先天性鉄芽球性貧血の原因遺伝子の同定及びin
vitroでの鉄芽球の解析
著者
張替 秀郎
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(東北大学医学部附属病院検査部軍師
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研究組織
研究代表者:張替秀郎(東北大学医学部附属病院講師)
研究分担者:古山軒道(東北大学大学院医学系研究科助手)
研究軽費
研究発表
直接経費 亊I
ィニ
N
合計
平成11年度 テ# x冷 0 テ# x冷 平成12年度 テ x冷 0 テ x冷 平成13年度 テ3 x冷 0 テ3 x冷 総1計 「テc x冷 o一 テc x冷(1)学会誌等
1) _馳_rigae H, Nakajima 0, Suwabe N, Yokoyama H, Furuyama K, Sasaki T,
Kaku M, Yamamoto M, Sas.sa S・ High content of iron and oxidative status of erythroid-specirlC 81aminolevulinate synthase (ALAS2)-deflC ient definitive
erythroblasts.発表予定
2) Akagi R, Nishitani C, Hari竺ae H, Horie Y, Garbaczewski L, Hassoun A, Mercelis 良, Verstraeten L, Sassa S. Molecular analysis
of8-aminolevulinate dehydratase deficiency ln a Patient with an unusual late-onset porphyria. Blood. 96;3618-23, 2000.
3)山本雅之,中島修,古山和道,張替秀郎,林典夫.遺伝性鉄芽球
性貧血の分子診断とモデルマウス臨床血液41:540-543, 2001(2)口頭発表
1)弔替秀郎,中島修,古山和道,佐々木毅,佐々茂,山本雅之 へム
欠損成体型赤芽球の形質解析 第63回日本血液学会総会
平成13年3月
2) IIari竺ae H, Nakajima 0, Suwabe N, Furuyama K, Sasaki T, Kaku M, Yamanoto M, Sassa S. Differential role of the erythroid-specific 8-aminolevulinate synthase in primitive and definitive erythropoiesis.
American society of hematology 42th amual meetlng. December 2000.
3) Harigae 汁, Furuyama K, Kondo K, Kimura A, Sasaki T, Kaku M, Hayashi
N, Yamamoto M, Sassa S.Two novel mutations of 8-aminolevulinate
synthase-2 gene in inherited and non-inherited sideroblastic anemia. American society
Aberrant iron accumulation and oxidized status of erythroid-specific
8-aminolevulinate synthase (ALAS2)-deficient definitive erythroblasts
Hideo HarigaeI", osamu NakajimaZ, Naruyoshi SuwabeZ, HisayLiki Yokoyama3・,
Kazumichi Furuyama4, Takeshi Sasaki3, Mitsuo KakuII MasaytJki Yamamoto2, and
Shigeru SassaS
lDepartment of Molecular Diagnostics, 3Rheumatology and Hematology, 4 Biochemistry, Tohoku Universlty School of Medicine, Sendai, Japan, 2center for Tsukuba Advanced Research Alliance・ Tsukuba Universlty, Tsukuba, Japan, 5The Rockefeller Universlty, New York, NY, USA
Running title: Iron accumulation in alas21null erythroblasts
Supported in part by Grant-in-Aid fTrom the Ministry of Education, Science and Culture of Japan(to HH),and USPHA grant DK 32890 (to SS)
a total text word count: 2597 an abstract text word count: 242
Category: Red Cells
Correspondence to:
Hideo Harigae, M.D.
Department of Molecular Diagnostics Tohoku University School of Medicine Aoba-ku, Sendai 980-8574, Japan
Tel:01 1-81-22-717-7373; Fax:01 1-81-22-717-7390
e-mail:[email protected]
-1-Abstract
alas2 encodes the erythroid specific 8-aminolevulinate synthase (ALAS2), the first
enzyme in heme biosynthesis in erythroid cells. In vivo in mice, alas2-null prlmitive
erythroblasts showed a maturation a汀eSt aS Well as massive cytoplasmic iron accumulation.
However, the effect of ALAS2 deficiency on definitive erythropoleSis still remains unclear,
because alas2-null mice died z'n utero by embryonic day 1 1.5 befわre definitive erythropoleSis
develotp'ed. To clarifythe effect ofheme deficiency on differentiation of definitive erythroid
cells, ES cells lacking the alas2 gene were induced to differentiate specifically Into erythroid
lineage t'n vitro, and phenotypes of definitive erythroblasts were examined・ In comparison to
red cell pellets of wild-りpe erythroblasts, alas2-null definitive erythroblasts were totally
white due to a marked deficiency of heme, although the morphology was similar to wild-type
erythroblasts・ Consistent with their similar morphology, levels of erythroid-Specific gene
expression such as GATA-1, NF-E2 and TERl 19 in alas2-null definitive erythroblasts were
also similar to those of wild-りpe Cells, indicatlng that both alas2-null and wild-りpe
erythroblasts developed to the stage of mature definitive erythroblasts・ In contrast to their
similar morphology, however, iron content in alas21null definitive erythroblasts was twice
more than that of wt-ld-りpe Cells. Consistent with the aberrant increase in iron content,
alas2-null definitive erythroblasts were more oxidized compared with wild-type erythroblasts
as judged by increased formation of peroxidized metabolites. These rlndings suggest that
alas2 deficiency does not influence erythroid differentiation per se, but induces aberrant iron
accumulation and an oxidized condition in derlnitive erythroblasts.
e-mai I : [email protected] p
ー2-Introduction
Heme, the prosthetic group of hemeproteins, is essential for the function of all
aerobic cells・ Approximately 85% of heme is synthesized in erythroid tissues and utilized
for hemoglobinformation (1). Besides the main function as an oxygen carrier in
hemoglobin, heme also plays several important roles in erythroid cells, and its deficiency has
been shown to result in dysregulation of gene expression of pTOteins (2), and apoptosis of
erythroid cells (3,4).
Erythroid specific 8-aminolevulinate synthase (ALAS2) gene is the first enzyme in
the heme biosynthetic pathway, which is exclusively expressed in erythroid cells (5,6).
During erythroid di飴rentiation of Friend virus-transformed murine erythroleukemia cells,
ALAS2 mRNA increased dramatically and resulted in marked increase in heme synthesis, as
well as in increased expression of genes for erythroid-specific proteins and f♭r enzymes in the
heme biosynthetic pathway (7,8). In humans, mutations of the alas2 gene, which is located
at Xpl 1 ・2 1, have been shown to be responsible f♭r X-linked sideroblastic anemia (XLSA), an
X chromosome-linked hypochromic and microcytlC anemia characterized by rlnged
sideroblasts (9-12). It is thought that ALAS2 deficiency in XLSA results in a decreased
supply ofprotoporphyrin IX which in tum elicits an iron overload in erythroblasts. Such an
iron overload may likely induce iron一mediated oxi血tive changes in the cell, which may
shorten the cellular lifTe span. All these findings polnt tO the critical role ofALAS2 0n
erythroid differentiation as weu as on the survival oferythroid cells.
In vertebrates, hematopoleSis orlgmateS im the yolk sac, which then mlgrateS tO liver,
finally to the bone marrow (13,14). Erythroid cells in the yolk sac and erythroid cellsin
-3-liverand the bone marrow, are termed primitive and definitive erythroid cells, respectively,
and they display different characteristics and their growth and survivals are controlled by
different growth factors (15-19). In 'our previous study, we demonstrated that alas2-null
prlmitive erythroid cells resulted in a maturation arrest as well as in massive cytoplasmic iron
accumulation in vt'vo in mice, indicatlng thefundamental role of alas2 in cell diffTerentiation
and iron homeostasis in primitive er叩hropoiesis (20)・ However㌔ the role of ALAS2 0n
definitive erythropoleSis remained unclear, because alas2-null animals died in utero by 1 I.5
embryonic days because of severeanemia (20). In order to studythe effect of the lack of
ALAS2 and resultant heme deficiency on definitive erythropoleSis in this study, We used a
culture system in which both prlmitive and definitive erythroid cells can be separately
obtained at different times in culture, using specific cytokines and OP9 stromalcells (21)・
Our results demonstrated that mutation of ALAS2 leads to abe汀ant iron accumulation and
hyperoxidized status in definitive erythroblasts.
ー4-Materials and Methods
Cell Culture
alis2-null ES cells (20) and wild 6pe ES cells were cultivated with OP9, which is an M-CSF
deficient mouse stromal cell line, and were induced to differentiate to erythroid cells as
described previously withminor modinlCations (21)・ Namely, ES cells were plated on to
con fluent OP9 cells at a concentration of 5xl03 per well in a 6-well plate uslng α-MEM
supplemented with 20pM of P-mercaptoethanol, 2U/miof human erythropoietin, 50ng/ml of
murine SCF (Gibco Lifetec Oriental, Rockeville, MD), and long/ml of VEGF (Peprotec,
Rocky Hills, NJ)・ Humanerythropoietin was kindly provided by Chugai Pharmaceutical Co.,
Tokyo, Japan・ On day 3 ofculture, halfofthe culture media was replenished with the fresh
medium and total cells were haⅣested on day 5 by trypslnlZation・ All cells collected were
transferred to a P100 culture dish covered with connuently grownOP9 cells, With the same
culture media but without VEGF・ To collect primitive erythroblasts, all noating cells were
haⅣested on day 8・ To collect de血itive erythroblasts, total cells were collected on血y 10
by pIPetting but without trypslnlZation and transfhed to a new OP9 cell-coated culture dish,
thenincubation was continued to day 14 when all noating cells were collected.
Reverse-transcriptase polymerase chain reaction (RT-PCR)
Total RNA was extracted by the guanidine-phenol method (22)・ CDNA was synthesized
from 2pg of totalRNA in 20pl of the reaction mixture containing O・5pg oligo(dt)12118 200
units or Moloney mu血e leukemia vims reverse transcriptase (SuperscriptTMII: Gibco BRL,
Gaithersburg, MD), 20mM Tris-HCl (pH 9・4), 50mM KCl, 2・5mM MgC12 , 0.5mM oreach
dNTP and 10mM DTT・ Then target genes were amplirled by PCR withSpeciflC PrumerS
-5-uslng ll⊥l ofcDNA solution as a template・ Sequences of each primers are asfollows.
GATA- I sense: 5 '-ACTCGTCATACCACTAAGGT,
anti-sense : 5 '-AGTGTCTGTAGGCCTCAGCT
ev globin sense: 5'-AACCCTCATCAATGGCCTGTGG,
anti-sense: 5 '-TCAGTGGTACTTGTGGGACAGC,
P-major globin sense: 5'- ATGGTGCACCTGACTGATGCTG,
anti-sense : 5 '-GGTTTAGTGGTACTTGTGAGcc,
Nramp2 sense: 5 '-GGTTCTGACATGCAGGAAGT,
anti-sense: 5 '-CAAAGACATTGATGATGAAG,
ALAS2 sense: 5 '-GATCCAAGGCATTCGCAACA,
anti-sense; 5 I-GATGGCCTGCACATAGATGC,
ALAS 1 sense: 5 LCATCTTCACCACCTCCTTGCCACCA,
anti-sense : 5 '-CTATGTGGGTATGGTAATGGCCTGGG,
H0- I sense.・5 I-ACGCATATACCCGCTACCTG,
anti-sense : 5 '-AAGCTGAGAGTGAGGACCCA,
β-actin sense: 5 '-GTGACGAGGCCCAGAGCAAG,
anti-sense : 5 '-AGGGGCCGGACTCATCGTAC,
plow Cytometric Analysis (FACS)
Floating cells collected on day 8 and day 14 were incubated with TERl 19 (Phamingen, Sam
Diego, CA), which is an antibody against erythroid-specific antigen (23), and anti-CD71,
which is an antibody for transferrin receptor (Caltag, Burlingame, CA). For apoptosis
analysis, day 14 erythroblasts were incubated with Anexin V and propidium iodide (PI),
accordirlg tO the manufacture's protocol (MBL Co., Ltd., Nagoya, Japan). Then flow
cytometric analysis was perfb-ed using FACS Calibur (Becton Dickinson, Lincoln Park,
NJ).
Heme assay
Floatlng Cells were haⅣested on day 14 and heme content was dete-ined仙orometrically
using 105 cells per assay as described previously (24). All determinationswere made in
triplicates.
Iron content
For iron quantification, cells were collected by centrifugation and cell pellet was dissolved in
nitric acid solution,and used for atomic absorption SPeCtrOmetric analysts uSlng Z-5000 type
polarized Zeeman atomic absorption spectrometer (20).
Measurement of intracellular reactive oxygen intermediates
Day 14 erythroblasts were washed in PBS, then incubated with
lOpM 2・,7-dichlorodihydronuorescein (DCFHDA: Sigma, St Louis, MO) for 30 min in physiological
saline contalnlng 2% FBS・ Cellular nuorescence, developed by products formed from
DCFHDA by oxidation, was determined by now cytometry (25).
-7-Results
Morphology of alas21null erythroblasts
First, erythroid cells haⅣested on day 8 or day 14 Were cytospun and stained with
May-Gruenwald Giemsa solution.Asshown in Fig. I , a/as2-null erythroblasts exhibited the
morphology of various stages of erythroblasts which was very similar to that of wild-Ewe
e.rythroblasts・ Namely, most of alas2-null erythroblasts were found differentiated to
polychromatophilic or orthochromatic stages, which are of a smaller size with more
condensed chromatin than proerythroblasts. Although the morphology of alas2-null
erythroblasts per se was not different from that of wt'ld-りpe erythroblasts, the cell pellet of
alas2-null erythroblasts were completely colorless which reflects their heme derlCiency (Fig.
le, the right tube). Heme content, as determined by nuorometry, was 1620i45pmol/106cells,
and 1 20±1 5pmol/ 1 06, fTor wild-りpe, and alas21null definitive erythroblasts, respectively・
Expression of genes which are erythroid-specific or irLVOIved in iron metabolism
Next, levels of erythroid-specific gene expression were examined by RTIPCR and
FACS・AsShown in Fig. 2a, P-major globin mRNA, an adult-type globin, was dominant in
deflnitive erythroid cells harvested on day 14, whereas ev globin mRNA, an embryonic-type
globin, was dominant on day 8. β-major globin mRNA in wt'ld-りpe erythroblasts was only
weakly detectable on day 8, and the level in alas2-null erythroblasts was even lower. The
expression level of GATA- I and NF-E2 mRNA was similar fわr both alas2-null definitive and
wild-りpe erythroblasts (Fig. 2a). By flow cytometric analysis, TERl19, a marker of well
differentiated erythroblasts beyond CFU-E, was also fわund to be expressed at a similar level
in alas2-null definitive erythroblasts, asinwi/d-type definitive erythroblasts (Fig. 3). In
-8-contrast, the expression level of this protein in prlmitive erythroblasts was markedly
suppressed in alas2-null cells as compared with wild-type cells (Fig. 3), consistent with
findings in in vivo in a/as21targeted mice (20)・ These results suggest that, in contrast to
alas2-null prlmitive erythroblasts which show maturation arrest, alas2-null definitive
erythroblasts do not show a maturation arrest, despite their heme deficiency・
Heme and iron metabolism in alas21muII derlnitive erythroblasts
ln addition to erythroid-specific genes, expression of genes involved in heme and iron
metabolism was also examined・ Since exon 8 through 10 of the alas2 gene was replaced by
a neomycln resistant cassette in alas2-null erythroblasts, the corresponding portion could not
be amplified by RT-PCR using primer pairs which anneal with exon 7 and exon 10 (Fig. 2b)
(26)・ Interestingly, ALAS I mRNA was highly expressed in alas21null erythroblasts, while it
was not detectable in wild-ore erythroblasts (Fig. 2b). Conversely, H0-1 mRNA, which
encodes the rate-limltlng enZyme in the heme catabolic pathway and is inducible by heme,
was decreased in a/as2-null erythroblasts, Consistent with their heme deficiency (Fig. 2b).
Levels of NRAMP2 mRNA and transferrin receptor protein, which are involved in iron
metabolism, were similarfor bothalas2-null and wt'ld-ore definitive erythroblasts (Fig. 2b
andFig.3).
Next, iron content of definitive erythroblasts was examined・ Siderotic granules,
characteristic of erythroblasts of patients withXLSA, were not observed in alas2-null
definitive erythroblasts by standard iron staining (data not shown), however, iron content of
alas2-null definitive erythroblasts determined by atomic absorption SPeCtrOmetric analysts,
was slgnificantly increased compared to wild-ore definitive erythroblastsI Thus this finding lS
ー9-similar tothat observed in in vivo alas2-null primitive erythroblasts (Fig. 4). This finding
clearly indicatesthat mutation in ALAS2 leads to aberrant iron accumulation in definitive
erythroblasts.
0Ⅹidized status of alas2-null erythroblasts
Since accumulation of iron causes peroxidation of membrane lipids of erythrocytes,
alas2-null erythroid cells may contain a higher level of oxidized substances aS compared with
wt'ld-ore erythroid cells・ This question was examined by now cytometric analysis, using
definitive erythroblasts harvested on day14・Asshown in Fig・ 5, nuorescence intensity
renecting the oxidized products of DCFHDAfollowlng Incubation withcells was higher in
alas2-null erythroblasts than wt'ld-ore erythroblasts・ Next, to study the effect of an oxidized
status of alas2-null erythroblasts on cell aglng, the number of apoptotic cells was examined
by flow cytometricanalysISuslng Anexin V as an indicator for apoptosis・ Significant
fraction of alas2-null erythroblasts on day 14 were apoptotic, however,the percentage of
apoptotic alas2-null erythroblasts was not different from that of wild-りpe erythroblasts,
because the slgnificant number of wild-Ore erythroblasts were apoptotic which renect
completed maturation of cells (data not shown).
-10-Discussion
XLSA has been shown to be due to a mutation of the alas2 gene, and various
mutations have been reported i品the catalytic domain of the ALAS2 protein (10-12).
Abnormal iron accumulation in prImitive erythroblasts in alas2-null mice proved
experimentally that ALAS2 deficiency in fact results in aberrant iron metabolism and is
responsible for sideroblastic anemia in vivo・ However, alas2-null mice died L・n utero by
embryonic day ll・5 before definitive erythropoleSis developed, therefore, the effect of
ALAS2 deficiency on definitive erythropoleSis still remained unclear・ In this study, we
prepared alas2-null definitive erythroblasts uslnganin vitro differentiation system with OP9
stromal cells・ In alas2-null definitive erythroblasts, both morphology and expression of
erythroid-Specific genes were similar to those found in wild-ore definitive erythroblasts,
though the cell pellet of alas2-null definitive erythroblasts was completely colorless,
suggestlng a lack of heme・ In fact, chemical quantification of cellular heme content by
fluorometry demonstrated that alas21null definitive erythroblasts contained less than10%
●
heme found in wild-りpe Cells・ Furthermore, iron content of alas2-null definitive
erythroblasts was approximately 3-fold higher thanthat of wild-りpe cells, a finding similar to
those in alas2-null primitive erythroid cells in vivo in mice・ These results clearly establish
that ALAS2 deficiency results in aberrant iron metabolism bothin prlmitiveand definitive
erythropoiesis, and confirm that ALAS2 deficiency is responsible for the development of
sideroblasts and severe anemia in XLSA.
An important aspect in t'n vitro culture should also be noted that siderotic granules,
the biochemical hallmark of XLSA in in vivo in patients, were not detected in alas2lnull
Ill-definitive erythroblasts・While certain differentiated erythroblasts, e・g・, Polychromatophilic
or orthochromatic erythroblasts, developed in culture, enucleated erythrocytes were not fbund・
Erythrocytes take up and achieve a 7000 fわld greater iron concentration in cells than plasma
which occurs at a very late stage of differentiation (I). Perhaps in viEro in culture,
environment to support full erythroid differentiation may be inadequate・ Altematively,
uplike alas2-null erythroblasts, residual ALAS activity in patients wi,th XLSA may contribute
to drive iron into mitochondria・ It should also be noted that ALASl mRNA is upregulated in
alas2-null erythroblasts, renectlng de-repression of alasI gene expression by heme deficiency,
while this level must be yet insufrlCient fわr the support fわr iron transport into mitochondria in
erythroblasts.
To date, there has not been any report which describes the induction of sideroblasts in f〃
vL'tro culture uslng hematopoletic cells of patients with XLSA・ This finding does not
indicate, however, that no sideroblasts can be developed uslng ln Vitro culhre, since
sideroblasts were detected in BFU-E from bone marrow cells of patients with primary
●
acquired sideroblastic anemia (PASA) (27, 28). Thus, E'n vt'lro culture system is capable for
supportlng development of sideroblasts, at least of the PASA origin・ However, PASA is an
acquired clonal disorder and is not due to a slngle gene mutation as is the case with XLSA,
thus the mechanism for the fわrmation of sideroblasts must be different between these
disorders・While alas21null erythroblasts accumulate an excessive amount of iron,
erythroblasts or PASA may be perhaps more aggressive in iron accumulation into their
mitochondria than erythroblasts of XLSA.
Iron isknown to produce active hydroxyl radicalsthat are highly toxic to cells・ It
ー12-has been shown thatferritin iron can also partlCIPate in the generation of reactive oxygen
species, and cause oxidative tissue damages (29, 30). In this study, we found that alas2-null
erythroblasts produced more oxidized conversion from DCFHDA than did wE・ld-ore cells.
Consistent with our findings, erythrocytes in sickle cellanemia and thalassemia are known to
contain excess amounts or iron as well as peroxidized lipids in the membrane. Thus, similar
to sickle cell anemia and thalassemia erythrocytes, erythrocyte! in XLSA may also be more
susceptible to oxidative damages than intact erythrocytes, and such a mechanism may also
contribute to the aggravation of anemia in XLSA・ If so, treatment or XLSA with
iron-chelating agents and/or antioxidants may be useful and such therapy should be evaluated for
its efficacy.
In conclusion, Our study is the first which systematically examined and described the
characteristics of null definitive erythroblasts. Aberrant iron accumulation in
alas2-null definitive erythroblasts unequlVOCally substantiates the notion that ALAS2 deficiency lS
responsible fわr the development ofsideroblasts and severe anemia in patients with XLSA.
-13-Acknowledgment
Authors thank Ms・ Y Nishiyama, K・ Sato, K Kozawa, A Aizawa, Dr・ T Miura f♭r their
teclmical assistance. Authors are alsoJgrateful to Dr・ T Nakano for providing OP9 cells・
-14-Referen ces
I ・ Ponka P・ Tissue-Specific regulation of iron metabolism and heme synthesis: Distinct control
in erythroid cells. Blood. 1997;g9:1-25.
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ー18-Legends to Figures
Figure l・ Morphology of Cultured erythroid cells
Wild-りpe and alas21null ES cells were cultured with OP9 cells and floating cells
were collected on day 8 and day 14l May-Gruenwald-Giemsa stainof (a) wild-Ewe and
alas2-null (b) erythroblasts on day 8, (C) wild-ore and (d) alas2Tnull erythroblasts on day 14.
Original magnification is x400・ (e) cell pellets of wild-ore (le氏) and alas2-null (right)
erythroid cells.
Figure2・ Expression of erythroid-specirIC genes and genes involved in
biosynthesis and catabolism
Total RNA was extracted fTrom harvested cells, and 2pg of total RNA was
reverse-transcribed・ Then target genes were amplified by PCR with specific prlmerS aS described in
Materials and Methods・ (a) erythroid-Specific genes (b) genes involved in heme biosynthesis
and catabolism, and in iron transport・
Figure 3・ Expression ofTERl19 and transferrin receptor examined by FACS
(a) wt'ldやpe erythroblasts on day 8, (b) alas2-null erythroblasts on day 8, (C) wt'ld-type
erythroblasts on day 14, (d) alas2-null erythroblasts on day 14.
Figure 4・ Iron content of dertnitive erythroblasts
lron content of cells haⅣested on day 14 was determined by atomic absorptlOn
-19-spectrometry as described previously (20). Iron content was- 1 15±10・6mg and 389・ 1±1 1・4ng
/lx 106 cells,for wild一昨e and alas2-null cells, respectively・
Figure 5. 0Ⅹidized state of alas2-rLull dertnitive erythroblasts comparedwith
wild-type erythroblasts
Cells harvested on day 14 Were incubated and cellular nuorescence intenslty Was
examined by FACS. alas2-null erythroblasts contain more oxidized cells than wild-type
erythroblasts, as indicated by a shift of peak toward right for alas2-null definitive
erythroblasts (b) compared to wt'ld-type cells (a). The number of positive cells are 60・55%
vs 38.79%,for alas2-null (d) and wild-type cells (C), respectively.
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