CN105296620B - 肠道宏基因组特征作为2型糖尿病阿卡波糖疗效筛选标志 - Google Patents
肠道宏基因组特征作为2型糖尿病阿卡波糖疗效筛选标志 Download PDFInfo
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Abstract
本发明公开了一种肠道宏基因组特征作为2型糖尿病阿卡波糖疗效筛选标志;所述肠道微生物宏基因特征为拟杆菌属肠型。本发明首次运用肠型的概念发现了,具有不同肠道寄生菌群的2型糖尿病患者,对糖尿病降糖药物,阿卡波糖的治疗反应差别显著,因此,在用该药前,可以对患者进行肠型的分型,以选择最佳疗效人群,判别个体2型糖尿病患者是否适合运用阿卡波糖进行糖尿病治疗。此外,肠型惯常的分型是利用粪便中的寄生菌的DNA进行测序或PCR扩增,然而基线情况下胆汁酸组分,尤其是次级胆汁酸即能对肠型有良好的区分作用;可实现通过血中的标志物鉴定肠型,成为用于诊断的标志。
Description
技术领域
本发明具体涉及一种肠道微生物宏基因特征在作为2型糖尿病阿卡波糖疗效筛选标志物中的用途。
背景技术
目前2型糖尿病治疗领域并没有药物疗效判断,以及治疗前的分型诊断。根据2型糖尿病的病理生理机制,主要为胰岛素抵抗和胰岛素分泌缺陷。虽然2型糖尿病治疗领域内分别有针对胰岛素抵抗和胰岛素分泌缺陷的药物,但是对于患者本身以胰岛素抵抗还是分泌缺陷为主的分型诊断并没有科学简便可行的方法。
现有临床上有可行性的方案是,测量患者BMI,腰围和胰岛素水平。BMI,腰围超过中国人标准,或者通过患者空腹血糖和胰岛素水平计算HOMAIR值即可判断其存在胰岛素抵抗。而胰岛素水平并无国际或国内通用标准,一般以患者血糖和胰岛素计算得HOMAβ指数来代表,但无法做为判断胰岛素抵抗和胰岛素分泌缺陷的程度的指标,因此无法满足精准医疗的要求。
临床上目前能够精确评判胰岛素抵抗和β细胞功能的实验为葡萄糖钳夹实验。评判胰岛素抵抗水平运用正糖高胰岛素水平的葡萄糖钳夹实验,而β细胞胰岛素分泌功能运用高葡萄糖水平的钳夹实验。这两种方法历时长,患者需卧床4-5个小时,需名有经验的医护人员操作,对患者进行多点采血,实时监测血糖,同时测定胰岛素水平。代价高昂,患者依从性差,不易在临床开展。
所谓精准医学把临床个体化诊疗的诉求提到了一个新的高度。肿瘤靶向药物已经应用到临床。然而,迄今并未找到一个2型糖尿病靶向治疗的有效方案。2型糖尿病的治疗方案繁多,患者反应不一,是导致2型糖尿病的血糖控制率低下的一个原因。针对2型糖尿病主要发病机制,胰岛素分泌缺陷和胰岛素抵抗的药物种类不可谓不多,但是患者本身以胰岛素抵抗为主,还是胰岛素分泌缺陷为主并没有简单确切的临床诊断方法。
目前的研究把肝脏、脂肪(胰岛素抵抗)和胰岛β细胞(胰岛功能)做为参与2型糖尿病发病的主要器官。而最近肠道微生物群落以及肠道粘膜上皮吸收,屏障以及内分泌功能的病理生理在2型糖尿病的发病机制以及治疗策略中的地位越来越受到重视。比如肠道菌群宏基因组研究发现,肠道菌群在2型糖尿病患者和正常患者中有显著差异[Qin,J.,etal.,A metagenome-wide association study of gut microbiota in type2diabetes.Nature,2012.]而肠道改道的减肥手术除了减轻肥胖患者的体重,出乎意料得可使得肥胖型2型糖尿病患者的血糖在术后脱离药物治疗也能得到良好的控制,甚至达到彻底治愈[Carlsson,L.M.S.,et al.,Bariatric Surgery and Prevention of Type2Diabetes in Swedish Obese Subjects.New England Journal of Medicine,2012.367(8):p.695-704,Schauer,P.R.,et al.,Bariatric surgery versus intensive medicaltherapy for diabetes--3-year outcomes.N Engl J Med,2014.370(21):p.2002-13]。而模拟肠道激素作用的药物,比如GLP-1激动剂以及DPPIV抑制剂等也已成为世界范围内处方量最大的口服降糖药物,并有不少相关心血管的受益。
肠型[Arumugam,M.,et al.,Enterotypes of the human gutmicrobiome.Nature,2011.473(7346):p.174-80]的概念被Peer Bork首次提出,意即肠道寄生菌组成成分在人群中有比较固定的模式。人群中大概可以分成2-3类,随着样本的增多和测序技术的提高,尤其是二代测序的推广,目前的肠型分型为2类,一个普氏菌属为主的普氏肠型,一个是拟杆菌属为主的拟杆肠型。目前看来肠型和人体的各种医疗健康指标并未找到直接相关的证据,相应的基因功能研究提示不同肠型代谢维生素的能力有差异,且与宿主荤素饮食习惯有关。然而,虽然肠道寄生菌群也被认为是参与药物在人体内代谢的一个重要媒介[Haiser,H.J.and P.J.Turnbaugh,Is it time for a metagenomic basisof therapeutics?Science,2012.336(6086):p.1253-5],目前无临床试验证据可以证明。
发明内容
本发明的目的在于针对上述现有技术存在的肠型和人体的各种医疗健康指标缺少直接相关的证据的缺陷,提供了肠道宏基因组特征作为2型糖尿病阿卡波糖疗效筛选标志;具体提供了一种肠道微生物宏基因特征在作为2型糖尿病阿卡波糖疗效筛选标志物中的用途。本发明首次发现具有不同肠道寄生菌群的2型糖尿病患者,对糖尿病降糖药物,阿卡波糖的治疗反应差别显著,因而,以拟杆菌属为主的拟杆肠型可作为2型糖尿病患者阿卡波糖疗效筛选标志。
本发明的目的是通过以下技术方案来实现的:
本发明涉及一种肠道微生物宏基因特征在作为2型糖尿病阿卡波糖疗效筛选标志物中的用途,所述肠道微生物宏基因特征为拟杆菌属肠型。
优选的,所述拟杆菌属肠型是通过对离体粪便中的寄生菌的DNA进行测序或PCR扩增来确定的。
优选的,所述PCR扩增具体包括:提取离体粪便中寄生菌DNA,针对特异富集的菌属,进行16Srna PCR扩增。
优选的,所述拟杆菌属肠型是通过检测离体血液样本中的次级胆汁酸来确定的。所述次级胆汁酸包括UDCA、TUDCA、GUDCA、DCA、TDCA、GDCA、LCA、TLCA、GLCA。在本发明研究的对象中,主要发现两种肠型一个普氏菌为主的普氏肠型,一个是拟杆菌为主的拟杆肠型。在拟杆肠型中,次级胆汁酸中的脱氧胆酸和石胆酸水平显著低于普氏肠型,而有保护作用的熊脱氧胆酸则高于普氏肠型。进一步肠道宏基因组分析,也发现熊去氧胆酸进一步降解成石胆酸的KO明显在普氏肠型中富集。说明两种肠型的患者,其肠道菌群代谢胆汁酸的能力有显著差异。
优选的,所述次级胆汁酸的检测包括如下步骤:
S1、样品预处理:每75μL血液样品,加入300μL含内标甲醇,提取目标化合物并沉淀蛋白,涡旋、离心,吸取上清,冻干,用50μL含25%(体积)乙腈水溶液复溶,等待进样;
S2、检测:采用1290Infinity液相及6460A三重四级杆质谱联用系统用于样品分析;
液相分离采用100mm×2.1mm ACQUITY UPLC C8色谱柱,粒径1.7μm,A相为10mMNH4HCO3水溶液,B相为纯乙腈;初始时25%(体积)B相,保持0.5分钟,随后在12.5分钟内线性升高到40%(体积)B相,接着,在1min内升高到90%(体积)B相,并冲洗系统3分钟,在0.5分钟恢复到25%(体积)B相,平衡2.5分钟,流速为0.35ml/min,柱温35℃,进样体积5μL;
质谱采用ESI源负离子模式检测,主要参数如下:Gas Temp:350℃;Gas Flow:8l/min;Nebulizer:40psi;Sheath Gas Temp:400℃;Sheath Gas Flow:8l/min;Capillary:3500V;Nozzle voltage:400V。
优选的,拟杆菌属肠型的2型糖尿病患者阿卡波糖疗效包括降糖外改善胰岛素抵抗、降低次级胆汁酸、促进心血管风险降低。
优选的,所述降低有害次级胆汁酸的指标包括:GDCA,TDCA,TLCA,降低牛磺酸结合胆汁酸指标包括,TCA,TDCA,TLCA,TUDCA。
优选的,所述改善胰岛素抵抗的指标包括空腹血糖下降,空腹C肽和胰岛素水平的下降,腰臀比下调,HOMA胰岛素抵抗指数下调,Adiponectin上调。
优选的,所述促进心血管风险降低的指标包括PDGFAA、PDGFAABB、内皮素、VegfC血浆因子的下降。
本发明还涉及一种用于2型糖尿病阿卡波糖疗效筛选的试剂盒,所述试剂盒包括:
收集离体粪便样品或离体血液样品的试剂;
对离体粪便样品中的寄生菌的DNA进行测序或PCR扩增来确定肠型的试剂,或检测离体血液样本中的次级胆汁酸来确定肠型的试剂。
检测出的肠型主要有两种肠型,一个是普氏菌为主的普氏肠型,一个是拟杆菌为主的拟杆肠型。不同肠型可以预测患者接受阿卡波糖治疗糖尿病的受益,尤其是降糖外改善胰岛素抵抗,降低次级胆汁酸,促进心血管风险降低的作用。具体而言,拟杆菌属肠型具有更好的降糖外改善胰岛素抵抗,降低次级胆汁酸,促进心血管风险降低的作用。
与现有技术相比,本发明具有如下有益效果:
1)本发明首次运用肠型的概念发现了,具有不同肠道寄生菌群的2型糖尿病患者,对糖尿病降糖药物,阿卡波糖的治疗反应差别显著。因此,在用该药前,可以对患者进行肠型的分型,以选择最佳疗效人群,判别个体2型糖尿病患者是否适合运用阿卡波糖进行糖尿病治疗。
2)肠型惯常的分型是利用粪便中的寄生菌的DNA进行测序或PCR扩增,然而基线情况下胆汁酸组分,尤其是次级胆汁酸即能对肠型有良好的区分作用;可实现通过血中的标志物(即血浆中次级胆汁酸的水平)鉴定肠道寄生菌群落的分型(即,肠型),成为用于诊断的标志。
附图说明
图1为肠型分型示意图,其中,A、拟杆菌肠型生物属水平聚类及相关关系,B、普氏菌肠型生物属水平聚类及相关关系,C、拟杆菌属生物丰度在两个肠型中的比较,D、普氏菌属生物丰度在两个肠型中的比较,EntB:拟杆菌肠型。EntP:普氏菌肠型;
图2为两种肠型中各类临床疗效指标在阿卡波糖治疗后的变化示意图,黑色代表治疗后显著下降,白色代表治疗后显著上升,灰色代表治疗后无显著变化,P<0.05;
图3为胆汁酸谱在两种肠型中的差异及阿卡波糖治疗后的变化示意图,其中,A、两种肠型基线水平有差异的胆汁酸,B、两种肠型胆汁酸谱在两个肠型基线中的差异,C、次级胆汁酸代谢相关两条KO在两个肠型基线水平中的差异,D、两种肠型在阿卡波糖治疗后水平有变化的胆汁酸成分及其信号图,黑色代表治疗后显著下降,白色代表治疗后显著上升,灰色代表治疗后无显著变化,P<0.05。
具体实施方式
下面结合实施例对本发明进行详细说明。以下实施例将有助于本领域的技术人员进一步理解本发明,但不以任何形式限制本发明。应当指出的是,对本领域的普通技术人员来说,在不脱离本发明构思的前提下,还可以做出若干调整和改进。这些都属于本发明的保护范围。
实施例
对初发2型糖尿病患者进行用药前评估肝肾功能,血糖血脂指标,肠道激素,炎症因子,以及心血管风险相关因子。并留取大便,尿液,以及血样。诊断明确,评估完成后,给予3个月阿卡波糖300mg每天的剂量进行治疗。3月内每月随访血糖,根据血糖调整用药。3月后,重复用药前评估,并同样留取尿液,大便和血样。
具体步骤如下:
1、临床标本收集
a)首先运用随机开放、阳性对照方法,收集初发2型糖尿病人群及其正常配偶对照人群,比较糖尿病患者服用阿卡波糖前后不同时期的临床及生化资料,胃肠运动情况并同时收集血样及粪便标本。在初诊未用药的2型糖尿病患者进行常规检查,包括粪便和血样留取。粪便样品的采集
b)粪便
ⅰ、实验器材:塑料小盆(直径小于家用抽水马桶口径)
ⅱ、保鲜袋,无菌细长柄小勺
ⅲ、无菌50ml离心管
ⅳ、将塑料小盆(直径小于家用抽水马桶口径)放入抽水马桶中,套上保鲜袋(勿将保鲜袋边缘浸入马桶的水中);如在医院内取样可直接在清洁便盆内套上保鲜袋,留取粪便样品;
ⅴ、用细长柄小勺将新鲜粪便样品上层混匀,挑取少量装入无菌的50ml离心管中,每管取至少10g样品,旋紧管盖(离心管壁上标明采样时间,采样个体组别、编号)。每个受试者每次留取大便,共取3管样品(RNAlater处理管,甘油管,以及无处理管)
ⅵ、采集的样品均立即置于-80℃冻存。
c)血清标本的留置
ⅰ、空腹抽取静脉血15ml,其中1.5ml检测血浆糖,余6.5ml于普管(含抑肽酶,DPPV抑制剂),6.5ml于抗凝管(含肝素和RNA later)
ⅱ、普管血于4℃离心,待血清析出后吸出约3ml,平均分于3个1.5ml Eppendorf中,盖紧管盖;
ⅲ、抗凝血需立即于4℃离心,析出血浆约3ml,平均分于3个1.5ml进口RNAasefree Eppendorf管中,
ⅳ、管上详细注明标本姓名,中心编号和随机号;
ⅴ、用胶布封管盖一周;
ⅵ、置于-20℃保存(有条件者可置于-80℃),分装血浆需立即置于-20℃或干冰内。
2、胆汁酸测定
试剂:Sodium taurochenodeoxycholate(TCDCA),Sodium glycocholate hydrate(GCA),Sodium taurodeoxycholate(TDCA),Chenodeoxycholic acid(CDCA),Ursodeoxycholic acid(UDCA),Taurocholic acid(TCA),Sodium glycodeoxycholate(GDCA),Glycoursodeoxycholic acid(GUDCA),Cholic acid(CA),Deoxycholic acid(DCA),Sodium glycochenodeoxycholate(GCDCA),Sodium tauroursodeoxycholate(TUDCA),Sodium taurolithocholate(TLCA),Lithocholic acid(LCA),NH4HCO3均购自美国Sigma公司;Glycochenodeoxycholic Acid 3-Sulfate Disodium Salt(GCDCS)由浙江大学实验室合成;Chenodeoxycholic Acid-d4(CDCA-d4),Glycochenodeoxycholic Acid-d53-Sulfate Disodium Salt(GCDCS-d5),Taurochenodeoxycholic Acid-d5(TCDCA-d5),Cholic Acid-d5(CA-d5),Glycocholic acid-d5(GCA-d5),Lithocholylglycine(GLCA)均购自加拿大TRC公司;Taurodeoxycholic Acid-d5(TDCA-d5),Taurocholic acid-d5(TCA-d5)购自美国CIL公司。乙腈,甲醇购自德国Merk公司。
样品预处理:取血液样品75μL,加入300μL含内标甲醇,提取目标化合物并沉淀蛋白,涡旋30S,转速15000rpm离心10min,吸取上清200μL,冻干,用50μL含25%乙腈水溶液复溶,等待进样。仪器方法:1290Infinity液相(Agilent,USA)及6460A三重四级杆质谱(Agilent,USA)联用系统用于样品分析。液相分离采用100mm×2.1mm ACQUITY UPLC C8色谱柱,粒径1.7μm(Waters,USA)。A相10mM NH4HCO3水溶液,B相纯乙腈。初始时25%B相,保持0.5分钟。随后在12.5分钟内线性升高到40%B。接着,在1min内升高到90%B,并冲洗系统3分钟,在0.5分钟恢复到25%B,平衡2.5分钟。流速为0.35ml/min,柱温35℃,进样体积5μL。质谱采用ESI源负离子模式检测。主要参数如下:Gas Temp:350℃;Gas Flow:8l/min;Nebulizer:40psi;Sheath Gas Temp:400℃;Sheath Gas Flow:8l/min;Capillary:3500V;Nozzle voltage:400V。各胆汁酸检测采用反应监测模式(MRM)。内标的配置浓度及主要的质谱参数如表1所示,胆汁酸分析的质谱参数设置如表2所示,
表1内标的配置浓度及主要的质谱参数
表2胆汁酸分析的质谱参数及校正采用内标
3、肠道菌群DNA测序
HiSeq 2500测序,每个样本以350bp长度的片段建库与9.9M人类肠道基因集比对。得到IMG的门,种,属的生物谱系(with门水平是70%的覆盖率和65%识别率,属水平有85%识别率,以及95%的种水平的识别率)。运用主成分分析的方法(PCA)对肠道寄生菌聚类进行分析判断。
本发明通过对患者粪便进行肠道微生物集落DNA抽提和宏基因组二代测序,并与已发表的9.9M人类肠道宏基因组基因集进行比对,比对率达到77%左右。运用聚类分析的方法找到有注释信息的肠道微生物在用药前后有差异的大概143种。根据属水平的情况进行分析的结果,发现2型糖尿病患者基线的肠道菌群有不同聚集的情况,据此根据特征性肠道菌群聚集的情况,得到所谓肠型(Enterotype)。在本发明研究的对象中,主要发现两种肠型一个普氏菌为主的普氏肠型,一个是拟杆菌为主的拟杆肠型(图1)。
根据肠型分型后,两种类型的2型糖尿病患者,性别年龄分布并无显著差异。基线血糖,体重以及各项肝肾功能等健康指标均无明显差异。仅红细胞,血红蛋白和白介6在普氏肠型中略高(P<0.05)。(表3)
治疗后观察基线状态下两组人群对该药治疗糖尿病的疗效。
首先,阿卡波糖最主要的疗效体现在餐后2小时血糖和糖化血红蛋的降低程度。这两个指标并没有在两种肠型中体现出差异(图2,表4)
第二,两种肠型在控制空腹血糖水平上出现了差异,无论是看治疗后较治疗前是否改善,还是看治疗后相对治疗前的改善程度,均在拟杆肠型中显著;而普氏肠型的2型糖尿病患者并无明显的空腹血糖改善。而其余代谢相关指标包括,胰岛素,体重,体重指数,腰围,心血管风险因子以及肠道激素等,均有明显差异。
空腹C肽和胰岛素水平均在拟杆肠型中在治疗后显著下降,经过计算,体现胰岛素抵抗的HOMAIR指数在阿卡波糖治疗后下降,但这种受益仅在拟杆肠型中显著,而普氏肠型中下降不显著。提示拟杆肠型的2型糖尿病患者更易在服用阿卡波糖后改善其胰岛素抵抗的状态。与胰岛素抵抗相关而标准餐诱导的胰岛素释放曲线,腰臀比和Adiponectin水平都是拟杆肠型肠型的T2DM患者接受拜糖平治疗后显著下降。在普氏肠型中这些疗效都不显著。
阿卡波糖带来血清甘油三酯,APOA和舒张压的降低,两个肠型中的治疗后变化并无显著差异,然而PDGFAA和PDGFAABB,内皮素,VegfC等一些和糖尿病血管并发症相关的血浆因子在拟杆肠型中下降显著,提示了有更好的降低血糖降低大血管病变风险以外,拟杆肠型在应用阿卡波糖后亦能收获更多降低血管并发症的益处。
肠道激素中作为最近2型糖尿病治疗领域中的热门靶点,其水平在阿卡波糖的应用中也得到显著改变。在检测到的几个肠道激素中,用药后上升的GLP1,glucagon,PYY,以及各个时间点的ghrelin和GIP都在拟杆肠型中显著,但在普氏肠型中不显著。提示如果阿卡波糖任何通过肠道激素所带来的代谢益处,可能都只在拟杆肠型中更为显著。
第三,两种肠型在基线水平上就出现了胆汁酸谱的差异(图3A、B)。在拟杆肠型中,次级胆汁酸中的脱氧胆酸和石胆酸水平显著低于普氏肠型,而有保护作用的熊脱氧胆酸则高于普氏肠型。进一步肠道宏基因组分析,也发现熊去氧胆酸进一步降解成石胆酸的KO明显在普氏肠型中富集(图3C)。提示两种肠型的患者,其肠道菌群代谢胆汁酸的能力有显著差异。经过阿卡波糖治疗之后,胆汁酸组成差异在两种肠型中更为显著(图3D)。两种初级胆汁酸在阿卡波糖治疗后在两种肠型中菌显著的升高,但并未出现肠型特异的变化,提示阿卡波糖可能整体影响了胆汁酸在小肠的重吸收。
因此,该研究显示,不同肠型可以预测患者接受阿卡波糖治疗糖尿病的受益,尤其是降糖外改善胰岛素抵抗,降低次级胆汁酸,促进心血管风险降低的作用。肠型的诊断,可以运用普通的DNA PCR扩增特征菌属的16sRNA即可完成,方便经济。为2型糖尿病的精准医疗带来新的可能。
表3两个肠型基线临床指标比较
表4
Claims (5)
1.一种肠道微生物宏基因特征在作为2型糖尿病阿卡波糖疗效筛选标志物中的用途,其特征在于,所述肠道微生物宏基因特征为拟杆菌属肠型;
拟杆菌属肠型的2型糖尿病患者阿卡波糖疗效包括降糖外改善胰岛素抵抗、降低次级胆汁酸、促进心血管风险降低。
2.根据权利要求1所述的用途,其特征在于,所述拟杆菌属肠型是通过对离体粪便中的寄生菌的DNA进行测序或PCR扩增来确定的。
3.根据权利要求2所述的用途,其特征在于,所述PCR扩增具体包括:提取离体粪便中寄生菌DNA,针对特异富集的菌属,进行16Srna PCR扩增。
4.根据权利要求1所述的用途,其特征在于,所述改善胰岛素抵抗的指标包括空腹血糖下降,空腹C肽和胰岛素水平的下降,腰臀比下调,HOMA 胰岛素抵抗指数下调,Adiponectin上调。
5.根据权利要求1所述的用途,其特征在于,所述促进心血管风险降低的指标包括PDGFAA、PDGFAABB、VegfC血浆因子的下降。
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CN104540962B (zh) * | 2012-08-01 | 2017-09-19 | 深圳华大基因研究院 | 糖尿病生物标志物及其应用 |
US20150299776A1 (en) * | 2012-10-03 | 2015-10-22 | Metabogen Ab | Identification of a Person having Risk for Atherosclerosis and Associated Disease by the Person's Gut Microbiome and the Prevention of such Diseases |
ES2683826T3 (es) * | 2012-10-17 | 2018-09-28 | Institute National De La Recherche Agronomique | Determinación de la diversidad bacteriana intestinal reducida |
KR101445243B1 (ko) * | 2014-03-28 | 2014-09-29 | 서울대학교산학협력단 | 장내 세균의 군집과 기능의 변화를 이용한 대사성 및 염증성 질환의 조기진단 |
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2015
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- 2015-12-16 US US15/771,398 patent/US20180340225A1/en not_active Abandoned
- 2015-12-16 KR KR1020187003917A patent/KR102061985B1/ko active IP Right Grant
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JP2018516593A (ja) | 2018-06-28 |
EP3301185A1 (en) | 2018-04-04 |
EP3301185A4 (en) | 2018-06-13 |
KR20180021388A (ko) | 2018-03-02 |
EP3301185B1 (en) | 2021-09-15 |
JP6644133B2 (ja) | 2020-02-12 |
KR102061985B1 (ko) | 2020-01-02 |
CN105296620A (zh) | 2016-02-03 |
US20180340225A1 (en) | 2018-11-29 |
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