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IMMUNOSTIMULATORY EFFECTS OF
INDOMETHACINE ON ALLOGENEIC AND SYNGENEIC PREGNANCY
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SUMMARY
Factors of
making and keeping immunotolerance in pregnancy mainly affect immunocompetent
cells by immunosuppressive factors or moving of Th1/Th2 balance in favour of Th2
response. Errors made in making and
keeping immunotolerance in pregnancy can lead to clinic entities such as
resorption of fetoplacental unit, miscarriage and reduced placental and fetal
weight. Besides, production of sex steroids in the yellow body of gravidity and
later in the fetoplacental unit depends on the factors such as prostaglandins
and cytokines. In our experiment the significance of paternal and maternal MHC (in)compatibility
of rats on the number of embryos, percentage of embryos in resorption, placental
and fetal weight and the level of serum steroids were tested. A specimen for
this investigation syngeneic Sprague Doley (SD) and Wistar (W) were taken. The
rats of SD and W lineage were treated by indomethacine of 2.1-2.8 mg/kg daily by
giving them drinking water in the period of 6-18 day of pregnancy. Stimulation
of Th1 response by indomethacine in allogeneic pregnancy led to resorption of
56% embryos while the rate of resorption in the control group of W rats was 12%.
Syngeneic SD animals treated by indomethacine did not show a significantly
larger rate of embryos in resorption (8.14%) than those ones in the control
group (5.13%) Acceleration of Th1 response by indomethacine led to activation of
decidual CTL and NK cells as well as to intensified expression of MHC antigens
on the cells of trophoblast. In allogeneic pregnancy this resulted in the
increased resorption of embryos, while in syngeneic pregnancy acceleration of
Th1 response did not result in increased resorption of embryos. Besides,
indomethacine leads to the significant fall of the level of serum progesterone
and estradiol no matter the MHC compatibility of pregnancy However, the level of
serum progesterone at W rats treated by indomethacine is significantly lower
than at SD rats also treated by indomethacine as well. This result shows the
possibility of greater damage of trophoblast at MHC incompatible pregnancies
under the influence of indomethacine or greater activities of cytokine of Th1
group, which inhibits synthesis of sex steroids.
Key words:
Pregnancy, indomethacine, progesterone, estradiol, prostaglandine,
immunomodulation, Th1 and Th2 response.
INTRODUCTION
From its early
days the embryo shows a good expression of MHC antigens class II and I and from
the point of view of MHC incompatibility, it can be defined as allogeneic
transplant [1,2]. Placenta has embryonic origin and it is directly connected
with maternal immunocompetent cells, but the character of expression of MHC
antigens on the placental tissues is selective, restrictive and conditional.
Varied limitations at the expression of MHC antigens impede the definition of
placenta as allogeneic transplant [1,2]. Fetoplacental unit under certain
conditions can become a target of aggression by maternal immune system. As a
counterpoise to the potential immunodestructive mechanisms, the whole series of
immunoprotective mechanisms of pregnancy immunotolerance have been developed
[3]. One of the main factors of making and keeping immunotolerance in pregnancy
is prostaglandins activity of decidua and trophoblast. Placenta mainly
synthesizes immunomodulatory PGE2 which major role is suppression of
immunocompetent cells over the inhibition of secretion IL-2 and the inhibition
of expression of receptors for IL-2 [2,3].
The whole series of research by Lala et al. shows in the best way the role of
prostaglandins in pregnancy. These authors got the high percentage of resorption
fetoplacental unit and miscarriages, which raised even to 89% in experiment
based on chronically treatment of allogravid female
rats by indomethacine or IL-2. The authors explained this phenomenon by immune
mechanisms, which were mediated by rejection of fetoplacental unit as allogeneic
transplant [3]. In the researches that appeared later the same group of authors
confirmed that for the fetoplacental unit resorption stimulated by indomethacine
or IL-2 are mainly responsible decidual NK cells, which are otherwise suppressed
by decidual prostaglandins and Th2 cytokines. Decidual NK cells show a very low
rate of activity to YAC-1 lymphoma cells. Decidual NK cells from allogeneic
pregnant animals treated by indomethacine or IL-2 show a high degree of
anti-YAC-1 activity [3,4]. In reference to the importance IL-10 compared by the
process of marring and keeping immunotolerance in pregnancy, it is significant
to mention that PGE2 fairly increases concentration IL-10 and IL-8 in the
maternal serum and decidual compartment [3,4].
One the other hand, pregnancy is the condition where a great concentration of
serum sex steroids occurs. This is the consequence of increased synthesis of
these hormones, first in the yellow body of pregnancy and later in placenta or
more precisely in the fetoplacental unit [5].
Hypotalamic-hypophysis hormones and chorionic gonadotropins, there are other
mediators that have influence on the intensity of biosynthesis of sex steroids,
first of all those which have influence on the level of cAMP, such as
prostaglandins and histamine [1,2,6].
Indomethacine efficiently suppresses luteolytic characteristics of
prostaglandins so that it is proved that the yellow body persists, even at
non-pregnant animals, until there is a significant suppression of synthesis of
prostaglandins by indomethacine [7,8]. As for ovarian steroidogenesis it is more
significant lipooxigenic way of metabolism of arahydonic acid than cyclooxygenic
way. Inhibition of lipooxygenic way results in decrease of intensity of ovarian
steroidogenesis, while the inhibition of cyclooxygenase (COX) by indomethacine
except anti-luteolytic effects has no any significant
effect on ovarian steroidogenesis [1,9].
The other mechanisms of including prostaglandins in regulation biosynthesis of
sex steroids in more significant for pregnancy and is based on stimulation of
adneil-cyclase and the increase of concentration of cAMP in trophoblast cells,
that results in intensifying of the process of basic steroidogenesis and
synthesis of all steroid hormones. Placenta is place of very intensive synthesis
of prostaglandins that by all means take part in the stimulation of the process
of biosynthesis of placental sex steroids. Sendrani et al. affirm that PGE2
stimulates synthesis of all steroid hormones [2,7,9]. Treatment of female
rabbits by indomethacine in the early pregnancy makes a significant slow down of
steroidogenesis and decrease of the level of serum progesterone and estradiol.
Parallel treatment of female rabbits by indomethacine and PGE2 return the level
of all products of steroidogenesis to the physiological level [7,9].
Cytokines are very often mentioned as factors that can have influence on the
level of sex steroids, and as well as on ovarian and placental production of
these hormones. Ohno et al. in their investigations in vitro got the
suppression of production of progesterone from granular cells cultivated with
IL-2, while in their research IL-1 did not show such effects. They came to
conclusion that the inhibition of production of progesterone depends on the
dosage related to concentrations IL-2 in medium [2,10,11].
In contrast to granular cells, trophoblast cells intensify steroidogenesis when
IL-1 stimulates them. This cytokine stimulates aromatase of steroidogenetic
enzymatic system of trophoblast cells and in that way intensified secretion of
progesterone and estrogenic hormones. This is explained by intensified
production of prostaglandins in cultured trophoblast cells stimulated by IL-1.
By adding anti-IL-1 antibody, the level of progesterone and estrogenic hormones
to the level of control is given back. The effects of IL-2 on trophoblast cells
and their steroidogentic potential are negative. It is proved that IL-2 inhibits
product on of sex steroids [2,10].
One of the aims of this research was to establish the significance of MHC
incompatibility on the number of embryos, the percentage of embryos in
resorption, placental and fetal weight. As the aim of research is also set the
observation of these parameters in the conditions of acceleration Th1 response
by indomethacine in allogeneic and syngeneic pregnancy and establishing of
effects of indomethacine on synthesis of sex steroids in pregnancy. As the aim
of research is also set a comparison of effects of indomethacine as an
accelerator of Th1 type immune response on synthesis of sex steroids in
allogeneic and syngeneic pregnancy.
SUMMARY
Factors of
making and keeping immunotolerance in pregnancy mainly affect immunocompetent
cells by immunosuppressive factors or moving of Th1/Th2 balance in favour of Th2
response. Errors made in making and
keeping immunotolerance in pregnancy can lead to clinic entities such as
resorption of fetoplacental unit, miscarriage and reduced placental and fetal
weight. Besides, production of sex steroids in the yellow body of gravidity and
later in the fetoplacental unit depends on the factors such as prostaglandins
and cytokines. In our experiment the significance of paternal and maternal MHC (in)compatibility
of rats on the number of embryos, percentage of embryos in resorption, placental
and fetal weight and the level of serum steroids were tested. A specimen for
this investigation syngeneic Sprague Doley (SD) and Wistar (W) were taken. The
rats of SD and W lineage were treated by indomethacine of 2.1-2.8 mg/kg daily by
giving them drinking water in the period of 6-18 day of pregnancy. Stimulation
of Th1 response by indomethacine in allogeneic pregnancy led to resorption of
56% embryos while the rate of resorption in the control group of W rats was 12%.
Syngeneic SD animals treated by indomethacine did not show a significantly
larger rate of embryos in resorption (8.14%) than those ones in the control
group (5.13%) Acceleration of Th1 response by indomethacine led to activation of
decidual CTL and NK cells as well as to intensified expression of MHC antigens
on the cells of trophoblast. In allogeneic pregnancy this resulted in the
increased resorption of embryos, while in syngeneic pregnancy acceleration of
Th1 response did not result in increased resorption of embryos. Besides,
indomethacine leads to the significant fall of the level of serum progesterone
and estradiol no matter the MHC compatibility of pregnancy However, the level of
serum progesterone at W rats treated by indomethacine is significantly lower
than at SD rats also treated by indomethacine as well. This result shows the
possibility of greater damage of trophoblast at MHC incompatible pregnancies
under the influence of indomethacine or greater activities of cytokine of Th1
group, which inhibits synthesis of sex steroids.
Key words:
Pregnancy, indomethacine, progesterone, estradiol, prostaglandine,
immunomodulation, Th1 and Th2 response.
INTRODUCTION
From its early
days the embryo shows a good expression of MHC antigens class II and I and from
the point of view of MHC incompatibility, it can be defined as allogeneic
transplant [1,2]. Placenta has embryonic origin and it is directly connected
with maternal immunocompetent cells, but the character of expression of MHC
antigens on the placental tissues is selective, restrictive and conditional.
Varied limitations at the expression of MHC antigens impede the definition of
placenta as allogeneic transplant [1,2]. Fetoplacental unit under certain
conditions can become a target of aggression by maternal immune system. As a
counterpoise to the potential immunodestructive mechanisms, the whole series of
immunoprotective mechanisms of pregnancy immunotolerance have been developed
[3]. One of the main factors of making and keeping immunotolerance in pregnancy
is prostaglandins activity of decidua and trophoblast. Placenta mainly
synthesizes immunomodulatory PGE2 which major role is suppression of
immunocompetent cells over the inhibition of secretion IL-2 and the inhibition
of expression of receptors for IL-2 [2,3].
The whole series of research by Lala et al. shows in the best way the role of
prostaglandins in pregnancy. These authors got the high percentage of resorption
fetoplacental unit and miscarriages, which raised even to 89% in experiment
based on chronically treatment of allogravid female
rats by indomethacine or IL-2. The authors explained this phenomenon by immune
mechanisms, which were mediated by rejection of fetoplacental unit as allogeneic
transplant [3]. In the researches that appeared later the same group of authors
confirmed that for the fetoplacental unit resorption stimulated by indomethacine
or IL-2 are mainly responsible decidual NK cells, which are otherwise suppressed
by decidual prostaglandins and Th2 cytokines. Decidual NK cells show a very low
rate of activity to YAC-1 lymphoma cells. Decidual NK cells from allogeneic
pregnant animals treated by indomethacine or IL-2 show a high degree of
anti-YAC-1 activity [3,4]. In reference to the importance IL-10 compared by the
process of marring and keeping immunotolerance in pregnancy, it is significant
to mention that PGE2 fairly increases concentration IL-10 and IL-8 in the
maternal serum and decidual compartment [3,4].
One the other hand, pregnancy is the condition where a great concentration of
serum sex steroids occurs. This is the consequence of increased synthesis of
these hormones, first in the yellow body of pregnancy and later in placenta or
more precisely in the fetoplacental unit [5].
Hypotalamic-hypophysis hormones and chorionic gonadotropins, there are other
mediators that have influence on the intensity of biosynthesis of sex steroids,
first of all those which have influence on the level of cAMP, such as
prostaglandins and histamine [1,2,6].
Indomethacine efficiently suppresses luteolytic characteristics of
prostaglandins so that it is proved that the yellow body persists, even at
non-pregnant animals, until there is a significant suppression of synthesis of
prostaglandins by indomethacine [7,8]. As for ovarian steroidogenesis it is more
significant lipooxigenic way of metabolism of arahydonic acid than cyclooxygenic
way. Inhibition of lipooxygenic way results in decrease of intensity of ovarian
steroidogenesis, while the inhibition of cyclooxygenase (COX) by indomethacine
except anti-luteolytic effects has no any significant
effect on ovarian steroidogenesis [1,9].
The other mechanisms of including prostaglandins in regulation biosynthesis of
sex steroids in more significant for pregnancy and is based on stimulation of
adneil-cyclase and the increase of concentration of cAMP in trophoblast cells,
that results in intensifying of the process of basic steroidogenesis and
synthesis of all steroid hormones. Placenta is place of very intensive synthesis
of prostaglandins that by all means take part in the stimulation of the process
of biosynthesis of placental sex steroids. Sendrani et al. affirm that PGE2
stimulates synthesis of all steroid hormones [2,7,9]. Treatment of female
rabbits by indomethacine in the early pregnancy makes a significant slow down of
steroidogenesis and decrease of the level of serum progesterone and estradiol.
Parallel treatment of female rabbits by indomethacine and PGE2 return the level
of all products of steroidogenesis to the physiological level [7,9].
Cytokines are very often mentioned as factors that can have influence on the
level of sex steroids, and as well as on ovarian and placental production of
these hormones. Ohno et al. in their investigations in vitro got the
suppression of production of progesterone from granular cells cultivated with
IL-2, while in their research IL-1 did not show such effects. They came to
conclusion that the inhibition of production of progesterone depends on the
dosage related to concentrations IL-2 in medium [2,10,11].
In contrast to granular cells, trophoblast cells intensify steroidogenesis when
IL-1 stimulates them. This cytokine stimulates aromatase of steroidogenetic
enzymatic system of trophoblast cells and in that way intensified secretion of
progesterone and estrogenic hormones. This is explained by intensified
production of prostaglandins in cultured trophoblast cells stimulated by IL-1.
By adding anti-IL-1 antibody, the level of progesterone and estrogenic hormones
to the level of control is given back. The effects of IL-2 on trophoblast cells
and their steroidogentic potential are negative. It is proved that IL-2 inhibits
product on of sex steroids [2,10].
One of the aims of this research was to establish the significance of MHC
incompatibility on the number of embryos, the percentage of embryos in
resorption, placental and fetal weight. As the aim of research is also set the
observation of these parameters in the conditions of acceleration Th1 response
by indomethacine in allogeneic and syngeneic pregnancy and establishing of
effects of indomethacine on synthesis of sex steroids in pregnancy. As the aim
of research is also set a comparison of effects of indomethacine as an
accelerator of Th1 type immune response on synthesis of sex steroids in
allogeneic and syngeneic pregnancy.
MATERIALS
AND METHODS
The animal have been divided into 4 groups, two of them control ones for W and
SD rats and two experimental groups of W and SD rats, which have been treated by
indomethacine. Animals for experiment have been female, 12-16 week old and
weighed 190±10
g. Female rats from all four groups have been mated in harem. Indomethacine has
been included in the drinking water to the experimental groups of W and SD rats
from 6th day of pregnancy. Regarding the fact that rat of 200 g weight drinks
30-40 ml water daily, concentration of indomethacine is adapted to 14
mg/ml,
so that a daily dosage of indomethacine, which animals consumed, was 2.1-2.8
mg/kg. The animals were sacrificed on the 18th day of pregnancy in Nesdonal
anaesthesia by heart puncture. The blood got by heart was kept at room
temperature for 2 hours in order to form a blood cake and to separate serum.
After that it was centrifuged at 3000 rpm in the period of 5 minutes. This serum
was taken by a automatic pipette and put aside at -20o C to the
moment of further treatment. The level of serum progesterone and estradiol has
been determined by RIA methods on the RIA System-Junior F-520, by means of
original kits of monoclonal antibodies (INEP-Zemun).
RESULTS
The results of this research show that the number
of embryos in allogeneic pregnancy is significantly larger (p<0.05) than in
syngeneic pregnancy, while the treatment by indomethacine did not significantly
have any influence on the total number of embryos of SD and W rats (table 1).
The percentage of embryos in resorption of allogravid
female rats treated by indomethacine is significantly larger (p<0.05) than the
percentage and the number of embryos in resorption of untreated allogravid
animals and syngeneic pregnant rats treated by indomethacine (table 2, graph 1).
Table 1.
Average values of the number of embryos found in the uterus of gravid rats.
|
|
Sprague
Doley
rats
|
Wistar
rats
|
|
Control
(n = 8)
|
Treated by
indomethacine
(n = 9)
|
Control
(n = 8)
|
Treated by
indomethacine
(n = 9
|
|
Altogether
|
78
|
86
|
104
|
109
|
|
Average
|
9.75
|
9.56
|
13.00
|
12.11
|
|
St.Dev.
|
0.85
|
1.24
|
2.56
|
1.96
|
Table 2.
Average values of the number of embryos in resorption found in the uterus of
gravid rats.
|
|
Sprague
Doley
rats
|
Wistar
rats
|
|
Control
(n = 8)
|
Treated by
indomethacine
(n = 9)
|
Control
(n = 8)
|
Treated by
indomethacine
(n = 9)
|
|
Altogether
|
4
|
7
|
13
|
61
|
|
Average
|
0.5
|
0.78
|
1.63
|
6.78
|
|
St.Dev.
|
0.53
|
0.67
|
1.19
|
2.11
|
The values of
serum progesterone in allogeneic pregnancy do not significantly differ (p<0.05)
from the values of serum progesterone of syngeneic pregnancy. Treatment by
indomethacine had a significant influence (p<0.05) on the little value of serum
progesterone in allogeneic and syngeneic pregnancy. Recorded fall of
concentration of serum progesterone under the influence of indomethacine in
allogeneic pregnancy is more significant (p<0.05) than the one in syngeneic
pregnancy (graph 2).
The values of serum estradiol in allogeneic pregnancy do not significantly
differ (p<0.05) from the values of serum estradiol of syngeneic pregnancy.
Treatment by indomethacine had a significant influence (p<0.05) on the fall of
value of serum estradiol in allogeneic and syngeneic pregnancy (graph 2).

|
% Of vital embryos
|
|
% Of embryos in resorption
|
Graph 1.
Percentage of the vital embryos and the embryos in resorption at all groups of
rats.

|
Level of serum progesterone
|
|
Level of serum estradiol
|
Graph 2. The
level of serum progesterone and estradiol at al four groups of rats.
DISCUSSION
Result related to comparison of number of embryos in allogeneic and syngeneic
pregnancy are in accordance with some citations from literature that
alloimmunization can be factor that will contribute to a larger number of
descendants [12]. There is opinion that activation of Th2 response in allogeneic
pregnancy contributes to a more successful implantation and keeping a large
number of embryos in the conditions of multifetal pregnancy [13]. Mechanisms
that induced a significantly rate of embryos in resorption at allogravid animals
treated by indomethacine are probably related to pushing out of synthesis PGE2.
Inhibition of placental production of prostaglandin induces activation Th1
response [2,3]. As a result of the intensified Th1 response, an intensified
secretion of cytokine such as IL-2, TNF, and IFN-g
is induced. These cytokines contribute to the intensified resorption of
fetoplacental unit activating decidual NK cells and Tc cells. Above mentioned
cytokines stimulate the expression of MHC antigens on the trophoblast cells and
in that way is emphasized the immune reaction focused against fetoplacental unit
[1,13].
Lala et al. got in parenteral treatment by indomethacine of allogravid mice the
percentage of embryos in resorption of 89%, and they got the same percentage of
embryos in resorption in the groups of mice treated by IL-2. This group of
authors affirms that NK cells are the main effector cells in the process of
fetoplacental resorption mediated by immune mechanisms [3,4].
For the phenomenon of fetoplacental unit resorption mediated by immune
mechanisms two prerequisites are necessary and they are: (i) the presence of
paternal MHC alloantigens and (ii) acceleration of Th1 responses. One fact shows
us that there is not statistically significant difference in the percentage of
embryos in resorption of control group of SD rats and in the percentage of
embryos in resorption of the group of SD rats treated by indomethacine. Namely,
besides the treatment by indomethacine of gravid syngeneic SD rats and factor of
acceleration of Th1 response it did not happen to come to the significant
increase in the percentage of resorption of embryos, and that is so because of
compatibility of paternal and maternal MHC phenotypes of the trophoblast cells
(table 1,2 and graph 1). The fact that there is no statistically significant
difference in the resorption between control groups W and SD rats, shown that in
the conditions of normal pregnancy when there is balance of Th1 and Th2
response, MHC incompatibility of allogeneic
pregnancy of W rats does not have any significance for developing the phenomenon
of fetoplacental unit resorption. Judging by the percentage of fetal resorption,
it can be said that allogeneic and syngeneic pregnant animals in the condition
of balance Th1 and Th2 response behave in the same way. This proves that
trophoblast show a very low rate of expression of MHC antigens, but only to the
moment of imbalance between Th1 and Th2 responses in favour of Th1 response
[1,2].
The results of our research show that MHC incompatibility in allogene pregnancy
has no any significance for the synthesis of progesterone and its serum level.
We come to this conclusion by observation that at syngeneic pregnant animals
treated by indomethacine, the level of serum progesterone is significantly lower
than at non-treated syngeneic animals and this
decrease of the level of progesterone is proportionate to decrease of the level
of progesterone at treated out bred animals.
Prostaglandins have the role to regulate the biosynthesis of sex steroids, which
is included in the stimulation of enzyme of adenilcylase, so that by the
increase of concentration of cAMP, they active proteinkinase and the process of
phosphorylation of ester-cholesterols, and as consequence of that intensifying
of the process of basic steroidogenesis and synthesis of all steroid hormones
[1,2,15]. The inhibition of synthesis of prostaglandins by indomethacine could
be responsible for the decrease of steroidogenic potential of trophoblast and
for the decrease of value of concentration of serum progesterone, as well as in
allogeneic and syngeneic pregnancy.
The level of serum progesterone of allogravid animals treated by indomethacine
is significantly lower than the level of serum progesterone of syngeneic animals
treated by indomethacine as well, and that is so because of greater damage of
placental tissue in relation to treated syngeneic animals, and that is why we
come to conclusion that the significance of MHC incompatibility in terms of the
level of serum progesterone can be emphasized in the conditions of
immunostimulation of maternal immune system and probably intensified expression
of MHC antigen on the trophoblast. This might show that MHC incompatibility
itself is not of essential significance for some pregnancy parameters, while in
the condition of immunostimulation and likely intensified expression of MHC
antigens on the placental cells result in disordered homeostasis in pregnancy.
It is well known that cytokines can have some influence on the level of sex
steroids, and on the ovarian as well as on the placental production of sex
steroids hormones [1,2,10]. The results related to the serum level of estradiol
in allogeneic and syngeneic pregnancy, show the little importance of MHC
incompatibility for the intensity of synthesis and level of this hormone in
pregnancy. The mechanisms of the inhibitory effect of indomethacine on the
synthesis of estrogens hormones in pregnancy are the same as if we talk about
the relation of indomethacine and progesterone. It might be said that
indomethacine generally inhibits all steroidogenetic process by the inhibition
of prostaglandins synthesis and by the significant changes in network of
cytokines, above all trophoblast-decidual union.
CONCLUSION
Based on the given data from literature and analyzing the given results, we
could wake the following conclusions:
MHC incompatibility in allogene pregnancy is the factor that has a considerable
influence on the total number of embryos.
The treatment by indomethacine can considerably increase the percentage of
embryos in the resorption, but only in case of presence incompatibility between
maternal and embryonic MHC phenotype, while in syngeneic pregnancy there is not
a significant influence in the percentage of embryos in the resorption.
MHC incompatibility of allogeneic pregnancy does not have a considerable
influence on the average values of serum progesterone.
Indomethacine considerably decreases the average values of serum progesterone
regardless the fact pregnancy is allogeneic or syngeneic.
Indomethacine efficiently inhibits the synthesis of progesterone in allogene
pregnancy that is probably related to MHC incompatibility and acceleration of
Th1 response.
MHC incompatibility of allogene pregnancy does not have a considerable influence
on average values of serum estradiol.
Indomethacine considerably decreases average values of serum estradiol
regardless the fact pregnancy is allogeneic or syngeneic.
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