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Wehrle CJ, Tocci NX, Sun K, Jiao C, Hong H, Gross A, Allkushi E, Uysal M, Linganna MW, Stackhouse K, Hashimoto K, Schlegel A, Walsh RM, Miller C, Kwon DCH, Aucejo F. Utility of circulating tumor DNA in secondary liver malignancies: What we know and what is to come. J Surg Oncol 2025; 131:888-894. [PMID: 39155652 PMCID: PMC12120384 DOI: 10.1002/jso.27838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/27/2024] [Indexed: 08/20/2024]
Abstract
Secondary liver malignancies are a serious and challenging global health concern. Secondary metastasis to the liver is most commonly from colorectal cancer that has metastatically spread through splanchnic circulation. Metastatic diseases can portend poor prognosis due to the progressive nature typically found on detection. Improvements in detection of disease, monitoring therapy response, and monitoring for recurrence are crucial to the improvement in the management of secondary liver malignancies. Assessment of ctDNA in these patient populations poses an opportunity to impact the management of secondary liver malignancies. In this review, we aim to discuss ctDNA, the current literature, and future directions of this technology within secondary liver malignancies.
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Affiliation(s)
- Chase J. Wehrle
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Noah X. Tocci
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Keyue Sun
- Cleveland Clinic Foundation, Lerner Research Institute, Inflammation & ImmunityClevelandOhioUSA
| | - Chunbao Jiao
- Cleveland Clinic Foundation, Lerner Research Institute, Inflammation & ImmunityClevelandOhioUSA
| | - Hanna Hong
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Abby Gross
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Erlind Allkushi
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Melis Uysal
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Maureen Whitsett Linganna
- Department of Gastroenterology, Hepatology, and NutritionCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Katheryn Stackhouse
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Koji Hashimoto
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Andrea Schlegel
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
- Cleveland Clinic Foundation, Lerner Research Institute, Inflammation & ImmunityClevelandOhioUSA
| | - R. Matthew Walsh
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Charles Miller
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - David C. H. Kwon
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
| | - Federico Aucejo
- Department of Hepato‐Pancreato‐Biliary & Liver Transplant SurgeryCleveland Clinic Foundation, Digestive Diseases and Surgery InstituteClevelandOhioUSA
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Wehrle CJ, Fujiki M, Schlegel A, Uysal M, Sobotka A, Whitsett Linganna M, Modaresi Esfeh J, Kamath S, Khalil M, Pita A, Kim JK, Kwon DCH, Miller C, Hashimoto K, Aucejo F. Intensive locoregional therapy before liver transplantation for colorectal cancer liver metastasis: A novel pretransplant protocol. Liver Transpl 2024; 30:1238-1249. [PMID: 38833301 DOI: 10.1097/lvt.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024]
Abstract
We describe a novel pre-liver transplant (LT) approach in colorectal liver metastasis, allowing for improved monitoring of tumor biology and reduction of disease burden before committing a patient to transplantation. Patients undergoing LT for colorectal liver metastasis at Cleveland Clinic were included. The described protocol involves intensive locoregional therapy with systemic chemotherapy, aiming to reach minimal disease burden revealed by positron emission tomography scan and carcinoembryonic Ag. Patients with no detectable disease or irreversible treatment-induced liver injury undergo transplant. Nine patients received liver transplant out of 27 who were evaluated (33.3%). The median follow-up was 700 days. Seven patients (77.8%) received a living donor LT. Five had no detectable disease, and 4 had treatment-induced cirrhosis. Pretransplant management included chemotherapy (n = 9) +/- bevacizumab (n = 6) and/or anti-EGFR (n = 6). The median number of pre-LT cycles of chemotherapy was 16 (range 10-40). Liver-directed therapy included Yttrium-90 (n = 5), ablation (n = 4), resection (n = 4), and hepatic artery infusion pump (n = 3). Three patients recurred after LT. Actuarial 1- and 2-year recurrence-free survival were 75% (n = 6/8) and 60% (n = 3/5). Recurrence occurred in the lungs (n = 1), liver graft (n = 1), and lungs+para-aortic nodes (n = 1). Patients with pre-LT detectable disease had reduced RFS ( p = 0.04). All patients with recurrence had histologically viable tumors in the liver explant. Patients treated in our protocol (n = 16) demonstrated improved survival versus those who were not candidates (n = 11) regardless of transplant status ( p = 0.01). A protocol defined by aggressive pretransplant liver-directed treatment and transplant for patients with the undetectable disease or treatment-induced liver injury may help prevent tumor recurrence.
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Affiliation(s)
- Chase J Wehrle
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Masato Fujiki
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Andrea Schlegel
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Melis Uysal
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Anastasia Sobotka
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Maureen Whitsett Linganna
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Suneel Kamath
- Department of Gastrointestinal Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Mazhar Khalil
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Alejandro Pita
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Jae-Keun Kim
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - David C H Kwon
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Charles Miller
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Koji Hashimoto
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Federico Aucejo
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
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Said R, Ghazzy A, Shakya AK, hunaiti AA. Iron oxide nanozymes as versatile analytical tools: an overview of their application as detection technique. Bioanalysis 2024; 16:1261-1278. [PMID: 39589819 PMCID: PMC11727870 DOI: 10.1080/17576180.2024.2415779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 10/09/2024] [Indexed: 11/28/2024] Open
Abstract
Iron oxide nanozymes (IONzymes) have become fundamental components in various analyte detection methodologies such as colorimetric, electrochemistry, fluorescence and luminescence. Their tunability, stability and the possibility of modification, alongside their ability to mimic the catalytic properties of natural enzymes like peroxidase, render them invaluable in analytical chemistry. This review explores the diverse applications of IONzymes across analytical chemistry, with a particular highlighting on their roles in different detection techniques and their potential in biomedical and diagnostic applications. This information would be valuable for researchers and practitioners in the fields of analytical chemistry, biochemistry, biotechnology and materials science who are interested in applying IONzymes in their work. In essence, this review article on iron oxide nanozymes in analytical chemistry would serve as a valuable resource for researchers, educators and industry professionals, offering insights, guidance and inspiration for further study and application of this promising class of nanomaterials.
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Affiliation(s)
- Rana Said
- Pharmacological & Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, 19328, Jordan
| | - Asma Ghazzy
- Pharmacological & Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, 19328, Jordan
| | - Ashok K. Shakya
- Pharmacological & Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, 19328, Jordan
- Michael Sayegh Faculty of Pharmacy, Aqaba University of Technology, Aqaba, 11191, Jordan
| | - Afnan Al hunaiti
- Department of Chemistry, University of Jordan, Amman, 11942, Jordan
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Coleman D, Kuwada S. miRNA as a Biomarker for the Early Detection of Colorectal Cancer. Genes (Basel) 2024; 15:338. [PMID: 38540397 PMCID: PMC10969835 DOI: 10.3390/genes15030338] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 06/14/2024] Open
Abstract
MicroRNAs (miRNAs) are short, non-coding RNA segments that can be detected in a variety of clinical samples, including serum, stool, and urine. While miRNAs were initially known for their effect on post-translational gene expression, the last decade of research has shown them to be promising biomarkers for the detection of many types of cancer. This paper explores the use of miRNA detection as a tool for colorectal cancer (CRC) screening. We discuss the current state of miRNA detection, compare it to the existing CRC screening tools, and highlight the advantages and drawbacks of this approach from a clinical and logistical perspective. Our research finds that miRNA-based tests for CRC show great potential, but that widespread clinical adoption will be conditional on future research overcoming key hurdles.
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Affiliation(s)
- David Coleman
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA
| | - Scott Kuwada
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA
- University of Hawaii Cancer Center, 01 Ilalo Street, Honolulu, HI 96813, USA
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Wehrle CJ, Fujiki M, Schlegel A, Whitsett Linganna M, Pita A, Kim JK, Kwon DCH, Miller C, Hashimoto K, Dueland S, Sasaki K, Sapisochin G, Line PD, Hernandez-Alejandro R, Aucejo F. Update to 'A Contemporary Systematic Review on Liver Transplantation for Unresectable Liver Metastasis of Colorectal Cancer'. Ann Surg Oncol 2024; 31:697-700. [PMID: 37996635 DOI: 10.1245/s10434-023-14611-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023]
Abstract
Colorectal cancer is the second most common cause of cancer-related death worldwide, and half of patients present with colorectal liver metastasis (CRLM). Liver transplant (LT) has emerged as a treatment modality for otherwise unresectable CRLM. Since the publication of the Lebeck-Lee systematic review in 2022, additional evidence has come to light supporting LT for CRLM in highly selected patients. This includes reports of >10-year follow-up with over 80% survival rates in low-risk patients. As these updated reports have significantly changed our collective knowledge, this article is intended to serve as an update to the 2022 systematic review to include the most up-to-date evidence on the subject.
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Affiliation(s)
- Chase J Wehrle
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Masato Fujiki
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrea Schlegel
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Alejandro Pita
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jae-Keun Kim
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David C H Kwon
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Charles Miller
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Koji Hashimoto
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Svein Dueland
- Department of Transplantation, Oslo University Hospital, Oslo, Norway
| | - Kazunari Sasaki
- Department of Abdominal Transplantation, Stanford University, Palo Alto, CA, USA
| | - Gonzalo Sapisochin
- Department of Abdominal Transplant and HPB Surgical Oncology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Pal-Dag Line
- Department of Transplantation, Oslo University Hospital, Oslo, Norway
| | | | - Federico Aucejo
- Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
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Wehrle CJ, Raj R, Aykun N, Orabi D, Stackhouse K, Chang J, Estfan B, Kamath S, Krishnamurthi S, Walsh RM, Kwon DCH, Aucejo F. Circulating Tumor DNA in Colorectal Cancer Liver Metastasis: Analysis of Patients Receiving Liver Resection and Transplant. JCO Clin Cancer Inform 2023; 7:e2300111. [PMID: 37820293 DOI: 10.1200/cci.23.00111] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/13/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Liver metastases occur in about 50% of colorectal cancer cases and drive patient outcomes. Circulating tumor DNA (ctDNA) is emerging as a diagnostic, surveillance, and tumor mutational information tool. METHODS Patients with colorectal cancer liver metastasis (CCLM) seen in a multidisciplinary liver tumor clinic from January to August 2022 received ctDNA testing on each visit. ctDNA was obtained using the Guardant360 platform. Tumor mutational burden (TMB) is defined as the number of identified mutations per megabase of genome analyzed. RESULTS Fifty-two patients had available ctDNA, with 34 (65%) tested preoperatively and 18 (35%) postoperatively; nine patients had sequential pre- and postoperative testing. The median time to test result was 12 days (IQR, 10-13.5). There were a greater number of somatic mutations identified preoperatively (n = 29 v n = 11) and a greater genomic heterogeneity (P = .0069). The mean TMB score was 12.77 in those without pathologic response to cytotoxic therapy and 6.0 in those with pathologic response (P = .10). All nine patients with sequential testing were positive preoperatively, compared with just three (33.3%) postoperatively (P = .0090). Positive postoperative ctDNA was associated with the increased likelihood of disease recurrence after resection (57%) versus negative ctDNA (0%, P = .0419). CONCLUSION Routine ctDNA screening in patients with CCLM is logistically feasible. Liver resection and/or transplant may be associated with clearance of detectable ctDNA and a reduction in TMB or genomic heterogeneity. Persistence of ctDNA alterations postresection appears predictive of disease recurrence. Further studies are necessary to confirm these findings, and longitudinal ctDNA testing is needed to monitor changing tumor biology.
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Affiliation(s)
- Chase J Wehrle
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Roma Raj
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Nihal Aykun
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Danny Orabi
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Kathryn Stackhouse
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Jenny Chang
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Bassam Estfan
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - Suneel Kamath
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - Smitha Krishnamurthi
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - R Matthew Walsh
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - David Choon Hyuck Kwon
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Federico Aucejo
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
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Logozzi M, Orefice NS, Di Raimo R, Mizzoni D, Fais S. The Importance of Detecting, Quantifying, and Characterizing Exosomes as a New Diagnostic/Prognostic Approach for Tumor Patients. Cancers (Basel) 2023; 15:cancers15112878. [PMID: 37296842 DOI: 10.3390/cancers15112878] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Exosomes are extracellular vesicles (EVs) of nanometric size studied for their role in tumor pathogenesis and progression and as a new source of tumor biomarkers. The clinical studies have provided encouraging but probably unexpected results, including the exosome plasmatic levels' clinical relevance and well-known biomarkers' overexpression on the circulating EVs. The technical approach to obtaining EVs includes methods to physically purify EVs and characterize EVs, such as Nanosight Tracking Analysis (NTA), immunocapture-based ELISA, and nano-scale flow cytometry. Based on the above approaches, some clinical investigations have been performed on patients with different tumors, providing exciting and promising results. Here we emphasize data showing that exosome plasmatic levels are consistently higher in tumor patients than in controls and that plasmatic exosomes express well-known tumor markers (e.g., PSA and CEA), proteins with enzymatic activity, and nucleic acids. However, we also know that tumor microenvironment acidity is a key factor in influencing both the amount and the characteristics of the exosome released by tumor cells. In fact, acidity significantly increases exosome release by tumor cells, which correlates with the number of exosomes that circulate through the body of a tumor patient.
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Affiliation(s)
- Mariantonia Logozzi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Nicola Salvatore Orefice
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | - Davide Mizzoni
- ExoLab Italia, Tecnopolo d'Abruzzo, 67100 L'Aquila, Italy
| | - Stefano Fais
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
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