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Warjukar PR, Mohabey AV, Jain PB, Bandre GR. Decoding the Correlation Between Inflammatory Response Marker Interleukin-6 (IL-6) and C-reactive Protein (CRP) With Disease Activity in Rheumatoid Arthritis. Cureus 2024; 16:e62954. [PMID: 39050325 PMCID: PMC11265957 DOI: 10.7759/cureus.62954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Excessive interleukin-6 (IL-6) production in rheumatoid arthritis (RA) leads to joint destruction, inflammation, and systemic symptoms. IL-6 inhibitors alleviate symptoms. C-reactive protein (CRP), an inflammation biomarker, correlates with RA activity. In this study, we assess IL-6 and CRP levels in RA patients to understand their association with disease activity. MATERIALS AND METHODS This cross-sectional study was conducted at a tertiary care hospital in central India for 15 months, from July 2022 to September 2023. The study involved 75 participants diagnosed with RA and receiving outpatient treatment. Exclusion criteria included anti-IL-6 drug treatment, bedridden individuals, proxy patients, and those without consent. Disease activity was assessed using the 28-joint disease activity score (DAS28), while IL-6 and CRP levels were measured following the standard procedures. RESULTS The average CRP levels were found to be 51.67 ± 47.49 mg/L, while IL-6 levels averaged 65.16 ± 43.67 pg/ml. The results revealed a substantial positive correlation between IL-6 levels and DAS28 (r = 0.603, p value < 0.001), indicating a significant association. Additionally, a moderate correlation between CRP levels and DAS28 (r = 0.493, p value < 0.001) highlighted a significant relationship between these variables. CONCLUSIONS The analysis showed that higher IL-6 levels were associated with increased disease activity and suggested IL-6 as a valuable indicator for assessing RA severity. Also, CRP levels had a moderate correlation with disease activity. Overall, IL-6 is a better marker for disease activity when compared to CRP levels in patients with RA.
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Affiliation(s)
- Prajakta R Warjukar
- Biochemistry, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Ankush V Mohabey
- Orthopedics, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Pradeep B Jain
- Biochemistry, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Gulshan R Bandre
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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More NE, Mandlik R, Zine S, Gawali VS, Godad AP. Exploring the therapeutic opportunities of potassium channels for the treatment of rheumatoid arthritis. Front Pharmacol 2024; 15:1286069. [PMID: 38783950 PMCID: PMC11111972 DOI: 10.3389/fphar.2024.1286069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/18/2024] [Indexed: 05/25/2024] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects the synovial joint, which leads to inflammation, loss of function, joint destruction, and disability. The disease biology of RA involves complex interactions between genetic and environmental factors and is strongly associated with various immune cells, and each of the cell types contributes differently to disease pathogenesis. Several immunomodulatory molecules, such as cytokines, are secreted from the immune cells and intervene in the pathogenesis of RA. In immune cells, membrane proteins such as ion channels and transporters mediate the transport of charged ions to regulate intracellular signaling pathways. Ion channels control the membrane potential and effector functions such as cytotoxic activity. Moreover, clinical studies investigating patients with mutations and alterations in ion channels and transporters revealed their importance in effective immune responses. Recent studies have shown that voltage-gated potassium channels and calcium-activated potassium channels and their subtypes are involved in the regulation of immune cells and RA. Due to the role of these channels in the pathogenesis of RA and from multiple pieces of clinical evidence, they can be considered therapeutic targets for the treatment of RA. Here, we describe the role of voltage-gated and calcium-activated potassium channels and their subtypes in RA and their pharmacological application as drug targets.
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Affiliation(s)
| | - Rahul Mandlik
- Medical Affairs, Shalina Healthcare DMCC, Dubai, United Arab Emirates
| | - Sandip Zine
- SVKM’s Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, India
| | | | - Angel Pavalu Godad
- SVKM’s Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, India
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai, India
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3
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Avouac J, Vandebeuque E, Combier A, Poiroux L, Steelandt A, Boisson M, Gonzalez V, Cauvet A, Barnetche T, Truchetet ME, Richez C, Allanore Y. Relevance of circulating Semaphorin 4A for rheumatoid arthritis response to treatment. Sci Rep 2023; 13:14626. [PMID: 37669994 PMCID: PMC10480203 DOI: 10.1038/s41598-023-41943-3] [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: 11/21/2022] [Accepted: 09/04/2023] [Indexed: 09/07/2023] Open
Abstract
The lack of validated tools to predict rheumatoid arthritis (RA) disease course warrants the development of new reliable biomarkers. Our aim was to evaluate the merit of circulating SEMA4A for the prediction of outcomes in patients with RA. In a first cohort of 101 consecutive RA patients followed up for 41 ± 15 months, increased baseline SEMA4A levels were identified as an independent predictor of treatment failure (hazard ratio, HR 2.71, 95% CI 1.14-6.43), defined by the occurrence of patient-reported flares and initiation or change of targeted therapy. The highest predictive value of treatment failure was obtained with the combination of increased circulating SEMA4A and/or Disease Activity Score (DAS) 28-CRP > 3.2 and/or active synovitis on doppler ultrasound (HR 10.42, 95% CI 1.41-76.94). In a second independent cohort of 40 consecutive RA patients who initiated new therapy because of insufficient disease control, baseline SEMA4A levels were significantly higher in patients who further experienced none or moderate response, and SEMA4A concentrations were markedly decreased in the group of patients with good clinical response as compared to non-responders. Circulating SEMA4A appears as an appealing biomarker in RA with ability to predict treatment failure, and with association with response to therapy.
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Affiliation(s)
- Jérôme Avouac
- INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France.
- Université Paris Cité, Paris, France.
- Service de Rhumatologie, Hôpital Cochin, AP-HP. Centre - Université Paris Cité, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Eloïse Vandebeuque
- INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
- Université Paris Cité, Paris, France
- Service de Rhumatologie, Hôpital Cochin, AP-HP. Centre - Université Paris Cité, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Alice Combier
- Université Paris Cité, Paris, France
- Service de Rhumatologie, Hôpital Cochin, AP-HP. Centre - Université Paris Cité, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Lucile Poiroux
- Université Paris Cité, Paris, France
- Service de Rhumatologie, Hôpital Cochin, AP-HP. Centre - Université Paris Cité, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Alexia Steelandt
- Université Paris Cité, Paris, France
- Service de Rhumatologie, Hôpital Cochin, AP-HP. Centre - Université Paris Cité, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Margaux Boisson
- Université Paris Cité, Paris, France
- Service de Rhumatologie, Hôpital Cochin, AP-HP. Centre - Université Paris Cité, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Virginie Gonzalez
- INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Anne Cauvet
- INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Thomas Barnetche
- Service de Rhumatologie, FHU ACRONIM, Hôpital Universitaire de Bordeaux, Bordeaux, France
| | - Marie-Elise Truchetet
- Service de Rhumatologie, FHU ACRONIM, Hôpital Universitaire de Bordeaux, Bordeaux, France
| | - Christophe Richez
- Service de Rhumatologie, FHU ACRONIM, Hôpital Universitaire de Bordeaux, Bordeaux, France
| | - Yannick Allanore
- INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
- Université Paris Cité, Paris, France
- Service de Rhumatologie, Hôpital Cochin, AP-HP. Centre - Université Paris Cité, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Saquib M, Agnihotri P, Biswas S. Interrelated grid of non-coding RNA: An important aspect in Rheumatoid Arthritis pathogenesis. Mol Biol Rep 2023:10.1007/s11033-023-08543-w. [PMID: 37294467 DOI: 10.1007/s11033-023-08543-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
Inflammation and autoimmunity are the root cause of rheumatoid arthritis, a destructive disease of joints. Multiple biomolecules are involved in the pathogenesis of RA and are related to various events of molecular biology. RNA is a versatile biomolecule, playing numerous roles at structural, functional, and regulatory stages to maintain cellular homeostasis. The involvement of RNA (coding/non-coding) in disease development and progression has left a wide whole to fill with newer approaches. Non-coding RNAs belong to the housekeeping and regulatory categories and both have their specific roles, and their alteration causes specific implications in disease pathogenesis. Housekeeping RNAs, rRNA, tRNA and regulatory RNA, micro-RNA, circular RNA, piRNA and long non-coding RNA were found to be important regulators of inflammation. They work at the pre-and post-transcriptional levels and were found to be more intriguing to study their regulatory impact on disease pathogenesis. The review addresses a question on how the non-coding RNA gets involved in early RA pathogenesis and can be utilized to know their targets to understand the disease better and make way towards the unresolved mystery of RA development.
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Affiliation(s)
- Mohd Saquib
- Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, Mall Road, Delhi University Campus, Delhi, 110007, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Prachi Agnihotri
- Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, Mall Road, Delhi University Campus, Delhi, 110007, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Sagarika Biswas
- Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, Mall Road, Delhi University Campus, Delhi, 110007, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
- Integrative and Functional Biology Department CSIR- Institute of Genomics & Integrative Biology, Mall Road, Delhi, 110 007, India.
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Ramnauth VA, Rooney P. An Atypical Presentation of Seronegative Rheumatoid Arthritis. Cureus 2023; 15:e36929. [PMID: 37131570 PMCID: PMC10148751 DOI: 10.7759/cureus.36929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 1987 classification for rheumatoid arthritis (RA) focuses on four main clinical findings without emphasizing biomarker serology. On the other hand, the updated ACR/EULAR 2010 classification relies more on acute-phase reactants and biomarker serology. While a positive rheumatoid factor (RF) and positive anti-citrullinated protein antibody (ACPA) are specific for RA, at least 15%-25% of patients are seronegative. Given that the ACR/EULAR 2010 classification is more likely to miss these seronegative patients, clinical judgment is important while assessing patients to avoid delays in diagnosis and onset of treatment.
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Laigle L, Chadli L, Moingeon P. Biomarker-driven development of new therapies for autoimmune diseases: current status and future promises. Expert Rev Clin Immunol 2023; 19:305-314. [PMID: 36680799 DOI: 10.1080/1744666x.2023.2172404] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Auto-immune diseases are complex and heterogeneous. Various types of biomarkers can be used to support precision medicine approaches to autoimmune diseases, ensuring that the right patient receives the most appropriate therapy to improve treatment outcomes. AREAS COVERED We review the recent progress made in modeling several autoimmune diseases such as Systemic Lupus Erythematosus, primary Sjogren Syndrome, and Rheumatoid Arthritis following extensive molecular profiling of large cohorts of patients. From this knowledge, BMKs are being identified which support diagnostic as well as patient stratification and prediction of response to treatment. The identification of biomarkers should be initiated early in drug development and properly validated during subsequent clinical trials. To ensure the robustness and reproducibility of biomarkers, the PERMIT Consortium recently established recommendations highlighting the importance of relevant study design, sample size, and appropriate validation of analytical methods. EXPERT OPINION The integration by AI-powered analytics of massive data provided by multi-omics technologies, high-resolution medical imaging and sensors borne by patients will eventually allow the identification of clinically relevant BMKs, likely in the form of combinatorial predictive algorithms, to support future drug development for autoimmune diseases.
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Affiliation(s)
| | - Loubna Chadli
- Servier Médical, Research and Development, Suresnes, France
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Platelet and Red Blood Cell Volume Indices in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12112633. [PMID: 36359478 PMCID: PMC9689783 DOI: 10.3390/diagnostics12112633] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
Alterations in the volume of platelets (mean platelet volume, MPV; platelet distribution width, PDW) and erythrocytes (red blood cell distribution width, RDW) have been reported in rheumatoid arthritis (RA) and might serve as diagnostic biomarkers. We conducted a systematic review and meta-analysis of the MPV, PDW, and RDW in RA patients and healthy controls. Relevant articles were searched in PubMed, Web of Science, Scopus, and Google Scholar from inception to June 2022. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and certainty of evidence was assessed using GRADE. In 23 studies (2194 RA patients and 1565 healthy controls), the RDW, but not MPV or PDW, was significantly higher in RA patients (standardized mean difference, SMD = 0.96, 95% CI 0.78 to 1.15, p < 0.001; moderate certainty of evidence). The substantial heterogeneity observed (I2 = 75.1%, p < 0.001) was virtually removed in a subgroup of prospective studies. In sensitivity analysis, the magnitude of the effect size was not substantially modified by sequentially removing individual studies. There was no significant publication bias. No significant associations were observed between the effect size and pre-defined study or patient characteristics. The results of our study suggest that the RDW might be a useful biomarker for the diagnosis of RA, and complement the clinical information provided by other patient characteristics and laboratory parameters (PROSPERO registration number: CRD42022349432).
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Hussein R, Aboukhamis I. The association of serum RANKL levels with disease activity and hematological parameters in Syrian patients with rheumatoid arthritis. Biochem Biophys Rep 2022; 32:101373. [PMID: 36304516 PMCID: PMC9593879 DOI: 10.1016/j.bbrep.2022.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Our study aims to detect whether the serum RANKL could be a novel potential biomarker for activity and diagnosis of rheumatoid arthritis (RA). It included fifty-eight of RA patients and thirty of equal age and sex matched controls. Disease activity was determined by using DAS28-ESR. Serum Levels of RANKL were assayed by ELISA and compared with parameters such as ESR, CRP, Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACPA). The serum RANKL levels were higher in RA patients compared to controls. There was an increase in its levels mean among post-menopausal patients compared to post-menopausal healthy group. RANKL levels were also higher in ACPA positive patients than ACPA negative. Our study found a correlation between RANKL levels and some parameters: DAS28, ACPA, CRP, and symptom duration. There was a moderate inverse correlation between RANKL levels and BMD. By ROC curve, our results displayed that the best cut-off value of RANKL was 178.99 pg/ml (sensitivity 79.31%; specificity 90%) to differentiate between RA patients and controls. In conclusion, elevated serum RANKL can be used as an indicator of disease activity and a diagnostic new biomarker in patients with early RA. Rheumatoid arthritis (RA) is categorized by chronic synovitis leads to cartilage degradation, and bone erosions. RANKL/RANK/OPG pathway stimulates osteoclasts and bone resorption. ACPA are associated with bone erosions. Serum RANKL correlates disease activity of Rheumatoid Arthritis. Serum RANKL is an innovative indicator in of Rheumatoid Arthritis patients.
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Affiliation(s)
- Rama Hussein
- Department of Microbiology, Hematology and Immunology, Faculty of Pharmacy, Damascus University, Syria
- Corresponding author.
| | - Imad Aboukhamis
- Department of Microbiology, Hematology and Immunology, Faculty of Pharmacy, Damascus University, Syria
- Department of Hematology and Immunology, Faculty of Pharmacy, Damascus University, Syria
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Hügle T, Caratsch L, Caorsi M, Maglione J, Dan D, Dumusc A, Blanchard M, Kalweit G, Kalweit M. Dorsal Finger Fold Recognition by Convolutional Neural Networks for the Detection and Monitoring of Joint Swelling in Patients with Rheumatoid Arthritis. Digit Biomark 2022; 6:31-35. [PMID: 35949225 PMCID: PMC9247561 DOI: 10.1159/000525061] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/25/2022] [Indexed: 08/09/2023] Open
Abstract
Digital biomarkers such as wearables are of increasing interest in monitoring rheumatic diseases, but they usually lack disease specificity. In this study, we apply convolutional neural networks (CNN) to real-world hand photographs in order to automatically detect, extract, and analyse dorsal finger fold lines as a correlate of proximal interphalangeal (PIP) joint swelling in patients with rheumatoid arthritis (RA). Hand photographs of RA patients were taken by a smartphone camera in a standardized manner. Overall, 190 PIP joints were categorized as either swollen or not swollen based on clinical judgement and ultrasound. Images were automatically preprocessed by cropping PIP joints and extracting dorsal finger folds. Subsequently, metrical analysis of dorsal finger folds was performed, and a CNN was trained to classify the dorsal finger lines into swollen versus non-swollen joints. Representative horizontal finger folds were also quantified in a subset of patients before and after resolution of PIP swelling and in patients with disease flares. In swollen joints, the number of automatically extracted deep skinfold imprints was significantly reduced compared to non-swollen joints (1.3, SD 0.8 vs. 3.3, SD 0.49, p < 0.01). The joint diameter/deep skinfold length ratio was significantly higher in swollen (4.1, SD 1.4) versus non-swollen joints (2.1, SD 0.6, p < 0.01). The CNN model successfully differentiated swollen from non-swollen joints based on finger fold patterns with a validation accuracy of 0.84, a sensitivity of 88%, and a specificity of 75%. A heatmap of the original images obtained by an extraction algorithm confirmed finger folds as the region of interest for correct classification. After significant response to disease-modifying antirheumatic drug ± corticosteroid therapy, longitudinal metrical analysis of eight representative deep finger folds showed a decrease in the mean diameter/finger fold length (finger fold index, FFI) from 3.03 (SD 0.68) to 2.08 (SD 0.57). Conversely, the FFI increased in patients with disease flares. In conclusion, automated preprocessing and the application of CNN algorithms in combination with longitudinal metrical analysis of dorsal finger fold patterns extracted from real-world hand photos might serve as a digital biomarker in RA.
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Affiliation(s)
- Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Leo Caratsch
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | | | - Jules Maglione
- Department of Informatics, EPFL, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Diana Dan
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Dumusc
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Marc Blanchard
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Gabriel Kalweit
- Department of Computer Science, University of Freiburg, Freiburg im Breisgau, Germany
| | - Maria Kalweit
- Department of Computer Science, University of Freiburg, Freiburg im Breisgau, Germany
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