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Genetic Causes, Clinical Features, and Survival of Underlying Inborn Errors of Immunity in Omani Patients: a Single-Center Study

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Abstract

Purpose

Early identification of inborn errors of immunity (IEIs) is crucial due to the significant risk of morbidity and mortality. This study aimed to describe the genetic causes, clinical features, and survival rate of IEIs in Omani patients.

Methods

A prospective study of all Omani patients evaluated for immunodeficiency was conducted over a 17-year period. Clinical features and diagnostic immunological findings were recorded. Targeted gene testing was performed in cases of obvious immunodeficiency. For cases with less conclusive phenotypes, a gene panel was performed, followed by whole-exome sequencing if necessary.

Results

A total of 185 patients were diagnosed with IEIs during the study period; of these, 60.5% were male. Mean ages at symptom onset and diagnosis were 30.0 and 50.5 months, respectively. Consanguinity and a family history of IEIs were present in 86.9% and 50.8%, respectively. Most patients presented with lower respiratory infections (65.9%), followed by growth and development manifestations (43.2%). Phagocytic defects were the most common cause of IEIs (31.9%), followed by combined immunodeficiency (21.1%). Overall, 109 of 132 patients (82.6%) who underwent genetic testing received a genetic diagnosis, while testing was inconclusive for the remaining 23 patients (17.4%). Among patients with established diagnoses, 37 genes and 44 variants were identified. Autosomal recessive inheritance was present in 81.7% of patients with gene defects. Several variants were novel. Intravenous immunoglobulin therapy was administered to 39.4% of patients and 21.6% received hematopoietic stem cell transplantation. The overall survival rate was 75.1%.

Conclusion

This study highlights the genetic causes of IEIs in Omani patients. This information may help in the early identification and management of the disease, thereby improving survival and quality of life.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on request.

References

  1. CEREDIH: The French PID study group. The French national registry of primary immunodeficiency diseases. Clin Immunol. 2010;135(2):264–72. https://doi.org/10.1016/j.clim.2010.02.021.

    Article  CAS  Google Scholar 

  2. Bruton OC. Agammaglobulinemia Pediatrics. 1952;9(6):722–8. https://doi.org/10.1542/peds.9.6.722.

    Article  CAS  Google Scholar 

  3. Kobrynski L, Powell RW, Bowen S. Prevalence and morbidity of primary immunodeficiency diseases, United States 2001–2007. J Clin Immunol. 2014;34(8):954–61. https://doi.org/10.1007/s10875-014-0102-8.

    Article  Google Scholar 

  4. Wong M. What has happened in the last 50 years in immunology. J Paediatr Child Health. 2015;51(2):135–9. https://doi.org/10.1111/jpc.12834.

    Article  Google Scholar 

  5. Fernandez Perez ER, Hunter M, Katial RK. United States trends in mortality rates for primary immunodeficiency diseases. J Allergy Clin Immunol Pract. 2019;7(3):1045–8. https://doi.org/10.1016/j.jaip.2018.09.030.

    Article  Google Scholar 

  6. Odnoletkova I, Kindle G, Quinti I, Grimbacher B, Knerr V, Gathmann B, et al. The burden of common variable immunodeficiency disorders: a retrospective analysis of the European Society for Immunodeficiency (ESID) registry data. Orphanet J Rare Dis. 2018;13(1):201. https://doi.org/10.1186/s13023-018-0941-0.

    Article  Google Scholar 

  7. Viti R, Marcellusi A, Capone A, Matucci A, Vultaggio A, Pignata C, et al. Direct and indirect costs of immunoglobulin replacement therapy in patients with common variable immunodeficiency (CVID) and X-linked agammaglobulinemia (XLA) in Italy. Clin Drug Investig. 2018;38(10):955–65. https://doi.org/10.1007/s40261-018-0688-3.

    Article  CAS  Google Scholar 

  8. Modarresi SZ, Sabetkish N, Badalzadeh M, Tajik S, Esmaeili B, Fazlollahi MR, et al. The critical role of prenatal genetic study in prevention of primary immunodeficiency in high-risk families: the largest report of 107 cases. Iran J Allergy, Asthma, Immunol. 2020;19(5):478–83. https://doi.org/10.18502/ijaai.v19i5.4463.

    Article  Google Scholar 

  9. Mateu L, Teniente-Serra A, Rocamora G, Marin-Muñiz A, Pàrraga N, Casas I, et al. Effect of an awareness campaign on the diagnosis and clinical impact of primary immunodeficiency. Med Clin (Barc). 2021;156(6):270–6. https://doi.org/10.1016/j.medcli.2020.04.066.

    Article  Google Scholar 

  10. Al-Tamemi S, Naseem SU, Al-Siyabi N, El-Nour I, Al-Rawas A, Dennison D. Primary immunodeficiency diseases in Oman: 10-year experience in a tertiary care hospital. J Clin Immunol. 2016;36(8):785–92. https://doi.org/10.1007/s10875-016-0337-7.

    Article  CAS  Google Scholar 

  11. Oliveira JB, Fleisher TA. Laboratory evaluation of primary immunodeficiencies. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S297-305. https://doi.org/10.1016/j.jaci.2009.08.043.

    Article  Google Scholar 

  12. Orange JS, Ballow M, Stiehm ER, Ballas ZK, Chinen J, De La Morena M, et al. Use and interpretation of diagnostic vaccination in primary immunodeficiency: a working group report of the Basic and Clinical Immunology Interest Section of the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2012;130(3 Suppl):S1-24. https://doi.org/10.1016/j.jaci.2012.07.002.

    Article  Google Scholar 

  13. Kanegane H, Hoshino A, Okano T, Yasumi T, Wada T, Takada H, et al. Flow cytometry-based diagnosis of primary immunodeficiency diseases. Allergol Int: Off J Japan Soc Allergol. 2018;67(1):43–54. https://doi.org/10.1016/j.alit.2017.06.003.

    Article  CAS  Google Scholar 

  14. Salzer U, Sack U, Fuchs I. Flow cytometry in the diagnosis and follow up of human primary immunodeficiencies. EJIFCC. 2019;30(4):407–22.

    CAS  Google Scholar 

  15. Reda SM, El-Ghoneimy DH, Afifi HM. Clinical predictors of primary immunodeficiency diseases in children. Allergy Asthma Immunol Res. 2013;5(2):88–95. https://doi.org/10.4168/aair.2013.5.2.88.

    Article  Google Scholar 

  16. Gathmann B, Mahlaoui N, Ceredih GL, Oksenhendler E, Warnatz K, et al. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. J Allergy Clin Immunol. 2014;134(1):116–26. https://doi.org/10.1016/j.jaci.2013.12.1077.

    Article  Google Scholar 

  17. Podjasek JC, Abraham RS. Autoimmune cytopenias in common variable immunodeficiency. Front Immunol. 2012;3:189. https://doi.org/10.3389/fimmu.2012.00189.

    Article  Google Scholar 

  18. Todoric K, Koontz JB, Mattox D, Tarrant TK. Autoimmunity in immunodeficiency. Curr Allergy Asthma Rep. 2013;13(4):361–70. https://doi.org/10.1007/s11882-013-0350-3.

    Article  CAS  Google Scholar 

  19. Hernandez-Trujillo VP, Scalchunes C, Cunningham-Rundles C, Ochs HD, Bonilla FA, Paris K, et al. Autoimmunity and inflammation in X-linked agammaglobulinemia. J Clin Immunol. 2014;34(6):627–32. https://doi.org/10.1007/s10875-014-0056-x.

    Article  CAS  Google Scholar 

  20. Lehman HK. Autoimmunity and immune dysregulation in primary immune deficiency disorders. Curr Allergy Asthma Rep. 2015;15(9):53. https://doi.org/10.1007/s11882-015-0553-x.

    Article  CAS  Google Scholar 

  21. Jonkman-Berk BM, van den Berg JM, Ten Berge IJ, Bredius RG, Driessen GJ, Dalm VA, et al. Primary immunodeficiencies in the Netherlands: national patient data demonstrate the increased risk of malignancy. Clin Immunol. 2015;156(2):154–62. https://doi.org/10.1016/j.clim.2014.10.003.

    Article  CAS  Google Scholar 

  22. Kersey JH, Spector BD, Good RA. Primary immunodeficiency diseases and cancer: the immunodeficiency-cancer registry. Int J Cancer. 1973;12(2):333–47. https://doi.org/10.1002/ijc.2910120204.

    Article  CAS  Google Scholar 

  23. Tiri A, Masetti R, Conti F, Tignanelli A, Turrini E, Bertolini P, et al. Inborn errors of immunity and cancer. Biology (Basel). 2021;10(4):313. https://doi.org/10.3390/biology10040313.

    Article  CAS  Google Scholar 

  24. Kwan A, Abraham RS, Currier R, Brower A, Andruszewski K, Abbott JK, et al. Newborn screening for severe combined immunodeficiency in 11 screening programs in the United States. JAMA. 2014;312(7):729–38. https://doi.org/10.1001/jama.2014.9132.

    Article  CAS  Google Scholar 

  25. El-Sayed ZA, Radwan N. Newborn screening for primary immunodeficiencies: the gaps, challenges, and outlook for developing countries. Front Immunol. 2019;10:2987. https://doi.org/10.3389/fimmu.2019.02987.

    Article  CAS  Google Scholar 

  26. Hale JE, Platt CD, Bonilla FA, Hay BN, Sullivan JL, Johnston AM, et al. Ten years of newborn screening for severe combined immunodeficiency (SCID) in Massachusetts. J Allergy Clin Immunolo Pract. 2021;9(5):2060-7.e2. https://doi.org/10.1016/j.jaip.2021.02.006.

    Article  CAS  Google Scholar 

  27. Maffucci P, Filion CA, Boisson B, Itan Y, Shang L, Casanova J-L, et al. Genetic diagnosis using whole exome sequencing in common variable immunodeficiency. Front Immunol. 2016;7:220. https://doi.org/10.3389/fimmu.2016.00220.

    Article  CAS  Google Scholar 

  28. Simon AJ, Golan AC, Lev A, Stauber T, Barel O, Somekh I, et al. Whole exome sequencing (WES) approach for diagnosing primary immunodeficiencies (PIDs) in a highly consanguineous community. Clin Immunol. 2020;214: 108376. https://doi.org/10.1016/j.clim.2020.108376.

    Article  CAS  Google Scholar 

  29. Rae W, Ward D, Mattocks C, Pengelly RJ, Eren E, Patel SV, et al. Clinical efficacy of a next-generation sequencing gene panel for primary immunodeficiency diagnostics. Clin Genet. 2018;93(3):647–55. https://doi.org/10.1111/cge.13163.

    Article  CAS  Google Scholar 

  30. Arts P, Simons A, AlZahrani MS, Yilmaz E, AlIdrissi E, van Aerde KJ, et al. Exome sequencing in routine diagnostics: a generic test for 254 patients with primary immunodeficiencies. Genome Med. 2019;11(1):38. https://doi.org/10.1186/s13073-019-0649-3.

    Article  Google Scholar 

  31. Cifaldi C, Brigida I, Barzaghi F, Zoccolillo M, Ferradini V, Petricone D, et al. Targeted NGS platforms for genetic screening and gene discovery in primary immunodeficiencies. Front Immunol. 2019;10:316. https://doi.org/10.3389/fimmu.2019.00316.

    Article  CAS  Google Scholar 

  32. Arunachalam AK, Maddali M, Aboobacker FN, Korula A, George B, Mathews V, et al. Primary immunodeficiencies in India: molecular diagnosis and the role of next-generation sequencing. J Clin Immunol. 2021;41(2):393–413. https://doi.org/10.1007/s10875-020-00923-2.

    Article  CAS  Google Scholar 

  33. Bousfiha A, Jeddane L, Picard C, Al-Herz W, Ailal F, Chatila T, et al. Human inborn errors of immunity: 2019 Update of the IUIS phenotypical classification. J Clin Immunol. 2020;40(1):66–81. https://doi.org/10.1007/s10875-020-00758-x.

    Article  Google Scholar 

  34. Picard C, Bobby Gaspar H, Al-Herz W, Bousfiha A, Casanova JL, Chatila T, et al. International Union of Immunological Societies: 2017 primary immunodeficiency diseases committee report on inborn errors of immunity. J Clin Immunol. 2018;38(1):96–128. https://doi.org/10.1007/s10875-017-0464-9.

    Article  Google Scholar 

  35. Badran YR, Massaad MJ, Bainter W, Cangemi B, Naseem SU, Javad H, et al. Combined immunodeficiency due to a homozygous mutation in ORAI1 that deletes the C-terminus that interacts with STIM 1. Clin Immunol. 2016;166–167:100–2. https://doi.org/10.1016/j.clim.2016.03.012.

    Article  CAS  Google Scholar 

  36. Al-Tamemi S, Alhinai Z, Al-Rahbi N, Al-Abdawani R, Al-Yazidi L, Al-Shekaili J, et al. BCL10 loss-of-function novel mutation leading to atypical severe combined immunodeficiency. Clin Immunol. 2022;241:109067. https://doi.org/10.1016/j.clim.2022.109067.

    Article  CAS  Google Scholar 

  37. Bainter W, Platt CD, Park SY, Stafstrom K, Wallace JG, Peters ZT, et al. Combined immunodeficiency due to a mutation in the γ1 subunit of the coat protein I complex. J Clin Invest. 2021;131(3): e140494. https://doi.org/10.1172/jci140494.

    Article  CAS  Google Scholar 

  38. Engelhardt KR, McGhee S, Winkler S, Sassi A, Woellner C, Lopez-Herrera G, et al. Large deletions and point mutations involving the dedicator of cytokinesis 8 (DOCK8) in the autosomal-recessive form of hyper-IgE syndrome. J Allergy Clin Immunol. 2009;124(6):1289-302.e4.

    Article  CAS  Google Scholar 

  39. Al-Marhoobi R, Al-Musalhi M, Wali Y, Alsayegh A, Al-Tamemi S. Combined immunodeficiency, hemolytic anemia, and growth retardation secondary to a homozygous mutation in the NHEJ1 gene. J Pediatr Hematol Oncol. 2020;42(4):333–5. https://doi.org/10.1097/MPH.0000000000001545.

    Article  CAS  Google Scholar 

  40. Al-Zadjali S, Al-Tamemi S, Elnour I, AlKindi S, Lapoumeroulie C, Al-Maamari S, et al. Clinical and molecular findings of chronic granulomatous disease in Oman: family studies. Clin Genet. 2015;87(2):185–9. https://doi.org/10.1111/cge.12351.

    Article  CAS  Google Scholar 

  41. Al-Riyami AZ, Al-Zadjali S, Al-Mamari S, Al-Said B, Al-Qassabi J, Al-Tamemi S. Correlation between flow cytometry and molecular findings in autosomal recessive chronic granulomatous disease: a cohort study from Oman. Int J Lab Hematol. 2018;40(5):592–6. https://doi.org/10.1111/ijlh.12873.

    Article  CAS  Google Scholar 

  42. Nazir HF, Rawas AA, Tamemi SA, Zadjali SA, Hosni SA, Tauro M, et al. Hematopoietic stem cell transplantation for patients with autosomal recessive complete INF-λ receptor 2 deficiency: experience in Oman. Transplant Cell Ther. 2021;27(10):881.e1-5. https://doi.org/10.1016/j.jtct.2021.07.013.

    Article  CAS  Google Scholar 

  43. Al-Tamemi S, Al-Zadjali S, Al-Ghafri F, Dennison D. Chediak-Higashi syndrome: novel mutation of the CHS1/LYST gene in 3 Omani patients. J Pediatr Hematol Oncol. 2014;36(4):e248–50. https://doi.org/10.1097/MPH.0000000000000025.

    Article  CAS  Google Scholar 

  44. Platt CD, Zaman F, Bainter W, Stafstrom K, Almutairi A, Reigle M, et al. Efficacy and economics of targeted panel versus whole-exome sequencing in 878 patients with suspected primary immunodeficiency. J Allergy Clin Immunol. 2021;147(2):723–6. https://doi.org/10.1016/j.jaci.2020.08.022.

    Article  CAS  Google Scholar 

  45. Al-Herz W, Chou J, Delmonte OM, Massaad MJ, Bainter W, Castagnoli R, et al. Comprehensive genetic results for primary immunodeficiency disorders in a highly consanguineous population. Front Immunol. 2018;9:3146. https://doi.org/10.3389/fimmu.2018.03146.

    Article  CAS  Google Scholar 

  46. Engelbrecht C, Urban M, Schoeman M, Paarwater B, van Coller A, Abraham DR, et al. Clinical utility of whole exome sequencing and targeted panels for the identification of inborn errors of immunity in a resource-constrained setting. Front Immunol. 2021;12:665621. https://doi.org/10.3389/fimmu.2021.12:665621.

    Article  CAS  Google Scholar 

  47. Aghamohammadi A, Rezaei N, Yazdani R, Delavari S, Kutukculer N, Topyildiz E, et al. Consensus Middle East and North Africa registry on inborn errors of immunity. J Clin Immunol. 2021;41(6):1339–51. https://doi.org/10.1007/s10875-021-01053-z.

    Article  Google Scholar 

  48. Köker MY, Camcıoğlu Y, van Leeuwen K, Kılıç S, Barlan I, Yılmaz M, et al. Clinical, functional, and genetic characterization of chronic granulomatous disease in 89 Turkish patients. J Allergy Clin Immunol. 2013;132(5):1156-63.e5. https://doi.org/10.1016/j.jaci.2013.05.039.

    Article  CAS  Google Scholar 

  49. de Boer M, Tzur S, van Leeuwen K, Dencher PC, Skorecki K, Wolach B, et al. A founder effect for p47(phox)Trp193Ter chronic granulomatous disease in Kavkazi Jews. Blood Cells Mol Dis. 2015;55(4):320–7. https://doi.org/10.1016/j.bcmd.2015.07.014.

    Article  CAS  Google Scholar 

  50. Islam MM. The practice of consanguineous marriage in Oman: prevalence, trends and determinants. J Biosoc Sci. 2012;44(5):571–94. https://doi.org/10.1017/S0021932012000016.

    Article  Google Scholar 

  51. Rezaei N, Pourpak Z, Aghamohammadi A, Farhoudi A, Movahedi M, Gharagozlou M, et al. Consanguinity in primary immunodeficiency disorders; the report from Iranian Primary Immunodeficiency Registry. Am J Reprod Immunol. 2006;56(2):145–51. https://doi.org/10.1111/j.1600-0897.2006.00409.x.

    Article  Google Scholar 

  52. Abd Elaziz D, Abd El-Ghany M, Meshaal S, El Hawary R, Lotfy S, Galal N, et al. Fungal infections in primary immunodeficiency diseases. Clin Immunol. 2020;219: 108553. https://doi.org/10.1016/j.clim.2020.108553.

    Article  CAS  Google Scholar 

  53. Demirdag YY, Gupta S. Update on infections in primary antibody deficiencies. Front Immunol. 2021;12: 634181. https://doi.org/10.3389/fimmu.2021.634181.

    Article  CAS  Google Scholar 

  54. Khalili N, Mohammadzadeh I, Khalili N, Heredia RJ, Zoghi S, Boztug K, et al. BCGitis as the primary manifestation of chronic granulomatous disease. IDCases. 2020;23: e01038. https://doi.org/10.1016/j.idcr.2020.e01038.

    Article  Google Scholar 

  55. Kuruvilla M, de la Morena MT. Antibiotic prophylaxis in primary immune deficiency disorders. J Allergy Clin Immunol Pract. 2013;1(6):573–82. https://doi.org/10.1016/j.jaip.2013.09.013.

    Article  Google Scholar 

  56. Pai SY, Logan BR, Griffith LM, Buckley RH, Parrott RE, Dvorak CC, et al. Transplantation outcomes for severe combined immunodeficiency, 2000–2009. N Engl J Med. 2014;371(5):434–46. https://doi.org/10.1056/NEJMoa1401177.

    Article  CAS  Google Scholar 

  57. Chan AY, Leiding JW, Liu X, Logan BR, Burroughs LM, Allenspach EJ, et al. Hematopoietic cell transplantation in patients with primary immune regulatory disorders (PIRD): a Primary Immune Deficiency Treatment Consortium (PIDTC) survey. Front Immunol. 2020;11:239. https://doi.org/10.3389/fimmu.2020.00239.

    Article  CAS  Google Scholar 

  58. Al-Herz W. Mortality among primary immunodeficient patients in Kuwait. J Allergy Clin Immunol. 2010;125(2S1):AB75. https://doi.org/10.1016/j.jaci.2009.12.296.

    Article  Google Scholar 

  59. Sasaki K, Jabbour E, Short NJ, Jain N, Ravandi F, Pui CH, et al. Acute lymphoblastic leukemia: a population-based study of outcome in the United States based on the Surveillance, Epidemiology, and End Results (SEER) database, 1980–2017. Am J Hematol. 2021;96(6):650–8. https://doi.org/10.1097/MPH.0000000000001545.

    Article  CAS  Google Scholar 

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Acknowledgements

We would like to thank Prof. Raif Geha, Harvard University for his valuable review of the manuscript. We would like to thank all staff who participated in the care of these patients and all patients and their families for their trust.

Funding

Part of this study was funded by a Sultan Qaboos University research grant. No support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. Clinical Immunology & Allergy Unit, Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman

    Salem Al-Tamemi & Shafiq-Ur-Rehman Naseem

  2. Molecular Hematology Unit, Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman

    Shoaib Al-Zadjali, Mohammed ALRawahi & David Dennison

  3. Department of Clinical Genetics, Sultan Qaboos University Hospital, Muscat, Oman

    Zandre Bruwer, Khalsa Alkharusi, Khalid Al-Thihli, Fathiya Al-Murshedi, Abeer AlSayegh & Almundher Al-Maawali

  4. Clinical Immunology & Allergy Unit, Directorate of Nursing, Sultan Qaboos University Hospital, Muscat, Oman

    Nabila Al-Siyabi

  5. Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman

    Almundher Al-Maawali

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  1. Salem Al-Tamemi
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Contributions

The corresponding author was responsible for all aspects of the study conception and design as well as the preparation of the manuscript for publication. SZ & MR performed targeted gene sequencing and analysis; DD supervised the targeted gene sequence and analysis; SN and NS participated in clinical care and family support; KA performed genetic counseling; ZB, KD, FM, AS, and AM supervised panel gene testing and analysis of panel and whole-exome sequencing.

Corresponding author

Correspondence to Salem Al-Tamemi.

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Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Research and Ethics Committee of the College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.

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Informed consent was obtained from all patients prior to genetic testing.

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The authors affirm that no identifying participant data was published in any form.

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The authors declare no competing interests.

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Al-Tamemi, S., Al-Zadjali, S., Bruwer, Z. et al. Genetic Causes, Clinical Features, and Survival of Underlying Inborn Errors of Immunity in Omani Patients: a Single-Center Study. J Clin Immunol 43, 452–465 (2023). https://doi.org/10.1007/s10875-022-01394-3

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