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Jess J, Yates B, Dulau-Florea A, Parker K, Inglefield J, Lichtenstein D, Schischlik F, Ongkeko M, Wang Y, Shahani S, Cullinane A, Smith H, Kane E, Little L, Chen D, Fry TJ, Shalabi H, Wang HW, Satpathy A, Lozier J, Shah NN. CD22 CAR T-cell associated hematologic toxicities, endothelial activation and relationship to neurotoxicity. J Immunother Cancer 2023; 11:e005898. [PMID: 37295816 PMCID: PMC10277551 DOI: 10.1136/jitc-2022-005898] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hematologic toxicities, including coagulopathy, endothelial activation, and cytopenias, with CD19-targeted chimeric antigen receptor (CAR) T-cell therapies correlate with cytokine release syndrome (CRS) and neurotoxicity severity, but little is known about the extended toxicity profiles of CAR T-cells targeting alternative antigens. This report characterizes hematologic toxicities seen following CD22 CAR T-cells and their relationship to CRS and neurotoxicity. METHODS We retrospectively characterized hematologic toxicities associated with CRS seen on a phase 1 study of anti-CD22 CAR T-cells for children and young adults with relapsed/refractory CD22+ hematologic malignancies. Additional analyses included correlation of hematologic toxicities with neurotoxicity and exploring effects of hemophagocytic lymphohistiocytosis-like toxicities (HLH) on bone marrow recovery and cytopenias. Coagulopathy was defined as evidence of bleeding or abnormal coagulation parameters. Hematologic toxicities were graded by Common Terminology Criteria for Adverse Events V.4.0. RESULTS Across 53 patients receiving CD22 CAR T-cells who experienced CRS, 43 (81.1%) patients achieved complete remission. Eighteen (34.0%) patients experienced coagulopathy, of whom 16 had clinical manifestations of mild bleeding (typically mucosal bleeding) which generally subsided following CRS resolution. Three had manifestations of thrombotic microangiopathy. Patients with coagulopathy had higher peak ferritin, D-dimer, prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), tissue factor, prothrombin fragment F1+2 and soluble vascular cell adhesion molecule-1 (s-VCAM-1). Despite a relatively higher incidence of HLH-like toxicities and endothelial activation, overall neurotoxicity was generally less severe than reported with CD19 CAR T-cells, prompting additional analysis to explore CD22 expression in the central nervous system (CNS). Single-cell analysis revealed that in contrast to CD19 expression, CD22 is not on oligodendrocyte precursor cells or on neurovascular cells but is seen on mature oligodendrocytes. Lastly, among those attaining CR, grade 3-4 neutropenia and thrombocytopenia were seen in 65% of patients at D28. CONCLUSION With rising incidence of CD19 negative relapse, CD22 CAR T-cells are increasingly important for the treatment of B-cell malignancies. In characterizing hematologic toxicities on CD22 CAR T-cells, we demonstrate that despite endothelial activation, coagulopathy, and cytopenias, neurotoxicity was relatively mild and that CD22 and CD19 expression in the CNS differed, providing one potential hypothesis for divergent neurotoxicity profiles. Systematic characterization of on-target off-tumor toxicities of novel CAR T-cell constructs will be vital as new antigens are targeted. TRIAL REGISTRATION NUMBER NCT02315612.
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Affiliation(s)
- Jennifer Jess
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bonnie Yates
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alina Dulau-Florea
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Kevin Parker
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Jon Inglefield
- Applied Developmental Research Directorate, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Dan Lichtenstein
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Fiorella Schischlik
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, Maryland, USA
| | - Martin Ongkeko
- Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Yanyu Wang
- Applied Developmental Research Directorate, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Shilpa Shahani
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ann Cullinane
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Hannah Smith
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eli Kane
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lauren Little
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dong Chen
- Mayo Clinic, Rochester, Minnesota, USA
| | - Terry J Fry
- University of Colorado Denver Children's Hospital Colorado Research Institute, Aurora, Colorado, USA
| | - Haneen Shalabi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hao-Wei Wang
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Ansuman Satpathy
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Jay Lozier
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Reddy OL, Sall MT, Dinh A, Cai Y, Ongkeko M, Arya N, Wilder J, Tran M, Jin P, Stroncek DF, Panch SR. Effects of extended transport on cryopreserved allogeneic hematopoietic progenitor cell (HPC) product quality and optimal methods to assess HPC stability. Transfusion 2023; 63:774-781. [PMID: 36975826 DOI: 10.1111/trf.17314] [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] [Received: 08/20/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 03/29/2023]
Abstract
BACKGROUND Since the beginning of the COVID-19 pandemic, cryopreservation of hematopoietic progenitor cell (HPC) products has been increasingly used to ensure allogeneic donor graft availability prior to recipient conditioning for transplantation. However, in addition to variables such as graft transport duration and storage conditions, the cryopreservation process itself may adversely affect graft quality. Furthermore, the optimal methods to assess graft quality have not yet been determined. STUDY DESIGN AND METHODS A retrospective review was performed on all cryopreserved HPCs processed and thawed at our facility from 2007 to 2020, including both those collected onsite and by the National Marrow Donor Program (NMDP). HPC viability studies were also performed on fresh products, retention vials, and corresponding final thawed products by staining for 7-AAD (flow cytometry), AO/PI (Cellometer), and trypan blue (manual microscopy). Comparisons were made using the Mann-Whitney test. RESULTS For HPC products collected by apheresis (HPC(A)), pre-cryopreservation and post-thaw viabilities, as well as total nucleated cell recoveries were lower for products collected by the NMDP compared to those collected onsite. However, there were no differences seen in CD34+ cell recoveries. Greater variation in viability testing was observed using image-based assays compared to flow-based assays, and on cryo-thawed versus fresh samples. No significant differences were observed between viability measurements obtained on retention vials versus corresponding final thawed product bags. DISCUSSION Our studies suggest extended transport may contribute to lower post-thaw viabilities, but without affecting CD34+ cell recoveries. To assess HPC viability prior to thaw, testing of retention vials offers predictive utility, particularly when automated analyzers are used.
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Affiliation(s)
- Opal L Reddy
- Department of Pathology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Mame Thioye Sall
- Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Anh Dinh
- Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Yihua Cai
- Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin Ongkeko
- Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Nina Arya
- Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Wilder
- NIH Unrelated Donor Hematopoietic Stem Cell Transplant Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Minh Tran
- Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Ping Jin
- Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - David F Stroncek
- Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandhya R Panch
- Division of Hematology, University of Washington, Seattle, Washington, USA
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Gedda MR, Danaher P, Shao L, Ongkeko M, Chen L, Dinh A, Thioye Sall M, Reddy OL, Bailey C, Wahba A, Dzekunova I, Somerville R, De Giorgi V, Jin P, West K, Panch SR, Stroncek DF. Longitudinal transcriptional analysis of peripheral blood leukocytes in COVID-19 convalescent donors. J Transl Med 2022; 20:587. [PMID: 36510222 PMCID: PMC9742656 DOI: 10.1186/s12967-022-03751-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND SARS-CoV2 can induce a strong host immune response. Many studies have evaluated antibody response following SARS-CoV2 infections. This study investigated the immune response and T cell receptor diversity in people who had recovered from SARS-CoV2 infection (COVID-19). METHODS Using the nCounter platform, we compared transcriptomic profiles of 162 COVID-19 convalescent donors (CCD) and 40 healthy donors (HD). 69 of the 162 CCDs had two or more time points sampled. RESULTS After eliminating the effects of demographic factors, we found extensive differential gene expression up to 241 days into the convalescent period. The differentially expressed genes were involved in several pathways, including virus-host interaction, interleukin and JAK-STAT signaling, T-cell co-stimulation, and immune exhaustion. A subset of 21 CCD samples was found to be highly "perturbed," characterized by overexpression of PLAU, IL1B, NFKB1, PLEK, LCP2, IRF3, MTOR, IL18BP, RACK1, TGFB1, and others. In addition, one of the clusters, P1 (n = 8) CCD samples, showed enhanced TCR diversity in 7 VJ pairs (TRAV9.1_TCRVA_014.1, TRBV6.8_TCRVB_016.1, TRAV7_TCRVA_008.1, TRGV9_ENST00000444775.1, TRAV18_TCRVA_026.1, TRGV4_ENST00000390345.1, TRAV11_TCRVA_017.1). Multiplexed cytokine analysis revealed anomalies in SCF, SCGF-b, and MCP-1 expression in this subset. CONCLUSIONS Persistent alterations in inflammatory pathways and T-cell activation/exhaustion markers for months after active infection may help shed light on the pathophysiology of a prolonged post-viral syndrome observed following recovery from COVID-19 infection. Future studies may inform the ability to identify druggable targets involving these pathways to mitigate the long-term effects of COVID-19 infection. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04360278 Registered April 24, 2020.
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Affiliation(s)
- Mallikarjuna R. Gedda
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA ,grid.280030.90000 0001 2150 6316Section of Retinal Ganglion Cell Biology, Laboratory of Retinal Cell and Molecular Biology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892 USA
| | - Patrick Danaher
- grid.510973.90000 0004 5375 2863NanoString Technologies, Seattle, WA 98109 USA
| | - Lipei Shao
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Martin Ongkeko
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Leonard Chen
- grid.94365.3d0000 0001 2297 5165Blood Services Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Anh Dinh
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Mame Thioye Sall
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Opal L. Reddy
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Christina Bailey
- grid.510973.90000 0004 5375 2863NanoString Technologies, Seattle, WA 98109 USA
| | - Amy Wahba
- grid.510973.90000 0004 5375 2863NanoString Technologies, Seattle, WA 98109 USA
| | - Inna Dzekunova
- grid.510973.90000 0004 5375 2863NanoString Technologies, Seattle, WA 98109 USA
| | - Robert Somerville
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Valeria De Giorgi
- grid.94365.3d0000 0001 2297 5165Infectious Disease Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Ping Jin
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Kamille West
- grid.94365.3d0000 0001 2297 5165Blood Services Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
| | - Sandhya R. Panch
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA ,grid.34477.330000000122986657Department of Medicine (Hematology Division), University of Washington/Fred Hutchinson Cancer Center, Seattle, WA 98109 USA
| | - David F. Stroncek
- grid.94365.3d0000 0001 2297 5165Center for Cellular Engineering, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892 USA
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Gedda M, Danaher P, Saho L, Ongkeko M, Chen L, Sall MT, Reddy O, Bailey C, Wahba A, Dzekunova I, Giorgi VD, Somerville R, Ping J, West K, Panch S, Stroncek D. 953 Transcriptional analysis of leukocytes from COVID convalescent donors reveals persistent activation of the innate and adaptive immune system. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundCoronavirus disease 2019 (COVID-19) results in robust but dysregulated acute immune response characterized by pro-inflammatory cytokine production and T-cell exhaustion, but little is known concerning immune response following recovery. We assessed immune function in convalescent plasma donors (CCD) who had recovered from COVID-19.MethodsThe cellular immune response and T-cell receptor (TCR) diversity in CCD was investigated using the nCounter host response and TCR diversity panels. 270 CCD and 40 healthy donor (HD) blood samples collected 11 to 193 days after diagnosis were analyzed. The CCD samples were from 162 donors, 69 donated more than once. All HD donated only once.ResultsMany genes were differentially expressed for months following infection. Analysis of samples collected 0 to 90 days post-diagnosis found that 19 of 773 genes were differentially expressed among CCD and HD (FDR < 0.05) (figure 1a). At 90 to 120 days, 120 to 150 and >150 post-diagnosis, 13, 58 and 4 genes were differentially expressed respectively (FDR < 0.05) (figures 1b-d). At 120 to 150 days the differentially expressed genes included those in Treg differentiation, type III interferon signaling and chemokine signaling pathways. 76 genes were differently expressed at least once during the time windows described above. (Figure 1e). Among CCD, the expression of CTLA-4, ICOS, ICOSLG, OSM and CXCR4 were initially elevated but fell to HD levels at the end of the study period. The expression of LILRA6, CCR2 and CX3CR1 increased or remained elevated throughout (figure 1f).A subset of samples departed notably from the average trend. The transcriptome of each CCD sample was scored by its similarity to the mean transcriptome of HD samples. This analysis revealed 21 CCD samples from 19 unique donors were highly perturbed from HD samples (figure 2a). Among these highly perturbed samples 80% were collected > 90 days post-diagnosis. The perturbed samples clustered into two groups, labelled P1 and P2 (figure 2b) and displayed dysregulation of distinct gene sets (figures 2c, 2d). The P1 were characterized by increased expression of genes in myeloid inflammation, type 1 interferon and innate immune signaling pathways, lower COVID antibody levels and increased T-cell receptor diversity. P2 were characterized by highly up-regulated CD44, BCL2, TGFB1, IL18BP, IL27RA, and IL11RA.Abstract 953 Figure 1Longitudinal trends in CCD gene expression. a-d: Differential expression results in HD vs. 4 time windows of CCD. Genes with FDR <0.1 are labeled; e: average CCD log2 fold-changes from HD over time. Color is only given for times where the Loess regression is different from the mean HD with p < 0.05; f: longitudinal results for selected genes. Orange lines connect CCD samples over time. Blue lines show inner 95% quantiles of HD samplesAbstract 953 Figure 2CCD with more severe departure from HD gene expression. a: CCD samples (in orange) were scored for perturbation from the mean HD (in blue), and 21 highly perturbed sample subsets emerged; b: clustering of the 21 highly perturbed patients. The dendrogram was cut to define two groups. c: volcano plots comparing expression in P1 (left) and P2 (right) vs. CCD; d: longitudinal trends of selected genes perturbed in P1 and P2ConclusionsImmune dysregulation in CCD continues at least 6 months post-infection. Some CCDs experienced marked transcriptional changes which may be the result of COVID-19 reactivation and could be responsible for long-haul syndrome.AcknowledgementsN/ATrial RegistrationNCT04360278ReferencesN/A Ethics ApprovalN/AConsentN/A
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Jeong J, Naab T, Ongkeko M, Makambi K, Khan FA, Blancato J. Abstract 737: Signficant DLX4 expression in inflammatory breast cancer tumors from African American patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To examine protein expression characteristics of Distal-less homeobox4 (DLX4) in inflammatory breast cancer (IBC) cases from an African-American population to determine if a) DLX4 over-expression occurs in IBC vs. normal mammary tissue and b) over-expression is associated with clinico-pathologic features such as ER, PR, HER2.
Experimental Design: Twenty nine blocks of formalin-fixed paraffin-embedded (FFPE) tissues from well-characterized human IBC cases were used for immuno-histochemical staining (IHC). Tumor tissues were from African American subjects seen at Howard University Hospital. Normal breast tissues from 30 mammoplasties were controls. IHC results were assigned intensity and percentage scores based upon intensity of positive staining and % of stained cells. Percentage scores were assigned as 0, 1 (0%-25%), 2 (26%-50%), 3 (51%-75%) or 4 (76%-100%) and intensity scores were assigned 0, 1+, 2+ or 3+. For the analysis of the IHC, a percentage score of 3 or 4 was considered high and an intensity score of 2+ or 3+ was categorized as high. Chi-square and Fisher’s exact tests were used for analysis.
Results: The staining pattern for the categorized cohort in which 82.8% (24 out of 29) of IBC cases showed high percentages of positive cells staining for DLX4 protein, while 40.0% (12 out of 30) normal breast tissues demonstrated DLX4 expression (P=0.001). In terms of staining intensity, 75.9% (22 out of 29) of IBC cases showed a high level of intensity, compared to 20.0% (6 out of 30) of normal breast tissues (P<0.001). In terms of the association between breast cancer characteristics and IHC staining, intensity of DLX4 was higher in HER2- (87.0%, 20 out of 23) than HER2+ (33.3%, 2 out of 6; P=0.018). Other associations were not statistically significant in this pilot study.
Conclusions: DLX4 expression is significantly higher in this pilot study of IBC cases from AA patients than in normal breast tissue cases. In addition, HER2- is associated with high intensity of DLX4 expression in IBC.
Associations DLX4 protein expression (IHC) In IBC and normal breast tissuesLowHighP-valuePercent positivityn (%)n (%)Controls (n=30)18 (60.0)12 (40.0)0.001IBCs (n=29)5 (17.2)24 (82.8)Staining intensityn (%)n (%)Controls (n=30)24 (80.0)6 (20.0)<0.001IBCs (n=29)7 (24.1)22 (75.9)
Citation Format: Jaehong Jeong, Tammey Naab, Martin Ongkeko, Kepher Makambi, Farhan A. Khan, Jan Blancato. Signficant DLX4 expression in inflammatory breast cancer tumors from African American patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 737. doi:10.1158/1538-7445.AM2017-737
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