Loading…

Sugar-Phosphate Toxicities Attenuate Salmonella Fitness in the Gut

Pathogens are becoming resistant to antimicrobials at an increasing rate, and novel therapeutic strategies are needed. Using Salmonella as a model, we have investigated the induction of sugar-phosphate toxicity as a potential therapeutic modality. The approach entails providing a nutrient while bloc...

Full description

Saved in:
Bibliographic Details
Published in:Journal of bacteriology 2022-12, Vol.204 (12), p.e0034422
Main Authors: Boulanger, Erin F, Sabag-Daigle, Anice, Baniasad, Maryam, Kokkinias, Katherine, Schwieters, Andrew, Wrighton, Kelly C, Wysocki, Vicki H, Ahmer, Brian M M
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-a442t-a2635ed49039668af6576fddc2ad7196cc25e412d8faa4d64e5262220ec07aa93
cites cdi_FETCH-LOGICAL-a442t-a2635ed49039668af6576fddc2ad7196cc25e412d8faa4d64e5262220ec07aa93
container_end_page
container_issue 12
container_start_page e0034422
container_title Journal of bacteriology
container_volume 204
creator Boulanger, Erin F
Sabag-Daigle, Anice
Baniasad, Maryam
Kokkinias, Katherine
Schwieters, Andrew
Wrighton, Kelly C
Wysocki, Vicki H
Ahmer, Brian M M
description Pathogens are becoming resistant to antimicrobials at an increasing rate, and novel therapeutic strategies are needed. Using Salmonella as a model, we have investigated the induction of sugar-phosphate toxicity as a potential therapeutic modality. The approach entails providing a nutrient while blocking the catabolism of that nutrient, resulting in the accumulation of a toxic intermediate. We hypothesize that this build-up will decrease the fitness of the organism during infection given nutrient availability. We tested this hypothesis using mutants lacking one of seven genes whose mutation is expected to cause the accumulation of a toxic metabolic intermediate. The , , , , , , and mutants were then provided the appropriate sugars, either or during gastrointestinal infection of mice. All but the mutant had nutrient-dependent growth defects , suggestive of sugar-phosphate toxicity. During gastrointestinal infection of mice, five mutants had decreased fitness. Providing the appropriate nutrient in the animal's drinking water was required to cause fitness defects with the and mutants and to enhance the fitness defect of the mutant. The and mutants were severely attenuated regardless of the nutrient being provided in the drinking water. Homologs of are widespread among bacteria and in humans, rendering the specific targeting of bacterial pathogens difficult. However, the , , and genes are not present in humans, appear to be rare in most phyla of bacteria, and are common in several genera of , making the encoded enzymes potential narrow-spectrum therapeutic targets. Bacterial pathogens are becoming increasingly resistant to antibiotics. There is an urgent need to identify novel drug targets and therapeutic strategies. In this work we have assembled and characterized a collection of mutations in our model pathogen, Salmonella enterica, that block a variety of sugar utilization pathways in such a way as to cause the accumulation of a toxic sugar-phosphate. Mutations in three genes, , , and , dramatically decrease the fitness of Salmonella in a mouse model of gastroenteritis, suggesting that RhaD, AraD, and MtlD may be good narrow-spectrum drug targets. The induction of sugar-phosphate toxicities may be a therapeutic strategy that is broadly relevant to other bacterial and fungal pathogens.
doi_str_mv 10.1128/jb.00344-22
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9765134</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2756701211</sourcerecordid><originalsourceid>FETCH-LOGICAL-a442t-a2635ed49039668af6576fddc2ad7196cc25e412d8faa4d64e5262220ec07aa93</originalsourceid><addsrcrecordid>eNptkU1Lw0AQhhdRbK2evEvAiyCpu7MfSS5CLbYKBYXW8zJNNk1KmtTsRvTfm9paFTwNzDw8M7xDyDmjfcYgvFnO-5RyIXyAA9JlNAp9KTk9JF1KgfkRi3iHnFi7pJQJIeGYdLjiIac07JK7abPA2n_OKrvO0BlvVr3nce5yY72Bc6ZsNs0pFquqNEWB3ih3pbHWy0vPZcYbN-6UHKVYWHO2qz3yMrqfDR_8ydP4cTiY-CgEOB9BcWkSEVEeKRViqmSg0iSJAZOARSqOQRrBIAlTRJEoYSQoAKAmpgFixHvkdutdN_OVSWJTuhoLva7zFdYfusJc_52UeaYX1ZuOAiUZF63gcieoq9fGWKeXVVOX7c0aAqkCyoCxlrreUnFdWVubdL-BUb0JXC_n-itwDdDSV1sa7Qp-fP-jF7_v32u_n8E_AeiSiCY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2756701211</pqid></control><display><type>article</type><title>Sugar-Phosphate Toxicities Attenuate Salmonella Fitness in the Gut</title><source>PubMed (Medline)</source><source>American Society for Microbiology Journals</source><creator>Boulanger, Erin F ; Sabag-Daigle, Anice ; Baniasad, Maryam ; Kokkinias, Katherine ; Schwieters, Andrew ; Wrighton, Kelly C ; Wysocki, Vicki H ; Ahmer, Brian M M</creator><contributor>O’Toole, George</contributor><creatorcontrib>Boulanger, Erin F ; Sabag-Daigle, Anice ; Baniasad, Maryam ; Kokkinias, Katherine ; Schwieters, Andrew ; Wrighton, Kelly C ; Wysocki, Vicki H ; Ahmer, Brian M M ; O’Toole, George</creatorcontrib><description>Pathogens are becoming resistant to antimicrobials at an increasing rate, and novel therapeutic strategies are needed. Using Salmonella as a model, we have investigated the induction of sugar-phosphate toxicity as a potential therapeutic modality. The approach entails providing a nutrient while blocking the catabolism of that nutrient, resulting in the accumulation of a toxic intermediate. We hypothesize that this build-up will decrease the fitness of the organism during infection given nutrient availability. We tested this hypothesis using mutants lacking one of seven genes whose mutation is expected to cause the accumulation of a toxic metabolic intermediate. The , , , , , , and mutants were then provided the appropriate sugars, either or during gastrointestinal infection of mice. All but the mutant had nutrient-dependent growth defects , suggestive of sugar-phosphate toxicity. During gastrointestinal infection of mice, five mutants had decreased fitness. Providing the appropriate nutrient in the animal's drinking water was required to cause fitness defects with the and mutants and to enhance the fitness defect of the mutant. The and mutants were severely attenuated regardless of the nutrient being provided in the drinking water. Homologs of are widespread among bacteria and in humans, rendering the specific targeting of bacterial pathogens difficult. However, the , , and genes are not present in humans, appear to be rare in most phyla of bacteria, and are common in several genera of , making the encoded enzymes potential narrow-spectrum therapeutic targets. Bacterial pathogens are becoming increasingly resistant to antibiotics. There is an urgent need to identify novel drug targets and therapeutic strategies. In this work we have assembled and characterized a collection of mutations in our model pathogen, Salmonella enterica, that block a variety of sugar utilization pathways in such a way as to cause the accumulation of a toxic sugar-phosphate. Mutations in three genes, , , and , dramatically decrease the fitness of Salmonella in a mouse model of gastroenteritis, suggesting that RhaD, AraD, and MtlD may be good narrow-spectrum drug targets. The induction of sugar-phosphate toxicities may be a therapeutic strategy that is broadly relevant to other bacterial and fungal pathogens.</description><identifier>ISSN: 0021-9193</identifier><identifier>EISSN: 1098-5530</identifier><identifier>DOI: 10.1128/jb.00344-22</identifier><identifier>PMID: 36383008</identifier><language>eng</language><publisher>United States: American Society for Microbiology</publisher><subject>Accumulation ; Animals ; Antimicrobial agents ; Bacteria ; Bacteriology ; Catabolism ; Defects ; Drinking water ; Drinking Water - metabolism ; Fitness ; Genes ; Humans ; Infections ; Mice ; Mutants ; Mutation ; Nutrient availability ; Pathogens ; Phosphates - metabolism ; Reproductive fitness ; Research Article ; Salmonella ; Salmonella - genetics ; Salmonella enterica - genetics ; Sugar ; Sugars - metabolism ; Therapeutic targets ; Toxicity</subject><ispartof>Journal of bacteriology, 2022-12, Vol.204 (12), p.e0034422</ispartof><rights>Copyright © 2022 American Society for Microbiology.</rights><rights>Copyright American Society for Microbiology Dec 2022</rights><rights>Copyright © 2022 American Society for Microbiology. 2022 American Society for Microbiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a442t-a2635ed49039668af6576fddc2ad7196cc25e412d8faa4d64e5262220ec07aa93</citedby><cites>FETCH-LOGICAL-a442t-a2635ed49039668af6576fddc2ad7196cc25e412d8faa4d64e5262220ec07aa93</cites><orcidid>0000-0003-3550-528X ; 0000-0002-4267-7322</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.asm.org/doi/pdf/10.1128/jb.00344-22$$EPDF$$P50$$Gasm2$$H</linktopdf><linktohtml>$$Uhttps://journals.asm.org/doi/full/10.1128/jb.00344-22$$EHTML$$P50$$Gasm2$$H</linktohtml><link.rule.ids>230,314,724,777,781,882,3175,27905,27906,52732,52733,52734,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36383008$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>O’Toole, George</contributor><creatorcontrib>Boulanger, Erin F</creatorcontrib><creatorcontrib>Sabag-Daigle, Anice</creatorcontrib><creatorcontrib>Baniasad, Maryam</creatorcontrib><creatorcontrib>Kokkinias, Katherine</creatorcontrib><creatorcontrib>Schwieters, Andrew</creatorcontrib><creatorcontrib>Wrighton, Kelly C</creatorcontrib><creatorcontrib>Wysocki, Vicki H</creatorcontrib><creatorcontrib>Ahmer, Brian M M</creatorcontrib><title>Sugar-Phosphate Toxicities Attenuate Salmonella Fitness in the Gut</title><title>Journal of bacteriology</title><addtitle>J Bacteriol</addtitle><addtitle>J Bacteriol</addtitle><description>Pathogens are becoming resistant to antimicrobials at an increasing rate, and novel therapeutic strategies are needed. Using Salmonella as a model, we have investigated the induction of sugar-phosphate toxicity as a potential therapeutic modality. The approach entails providing a nutrient while blocking the catabolism of that nutrient, resulting in the accumulation of a toxic intermediate. We hypothesize that this build-up will decrease the fitness of the organism during infection given nutrient availability. We tested this hypothesis using mutants lacking one of seven genes whose mutation is expected to cause the accumulation of a toxic metabolic intermediate. The , , , , , , and mutants were then provided the appropriate sugars, either or during gastrointestinal infection of mice. All but the mutant had nutrient-dependent growth defects , suggestive of sugar-phosphate toxicity. During gastrointestinal infection of mice, five mutants had decreased fitness. Providing the appropriate nutrient in the animal's drinking water was required to cause fitness defects with the and mutants and to enhance the fitness defect of the mutant. The and mutants were severely attenuated regardless of the nutrient being provided in the drinking water. Homologs of are widespread among bacteria and in humans, rendering the specific targeting of bacterial pathogens difficult. However, the , , and genes are not present in humans, appear to be rare in most phyla of bacteria, and are common in several genera of , making the encoded enzymes potential narrow-spectrum therapeutic targets. Bacterial pathogens are becoming increasingly resistant to antibiotics. There is an urgent need to identify novel drug targets and therapeutic strategies. In this work we have assembled and characterized a collection of mutations in our model pathogen, Salmonella enterica, that block a variety of sugar utilization pathways in such a way as to cause the accumulation of a toxic sugar-phosphate. Mutations in three genes, , , and , dramatically decrease the fitness of Salmonella in a mouse model of gastroenteritis, suggesting that RhaD, AraD, and MtlD may be good narrow-spectrum drug targets. The induction of sugar-phosphate toxicities may be a therapeutic strategy that is broadly relevant to other bacterial and fungal pathogens.</description><subject>Accumulation</subject><subject>Animals</subject><subject>Antimicrobial agents</subject><subject>Bacteria</subject><subject>Bacteriology</subject><subject>Catabolism</subject><subject>Defects</subject><subject>Drinking water</subject><subject>Drinking Water - metabolism</subject><subject>Fitness</subject><subject>Genes</subject><subject>Humans</subject><subject>Infections</subject><subject>Mice</subject><subject>Mutants</subject><subject>Mutation</subject><subject>Nutrient availability</subject><subject>Pathogens</subject><subject>Phosphates - metabolism</subject><subject>Reproductive fitness</subject><subject>Research Article</subject><subject>Salmonella</subject><subject>Salmonella - genetics</subject><subject>Salmonella enterica - genetics</subject><subject>Sugar</subject><subject>Sugars - metabolism</subject><subject>Therapeutic targets</subject><subject>Toxicity</subject><issn>0021-9193</issn><issn>1098-5530</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNptkU1Lw0AQhhdRbK2evEvAiyCpu7MfSS5CLbYKBYXW8zJNNk1KmtTsRvTfm9paFTwNzDw8M7xDyDmjfcYgvFnO-5RyIXyAA9JlNAp9KTk9JF1KgfkRi3iHnFi7pJQJIeGYdLjiIac07JK7abPA2n_OKrvO0BlvVr3nce5yY72Bc6ZsNs0pFquqNEWB3ih3pbHWy0vPZcYbN-6UHKVYWHO2qz3yMrqfDR_8ydP4cTiY-CgEOB9BcWkSEVEeKRViqmSg0iSJAZOARSqOQRrBIAlTRJEoYSQoAKAmpgFixHvkdutdN_OVSWJTuhoLva7zFdYfusJc_52UeaYX1ZuOAiUZF63gcieoq9fGWKeXVVOX7c0aAqkCyoCxlrreUnFdWVubdL-BUb0JXC_n-itwDdDSV1sa7Qp-fP-jF7_v32u_n8E_AeiSiCY</recordid><startdate>20221220</startdate><enddate>20221220</enddate><creator>Boulanger, Erin F</creator><creator>Sabag-Daigle, Anice</creator><creator>Baniasad, Maryam</creator><creator>Kokkinias, Katherine</creator><creator>Schwieters, Andrew</creator><creator>Wrighton, Kelly C</creator><creator>Wysocki, Vicki H</creator><creator>Ahmer, Brian M M</creator><general>American Society for Microbiology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7TM</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>M7N</scope><scope>P64</scope><scope>RC3</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3550-528X</orcidid><orcidid>https://orcid.org/0000-0002-4267-7322</orcidid></search><sort><creationdate>20221220</creationdate><title>Sugar-Phosphate Toxicities Attenuate Salmonella Fitness in the Gut</title><author>Boulanger, Erin F ; Sabag-Daigle, Anice ; Baniasad, Maryam ; Kokkinias, Katherine ; Schwieters, Andrew ; Wrighton, Kelly C ; Wysocki, Vicki H ; Ahmer, Brian M M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a442t-a2635ed49039668af6576fddc2ad7196cc25e412d8faa4d64e5262220ec07aa93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Accumulation</topic><topic>Animals</topic><topic>Antimicrobial agents</topic><topic>Bacteria</topic><topic>Bacteriology</topic><topic>Catabolism</topic><topic>Defects</topic><topic>Drinking water</topic><topic>Drinking Water - metabolism</topic><topic>Fitness</topic><topic>Genes</topic><topic>Humans</topic><topic>Infections</topic><topic>Mice</topic><topic>Mutants</topic><topic>Mutation</topic><topic>Nutrient availability</topic><topic>Pathogens</topic><topic>Phosphates - metabolism</topic><topic>Reproductive fitness</topic><topic>Research Article</topic><topic>Salmonella</topic><topic>Salmonella - genetics</topic><topic>Salmonella enterica - genetics</topic><topic>Sugar</topic><topic>Sugars - metabolism</topic><topic>Therapeutic targets</topic><topic>Toxicity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boulanger, Erin F</creatorcontrib><creatorcontrib>Sabag-Daigle, Anice</creatorcontrib><creatorcontrib>Baniasad, Maryam</creatorcontrib><creatorcontrib>Kokkinias, Katherine</creatorcontrib><creatorcontrib>Schwieters, Andrew</creatorcontrib><creatorcontrib>Wrighton, Kelly C</creatorcontrib><creatorcontrib>Wysocki, Vicki H</creatorcontrib><creatorcontrib>Ahmer, Brian M M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of bacteriology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boulanger, Erin F</au><au>Sabag-Daigle, Anice</au><au>Baniasad, Maryam</au><au>Kokkinias, Katherine</au><au>Schwieters, Andrew</au><au>Wrighton, Kelly C</au><au>Wysocki, Vicki H</au><au>Ahmer, Brian M M</au><au>O’Toole, George</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sugar-Phosphate Toxicities Attenuate Salmonella Fitness in the Gut</atitle><jtitle>Journal of bacteriology</jtitle><stitle>J Bacteriol</stitle><addtitle>J Bacteriol</addtitle><date>2022-12-20</date><risdate>2022</risdate><volume>204</volume><issue>12</issue><spage>e0034422</spage><pages>e0034422-</pages><issn>0021-9193</issn><eissn>1098-5530</eissn><abstract>Pathogens are becoming resistant to antimicrobials at an increasing rate, and novel therapeutic strategies are needed. Using Salmonella as a model, we have investigated the induction of sugar-phosphate toxicity as a potential therapeutic modality. The approach entails providing a nutrient while blocking the catabolism of that nutrient, resulting in the accumulation of a toxic intermediate. We hypothesize that this build-up will decrease the fitness of the organism during infection given nutrient availability. We tested this hypothesis using mutants lacking one of seven genes whose mutation is expected to cause the accumulation of a toxic metabolic intermediate. The , , , , , , and mutants were then provided the appropriate sugars, either or during gastrointestinal infection of mice. All but the mutant had nutrient-dependent growth defects , suggestive of sugar-phosphate toxicity. During gastrointestinal infection of mice, five mutants had decreased fitness. Providing the appropriate nutrient in the animal's drinking water was required to cause fitness defects with the and mutants and to enhance the fitness defect of the mutant. The and mutants were severely attenuated regardless of the nutrient being provided in the drinking water. Homologs of are widespread among bacteria and in humans, rendering the specific targeting of bacterial pathogens difficult. However, the , , and genes are not present in humans, appear to be rare in most phyla of bacteria, and are common in several genera of , making the encoded enzymes potential narrow-spectrum therapeutic targets. Bacterial pathogens are becoming increasingly resistant to antibiotics. There is an urgent need to identify novel drug targets and therapeutic strategies. In this work we have assembled and characterized a collection of mutations in our model pathogen, Salmonella enterica, that block a variety of sugar utilization pathways in such a way as to cause the accumulation of a toxic sugar-phosphate. Mutations in three genes, , , and , dramatically decrease the fitness of Salmonella in a mouse model of gastroenteritis, suggesting that RhaD, AraD, and MtlD may be good narrow-spectrum drug targets. The induction of sugar-phosphate toxicities may be a therapeutic strategy that is broadly relevant to other bacterial and fungal pathogens.</abstract><cop>United States</cop><pub>American Society for Microbiology</pub><pmid>36383008</pmid><doi>10.1128/jb.00344-22</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0003-3550-528X</orcidid><orcidid>https://orcid.org/0000-0002-4267-7322</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0021-9193
ispartof Journal of bacteriology, 2022-12, Vol.204 (12), p.e0034422
issn 0021-9193
1098-5530
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9765134
source PubMed (Medline); American Society for Microbiology Journals
subjects Accumulation
Animals
Antimicrobial agents
Bacteria
Bacteriology
Catabolism
Defects
Drinking water
Drinking Water - metabolism
Fitness
Genes
Humans
Infections
Mice
Mutants
Mutation
Nutrient availability
Pathogens
Phosphates - metabolism
Reproductive fitness
Research Article
Salmonella
Salmonella - genetics
Salmonella enterica - genetics
Sugar
Sugars - metabolism
Therapeutic targets
Toxicity
title Sugar-Phosphate Toxicities Attenuate Salmonella Fitness in the Gut
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-17T17%3A42%3A29IST&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=Sugar-Phosphate%20Toxicities%20Attenuate%20Salmonella%20Fitness%20in%20the%20Gut&rft.jtitle=Journal%20of%20bacteriology&rft.au=Boulanger,%20Erin%20F&rft.date=2022-12-20&rft.volume=204&rft.issue=12&rft.spage=e0034422&rft.pages=e0034422-&rft.issn=0021-9193&rft.eissn=1098-5530&rft_id=info:doi/10.1128/jb.00344-22&rft_dat=%3Cproquest_pubme%3E2756701211%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-a442t-a2635ed49039668af6576fddc2ad7196cc25e412d8faa4d64e5262220ec07aa93%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2756701211&rft_id=info:pmid/36383008&rfr_iscdi=true