Category Archives: Clinical Research

Orphan Drug Designation for Treatment of ALS – Amyotrophic Lateral Sclerosis

On March 29, 2018 the U.S. Food and Drug Administration (FDA) Office of Orphan Products Development granted Orphan Drug Designation (ODD) to experimental therapeutic EH301 for the treatment of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease.

The Orphan Drug Designation submission included data from a 2017 double-blind placebo-controlled European pilot study in humans. To expand on the results of the pilot study, Elysium Health expects to initiate a placebo-controlled study in collaboration with Mayo Clinic to evaluate EH301 in up to 150 adults with ALS by the fourth quarter of 2018. The granting of ODD to EH301 does not alter the standard regulatory requirement through adequate and well-controlled studies to support FDA approval, and there is no guarantee EH301 will be approved for the treatment of ALS by FDA.

Elysium Health Chief Scientist Dr. Leonard Guarente remarked that “There is a great deal of work to be done to address the need for continued research to better understand and to treat all neurodegenerative diseases. We believe that the FDA’s granting of Orphan Drug Designation for EH301 for ALS underscores the need for novel treatments for this rare condition.”

ALS is a rare neurodegenerative disease that affects nerve cells that control voluntary muscles throughout the body to produce movements including talking, eating, walking, and breathing. ALS is progressive, meaning it gets worse over time. As the nerves lose the ability to control muscles, the muscles become weak and eventually lead to paralysis. Most people with ALS succumb to respiratory failure, usually within three to five years from when symptoms first appear. Please visit the ALS website for more information.

The FDA’s ODD program provides orphan status to drugs intended for the safe and effective treatment, diagnosis, or prevention of rare diseases or disorders that affect fewer than 200,000 people in the United States. It is estimated that there are approximately 15,000-20,000 Americans with ALS. Please see the NIH ALS Fact Sheet for details.

Additional information can be found on the Christopher & Dana Reeve Foundation website regarding current therapies and disease trends.

Disclosure: Mayo Clinic has a financial interest in Elysium Health. All revenue Mayo Clinic receives will be used to fund its not-for-profit mission in medical research and education.

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Beneficial Skin Bacteria Protect Against Skin Cancer

Science continues to peel away layers of the skin microbiome to reveal its protective properties.  Researchers now report on a potential new role for some bacteria on the skin: protecting against cancer.

“We have identified a strain of Staphylococcus epidermidis, common on healthy human skin, that exerts a selective ability to inhibit the growth of some cancers,” said Richard Gallo, MD, PhD, Distinguished Professor and chair of the Department of Dermatology at UC San Diego School of Medicine. “This unique strain of skin bacteria produces a chemical that kills several types of cancer cells but does not appear to be toxic to normal cells.”

The team discovered the S. epidermidis strain produces the chemical compound 6-N-hydroxyaminopurine (6-HAP). Mice with S. epidermidis on their skin that did not make 6-HAP had many skin tumors after being exposed to cancer-causing ultraviolet rays (UV), but mice with the S. epidermidis strain producing 6-HAP did not.  6-HAP is a molecule that impairs the creation of DNA, known as DNA synthesis, and prevents the spread of transformed tumor cells as well as the potential to suppress development of UV-induced skin tumors.

Mice that received intravenous injections of 6-HAP every 48 hours over a two-week period experienced no apparent toxic effects, but when transplanted with melanoma cells, their tumor size was suppressed by more than 50 percent compared to controls.

“There is increasing evidence that the skin microbiome is an important element of human health. In fact, we previously reported that some bacteria on our skin produce antimicrobial peptides that defend against pathogenic bacteria such as, Staph aureus,” said Gallo.

In the case of S. epidermidis, it appears to also be adding a layer of protection against some forms of cancer, said Gallo. Further studies are needed to understand how 6-HAP is produced, if it can be used for prevention of cancer or if loss of 6-HAP increases cancer risk, said Gallo.

More than 1 million cases of skin cancer are diagnosed in the United States each year. More than 95 percent of these are non-melanoma skin cancer, which is typically caused by overexposure to the sun’s UV rays. Melanoma is the most serious form of skin cancer that starts in the pigment-producing skin cells, called melanocytes.

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Huntington’s Disease Molecule Can Kill Cancer Cells

Scientists have destroyed numerous types of human cancer cells with a toxic molecule characteristic of fatal genetic illness Huntington’s disease.

The researchers hailed the molecule—which has killed both human and mouse ovarian, breast, prostate, liver, brain, lung, skin and colon cancer cell lines in mice—as a “super assassin.” Their results were published in the journal EMBO Reports.

Huntington’s disease is a progressive illness caused by an excess of a specific repeating RNA sequence in the Huntington gene, which is present in every cell. The defect causes the death of brain cells, and gradually worsens a person’s physical and mental abilities. The disease has no cure.

Researchers believe that the defect may be even more powerful against cancer cells than nerve cells in the brain, and the team hopes it can be harnessed to kill cancer cells without causing Huntington’s symptoms.  “This molecule is a super assassin against all tumor cells,” said senior author Marcus Peter, a professor of cancer metabolism at Northwestern University Feinberg School of Medicine, Chicago, in a press statement. “We’ve never seen anything this powerful.”

Peter collaborated with Feinberg colleague Shad Thaxton, associate professor of urology, to deliver the molecule in the form of nanoparticles to mice with human ovarian cancer. The targeted molecule decreased tumor growth with no toxicity to the mice.

First author Andrea Murmann, a research assistant professor who discovered the cancer-killing mechanism, used the molecule to kill numerous other human and mouse cancer cell lines. Building on previous research into a cancer “kill switch”, Murmann looked to diseases associated with low rates of cancer and a suspected RNA link.  “I thought maybe there is a situation where this kill switch is overactive in certain people, and where it could cause loss of tissues,” Murmann said in the statement. “These patients would not only have a disease with an RNA component, but they also had to have less cancer.“

There is up to 80 percent less cancer in people with Huntington’s disease than the general population.  Murmann recognised similarities between the kill switch and the toxic Huntington’s disease RNA sequences.  Based on their results, the team believe the “super assassin” molecule could be used to fight cancer in humans. “We believe a short-term treatment cancer therapy for a few weeks might be possible, where we could treat a patient to kill the cancer cells without causing the neurological issues that Huntington’s patients suffer from,” Peter said.  The scientists next aim to refine the molecule’s delivery method to improve tumor targeting, and to stabilize the nanoparticles for storage.

By Katherine Hignett – Displayed with permission from Newsweek via RePubHub License; Cancer Cells courtesy of PixaBay FREE LIC CC0 

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ABRCC Consortia MD Elena Shagisultanova Targets Treatment-Resistant Breast Cancer

Metastatic triple-positive breast cancer frequently resists treatments. Scientists at the University of Colorado Cancer Center are testing a unique combination of medications to change that.

Growth of breast cancer cells is often propelled by one of three receptors – estrogen receptors (ER), progesterone receptors (PR) or the growth factor receptor called HER2. Treatments exist targeting each of these receptors individually. However, when all three receptors are present – this “triple-positive” breast cancer – blocking any single receptor is not enough.  Treatments that block hormonal (estrogen and progesterone) receptors may be not very effective because tumor cells may use HER2 receptor to grow. The drugs that block HER2 receptors may not work as well because the cells will use hormonal receptors to survive. Chemotherapy works against triple-positive breast cancers, however, it has multiple side effects. Previous clinical trials have been largely unsuccessful in defining a well-tolerated targeted drug combination that blocks all avenues for growth of triple-positive breast tumors.

“Under the current guidelines, patients with triple-positive metastatic breast cancer have two options as a first line of treatment and neither is a great option,” says Elena Shagisultanova, MD, PhD, investigator at the CU Cancer Center and assistant professor in the University of Colorado School of Medicine’s Division of Medical Oncology. “One approach is to start an anti-hormonal pill, which is generally non-toxic. However, the response usually lasts only three to four months. The other choice is to start chemotherapy combined with HER-2 targeted agents. This option is effective, but it has multiple side effects.”

Shagisultanova is the principal investigator on the multi-institutional trial.  It is also an investigator-initiated trial which allows physician/scientists to test treatments that their hands-on experience in the lab and clinic indicate may offer meaningful results. Shagisultanova believes she and CU Cancer Center colleagues may have another option: a regimen using three pills, each targeting a different pathway of the disease. The trial combines tucatinib, which inhibits HER2, with letrozole targeting hormone receptors, and the CDK4/6 inhibitor palbociclib.

“We think hormone receptor and HER-2 signals are coming together to help cancer cells resist treatment,” says Shagisultanova. “The CDK4/6 inhibitor palbociclib can block these converging signals in the nucleus. We believe that if we can inhibit the signaling deeper in the tumor cell using this triple blockade, patients will have longer lives and better quality of life.”  Tucatinib, palbociclib and letrozole tend to have different side-effects, leading Shagisultanova to believe the triple combination of targeted agents will be well- tolerated.

Early clinical trials often exclude patients whose cancer has already metastasized to the brain, in large part due to the inability of anti-cancer drugs to penetrate the blood-brain barrier to reach the disease in the central nervous system. However, because tucatinib has proven effective in shrinking HER2-positive breast tumors that have spread to the brain, patients with brain metastases are, in fact, included in the current trial.

“Metastatic disease in the brain is one of the most dangerous complications of triple-positive breast cancer. If we can prevent development of brain metastases, or effectively treat metastatic disease in the brain, it will improve the lives of many patients,” Shagisultanova says.  “There are many challenges in designing and delivering clinical trials,” says Christopher Lieu, MD, CU Cancer Center’s deputy associate director for clinical research. Lieu also leads CU Cancer Center’s efforts in further developing an Investigator-Initiated Trials Committee.

“We are fortunate at CU Cancer Center to have innovative clinicians who are analyzing data to find novel and innovative strategies to target malignancies that are in serious need of better therapies,” Lieu adds.  “Trials like this one are critical in moving cancer science forward and finding effective, non-toxic therapies.”

This trial is currently open for enrollment at the ABRCC Consortia Academic sites of: University of Colorado Cancer Center, Northwestern University, Chicago, IL; University of Texas Health and Science Center in San Antonio, TX; Stony Brook University, NY; University of Arizona, Tucson, AZ, and University of New Mexico, Albuquerque, NM.

The trial is funded by the Pfizer ASPIRE Award in Breast Cancer Research. Cascadian Therapeutics and Pfizer are providing the study drugs tucatinib and palbociclib.

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AI-Driven Discovery of Novel Predictors of Parkinson’s

The discovery was powered by patient data from the Parkinson’s Progression Markers Initiative, sponsored by the Michael J. Fox Foundation for Parkinson’s Research.

GNS Healthcare (GNS), a leading precision medicine company, announced the discovery of genetic and molecular markers of faster motor progression of Parkinson’s Disease (PD) patients, the LINGO2 gene together with a second genetic variant, along with demographic factors.

The publication describing the discovery, titled “Large-scale identification of clinical and genetic predictors of Parkinson’s disease motor progression in newly-diagnosed patients: a longitudinal cohort study and validation,” appears in the journal The Lancet Neurology. This discovery may accelerate the development of new drugs and better match new drugs to individual patients.

“Being able to use these predictors in the clinical setting will lead to faster and significantly cheaper clinical trials and accelerate the availability of new Parkinson’s Disease drugs for patients in need,” said Colin Hill, Chairman, CEO, and co-founder of GNS Healthcare. “A major hurdle in Parkinson’s research is that rates of progression are extremely varied. Some patients progress very quickly while others do not. With accurate predictors of rates of progression, we will be able to remove uncertainties from drug development and patient response, reduce the number of clinical trial enrollees required by as much as twenty percent, and speed up the development of effective new drugs.”

REFS™, the GNS causal machine learning (ML) and simulation platform was used to transform the longitudinal genetic and clinical patient data from 429 individuals (312 PD patients and 117 controls) into computer models that connect the genetic and molecular variation of patients to motor progression rates. These computer models were used to simulate the future effects of the genetic and prognostic variables on motor outcomes, essentially predicting the motor progression rate for each patient. The models were validated in an independent longitudinal study, and clearly demonstrated the ability to prospectively differentiate between patient progression rates.

“There is still so much to understand about the progression of chronic, debilitating illnesses like Parkinson’s disease,” said Jeanne C. Latourelle, D.Sc., a co-author of the study and Director of Precision Medicine, GNS Healthcare. “The validation of our models in this study underscores the power of our REFS™ technology and its ability to accelerate the development of effective therapies for patients in need.”

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Vaccine for Meningitis Shows Some Protection Against Gonorrhea

Scientists have not been able to develop a vaccine against the sexually transmitted disease gonorrhea, despite working toward one for more than 100 years.  However, they may have stumbled onto something that could provide clues to advance the development of such a vaccine.

Decades ago, in the late 1990s, a strain of meningitis B was reaching epidemic proportions in New Zealand. A vaccine, MeNZB, was developed to protect young people who were at the highest risk of getting this particular type. It did not provide protection against any other strain.

Between 2004 and 2006, MeNZB was given to anyone under the age of 20. Babies and preschoolers were routinely immunized until 2008. People with a high medical risk continued to get the vaccine until 2011. Once the epidemic was over, the vaccination program was stopped.

However, scientists noticed that the meningitis vaccine also seemed to offer some protection against gonorrhea. A study published in the Lancet last month showed that one-third of the people who had received MeNZB did not get gonorrhea, compared to a control group who was not inoculated. The lead author noted that the bacteria causing both diseases share between 80 and 90 percent of their primary genetic sequences.

Dr. Steven Black, an infectious disease expert at Cincinnati Children’s Hospital, noted, “This is the first time it’s been shown that you could have a vaccine that would protect against gonorrhea. And if these results are confirmed in another setting, that would mean that it would be very reasonable … to go forward with developing perhaps a more targeted vaccine.” Black’s comments were published in the current issue of JAMA, the Journal of the American Medical Association.  The JAMA article concludes that ultimately, a preventive vaccine could be the only sustainable solution to a fast-changing bug that has proven adept at developing resistance.

The World Health Organization reports that gonorrhea is becoming harder, and sometimes impossible, to treat, warning that it could become incurable in the not-too-distant future. At the moment, there no new antibiotics being developed to treat this disease.

The U.S. CDC reports that gonorrhea is the second most commonly reported notifiable disease in the United States. All known cases must be reported to the CDC, but officials there estimate that they are notified of fewer than half of the 800,000 new cases each year.

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First FDA Approval for Sickle Cell Treatment in Nearly 20 Years

The U.S. Food and Drug Administration approved Endari (L-glutamine oral powder) for patients age five years and older with sickle cell disease to reduce severe complications associated with the blood disorder.  The FDA granted the approval of Endari to Emmaus Medical Inc.

“Endari is the first treatment approved for patients with sickle cell disease in almost 20 years,” said Richard Pazdur, M.D., acting director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research and director of the FDA’s Oncology Center of Excellence. “Until now, only one other drug was approved for patients living with this serious, debilitating condition.”

Sickle cell disease is an inherited blood disorder in which the red blood cells are abnormally shaped (in a crescent, or “sickle,” shape). This restricts the flow in blood vessels and limits oxygen delivery to the body’s tissues, leading to severe pain and organ damage. According to the National Institutes of Health, approximately 100,000 people in the United States have sickle cell disease. The disease occurs most often in African-Americans, Latinos and other minority groups. The average life expectancy for patients with sickle cell disease in the United States is approximately 40 to 60 years.

The safety and efficacy of Endari were studied in a randomized trial of patients ages five to 58 years old with sickle cell disease who had two or more painful crises within the 12 months prior to enrollment in the trial. Patients were assigned randomly to treatment with Endari or placebo, and the effect of treatment was evaluated over 48 weeks. Patients who were treated with Endari experienced fewer hospital visits for pain treated with a parenterally administered narcotic or ketorolac (sickle cell crises), on average, compared to patients who received a placebo (median 3 vs. median 4), fewer hospitalizations for sickle cell pain (median 2 vs. median 3), and fewer days in the hospital (median 6.5 days vs. median 11 days).  Patients who received Endari also had fewer occurrences of acute chest syndrome (a life-threatening complication of sickle cell disease) compared with patients who received a placebo (8.6 percent vs. 23.1 percent).

Endari received Orphan Drug designation for this use, which provides incentives to assist and encourage the development of drugs for rare diseases.  In addition, development of this drug was in part supported by the FDA Orphan Products Grants Program, which provides grants for clinical studies on safety and/or effectiveness of products for use in rare diseases or conditions.

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Probiotics to Treat Symptoms of Depression?

A new study is the first to show improved depression scores with a probiotic. It adds to the whole field of microbiota-gut-brain axis, providing evidence that bacteria affect behavior.

In a study published in the medical journal Gastroenterology, researchers of the Farncombe Family Digestive Health Research Institute found that twice as many adults with irritable bowel syndrome (IBS) reported improvements from co-existing depression when they took a specific probiotic than adults with IBS who took a placebo. The study provides further evidence of the microbiota environment in the intestines being in direct communication with the brain said senior author Dr. Premysl Bercik, an associate professor of medicine at McMaster and a gastroenterologist for Hamilton Health Sciences.

“This study shows that consumption of a specific probiotic can improve both gut symptoms and psychological issues in IBS. This opens new avenues not only for the treatment of patients with functional bowel disorders but also for patients with primary psychiatric diseases,” he said. IBS is the most common gastrointestinal disorder in the world, and is highly prevalent in Canada. It affects the large intestine and patients suffer from abdominal pain and altered bowel habits like diarrhea and constipation. They are also frequently affected by chronic anxiety or depression.

The pilot study involved 44 adults with IBS and mild to moderate anxiety or depression. They were followed for 10 weeks, as half took a daily dose of the probiotic Bifidobacterium longum NCC3001, while the others had a placebo. At six weeks, 14 of 22, or 64%, of the patients taking the probiotic had decreased depression scores, compared to seven of 22 (or 32%) of patients given placebo. Functional Magnetic Resonance Imaging (fMRI) showed that the improvement in depression scores was associated with changes in multiple brain areas involved in mood control.

“This is the result of a decade long journey — from identifying the probiotic, testing it in preclinical models and investigating the pathways through which the signals from the gut reach the brain,” said Bercik. “The results of this pilot study are very promising but they have to be confirmed in a future, larger scale trial,” said Dr. Maria Pinto Sanchez, the first author and a McMaster clinical research fellow.

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Adding Friendly Bacteria to Skin Lotion Wards Off Bad Germs

Customized creams guarded five patients with a kind of itchy eczema against risky bacteria that were gathering on their cracked skin.

Bacteria live on everyone’s skin, and new research shows some friendly germs produce natural antibiotics that ward off their disease-causing cousins. Now scientists are mixing the good bugs into lotions in hopes of spreading protection. In one early test, those customized creams guarded five patients with a kind of itchy eczema against risky bacteria that were gathering on their cracked skin, researchers reported.

Image courtesy of Shutterstock

“It’s boosting the body’s overall immune defenses,” said Dr. Richard Gallo, dermatology chairman at the University of California, San Diego, who is leading the work.

We share our bodies with trillions of microbes that live on our skin, in our noses, in the gut. This community  – what scientists call the microbiome  – plays critical roles in whether we stay healthy or become more vulnerable to various diseases. Learning what makes a healthy microbiome is a huge field of research, and already scientists are altering gut bacteria to fight diarrhea-causing infections.  The research sheds new light on the skin’s microbiome, suggesting that one day it may be possible to restore the right balance of good bugs to treat skin disorders, too.

Healthy skin harbors a different mix of bacteria than skin damaged by disorders such as atopic dermatitis, the most common form of eczema. Those patches of dry, red, itchy skin are at increased risk of infections, particularly from a worrisome germ known as Staphylococcus aureus.

Gallo’s team took a closer look at how microbes in healthy skin might be keeping that bad staph in check.  They discovered certain strains of some protective bacteria secrete two “antimicrobial peptides,” a type of natural antibiotic. In lab tests and on the surface of animal skin, those substances could selectively kill Staph aureus, and even a drug-resistant strain known as MRSA, without killing neighboring bacteria like regular antibiotics do, the team reported in the journal Science Translational Medicine.

But those good bugs are rare in the skin of people with atopic dermatitis, Gallo said.  “People with this type of eczema, for some reason that’s not quite known yet, have a lot of bacteria on the skin but it’s the wrong type of bacteria. They’re not producing the antimicrobials they need,” he explained. Would replenishing the good bugs help? “They’re normal skin bacteria, so we knew they would be safe,” Gallo noted.

His team tested five volunteers with atopic dermatitis who had Staph aureus growing on their skin’s surface  – what’s called colonization, but didn’t have an infection. Researchers culled some of the rare protective bacteria from the volunteers’ skin, grew a larger supply and mixed a dose into an over-the-counter moisturizer. Volunteers had the doctored lotion slathered onto one arm and regular moisturizer on the other.

A day later, much of the staph on the treated arms was killed – and in two cases, it was wiped out, compared to the untreated arms, Gallo said.  “We’re encouraged that we see the Staph aureus, which we know makes the disease worse, go away,” he said.

The study couldn’t address the bigger question of whether exposure to the right mix of protective bacteria might improve atopic dermatitis itself, cautioned Mount Sinai’s Guttman-Yassky. Next-step clinical trials are underway to start testing effects of longer-term use.

Source: By Lauran Neergaard, AP, Displayed with permission from STAT via RePubHub

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This Is Why Red Peppers Could Reduce Lung Cancer Risk In Smokers

In a new study, researchers from Tufts University in Massachusetts have uncovered the molecular reasoning for beta-cryptoxanthin pigment’s powerful cancer-fighting skills.

red-bell-peppers-1836560_1920-by-pexels-pixabay-free-cc0-lic

Red Bell Peppers — Image courtesy Pexels PIXABAY CC0 Lic

Researchers discovered in 2004 that beta-cryptoxanthin (BCX), a natural pigment which gives many fruits and vegetables their bright red and orange colorings, was able to reduce smokers’ risk of developing lung cancer — although exactly why remained unclear.

Tufts cancer researcher Xiang-Dong Wang and his team found that BCX has the opposite effect of nicotine on lung cells in mice and is able to decrease erratic cell growth in the lung and limit the cancer from spreading. While more research is needed, Wang predicts that understanding BCX’s effect on lung cells could lead to new chemoprevention techniques and could be implemented in dietary recommendations for patients undergoing lung cancer treatment, and for lung cancer survivors.

Read More:  3 Reasons Why Non-Smokers Get Lung Cancer

“For smokers, tobacco product users or individuals at higher risk for tobacco smoke exposure, our results provide experimental evidence that eating foods high in BCX may have a beneficial effect on lung cancer risk,” said Wang in a statement.

Nicotine binds to lung cells, triggering a biochemical response that may lead to erratic cell growth, and new blood vessel development — the perfect storm for lung cancer. However, Wang and his team discovered that BCX is able to counteract this response by inhibiting lung cell growth and preventing cancer cells from spreading to different parts of the body.

In the study, the team observed that mice that had purposely been given a nicotine-derived carcinogen, and which were treated with BCX had fewer lung tumors than those who were not given BCX. According to Wang, the greatest benefit in mice was equivalent to a daily human dose of about 870 micrograms, or the amount contained in one sweet red pepper or a couple of tangerines a day. Also, human lung cancer cells in a petri dish treated with BCX migrated less than those that were not.

The researchers emphasized that their study does not show that BCX has the ability to prevent or cure lung cancer in humans. Still, the results are promising and the team hope to take their research further to better understand the cancer-killing capabilities of red and orange fruits and veggies.

Source: WAng XD, Iskandar AR, Miao B, et al. β-Cryptoxanthin Reduced Lung Tumor Multiplicity and Inhibited Lung Cancer Cell Motility by Downregulating Nicotinic Acetylcholine Receptor α7 Signaling.  Cancer Prevention Research .2016

By Dana Dovey; Displayed with permission from Medical Daily via RePubHub

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