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Infection and Immunity, January 2002, p. 62-68, Vol. 70, No. 1
0019-9567/01/$04.00+0 DOI: 10.1128/IAI.70.1.62-68.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Reduced Infectivity of a Leishmania donovani Biopterin Transporter Genetic Mutant and Its Use as an Attenuated Strain for Vaccination
Barbara Papadopoulou, Gaétan Roy, Marie Breton, Christoph Kündig,,
Carole Dumas, Isabelle Fillion, Ajay K. Singh,,
Martin Olivier, and Marc Ouellette*
Centre de Recherche en Infectiologie du Centre de Recherche du CHUL and Division de Microbiologie, Faculté de Médecine, Université Laval, Québec, Canada
Received 19 June 2001/
Returned for modification 27 August 2001/
Accepted 16 October 2001

ABSTRACT
Pterins are essential for the growth of
Leishmania species,
and recent work has led to the isolation of the biopterin transporter
BT1. In this study, we inactivated the
Leishmania donovani biopterin
transporter BT1 by gene disruption mediated by homologous recombination.
No transport of biopterin was detected in this mutant. The
L. donovani BT1 null mutant showed a much lesser capacity for inducing
infection in mice than wild-type parasites and could elicit
protective immunity in mice susceptible to infection against
a
L. donovani challenge. Splenocytes isolated from mice immunized
with the
BT1 null mutant parasites produced significant amounts
of interferon gamma following stimulation with
L. donovani promastigotes
as measured by enzyme-linked immunosorbent assay and enzyme-linked
immunospot assays. Overall, these results show that by genetically
manipulating the pterin transport in
L. donovani, it is possible
to generate an attenuated organism that could be part of a vaccination
strategy.

INTRODUCTION
Leishmania is a protozoan parasite that is distributed worldwide,
being endemic in 88 countries. Each year, 1.5 million new cases
of cutaneous leishmaniasis and 500,000 new cases of visceral
leishmaniasis are estimated (
15). The latter, caused mainly
by
Leishmania donovani, can be fatal if left untreated. The
treatment relies mainly on chemotherapy, and the mainstay consists
in different formulations of pentavalent antimony, although
alternatives, such as liposomal amphotericin B, are also effective
(
3,
15). Nonetheless, in some parts of the world, notably in
the state of Bihar, India, more than 50% of the patients are
unresponsive or relapse after conventional chemotherapy (
42).
Several approaches (killed parasites with or without BCG [a
naturally attenuated form of
Mycobacterium bovis]; subunit vaccines;
DNA vaccines; attenuated organisms) have been used as vaccination
strategies against
Leishmania, but none has yet translated into
an effective product (see references
14 and
31 for recent reviews).
With the advent of gene transfection technology with Leishmania, a number of innovative approaches were used in attempts to generate vaccines. These include the inactivation of genes encoding enzymes thought to be important for parasite intracellular survival, including the dihydrofolate reductase gene (43), the cysteine proteinase genes (2), the HSP100 heat shock protein (16), and the trypanothione reductase (10; also unpublished data). Other approaches relying on the expression of antisense RNA (45) or of cytotoxic genes (26) were also used. Most of this work was done with Leishmania species giving rise to cutaneous lesions, and with the exception of antisense RNA, no recombinant attenuated L. donovani organisms produced by gene inactivation have been reported. In order to generate attenuated L. donovani organisms for vaccination purposes, we have targeted genes thought to be important for intracellular survival. Our first attempt was to inactivate trypanothione reductase (10), a gene product essential for keeping thiols in a reduced form (11). Generation of a heterozygous mutant was readily achieved, but generation of a trypanothione reductase null mutant turned out not to be feasible, since a third allele was obtained by genomic rearrangements. The ability of Leishmania to rearrange its genome during attempts to disrupt genes thought to be essential has been frequently reported (7, 25) (10).
Pterins are known to be essential for growth of Leishmania and of other kinetoplastid parasites (44), and pterins, including biopterin, have been demonstrated to reduce the requirements for folates for Crithidia fasciculata (21). Work on the mechanisms of resistance to the antifolate methotrexate has contributed greatly to the isolation of gene products involved in pterin metabolism and transport (28, 30). A recent study has shown that the expression of genes involved in either pterin reduction (PTR1) or transport of biopterin (BT1) is modulated in Leishmania grown in pterin-limited medium (35). Pterins may be involved in the biosynthesis of folates, but other roles in Leishmania still remain to be elucidated (28, 30), although reduced pterins appear to be important for the process of metacyclogenesis (8). The biopterin transporter BT1 has recently been characterized (22, 24), and due to the central role of biopterin in Leishmania growth, we hypothesized that generating an L. donovani BT1 null mutant may lead to an attenuated strain useful for vaccination. In this study, we report on the generation of an L. donovani recombinant BT1 null mutant and the possibility of using this attenuated organism as part of a strategy of vaccination against visceral leishmaniasis.

MATERIALS AND METHODS
Leishmania growth and infection.
The
Leishmania donovani donovani Sudanese 1S2D strain was grown
in SDM-79 medium (
5) supplemented with 10% heat-inactivated
fetal bovine serum and 5 mg of hemin/ml.
L. donovani promastigotes
were transfected by electroporation as reported previously (
33).
Late-stationary-phase
L. donovani promastigotes (5
x 10
7 cells)
were injected in the tail veins of BALB/c mice (Charles River,
St-Constant, Canada). At 4 weeks postinfection, impression smears
of the livers and spleens were made and stained using Giemsa
or Diff-Quick as described previously (
29). Four weeks represents
the time point for maximum infection rates of
L. donovani in
the BALB/c mouse model (
9,
34). Alternatively, the infection
was measured using recombinant parasites expressing the luciferase
gene (
34). For immunization and challenge experiments, stationary-phase
L. donovani BT1 null mutants (5
x 10
7 promastigotes) were injected
intravenously (i.v.) into the tail veins of BALB/c mice. After
6 weeks, the mice were challenged by i.v. injection of 5
x 10
7 stationary-phase
L. donovani promastigotes expressing the luciferase
(
LUC) gene. Four weeks after the i.v. challenge, mice were sacrificed
and livers and spleens were isolated, and the luciferase activity
was measured as described previously (
34).
Construction of an L. donovani BT1 null mutant.
The 2.3-kb BglII-NheI L. donovani fragment containing the BT1 gene was subcloned into pSP72 (Promega), and a hygromycin B phosphotransferase expression cassette (HYG) derived from pSPY-HYG (32) was introduced into the unique ApaI site of the BT1 gene. A 3.6-kb BglII-SalI HYG-containing fragment was used to disrupt one chromosomal BT1 allele by homologous recombination. A BT1 null mutant was obtained by selection for loss of heterozygosity (13) by increasing the hygromycin B selection pressure up to 600 µg/ml and cloning of the cell pool. The homozygous L. donovani BT1 mutant was characterized by Southern blot analysis as described previously (36).
Pteridine transport experiments.
Transport experiments were performed as described previously (22, 24). Tritium-labeled [3H]-biopterin (5.8 µCi/mmol)) was purchased from Movarek Biochemicals. Transport studies were carried out with 150 nM radioactive pteridines. To measure active biopterin transport, uptake in cells incubated on ice was subtracted from values obtained at room temperature.
Detection of secreted interferon-gamma by enzyme-linked immunosorbent assay (ELISA) and enzyme-linked immunospot (ELISPOT) assays.
Spleens of naive and vaccinated BALB/c mice were removed under aseptic conditions 1, 2, 4, 8 and 12 weeks postinfection, and splenocytes were cultured in triplicate in 96-well flat-bottom microplates (Costar). L. donovani promastigotes (4 x 105) were added to 5 x 106 splenocytes in RPMI 1640 supplemented with 10% fetal bovine serum, 100 U of penicillin/ml, 100 µg of streptomycin/ml, 2 mM l-glutamine, and 50 µM 2-mercaptoethanol. After 4 days, supernatants were collected and stored at -80°C. The production of interferon-gamma (IFN-
) was first measured by sandwich ELISA using reagents from the R&D system (Minneapolis, Minn.). Briefly, 1 µg of anti-IFN-
/ml was coated on 96-well plates (ImmunoPlate; Nunc, Naperville, Ill.) and incubated overnight at 4°C. The plates were blocked with 5% bovine serum albumin in phosphate-buffered saline, and culture supernatants were then added and incubated for 2 h at room temperature. Biotinylated anti-IFN-
(50 ng/ml) was added and incubated for 1 h in 2% bovine serum albumin-phosphate-buffered saline. The bounded biotinylated antibody was detected by streptavidin-peroxidase conjugate (Research Diagnostics Inc., Flanders, N.J.). The absorbance was measured at 450 nm (Microwell system; Organon Teknika). ELISA permits the detection of bulk IFN-
production. We also measured IFN-
production by the ELISPOT assay, which permits the enumeration of individual cytokine-producing T cells. Plates (multiscreen; Millipore) were coated overnight at 4°C with the anti-IFN-
(1 µg/ml) and then washed with RPMI and 10% fetal calf serum at 37°C. Freshly isolated splenocytes (7.5 x 106) were incubated with 4 x 105 Leishmania organisms for 3 h at 37°C, 5% CO2, in a 1.5-ml tube with complete RPMI medium. Then, 105 stimulated cells were added to the blocked plates and incubated at 37°C overnight. The cells were washed off, and bounded cytokines were detected with 100 ng of biotinylated anti-IFN-
/ml, followed by streptavidin-alkaline phosphatase reaction. ELISPOT assays were developed using the substrate nitroblue tetrazolium (NBT)-5-bromo-4-chloro-3-indolyl phosphate (Bio-Rad, Mississauga, Ontario, Canada). The number of specific IFN-
-secreting T cells was calculated by subtracting the negative control value from the established spot-forming cells (SFC) count. The count was calculated by averaging the numbers of spots for triplicate wells.

RESULTS
Generation of an L. donovani BT1 null mutant.
Disruption of the
BT1 gene has already been achieved in a
Leishmania tarentolae strain (
22), in an
L. donovani strain which has three
BT1 alleles, one of which is translocated within the ribosomal
locus (
24), and more recently in one
Leishmania major strain
(
8). No animal studies have been reported with any of these
mutants. To study the role of biopterin transport in
Leishmania infectivity and pathogenesis, we attempted to inactivate the
BT1 gene in
L. donovani. The
L. donovani 1S strain has only
two copies of
BT1, and the parasites used were freshly isolated
from animals and were highly infective. Experiments were done
to disrupt the first
BT1 allele using a hygromycin phosphotransferase
(
HYG) expression cassette (
32) (Fig.
1A) which was electroporated
into
Leishmania. The analysis of a Southern blot indicated that
a 2.8-kb
PstI-
PstI fragment harboring the
BT1 gene hybridized
to a
BT1 probe in wild-type
L. donovani (Fig.
1B, lane 1). Disruption
of one copy of
BT1 by the integration of the
HYG cassette introduced
an extra
PstI restriction site, giving rise to two fragments,
of 2.4 and 1.4 kb, hybridizing to both
BT1 and
HYG probes (Fig.
1A). Analysis of the initial hygromycin B-resistant cell pool
showed the appearance of the two expected additional fragments
in addition to one remaining intact
BT1 allele (data not shown).
The second
BT1 allele was inactivated by loss of heterozygosity
(
13) by increasing the selection pressure with hygromycin B.
This led to the disruption of the second
BT1 allele by the
HYG resistance marker, as indicated by Southern blot hybridization
studies (Fig.
1B, lane 2). Biopterin transport in
Leishmania appears nonetheless essential, since growth of the
L. donovani BT1 null mutant was observed only when the medium was supplemented
with biopterin.
Transport properties of the BT1 null mutant.
L. donovani 1S is capable of transporting biopterin (Fig.
2),
although at a much lower level of efficiency than is described
for
L. tarentolae (
22). Under our experimental conditions, no
biopterin accumulation could be measured in the
L. donovani BT1 null mutant (Fig.
2), suggesting that we have indeed disrupted
the main biopterin transporter in this parasite. By introducing
an expression vector carrying the
BT1 gene into the
BT1 null
mutant (Fig.
1B, lane 3), we were able to rescue the transport
phenotype of the mutant. In fact, overexpression of BT1 increases
significantly the transport of biopterin compared to that observed
in wild-type cells (Fig.
2).
Reduced infectivity of the L. donovani BT1 null mutant in mice.
Given the known importance of pterins in
Leishmania growth,
we hypothesized that an
L. donovani BT1 disruption mutant would
be at a disadvantage during in vivo infection in the BALB/c
model. Three groups of five BALB/c mice were each injected i.v.
in the tail vein with late-stationary-phase promastigotes of
either the
L. donovani wild type or the
L. donovani BT1 null
mutant and/or the
L. donovani BT1 null mutant expressing the
BT1 gene as part of an episome (rescue transfectant). From previous
data we know that in our infection model, the peak of
L. donovani 1S infection in BALB/c mice is at 4 weeks (
34). Consequently,
the presence of
L. donovani cells was measured at 4 weeks postinfection.
A 65% lower infection load was observed in mice infected with
the
L. donovani BT1 null mutant than in wild-type cells when
the
Leishmania cells were analyzed microscopically (Fig.
3A).
This reduced infectivity is a direct consequence of
BT1 disruption,
since mutants rescued with an episomal
BT1 gene were equally
as infective as wild-type cells (Fig.
3A). Expression of the
luciferase reporter gene (
LUC) allows a rapid, much simpler
and yet accurate monitoring of
Leishmania infections (
34). In
a separate set of experiments, and exploiting the
LUC expression
of the challenging parasites, we investigated the presence of
L. donovani cells in the livers and spleens of infected mice
4 weeks postinfection and found an 80% reduction in infectivity
of the
BT1 null mutant in livers and 90% reduction in spleens
(Fig.
3B). Thus, inactivation of
BT1 reduces considerably the
survival rate of
L. donovani in mice. We could not detect attenuated
parasites in either the liver or the spleen using impression
smears or by measuring luciferase activity after 8 or 12 weeks
postinfection (data not shown). Thus, the growth kinetic of
the attenuated parasite was not delayed. We also isolated the
livers and spleens of two mice 12 weeks postinfection. These
organs were homogenized and put in culture. No
Leishmania cells
could be observed from the combined livers of two mice, but
after 1 week we could detect growth of parasites in the culture
of the combined spleens. From the generation time of the parasites,
we estimated that they were fewer than 50 parasites/spleen,
which is below the detection levels of our luciferase assay
with amastigotes (
38).
Protection against infectious challenge and correlates of immunity in mice.
We have tested whether immunization with genetically attenuated
L. donovani organisms in which the main biopterin transporter
was inactivated could induce protective immunity in genetically
susceptible mice. Groups of five naive and vaccinated BALB/c
mice were challenged 6 weeks postimmunization i.v. with 5
x 10
7 luciferase-expressing virulent
L. donovani promastigotes.
Parasite loads in the liver were compared in naive and vaccinated
mice 4 weeks postchallenge. Mice immunized with the
L. donovani BT1 null mutant were significantly protected against infectious
challenge, since infection rates in these animals were 75% lower
than those for naive animals (Fig.
4). Since
L. donovani infections
are controlled in BALB/c mice, we compared the protection against
reinfection in mice initially infected with the
BT1 null mutant
or with the wild-type strain. No significant protection was
observed when mice were initially infected with the wild-type
strain (Fig.
4).
To assess immune correlates contributing to the significant
protection seen with mice immunized with the
L. donovani BT1 null mutant, we measured the release of IFN-

by stimulated splenocytes.
The production of IFN-

is strongly associated with the control
of
L. donovani infection in mice (
23,
40). Splenocytes from
mice immunized with the attenuated recombinant parasites already
at 1 week postimmunization produced much larger amounts of IFN-
(210 versus 23 pg/ml) than mice infected with wild-type organisms,
as shown by an ELISA assay (Fig.
5). In the second week of infection,
the level of IFN-

decreased in splenocytes isolated both from
mice infected with the wild-type strain and from those infected
with the mutant strain, but afterwards, the production of IFN-
was consistently increasing upon stimulation in the splenocytes
derived from the mice infected with the
BT1 null mutant (Fig.
5). No production of IFN-

was measured in splenocytes derived
from mice vaccinated with the wild-type
L. donovani cells (Fig.
5). Interestingly, upon stimulation, splenocytes from immunized
mice were capable of specifically secreting IFN-

even after
3 months postimmunization, suggesting the development of specific
memory T cells. We have also looked for the production of the
cytokine interleukin 4 (IL-4), which potentially inhibits the
protective immune response in the mouse model, but we could
not detect any measurable levels of IL-4 in stimulated splenocytes
derived from the
BT1 null-immunized mice at any time postimmunization
(data not shown). To assess more quantitatively the IFN-

response
in the immunized mice, we have measured the ability of T cells
to secrete IFN-

at the second week postinfection, using the
ELISPOT assay. A similar number of splenocytes (

20/10
6 cells)
isolated either from mice immunized with the
BT1 null mutant
or from naive animals secreted IFN-

. The number of T cells derived
from splenocytes of mice immunized with the
BT1 null mutant
that specifically secreted IFN-

was increased very much above
the background level upon stimulation with
L. donovani promastigotes
(Fig.
6), hence corroborating the ELISA results.

DISCUSSION
The importance of pterins in
Leishmania has been established
for a long time, but it is only recently that gene products
involved in pterin metabolism or transport were isolated. The
biopterin transporter BT1 (
22,
24) is likely to be important
for
Leishmania growth, and purified BT1 was shown to protect
against experimental leishmaniasis (
9). The
BT1 gene (formerly
known as
ORFG [
27]) is frequently amplified in various unselected
Leishmania species (
37), and it was recently shown to be overexpressed
in cells grown in pterin-limited medium (
35). The
L. donovani BT1 null mutant does not demonstrate any biopterin transport
activity (Fig.
2). However, the addition of biopterin in the
culture medium was necessary for growth in vitro, suggesting
that biopterin was entering by other routes, possibly by diffusion.
The
BT1 null mutant shows a marked reduction in infectivity
in the BALB/c mouse model (Fig.
3), suggesting that the ability
to transport pterins is important for parasite survival in vivo.
Rescue of the attenuated phenotype was complete when the
BT1 gene was retransfected into the mutant parasite (Fig.
3). An
increased ability to transport pterins does not seem to increase
parasitic load, suggesting that scavenging biopterin from the
host is not a pathogenesis mechanism for
L. donovani. This could
have been the case, since reduced pterins are cofactors of nitric
oxide synthase and the latter is important in the resolution
of
Leishmania infections (
4). Metacyclogenesis was found to
be increased in
PTR1 and
BT1 null mutants of
L. major, suggesting
that reduced pterin levels regulate metacyclogenesis (
8). We
have also observed an increase in metacyclogenesis with our
L. donovani BT1 null mutant (unpublished observation).
L. major PTR1 null mutants were unexpectedly more virulent than wild-type
cells (
8). Nonetheless, as shown in this study (Fig.
3),
L. donovani BT1 disruption mutants are clearly less virulent. Hence,
although low levels of reduced pterins are important for metacyclogenesis,
the transport of pterins, at least for
L. donovani, is important
during in vivo infection.
Mice susceptible to L. donovani infection were immunized using genetically engineered L. donovani cells that are deficient in biopterin transport. These vaccinated mice were partially protected from further parasite challenge, while mice initially infected with L. donovani wild-type cells were not (Fig. 4). Splenic T cells derived from mice infected with the BT1 null mutant, but not from mice infected with the wild-type parasites, are primed to produce IFN-
upon stimulation with Leishmania cells (Fig. 5 and 6). It is likely that the ability of the L. donovani BT1 null mutant to protect mice from further challenge is due, at least in part, to the capacity of the splenic T cells of the vaccinated animals to produce IFN-
. From these results, it would appear that the BT1 null mutant is both attenuated and more immunogenic than wild-type parasites. Previous reports of L. donovani immune protective correlates in mice showed that IFN-
production is important for the control and acquired resistance to L. donovani (40) and that the capacity to produce IFN-
determines the efficacy of the immune response in susceptible mice (23). Successful immunization with L. donovani recombinant proteins in BALB/c mice led to IFN-
-producing splenocytes (39, 41). The produced IFN-
may induce type 2 nitric oxide synthase, generating nitric oxide that exerts antileishmanial activity (reviewed in reference 4). The outcome of L. donovani infection in mice is highly dependent on the cytokines produced by T cells upon stimulation. Generally, the production of Th1 cytokines, such as IFN-
, is protective and determines the efficacy of the immune response in susceptible mice, while production of Th2 cytokines, such as IL-4, results in progressive disease (reviewed in reference 17). The Th1/Th2 polarization in human visceral leishmaniasis is not as clear-cut, but numbers of Leishmania-specific T cells producing IFN-
have been increased in patients who have recovered from visceral leishmaniasis (6, 18), although mixed Th1/Th2 Leishmania antigen-specific cells can be observed with infected or cured patients (17, 19). At 1 week postinfection we measured high levels of IFN-
secretion in splenocytes derived from the immunized animals, and this level rapidly decreased at 2 weeks (Fig. 5). Possibly the L. donovani BT1 null mutant is eliminated rapidly, which leads to massive recruitment of cells involved in innate response, which may lead to secretion of IFN-
. Interestingly, IL-12, which stimulates the production of IFN-
from natural killer cells, was found to be produced early following L. donovani infections (12). This may explain the early massive production of IFN-
.
In this study, we investigated whether live parasites that are genetically attenuated could induce a protective immunity against L. donovani infection. Although live attenuated parasites have been shown to be useful against experimental cutaneous leishmaniasis (43), this is the first report demonstrating their usefulness against visceral leishmaniasis. Given that a T-cell-mediated immunity is required for a protective immune response against Leishmania infections, live attenuated vaccines should be good candidates for use against visceral leishmaniasis. Although safety issues will need to be investigated in great detail, live attenuated vaccines are already in extensive use against several viral and bacterial diseases, and BCG, a naturally attenuated form of M. bovis, although of varying efficacy, is still being administered to millions of children every year. In fact, one of the largest clinical trial for Leishmania vaccines included BCG as an adjuvant combined with killed parasites (20). A complete attenuation of the parasite may be achieved by disrupting additional genes, since some growth of the BT1 null mutant is observed (Fig. 3A and B). Indeed, 3 months postinfection we could detect a few living attenuated parasites in the spleens by culturing them, although we could not detect them either by impression smears or by measuring luciferase activity. This residual growth may be due to the expression of other proteins capable of transporting in vivo low levels of pterins or to the entry of pterins by other means, such as diffusion. Some parasite replication is likely to be required for generating a T-cell-mediated response; this may not occur, however, if the parasites are too attenuated and hence do not replicate. Splenocytes derived from mice immunized with the BT1 null mutant still produce, upon stimulation, IFN-
3 months postimmunization (Fig. 5), suggesting the presence of specific memory T cells, and this may indeed require few rounds of parasite replication. We cannot exclude, however, the possibility that part of the stimulation might be due to the few persisting parasites, but this is unlikely, since splenocytes isolated form mice infected with wild-type parasites, which are also persisting, do not respond to stimulation (Fig. 5). To further boost the immunological response, it may be appropriate either to have a second round of immunization with the BT1 null strain or to coinject cytokines, such as IL-12 or other adjuvants (1), in addition to the attenuated parasites. Clearly, the generation of attenuated strains of L. donovani is a valid approach for vaccination strategies against visceral leishmaniasis, and further work is warranted to improve the efficacy of these vectors.

ACKNOWLEDGMENTS
This work was supported in part by the Canadian Institutes of
Health Research (CIHR) to M. Ouellette and by an CIHR-Industry
grant and a grant from the CURP program of Pasteur-Merieux-Connaught
to B.P., M. Ouellette, and M. Olivier and more recently by the
CANVAC Center of Excellence. C.K. is a postdoctoral fellow of
the Schweizerischer Nationalfonds. B.P. is a senior FRSQ Scholar,
M. Ouellette and M. Olivier are CIHR Investigators, and M.B.
holds a CIHR studentship. B.P. and M. Olivier are Burroughs
Wellcome Fund New Investigators in Molecular Parasitology, and
M. Ouellette is a Burroughs Wellcome Fund Scholar in Molecular
Parasitology.

FOOTNOTES
* Corresponding author. Mailing address: Centre de Recherche en Infectiologie, CHUQ, pavillon CHUL, 2705 boul. Laurier, Ste-Foy, Québec, Canada G1V 4G2. Phone: 418-654 2705. Fax: 418-654 2715. E-mail:
Marc.Ouellette{at}crchul.ulaval.ca.

Editor: W. A. Petri, Jr.
Present address: Microcide Pharmaceuticals, Mountain View, Calif. 
Present address: Division of Infectious Diseases, UCSF, San Francisco, Calif. 

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Infection and Immunity, January 2002, p. 62-68, Vol. 70, No. 1
0019-9567/01/$04.00+0 DOI: 10.1128/IAI.70.1.62-68.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
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