Loading…

Protection of Mice against Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia by Cell-based Vaccination Using Nonviral, Minimalistic Expression Vectors and Immunomodulatory Oligonucleotides

Purpose: Childhood Philadelphia chromosome positive (Ph + ) acute lymphoblastic leukemia (ALL) has a poor prognosis. Because leukemia cell burden is reduced but not eradicated by polychemotherapy, improved treatment strategies should enhance those immune mechanisms responsible for the maintenance of...

Full description

Saved in:
Bibliographic Details
Published in:Clinical cancer research 2003-08, Vol.9 (8), p.3142-3149
Main Authors: KÖCHLING, Joachim, KÖNIG-MEREDIZ, Sven A, SCHMIDT, Manuel, STRIPECKE, Renata, BUCHWALD, Dirk, KORTE, Alexander, VON EINSIEDEL, Hagen G, SACK, Florian, HENZE, Günter, SEEGER, Karl, WITTIG, Burghardt
Format: Article
Language:English
Subjects:
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites
container_end_page 3149
container_issue 8
container_start_page 3142
container_title Clinical cancer research
container_volume 9
creator KÖCHLING, Joachim
KÖNIG-MEREDIZ, Sven A
SCHMIDT, Manuel
STRIPECKE, Renata
BUCHWALD, Dirk
KORTE, Alexander
VON EINSIEDEL, Hagen G
SACK, Florian
HENZE, Günter
SEEGER, Karl
WITTIG, Burghardt
description Purpose: Childhood Philadelphia chromosome positive (Ph + ) acute lymphoblastic leukemia (ALL) has a poor prognosis. Because leukemia cell burden is reduced but not eradicated by polychemotherapy, improved treatment strategies should enhance those immune mechanisms responsible for the maintenance of complete remission. The aim of this study was to evaluate the protection of mice challenged with the syngeneic Ph + ALL cell line BM185 using genetically modified leukemia cell vaccines and immunomodulating oligonucleotides. Experimental Design: Because retroviral vectors are ineffective at transducing nondividing primary cells from human hematopoietic malignancies, we first evaluated nonviral techniques (electroporation and ballistic transfer) using minimalistic immunogenically defined gene expression vectors to generate B7.1 or granulocyte macrophage colony-stimulating factor (GM-CSF)-expressing BM185 cells. Subsequently, protective vaccination experiments with these cells were performed in a leukemia challenge mouse model. Results: Electroporation yielded a high transfection rate (82.6% for B7.1) with moderate GM-CSF secretion/1 × 10 6 cells (228 pg), whereas ballistic transfer led to a lower transfection rate (30.9%) with high GM-CSF secretion (614 pg). Secondly, we immunized mice with B7.1/interleukin 2- or B7.1/GM-CSF-expressing BM185 cell vaccines. We observed a better protection of mice that received the B7.1/GM-CSF vaccine compared with these receiving the B7.1/interleukin 2 vaccine. Protection was additionally enhanced by application of a double stem-loop immunomodulating oligonucleotide containing CpG motifs. Conclusion: Our data indicate that immunization with B7.1/GM-CSF-expressing cell vaccines generated by electroporation and application of double stem-loop immunomodulating oligonucleotide protected mice against a murine Ph + ALL challenge. Ultimately, this approach may also lead to clinical benefit in patients with Ph + ALL.
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_73564104</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>73564104</sourcerecordid><originalsourceid>FETCH-LOGICAL-h271t-7a5f7b9f872d65e4cc71fddcdde6cfcc5dda73803893aecc55e5edee84783a313</originalsourceid><addsrcrecordid>eNpFkN1u1DAQhSNERUvLKyDfADdESuI4zl5Wq5ZWWmgv2t5GE3uyGfBPsJPCvmEfC2-7qJIle6xv5sw5b7KTUgiZ86oRb9O7kG1e1Lw6zt7H-LMoyros6nfZcVmt0mmak-zpNvgZ1UzeMT-w76SQwRbIxZndjmRAo5lGArYeg7c-eov55CPN9IjsXC0zss3OTqPvDcSZFNvg8gttauh3bI3G5D1E1OwBlCIHzzr3kdyW_fDukQKYr0nUkQVDz_0Xf6eAMe65h7SXD5GB0-za2sWlBfRiIH3u2I2hrXeLMuhn0hjPsqMBTMQPh_s0u7-8uFtf5Zubb9fr800-VrKccwlikP1qaGWlG4G1UrIctFZaY6MGpYTWIHlb8HbFAVMtUKBGbGvZcuAlP80-v8ydgv-9YJw7S1Elo-DQL7GTXDT7lBP48QAuvUXdTSGZDLvuf_YJ-HQAICowQwCnKL5youA1b_eKX164kbbjHwrYqURiSDEhBDV2q67teFlX_B_4AKOL</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>73564104</pqid></control><display><type>article</type><title>Protection of Mice against Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia by Cell-based Vaccination Using Nonviral, Minimalistic Expression Vectors and Immunomodulatory Oligonucleotides</title><source>Freely Accessible Journals</source><creator>KÖCHLING, Joachim ; KÖNIG-MEREDIZ, Sven A ; SCHMIDT, Manuel ; STRIPECKE, Renata ; BUCHWALD, Dirk ; KORTE, Alexander ; VON EINSIEDEL, Hagen G ; SACK, Florian ; HENZE, Günter ; SEEGER, Karl ; WITTIG, Burghardt</creator><creatorcontrib>KÖCHLING, Joachim ; KÖNIG-MEREDIZ, Sven A ; SCHMIDT, Manuel ; STRIPECKE, Renata ; BUCHWALD, Dirk ; KORTE, Alexander ; VON EINSIEDEL, Hagen G ; SACK, Florian ; HENZE, Günter ; SEEGER, Karl ; WITTIG, Burghardt</creatorcontrib><description>Purpose: Childhood Philadelphia chromosome positive (Ph + ) acute lymphoblastic leukemia (ALL) has a poor prognosis. Because leukemia cell burden is reduced but not eradicated by polychemotherapy, improved treatment strategies should enhance those immune mechanisms responsible for the maintenance of complete remission. The aim of this study was to evaluate the protection of mice challenged with the syngeneic Ph + ALL cell line BM185 using genetically modified leukemia cell vaccines and immunomodulating oligonucleotides. Experimental Design: Because retroviral vectors are ineffective at transducing nondividing primary cells from human hematopoietic malignancies, we first evaluated nonviral techniques (electroporation and ballistic transfer) using minimalistic immunogenically defined gene expression vectors to generate B7.1 or granulocyte macrophage colony-stimulating factor (GM-CSF)-expressing BM185 cells. Subsequently, protective vaccination experiments with these cells were performed in a leukemia challenge mouse model. Results: Electroporation yielded a high transfection rate (82.6% for B7.1) with moderate GM-CSF secretion/1 × 10 6 cells (228 pg), whereas ballistic transfer led to a lower transfection rate (30.9%) with high GM-CSF secretion (614 pg). Secondly, we immunized mice with B7.1/interleukin 2- or B7.1/GM-CSF-expressing BM185 cell vaccines. We observed a better protection of mice that received the B7.1/GM-CSF vaccine compared with these receiving the B7.1/interleukin 2 vaccine. Protection was additionally enhanced by application of a double stem-loop immunomodulating oligonucleotide containing CpG motifs. Conclusion: Our data indicate that immunization with B7.1/GM-CSF-expressing cell vaccines generated by electroporation and application of double stem-loop immunomodulating oligonucleotide protected mice against a murine Ph + ALL challenge. Ultimately, this approach may also lead to clinical benefit in patients with Ph + ALL.</description><identifier>ISSN: 1078-0432</identifier><identifier>EISSN: 1557-3265</identifier><identifier>PMID: 12912966</identifier><language>eng</language><publisher>Philadelphia, PA: American Association for Cancer Research</publisher><subject>Amino Acid Motifs ; Animals ; Antineoplastic agents ; Base Sequence ; Biological and medical sciences ; Cancer Vaccines ; Cell Line ; Cell Line, Tumor ; CpG Islands ; Disease-Free Survival ; Electroporation ; Female ; Gene Expression Regulation, Neoplastic ; Gene Transfer Techniques ; Genetic Vectors ; Humans ; Immunotherapy ; Medical sciences ; Mice ; Mice, Inbred BALB C ; Oligonucleotides - therapeutic use ; Pharmacology. Drug treatments ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy ; Retroviridae - genetics ; Time Factors ; Transfection ; Transgenes ; Tumor Cells, Cultured</subject><ispartof>Clinical cancer research, 2003-08, Vol.9 (8), p.3142-3149</ispartof><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=15034381$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12912966$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>KÖCHLING, Joachim</creatorcontrib><creatorcontrib>KÖNIG-MEREDIZ, Sven A</creatorcontrib><creatorcontrib>SCHMIDT, Manuel</creatorcontrib><creatorcontrib>STRIPECKE, Renata</creatorcontrib><creatorcontrib>BUCHWALD, Dirk</creatorcontrib><creatorcontrib>KORTE, Alexander</creatorcontrib><creatorcontrib>VON EINSIEDEL, Hagen G</creatorcontrib><creatorcontrib>SACK, Florian</creatorcontrib><creatorcontrib>HENZE, Günter</creatorcontrib><creatorcontrib>SEEGER, Karl</creatorcontrib><creatorcontrib>WITTIG, Burghardt</creatorcontrib><title>Protection of Mice against Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia by Cell-based Vaccination Using Nonviral, Minimalistic Expression Vectors and Immunomodulatory Oligonucleotides</title><title>Clinical cancer research</title><addtitle>Clin Cancer Res</addtitle><description>Purpose: Childhood Philadelphia chromosome positive (Ph + ) acute lymphoblastic leukemia (ALL) has a poor prognosis. Because leukemia cell burden is reduced but not eradicated by polychemotherapy, improved treatment strategies should enhance those immune mechanisms responsible for the maintenance of complete remission. The aim of this study was to evaluate the protection of mice challenged with the syngeneic Ph + ALL cell line BM185 using genetically modified leukemia cell vaccines and immunomodulating oligonucleotides. Experimental Design: Because retroviral vectors are ineffective at transducing nondividing primary cells from human hematopoietic malignancies, we first evaluated nonviral techniques (electroporation and ballistic transfer) using minimalistic immunogenically defined gene expression vectors to generate B7.1 or granulocyte macrophage colony-stimulating factor (GM-CSF)-expressing BM185 cells. Subsequently, protective vaccination experiments with these cells were performed in a leukemia challenge mouse model. Results: Electroporation yielded a high transfection rate (82.6% for B7.1) with moderate GM-CSF secretion/1 × 10 6 cells (228 pg), whereas ballistic transfer led to a lower transfection rate (30.9%) with high GM-CSF secretion (614 pg). Secondly, we immunized mice with B7.1/interleukin 2- or B7.1/GM-CSF-expressing BM185 cell vaccines. We observed a better protection of mice that received the B7.1/GM-CSF vaccine compared with these receiving the B7.1/interleukin 2 vaccine. Protection was additionally enhanced by application of a double stem-loop immunomodulating oligonucleotide containing CpG motifs. Conclusion: Our data indicate that immunization with B7.1/GM-CSF-expressing cell vaccines generated by electroporation and application of double stem-loop immunomodulating oligonucleotide protected mice against a murine Ph + ALL challenge. Ultimately, this approach may also lead to clinical benefit in patients with Ph + ALL.</description><subject>Amino Acid Motifs</subject><subject>Animals</subject><subject>Antineoplastic agents</subject><subject>Base Sequence</subject><subject>Biological and medical sciences</subject><subject>Cancer Vaccines</subject><subject>Cell Line</subject><subject>Cell Line, Tumor</subject><subject>CpG Islands</subject><subject>Disease-Free Survival</subject><subject>Electroporation</subject><subject>Female</subject><subject>Gene Expression Regulation, Neoplastic</subject><subject>Gene Transfer Techniques</subject><subject>Genetic Vectors</subject><subject>Humans</subject><subject>Immunotherapy</subject><subject>Medical sciences</subject><subject>Mice</subject><subject>Mice, Inbred BALB C</subject><subject>Oligonucleotides - therapeutic use</subject><subject>Pharmacology. Drug treatments</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy</subject><subject>Retroviridae - genetics</subject><subject>Time Factors</subject><subject>Transfection</subject><subject>Transgenes</subject><subject>Tumor Cells, Cultured</subject><issn>1078-0432</issn><issn>1557-3265</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><recordid>eNpFkN1u1DAQhSNERUvLKyDfADdESuI4zl5Wq5ZWWmgv2t5GE3uyGfBPsJPCvmEfC2-7qJIle6xv5sw5b7KTUgiZ86oRb9O7kG1e1Lw6zt7H-LMoyros6nfZcVmt0mmak-zpNvgZ1UzeMT-w76SQwRbIxZndjmRAo5lGArYeg7c-eov55CPN9IjsXC0zss3OTqPvDcSZFNvg8gttauh3bI3G5D1E1OwBlCIHzzr3kdyW_fDukQKYr0nUkQVDz_0Xf6eAMe65h7SXD5GB0-za2sWlBfRiIH3u2I2hrXeLMuhn0hjPsqMBTMQPh_s0u7-8uFtf5Zubb9fr800-VrKccwlikP1qaGWlG4G1UrIctFZaY6MGpYTWIHlb8HbFAVMtUKBGbGvZcuAlP80-v8ydgv-9YJw7S1Elo-DQL7GTXDT7lBP48QAuvUXdTSGZDLvuf_YJ-HQAICowQwCnKL5youA1b_eKX164kbbjHwrYqURiSDEhBDV2q67teFlX_B_4AKOL</recordid><startdate>20030801</startdate><enddate>20030801</enddate><creator>KÖCHLING, Joachim</creator><creator>KÖNIG-MEREDIZ, Sven A</creator><creator>SCHMIDT, Manuel</creator><creator>STRIPECKE, Renata</creator><creator>BUCHWALD, Dirk</creator><creator>KORTE, Alexander</creator><creator>VON EINSIEDEL, Hagen G</creator><creator>SACK, Florian</creator><creator>HENZE, Günter</creator><creator>SEEGER, Karl</creator><creator>WITTIG, Burghardt</creator><general>American Association for Cancer Research</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20030801</creationdate><title>Protection of Mice against Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia by Cell-based Vaccination Using Nonviral, Minimalistic Expression Vectors and Immunomodulatory Oligonucleotides</title><author>KÖCHLING, Joachim ; KÖNIG-MEREDIZ, Sven A ; SCHMIDT, Manuel ; STRIPECKE, Renata ; BUCHWALD, Dirk ; KORTE, Alexander ; VON EINSIEDEL, Hagen G ; SACK, Florian ; HENZE, Günter ; SEEGER, Karl ; WITTIG, Burghardt</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h271t-7a5f7b9f872d65e4cc71fddcdde6cfcc5dda73803893aecc55e5edee84783a313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Amino Acid Motifs</topic><topic>Animals</topic><topic>Antineoplastic agents</topic><topic>Base Sequence</topic><topic>Biological and medical sciences</topic><topic>Cancer Vaccines</topic><topic>Cell Line</topic><topic>Cell Line, Tumor</topic><topic>CpG Islands</topic><topic>Disease-Free Survival</topic><topic>Electroporation</topic><topic>Female</topic><topic>Gene Expression Regulation, Neoplastic</topic><topic>Gene Transfer Techniques</topic><topic>Genetic Vectors</topic><topic>Humans</topic><topic>Immunotherapy</topic><topic>Medical sciences</topic><topic>Mice</topic><topic>Mice, Inbred BALB C</topic><topic>Oligonucleotides - therapeutic use</topic><topic>Pharmacology. Drug treatments</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy</topic><topic>Retroviridae - genetics</topic><topic>Time Factors</topic><topic>Transfection</topic><topic>Transgenes</topic><topic>Tumor Cells, Cultured</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>KÖCHLING, Joachim</creatorcontrib><creatorcontrib>KÖNIG-MEREDIZ, Sven A</creatorcontrib><creatorcontrib>SCHMIDT, Manuel</creatorcontrib><creatorcontrib>STRIPECKE, Renata</creatorcontrib><creatorcontrib>BUCHWALD, Dirk</creatorcontrib><creatorcontrib>KORTE, Alexander</creatorcontrib><creatorcontrib>VON EINSIEDEL, Hagen G</creatorcontrib><creatorcontrib>SACK, Florian</creatorcontrib><creatorcontrib>HENZE, Günter</creatorcontrib><creatorcontrib>SEEGER, Karl</creatorcontrib><creatorcontrib>WITTIG, Burghardt</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical cancer research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>KÖCHLING, Joachim</au><au>KÖNIG-MEREDIZ, Sven A</au><au>SCHMIDT, Manuel</au><au>STRIPECKE, Renata</au><au>BUCHWALD, Dirk</au><au>KORTE, Alexander</au><au>VON EINSIEDEL, Hagen G</au><au>SACK, Florian</au><au>HENZE, Günter</au><au>SEEGER, Karl</au><au>WITTIG, Burghardt</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Protection of Mice against Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia by Cell-based Vaccination Using Nonviral, Minimalistic Expression Vectors and Immunomodulatory Oligonucleotides</atitle><jtitle>Clinical cancer research</jtitle><addtitle>Clin Cancer Res</addtitle><date>2003-08-01</date><risdate>2003</risdate><volume>9</volume><issue>8</issue><spage>3142</spage><epage>3149</epage><pages>3142-3149</pages><issn>1078-0432</issn><eissn>1557-3265</eissn><abstract>Purpose: Childhood Philadelphia chromosome positive (Ph + ) acute lymphoblastic leukemia (ALL) has a poor prognosis. Because leukemia cell burden is reduced but not eradicated by polychemotherapy, improved treatment strategies should enhance those immune mechanisms responsible for the maintenance of complete remission. The aim of this study was to evaluate the protection of mice challenged with the syngeneic Ph + ALL cell line BM185 using genetically modified leukemia cell vaccines and immunomodulating oligonucleotides. Experimental Design: Because retroviral vectors are ineffective at transducing nondividing primary cells from human hematopoietic malignancies, we first evaluated nonviral techniques (electroporation and ballistic transfer) using minimalistic immunogenically defined gene expression vectors to generate B7.1 or granulocyte macrophage colony-stimulating factor (GM-CSF)-expressing BM185 cells. Subsequently, protective vaccination experiments with these cells were performed in a leukemia challenge mouse model. Results: Electroporation yielded a high transfection rate (82.6% for B7.1) with moderate GM-CSF secretion/1 × 10 6 cells (228 pg), whereas ballistic transfer led to a lower transfection rate (30.9%) with high GM-CSF secretion (614 pg). Secondly, we immunized mice with B7.1/interleukin 2- or B7.1/GM-CSF-expressing BM185 cell vaccines. We observed a better protection of mice that received the B7.1/GM-CSF vaccine compared with these receiving the B7.1/interleukin 2 vaccine. Protection was additionally enhanced by application of a double stem-loop immunomodulating oligonucleotide containing CpG motifs. Conclusion: Our data indicate that immunization with B7.1/GM-CSF-expressing cell vaccines generated by electroporation and application of double stem-loop immunomodulating oligonucleotide protected mice against a murine Ph + ALL challenge. Ultimately, this approach may also lead to clinical benefit in patients with Ph + ALL.</abstract><cop>Philadelphia, PA</cop><pub>American Association for Cancer Research</pub><pmid>12912966</pmid><tpages>8</tpages></addata></record>
fulltext fulltext
identifier ISSN: 1078-0432
ispartof Clinical cancer research, 2003-08, Vol.9 (8), p.3142-3149
issn 1078-0432
1557-3265
language eng
recordid cdi_proquest_miscellaneous_73564104
source Freely Accessible Journals
subjects Amino Acid Motifs
Animals
Antineoplastic agents
Base Sequence
Biological and medical sciences
Cancer Vaccines
Cell Line
Cell Line, Tumor
CpG Islands
Disease-Free Survival
Electroporation
Female
Gene Expression Regulation, Neoplastic
Gene Transfer Techniques
Genetic Vectors
Humans
Immunotherapy
Medical sciences
Mice
Mice, Inbred BALB C
Oligonucleotides - therapeutic use
Pharmacology. Drug treatments
Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy
Retroviridae - genetics
Time Factors
Transfection
Transgenes
Tumor Cells, Cultured
title Protection of Mice against Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia by Cell-based Vaccination Using Nonviral, Minimalistic Expression Vectors and Immunomodulatory Oligonucleotides
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T12%3A50%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Protection%20of%20Mice%20against%20Philadelphia%20Chromosome-positive%20Acute%20Lymphoblastic%20Leukemia%20by%20Cell-based%20Vaccination%20Using%20Nonviral,%20Minimalistic%20Expression%20Vectors%20and%20Immunomodulatory%20Oligonucleotides&rft.jtitle=Clinical%20cancer%20research&rft.au=K%C3%96CHLING,%20Joachim&rft.date=2003-08-01&rft.volume=9&rft.issue=8&rft.spage=3142&rft.epage=3149&rft.pages=3142-3149&rft.issn=1078-0432&rft.eissn=1557-3265&rft_id=info:doi/&rft_dat=%3Cproquest_pubme%3E73564104%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-h271t-7a5f7b9f872d65e4cc71fddcdde6cfcc5dda73803893aecc55e5edee84783a313%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=73564104&rft_id=info:pmid/12912966&rfr_iscdi=true