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Darling A, Irún P, Giraldo P, Armstrong J, Gort L, Díaz-Conradi Á, Yubero D, De Oryazábal Sanz AL, Ormazábal A, Artuch R, García-Cazorla À, O'Callaghan M. Pediatric Gaucher disease with intermediate type 2-3 phenotype associated with parkinsonian features and levodopa responsiveness. Parkinsonism Relat Disord 2021; 91:19-22. [PMID: 34454394 DOI: 10.1016/j.parkreldis.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gaucher disease (GD) is an autosomal recessive lysosomal storage disorder caused by a deficiency of acid β-glucosidase encoded by the GBA gene. In patients with GD, childhood onset parkinsonian features have been rarely described. METHODS Twin siblings with GD are described, including clinical follow-up and treatment response. Bone marrow, enzyme activity studies and genotyping were performed. RESULTS By age 9 months, symptoms at onset were thrombocytopenia and splenomegaly. By age 2, hypokinesia, bradykinesia and oculomotor apraxia were observed. By age 5 a complete rigid hypokinetic syndrome was stablished in both patients, including bradykinesia, tremor and rigidity. Treatment with imiglucerase, miglustat, ambroxol and levodopa were performed. Levodopa showed a good response with improvement in motor and non-motor skills. Foamy cells were found in the bone marrow study. Glucocerebrosidase activity was 28% and 26%. Sanger sequencing analysis identified a missense mutation and a complex allele (NP_000148: p.[(Asp448His)]; [(Leu422Profs*4)]) in compound heterozygosity in GBA gene. CONCLUSIONS Two siblings with neuronopathic GD with an intermediate form between type 2 and 3, with a systemic and neurological phenotype are described. The complex neurological picture included a hypokinetic-rigid and tremor syndrome that improved with levodopa treatment. These conditions together have not been previously described in pediatric GD. We suggest that in children with parkinsonian features, lysosomal storage disorders must be considered, and a levodopa trial must be performed. Moreover, this report give support to the finding that GBA and parkinsonian features share biological pathways and highlight the importance of lysosomal mechanisms in parkinsonism pathogenesis, what might have therapeutic implications.
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Affiliation(s)
- Alejandra Darling
- Pediatric Neurology Department, Metabolic Unit, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Carlos III, IIS Aragón, Zaragoza, 50009, Spain
| | - Pilar Giraldo
- CIBER Enfermedades Raras (CIBERER), Translational Research Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - Judith Armstrong
- Genetic Department, Hospital Sant Joan de Déu, Barcelona, Spain; CIBERER, Instituto de Salud Carlos III, Spain
| | - Laura Gort
- Errors Congènits Del Metabolisme, Servei de Bioquímica I Genètica Molecular, CDB, Hospital Clínic, IDIBAPS, CIBERER, Barcelona, Spain
| | - Álvaro Díaz-Conradi
- Departamento de Hematología Pediátrica, HMNens, HMHospitales, Barcelona, Spain
| | - Delia Yubero
- Genetic Department, Hospital Sant Joan de Déu, Barcelona, Spain; CIBERER, Instituto de Salud Carlos III, Spain
| | | | - Aída Ormazábal
- CIBERER, Instituto de Salud Carlos III, Spain; Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rafael Artuch
- CIBERER, Instituto de Salud Carlos III, Spain; Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Àngels García-Cazorla
- Pediatric Neurology Department, Metabolic Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mar O'Callaghan
- Pediatric Neurology Department, Metabolic Unit, Hospital Sant Joan de Déu, Barcelona, Spain
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Díez H, Cortès-Saladelafont E, Ormazábal A, Marmiese AF, Armstrong J, Matalonga L, Bravo M, Briones P, Emperador S, Montoya J, Artuch R, Giros M, Garcia-Cazorla À. Severe infantile parkinsonism because of a de novo mutation on DLP1
mitochondrial-peroxisomal protein. Mov Disord 2017; 32:1108-1110. [DOI: 10.1002/mds.27021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 02/22/2017] [Accepted: 03/13/2017] [Indexed: 01/19/2023] Open
Affiliation(s)
- H. Díez
- Synaptic Metabolism Laboratory; Hospital Sant Joan de Déu, Institut de Recerca Pediatric; Barcelona Spain
| | - E. Cortès-Saladelafont
- Department of Neurology; Hospital Sant Joan de Déu, Institut de Recerca Pediatric; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
| | - A. Ormazábal
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Department of Clinical Biochemistry and Institut d'Investigació Sanitària Sant Joan de Déu; Hospital Sant Joan de Déu; Barcelona Spain
| | - A. Fernández Marmiese
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases; Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela; Santiago de Compostela Spain
| | - J. Armstrong
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Department of Clinical Biochemistry and Institut d'Investigació Sanitària Sant Joan de Déu; Hospital Sant Joan de Déu; Barcelona Spain
| | - Leslie Matalonga
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Hospital Clinic-IBC, IDIBAPS; Barcelona Spain
| | - Miren Bravo
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Hospital Clinic-IBC, IDIBAPS; Barcelona Spain
| | - Paz Briones
- Institut de Bioquímica Clínica; Hospital Clínic i Provincial; Barcelona Spain
| | - Sonia Emperador
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Department of Biochemistry; Molecular and Cellular Biology, Universidad de Zaragoza; Zaragoza Spain
| | - Julio Montoya
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Department of Biochemistry; Molecular and Cellular Biology, Universidad de Zaragoza; Zaragoza Spain
| | - Rafael Artuch
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Department of Clinical Biochemistry and Institut d'Investigació Sanitària Sant Joan de Déu; Hospital Sant Joan de Déu; Barcelona Spain
| | - Marisa Giros
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
- Hospital Clinic-IBC, IDIBAPS; Barcelona Spain
| | - Àngels Garcia-Cazorla
- Synaptic Metabolism Laboratory; Hospital Sant Joan de Déu, Institut de Recerca Pediatric; Barcelona Spain
- Department of Neurology; Hospital Sant Joan de Déu, Institut de Recerca Pediatric; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras; Instituto de Salud Carlos III; Barcelona Spain
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Ortez C, Duarte ST, Ormazábal A, Serrano M, Pérez A, Pons R, Pineda M, Yapici Z, Fernández-Álvarez E, Domingo-Jiménez R, De Castro P, Artuch R, García-Cazorla A. Cerebrospinal fluid synaptic proteins as useful biomarkers in tyrosine hydroxylase deficiency. Mol Genet Metab 2015; 114:34-40. [PMID: 25468651 DOI: 10.1016/j.ymgme.2014.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 11/24/2022]
Abstract
Tyrosine hydroxylase (TH) deficiency is an inborn error of dopamine biosynthesis and a cause of early parkinsonism. Two clinical phenotypes have been described. Type "B": early onset severe encephalopathy; type "A": later onset, less severe and better response to L-dopa. We aimed to study the expression of several key dopaminergic and gabaergic synaptic proteins in the cerebrospinal fluid (CSF) of a series of patients with TH deficiency and their possible relation with the clinical phenotype and response to L-DOPA. Dopamine transporter (DAT), D2-receptor and vesicular monoamine transporter (VMAT2) were measured in the CSF of 10 subjects with TH deficiency by Western blot analysis. In 3 patients, data of pre- and post-treatment with L-DOPA were available, and in one of them, GABA vesicular transporter was determined. Results were compared to an age-matched control population. The concentration of D2-receptors in CSF was significantly higher in patients with TH deficiency than in controls. Similarly, DAT and vesicular monoamine transporter type 2 were up-regulated. Studies performed before L-DOPA, and on L-DOPA therapy showed a paradoxical response with D2 receptor expression increase as L-Dopa doses and homovanillic concentration gradually raised in a B phenotype patient. The opposite results were found in two patients with A phenotype. However, this is a very small sample, and further studies are needed to conclude robust differences between phenotypes. Synaptic proteins are detectable in the CSF and their quantification can be useful for understanding the pathophysiology of neurotransmitter defects and potentially to adjust and personalize treatments in the future.
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Affiliation(s)
- C Ortez
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - S T Duarte
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Hospital Dona Estefânia, CHLC, Lisbon, Portugal
| | - A Ormazábal
- Department of Biochemistry, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - M Serrano
- Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - A Pérez
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - R Pons
- Department of Pediatrics, University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - M Pineda
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - Z Yapici
- Istanbul Faculty of Medicine, Department of Child Neurology, Istanbul, Turkey
| | - E Fernández-Álvarez
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - R Domingo-Jiménez
- Departament of Pediatric Neurology, Hospital V. Arrixaca, Murcia, Spain
| | - P De Castro
- Department of Pediatric Neurology, Hospital Gregorio Marañón, Madrid, Spain
| | - R Artuch
- Department of Biochemistry, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - A García-Cazorla
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Department of Biochemistry, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain.
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Garcia-Cazorla A, Quadros EV, Nascimento A, Garcia-Silva MT, Briones P, Montoya J, Ormazábal A, Artuch R, Sequeira JM, Blau N, Arenas J, Pineda M, Ramaekers VT. Mitochondrial diseases associated with cerebral folate deficiency. Neurology 2008; 70:1360-2. [PMID: 18413591 DOI: 10.1212/01.wnl.0000309223.98616.e4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Garcia-Cazorla
- Neurology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.
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Artuch Iriberri R, Moreno J, Puig R, Quintana M, Montero R, Ormazábal A, Vilaseca M. [Laboratory diagnosis of rare diseases]. An Sist Sanit Navar 2008; 31 Suppl 2:91-103. [PMID: 18953374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Inborn errors of metabolism (IEM) are a group of diseases whose diagnosis is usually performed by quantification of several metabolites in biological fluids. The aim of this review is to report the role of the laboratory in IEM diagnosis, highlighting the methods available at present and their advantages and limitations. In conclusion, the huge number of recognized IEMs strongly advises the implementation of new high- output technologies in the laboratories devoted to IEM diagnosis. Although these technologies offer a high diagnostic ability, routine analyses are still very important, as well as consideration of several variables involved in biological sample collection and disease expression that may lead to misdiagnosis of IEMs.
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Affiliation(s)
- R Artuch Iriberri
- Departamento de Bioquímica Clínica, Hospital San Juan de Dios, Esplugues, Barcelona, 08950, Spain.
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Artuch R, Moreno J, Puig RM, Quintana M, Montero R, Ormazábal A, Vilaseca MA. El laboratorio en el diagnóstico de las enfermedades raras. An Sist Sanit Navar 2008. [DOI: 10.4321/s1137-66272008000400007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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García-Cazorla A, Serrano M, Pérez-Dueñas B, González V, Ormazábal A, Pineda M, Fernández-Alvarez E, Campistol JMD, Artuch RMD. Secondary abnormalities of neurotransmitters in infants with neurological disorders. Dev Med Child Neurol 2007; 49:740-4. [PMID: 17880642 DOI: 10.1111/j.1469-8749.2007.00740.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurotransmitters are essential in young children for differentiation and neuronal growth of the developing nervous system. We aimed to identify possible factors related to secondary neurotransmitter abnormalities in pediatric patients with neurological disorders. We analyzed cerebrospinal fluid (CSF) and biogenic amine metabolites in 56 infants (33 males, 23 females; mean age 5.8mo [SD 4.1mo] range 1d-1y) with neurological disorders whose aetiology was initially unknown. Patients were classified into three clinical phenotypes: epileptic encephalopathy, severe motor impairment, and non-specific manifestations. All patients showed normal results for screening of inborn errors of metabolism. We report clinical, neuroimaging, and follow-up data. Among the patients studied, 10 had low homovanillic acid (HVA) levels and in four patients, 5-hydroxyindoleacetic acid (5-HIAA) was also reduced. Patients with neonatal onset had significantly lower levels of HVA than a comparison group. HVA deficiency was also associated with severe motor impairment and the final diagnosis related to neurodegenerative disorders. 5-HIAA values tended to be decreased in patients with brain cortical atrophy. The possibility of treating patients with L-Dopa and 5-hydroxytryptophan, in order to improve their neurological function and maturation, may be considered.
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Affiliation(s)
- A García-Cazorla
- Neurology Department, Hospital Sant Joan de Déu, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.
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Serrano M, Ormazábal A, Pérez-Dueñas B, Artuch R, Coroleu W, Krauel X, Campistol J, García-Cazorla A. PERINATAL ASPHYXIA MAY CAUSE REDUCTION IN CSF DOPAMINE METABOLITE CONCENTRATIONS. Neurology 2007; 69:311-3. [PMID: 17636071 DOI: 10.1212/01.wnl.0000265855.13026.dd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Serrano
- Department of Pediatric Neurology, Hospital Sant Joan de Déu, University of Barcelona, Badalona, Barcelona, Spain.
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García-Cazorla A, Ormazábal A, Artuch R, Pérez-Dueñas B, López-Casas J, Fernández-Alvarez E, Campistol J. [Inborn errors of neurotransmitters in neuropaediatrics]. Rev Neurol 2005; 41:99-108. [PMID: 16028189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
AIMS The aim of this work is to describe the clinical, biochemical and genetic characteristics of neurotransmitter diseases at the paediatric age, together with possible forms of treatment. We also sought to determine the diagnostic methodology of these disorders (collection and analysis of samples). DEVELOPMENT These diseases essentially consist of a deficit of biogenic amines and alterations in GABA metabolism (gamma-aminobutyric acid). Disorders affecting the neurotransmission of biogenic amines often present in the form of hypokinesia, trunk hypotonia with increased limb tone, oculogyric crises, ptosis, faulty temperature regulation or abnormal movements. Defects in GABA metabolism give rise to epileptic encephalopathies and unspecific mental retardation, sometimes associated to signs of cerebellar dysfunction, convulsions and alterations in neuroimaging studies. Overall incidence of these diseases is low but they are unquestionably under-diagnosed, since they cannot be detected by conventional studies in plasma and urine, and require extraction and directed analysis of cerebrospinal fluid (CSF) for their detection. Additionally, the CSF study must be carried out in specific standardised conditions. Segawa's disease, or dopa-responsive dystonia, responds extremely well to therapy, whereas the other entities respond in varying ways to the different therapeutic alternatives. CONCLUSIONS It is important for the paediatrician to know about these entities as a group of treatable neurometabolic diseases. Moreover, their detection would allow prenatal diagnosis in the vast majority of cases.
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Affiliation(s)
- A García-Cazorla
- Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
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Ormazábal A, Artuch R, Vilaseca MA, García-Cazorla A, Campistol J. [Pathogenetic mechanisms in phenylketonuria: disorders affecting the metabolism of neurotransmitters and the antioxidant system]. Rev Neurol 2004; 39:956-61. [PMID: 15573314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM To review the clinical and biochemical changes in neurotransmission and antioxidant system in phenylketonuric patients under dietary treatment. DEVELOPMENT Phenylketonuria (PKU) is an inborn error of metabolism caused by decreased activity of the enzyme L-phenylalanine-4-mono-oxigenase that synthesizes tyrosine from phenylalanine. According to analytical data from PKU patients and to experimental studies in animal models, high phenylalanine values in plasma and tissues seem to be related with defective biosynthesis of neurotransmitter (mainly serotonin and dopamine) and impairment of antioxidant system. Despite dietary treatment, PKU patients usually present moderate hyperphenylalaninemia over the evolution of the disease that might cause clinical and biochemical abnormalities. CONCLUSIONS Increased plasma phenylalanine concentrations and dietary treatment might be related with neurotransmitter and antioxidant system abnormalities in human phenylketonuria. These biochemical alterations might be involved in the physiopathology of PKU.
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Affiliation(s)
- A Ormazábal
- Servicio de Bioquímica, Hospital Sant Joan de Déu, Esplugues de Ll., Barcelona, Spain
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