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1.
Kidney Int ; 2024 Aug 29.
Article in English | MEDLINE | ID: mdl-39216658

ABSTRACT

Anti-neutrophil cytoplasmic autoantibody (ANCA) vasculitis has diverse patterns of injury including microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Necrotizing and crescentic glomerulonephritis (NCGN) occurs in all syndromes and as renal limited vasculitis (RLV). Single dose intravenous ANCA IgG-specific for mouse myeloperoxidase (MPO) causes RLV in mice. Although multiple mouse models have elucidated ANCA-IgG induced necrotizing and crescentic glomerulonephritis (NCGN), pathogenesis of ANCA-induced granulomatosis and vasculitis outside the kidney has not been clarified. To investigate this, we used intravenous MPO-ANCA IgG in the same strain of mice to induce different patterns of lung disease mirroring patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Repeated intravenous MPO-ANCA IgG induced GPA with NCGN, lung capillaritis, arteritis and granulomatosis. Lung leukocyte phenotypes were evaluated by immunohistochemical image analysis and by flow cytometry. ANCA lung capillaritis and microabscesses began within one day and evolved into granulomas in under seven days. Influenza plus single dose MPO-ANCA IgG induced MPA with NCGN, lung capillaritis and arteritis, but no granulomatosis. Allergic airway disease caused by house dust mites or ovalbumin plus single dose intravenous MPO-ANCA IgG induced EGPA with eosinophilic bronchiolitis, NCGN, capillaritis, arteritis, and granulomatosis. Thus, our study shows that the occurrence and pattern of lung lesions are determined by the same ANCA IgG accompanied by different synergistic immune factors.

2.
J Leukoc Biol ; 115(1): 1-3, 2024 01 05.
Article in English | MEDLINE | ID: mdl-37931143

ABSTRACT

Mechanisms of regulating the beneficial and harmful capabilities of neutrophils include IL-10/IL-10RA signaling in neutrophils that limits clearance of Streptococcus pneumoniae and accumulation of neutrophils in pneumonic lung tissue.


Subject(s)
Pneumonia , Streptococcus pneumoniae , Humans , Neutrophils/physiology , Interleukin-10 , Lung
3.
Am J Respir Cell Mol Biol ; 66(6): 671-681, 2022 06.
Article in English | MEDLINE | ID: mdl-35358404

ABSTRACT

Bacterial pneumonia induces the rapid recruitment and activation of neutrophils and macrophages into the lung, and these cells contribute to bacterial clearance and other defense functions. TBK1 (TANK-binding kinase 1) performs many functions, including activation of the type I IFN pathway and regulation of autophagy and mitophagy, but its contribution to antibacterial defenses in the lung is unclear. We previously showed that lung neutrophils upregulate mRNAs for TBK1 and its accessory proteins during Streptococcus pneumoniae pneumonia, despite low or absent expression of type I IFN in these cells. We hypothesized that TBK1 performs key antibacterial functions in pneumonia apart from type I IFN expression. Using TBK1 null mice, we show that TBK1 contributes to antibacterial defenses and promotes bacterial clearance and survival. TBK1 null mice express lower concentrations of many cytokines in the infected lung. Conditional deletion of TBK1 with LysMCre results in TBK1 deletion from macrophages but not neutrophils. LysMCre TBK1 mice have no defect in cytokine expression, implicating a nonmacrophage cell type as a key TBK1-dependent cell. TBK1 null neutrophils have no defect in recruitment to the infected lung but show impaired activation of p65/NF-κB and STAT1 and lower expression of reactive oxygen species, IFNγ, and IL12p40. TLR1/2 and 4 agonists each induce phosphorylation of TBK1 in neutrophils. Surprisingly, neutrophil TBK1 activation in vivo does not require the adaptor STING. Thus, TBK1 is a critical component of STING-independent antibacterial responses in the lung, and TBK1 is necessary for multiple neutrophil functions.


Subject(s)
Interferon Type I , Pneumonia, Pneumococcal , Protein Serine-Threonine Kinases , Streptococcus pneumoniae , Animals , Cytokines/immunology , Interferon Type I/biosynthesis , Interferon Type I/immunology , Mice , Mice, Inbred C57BL , Mice, Knockout , Myeloid Cells/immunology , Pneumonia, Pneumococcal/immunology , Pneumonia, Pneumococcal/microbiology , Protein Serine-Threonine Kinases/immunology , Signal Transduction , Streptococcus pneumoniae/immunology
5.
J Exp Med ; 219(1)2022 01 03.
Article in English | MEDLINE | ID: mdl-34910084

ABSTRACT

Neutrophil functions and responses are heterogeneous, and the nature and categorization of this heterogeneity is achieving considerable interest. Work by Li et al. in this issue of JEM (2021. J. Exp. Med.https://doi.org/10.1084/jem.20211083) identifies how a transcriptional repressor, DREAM, regulates adhesion of neutrophils to endothelial cells and their transmigration into tissue. This study offers a mechanism for heterogeneity in this critical response of neutrophils to inflammatory stimuli.


Subject(s)
Endothelial Cells , Neutrophils
7.
PLoS One ; 14(2): e0212866, 2019.
Article in English | MEDLINE | ID: mdl-30818335

ABSTRACT

Cigarette smoke is well recognized to cause injury to the airways and the alveolar walls over time. This injury usually requires many years of exposure, suggesting that the lungs may rapidly develop responses that initially protect it from this repetitive injury. Our studies tested the hypotheses that smoke induces an inflammatory response and changes in mRNA profiles that are dependent on sex and the health status of the lung, and that the response of the lungs to smoke differs after 1 day compared to 5 days of exposure. Male and female wildtype (WT) and Scnn1b-transgenic (ßENaC) mice, which have chronic bronchitis and emphysematous changes due to dehydrated mucus, were exposed to cigarette smoke or sham air conditions for 1 or 5 days. The inflammatory response and gene expression profiles were analyzed in lung tissue. Overall, the inflammatory response to cigarette smoke was mild, and changes in mediators were more numerous after 1 than 5 days. ßENaC mice had more airspace leukocytes than WT mice, and smoke exposure resulted in additional significant alterations. Many genes and gene sets responded similarly at 1 and 5 days: genes involved in oxidative stress responses were upregulated while immune response genes were downregulated. However, certain genes and biological processes were regulated differently after 1 compared to 5 days. Extracellular matrix biology genes and gene sets were upregulated after 1 day but downregulated by 5 days of smoke compared to sham exposure. There was no difference in the transcriptional response to smoke between WT and ßENaC mice or between male and female mice at either 1 or 5 days. Taken together, these studies suggest that the lungs rapidly alter gene expression after only one exposure to cigarette smoke, with few additional changes after four additional days of repeated exposure. These changes may contribute to preventing lung damage.


Subject(s)
Bronchitis, Chronic/pathology , Emphysema/pathology , Lung/drug effects , Nicotiana/toxicity , Smoke/adverse effects , Animals , Bronchitis, Chronic/diagnosis , Bronchitis, Chronic/etiology , Bronchoalveolar Lavage Fluid/chemistry , Bronchoalveolar Lavage Fluid/cytology , Disease Models, Animal , Emphysema/diagnosis , Emphysema/etiology , Epithelial Sodium Channels/genetics , Female , Gene Expression Profiling , Gene Expression Regulation/drug effects , Humans , Lung/pathology , Male , Mice , Mice, Inbred C57BL , Mice, Transgenic , Oxidative Stress/drug effects , Sex Factors , Smoking/adverse effects , Time Factors
8.
JCI Insight ; 4(6)2019 03 21.
Article in English | MEDLINE | ID: mdl-30753170

ABSTRACT

Recovery from acute lung injury (ALI) is an active process. Foxp3+ Tregs contribute to recovery from ALI through modulating immune responses and enhancing alveolar epithelial proliferation and tissue repair. The current study investigates Treg transcriptional profiles during resolution of ALI in mice. Tregs from either lung or splenic tissue were isolated from uninjured mice or mice recovering from ALI and then examined for differential gene expression between these conditions. In mice with ALI, Tregs isolated from the lungs had hundreds of differentially expressed transcripts compared with those from the spleen, indicating that organ specificity and microenvironment are critical in Treg function. These regulated transcripts suggest which intracellular signaling pathways modulate Treg behavior. Interestingly, several transcripts having no prior recognized function in Tregs were differentially expressed by lung Tregs during resolution. Further investigation into 2 identified transcripts, Mmp12 and Sik1, revealed that Treg-specific expression of each plays a role in Treg-promoted ALI resolution. This study provides potentially novel information describing the signals that may expand resident Tregs, recruit or retain them to the lung during ALI, and modulate their function. The results provide insight into both tissue- and immune microenvironment-specific transcriptional differences through which Tregs direct their effects.


Subject(s)
Acute Lung Injury/metabolism , Forkhead Transcription Factors/metabolism , T-Lymphocytes, Regulatory/metabolism , Transcriptome , Animals , Chemokines/metabolism , Cytokines/metabolism , Disease Models, Animal , Female , Gene Expression , Lung/immunology , Male , Matrix Metalloproteinase 12/genetics , Matrix Metalloproteinase 12/metabolism , Mice , Mice, Inbred C57BL , Mice, Knockout , Neutrophils , Protein Serine-Threonine Kinases/genetics , Protein Serine-Threonine Kinases/metabolism , Spleen/immunology , T-Lymphocytes, Regulatory/immunology
9.
Sci Rep ; 7(1): 11258, 2017 09 12.
Article in English | MEDLINE | ID: mdl-28900269

ABSTRACT

The complex role of neutrophils in modulating the inflammatory response is increasingly appreciated. Our studies profiled the expression of mRNAs and microRNAs (miRs) in lung neutrophils in mice during S. pneumoniae pneumonia and performed in depth in silico analyses. Lung neutrophils were isolated 24 hours after intratracheal instillation of PBS or S. pneumoniae, and differentially expressed (DE) mRNAs and miRs were identified. Lung neutrophils from mice with S. pneumoniae pneumonia contained 4127 DE mRNAs, 36% of which were upregulated at least 2-fold. During pneumonia, lung neutrophils increase expression of pattern recognition receptors, receptors for inflammatory mediators, transcription factors including NF-κB and AP-1, Nrf2 targets, cytokines, chemokines and other inflammatory mediators. Interestingly, neutrophils responded to Type I interferons, whereas they both produced and responded to Type II interferon. Expression of regulators of the inflammatory and immune response was verified at the mRNA and protein level. Of approximately 1100 miRs queried, 31 increased and 67 decreased more than 2-fold in neutrophils from S. pneumoniae pneumonia. Network analyses of potential DE miR-target DE mRNA interactions revealed candidate key regulatory miRs. Thus, S. pneumoniae modulates mRNA and miR expression by lung neutrophils, increasing their ability to respond and facilitating host defense.


Subject(s)
Gene Expression Profiling , Lung/pathology , MicroRNAs/analysis , Neutrophils/immunology , Pneumonia, Pneumococcal/pathology , RNA, Messenger/analysis , Animals , Computational Biology , Disease Models, Animal , Gene Regulatory Networks , Mice
10.
Am J Physiol Lung Cell Mol Physiol ; 313(3): L425-L452, 2017 Sep 01.
Article in English | MEDLINE | ID: mdl-28522563

ABSTRACT

Accurate and reliable measurements of exposure to tobacco products are essential for identifying and confirming patterns of tobacco product use and for assessing their potential biological effects in both human populations and experimental systems. Due to the introduction of new tobacco-derived products and the development of novel ways to modify and use conventional tobacco products, precise and specific assessments of exposure to tobacco are now more important than ever. Biomarkers that were developed and validated to measure exposure to cigarettes are being evaluated to assess their use for measuring exposure to these new products. Here, we review current methods for measuring exposure to new and emerging tobacco products, such as electronic cigarettes, little cigars, water pipes, and cigarillos. Rigorously validated biomarkers specific to these new products have not yet been identified. Here, we discuss the strengths and limitations of current approaches, including whether they provide reliable exposure estimates for new and emerging products. We provide specific guidance for choosing practical and economical biomarkers for different study designs and experimental conditions. Our goal is to help both new and experienced investigators measure exposure to tobacco products accurately and avoid common experimental errors. With the identification of the capacity gaps in biomarker research on new and emerging tobacco products, we hope to provide researchers, policymakers, and funding agencies with a clear action plan for conducting and promoting research on the patterns of use and health effects of these products.


Subject(s)
Biomarkers/analysis , Electronic Nicotine Delivery Systems , Environmental Exposure/analysis , Nicotiana/adverse effects , Humans , Metabolome , Nicotine/analysis , Nicotine/chemistry
12.
J Immunol ; 197(7): 2864-79, 2016 10 01.
Article in English | MEDLINE | ID: mdl-27566827

ABSTRACT

Nrf2 regulates the transcriptional response to oxidative stress. These studies tested the role of Nrf2 during Streptococcus pneumoniae pneumonia and identified Nrf2-dependent genes and pathways in lung tissue and in recruited neutrophils. Nrf2 null and wild type (WT) mice were studied at 6 and 24 h after instillation of S. pneumoniae or PBS. At 6 h, fewer neutrophils were recruited and the number of bacteria remaining in the lungs tended to be less (p = 0.06) in the Nrf2 null compared with WT mice. In uninfected lungs, 53 genes were already differentially expressed in Nrf2 null compared with WT mouse lungs, and gene sets involved in phagocytosis, Fc receptor function, complement, and Ig regulation are enhanced in PBS-treated Nrf2 null gene profiles compared with those of WT mice. These results suggest that initial host defense is enhanced in Nrf2 null mice, resulting in less recruitment of neutrophils. At 24 h, neutrophil recruitment was greater. The percentages of early apoptotic and late apoptotic/necrotic neutrophils were similar. At increasing inoculum numbers, mortality rates strikingly increased from 15 to 31 and 100% in Nrf2 null mice, whereas all WT mice survived, and Nrf2 null mice had a defect in clearance, particularly at the intermediate dose. The mortality was due to enhanced lung injury and greater systemic response. Gene profiling identified differentially regulated genes and pathways in neutrophils and lung tissue, including those involved in redox stress response, metabolism, inflammation, immunoregulatory pathways, and tissue repair, providing insight into the mechanisms for the greater tissue damage and increased neutrophil accumulation.


Subject(s)
NF-E2-Related Factor 2/metabolism , Pneumonia, Pneumococcal/immunology , Pneumonia, Pneumococcal/metabolism , Streptococcus pneumoniae/immunology , Streptococcus pneumoniae/metabolism , Animals , Apoptosis/immunology , Mice , Mice, Inbred C57BL , Mice, Knockout , NF-E2-Related Factor 2/deficiency , Neutrophils/immunology , Neutrophils/metabolism , Neutrophils/pathology
13.
Am J Respir Cell Mol Biol ; 52(3): 349-64, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25100610

ABSTRACT

Bacterial pneumonia is a common public health problem associated with significant mortality, morbidity, and cost. Neutrophils are usually the earliest leukocytes to respond to bacteria in the lungs. Neutrophils rapidly sequester in the pulmonary microvasculature and migrate into the lung parenchyma and alveolar spaces, where they perform numerous effector functions for host defense. Previous studies showed that migrated neutrophils produce IFN-γ early during pneumonia induced by Streptococcus pneumoniae and that early production of IFN-γ regulates bacterial clearance. IFN-γ production by neutrophils requires Rac2, Hck/Lyn/Fgr Src family tyrosine kinases, and NADPH oxidase. Our current studies examined the mechanisms that regulate IFN-γ production by lung neutrophils during acute S. pneumoniae pneumonia in mice and its function. We demonstrate that IFN-γ production by neutrophils is a tightly regulated process that does not require IL-12. The adaptor molecule MyD88 is critical for IFN-γ production by neutrophils. The guanine nucleotide exchange factor CalDAG-GEFI modulates IFN-γ production. The CD11/CD18 complex, CD44, Toll-like receptors 2 and 4, TRIF, and Nrf2 are not required for IFN-γ production by neutrophils. The recently described neutrophil-dendritic cell hybrid cell, identified by its expression of Ly6G and CD11c, is present at low numbers in pneumonic lungs and is not a source of IFN-γ. IFN-γ produced by neutrophils early during acute S. pneumoniae pneumonia induces transcription of target genes in the lungs, which are critical for host defense. These studies underline the complexity of the neutrophil responses during pneumonia in the acute inflammatory response and in subsequent resolution or initiation of immune responses.


Subject(s)
Interferon-gamma/immunology , Neutrophils/immunology , Pneumococcal Infections/immunology , Pneumonia, Bacterial/immunology , Streptococcus pneumoniae/immunology , Animals , Guanine Nucleotide Exchange Factors/immunology , Interleukin-12/immunology , Lung/immunology , Lung/microbiology , Mice , Mice, Inbred C57BL , Myeloid Differentiation Factor 88/immunology , Signal Transduction/immunology
14.
Am J Respir Crit Care Med ; 183(10): 1391-401, 2011 May 15.
Article in English | MEDLINE | ID: mdl-21169470

ABSTRACT

RATIONALE: Neutrophils are usually the first circulating leukocytes to respond during bacterial pneumonia. Their expression of oxidants, proteases, and other mediators present in granules is well documented, but their ability to produce mediators through transcription and translation after migration to an inflammatory site has been appreciated only more recently. Interferon (IFN)-γ is a cytokine with many functions important in host defense and immunity. OBJECTIVES: To examine the expression and function of IFN-γ in bacterial pneumonias. METHODS: IFN-γ mRNA and protein were measured in digests of mouse lungs with 24-hour bacterial pneumonia. Bacterial clearance was studied with IFN-γ-deficient mice. MEASUREMENTS AND MAIN RESULTS: Streptococcus pneumoniae and Staphylococcus aureus each induce expression of IFN-γ mRNA and protein by neutrophils by 24 hours. Only neutrophils that have migrated into pneumonic tissue produce IFN-γ. Deficiency of Hck/Fgr/Lyn, Rac2, or gp91(phox) prevents IFN-γ production. IFN-γ enhances bacterial clearance and is required for formation of neutrophil extracellular traps. In contrast, Pseudomonas aeruginosa and Escherichia coli induce production of IFN-γ mRNA but not protein. During pneumonia induced by E. coli but not S. pneumoniae, neutrophils produce microRNAs that target the 3' untranslated region of the IFN-γ gene. CONCLUSIONS: S. pneumoniae and S. aureus, but not P. aeruginosa and E. coli, induce emigrated neutrophils to produce IFN-γ within 24 hours. Hck/Fgr/Lyn, Rac2, and NADPH oxidase are required for IFN-γ production. IFN-γ facilitates bacterial clearance at least in part through regulating formation of neutrophil extracellular traps. Differential expression by neutrophils of microRNAs that target the 3' untranslated region of the IFN-γ gene may contribute to the pathogen-specific regulation of translation.


Subject(s)
Interferon-gamma/immunology , Neutrophils/immunology , Pneumonia, Bacterial/immunology , Animals , Bronchoalveolar Lavage Fluid/immunology , Cells, Cultured , Disease Models, Animal , Enzyme-Linked Immunosorbent Assay , Escherichia coli/immunology , Immunity, Innate/immunology , Lung/immunology , Mice , Mice, Inbred C57BL , Pseudomonas aeruginosa/immunology , Reverse Transcriptase Polymerase Chain Reaction , Staphylococcus aureus/immunology , Streptococcus pneumoniae/immunology
15.
Lab Invest ; 90(4): 599-610, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20142805

ABSTRACT

Neutrophil numbers must be tightly controlled to maintain host protection and prevent neutrophil-mediated tissue injury. CD18 deficiency leads to neutrophilia and myeloid hyperplasia in the bone marrow (BM). These studies examined the function of CD18 in regulating neutrophil production and determined whether the defects in neutrophil production that are observed in CD18 deficiency persist in the presence of wild-type (WT) leukocytes that confer host protection. Neutrophil production was evaluated in CD18(-/-) mice and lethally irradiated WT mice reconstituted with mixtures of CD18(-/-) and WT stem cells. Neutrophil kinetic studies suggest that CD18 may facilitate the release of the most mature neutrophils into the circulation. The proportion of CD18(-/-) neutrophils in chimeric animals was greater than the proportion of CD18(-/-) donor cells used to reconstitute the mice, and the percentage of CD18(-/-) leukocytes that were neutrophils was greater than for WT leukocytes, indicating that CD18 may regulate the lineage distribution of hematopoietic cells in the blood and BM. The proportion of Annexin V+ Gr-1+ cells in both the BM of chimeric animals and in vitro cultures of WT and CD18(-/-) hematopoietic stem cells was lower in CD18(-/-) than in WT cells, suggesting that CD18 modulates apoptosis. These data suggest that CD18 directly regulates neutrophil production, in part by limiting the survival of neutrophils and their precursors. Thus, the granulocytosis observed in CD18(-/-) mice and CD18-deficient patients is due to both defects in host defense and BM-intrinsic functions of CD18 in regulating neutrophil production.


Subject(s)
CD18 Antigens/physiology , Myelopoiesis/physiology , Neutrophils/physiology , Animals , Apoptosis/physiology , Cells, Cultured , Chimera , Female , Flow Cytometry , Hematopoietic Stem Cells/physiology , Male , Mice , Mice, Knockout
16.
Am J Pathol ; 173(2): 507-17, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18583316

ABSTRACT

Circulating neutrophils are persistently higher in mice deficient in the small GTPase Rac2 than in wild-type (WT) mice. Therefore, we examined the mechanisms through which the small GTPase Rac2 regulates neutrophil production and release. Lethally irradiated WT mice reconstituted with a 50:50 mixture of WT and Rac2(-/-) fetal liver cells were protected from neutrophilia, suggesting that neutrophilia is primarily because of extrinsic defects that can be corrected by WT leukocytes. However, the differential counts and numbers of leukocyte subtypes differed between Rac2(-/-) and WT cells, suggesting that Rac2 modulates leukocyte lineage distribution. Kinetic studies suggest Rac2 modulates the release of neutrophils into the circulation and does not prolong their circulating half life. The percentage of bone marrow cells that expressed the neutrophil marker Gr-1 in lethally irradiated WT or Rac2(-/-) recipients of Rac2(-/-) stem cells was greater than in recipients of WT stem cells; however, circulating neutrophil counts were higher only in Rac2(-/-) recipients of Rac2(-/-) stem cells. Rac2 mRNA was expressed in the bone marrow of WT recipients of Rac2(-/-) stem cells and in human mesenchymal stem cells. The data presented here suggest that Rac2 in hematopoietic cells regulates leukocyte lineage distribution and Rac2 in nonhematopoietic cells might contribute to regulating circulating neutrophil counts.


Subject(s)
Bone Marrow Cells/cytology , Neutrophils/cytology , rac GTP-Binding Proteins/physiology , Animals , Bone Marrow Cells/metabolism , Cell Lineage , Granulocyte Colony-Stimulating Factor/blood , Interleukin-17/metabolism , Kinetics , Leukocyte Count , Liver/cytology , Liver/metabolism , Lung/metabolism , Mice , Mice, Knockout , Neutrophil Activation , Neutrophils/metabolism , Receptors, Chemokine/metabolism , Stem Cell Transplantation , Stem Cells/cytology , Stem Cells/metabolism , rac GTP-Binding Proteins/genetics , RAC2 GTP-Binding Protein
17.
Am J Trop Med Hyg ; 69(4): 377-9, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14640496

ABSTRACT

Microsatellite markers derived from simple sequence repeats have been useful in studying a number of human pathogens, including the human malaria parasite Plasmodium falciparum. Genetic markers for P. vivax would likewise help elucidate the genetics and population characteristics of this other important human malaria parasite. We have identified a locus in a P. vivax telomeric clone that contains simple sequence repeats. Primers were designed to amplify this region using a two-step semi-nested polymerase chain reaction protocol. The primers did not amplify template obtained from non-infected individuals, nor DNA from primates infected with the other human malaria parasites (P. ovale, P. malariae, or P. falciparum). The marker was polymorphic in P. vivax-infected field isolates obtained from Papua New Guinea, Indonesia and Guyana. This microsatellite marker may be useful in genetic and epidemiologic studies of P. vivax malaria.


Subject(s)
DNA, Protozoan/analysis , Malaria, Vivax/diagnosis , Microsatellite Repeats , Plasmodium vivax/genetics , Polymerase Chain Reaction/standards , Adult , Animals , Base Sequence , Child , DNA Primers , Genetic Markers , Humans , Molecular Sequence Data , Plasmodium vivax/isolation & purification , Polymerase Chain Reaction/methods , Predictive Value of Tests , Sensitivity and Specificity , Sequence Alignment
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