has been assessed in dose-finding studies of various BTK inhibitors, but the minimum doses that result in full BTK occupancy were not determined. Although targeted agents have a different dose–response relationship than cytotoxic agents, which are more effective near the maximum tolerated dose, the traditional 3 + 3 toxicity-driven trial design remains heavily used in the era of targeted therapies. If pharmacodynamic biomarkers were more stringently used to guide dose selection, the recommended phase II dose would likely be lower as compared to the toxicity-driven selection. Reduced drug doses may lower toxicity, which in some cases is severe for these agents, and are supported by retrospective studies demonstrating non-inferior outcomes for patients with clinically indicated dose reductions. Here, we review strategies that were used for dose selection in phase I studies of currently approved and select investigational targeted therapies in CLL, and discuss how our initial clinical experience with targeted therapies have pointed to dose reductions, intermittent dosing, and drug combinations as strategies to overcome treatment intolerance and resistance.
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