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Singh S, Pezeshkpoor B, Jamil MA, Dodt J, Sharma A, Ramar V, Ivaskevicius V, Hethershaw E, Philippou H, Pavlova A, Oldenburg J, Biswas A. Heterozygosity in factor XIII genes and the manifestation of mild inherited factor XIII deficiency. J Thromb Haemost 2024; 22:379-393. [PMID: 37832789 DOI: 10.1016/j.jtha.2023.09.032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND The characterization of inherited mild factor XIII deficiency is more imprecise than its rare, inherited severe forms. It is known that heterozygosity at FXIII genetic loci results in mild FXIII deficiency, characterized by circulating FXIII activity levels ranging from 20% to 60%. There exists a gap in information on 1) how genetic heterozygosity renders clinical bleeding manifestations among these individuals and 2) the reversal of unexplained bleeding upon FXIII administration in mild FXIII-deficient individuals. OBJECTIVES To assess the prevalence and burden of mild FXIII deficiency among the apparently healthy German-Caucasian population and correlate it with genetic heterozygosity at FXIII and fibrinogen gene loci. METHODS Peripheral blood was collected from 752 donors selected from the general population with essentially no bleeding complications to ensure asymptomatic predisposition. These were assessed for FXIII and fibrinogen activity, and FXIII and fibrinogen genes were resequenced using next-generation sequencing. For comparison, a retrospective analysis was performed on a cohort of mild inherited FXIII deficiency patients referred to us. RESULTS The prevalence of mild FXIII deficiency was high (∼0.8%) among the screened German-Caucasian population compared with its rare-severe forms. Although no new heterozygous missense variants were found, certain combinations were relatively dominant/prevalent among the mild FXIII-deficient individuals. CONCLUSION This extensive, population-based quasi-experimental approach revealed that the burden of heterozygosity in FXIII and fibrinogen gene loci causes the clinical manifestation of inherited mild FXIII deficiency, resulting in ''unexplained bleeding'' upon provocation.
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Affiliation(s)
- Sneha Singh
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Behnaz Pezeshkpoor
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Muhammad Ahmer Jamil
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | | | - Amit Sharma
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Vasanth Ramar
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Vytautas Ivaskevicius
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Emma Hethershaw
- Division of Cardiovascular and Diabetes Research, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Helen Philippou
- Division of Cardiovascular and Diabetes Research, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Anna Pavlova
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Johannes Oldenburg
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Arijit Biswas
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany.
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Javed H, Singh S, Urs SUR, Oldenburg J, Biswas A. Genetic landscape in coagulation factor XIII associated defects – Advances in coagulation and beyond. Blood Rev 2022; 59:101032. [PMID: 36372609 DOI: 10.1016/j.blre.2022.101032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
Coagulation factor XIII (FXIII) acts as a fine fulcrum in blood plasma that maintains the balance between bleeding and thrombosis by covalently crosslinking the pre-formed fibrin clot into an insoluble one that is resistant to premature fibrinolysis. In plasma, FXIII circulates as a pro-transglutaminase complex composed of the dimeric catalytic FXIII-A encoded by the F13A1 gene and dimeric carrier/regulatory FXIII-B subunits encoded by the F13B gene. Growing evidence accumulated over decades of exhaustive research shows that not only does FXIII play major roles in both pathological extremes of hemostasis i.e. bleeding and thrombosis, but that it is, in fact, a pleiotropic protein with physiological roles beyond coagulation. However, the current FXIII genetic-epidemiological literature is overwhelmingly derived from the bleeding pathology associated with its deficiency. In this article we review the current clinical, functional, and molecular understanding of this fascinating multifaceted protein, especially putting into the same perspective its genetic landscape.
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Cai R, Li Y, Wang W, Feng Q. A novel Cys328-terminator mutant implicated in severe coagulation factor XIII deficiency: a case report. BMC Med Genet 2020; 21:175. [PMID: 32883222 PMCID: PMC7650518 DOI: 10.1186/s12881-020-01111-0] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Factor XIII (FXIII) deficiency is an extremely rare bleeding disorder that is commonly due to mutations in the FXIIIA subunit gene (F13A1), and it has been reported to have a prevalence of one per 2 million. We describe a new genetic variant in the F13A1 gene that caused a patient to suffer from lifelong hemorrhagic diathesis. CASE PRESENTATION We evaluated a 20-year-old female with umbilical cord bleeding after birth, an intracerebral hemorrhage at age 6, and other bleeding episodes, including hematuria and cephalohematoma, who suffered from a lifelong hemorrhagic diathesis. The clot solubility test showed that the clot of the patient was dissolved in urea solution at 10 h. Genetic testing identified a novel homozygous mutation, c.984C > A(p. Cys328stop), resulting in a premature stop codon in exon 8 of the F13A1 gene. The results obtained with ClusterX software showed that Cys328 of exon 8 in the F13A1 gene is highly conserved among species. CONCLUSION We reported a novel homozygous mutation in the F13A1 gene in a factor XIII (FXIII)-deficient patient, which adds a new point mutation to the mutant library. In this paper, we discuss other aspects of the disease, including laboratory examination, homogeneous sequence alignment and molecular modeling.
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Affiliation(s)
- Ruimin Cai
- Department of Clinical Laboratory, Taian City Central Hospital, No. 29, Longtan Road, Taishan District, Taian, 271000, Shandong Province, China
| | - Yi Li
- Department of Clinical Laboratory, Taian City Central Hospital, No. 29, Longtan Road, Taishan District, Taian, 271000, Shandong Province, China
| | - Wenyang Wang
- Department of Clinical Laboratory, Taian City Central Hospital, No. 29, Longtan Road, Taishan District, Taian, 271000, Shandong Province, China
| | - Qiang Feng
- Department of Clinical Laboratory, Taian City Central Hospital, No. 29, Longtan Road, Taishan District, Taian, 271000, Shandong Province, China.
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Ivaškevičius V, Biswas A, Garly ML, Oldenburg J. Comparison ofF13A1gene mutations in 73 patients treated with recombinant FXIII-A2. Haemophilia 2017; 23:e194-e203. [DOI: 10.1111/hae.13233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- V. Ivaškevičius
- Institute of Experimental Haematology and Transfusion Medicine; University Hospital Bonn; Bonn Germany
| | - A. Biswas
- Institute of Experimental Haematology and Transfusion Medicine; University Hospital Bonn; Bonn Germany
| | | | - J. Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine; University Hospital Bonn; Bonn Germany
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Dorgalaleh A, Rashidpanah J. Blood coagulation factor XIII and factor XIII deficiency. Blood Rev 2016; 30:461-75. [PMID: 27344554 DOI: 10.1016/j.blre.2016.06.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/01/2016] [Accepted: 06/10/2016] [Indexed: 11/20/2022]
Abstract
Factor XIII (FXIII) is a multifunctional pro-γ-transglutaminase that, in addition to its well-known role in hemostasis, has a crucial role in angiogenesis, maintenance of pregnancy, wound healing, bone metabolism, and even cardio protection. FXIII deficiency (FXIIID) is a rare bleeding disorder (RBD) with an estimated incidence of one per two million that is accompanied by life-threatening bleeding such as umbilical cord bleeding, recurrent spontaneous miscarriage, and intracranial hemorrhage (ICH). Today, the disease is successfully managed by FXIII concentrate and recombinant FXIII for prophylaxis, management of minor and major bleeding, treatment of ICH, and successful delivery in women with recurrent pregnancy loss. Molecular analysis of patients with FXIIID revealed a wide spectrum of mutations, most frequently missense mutations in the FXIII-A subunit, with a few recurrent mutations observed worldwide. In vitro expression studies revealed that most of the missense mutations cause intracellular instability of the FXIII protein and, subsequently, FXIIID.
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Borhany M, Handrkova H, Cairo A, Schroeder V, Fatima N, Naz A, Amanat S, Shamsi T, Peyvandi F, Kohler HP. Congenital factor XIII deficiency in Pakistan: characterization of seven families and identification of four novel mutations. Haemophilia 2013; 20:568-74. [DOI: 10.1111/hae.12340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M. Borhany
- Department of Haematology, Haemostasis & Thrombosis; National Institute of Blood Disease and Bone Marrow Transplantation (NIBD); Karachi Pakistan
| | - H. Handrkova
- Haemostasis Research Laboratory; University Clinic of Haematology; University Hospital & University of Bern; Bern Switzerland
| | - A. Cairo
- U.O.S. Dipartimentale per la Diagnosi e la Terapia delle Coagulopatie; A. Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico; Università degli Studi di Milano and Luigi Villa Foundation; Milan Italy
| | - V. Schroeder
- Haemostasis Research Laboratory; University Clinic of Haematology; University Hospital & University of Bern; Bern Switzerland
| | - N. Fatima
- Department of Haematology, Haemostasis & Thrombosis; National Institute of Blood Disease and Bone Marrow Transplantation (NIBD); Karachi Pakistan
| | - A. Naz
- Department of Haematology, Haemostasis & Thrombosis; National Institute of Blood Disease and Bone Marrow Transplantation (NIBD); Karachi Pakistan
| | | | - T. Shamsi
- Department of Haematology, Haemostasis & Thrombosis; National Institute of Blood Disease and Bone Marrow Transplantation (NIBD); Karachi Pakistan
| | - F. Peyvandi
- U.O.S. Dipartimentale per la Diagnosi e la Terapia delle Coagulopatie; A. Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico; Università degli Studi di Milano and Luigi Villa Foundation; Milan Italy
| | - H. P. Kohler
- Haemostasis Research Laboratory; University Clinic of Haematology; University Hospital & University of Bern; Bern Switzerland
- Department of Internal Medicine; Spital Netz Bern; Bern Switzerland
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Abstract
Mutational reports over the past two decades have accumulated an immense amount of literature for inherited Factor XIII deficiency. However, the genotype and phenotype correlations for inherited Factor XIII deficiency are complicated. While many studies clearly prove a cause and effect relationship for the reported mutations, others are lacking in this regard. The F13B gene remains an elusive component as far as inherited Factor XIII deficiencies are concerned. Also, an in-depth analysis into the heterozygous state of this deficiency is also lacking. In this review we have tried to analyze and present an exhaustive amount of mutational data from the past three decades. The source of our mutational data is our website dedicated to Factor XIII deficiencies (www.F13-database.de) as well as literature search done on the Pubmed (www.ncbi.nlm.nih.gov/pubmed).
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Affiliation(s)
- Arijit Biswas
- Institute of Experimental Hematology and Transfusion Medicine, University Clinic Bonn, Germany.
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Abstract
Inherited factor XIII (FXIII) deficiency is a rare bleeding disorder that can present with umbilical bleeding during the neonatal period, delayed soft tissue bruising, mucosal bleeding and life-threatening intracranial haemorrhage. FXIII deficiency has also been associated with poor wound healing and recurrent miscarriages. FXIII plays an integral role in haemostasis by catalysing the cross-linking of fibrin, platelet membrane and matrix proteins throughout thrombus formation, thus stabilizing the blood clot. The molecular basis of FXIII deficiency is characterized by a high degree of heterogeneity, which contributes to the different clinical manifestations of the disease. There have been more than 60 FXIII mutations identified in the current literature. In addition, single nucleotide polymorphisms have been described, some of which have been shown to affect FXIII activity, contributing further to the heterogeneity in patient presentation and severity of clinical symptoms. Although there is a lifelong risk of bleeding, the prognosis is excellent when current prophylactic treatment is available using cryoprecipitate or plasma-derived FXIII concentrate.
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Affiliation(s)
- L Hsieh
- Division of Hematology, Children's Hospital of Orange County, Orange, CA 92868, USA.
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Hashiramoto M, Osawa H, Ando M, Murakami A, Nishimiya T, Nakano M, Nishida W, Onuma H, Makino H. A nonsense mutation in the Arg345 of the insulin receptor gene in a Japanese type A insulin-resistant patient. Endocr J 2005; 52:499-504. [PMID: 16127220 DOI: 10.1507/endocrj.52.499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Defects in insulin receptor function have been associated with insulin resistant states such as obesity and type 2 diabetes mellitus. Several types of mutations in the insulin receptor gene have been identified in patients with genetic syndromes of extreme insulin resistance. We have studied a 10-year-old Japanese girl with type A insulin resistance with hirsutism and hyperinsulinemia but without the dysmorphic features characteristic of leprechaunism or Rabson-Mendenhall syndrome. Despite the presence of severe insulin resistance, the patient did not develop overt diabetes mellitus at the time of investigation. Using direct sequencing, we identified a nonsense mutation causing premature termination after amino acid 345 in the alpha subunit of the insulin receptor.
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Affiliation(s)
- Mitsuru Hashiramoto
- Department of Diabetology and Clinical Laboratory Medicine, National University Corporation, Ehime University School of Medicine, Ehime
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Abstract
A defect in the factor XIII gene can result in lifelong bleeding tendency. In 3 Chinese families, hereditary coagulation factor XIII deficiency was diagnosed on the basis of the clinical syndrome and solubility of fibrin clot in 5 mol/L urea. We sequenced all of the FXIIIA gene exons and the flanking region and found 3 novel defects in the factor XIII gene. First, C --> G transition at nucleotide (nt) position 1241 in exon 10 results in substitution of Ser413 with Trp. Second, C --> T transition at nt232 in exon 3 results in Arg 77 --> Cys. The third mutation is in exon 5: del-aa at nt598 (codon 191) causes frameshift and premature termination. In the cytoplasm of 3 probands the FXIII gene was normal at the messenger RNA level. Three mutations may affect FXIIIA protein conformation or incorrect protein folding and lead to formation of mutant FXIII that is very unstable and rapidly degraded in cytoplasm.
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Affiliation(s)
- Baohua Duan
- Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Second Medical University, Shanghai, China
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Souri M, Ichinose A. Impaired protein folding, dimer formation, and heterotetramer assembly cause intra- and extracellular instability of a Y283C mutant of the A subunit for coagulation factor XIII. Biochemistry 2001; 40:13413-20. [PMID: 11695887 DOI: 10.1021/bi0111449] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Factor XIII (XIII) is a heterotetramer consisting of two catalytic A subunits (XIIIA) and two noncatalytic B subunits (XIIIB). We examined the molecular mechanisms of a Y283C mutation which had previously been identified in a patient with XIIIA deficiency. The recombinant Y283C protein was labile when expressed in MEG-01 cells, which can endogenously synthesize XIIIA. We also included two other mutants, G562R and I464stop, previously characterized in a non-XIIIA-producing cell line. All these mutants exhibited decreased thermostability and resistance against proteolytic digestion when compared with the wild-type. Gel-filtration analysis revealed that the mutants were in monomer form, while the wild-type formed a dimer. These results were consistent with the prediction by molecular modeling that the mutant molecules would be misfolded. Although assembly of a heterotetramer with XIIIB was demonstrated for Y283C, its binding ability was 10% that of the wild-type. No complex formation was observed for the G562R or I464stop mutants. The wild-type was stabilized in plasma by complex formation with XIIIB, resulting in an increased resistance against proteolytic digestion. In contrast, the mutants were unstable in plasma even in the presence of XIIIB. Thus, impaired folding, dimer formation, and heterotetramer assembly of the mutant XIIIAs lead to both intra- and extracellular instability, which must be responsible for XIIIA deficiency in the patient.
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Affiliation(s)
- M Souri
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, 990-8595 Japan
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Niiya T, Osawa H, Onuma H, Suzuki Y, Taira M, Yamada K, Makino H. Activation of mouse phosphodiesterase 3B gene promoter by adipocyte differentiation in 3T3-L1 cells. FEBS Lett 2001; 505:136-40. [PMID: 11557056 DOI: 10.1016/s0014-5793(01)02807-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Activation of phosphodiesterase (PDE) 3B reduces free fatty acid output from adipocytes. Induction of PDE3B gene expression by adipocyte differentiation could improve insulin resistance. To examine whether the PDE3B promoter is activated by this differentiation, the 5' flanking sequence of the mouse PDE3B gene was isolated. The transcription initiation site was determined to be located 195 bp upstream of the translation start site. No putative binding site for peroxisome proliferator-activated receptor gamma was found within 2 kb upstream of the transcription initiation site. This region had promoter activity, which was further activated on adipocyte differentiation in 3T3-L1 cells.
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Affiliation(s)
- T Niiya
- Department of Laboratory Medicine, Ehime University School of Medicien, Shigenobu, Japan
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Osawa H, Nishimiya T, Ochi M, Niiya T, Onuma H, Kitamuro F, Kaino Y, Kida K, Makino H. Identification of novel C253Y missense and Y864X nonsense mutations in the insulin receptor gene in type A insulin-resistant patients. Clin Genet 2001; 59:194-7. [PMID: 11260230 DOI: 10.1034/j.1399-0004.2001.590309.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mutations in the insulin receptor gene have been reported in cases of type A insulin resistance. We report herein two cases of type A insulin resistance, which involve some novel mutations. Case 1 is a heterozygote of the C253Y missense mutation and case 2 is a heterozygote of the Y864X nonsense mutation. In the C253Y missense mutation in exon 3, a cysteine residue is replaced with tyrosine in the cysteine-rich domain of the alpha subunit. The Y864X in exon 13 results in a truncated receptor, which is devoid of most of the beta subunit. This mutant receptor could not be expressed on a cell membrane since the transmembrane domain is missing. Other significant mutations were not found for the entire coding regions and splice/donor sites.
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Affiliation(s)
- H Osawa
- Department of Laboratory Medicine, Kitamuro Clinic, Department of Pediatrics, Ehime University School of Medicine, Ehime, Japan.
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