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Infection and Immunity, February 2000, p. 688-693, Vol. 68, No. 2
0019-9567/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
Mannose-Binding Lectin Binds to a Range of
Clinically Relevant Microorganisms and Promotes Complement
Deposition
Olaf
Neth,1
Dominic L.
Jack,1
Alister W.
Dodds,2
Helen
Holzel,3
Nigel J.
Klein,1 and
Malcolm W.
Turner1,*
Immunobiology Unit, Institute of Child
Health, University College London,1 and
Department of Microbiology, Great Ormond Street Hospital
for Children,3 NHS Trust, London, and
Immunochemistry Unit, Medical Research Council,
Oxford,2 United Kingdom
Received 6 August 1999/Returned for modification 7 October
1999/Accepted 7 November 1999
 |
ABSTRACT |
Mannose-binding lectin (MBL) is a collagenous serum lectin believed
to be of importance in innate immunity. Genetically determined low
levels of the protein are known to predispose to infections. In this
study the binding of purified MBL to pathogens isolated from
immunocompromised children was investigated by flow cytometry. Diverse
Candida species, Aspergillus fumigatus,
Staphylococcus aureus, and beta-hemolytic group A
streptococci exhibited strong binding of MBL, whereas Escherichia
coli, Klebsiella species, and Haemophilus
influenzae type b were characterized by heterogeneous binding
patterns. In contrast, beta-hemolytic group B streptococci, Streptococcus pneumoniae, and Staphylococcus
epidermidis showed low levels of binding. Bound MBL was able to
promote C4 deposition in a concentration-dependent manner. We conclude
that MBL may be of importance in first-line immune defense against
several important pathogens.
 |
INTRODUCTION |
Mannose-binding lectin (MBL) is a
serum protein of hepatic origin belonging to a family of
Ca2+-dependent collagenous lectins, most of which are
components of the innate immune system (10). MBL is able to
bind through multiple sites to various carbohydrate structures
(29, 37) and, on binding to its ligands, is able to activate
complement in an antibody- and C1q-independent manner (12, 24,
26) using MBL-associated serine protease 1 (MASP-1) and MASP-2
(23, 34).
In humans, low levels of MBL are caused by one of three structural
mutations found within exon 1 of the MBL gene (20, 22, 31).
These single point mutations in codons 52, 54, and 57 result in amino
acid substitutions which are believed to interfere with the stability
of the protein (20, 22, 31). Individuals heterozygous for
the codon 54 or 57 mutation are found at relatively high frequency within Eurasian and sub-Saharan African populations, respectively (7, 19, 20, 22, 25), and such mutations have been shown to
be associated with a generalized increased risk of infections (6,
32).
MBL has the potential to express multiple biological effector
functions, but a prerequisite for all such activity is primary binding
to multiple arrays of sugar ligands such as those expressed on
microbial surfaces. However, to date, there have been few detailed studies of the interactions between MBL and a wide range of clinically relevant microorganisms. Here, we report such a study in which, by
using flow cytometry, it has been possible to detect major differences
in the MBL binding capacities of different microorganisms and even
differences among organisms of the same genus. In addition, we have
shown that bound MBL promotes, in a concentration-dependent manner, C4
deposition on the surfaces of organisms.
 |
MATERIALS AND METHODS |
Preparation of MBL.
MBL was prepared as previously described
by Kilpatrick (17). Briefly, 500 g of frozen
ethanol-fractionated human plasma paste (fraction B+1, equivalent to
Cohn fraction I+III; donated by C. Dash, Blood Products Laboratory,
Elstree, United Kingdom) was purified by ammonium sulfate precipitation
to give 42% saturation. After dialysis the solution was applied to a
mannan-agarose (Sigma, Poole, United Kingdom) column (5-ml packed
volume; Pharmacia Biotech, Uppsala, Sweden) and the calcium-dependent
proteins were eluted with 0.01 M EDTA. The first EDTA eluate was
recalcified to 0.05 M CaCl2, reapplied to the same
mannan-agarose column, and eluted with 0.1 M mannose. The concentration
of MBL was determined by enzyme-linked immunosorbent assay
(19), and sample purity was verified by nonreducing sodium
dodecyl sulfate-polyacrylamide gel electrophoresis using a 3 to 10%
polyacrylamide gradient gel and silver staining. Bands observed on
silver staining were confirmed to be higher-order oligomers of MBL by
immunoblotting and enhanced chemiluminescence detection according to
the method of Lipscombe et al. (21). MBL prepared in this
manner is known to be noncovalently associated with MASP
(23).
Preparation of C4.
C4 was prepared from the plasma of a
single donor by chromatography on Q Sepharose FF, followed by affinity
chromatography using monoclonal (clone L003) anti-C4 Sepharose and
anion exchange using MonoQ (Pharmacia) (2).
Organisms.
The organisms studied comprised isolates from the
nasopharynx and blood cultures from immunocompromised children treated
at Great Ormond Street Hospital for Children. The patient group
included patients with oncological disease undergoing chemotherapy,
children undergoing dialysis while suffering from renal failure, and
patients with a clearly defined immunodeficiency. Isolates were
collected and randomized by the Department of Medical Microbiology.
Organisms were identified by standard laboratory techniques or
classified using API20 NE and API20 Strep (BioMerieux). At least three
different isolates of the same genus were collected. In addition to
these clinical isolates the following organisms were also available for
study: 7 defined strains (Staphylococcus aureus NCTC6571, Pseudomonas aeruginosa NCTC10662, Escherichia
coli NCTC10418, Staphylococcus epidermidis ATCC 1228, Enterobacter aerogenes ATCC 13048, Streptococcus
pneumoniae ATCC 6305, and Candida albicans ATCC 10231),
7 internal quality controls (S. aureus, C. albicans, Candida parapsilosis, Candida
tropicalis, Candida lusitanae, and Cryptococcus
neoformans [n = 2]; Department of Medical
Microbiology), 10 defined S. pneumoniae vaccination strains
(1, 3-6, 9V, 14, 19F, 18, and 23; kindly provided by the Public Health
Laboratory Service), and 2 defined C. neoformans strains (1 encapsulated isolate, B3501, and its coisogenic acapsular mutant, B4131).
Growth and preparation of organisms.
Bacteria and fungi were
cultured as described by Bridson (The Oxoid manual, 7th ed., Oxoid,
Buckinghamshire, United Kingdom). Organisms were subcultured on agar
once before use. Immediately before each experiment organisms were
suspended in Veronal-buffered saline supplemented with 5 mM
CaCl2 and 5 mM MgCl2 at 3 × 108 to 8 × 108 organisms/ml (measured as
an absorbance of 1.0 at 540 nm).
Binding of MBL to organisms.
Binding of MBL to organisms was
performed as previously described by Jack et al. (14).
Briefly, 3 × 108 to 8 × 108
organisms/ml were incubated with 5 µg of MBL/ml for 30 min at 37°C.
After the addition of 2.5 µg of fluorescein isothiocyanate (FITC)-conjugated anti-MBL (FITC-labeled clone 131-1; State Serum Institute, Copenhagen, Denmark; conjugated as described by Johnson and
Holborow [15])/ml and incubation as described above,
MBL binding was measured by flow cytometry performed on a FACS-Calibur at low flow rates using CellQuest software (Becton Dickinson).
The binding of MBL to the organisms was evaluated on at least three
occasions and, whenever possible, compared to that for the defined
strains. MBL binding to S. aureus NCTC6571 was included in
each experiment as a positive control. A negative control comprising organisms processed in the same way but in the absence of MBL was
included in every assay. Data were evaluated both as the percentage of
positive organisms and as median fluorescence intensity (MFI). The
binding of MBL to organisms was categorized arbitrarily into three
levels based on MFI, namely, low (<5), moderate (5 to 20), or high
(>20).
Specificity of MBL binding.
In order to evaluate whether the
binding observed was mediated by C-type lectin interactions, inhibition
experiments using different concentrations of monosaccharides
(D-mannose and
N-acetyl-D-glucosamine) as well as calcium
chelating agent EDTA were performed. The monosaccharide or EDTA was
added to the MBL solution 10 min prior to the addition of the MBL to
six different microorganisms.
Binding of C4 to organisms.
The binding of C4 to organisms
was performed as previously described by Jack et al. (14)
with some modifications. Briefly, 3 × 108 to 8 × 108 organisms/ml were preincubated with MBL for 30 min
at 37°C. C4 was added at a concentration of 140 µg/ml, and the
organisms were incubated for a further 15 min at 37°C. A mixture of
FITC-conjugated anti-MBL and biotinylated anti-C4d (Quidel) was added
at a final concentration of 4 µg/ml for each, and the organisms were
incubated for 20 min at 37°C. Biotin conjugation of anti-C4d was
carried out using standard methodology. Streptavidin-phycoerythrin-Cy 5 (Pharmingen) at a concentration of 0.66 µg/ml was added, and the
organisms were incubated as described above. MBL binding and C4
deposition were measured by two-color flow cytometry performed as
described above.
 |
RESULTS |
Clinical isolates.
Over a period of 4 months 54 clinical
isolates from either the nasopharynges (n = 30) or
cultured blood (n = 24) of immunocompromised children
were collected and investigated. These included S. aureus (n = 12), S. epidermidis (n = 6), gram-negative bacterium (n = 12), C. albicans (n = 3), Aspergillus fumigatus
(n = 3), beta-hemolytic group A streptococci
(n = 5), beta-hemolytic group B streptococci (n = 4), Streptococcus sanguis (n = 2), Enterococcus faecalis (n = 2),
and S. pneumoniae (n = 5) isolates.
Flow cytometric analysis.
Distinct populations of all of the
above organisms could be visualized on the basis of size (forward
scatter) and granularity (side scatter) by flow cytometry.
Representative population density plots for three of these organisms
(S. aureus NCTC6571, C. lusitanae, and E. faecalis) are shown in Fig. 1a to c.
The levels of binding of MBL to each of these three organisms also
differed markedly and are shown in Fig. 1d to f.

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FIG. 1.
Representative population density plots of three
organisms (S. aureus NCTC6571, C. lusitanae, and
E. faecalis) detected by a combination of forward scatter
and side scatter and gated as regions R1, R2, and R3, respectively (a
to c). The corresponding flow cytometric profiles of MBL binding to
these organisms using the protein at a final concentration of 5 µg/ml
are shown (d to f). The control profiles (shaded) show organisms
incubated with FITC-conjugated anti-MBL alone. Experimental samples
(open profiles) were obtained after incubation of organisms with MBL
and FITC-conjugated anti-MBL.
|
|
The use of MBL at a final concentration of 5 µg/ml resulted in strong
binding of the lectin to
S. aureus NCTC6571 and also
to
C. lusitanae. In contrast, a low level of binding to
E. faecalis was
observed.
Binding of MBL to microorganisms.
The commonest isolate
studied was S. aureus. Eight isolates were collected from
the nasopharynx, and four isolates were from blood culture. All
isolates of S. aureus (n = 12), including
three methicillin-resistant isolates, were found to bind MBL in the moderate and high categories. Similar binding patterns were also seen
with C. albicans (n = 3) and A. fumigatus (n = 3). In addition, all beta-hemolytic
group A streptococci (n = 5), three isolates collected
from the nasopharynx and two isolates from blood culture, showed a
distinct pattern of MBL deposition, with 60 to 80% of the organisms
binding the protein. In contrast, all beta-hemolytic group B
streptococci (n = 4), all S. pneumoniae
isolates (n = 5), and two isolates each of E. faecalis and S. sanguis showed low binding. The same
results were obtained when selected S. pneumoniae isolates
were grown in log phase. Similarly S. epidermidis
(n = 6) generally demonstrated low binding activity
except for one isolate, which showed moderate binding. Most
gram-negative isolates (n = 12) bound little or no MBL,
apart from one isolate each of E. coli, Klebsiella
aerogenes, and Haemophilus influenzae type b showing
high or moderate MBL binding. The E. coli and K. aerogenes strains were isolated from blood cultures obtained from
the same patient, who was subsequently shown to be heterozygous for the codon 54 mutation of the MBL gene.
In many analyses it was noted that a minority of organisms (up to 20%)
bound MBL whereas the majority showed no such binding.
In Fig.
2a a typical example of such a pattern is
shown. Further
analysis of the binding population (Fig.
2c) failed to
demonstrate
any distinctive features (e.g., in size and granularity)
compared
to the population as a whole, shown in Fig.
2b, indicating
that
the binding was not due to clumping or major disruption of the
organisms. However, the intensity of the binding was always low,
so,
compared to background staining (in the absence of MBL) little
difference was observed.

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FIG. 2.
Representative cytometric profile of MBL binding to
K. aerogenes (a). A typical tail is seen in the experimental
sample, shown as an open profile, but not in the control profile
(shaded). The forward scatter-versus-side scatter density plot of the
entire population (b) is shown. The size and granularity
characteristics of the subpopulation (c) did not differ markedly from
those shown in panel b.
|
|
When MBL binding to organisms was expressed as the MFI rather than as
the percentage of positive organisms, differences not
only between
different genera but also within one species were
observed. This is
illustrated in Fig.
3, where
S. aureus isolates
have been ranked in order of binding.

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FIG. 3.
MBL binding to S. aureus isolates ranked in
order of binding. Results are expressed as median fluorescence, with
each bar representing the mean of three to six experiments; error bars,
standard errors of the means. Solid bars, clinical isolates; open bars,
defined strains.
|
|
Serum MBL levels are determined by both structural gene mutations and
promoter region polymorphisms, which differ in frequency
in the general
population. Because of this heterogeneity, it was
considered important
to determine the concentration dependence
of MBL binding, and Fig.
4 shows the results of an experiment
in
which
S. aureus NCTC6571 was incubated with the protein.

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FIG. 4.
MBL binding to S. aureus NCTC6571 at
different concentrations. Binding of MBL is expressed as median
fluorescence. Each point represents the mean of three experiments ± the standard error of the mean. Both structural gene mutations and
promoter polymorphisms determine the serum MBL level and may influence
the degree of MBL binding to the organisms in vivo. The approximate MBL
concentration ranges of individuals with and without mutations are
indicated by arrows.
|
|
In British Caucasians lacking MBL mutations, the protein is present at
a median concentration of 1.63 µg/ml. Strong binding
to
S. aureus NCTC6571 was observed at a concentration close to
this
median. Minimal or poor binding was seen at MBL concentrations
typically found in individuals heterozygous for the codon 54 mutation
(0.358 µg/ml) and the codon 52 mutation (0.6 µg/ml). The median
fluorescence of staining increased with increasing MBL concentrations
and did not reach a
plateau.
In order to study the influence of bacterial concentration on MBL
binding, suspensions of
S. aureus NCTC6571 were prepared
over a range of concentrations from 10
8/ml to 7.25 × 10
5/ml. No differences in MBL binding were observed (in
three separate
experiments performed on three independent occasions;
data not
shown).
Specificity of MBL binding.
MBL binding to six representative
organisms was markedly reduced in the presence of 10 mM EDTA,
demonstrating the divalent-cation-dependent nature of the observed
interactions (Fig. 5). In addition
mannose and N-acetylglucosamine inhibited binding of MBL in
a dose-dependent manner.

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FIG. 5.
Inhibition of MBL binding to six representative
microorganisms using two monosaccharides (solid line,
D-mannose; dotted line, N-acetylglucosamine) at
different concentrations and 10 mM EDTA ( ). The monosaccharide or
EDTA was added to the MBL solution 10 min prior to the addition of the
MBL to the organisms. Each point represents the mean ± standard
error of the mean of the MFI for three independent experiments.
|
|
Overall summary of observed MBL binding patterns.
In total 80 microorganisms were studied (clinical isolates and defined strains).
The results, expressed as the ratio of median fluorescence using 5 µg
of MBL/ml relative to the appropriate control, are illustrated in Fig.
6. Nearly half of the organisms bound
MBL. However, three patterns of binding were observed. All isolates
from S. aureus, C. albicans, A. fumigatus, and beta-hemolytic group A streptococci showed MBL
binding. For several organisms a single isolate was observed to exhibit
binding (E. coli, K. aerogenes, H. influenzae type b, S. epidermidis, and nonencapsulated C. neoformans). For six of the organisms (beta-hemolytic
group B streptococci, S. pneumoniae, S. sanguis,
E. faecalis, non-type b H. influenzae, and
P. aeruginosa) there was no evidence of binding with any of
the isolates tested.

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FIG. 6.
MBL binding to 80 microorganisms. Data are expressed as
the ratios of median fluorescence of the experimental samples
(incubated with MBL and FITC-conjugated anti-MBL) to the median
fluorescence of the control samples (incubated with FITC-conjugated
anti-MBL alone). Each circle represents the mean of three to six
experiments. The solid circles represent clinical isolates, whereas the
open circles show either defined National Collection of Type Cultures
strains or internal quality controls. The dashed line represents a
ratio of one. -haem. Strep. A indicates beta-hemolytic group A
streptococcus.
|
|
Binding of C4.
In order to investigate the ability of MBL and
MASP bound to different organisms to activate the complement system,
purified C4 was added to suspensions of three selected organisms. MBL
at a range of concentrations (0 to 2.5 µg/ml) was preincubated with these organisms before exposure to C4 (140 µg/ml). As shown in Fig.
7, MBL concentration-dependent C4 binding
was observed with S. aureus NCTC6571 and one strain of
Klebsiella whereas no C4 was bound by another strain of
Klebsiella, which had previously been shown not to bind MBL.

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FIG. 7.
C4 deposition on three representative organisms
previously incubated with different concentrations of MBL. S. aureus NCTC6571 ( ) and one strain of Klebsiella
( ) were selected for their known ability to bind MBL, whereas
another strain of Klebsiella ( ) did not bind to the
protein. Each point represents the mean ± the standard error of
the mean of the MFI for three independent experiments.
|
|
 |
DISCUSSION |
The acquisition of detailed knowledge of the fine structure of MBL
has been paralleled by a series of publications reporting significant
binding of this collectin to particular microorganisms. Such
reports have presented evidence of MBL binding to individual pathogens, including human immunodeficiency virus type 1 and influenza A virus (4, 8, 9), and to the yeasts C. albicans
and C. neoformans (28, 33). There have also been
studies of MBL binding to various bacteria such as Salmonella
enterica serovar Montevideo (18), E. coli
(16), Mycobacterium avium (27), and
Neisseria meningitidis (14). To the best of our
knowledge only one other study has attempted a more comprehensive
investigation of binding. This was the report by van Emmerik et al.
(36), which described studies using radiolabeled MBL and
which focused on organisms known to cause meningeal disease (e.g.,
Listeria monocytogenes, streptococci, H. influenzae type b, and Neisseria species).
In the present study we have used a flow cytometric methodology
developed and refined in a previous study (14) to
investigate a wide range of clinically relevant microorganisms. In
addition to being a nonisotopic procedure, this has the advantage that single organisms can be visualized and specificity controls can be
readily incorporated.
We were particularly concerned that misleading results could arise if
surface lectins expressed by the bacteria were able to interact with
sugar groups on the MBL molecule. We have attempted to control for this
by performing calcium chelation and dose-dependent inhibition
experiments using N-acetylglucosamine and mannose with each
organism exhibiting strong binding of MBL. The concordance observed
suggests that the binding was indeed between the C-type lectin domain
of MBL and sugar groups expressed on the surfaces of organisms.
While the binding of MBL to simple sugars is relatively well understood
(3, 13, 29, 37, 38), the binding to complex microbial
structures and surfaces has not been extensively studied. Although the
variation in expression of mannose structures has been shown to alter
MBL binding (18, 27), it is likely that in many instances
pathogens also utilize other structures to evade MBL binding. The
expression of capsular polysaccharide has been shown to decrease the
binding of MBL to N. meningitidis serogroup B and H. influenzae type b (36) and to C. neoformans
(28). The structure and composition of bacterial endotoxins
have also been shown to have a major influence on MBL binding (11,
14). These structures appear to be able to mask ligands to which
MBL could bind (e.g., mannose and N-acetylglucosamine) or
may alter the sugar conformation or density to prevent MBL binding.
For certain microorganisms every isolate studied bound MBL
unequivocally, although there was considerable variation in the amount
deposited on the microbial surface as determined by measuring the MFI
of binding. Examples of such organisms included S. aureus, C. albicans, A. fumigatus, and beta-hemolytic
group A streptococcus. However, one of the most striking findings in
this study was the identification of heterogeneity in MBL binding for
certain organisms such as E. coli, Klebsiella
species, and H. influenzae type b. This emphasizes the need
to study several isolates of a particular organism before concluding
that MBL either binds or does not bind.
It was noteworthy that in many of the analyses reported here a
significant proportion of organisms (up to 20%) were observed to bind
MBL (visualized typically as a tail in the fluorescence histogram)
while the majority of organisms showed no such binding. Initially it
was considered that this might be a technical artifact. However, the
binding population failed to demonstrate any gross distinctive features
(size and granularity) compared to the population as a whole. This
suggests that the binding was not due to clumping or major disruption
of the organisms. An alternative explanation is that it represents
organisms expressing sugar arrays differing from those of the
nonbinding majority. Such differences could reflect experimental damage
or simply natural variation.
At the time of primary contact with any microorganism the role of the
innate immune system, including MBL, is paramount. For this reason
individuals who are homozygous for the structural gene mutations are
believed to be at increased risk of infection, and several studies
support this (5, 6, 32). However, heterozygous individuals
also manifest significant reductions in protein level (typically 0.3 to
0.6 µg/ml) (20), and MBL binding to S. aureus
at these concentrations was shown to be markedly impaired in this study.
We were also able to demonstrate a close relationship between C4
deposition and initial MBL concentration for both S. aureus NCTC6571 and one strain of Klebsiella. At an MBL
concentration of 0.3 µg/ml there was minimal C4 deposition, but at
1.3 µg of MBL/ml significant levels of C4 could be detected. It is
reasonable to extrapolate from these findings and conclude that C3b
deposition would parallel the C4 results. The latter may therefore be
regarded as a surrogate for MBL-mediated opsonophagocytosis.
It was of interest that two of the clinical isolates of organisms
showing heterogeneity in MBL binding (K. aerogenes and
E. coli) were from the same patient and that that particular
individual was heterozygous for the codon 54 mutation of the MBL gene.
There is, at present, no clear evidence about the minimal levels of MBL
which might be protective against particular pathogens. The levels of
MBL required may be dependent upon the nature of the infectious agent
and/or variations in host defense mechanisms. Arriving at such
estimates will pose formidable difficulties until we have more data on
the relative importance of the various clearance mechanisms involved.
In some cases simple steric hindrance by MBL may effectively inhibit
the spread of organisms by blocking access to appropriate receptors. In
other cases direct opsonic adherence or, more likely, complement
activation and the deposition of C3b opsonins will be the critical
routes of elimination. Recent evidence has also indicated that MBL can
modulate the host inflammatory response to infections (1,
30). All of these aspects should be the target of further
research and will help to identify the clinical situations in which MBL
replacement or adjunctive therapy (35) might play a positive role.
 |
ACKNOWLEDGMENTS |
O.N. was supported by the Dr. Mildred Scheel Stiftung für
Krebsforschung, Germany. D.L.J. is supported by the Wellcome Trust, United Kingdom.
We are grateful for the help and assistance of members of the
Microbiology Department, Great Ormond Street Hospital For Children. We
also thank D. Goldblatt for providing selected isolates of S. pneumoniae and G. Bancroft for providing the
acapsular mutant of C. neoformans.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Immunobiology
Unit, Institute of Child Health, 30 Guilford St., London, United
Kingdom WC1N 1EH. Phone: 0044-171-2079-052215. Fax: 0044-2078-8138494. E-mail: mturner{at}ich.ucl.ac.uk.
Editor:
T. R. Kozel
 |
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Infection and Immunity, February 2000, p. 688-693, Vol. 68, No. 2
0019-9567/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
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