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1.
J Exp Clin Cancer Res ; 40(1): 289, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521429

RESUMO

BACKGROUND: The development of persistent endoplasmic reticulum (ER) stress is one of the cornerstones of prostate carcinogenesis; however, the mechanism is missing. Also, alcohol is a physiological ER stress inducer, and the link between alcoholism and progression of prostate cancer (PCa) is well documented but not well characterized. According to the canonical model, the mediator of ER stress, ATF6, is cleaved sequentially in the Golgi by S1P and S2P proteases; thereafter, the genes responsible for unfolded protein response (UPR) undergo transactivation. METHODS: Cell lines used were non-malignant prostate epithelial RWPE-1 cells, androgen-responsive LNCaP, and 22RV1 cells, as well as androgen-refractory PC-3 cells. We also utilized PCa tissue sections from patients with different Gleason scores and alcohol consumption backgrounds. Several sophisticated approaches were employed, including Structured illumination superresolution microscopy, Proximity ligation assay, Atomic force microscopy, and Nuclear magnetic resonance spectroscopy. RESULTS: Herein, we identified the trans-Golgi matrix dimeric protein GCC185 as a Golgi retention partner for both S1P and S2P, and in cells lacking GCC185, these enzymes lose intra-Golgi situation. Progression of prostate cancer (PCa) is associated with overproduction of S1P and S2P but monomerization of GCC185 and its downregulation. Utilizing different ER stress models, including ethanol administration, we found that PCa cells employ an elegant mechanism that auto-activates ER stress by fragmentation of Golgi, translocation of S1P and S2P from Golgi to ER, followed by intra-ER cleavage of ATF6, accelerated UPR, and cell proliferation. The segregation of S1P and S2P from Golgi and activation of ATF6 are positively correlated with androgen receptor signaling, different disease stages, and alcohol consumption. Finally, depletion of ATF6 significantly retarded the growth of xenograft prostate tumors and blocks production of pro-metastatic metabolites. CONCLUSIONS: We found that progression of PCa associates with translocation of S1P and S2P proteases to the ER and subsequent ATF6 cleavage. This obviates the need for ATF6 transport to the Golgi and enhances UPR and cell proliferation. Thus, we provide the novel mechanistic model of ATF6 activation and ER stress implication in the progression of PCa, suggesting ATF6 is a novel promising target for prostate cancer therapy.


Assuntos
Estresse do Retículo Endoplasmático , Retículo Endoplasmático/metabolismo , Neoplasias da Próstata/metabolismo , Animais , Linhagem Celular Tumoral , Modelos Animais de Doenças , Progressão da Doença , Complexo de Golgi/metabolismo , Xenoenxertos , Humanos , Masculino , Metaloendopeptidases/metabolismo , Camundongos , ATPases Mitocondriais Próton-Translocadoras/genética , ATPases Mitocondriais Próton-Translocadoras/metabolismo , Pró-Proteína Convertases/metabolismo , Neoplasias da Próstata/etiologia , Neoplasias da Próstata/patologia , Ligação Proteica , Transporte Proteico , Serina Endopeptidases/metabolismo
2.
ACS Chem Biol ; 15(10): 2692-2701, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-32809798

RESUMO

Various biological processes at the cellular level are regulated by glycosylation which is a highly microheterogeneous post-translational modification (PTM) on proteins and lipids. The dynamic nature of glycosylation can be studied through metabolic incorporation of non-natural sugars into glycan epitopes and their detection using bio-orthogonal probes. However, this approach possesses a significant drawback due to nonspecific background reactions and ambiguity of non-natural sugar metabolism. Here, we report a probe-free strategy for their direct detection by glycoproteomics and glycomics using mass spectrometry (MS). The method dramatically simplifies the detection of non-natural functional group bearing monosaccharides installed through promiscuous sialic acid, N-acetyl-d-galactosamine (GalNAc) and N-acetyl-d-glucosamine (GlcNAc) biosynthetic pathways. Multistage enrichment of glycoproteins by cellular fractionation, subsequent ZIC-HILIC (zwitterionic-hydrophilic interaction chromatography) based glycopeptide enrichment, and a spectral enrichment algorithm for the MS data processing enabled direct detection of non-natural monosaccharides that are incorporated at low abundance on the N/O-glycopeptides along with their natural counterparts. Our approach allowed the detection of both natural and non-natural sugar bearing glycopeptides, N- and O-glycopeptides, differentiation of non-natural monosaccharide types on the glycans and also their incorporation efficiency through quantitation. Through this, we could deduce interconversion of monosaccharides during their processing through glycan salvage pathway and subsequent incorporation into glycan chains. The study of glycosylation dynamics through this method can be conducted in high throughput, as few sample processing steps are involved, enabling understanding of glycosylation dynamics under various external stimuli and thereby could bolster the use of metabolic glycan engineering in glycosylation functional studies.


Assuntos
Glicopeptídeos/análise , Glicoproteínas de Membrana/análise , Espectrometria de Massas em Tandem/métodos , Algoritmos , Sequência de Carboidratos , Linhagem Celular Tumoral , Cromatografia Líquida , Glicômica , Glicopeptídeos/metabolismo , Glicosilação , Humanos , Células Jurkat , Glicoproteínas de Membrana/química , Glicoproteínas de Membrana/metabolismo , Fragmentos de Peptídeos/análise , Fragmentos de Peptídeos/metabolismo , Processamento de Proteína Pós-Traducional , Proteólise , Proteômica , Espectrometria de Massas em Tandem/estatística & dados numéricos
3.
Biochem Biophys Res Commun ; 527(2): 406-410, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32331836

RESUMO

The ability to distinguish malignant from indolent prostate cancer cells is critically important for identification of clinically significant prostate cancer to minimize unnecessary overtreatment and sufferings endured by patients who have indolent cancer. Recently, we discovered that loss of giantin function as the primary Golgi targeting site for endoplasmic reticulum-derived transport vesicles in aggressive prostate cancer cells caused a shift of the Golgi localization site of α-mannosidase 1A to 130 KDa Golgi matrix protein (GM130)-65 KDa Golgi reassembly-stacking protein (GRASP65) site resulting in emergence of high mannose N-glycans on trans-Golgi enzymes and cell surface glycoproteins. To extend this observation, we isolated two cell clones (Clone 1 and Clone 2) from high passage LNCaP cells, which exhibited androgen refractory property missing in low passage LNCaP cells, and characterized their malignant property. We have found that comparing to Clone 2, which does not have cell surface high mannose N-glycans and exhibits localization of α-mannosidase 1A at giantin site, Clone 1 displays cell surface high mannose N-glycans, exhibits localization of α-mannosidase 1A at GM130-GRASP65 site, and shows a faster rate of closing the wound in a wound healing assay. The results indicate that Golgi localization of α-mannosidase 1A at GM130-GRASP65 site and appearance of cell surface high mannose N-glycans may serve as markers of malignant prostate cancer cells.


Assuntos
Autoantígenos/análise , Complexo de Golgi/patologia , Proteínas da Matriz do Complexo de Golgi/análise , Manose/análise , Proteínas de Membrana/análise , Neoplasias da Próstata/patologia , Biomarcadores Tumorais/análise , Linhagem Celular Tumoral , Membrana Celular/patologia , Humanos , Masculino , Polissacarídeos/análise
4.
ACS Infect Dis ; 5(3): 385-393, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30623643

RESUMO

Stable isotope probing (SIP) has emerged as a powerful tool to address key questions about microbiota structure and function. To date, diverse isotopically labeled substrates have been used to characterize in situ growth activity of specific bacterial taxa and have revealed the flux of bioavailable substrates through microbial communities associated with health and disease. A major limitation to the growth of the field is the dearth of biologically relevant "heavy" labeled substrates. Mucin glycoproteins, for example, comprise an abundant source of carbon in the gut, oral cavity, respiratory tract, and other mucosal surfaces but are not commercially available. Here, we describe a method to incorporate a 13C-labeled monosaccharide into MUC5AC, a predominant mucin in both gastrointestinal and airway environments. Using the lung adenocarcinoma cell line, Calu-3, polarized cell cultures grown in 13C-labeled d-glucose resulted in liberal mucin production on the apical surface. Mucins were isolated by size-exclusion chromatography, and O-linked glycans were released by ß-elimination, permethylated, and analyzed by electrospray ionization tandem mass spectrometry (ESI-MS/MS) and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) techniques. We demonstrate a 98.7% incorporation of 13C in the heterogeneous O-linked oligosaccharides that make up >80% of mucin dry weight. These "heavy" labeled glycoproteins represent a valuable tool for probing in vivo activity of host-associated bacterial communities and their interactions with the mucosal barrier. The continued expansion of labeled substrates for use in SIP will eventually allow bacterial taxa that degrade host compounds to be identified, with long-term potential for improved health and disease management.


Assuntos
Microbioma Gastrointestinal , Marcação por Isótopo/métodos , Mucina-5AC/química , Oligossacarídeos/química , Animais , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Isótopos de Carbono , Trato Gastrointestinal/química , Trato Gastrointestinal/metabolismo , Trato Gastrointestinal/microbiologia , Glucose/química , Glucose/metabolismo , Humanos , Microbiota , Mucina-5AC/metabolismo , Oligossacarídeos/metabolismo
5.
Biochim Biophys Acta Gen Subj ; 1861(11 Pt A): 2891-2901, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28782625

RESUMO

BACKGROUND: There is a pressing need for biomarkers that can distinguish indolent from aggressive prostate cancer to prevent over-treatment of patients with indolent tumor. METHODS: Golgi targeting of glycosyltransferases was characterized by confocal microscopy after knockdown of GM130, giantin, or both. N-glycans on a trans-Golgi enzyme ß4galactosyltransferase-1 isolated by immunoprecipitation from androgen-sensitive and independent prostate cancer cells were determined by matrix-assisted laser desorption-time of flight-mass spectrometry. In situ proximity ligation assay was employed to determine co-localization of (a) α-mannosidase IA, an enzyme required for processing Man8GlcNAc2 down to Man5GlcNAc2 to enable synthesis of complex-type N-glycans, with giantin, GM130, and GRASP65, and (b) trans-Golgi glycosyltransferases with high mannose N-glycans terminated with α3-mannose. RESULTS: Defective giantin in androgen-independent prostate cancer cells results in a shift of Golgi targeting of glycosyltransferases and α-mannosidase IA from giantin to GM130-GRASP65. Consequently, trans-Golgi enzymes and cell surface glycoproteins acquire high mannose N-glycans, which are absent in cells with functional giantin. In situ proximity ligation assays of co-localization of α-mannosidase IA with GM130 and GRASP65, and trans-Golgi glycosyltransferases with high mannose N-glycans are negative in androgen-sensitive LNCaP C-33 cells but positive in androgen-independent LNCaP C-81 and DU145 cells, and LNCaP C-33 cells devoid of giantin. CONCLUSION: In situ proximity ligation assays of Golgi localization of α-mannosidase IA at giantin versus GM130-GRASP65 site, and absence or presence of N-glycans terminated with α3-mannose on trans-Golgi glycosyltransferases may be useful for distinguishing indolent from aggressive prostate cancer cells.


Assuntos
Autoantígenos/genética , Biomarcadores Tumorais/biossíntese , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Neoplasias da Próstata/metabolismo , alfa-Manosidase/metabolismo , Autoantígenos/metabolismo , Biomarcadores Tumorais/química , Linhagem Celular Tumoral , Glicosiltransferases/química , Glicosiltransferases/metabolismo , Complexo de Golgi/enzimologia , Complexo de Golgi/metabolismo , Complexo de Golgi/patologia , Proteínas da Matriz do Complexo de Golgi , Humanos , Masculino , Manose/metabolismo , Glicoproteínas de Membrana/química , Glicoproteínas de Membrana/metabolismo , Proteínas de Membrana/antagonistas & inibidores , Polissacarídeos/biossíntese , Polissacarídeos/química , Neoplasias da Próstata/enzimologia , Neoplasias da Próstata/patologia , Ligação Proteica , Transporte Proteico/genética , alfa-Manosidase/química
6.
Molecules ; 20(6): 10848-65, 2015 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-26076107

RESUMO

SRL is a cell wall associated developmental-stage specific lectin secreted by Sclerotium rolfsii, a soil-born pathogenic fungus. SRL displays specificity for TF antigen (Galß1→3GalNAc-α-Ser//Thr) expressed in all cancer types and has tumour suppressing effects in vivo. Considering the immense potential of SRL in cancer research, we have generated two variant gene constructs of SRL and expressed in E. coli to refine the sugar specificity and solubility by altering the surface charge. SSR1 and SSR2 are two different recombinant variants of SRL, both of which recognize TF antigen but only SSR1 binds to Tn antigen (GalNAcα-Ser/Thr). The glycan array analysis of the variants demonstrated that SSR1 recognizes TF antigen and their derivative with high affinity similar to SRL but showed highest affinity towards the sialylated Tn antigen, unlike SRL. The carbohydrate binding property of SSR2 remains unaltered compared to SRL. The crystal structures of the two variants were determined in free form and in complex with N-acetylglucosamine at 1.7 Å and 1.6 Å resolution, respectively. Structural analysis highlighted the structural basis of the fine carbohydrate specificity of the two SRL variants and results are in agreement with glycan array analysis.


Assuntos
Basidiomycota/genética , Clonagem Molecular , Variação Genética , Lectinas/química , Lectinas/genética , Modelos Moleculares , Sequência de Aminoácidos , Basidiomycota/metabolismo , Metabolismo dos Carboidratos , Carboidratos/química , Ligação de Hidrogênio , Lectinas/isolamento & purificação , Lectinas/metabolismo , Dados de Sequência Molecular , Polissacarídeos/metabolismo , Ligação Proteica , Conformação Proteica , Alinhamento de Sequência , Análise de Sequência de DNA , Especificidade por Substrato
7.
Glycobiology ; 25(9): 963-75, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25972125

RESUMO

The sialyl Lewis a and x (sLe(a/x)) antigens frequently displayed on the surface of tumor cells are involved in metastasis. Their synthesis has been attributed to altered expression of selective glycosyltransferases. Identification of these glycosyltransferases and the glycoproteins that carry these carbohydrate antigens should help advance our understanding of selectin-mediated cancer metastasis. In this study, quantitative real-time polymerase chain reaction analysis coupled with in situ proximity ligation assay and small interference RNA treatment shows involvement of ß3galactosyltransferase-V in the synthesis of MUC16-associated sLe(a) in H292 cells. Also, α3fucosyltransferase-V, which is absent in BEAS-2B human immortalized bronchial epithelial cells and A549 lung carcinoma cells, participates in the synthesis of MUC1-associated sLe(x) in CFT1 human immortalized bronchial epithelial cells and H292 lung carcinoma cells. Neither selectin ligand is found on MUC1 in BEAS-2B and A549 cells. Knockdown of either enzyme suppresses migration, and selectin tethering and rolling properties of H292 cells under dynamic flow as determined by wound healing and parallel plate flow chamber assays, respectively. These results provide insights into how the synthesis of mucin-associated selectin ligands and the metastatic properties of cancer cells can be regulated by selective glycosyltransferases that work on mucins. They may help develop novel anticancer drugs.


Assuntos
Movimento Celular , Células Epiteliais/metabolismo , Galactosiltransferases/metabolismo , Glicoproteínas de Membrana/metabolismo , Mucinas/metabolismo , Antígeno CA-19-9 , Adesão Celular , Linhagem Celular Tumoral , Células Epiteliais/fisiologia , Humanos , Glicoproteínas de Membrana/genética , Oligossacarídeos/metabolismo , Antígeno Sialil Lewis X
8.
Immunol Lett ; 163(2): 163-72, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25555439

RESUMO

We have previously reported that a fungal lectin, Rhizoctonia bataticola lectin (RBL), stimulates proliferation and secretion of Th1/Th2 cytokines in human peripheral blood mononuclear cells (PBMC). In the present study, we evaluated the ability of RBL to differentiate human monocytes to macrophages. RBL induced morphological changes indicative of differentiation in primary monocytes and THP-1 cells. Stimulation with RBL resulted in significant up-regulation of differentiation markers - CD54, HLA-DR, CD11b and CD11c and secretion of proinflammatory cytokines - IL-1ß, TNF-α and IL-6. Functionally, RBL profoundly increased phagocytic activity in monocytes. In THP-1 cells, RBL-induced phagocytosis was higher compared to the effect induced by combination of phorbol-12-myristate-13-acetate (PMA) and lipopolysaccharide (LPS). RBL induced a significant increase in matrix metalloproteinase-9 (MMP-9) activity in comparison with a combined treatment of PMA+LPS. Mechanistic studies revealed the involvement of the NF-κB pathway in RBL-induced differentiation of monocytes. The data suggest that RBL mimics the combined action of PMA and LPS to induce morphological and functional differentiation in human monocytes and monocytic cell line - THP-1 to macrophages. Human monocytes differentiated to macrophages with RBL have the potential as an in vitro model to study macrophage biology.


Assuntos
Lectinas/farmacologia , Macrófagos/efeitos dos fármacos , Monócitos/efeitos dos fármacos , Rhizoctonia/química , Ligação Competitiva , Adesão Celular/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Células Cultivadas , Citocinas/metabolismo , Ensaio de Imunoadsorção Enzimática , Citometria de Fluxo , Humanos , Molécula 1 de Adesão Intercelular/metabolismo , Lectinas/metabolismo , Lipopolissacarídeos/farmacologia , Ativação de Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Microscopia Confocal , Monócitos/metabolismo , NF-kappa B/antagonistas & inibidores , NF-kappa B/metabolismo , Nitrilas/farmacologia , Fagocitose/efeitos dos fármacos , Sulfonas/farmacologia , Acetato de Tetradecanoilforbol/farmacologia
9.
Glycoconj J ; 27(3): 309-20, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20213246

RESUMO

A mannose-binding lectin (RVL) was purified from the tubers of Remusatia vivipara, a monocot plant by single-step affinity chromatography on asialofetuin-Sepharose 4B. RVL agglutinated only rabbit erythrocytes and was inhibited by mucin, asialomucin, asialofetuin and thyroglobulin. Lectin activity was stable up to 80 degrees C and under wide range of pH (2.0-9.3). SDS-PAGE and gel filtration results showed the lectin is a homotetramer of Mr 49.5 kDa, but MALDI analysis showed two distinct peaks corresponding to subunit mass of 12 kDa and 12.7 kDa. Also the N-terminal sequencing gave two different sequences indicating presence of two polypeptide chains. Cloning of RVL gene indicated posttranslational cleavage of RVL precursor into two mature polypeptides of 116 and 117 amino-acid residues. Dynamic light scattering (DLS) and gel filtration studies together confirmed the homogeneity of the purified lectin and supported RVL as a dimer with Mr 49.5 kDa derived from single polypeptide precursor of 233 amino acids. Purified RVL exerts potent nematicidal activity on Meloidogyne incognita, a root knot nematode. Fluorescent confocal microscopic studies demonstrated the binding of RVL to specific regions of the alimentary-tract and exhibited a potent toxic effect on M. incognita. RVL-mucin complex failed to interact with the gut confirming the receptor mediated lectin interaction. Very high mortality (88%) rate was observed at lectin concentration as low as 30 microg/ml, suggesting its potential application in the development of nematode resistant transgenic-crops.


Assuntos
Magnoliopsida/química , Lectina de Ligação a Manose/isolamento & purificação , Lectina de Ligação a Manose/farmacologia , Tylenchoidea/efeitos dos fármacos , Animais , Cromatografia em Gel , Eletroforese em Gel de Poliacrilamida , Concentração de Íons de Hidrogênio , Lectina de Ligação a Manose/genética , Lectina de Ligação a Manose/metabolismo , Microscopia Confocal , Espalhamento de Radiação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Temperatura
10.
J Infect Dis ; 189(12): 2260-70, 2004 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-15181574

RESUMO

BACKGROUND: The seroprevalence of Kaposi sarcoma-associated herpesvirus (KSHV)/human herpesvirus 8 (HHV-8) in sub-Saharan Africa suggests that multiple routes of transmission exist. In the present study, we examined 2 possible routes of mother-to-child transmission, through breast milk and saliva, during the first 6 months after delivery. METHODS: The prevalence of HHV-8 DNA in the breast-milk cells (n=75), milk supernatant (n=56), colostrum (n=2), and saliva cells (n=65) of HHV-8-seropositive mothers who recently gave birth was examined. Polymerase chain reaction analysis was performed for the detection of HHV-8 in cross-sectional samples isolated at 2, 4, and 6 months after delivery. RESULTS: None of the 75 breast-milk samples but 2 of the colostrum samples that were analyzed contained HHV-8 DNA at a limit of detection of approximately 1 HHV-8 copy/10(4) cellular genomes, whereas Epstein-Barr virus DNA and HIV-1 DNA were detected in 16 and 22 samples, respectively. Analysis of 65 saliva cell samples, which were obtained from mothers who also provided milk samples, revealed that 19 of the samples had detectable HHV-8 DNA. Viral DNA was found at all time points, but the presence of viral DNA in saliva was independent of maternal HIV-1 serostatus (chi 2=0.33; P=.57). CONCLUSIONS: Our findings demonstrate the lack of HHV-8 DNA in the breast milk of seropositive mothers, and they suggest that contact with breast milk is not a likely source of horizontal transmission of virus to infants in sub-Saharan Africa.


Assuntos
Infecções por Herpesviridae/transmissão , Herpesvirus Humano 8/isolamento & purificação , Transmissão Vertical de Doenças Infecciosas , Leite Humano/virologia , Saliva/virologia , Sequência de Aminoácidos , DNA Viral/análise , Feminino , Infecções por Herpesviridae/virologia , Herpesvirus Humano 8/genética , Humanos , Filogenia , Alinhamento de Sequência , Análise de Sequência de DNA , Proteínas Virais/genética
11.
J Infect Dis ; 187(4): 559-68, 2003 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-12599072

RESUMO

The specific route and timing of human herpesvirus (HHV) 8 infection in regions where Kaposi sarcoma is endemic are not known. HHV-8 infection and any risk factors that may be associated with HHV-8, including human immunodeficiency virus (HIV) type 1 infection, were monitored during the 12-month postdelivery period for 416 mothers and 485 infants from Lusaka, Zambia. HHV-8 incident infection rates during this period were 3.2 and 5.3 infections/100 person-years for infants and mothers, respectively. HHV-8 infection among infants was not associated with HHV-8 or HIV-1 infection in the mother. Among the HHV-8-positive infants, 2 of 12 tested were found to have HHV-8 DNA in their peripheral blood mononuclear cells at birth, which suggests that in utero infection is possible. However, most HHV-8-positive infants appeared to have acquired infection either intrapartum or postpartum. The present study indicates that transmission of HHV-8 to infants can occur early and is likely via multiple routes.


Assuntos
Infecções por HIV/epidemiologia , HIV-1 , Infecções por Herpesviridae/epidemiologia , Herpesvirus Humano 8 , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Estudos de Coortes , Transmissão de Doença Infecciosa , Feminino , Anticorpos Anti-HIV/sangue , Infecções por HIV/sangue , Infecções por Herpesviridae/sangue , Infecções por Herpesviridae/transmissão , Herpesvirus Humano 8/imunologia , Herpesvirus Humano 8/isolamento & purificação , Humanos , Incidência , Lactente , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Leucócitos Mononucleares/virologia , Masculino , Gravidez , Complicações Infecciosas na Gravidez/sangue , Fatores de Risco , Estudos Soroepidemiológicos , Zâmbia/epidemiologia
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