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Zhang S, Kim KB, Huang Y, Kim DW, Kim B, Ko KP, Zou G, Zhang J, Jun S, Kirk NA, Hwang YE, Ban YH, Chan JM, Rudin CM, Park KS, Park JI. CRACD loss promotes small cell lung cancer tumorigenesis via EZH2-mediated immune evasion. bioRxiv 2023:2023.02.15.528365. [PMID: 36824957 PMCID: PMC9949038 DOI: 10.1101/2023.02.15.528365] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The mechanisms underlying immune evasion and immunotherapy resistance in small cell lung cancer (SCLC) remain unclear. Herein, we investigate the role of CRACD tumor suppressor in SCLC. We found that CRACD is frequently inactivated in SCLC, and Cracd knockout (KO) significantly accelerates SCLC development driven by loss of Rb1, Trp53, and Rbl2. Notably, the Cracd-deficient SCLC tumors display CD8+ T cell depletion and suppression of antigen presentation pathway. Mechanistically, CRACD loss silences the MHC-I pathway through EZH2. EZH2 blockade is sufficient to restore the MHC-I pathway and inhibit CRACD loss-associated SCLC tumorigenesis. Unsupervised single-cell transcriptomic analysis identifies SCLC patient tumors with concomitant inactivation of CRACD, impairment of tumor antigen presentation, and downregulation of EZH2 target genes. Our findings define CRACD loss as a new molecular signature associated with immune evasion of SCLC cells and proposed EZH2 blockade as a viable option for CRACD-negative SCLC treatment.
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Affiliation(s)
- Shengzhe Zhang
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kee-Beom Kim
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- BK21 FOUR KNU Creative BioResearch Group, School of Life Sciences, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Yuanjian Huang
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dong-Wook Kim
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Bongjun Kim
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kyung-Pil Ko
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gengyi Zou
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jie Zhang
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sohee Jun
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nicole A. Kirk
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Ye Eun Hwang
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Young Ho Ban
- Hamatovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Joseph M. Chan
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Charles M. Rudin
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kwon-Sik Park
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Jae-Il Park
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Program in Genetics and Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Kirk NA, Kim KB, Park KS. Effect of chromatin modifiers on the plasticity and immunogenicity of small-cell lung cancer. Exp Mol Med 2022; 54:2118-2127. [PMID: 36509828 PMCID: PMC9794818 DOI: 10.1038/s12276-022-00905-x] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Tumor suppressor genes (TSGs) are often involved in maintaining homeostasis. Loss of tumor suppressor functions causes cellular plasticity that drives numerous types of cancer, including small-cell lung cancer (SCLC), an aggressive type of lung cancer. SCLC is largely driven by numerous loss-of-function mutations in TSGs, often in those encoding chromatin modifiers. These mutations present a therapeutic challenge because they are not directly actionable. Alternatively, understanding the resulting molecular changes may provide insight into tumor intervention strategies. We hypothesize that despite the heterogeneous genomic landscape in SCLC, the impacts of mutations in patient tumors are related to a few important pathways causing malignancy. Specifically, alterations in chromatin modifiers result in transcriptional dysregulation, driving mutant cells toward a highly plastic state that renders them immune evasive and highly metastatic. This review will highlight studies in which imbalance of chromatin modifiers with opposing functions led to loss of immune recognition markers, effectively masking tumor cells from the immune system. This review also discusses the role of chromatin modifiers in maintaining neuroendocrine characteristics and the role of aberrant transcriptional control in promoting epithelial-to-mesenchymal transition during tumor development and progression. While these pathways are thought to be disparate, we highlight that the pathways often share molecular drivers and mediators. Understanding the relationships among frequently altered chromatin modifiers will provide valuable insights into the molecular mechanisms of SCLC development and progression and therefore may reveal preventive and therapeutic vulnerabilities of SCLC and other cancers with similar mutations.
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Affiliation(s)
- Nicole A. Kirk
- grid.27755.320000 0000 9136 933XDepartment of Microbiology, Immunology, and Cancer Biology, School of Medicine, University of Virginia, Charlottesville, VA 22908 USA
| | - Kee-Beom Kim
- grid.258803.40000 0001 0661 1556BK21 FOUR KNU Creative BioResearch Group, School of Life Sciences, Kyungpook National University, Daegu, 41566 Republic of Korea
| | - Kwon-Sik Park
- grid.27755.320000 0000 9136 933XDepartment of Microbiology, Immunology, and Cancer Biology, School of Medicine, University of Virginia, Charlottesville, VA 22908 USA
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Scheffer LK, Xu CS, Januszewski M, Lu Z, Takemura SY, Hayworth KJ, Huang GB, Shinomiya K, Maitlin-Shepard J, Berg S, Clements J, Hubbard PM, Katz WT, Umayam L, Zhao T, Ackerman D, Blakely T, Bogovic J, Dolafi T, Kainmueller D, Kawase T, Khairy KA, Leavitt L, Li PH, Lindsey L, Neubarth N, Olbris DJ, Otsuna H, Trautman ET, Ito M, Bates AS, Goldammer J, Wolff T, Svirskas R, Schlegel P, Neace E, Knecht CJ, Alvarado CX, Bailey DA, Ballinger S, Borycz JA, Canino BS, Cheatham N, Cook M, Dreher M, Duclos O, Eubanks B, Fairbanks K, Finley S, Forknall N, Francis A, Hopkins GP, Joyce EM, Kim S, Kirk NA, Kovalyak J, Lauchie SA, Lohff A, Maldonado C, Manley EA, McLin S, Mooney C, Ndama M, Ogundeyi O, Okeoma N, Ordish C, Padilla N, Patrick CM, Paterson T, Phillips EE, Phillips EM, Rampally N, Ribeiro C, Robertson MK, Rymer JT, Ryan SM, Sammons M, Scott AK, Scott AL, Shinomiya A, Smith C, Smith K, Smith NL, Sobeski MA, Suleiman A, Swift J, Takemura S, Talebi I, Tarnogorska D, Tenshaw E, Tokhi T, Walsh JJ, Yang T, Horne JA, Li F, Parekh R, Rivlin PK, Jayaraman V, Costa M, Jefferis GSXE, Ito K, Saalfeld S, George R, Meinertzhagen IA, Rubin GM, Hess HF, Jain V, Plaza SM. A connectome and analysis of the adult Drosophila central brain. eLife 2020; 9:e57443. [PMID: 32880371 PMCID: PMC7546738 DOI: 10.7554/elife.57443] [Citation(s) in RCA: 393] [Impact Index Per Article: 98.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] Open
Abstract
The neural circuits responsible for animal behavior remain largely unknown. We summarize new methods and present the circuitry of a large fraction of the brain of the fruit fly Drosophila melanogaster. Improved methods include new procedures to prepare, image, align, segment, find synapses in, and proofread such large data sets. We define cell types, refine computational compartments, and provide an exhaustive atlas of cell examples and types, many of them novel. We provide detailed circuits consisting of neurons and their chemical synapses for most of the central brain. We make the data public and simplify access, reducing the effort needed to answer circuit questions, and provide procedures linking the neurons defined by our analysis with genetic reagents. Biologically, we examine distributions of connection strengths, neural motifs on different scales, electrical consequences of compartmentalization, and evidence that maximizing packing density is an important criterion in the evolution of the fly's brain.
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Affiliation(s)
- Louis K Scheffer
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - C Shan Xu
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Zhiyuan Lu
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
- Life Sciences Centre, Dalhousie UniversityHalifaxCanada
| | - Shin-ya Takemura
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Kenneth J Hayworth
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Gary B Huang
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Kazunori Shinomiya
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Stuart Berg
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Jody Clements
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Philip M Hubbard
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - William T Katz
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Lowell Umayam
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Ting Zhao
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - David Ackerman
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - John Bogovic
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Tom Dolafi
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Dagmar Kainmueller
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Takashi Kawase
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Khaled A Khairy
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Peter H Li
- Google ResearchMountain ViewUnited States
| | | | - Nicole Neubarth
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Donald J Olbris
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Hideo Otsuna
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Eric T Trautman
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Masayoshi Ito
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
- Institute for Quantitative Biosciences, University of TokyoTokyoJapan
| | | | - Jens Goldammer
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
- Institute of Zoology, Biocenter Cologne, University of CologneCologneGermany
| | - Tanya Wolff
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Robert Svirskas
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Erika Neace
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Chelsea X Alvarado
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Dennis A Bailey
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Samantha Ballinger
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Brandon S Canino
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Natasha Cheatham
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Michael Cook
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Marisa Dreher
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Octave Duclos
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Bryon Eubanks
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Kelli Fairbanks
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Samantha Finley
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Nora Forknall
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Audrey Francis
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Emily M Joyce
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - SungJin Kim
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Nicole A Kirk
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Julie Kovalyak
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Shirley A Lauchie
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Alanna Lohff
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Charli Maldonado
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Emily A Manley
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Sari McLin
- Life Sciences Centre, Dalhousie UniversityHalifaxCanada
| | - Caroline Mooney
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Miatta Ndama
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Omotara Ogundeyi
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Nneoma Okeoma
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Christopher Ordish
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Nicholas Padilla
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Tyler Paterson
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Elliott E Phillips
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Emily M Phillips
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Neha Rampally
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Caitlin Ribeiro
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Jon Thomson Rymer
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Sean M Ryan
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Megan Sammons
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Anne K Scott
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Ashley L Scott
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Aya Shinomiya
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Claire Smith
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Kelsey Smith
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Natalie L Smith
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Margaret A Sobeski
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Alia Suleiman
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Jackie Swift
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Satoko Takemura
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Iris Talebi
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Emily Tenshaw
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Temour Tokhi
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - John J Walsh
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Tansy Yang
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | | | - Feng Li
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Ruchi Parekh
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Patricia K Rivlin
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Vivek Jayaraman
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Marta Costa
- Department of Zoology, University of CambridgeCambridgeUnited Kingdom
| | - Gregory SXE Jefferis
- MRC Laboratory of Molecular BiologyCambridgeUnited States
- Department of Zoology, University of CambridgeCambridgeUnited Kingdom
| | - Kei Ito
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
- Institute for Quantitative Biosciences, University of TokyoTokyoJapan
- Institute of Zoology, Biocenter Cologne, University of CologneCologneGermany
| | - Stephan Saalfeld
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Reed George
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Ian A Meinertzhagen
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
- Life Sciences Centre, Dalhousie UniversityHalifaxCanada
| | - Gerald M Rubin
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Harald F Hess
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Viren Jain
- Google Research, Google LLCZurichSwitzerland
| | - Stephen M Plaza
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
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Eccles JD, Turner RB, Kirk NA, Muehling LM, Borish L, Steinke JW, Payne SC, Wright PW, Thacker D, Lahtinen SJ, Lehtinen MJ, Heymann PW, Woodfolk JA. T-bet+ Memory B Cells Link to Local Cross-Reactive IgG upon Human Rhinovirus Infection. Cell Rep 2020; 30:351-366.e7. [PMID: 31940481 PMCID: PMC6994188 DOI: 10.1016/j.celrep.2019.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/01/2019] [Accepted: 12/06/2019] [Indexed: 01/01/2023] Open
Abstract
Human rhinoviruses cause the common cold and exacerbate chronic respiratory diseases. Although infection elicits neutralizing antibodies, these do not persist or cross-protect across multiple rhinovirus strains. To analyze rhinovirus-specific B cell responses in humans, we developed techniques using intact RV-A16 and RV-A39 for high-throughput high-dimensional single-cell analysis, with parallel assessment of antibody isotypes in an experimental infection model. Our approach identified T-bet+ B cells binding both viruses that account for ∼5% of CXCR5- memory B cells. These B cells infiltrate nasal tissue and expand in the blood after infection. Their rapid secretion of heterotypic immunoglobulin G (IgG) in vitro, but not IgA, matches the nasal antibody profile post-infection. By contrast, CXCR5+ memory B cells binding a single virus are clonally distinct, absent in nasal tissue, and secrete homotypic IgG and IgA, mirroring the systemic response. Temporal and spatial functions of dichotomous memory B cells might explain the ability to resolve infection while rendering the host susceptible to re-infection.
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Affiliation(s)
- Jacob D Eccles
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Ronald B Turner
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Nicole A Kirk
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Lyndsey M Muehling
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Larry Borish
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - John W Steinke
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Spencer C Payne
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA; Department of Otolaryngology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Paul W Wright
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Deborah Thacker
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Sampo J Lahtinen
- DuPont Nutrition & Biosciences, Global Health and Nutrition Science, Sokeritehtaantie 20, 02460 Kantvik, Finland
| | - Markus J Lehtinen
- DuPont Nutrition & Biosciences, Global Health and Nutrition Science, Sokeritehtaantie 20, 02460 Kantvik, Finland
| | - Peter W Heymann
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Judith A Woodfolk
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
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