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1.
Sci Rep ; 14(1): 2671, 2024 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-38302474

RESUMEN

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by significant metabolic disruptions, including weight loss and hypermetabolism in both patients and animal models. Leptin, an adipose-derived hormone, displays altered levels in ALS. Genetically reducing leptin levels (Lepob/+) to maintain body weight improved motor performance and extended survival in female SOD1G93A mice, although the exact molecular mechanisms behind these effects remain elusive. Here, we corroborated the sexual dimorphism in circulating leptin levels in ALS patients and in SOD1G93A mice. We reproduced a previous strategy to generate a genetically deficient leptin SOD1G93A mice (SOD1G93ALepob/+) and studied the transcriptomic profile in the subcutaneous adipose tissue and the spinal cord. We found that leptin deficiency reduced the inflammation pathways activated by the SOD1G93A mutation in the adipose tissue, but not in the spinal cord. These findings emphasize the importance of considering sex-specific approaches in metabolic therapies and highlight the role of leptin in the systemic modulation of ALS by regulating immune responses outside the central nervous system.


Asunto(s)
Esclerosis Amiotrófica Lateral , Animales , Femenino , Humanos , Masculino , Ratones , Tejido Adiposo/metabolismo , Esclerosis Amiotrófica Lateral/metabolismo , Modelos Animales de Enfermedad , Haploinsuficiencia , Leptina/metabolismo , Ratones Transgénicos , Médula Espinal/metabolismo , Superóxido Dismutasa/metabolismo , Superóxido Dismutasa-1/genética , Superóxido Dismutasa-1/metabolismo
2.
EBioMedicine ; 94: 104711, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37453364

RESUMEN

BACKGROUND: Cognitive deficits are among the main disabling symptoms in COVID-19 patients and post-COVID syndrome (PCS). Within brain regions, the hippocampus, a key region for cognition, has shown vulnerability to SARS-CoV-2 infection. Therefore, in vivo detailed evaluation of hippocampal changes in PCS patients, validated on post-mortem samples of COVID-19 patients at the acute phase, would shed light into the relationship between COVID-19 and cognition. METHODS: Hippocampal subfields volume, microstructure, and perfusion were evaluated in 84 PCS patients and compared to 33 controls. Associations with blood biomarkers, including glial fibrillary acidic protein (GFAP), myelin oligodendrocyte glycoprotein (MOG), eotaxin-1 (CCL11) and neurofilament light chain (NfL) were evaluated. Besides, biomarker immunodetection in seven hippocampal necropsies of patients at the acute phase were contrasted against eight controls. FINDINGS: In vivo analyses revealed that hippocampal grey matter atrophy is accompanied by altered microstructural integrity, hypoperfusion, and functional connectivity changes in PCS patients. Hippocampal structural and functional alterations were related to cognitive dysfunction, particularly attention and memory. GFAP, MOG, CCL11 and NfL biomarkers revealed alterations in PCS, and showed associations with hippocampal volume changes, in selective hippocampal subfields. Moreover, post mortem histology showed the presence of increased GFAP and CCL11 and reduced MOG concentrations in the hippocampus in post-mortem samples at the acute phase. INTERPRETATION: The current results evidenced that PCS patients with cognitive sequalae present brain alterations related to cognitive dysfunction, accompanied by a cascade of pathological alterations in blood biomarkers, indicating axonal damage, astrocyte alterations, neuronal injury, and myelin changes that are already present from the acute phase. FUNDING: Nominative Grant FIBHCSC 2020 COVID-19. Department of Health, Community of Madrid. Instituto de Salud Carlos III through the project INT20/00079, co-funded by European Regional Development Fund "A way to make Europe" (JAMG). Instituto de Salud Carlos III (ISCIII) through Sara Borrell postdoctoral fellowship Grant No. CD22/00043) and co-funded by the European Union (MDC). Instituto de Salud Carlos III through a predoctoral contract (FI20/000145) (co-funded by European Regional Development Fund "A way to make Europe") (MVS). Fundación para el Conocimiento Madri+d through the project G63-HEALTHSTARPLUS-HSP4 (JAMG, SOM).


Asunto(s)
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/patología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Hipocampo/patología , Atrofia , Síndrome , Biomarcadores
3.
Cells ; 12(11)2023 05 30.
Artículo en Inglés | MEDLINE | ID: mdl-37296635

RESUMEN

The implantation of oligodendrocyte precursor cells may be a useful therapeutic strategy for targeting remyelination. However, it is yet to be established how these cells behave after implantation and whether they retain the capacity to proliferate or differentiate into myelin-forming oligodendrocytes. One essential issue is the creation of administration protocols and determining which factors need to be well established. There is controversy around whether these cells may be implanted simultaneously with corticosteroid treatment, which is widely used in many clinical situations. This study assesses the influence of corticosteroids on the capacity for proliferation and differentiation and the survival of human oligodendroglioma cells. Our findings show that corticosteroids reduce the capacity of these cells to proliferate and to differentiate into oligodendrocytes and decrease cell survival. Thus, their effect does not favour remyelination; this is consistent with the results of studies with rodent cells. In conclusion, protocols for the administration of oligodendrocyte lineage cells with the aim of repopulating oligodendroglial niches or repairing demyelinated axons should not include corticosteroids, given the evidence that the effects of these drugs may undermine the objectives of cell transplantation.


Asunto(s)
Metilprednisolona , Oligodendroglía , Humanos , Metilprednisolona/farmacología , Vaina de Mielina , Axones , Diferenciación Celular
5.
Brain ; 146(5): 2142-2152, 2023 05 02.
Artículo en Inglés | MEDLINE | ID: mdl-36288544

RESUMEN

Brain changes have been reported in the first weeks after SARS-CoV-2 infection. However, limited literature exists about brain alterations in post-COVID syndrome, a condition increasingly associated with cognitive impairment. The present study aimed to evaluate brain functional and structural alterations in patients with post-COVID syndrome, and assess whether these brain alterations were related to cognitive dysfunction. Eighty-six patients with post-COVID syndrome and 36 healthy controls were recruited and underwent neuroimaging acquisition and a comprehensive neuropsychological assessment. Cognitive and neuroimaging examinations were performed 11 months after the first symptoms of SARS-CoV-2. Whole-brain functional connectivity analysis was performed. Voxel-based morphometry was performed to evaluate grey matter volume, and diffusion tensor imaging was carried out to analyse white-matter alterations. Correlations between cognition and brain changes were conducted and Bonferroni corrected. Post-COVID syndrome patients presented with functional connectivity changes, characterized by hypoconnectivity between left and right parahippocampal areas, and between bilateral orbitofrontal and cerebellar areas compared to controls. These alterations were accompanied by reduced grey matter volume in cortical, limbic and cerebellar areas, and alterations in white matter axial and mean diffusivity. Grey matter volume loss showed significant associations with cognitive dysfunction. These cognitive and brain alterations were more pronounced in hospitalized patients compared to non-hospitalized patients. No associations with vaccination status were found. The present study shows persistent structural and functional brain abnormalities 11 months after the acute infection. These changes are associated with cognitive dysfunction and contribute to a better understanding of the pathophysiology of the post-COVID syndrome.


Asunto(s)
COVID-19 , Sustancia Blanca , Humanos , Imagen de Difusión Tensora/métodos , Imagen por Resonancia Magnética/métodos , SARS-CoV-2 , Encéfalo , Neuroimagen/métodos , Cognición/fisiología , Sustancia Gris , Síndrome
6.
Biomolecules ; 14(1)2023 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-38275749

RESUMEN

One of the main concerns related to SARS-CoV-2 infection is the symptoms that could be developed by survivors, known as long COVID, a syndrome characterized by persistent symptoms beyond the acute phase of the infection. This syndrome has emerged as a complex and debilitating condition with a diverse range of manifestations affecting multiple organ systems. It is increasingly recognized for affecting the Central Nervous System, in which one of the most prevalent manifestations is cognitive impairment. The search for effective therapeutic interventions has led to growing interest in Mesenchymal Stem Cell (MSC)-based therapies due to their immunomodulatory, anti-inflammatory, and tissue regenerative properties. This review provides a comprehensive analysis of the current understanding and potential applications of MSC-based interventions in the context of post-acute neurological COVID-19 syndrome, exploring the underlying mechanisms by which MSCs exert their effects on neuroinflammation, neuroprotection, and neural tissue repair. Moreover, we discuss the challenges and considerations specific to employing MSC-based therapies, including optimal delivery methods, and functional treatment enhancements.


Asunto(s)
COVID-19 , Células Madre Mesenquimatosas , Humanos , COVID-19/terapia , SARS-CoV-2 , Síndrome Post Agudo de COVID-19 , Células Madre Mesenquimatosas/fisiología , Sistema Nervioso Central
7.
Cells ; 11(19)2022 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-36231058

RESUMEN

Neurological disorders are a leading cause of morbidity worldwide, giving rise to a growing need to develop treatments to revert their symptoms. This review highlights the great potential of recent advances in cell therapy for the treatment of neurological disorders. Through the administration of pluripotent or stem cells, this novel therapy may promote neuroprotection, neuroplasticity, and neuroregeneration in lesion areas. The review also addresses the administration of these therapeutic molecules by the intranasal route, a promising, non-conventional route that allows for direct access to the central nervous system without crossing the blood-brain barrier, avoiding potential adverse reactions and enabling the administration of large quantities of therapeutic molecules to the brain. Finally, we focus on the need to use biomaterials, which play an important role as nutrient carriers, scaffolds, and immune modulators in the administration of non-autologous cells. Little research has been conducted into the integration of biomaterials alongside intranasally administered cell therapy, a highly promising approach for the treatment of neurological disorders.


Asunto(s)
Materiales Biocompatibles , Enfermedades del Sistema Nervioso , Administración Intranasal , Materiales Biocompatibles/uso terapéutico , Encéfalo , Humanos , Enfermedades del Sistema Nervioso/terapia , Células Madre
8.
Int J Mol Sci ; 23(20)2022 Oct 18.
Artículo en Inglés | MEDLINE | ID: mdl-36293330

RESUMEN

Over the past thirty years, research has shown the huge potential of chitosan in biomedical applications such as drug delivery, tissue engineering and regeneration, cancer therapy, and antimicrobial treatments, among others. One of the major advantages of this interesting polysaccharide is its modifiability, which facilitates its use in tailor-made applications. In this way, the molecular structure of chitosan has been conjugated with multiple molecules to modify its mechanical, biological, or chemical properties. Here, we review the conjugation of chitosan with some bioactive molecules: hydroxycinnamic acids (HCAs); since these derivatives have been probed to enhance some of the biological effects of chitosan and to fine-tune its characteristics for its application in the biomedical field. First, the main characteristics of chitosan and HCAs are presented; then, the currently employed conjugation strategies between chitosan and HCAs are described; and, finally, the studied biomedical applications of these derivatives are discussed to present their limitations and advantages, which could lead to proximal therapeutic uses.


Asunto(s)
Antiinfecciosos , Quitosano , Quitosano/química , Materiales Biocompatibles/química , Ácidos Cumáricos/uso terapéutico , Ingeniería de Tejidos , Antiinfecciosos/farmacología , Antiinfecciosos/uso terapéutico , Antiinfecciosos/química
10.
Life (Basel) ; 12(9)2022 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-36143453

RESUMEN

Current efforts to find novel treatments that counteract multiple sclerosis (MS) have pointed toward immunomodulation and remyelination. Currently, cell therapy has shown promising potential to achieve this purpose. However, disadvantages such as poor survival, differentiation, and integration into the target tissue have limited its application. A series of recent studies have focused on the cell secretome, showing it to provide the most benefits of cell therapy. Exosomes are a key component of the cell secretome, participating in the transfer of bioactive molecules. These nano-sized vesicles offer many therapeutical advantages, such as the capacity to cross the blood-brain barrier, an enrichable cargo, and a customizable membrane. Moreover, integrating of biomaterials into exosome therapy could lead to new tissue-specific therapeutic strategies. In this work, the use of exosomes and their integration with biomaterials is presented as a novel strategy in the treatment of MS.

11.
Life (Basel) ; 12(4)2022 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-35454965

RESUMEN

Multiple sclerosis (MS) is a chronic degenerative autoimmune disease of the central nervous system that causes inflammation, demyelinating lesions, and axonal damage and is associated with a high rate of early-onset disability. Disease-modifying therapies are used to mitigate the inflammatory process in MS but do not promote regeneration or remyelination; cell therapy may play an important role in these processes, modulating inflammation and promoting the repopulation of oligodendrocytes, which are responsible for myelin repair. The development of genetic engineering has led to the emergence of stable, biocompatible biomaterials that may promote a favorable environment for exogenous cells. This review summarizes the available evidence about the effects of transplantation of different types of stem cells reported in studies with several animal models of MS and clinical trials in human patients. We also address the advantages of combining cell therapy with biomaterials.

13.
Neural Regen Res ; 17(1): 31-37, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34100423

RESUMEN

The presenilin genes (PSEN1 and PSEN2) are mainly responsible for causing early-onset familial Alzheimer's disease, harboring ~300 causative mutations, and representing ~90% of all mutations associated with a very aggressive disease form. Presenilin 1 is the catalytic core of the γ-secretase complex that conducts the intramembranous proteolytic excision of multiple transmembrane proteins like the amyloid precursor protein, Notch-1, N- and E-cadherin, LRP, Syndecan, Delta, Jagged, CD44, ErbB4, and Nectin1a. Presenilin 1 plays an essential role in neural progenitor maintenance, neurogenesis, neurite outgrowth, synaptic function, neuronal function, myelination, and plasticity. Therefore, an imbalance caused by mutations in presenilin 1/γ-secretase might cause aberrant signaling, synaptic dysfunction, memory impairment, and increased Aß42/Aß40 ratio, contributing to neurodegeneration during the initial stages of Alzheimer's disease pathogenesis. This review focuses on the neuronal differentiation dysregulation mediated by PSEN1 mutations in Alzheimer's disease. Furthermore, we emphasize the importance of Alzheimer's disease-induced pluripotent stem cells models in analyzing PSEN1 mutations implication over the early stages of the Alzheimer's disease pathogenesis throughout neuronal differentiation impairment.

14.
Int J Mol Sci ; 22(19)2021 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-34639079

RESUMEN

Oligodendrocyte precursor cell (OPC) migration is a mechanism involved in remyelination; these cells migrate from niches in the adult CNS. However, age and disease reduce the pool of OPCs; as a result, the remyelination capacity of the CNS decreases over time. Several experimental studies have introduced OPCs to the brain via direct injection or intrathecal administration. In this study, we used the nose-to brain pathway to deliver oligodendrocyte lineage cells (human oligodendroglioma (HOG) cells), which behave similarly to OPCs in vitro. To this end, we administered GFP-labelled HOG cells intranasally to experimental animals, which were subsequently euthanised at 30 or 60 days. Our results show that the intranasal route is a viable route to the CNS and that HOG cells administered intranasally migrate preferentially to niches of OPCs (clusters created during embryonic development and adult life). Our study provides evidence, albeit limited, that HOG cells either form clusters or adhere to clusters of OPCs in the brains of experimental animals.


Asunto(s)
Encéfalo/fisiología , Enfermedades Desmielinizantes/terapia , Células Precursoras de Oligodendrocitos/citología , Oligodendroglioma/química , Remielinización , Células Madre/citología , Administración Intranasal , Animales , Encéfalo/citología , Diferenciación Celular , Células Cultivadas , Humanos
15.
Int J Mol Sci ; 22(10)2021 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-34068922

RESUMEN

INTRODUCTION: AQP4 (aquaporin-4)-immunoglobulin G (IgG)-mediated neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disease that affects the central nervous system, particularly the spinal cord and optic nerve; remyelination capacity in neuromyelitis optica is yet to be determined, as is the role of AQP4-IgG in cell differentiation. MATERIAL AND METHODS: We included three groups-a group of patients with AQP4-IgG-positive neuromyelitis optica, a healthy group, and a sham group. We analyzed differentiation capacity in cultures of neurospheres from the subventricular zone of mice by adding serum at two different times: early and advanced stages of differentiation. We also analyzed differentiation into different cell lines. RESULTS AND CONCLUSIONS: The effect of sera from patients with NMOSD on precursor cells differs according to the degree of differentiation, and probably affects oligodendrocyte progenitor cells from NG2 cells to a lesser extent than cells from the subventricular zone; however, the resulting oligodendrocytes may be compromised in terms of maturation and possibly limited in their ability to generate myelin. Furthermore, these cells decrease in number with age. It is very unlikely that the use of drugs favoring the migration and differentiation of oligodendrocyte progenitor cells in multiple sclerosis would be effective in the context of neuromyelitis optica, but cell therapy with oligodendrocyte progenitor cells seems to be a potential alternative.


Asunto(s)
Acuaporina 4/inmunología , Autoanticuerpos/inmunología , Diferenciación Celular , Sistema Nervioso Central/patología , Inmunoglobulina G/inmunología , Neuromielitis Óptica/inmunología , Células Precursoras de Oligodendrocitos/patología , Animales , Autoanticuerpos/sangre , Estudios de Casos y Controles , Sistema Nervioso Central/inmunología , Cerebelo/inmunología , Cerebelo/patología , Femenino , Humanos , Masculino , Ratones Endogámicos BALB C , Persona de Mediana Edad , Neuromielitis Óptica/sangre , Neuromielitis Óptica/patología , Células Precursoras de Oligodendrocitos/inmunología
17.
Mater Sci Eng C Mater Biol Appl ; 121: 111806, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33579450

RESUMEN

Nowadays it is known that neural cells are capable of regenerating after brain injury, but their success highly depends on the local environment, including the presence of a biological structure to support cell proliferation and restore the lost tissue. Different chitosan-based biomaterials have been employed in response to this necessity. We hypothesized that hydrogels made of antioxidant compounds functionalizing chitosan could provide a suitable environment to home new cells and offer a way to achieve brain repair. In this work, the implantation of functionalized chitosan biomaterials in a brain injury animal model was evaluated. The injury consisted of mechanical damage applied to the cerebral cortex of Wistar rats followed by the implantation of four different chitosan-based biomaterials. After 15 and 30 days, animals underwent magnetic resonance imaging, then they were sacrificed, and the brain tissue was analyzed by immunohistochemistry. The proliferation of microglia and astrocytes increased at the lesion zone, showing differences between the evaluated biomaterials. Also, cell nuclei were seen inside the biomaterials, indicating cell migration and biodegradation. Chitosan-based hydrogels are able to fill in the tissue cavity and bare cells for the endogenous restoration process. The addition of ferulic and succinic acid to the chitosan structure increases this capacity and decreases the inflammatory reaction to the implant.


Asunto(s)
Lesiones Encefálicas , Quitosano , Animales , Materiales Biocompatibles/farmacología , Lesiones Encefálicas/tratamiento farmacológico , Hidrogeles , Ratas , Ratas Wistar , Ácido Succínico
18.
J Alzheimers Dis ; 80(3): 985-990, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33612544

RESUMEN

Primary progressive aphasia (PPA) is mainly considered a sporadic disease and few studies have systematically analyzed its genetic basis. We here report the analyses of C9orf72 genotyping and whole-exome sequencing data in a consecutive and well-characterized cohort of 50 patients with PPA. We identified three pathogenic GRN variants, one of them unreported, and two cases with C9orf72 expansions. In addition, one likely pathogenic variant was found in the SQSTM1 gene. Overall, we found 12%of patients carrying pathogenic or likely pathogenic variants. These results support the genetic role in the pathophysiology of a proportion of patients with PPA.


Asunto(s)
Afasia Progresiva Primaria/genética , Proteína C9orf72/genética , Anciano , Femenino , Variación Genética , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Mutación , Progranulinas/genética , Proteína Sequestosoma-1/genética , Secuenciación del Exoma
19.
J Med Virol ; 93(2): 863-869, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32691890

RESUMEN

It has been suggested that some individuals may present genetic susceptibility to SARS-CoV-2 infection, with particular research interest in variants of the ACE2 and TMPRSS2 genes, involved in viral penetration into cells, in different populations and geographic regions, although insufficient information is currently available. This study addresses the apparently reasonable hypothesis that variants of these genes may modulate viral infectivity, making some individuals more vulnerable than others. Through whole-exome sequencing, the frequency of exonic variants of the ACE2, TMPRSS2, and Furin genes was analyzed in relation to presence or absence of SARS-CoV-2 infection in a familial multiple sclerosis cohort including 120 individuals from Madrid. The ACE2 gene showed a low level of polymorphism, and none variant was significantly associated with SARS-CoV-2 infection. These variants have previously been detected in Italy. While TMPRSS2 is highly polymorphic, the variants found do not coincide with those described in other studies, with the exception of rs75603675, which may be associated with SARS-CoV-2 infection. The synonymous variants rs61735792 and rs61735794 showed a significant association with infection. Despite the limited number of patients with SARS-CoV-2 infection, some variants, especially in TMPRSS2, may be associated with COVID-19.


Asunto(s)
Enzima Convertidora de Angiotensina 2/genética , COVID-19/genética , Furina/genética , Esclerosis Múltiple/genética , Receptores Virales/genética , Serina Endopeptidasas/genética , Enzima Convertidora de Angiotensina 2/metabolismo , COVID-19/metabolismo , COVID-19/virología , Estudios de Cohortes , Furina/metabolismo , Expresión Génica , Predisposición Genética a la Enfermedad , Interacciones Huésped-Patógeno/genética , Humanos , Esclerosis Múltiple/metabolismo , Esclerosis Múltiple/virología , Polimorfismo Genético , Unión Proteica , Receptores Virales/metabolismo , SARS-CoV-2/genética , SARS-CoV-2/metabolismo , SARS-CoV-2/patogenicidad , Serina Endopeptidasas/metabolismo , España , Glicoproteína de la Espiga del Coronavirus/genética , Glicoproteína de la Espiga del Coronavirus/metabolismo , Encuestas y Cuestionarios , Internalización del Virus , Secuenciación del Exoma
20.
Front Immunol ; 11: 2163, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32983181

RESUMEN

INTRODUCTION: The response to the SARS-CoV-2 coronavirus epidemic requires increased research efforts to expand our knowledge of the disease. Questions related to infection rates and mechanisms, the possibility of reinfection, and potential therapeutic approaches require us not only to use the experimental models previously employed for the SARS-CoV and MERS-CoV coronaviruses but also to generate new models to respond to urgent questions. DEVELOPMENT: We reviewed the different experimental models used in the study of central nervous system (CNS) involvement in COVID-19 both in different cell lines that have enabled identification of the virus' action mechanisms and in animal models (mice, rats, hamsters, ferrets, and primates) inoculated with the virus. Specifically, we reviewed models used to assess the presence and effects of SARS-CoV-2 on the CNS, including neural cell lines, animal models such as mouse hepatitis virus CoV (especially the 59 strain), and the use of brain organoids. CONCLUSION: Given the clear need to increase our understanding of SARS-CoV-2, as well as its potential effects on the CNS, we must endeavor to obtain new information with cellular or animal models, with an appropriate resemblance between models and human patients.


Asunto(s)
Betacoronavirus , Infecciones del Sistema Nervioso Central/complicaciones , Infecciones del Sistema Nervioso Central/inmunología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/inmunología , Modelos Animales de Enfermedad , Neumonía Viral/complicaciones , Neumonía Viral/inmunología , Animales , COVID-19 , Línea Celular Tumoral , Infecciones del Sistema Nervioso Central/virología , Infecciones por Coronavirus/virología , Cricetinae , Células HEK293 , Humanos , Ratones , Organoides , Pandemias , Neumonía Viral/virología , SARS-CoV-2
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