1
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Catar RA, Chen L, Cuff SM, Kift-Morgan A, Eberl M, Kettritz R, Kamhieh-Milz J, Moll G, Li Q, Zhao H, Kawka E, Zickler D, Parekh G, Davis P, Fraser DJ, Dragun D, Eckardt KU, Jörres A, Witowski J. Control of neutrophil influx during peritonitis by transcriptional cross-regulation of chemokine CXCL1 by IL-17 and IFN-γ. J Pathol 2020; 251:175-186. [PMID: 32232854 DOI: 10.1002/path.5438] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 02/08/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
Neutrophil infiltration is a hallmark of peritoneal inflammation, but mechanisms regulating neutrophil recruitment in patients with peritoneal dialysis (PD)-related peritonitis are not fully defined. We examined 104 samples of PD effluent collected during acute peritonitis for correspondence between a broad range of soluble parameters and neutrophil counts. We observed an association between peritoneal IL-17 and neutrophil levels. This relationship was evident in effluent samples with low but not high IFN-γ levels, suggesting a differential effect of IFN-γ concentration on neutrophil infiltration. Surprisingly, there was no association of neutrophil numbers with the level of CXCL1, a key IL-17-induced neutrophil chemoattractant. We investigated therefore the production of CXCL1 by human peritoneal mesothelial cells (HPMCs) under in vitro conditions mimicking clinical peritonitis. Stimulation of HPMCs with IL-17 increased CXCL1 production through induction of transcription factor SP1 and activation of the SP1-binding region of the CXCL1 promoter. These effects were amplified by TNFα. In contrast, IFN-γ dose-dependently suppressed IL-17-induced SP1 activation and CXCL1 production through a transcriptional mechanism involving STAT1. The SP1-mediated induction of CXCL1 was also observed in HPMCs exposed to PD effluent collected during peritonitis and containing IL-17 and TNFα, but not IFN-γ. Supplementation of the effluent with IFN-γ led to a dose-dependent activation of STAT1 and a resultant inhibition of SP1-induced CXCL1 expression. Transmesothelial migration of neutrophils in vitro increased upon stimulation of HPMCs with IL-17 and was reduced by IFN-γ. In addition, HPMCs were capable of binding CXCL1 at their apical cell surface. These observations indicate that changes in relative peritoneal concentrations of IL-17 and IFN-γ can differently engage SP1-STAT1, impacting on mesothelial cell transcription of CXCL1, whose release and binding to HPMC surface may determine optimal neutrophil recruitment and retention during peritonitis. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Rusan A Catar
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Lei Chen
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Simone M Cuff
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Ann Kift-Morgan
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Matthias Eberl
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Systems Immunity Research Institute, Cardiff University, Cardiff, UK
| | - Ralph Kettritz
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
- Experimental and Clinical Research Center, Max-Delbrück-Center für Molekulare Medizin in der Helmholtz-Gemeinschaft, Berlin, Germany
| | - Julian Kamhieh-Milz
- Department of Transfusion Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | - Guido Moll
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin, Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies, Charité Universitätsmedizin, Berlin, Germany
- Julius Wolff Institute, Charité Universitätsmedizin, Berlin, Germany
| | - Qing Li
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Hongfan Zhao
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Edyta Kawka
- Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Gita Parekh
- Mologic Ltd, Bedford Technology Park, Thurleigh, Bedford, UK
| | - Paul Davis
- Mologic Ltd, Bedford Technology Park, Thurleigh, Bedford, UK
| | - Donald J Fraser
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Systems Immunity Research Institute, Cardiff University, Cardiff, UK
- Wales Kidney Research Unit, Cardiff University, Cardiff, UK
| | - Duska Dragun
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Achim Jörres
- Department of Medicine I, Nephrology, Transplantation and Medical Intensive Care, University Witten/Herdecke, Medical Center Cologne-Merheim, Cologne, Germany
| | - Janusz Witowski
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
- Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland
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2
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Gadalla AAH, Friberg IM, Kift-Morgan A, Zhang J, Eberl M, Topley N, Weeks I, Cuff S, Wootton M, Gal M, Parekh G, Davis P, Gregory C, Hood K, Hughes K, Butler C, Francis NA. Identification of clinical and urine biomarkers for uncomplicated urinary tract infection using machine learning algorithms. Sci Rep 2019; 9:19694. [PMID: 31873085 PMCID: PMC6928162 DOI: 10.1038/s41598-019-55523-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022] Open
Abstract
Women with uncomplicated urinary tract infection (UTI) symptoms are commonly treated with empirical antibiotics, resulting in overuse of antibiotics, which promotes antimicrobial resistance. Available diagnostic tools are either not cost-effective or diagnostically sub-optimal. Here, we identified clinical and urinary immunological predictors for UTI diagnosis. We explored 17 clinical and 42 immunological potential predictors for bacterial culture among women with uncomplicated UTI symptoms using random forest or support vector machine coupled with recursive feature elimination. Urine cloudiness was the best performing clinical predictor to rule out (negative likelihood ratio [LR−] = 0.4) and rule in (LR+ = 2.6) UTI. Using a more discriminatory scale to assess cloudiness (turbidity) increased the accuracy of UTI prediction further (LR+ = 4.4). Urinary levels of MMP9, NGAL, CXCL8 and IL-1β together had a higher LR+ (6.1) and similar LR− (0.4), compared to cloudiness. Varying the bacterial count thresholds for urine culture positivity did not alter best clinical predictor selection, but did affect the number of immunological predictors required for reaching an optimal prediction. We conclude that urine cloudiness is particularly helpful in ruling out negative UTI cases. The identified urinary biomarkers could be used to develop a point of care test for UTI but require further validation.
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Affiliation(s)
- Amal A H Gadalla
- Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom.
| | - Ida M Friberg
- Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Ann Kift-Morgan
- Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jingjing Zhang
- Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Matthias Eberl
- Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom.,Systems Immunity Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Nicholas Topley
- Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom.,Systems Immunity Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Ian Weeks
- Systems Immunity Research Institute, Cardiff University, Cardiff, United Kingdom.,Clinical Innovation Hub, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Simone Cuff
- Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom.,Systems Immunity Research Institute, Cardiff University, Cardiff, United Kingdom.,Clinical Innovation Hub, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, United Kingdom
| | - Micaela Gal
- Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Gita Parekh
- Mologic Ltd., Bedford Technology Park, Thurleigh, Bedford, United Kingdom
| | - Paul Davis
- Mologic Ltd., Bedford Technology Park, Thurleigh, Bedford, United Kingdom
| | - Clive Gregory
- Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Kathryn Hughes
- Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Christopher Butler
- Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nick A Francis
- Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom.,Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
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3
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Brook AC, Jenkins RH, Clayton A, Kift-Morgan A, Raby AC, Shephard AP, Mariotti B, Cuff SM, Bazzoni F, Bowen T, Fraser DJ, Eberl M. Neutrophil-derived miR-223 as local biomarker of bacterial peritonitis. Sci Rep 2019; 9:10136. [PMID: 31300703 PMCID: PMC6625975 DOI: 10.1038/s41598-019-46585-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/01/2019] [Indexed: 02/08/2023] Open
Abstract
Infection remains a major cause of morbidity, mortality and technique failure in patients with end stage kidney failure who receive peritoneal dialysis (PD). Recent research suggests that the early inflammatory response at the site of infection carries diagnostically relevant information, suggesting that organ and pathogen-specific "immune fingerprints" may guide targeted treatment decisions and allow patient stratification and risk prediction at the point of care. Here, we recorded microRNA profiles in the PD effluent of patients presenting with symptoms of acute peritonitis and show that elevated peritoneal miR-223 and reduced miR-31 levels were useful predictors of bacterial infection. Cell culture experiments indicated that miR-223 was predominantly produced by infiltrating immune cells (neutrophils, monocytes), while miR-31 was mainly derived from the local tissue (mesothelial cells, fibroblasts). miR-223 was found to be functionally stabilised in PD effluent from peritonitis patients, with a proportion likely to be incorporated into neutrophil-derived exosomes. Our study demonstrates that microRNAs are useful biomarkers of bacterial infection in PD-related peritonitis and have the potential to contribute to disease-specific immune fingerprints. Exosome-encapsulated microRNAs may have a functional role in intercellular communication between immune cells responding to the infection and the local tissue, to help clear the infection, resolve the inflammation and restore homeostasis.
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Affiliation(s)
- Amy C Brook
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Robert H Jenkins
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom.,Wales Kidney Research Unit, Heath Park Campus, Cardiff, United Kingdom
| | - Aled Clayton
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ann Kift-Morgan
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Anne-Catherine Raby
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom.,Wales Kidney Research Unit, Heath Park Campus, Cardiff, United Kingdom
| | - Alex P Shephard
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Barbara Mariotti
- Department of Medicine, Section of General Pathology, University of Verona, Verona, Italy
| | - Simone M Cuff
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Flavia Bazzoni
- Department of Medicine, Section of General Pathology, University of Verona, Verona, Italy
| | - Timothy Bowen
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom.,Wales Kidney Research Unit, Heath Park Campus, Cardiff, United Kingdom
| | - Donald J Fraser
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom.,Wales Kidney Research Unit, Heath Park Campus, Cardiff, United Kingdom.,Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, United Kingdom.,Systems Immunity Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Matthias Eberl
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom. .,Systems Immunity Research Institute, Cardiff University, Cardiff, United Kingdom.
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4
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Zhang J, Friberg IM, Kift-Morgan A, Parekh G, Morgan MP, Liuzzi AR, Lin CY, Donovan KL, Colmont CS, Morgan PH, Davis P, Weeks I, Fraser DJ, Topley N, Eberl M. Machine-learning algorithms define pathogen-specific local immune fingerprints in peritoneal dialysis patients with bacterial infections. Kidney Int 2017; 92:179-191. [PMID: 28318629 PMCID: PMC5484022 DOI: 10.1016/j.kint.2017.01.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 12/01/2022]
Abstract
The immune system has evolved to sense invading pathogens, control infection, and restore tissue integrity. Despite symptomatic variability in patients, unequivocal evidence that an individual's immune system distinguishes between different organisms and mounts an appropriate response is lacking. We here used a systematic approach to characterize responses to microbiologically well-defined infection in a total of 83 peritoneal dialysis patients on the day of presentation with acute peritonitis. A broad range of cellular and soluble parameters was determined in peritoneal effluents, covering the majority of local immune cells, inflammatory and regulatory cytokines and chemokines as well as tissue damage–related factors. Our analyses, utilizing machine-learning algorithms, demonstrate that different groups of bacteria induce qualitatively distinct local immune fingerprints, with specific biomarker signatures associated with Gram-negative and Gram-positive organisms, and with culture-negative episodes of unclear etiology. Even more, within the Gram-positive group, unique immune biomarker combinations identified streptococcal and non-streptococcal species including coagulase-negative Staphylococcus spp. These findings have diagnostic and prognostic implications by informing patient management and treatment choice at the point of care. Thus, our data establish the power of non-linear mathematical models to analyze complex biomedical datasets and highlight key pathways involved in pathogen-specific immune responses.
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Affiliation(s)
- Jingjing Zhang
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Ida M Friberg
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Ann Kift-Morgan
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Gita Parekh
- Mologic Ltd., Bedford Technology Park, Thurleigh, Bedford, UK
| | - Matt P Morgan
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; Directorate of Critical Care, Cardiff and Vale University Health Board, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Anna Rita Liuzzi
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Chan-Yu Lin
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; Kidney Research Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan
| | - Kieron L Donovan
- Wales Kidney Research Unit, Heath Park Campus, Cardiff, UK; Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Heath Park, Cardiff, UK
| | | | - Peter H Morgan
- Cardiff Business School, Cardiff University, Cardiff, UK
| | - Paul Davis
- Mologic Ltd., Bedford Technology Park, Thurleigh, Bedford, UK
| | - Ian Weeks
- Systems Immunity Research Institute, Cardiff University, Cardiff, UK
| | - Donald J Fraser
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; Wales Kidney Research Unit, Heath Park Campus, Cardiff, UK; Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Heath Park, Cardiff, UK; Systems Immunity Research Institute, Cardiff University, Cardiff, UK
| | - Nicholas Topley
- Wales Kidney Research Unit, Heath Park Campus, Cardiff, UK; Systems Immunity Research Institute, Cardiff University, Cardiff, UK
| | - Matthias Eberl
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; Systems Immunity Research Institute, Cardiff University, Cardiff, UK.
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5
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Liao CT, Andrews R, Wallace LE, Khan MWA, Kift-Morgan A, Topley N, Fraser DJ, Taylor PR. Peritoneal macrophage heterogeneity is associated with different peritoneal dialysis outcomes. Kidney Int 2017; 91:1088-1103. [PMID: 28065517 PMCID: PMC5402633 DOI: 10.1016/j.kint.2016.10.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/20/2016] [Accepted: 10/20/2016] [Indexed: 12/20/2022]
Abstract
Peritonitis remains the major obstacle for the maintenance of long-term peritoneal dialysis and dysregulated host peritoneal immune responses may compromise local anti-infectious defense, leading to treatment failure. Whilst, tissue mononuclear phagocytes, comprising macrophages and dendritic cells, are central to a host response to pathogens and the development of adaptive immune responses, they are poorly characterized in the human peritoneum. Combining flow cytometry with global transcriptome analysis, the phenotypic features and lineage identity of the major CD14+ macrophage and CD1c+ dendritic cell subsets in dialysis effluent were defined. Their functional specialization was reflected in cytokine generation, phagocytosis, and antigen processing/presentation. By analyzing acute bacterial peritonitis, stable (infection-free) and new-starter patients receiving peritoneal dialysis, we identified a skewed distribution of macrophage to dendritic cell subsets (increasing ratio) that associated with adverse peritonitis outcomes, history of multiple peritonitis episodes, and early catheter failure, respectively. Intriguingly, we also noted significant alterations of macrophage heterogeneity, indicative of different maturation and activation states that were associated with different peritoneal dialysis outcomes. Thus, our studies delineate peritoneal dendritic cells from macrophages within dialysate, and define cellular characteristics associated with peritoneal dialysis treatment failure. These are the first steps to unravelling the detrimental adaptive immune responses occurring as a consequence of peritonitis.
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Affiliation(s)
- Chia-Te Liao
- Systems Immunity University Research Institute and Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Robert Andrews
- Systems Immunity University Research Institute and Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Leah E Wallace
- Systems Immunity University Research Institute and Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Mohd Wajid A Khan
- Systems Immunity University Research Institute and Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Ann Kift-Morgan
- Systems Immunity University Research Institute and Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Nicholas Topley
- Wales Kidney Research Unit, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Donald J Fraser
- Systems Immunity University Research Institute and Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, UK; Wales Kidney Research Unit, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Philip R Taylor
- Systems Immunity University Research Institute and Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, UK.
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6
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Liuzzi AR, Kift-Morgan A, Lopez-Anton M, Friberg IM, Zhang J, Brook AC, Roberts GW, Donovan KL, Colmont CS, Toleman MA, Bowen T, Johnson DW, Topley N, Moser B, Fraser DJ, Eberl M. Unconventional Human T Cells Accumulate at the Site of Infection in Response to Microbial Ligands and Induce Local Tissue Remodeling. J Immunol 2016; 197:2195-207. [PMID: 27527598 PMCID: PMC5009878 DOI: 10.4049/jimmunol.1600990] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/12/2016] [Indexed: 12/13/2022]
Abstract
The antimicrobial responsiveness and function of unconventional human T cells are poorly understood, with only limited access to relevant specimens from sites of infection. Peritonitis is a common and serious complication in individuals with end-stage kidney disease receiving peritoneal dialysis. By analyzing local and systemic immune responses in peritoneal dialysis patients presenting with acute bacterial peritonitis and monitoring individuals before and during defined infectious episodes, our data show that Vγ9/Vδ2+ γδ T cells and mucosal-associated invariant T cells accumulate at the site of infection with organisms producing (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate and vitamin B2, respectively. Such unconventional human T cells are major producers of IFN-γ and TNF-α in response to these ligands that are shared by many microbial pathogens and affect the cells lining the peritoneal cavity by triggering local inflammation and inducing tissue remodeling with consequences for peritoneal membrane integrity. Our data uncover a crucial role for Vγ9/Vδ2 T cells and mucosal-associated invariant T cells in bacterial infection and suggest that they represent a useful predictive marker for important clinical outcomes, which may inform future stratification and patient management. These findings are likely to be applicable to other acute infections where local activation of unconventional T cells contributes to the antimicrobial inflammatory response.
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Affiliation(s)
- Anna Rita Liuzzi
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Ann Kift-Morgan
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Melisa Lopez-Anton
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom
| | - Ida M Friberg
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Jingjing Zhang
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Amy C Brook
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Gareth W Roberts
- Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom; Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Kieron L Donovan
- Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom; Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Chantal S Colmont
- Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom
| | - Mark A Toleman
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Timothy Bowen
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom
| | - David W Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland 4102, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia 5001, Australia
| | - Nicholas Topley
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; and Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Bernhard Moser
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Donald J Fraser
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom; Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom; Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Matthias Eberl
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
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7
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Raby AC, Colmont CS, Kift-Morgan A, Köhl J, Eberl M, Fraser D, Topley N, Labéta MO. Toll-Like Receptors 2 and 4 Are Potential Therapeutic Targets in Peritoneal Dialysis-Associated Fibrosis. J Am Soc Nephrol 2016; 28:461-478. [PMID: 27432741 DOI: 10.1681/asn.2015080923] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 06/02/2016] [Indexed: 01/07/2023] Open
Abstract
Peritoneal dialysis (PD) remains limited by dialysis failure due to peritoneal membrane fibrosis driven by inflammation caused by infections or sterile cellular stress. Given the fundamental role of Toll-like receptors (TLRs) and complement in inflammation, we assessed the potential of peritoneal TLR2, TLR4 and C5a receptors, C5aR and C5L2, as therapeutic targets in PD-associated fibrosis. We detected TLR2-, TLR4-, and C5aR-mediated proinflammatory and fibrotic responses to bacteria that were consistent with the expression of these receptors in peritoneal macrophages (TLR2/4, C5aR) and mesothelial cells (TLR2, C5aR). Experiments in knockout mice revealed a major role for TLR2, a lesser role for TLR4, a supplementary role for C5aR, and no apparent activity of C5L2 in infection-induced peritoneal fibrosis. Similarly, antibody blockade of TLR2, TLR4, or C5aR differentially inhibited bacteria-induced profibrotic and inflammatory mediator production by peritoneal leukocytes isolated from the peritoneal dialysis effluent (PDE) of noninfected uremic patients. Additionally, antibodies against TLR2, TLR4, or the coreceptor CD14 reduced the profibrotic responses of uremic leukocytes to endogenous components present in the PDE of noninfected patients. Enhancing TLR2-mediated inflammation increased fibrosis in vivo Furthermore, soluble TLR2 (sTLR2), a negative modulator of TLRs that we detected in PDE, inhibited PDE-induced, TLR2- or TLR4-mediated profibrotic responses. Notably, sTLR2 treatment markedly reduced Gram-positive and -negative bacteria-induced fibrosis in vivo, inhibiting proinflammatory and fibrotic genes without affecting infection clearance. These findings reveal the influence of peritoneal TLR2 and TLR4 on PD-associated fibrosis and describe a therapeutic strategy against fibrosis.
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Affiliation(s)
- Anne-Catherine Raby
- Division of Infection and Immunity and The Wales Kidney Research Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom;
| | - Chantal S Colmont
- Division of Infection and Immunity and The Wales Kidney Research Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ann Kift-Morgan
- Division of Infection and Immunity and The Wales Kidney Research Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jörg Köhl
- Institute for Systemic Inflammation Research, University of Lübeck, Lubeck, Germany; and.,Division of Immunobiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Matthias Eberl
- Division of Infection and Immunity and The Wales Kidney Research Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Donald Fraser
- Division of Infection and Immunity and The Wales Kidney Research Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Nicholas Topley
- Division of Infection and Immunity and The Wales Kidney Research Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Mario O Labéta
- Division of Infection and Immunity and The Wales Kidney Research Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom;
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8
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Fielding C, Jones G, McLoughlin R, McLeod L, Hammond V, Uceda J, Williams A, Lambie M, Foster T, Liao CT, Rice C, Greenhill C, Colmont C, Hams E, Coles B, Kift-Morgan A, Newton Z, Craig K, Williams J, Williams G, Davies S, Humphreys I, O’Donnell V, Taylor P, Jenkins B, Topley N, Jones S. Interleukin-6 signaling drives fibrosis in unresolved inflammation. Immunity 2014; 40:40-50. [PMID: 24412616 PMCID: PMC3919204 DOI: 10.1016/j.immuni.2013.10.022] [Citation(s) in RCA: 263] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 10/28/2013] [Indexed: 02/06/2023]
Abstract
Fibrosis in response to tissue damage or persistent inflammation is a pathological hallmark of many chronic degenerative diseases. By using a model of acute peritoneal inflammation, we have examined how repeated inflammatory activation promotes fibrotic tissue injury. In this context, fibrosis was strictly dependent on interleukin-6 (IL-6). Repeat inflammation induced IL-6-mediated T helper 1 (Th1) cell effector commitment and the emergence of STAT1 (signal transducer and activator of transcription-1) activity within the peritoneal membrane. Fibrosis was not observed in mice lacking interferon-γ (IFN-γ), STAT1, or RAG-1. Here, IFN-γ and STAT1 signaling disrupted the turnover of extracellular matrix by metalloproteases. Whereas IL-6-deficient mice resisted fibrosis, transfer of polarized Th1 cells or inhibition of MMP activity reversed this outcome. Thus, IL-6 causes compromised tissue repair by shifting acute inflammation into a more chronic profibrotic state through induction of Th1 cell responses as a consequence of recurrent inflammation.
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Affiliation(s)
- Ceri A. Fielding
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Gareth W. Jones
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Rachel M. McLoughlin
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Louise McLeod
- Centre for Innate Immunity and Infectious Diseases, Monash Institute for Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Victoria J. Hammond
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Javier Uceda
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Anwen S. Williams
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Mark Lambie
- Department of Nephrology, University Hospital of North Staffordshire and Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent ST4 7QB, UK
| | - Thomas L. Foster
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Chia-Te Liao
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Christopher M. Rice
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Claire J. Greenhill
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Chantal S. Colmont
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Emily Hams
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Barbara Coles
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Ann Kift-Morgan
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Zarabeth Newton
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Katherine J. Craig
- Institute of Nephrology, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - John D. Williams
- Institute of Nephrology, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - Geraint T. Williams
- Section of Pathology, Institute of Cancer and Genetics, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Simon J. Davies
- Department of Nephrology, University Hospital of North Staffordshire and Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent ST4 7QB, UK
| | - Ian R. Humphreys
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Valerie B. O’Donnell
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Philip R. Taylor
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Brendan J. Jenkins
- Centre for Innate Immunity and Infectious Diseases, Monash Institute for Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Nicholas Topley
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK.
| | - Simon A. Jones
- Cardiff Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XN, UK,Corresponding author
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Lin CY, Roberts GW, Kift-Morgan A, Donovan KL, Topley N, Eberl M. Pathogen-specific local immune fingerprints diagnose bacterial infection in peritoneal dialysis patients. J Am Soc Nephrol 2013; 24:2002-9. [PMID: 24179164 PMCID: PMC3839555 DOI: 10.1681/asn.2013040332] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/26/2013] [Indexed: 12/21/2022] Open
Abstract
Accurate and timely diagnosis of bacterial infection is crucial for effective and targeted treatment, yet routine microbiological identification is inefficient and often delayed to an extent that makes it clinically unhelpful. The immune system is capable of a rapid, sensitive and specific detection of a broad spectrum of microbes, which has been optimized over millions of years of evolution. A patient's early immune response is therefore likely to provide far better insight into the true nature and severity of microbial infections than conventional tests. To assess the diagnostic potential of pathogen-specific immune responses, we characterized the local responses of 52 adult patients during episodes of acute peritoneal dialysis (PD)-associated peritonitis by multicolor flow cytometry and multiplex ELISA, and defined the immunologic signatures in relation to standard microbiological culture results and to clinical outcomes. We provide evidence that unique local "immune fingerprints" characteristic of individual organisms are evident in PD patients on the day of presentation with acute peritonitis and discriminate between culture-negative, Gram-positive, and Gram-negative episodes of infection. Those humoral and cellular parameters with the most promise for defining disease-specific immune fingerprints include the local levels of IL-1β, IL-10, IL-22, TNF-α, and CXCL10, as well as the frequency of local γδ T cells and the relative proportion of neutrophils and monocytes/macrophages among total peritoneal cells. Our data provide proof of concept for the feasibility of using immune fingerprints to inform the design of point-of-care tests that will allow rapid and accurate infection identification and facilitate targeted antibiotic prescription and improved patient management.
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Affiliation(s)
- Chan-Yu Lin
- Cardiff Institute of Infection and Immunity, Cardiff University, Cardiff, Wales, United Kingdom
- Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Gareth W. Roberts
- Institute of Molecular and Experimental Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ann Kift-Morgan
- Cardiff Institute of Infection and Immunity, Cardiff University, Cardiff, Wales, United Kingdom
| | - Kieron L. Donovan
- Department of Nephrology and Transplant, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom; and
| | - Nicholas Topley
- Institute of Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Matthias Eberl
- Cardiff Institute of Infection and Immunity, Cardiff University, Cardiff, Wales, United Kingdom
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Raby AC, Holst B, Le Bouder E, Diaz C, Ferran E, Conraux L, Guillemot JC, Coles B, Kift-Morgan A, Colmont CS, Szakmany T, Ferrara P, Hall JE, Topley N, Labeta MO. Targeting the TLR Co-Receptor CD14 with TLR2-Derived Peptides Modulates Immune Responses to Pathogens. Sci Transl Med 2013; 5:185ra64. [DOI: 10.1126/scitranslmed.3005544] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lin CY, Kift-Morgan A, Moser B, Topley N, Eberl M. Suppression of pro-inflammatory T-cell responses by human mesothelial cells. Nephrol Dial Transplant 2013; 28:1743-50. [PMID: 23355626 DOI: 10.1093/ndt/gfs612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Human γδ T cells reactive to the microbial metabolite (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMB-PP) contribute to acute inflammatory responses. We have previously shown that peritoneal dialysis (PD)-associated infections with HMB-PP producing bacteria are characterized by locally elevated γδ T-cell frequencies and poorer clinical outcome compared with HMB-PP negative infections, implying that γδ T cells may be of diagnostic, prognostic and therapeutic value in acute disease. The regulation by local tissue cells of these potentially detrimental γδ T-cell responses remains to be investigated. METHODS Freshly isolated γδ or αβ T cells were cultured with primary mesothelial cells derived from omental tissue, or with mesothelial cell-conditioned medium. Stimulation of cytokine production and proliferation by peripheral T cells in response to HMB-PP or CD3/CD28 beads was assessed by flow cytometry. RESULTS Resting mesothelial cells were potent suppressors of pro-inflammatory γδ T cells as well as CD4+ and CD8+ αβ T cells. The suppression of γδ T-cell responses was mediated through soluble factors released by primary mesothelial cells and could be counteracted by SB-431542, a selective inhibitor of TGF-β and activin signalling. Recombinant TGF-β1 but not activin-A mimicked the mesothelial cell-mediated suppression of γδ T-cell responses to HMB-PP. CONCLUSIONS The present findings indicate an important regulatory function of mesothelial cells in the peritoneal cavity by dampening pro-inflammatory T-cell responses, which may help preserve the tissue integrity of the peritoneal membrane in the steady state and possibly during the resolution of acute inflammation.
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Affiliation(s)
- Chan-Yu Lin
- Cardiff Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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12
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Coles B, Colmont C, Fielding CA, Kift-Morgan A, Hams E, Topley N, Jones SA. SS11-4 Local manipulation of IL-6 trans-signaling therapeutically enhances anti-microbial host defense. Cytokine 2010. [DOI: 10.1016/j.cyto.2010.07.335] [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: 11/24/2022]
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