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Vargas-Blanco DA, Hepworth OW, Basham KJ, Simaku P, Crossen AJ, Timmer KD, Hopke A, Brown Harding H, Vandal SR, Jensen KN, Floyd DJ, Reedy JL, Reardon C, Mansour MK, Ward RA, Irimia D, Abramson JS, Vyas JM. BTK inhibitor-induced defects in human neutrophil effector activity against Aspergillus fumigatus are restored by TNFα. JCI Insight 2024:e176162. [PMID: 38713531 DOI: 10.1172/jci.insight.176162] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024] Open
Abstract
Inhibition of Bruton's tyrosine kinase (BTK) through covalent modifications of its active site (e.g., ibrutinib [IBT]) is a preferred treatment for multiple B cell malignancies. However, IBT-treated patients are more susceptible to invasive fungal infections, although the mechanism is poorly understood. Neutrophils are the primary line of defense against these infections; therefore, we examined the impact of IBT on primary human neutrophil effector activity against Aspergillus fumigatus. IBT significantly impaired the ability of neutrophils to kill A. fumigatus and potently inhibited reactive oxygen species (ROS) production, chemotaxis, and phagocytosis. Importantly, exogenous TNFα fully compensated for defects imposed by IBT and newer-generation BTK inhibitors and restored the ability of neutrophils to contain A. fumigatus hyphal growth. Blocking TNFα did not impact ROS production in healthy neutrophils but prevented exogenous TNFα from rescuing the phenotype of IBT-treated neutrophils. The restorative capacity of TNFα was independent of transcription. Moreover, the addition of TNFα immediately rescued ROS production in IBT-treated neutrophils indicating that TNFα worked through a BTK-independent signaling pathway. Finally, TNFα restored effector activity of primary neutrophils from patients on IBT therapy. Altogether, our data indicate that TNFα rescues the antifungal immunity block imposed by inhibition of BTK in primary human neutrophils.
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Affiliation(s)
- Diego A Vargas-Blanco
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Olivia W Hepworth
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Kyle J Basham
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Patricia Simaku
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Arianne J Crossen
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Kyle D Timmer
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Alex Hopke
- Harvard Medical School, Boston, United States of America
| | - Hannah Brown Harding
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Steven R Vandal
- Beth Israel Deaconess Medical Center, Boston, United States of America
| | - Kirstine N Jensen
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Daniel J Floyd
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Jennifer L Reedy
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Christopher Reardon
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Michael K Mansour
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Rebecca A Ward
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Daniel Irimia
- Harvard Medical School, Boston, United States of America
| | - Jeremy S Abramson
- Center for Lymphoma, Mass General Cancer Center, Boston, United States of America
| | - Jatin M Vyas
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
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Atallah J, Ghebremichael M, Timmer KD, Warren HM, Mallinger E, Wallace E, Strouts FR, Persing DH, Mansour MK. Novel Host Response-Based Diagnostics to Differentiate the Etiology of Fever in Patients Presenting to the Emergency Department. Diagnostics (Basel) 2023; 13:953. [PMID: 36900096 PMCID: PMC10000761 DOI: 10.3390/diagnostics13050953] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Fever is a common presentation to urgent-care services and is linked to multiple disease processes. To rapidly determine the etiology of fever, improved diagnostic modalities are necessary. This prospective study of 100 hospitalized febrile patients included both positive (FP) and negative (FN) subjects in terms of infection status and 22 healthy controls (HC). We evaluated the performance of a novel PCR-based assay measuring five host mRNA transcripts directly from whole blood to differentiate infectious versus non-infectious febrile syndromes as compared to traditional pathogen-based microbiology results. The FP and FN groups observed a robust network structure with a significant correlation between the five genes. There were statistically significant associations between positive infection status and four of the five genes: IRF-9 (OR = 1.750, 95% CI = 1.16-2.638), ITGAM (OR = 1.533, 95% CI = 1.047-2.244), PSTPIP2 (OR = 2.191, 95% CI = 1.293-3.711), and RUNX1 (OR = 1.974, 95% CI = 1.069-3.646). We developed a classifier model to classify study participants based on these five genes and other variables of interest to assess the discriminatory power of the genes. The classifier model correctly classified more than 80% of the participants into their respective groups, i.e., FP or FN. The GeneXpert prototype holds promise for guiding rapid clinical decision-making, reducing healthcare costs, and improving outcomes in undifferentiated febrile patients presenting for urgent evaluation.
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Affiliation(s)
- Johnny Atallah
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Infectious Diseases Division, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Musie Ghebremichael
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02138, USA
| | - Kyle D. Timmer
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Infectious Diseases Division, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hailey M. Warren
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Infectious Diseases Division, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ella Mallinger
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Infectious Diseases Division, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | - Michael K. Mansour
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Infectious Diseases Division, Massachusetts General Hospital, Boston, MA 02114, USA
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Reedy JL, Crossen AJ, Negoro PE, Harding HB, Ward RA, Vargas-Blanco DA, Timmer KD, Reardon CM, Basham KJ, Mansour MK, Wüthrich M, Fontaine T, Latgé JP, Vyas JM. The C-Type Lectin Receptor Dectin-2 Is a Receptor for Aspergillus fumigatus Galactomannan. mBio 2023; 14:e0318422. [PMID: 36598192 PMCID: PMC9973300 DOI: 10.1128/mbio.03184-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
Aspergillus fumigatus is a ubiquitous environmental mold that causes significant mortality particularly among immunocompromised patients. The detection of the Aspergillus-derived carbohydrate galactomannan in patient serum and bronchoalveolar lavage fluid is the major biomarker used to detect A. fumigatus infection in clinical medicine. Despite the clinical relevance of this carbohydrate, we lack a fundamental understanding of how galactomannan is recognized by the immune system and its consequences. Galactomannan is composed of a linear mannan backbone with galactofuranose sidechains and is found both attached to the cell surface of Aspergillus and as a soluble carbohydrate in the extracellular milieu. In this study, we utilized fungal-like particles composed of highly purified Aspergillus galactomannan to identify a C-type lectin host receptor for this fungal carbohydrate. We identified a novel and specific interaction between Aspergillus galactomannan and the C-type lectin receptor Dectin-2. We demonstrate that galactomannan bound to Dectin-2 and induced Dectin-2-dependent signaling, including activation of spleen tyrosine kinase, gene transcription, and tumor necrosis factor alpha (TNF-α) production. Deficiency of Dectin-2 increased immune cell recruitment to the lungs but was dispensable for survival in a mouse model of pulmonary aspergillosis. Our results identify a novel interaction between galactomannan and Dectin-2 and demonstrate that Dectin-2 is a receptor for galactomannan, which leads to a proinflammatory immune response in the lung. IMPORTANCE Aspergillus fumigatus is a fungal pathogen that causes serious and often fatal disease in humans. The surface of Aspergillus is composed of complex sugar molecules. Recognition of these carbohydrates by immune cells by carbohydrate lectin receptors can lead to clearance of the infection or, in some cases, benefit the fungus by dampening the host response. Galactomannan is a carbohydrate that is part of the cell surface of Aspergillus but is also released during infection and is found in patient lungs as well as their bloodstreams. The significance of our research is that we have identified Dectin-2 as a mammalian immune cell receptor that recognizes, binds, and signals in response to galactomannan. These results enhance our understanding of how this carbohydrate interacts with the immune system at the site of infection and will lead to broader understanding of how release of galactomannan by Aspergillus effects the immune response in infected patients.
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Affiliation(s)
- Jennifer L. Reedy
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
| | - Arianne J. Crossen
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paige E. Negoro
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah Brown Harding
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca A. Ward
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Diego A. Vargas-Blanco
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle D. Timmer
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher M. Reardon
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle J. Basham
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael K. Mansour
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
| | - Marcel Wüthrich
- Department of Pediatrics, University of Wisconsin Medical School, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Thierry Fontaine
- Institut Pasteur, Université de Paris, INRAE, USC2019, Unité Biologie et Pathogénicité Fongiques, Paris, France
| | - Jean-Paul Latgé
- Institute of Molecular Biology and Biotechnology (IMBBFORTH), University of Crete, Heraklion, Greece
| | - Jatin M. Vyas
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
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Hopke A, Lin T, Scherer AK, Shay AE, Timmer KD, Wilson-Mifsud B, Mansour MK, Serhan CN, Irimia D, Hurley BP. Transcellular Biosynthesis of Leukotriene B4 Orchestrates Neutrophil Swarming to Fungi. iScience 2022; 25:105226. [PMID: 36267914 PMCID: PMC9576560 DOI: 10.1016/j.isci.2022.105226] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/25/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022] Open
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Viens AL, Timmer KD, Alexander NJ, Barghout R, Milosevic J, Hopke A, Atallah NJ, Scherer AK, Sykes DB, Irimia D, Mansour MK. TLR Signaling Rescues Fungicidal Activity in Syk-Deficient Neutrophils. J Immunol 2022; 208:1664-1674. [PMID: 35277418 PMCID: PMC8976732 DOI: 10.4049/jimmunol.2100599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
An impaired neutrophil response to pathogenic fungi puts patients at risk for fungal infections with a high risk of morbidity and mortality. Acquired neutrophil dysfunction in the setting of iatrogenic immune modulators can include the inhibition of critical kinases such as spleen tyrosine kinase (Syk). In this study, we used an established system of conditionally immortalized mouse neutrophil progenitors to investigate the ability to augment Syk-deficient neutrophil function against Candida albicans with TLR agonist signaling. LPS, a known immunomodulatory molecule derived from Gram-negative bacteria, was capable of rescuing effector functions of Syk-deficient neutrophils, which are known to have poor fungicidal activity against Candida species. LPS priming of Syk-deficient mouse neutrophils demonstrates partial rescue of fungicidal activity, including phagocytosis, degranulation, and neutrophil swarming, but not reactive oxygen species production against C. albicans, in part due to c-Fos activation. Similarly, LPS priming of human neutrophils rescues fungicidal activity in the presence of pharmacologic inhibition of Syk and Bruton's tyrosine kinase (Btk), both critical kinases in the innate immune response to fungi. In vivo, neutropenic mice were reconstituted with wild-type or Syk-deficient neutrophils and challenged i.p. with C. albicans. In this model, LPS improved wild-type neutrophil homing to the fungal challenge, although Syk-deficient neutrophils did not persist in vivo, speaking to its crucial role on in vivo persistence. Taken together, we identify TLR signaling as an alternate activation pathway capable of partially restoring neutrophil effector function against Candida in a Syk-independent manner.
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Affiliation(s)
- Adam L Viens
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA;
| | - Kyle D Timmer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | | | - Rana Barghout
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Stem Cell Institute, Boston, MA
| | - Jelena Milosevic
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Stem Cell Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alex Hopke
- Harvard Medical School, Boston, MA
- Shriners Burns Hospital, Boston, MA; and
- Center for Engineering in Medicine and Surgery, Department of Surgery, Harvard Medical School, Boston, MA
| | - Natalie J Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Allison K Scherer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - David B Sykes
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Stem Cell Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Daniel Irimia
- Harvard Medical School, Boston, MA
- Shriners Burns Hospital, Boston, MA; and
- Center for Engineering in Medicine and Surgery, Department of Surgery, Harvard Medical School, Boston, MA
| | - Michael K Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA;
- Harvard Medical School, Boston, MA
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6
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Atallah NJ, Warren HM, Roberts MB, Elshaboury RH, Bidell MR, Gandhi RG, Adamsick M, Ibrahim MK, Sood R, Bou Zein Eddine S, Cobler-Lichter MJ, Alexander NJ, Timmer KD, Atallah CJ, Viens AL, Panossian VS, Scherer AK, Proctor T, Smartt S, Letourneau AR, Paras ML, Johannes S, Wiemer J, Mansour MK. Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study. PLoS One 2022; 17:e0262342. [PMID: 35025929 PMCID: PMC8758006 DOI: 10.1371/journal.pone.0262342] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Coronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). METHODS Adult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records. RESULTS 324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia. CONCLUSIONS Baseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.
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Affiliation(s)
- Natalie J. Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail: (MM); (NA)
| | - Hailey M. Warren
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Matthew B. Roberts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ramy H. Elshaboury
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Monique R. Bidell
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ronak G. Gandhi
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Meagan Adamsick
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Maryam K. Ibrahim
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rupali Sood
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Savo Bou Zein Eddine
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Natalie J. Alexander
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Kyle D. Timmer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Adam L. Viens
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Vahe S. Panossian
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Allison K. Scherer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Teddie Proctor
- Fisher Diagnostics, Part of Thermo Fisher Scientific, Middletown, VA, United States of America
| | - Sherrie Smartt
- Fisher Diagnostics, Part of Thermo Fisher Scientific, Middletown, VA, United States of America
| | - Alyssa R. Letourneau
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Molly L. Paras
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sascha Johannes
- B·R·A·H·M·S GmbH, Part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Jan Wiemer
- B·R·A·H·M·S GmbH, Part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Michael K. Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail: (MM); (NA)
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