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Achieving symptom relief in patients with myalgic encephalomyelitis by targeting the neuro-immune interface and optimizing disease tolerance. 通过靶向神经免疫界面和优化疾病耐受性实现肌痛性脑脊髓炎患者的症状缓解。
Pub Date : 2023-01-01 DOI: 10.1093/oxfimm/iqad003
Lucie Rodriguez, Christian Pou, Tadepally Lakshmikanth, Jingdian Zhang, Constantin Habimana Mugabo, Jun Wang, Jaromir Mikes, Axel Olin, Yang Chen, Joanna Rorbach, Jan-Erik Juto, Tie Qiang Li, Per Julin, Petter Brodin

Myalgic encephalomyelitis (ME) previously also known as chronic fatigue syndrome is a heterogeneous, debilitating syndrome of unknown etiology responsible for long-lasting disability in millions of patients worldwide. The most well-known symptom of ME is post-exertional malaise, but many patients also experience autonomic dysregulation, cranial nerve dysfunction and signs of immune system activation. Many patients also report a sudden onset of disease following an infection. The brainstem is a suspected focal point in ME pathogenesis and patients with structural impairment to the brainstem often show ME-like symptoms. The brainstem is also where the vagus nerve originates, a critical neuro-immune interface and mediator of the inflammatory reflex which regulate systemic inflammation. Here, we report the results of a randomized, placebo-controlled trial using intranasal mechanical stimulation targeting nerve endings in the nasal cavity, likely from the trigeminal nerve, possibly activating additional centers in the brainstem of ME patients and correlating with a ∼30% reduction in overall symptom scores after 8 weeks of treatment. By performing longitudinal, systems-level monitoring of the blood immune system in these patients, we uncover signs of chronic immune activation in ME, as well as immunological correlates of improvement that center around gut-homing immune cells and reduced inflammation. The mechanisms of symptom relief remain to be determined, but transcriptional analyses suggest an upregulation of disease tolerance mechanisms. We believe that these results are suggestive of ME as a condition explained by a maladaptive disease tolerance response following infection.

肌痛性脑脊髓炎(Myalgic encephalomyelitis, ME)以前也被称为慢性疲劳综合征,是一种病因不明的异质性衰弱综合征,导致全球数百万患者长期残疾。ME最著名的症状是运动后不适,但许多患者也会出现自主神经失调、颅神经功能障碍和免疫系统激活的迹象。许多患者还报告在感染后突然发病。脑干是ME发病的疑点,脑干结构损伤的患者常表现为ME样症状。脑干也是迷走神经产生的地方,迷走神经是一个重要的神经免疫界面和调节全身炎症反应的媒介。在这里,我们报告了一项随机、安慰剂对照试验的结果,该试验使用鼻内机械刺激针对鼻腔神经末梢,可能来自三叉神经,可能激活ME患者脑干中的其他中枢,并与8周治疗后总症状评分降低~ 30%相关。通过对这些患者的血液免疫系统进行纵向、系统水平的监测,我们发现了ME中慢性免疫激活的迹象,以及以肠道归巢免疫细胞和炎症减少为中心的免疫相关改善。症状缓解的机制仍有待确定,但转录分析提示疾病耐受性机制上调。我们认为这些结果提示ME是一种由感染后的不适应疾病耐受性反应解释的疾病。
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引用次数: 1
A cellular overview of immunometabolism in systemic lupus erythematosus. 系统性红斑狼疮免疫代谢的细胞综述。
Pub Date : 2023-01-01 DOI: 10.1093/oxfimm/iqad005
Antonios Psarras, Alexander Clarke

Systemic lupus erythematosus (SLE) is a complex autoimmune disease, characterized by a breakdown of immune tolerance and the development of autoantibodies against nucleic self-antigens. Immunometabolism is a rapidly expanding scientific field investigating the metabolic programming of cells of the immune system. During the normal immune response, extensive reprogramming of cellular metabolism occurs, both to generate adenosine triphosphate and facilitate protein synthesis, and also to manage cellular stress. Major pathways upregulated include glycolysis, oxidative phosphorylation, the tricarboxylic acid cycle and the pentose phosphate pathway, among others. Metabolic reprogramming also occurs to aid resolution of inflammation. Immune cells of both patients with SLE and lupus-prone mice are characterized by metabolic abnormalities resulting in an altered functional and inflammatory state. Recent studies have described how metabolic reprogramming occurs in many cell populations in SLE, particularly CD4+ T cells, e.g. favouring a glycolytic profile by overactivation of the mechanistic target of rapamycin pathway. These advances have led to an increased understanding of the metabolic changes affecting the inflammatory profile of T and B cells, monocytes, dendritic cells and neutrophils, and how they contribute to autoimmunity and SLE pathogenesis. In the current review, we aim to summarize recent advances in the field of immunometabolism involved in SLE and how these could potentially lead to new therapeutic strategies in the future.

系统性红斑狼疮(SLE)是一种复杂的自身免疫性疾病,其特征是免疫耐受的破坏和针对核酸自身抗原的自身抗体的发展。免疫代谢是一个快速发展的科学领域,研究免疫系统细胞的代谢程序。在正常的免疫反应中,细胞代谢发生广泛的重编程,既产生三磷酸腺苷,促进蛋白质合成,也管理细胞应激。上调的主要途径包括糖酵解、氧化磷酸化、三羧酸循环和戊糖磷酸途径等。代谢重编程也有助于消除炎症。SLE患者和狼疮易感小鼠的免疫细胞都以代谢异常为特征,导致功能和炎症状态的改变。最近的研究描述了代谢重编程如何发生在SLE的许多细胞群中,特别是CD4+ T细胞,例如,通过过度激活雷帕霉素途径的机制靶点,有利于糖酵解谱。这些进展增加了对影响T细胞和B细胞、单核细胞、树突状细胞和中性粒细胞炎症谱的代谢变化的理解,以及它们如何促进自身免疫和SLE发病机制。在当前的综述中,我们旨在总结SLE免疫代谢领域的最新进展,以及这些进展如何可能在未来导致新的治疗策略。
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引用次数: 0
Combating the challenges of COVID-19 pandemic: Insights into molecular mechanisms, immune responses and therapeutics against SARS-CoV-2. 应对COVID-19大流行的挑战:洞察SARS-CoV-2的分子机制、免疫反应和治疗方法。
Pub Date : 2023-01-01 DOI: 10.1093/oxfimm/iqad001
Kriti Negi, Meetu Agarwal, Isha Pahuja, Bhavya Bhardwaj, Mansi Rawat, Ashima Bhaskar, Ved Prakash Dwivedi

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes lethal coronavirus disease (COVID-19). SARS-CoV-2 has been the chief source of threat to public health and safety from 2019 to the present. SARS-CoV-2 caused a sudden and significant rise in hospitalization due to respiratory issues and pneumonia. We are consistently uncovering new information about SARS-CoV-2, and yet so much is to explore to implement efficient interventions to combat the emergent variants and spread of the ongoing pandemic. Information regarding the existing COVID-19 pandemic is streamlining continuously. However, clinical symptoms of SARS-CoV-2 infections spanning from asymptomatic infection to severe death-instigating disease remain consistent with preliminary reports. In this review, we have briefly introduced highlights of the COVID-19 pandemic and features of SARS-CoV-2. We have focused on current knowledge of innate and adaptive immune responses during SARS-CoV-2 infections and persisting clinical features of recovered patients. Furthermore, we have discussed how these immune responses are not tightly regulated and imbalance can direct the latter phases of COVID-19, long-COVID symptoms, and cause detrimental immunopathogenesis. COVID-19 vaccines are also discussed in detail to describe the efforts going around the world to control and prevent the infection. Overall, we have summarized the current knowledge on the immunology of SARS-CoV-2 infection and the utilization of that knowledge in the development of a suitable COVID-19 therapeutics and vaccines.

严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)感染会导致致命的冠状病毒病(COVID-19)。从2019年到现在,SARS-CoV-2一直是公共卫生和安全的主要威胁来源。由于呼吸系统问题和肺炎,SARS-CoV-2导致住院人数突然大幅上升。我们不断发现关于SARS-CoV-2的新信息,但要实施有效的干预措施,以对抗新出现的变体和持续大流行的传播,还有很多工作要探索。有关当前COVID-19大流行的信息正在不断精简。然而,从无症状感染到严重致死疾病的SARS-CoV-2感染的临床症状与初步报告保持一致。本文简要介绍了2019冠状病毒病大流行的要点和SARS-CoV-2的特点。我们的重点是目前对SARS-CoV-2感染期间的先天性和适应性免疫反应的了解以及康复患者的持续临床特征。此外,我们还讨论了这些免疫反应如何不受严格调节,不平衡如何指导COVID-19的后期阶段,长期的COVID-19症状,并导致有害的免疫发病机制。还详细讨论了COVID-19疫苗,以描述世界各地为控制和预防感染所做的努力。总的来说,我们总结了目前关于SARS-CoV-2感染的免疫学知识以及在开发合适的COVID-19治疗方法和疫苗中的应用。
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引用次数: 3
Long COVID: a narrative review of the clinical aftermaths of COVID-19 with a focus on the putative pathophysiology and aspects of physical activity. 长COVID:对COVID-19临床后果的叙述性回顾,重点是推测的病理生理学和体育锻炼方面。
Pub Date : 2022-09-16 eCollection Date: 2022-01-01 DOI: 10.1093/oxfimm/iqac006
Simon Haunhorst, Wilhelm Bloch, Heiko Wagner, Claudia Ellert, Karsten Krüger, Daniel C Vilser, Kathrin Finke, Philipp Reuken, Mathias W Pletz, Andreas Stallmach, Christian Puta

The pandemic coronavirus disease 2019 (COVID-19) can cause multi-systemic symptoms that can persist beyond the acute symptomatic phase. The post-acute sequelae of COVID-19 (PASC), also referred to as long COVID, describe the persistence of symptoms and/or long-term complications beyond 4 weeks from the onset of the acute symptoms and are estimated to affect at least 20% of the individuals infected with SARS-CoV-2 regardless of their acute disease severity. The multi-faceted clinical picture of long COVID encompasses a plethora of undulating clinical manifestations impacting various body systems such as fatigue, headache, attention disorder, hair loss and exercise intolerance. The physiological response to exercise testing is characterized by a reduced aerobic capacity, cardiocirculatory limitations, dysfunctional breathing patterns and an impaired ability to extract and use oxygen. Still, to this day, the causative pathophysiological mechanisms of long COVID remain to be elucidated, with long-term organ damage, immune system dysregulation and endotheliopathy being among the hypotheses discussed. Likewise, there is still a paucity of treatment options and evidence-based strategies for the management of the symptoms. In sum, this review explores different aspects of long COVID and maps the literature on what is known about its clinical manifestations, potential pathophysiological mechanisms, and treatment options.

2019 年冠状病毒大流行病(COVID-19)可引起多系统症状,这些症状可持续到急性症状阶段之后。COVID-19急性后遗症(PASC)也被称为长COVID,描述的是急性症状出现4周后症状和/或长期并发症的持续存在,估计至少有20%的SARS-CoV-2感染者会受到影响,无论其急性病的严重程度如何。长期 COVID 的临床表现多种多样,包括影响身体各系统的大量起伏不定的临床表现,如疲劳、头痛、注意力障碍、脱发和运动不耐受。运动测试的生理反应表现为有氧能力下降、心循环系统受限、呼吸模式失调以及汲取和利用氧气的能力受损。时至今日,长期 COVID 的致病生理机制仍有待阐明,其中包括长期器官损伤、免疫系统失调和内皮病变等假说。同样,目前仍缺乏治疗方案和循证策略来控制症状。总之,这篇综述探讨了长期 COVID 的各个方面,并绘制了有关其临床表现、潜在病理生理机制和治疗方案的文献地图。
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引用次数: 0
SARS-CoV-2 immunity and vaccine strategies in people with HIV. 艾滋病毒感染者的 SARS-CoV-2 免疫力和疫苗策略。
Pub Date : 2022-08-17 eCollection Date: 2022-01-01 DOI: 10.1093/oxfimm/iqac005
Claire Mullender, Kelly A S da Costa, Aljawharah Alrubayyi, Sarah L Pett, Dimitra Peppa

Current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccines, based on the ancestral Wuhan strain, were developed rapidly to meet the needs of a devastating global pandemic. People living with Human Immunodeficiency Virus (PLWH) have been designated as a priority group for SARS-CoV-2 vaccination in most regions and varying primary courses (two- or three-dose schedule) and additional boosters are recommended depending on current CD4+ T cell count and/or detectable HIV viraemia. From the current published data, licensed vaccines are safe for PLWH, and stimulate robust responses to vaccination in those well controlled on antiretroviral therapy and with high CD4+ T cell counts. Data on vaccine efficacy and immunogenicity remain, however, scarce in PLWH, especially in people with advanced disease. A greater concern is a potentially diminished immune response to the primary course and subsequent boosters, as well as an attenuated magnitude and durability of protective immune responses. A detailed understanding of the breadth and durability of humoral and T cell responses to vaccination, and the boosting effects of natural immunity to SARS-CoV-2, in more diverse populations of PLWH with a spectrum of HIV-related immunosuppression is therefore critical. This article summarizes focused studies of humoral and cellular responses to SARS-CoV-2 infection in PLWH and provides a comprehensive review of the emerging literature on SARS-CoV-2 vaccine responses. Emphasis is placed on the potential effect of HIV-related factors and presence of co-morbidities modulating responses to SARS-CoV-2 vaccination, and the remaining challenges informing the optimal vaccination strategy to elicit enduring responses against existing and emerging variants in PLWH.

目前的严重急性呼吸系统综合症冠状病毒-2(SARS-CoV-2)疫苗是在武汉祖先毒株的基础上迅速开发的,以满足破坏性全球大流行的需要。在大多数地区,人类免疫缺陷病毒感染者(PLWH)已被指定为 SARS-CoV-2 疫苗接种的优先群体,根据目前的 CD4+ T 细胞计数和/或可检测到的 HIV 病毒血症,建议进行不同的初级接种(两剂或三剂)和额外的加强接种。从目前公布的数据来看,获得许可的疫苗对艾滋病毒感染者是安全的,对于那些抗逆转录病毒治疗控制良好且 CD4+ T 细胞计数较高的人来说,疫苗接种可激发强有力的反应。然而,有关 PLWH 疫苗疗效和免疫原性的数据仍然很少,尤其是在晚期患者中。更令人担忧的是,初种疫苗和后续强化疫苗的免疫反应可能会减弱,保护性免疫反应的程度和持久性也会减弱。因此,详细了解具有各种艾滋病相关免疫抑制的 PLWH 群体对疫苗接种的体液和 T 细胞反应的广度和持久性以及对 SARS-CoV-2 的天然免疫的增强效应至关重要。本文总结了对 PLWH 感染 SARS-CoV-2 后体液和细胞反应的重点研究,并全面综述了有关 SARS-CoV-2 疫苗反应的新兴文献。文章重点论述了艾滋病相关因素和并发症的存在对SARS-CoV-2疫苗接种反应的潜在影响,以及在确定最佳疫苗接种策略以激发 PLWH 对现有和新出现变种的持久反应方面仍然存在的挑战。
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引用次数: 0
Polymer formulated self-amplifying RNA vaccine is partially protective against influenza virus infection in ferrets. 聚合物配制的自扩增RNA疫苗对雪貂流感病毒感染具有部分保护作用。
Pub Date : 2022-06-27 eCollection Date: 2022-01-01 DOI: 10.1093/oxfimm/iqac004
P F McKay, J Zhou, R Frise, A K Blakney, C R Bouton, Z Wang, K Hu, K Samnuan, J C Brown, R Kugathasan, J Yeow, M M Stevens, W S Barclay, J S Tregoning, R J Shattock

COVID-19 has demonstrated the power of RNA vaccines as part of a pandemic response toolkit. Another virus with pandemic potential is influenza. Further development of RNA vaccines in advance of a future influenza pandemic will save time and lives. As RNA vaccines require formulation to enter cells and induce antigen expression, the aim of this study was to investigate the impact of a recently developed bioreducible cationic polymer, pABOL for the delivery of a self-amplifying RNA (saRNA) vaccine for seasonal influenza virus in mice and ferrets. Mice and ferrets were immunized with pABOL formulated saRNA vaccines expressing either haemagglutinin (HA) from H1N1 or H3N2 influenza virus in a prime boost regime. Antibody responses, both binding and functional were measured in serum after immunization. Animals were then challenged with a matched influenza virus either directly by intranasal inoculation or in a contact transmission model. While highly immunogenic in mice, pABOL-formulated saRNA led to variable responses in ferrets. Animals that responded to the vaccine with higher levels of influenza virus-specific neutralizing antibodies were more protected against influenza virus infection. pABOL-formulated saRNA is immunogenic in ferrets, but further optimization of RNA vaccine formulation and constructs is required to increase the quality and quantity of the antibody response to the vaccine.

COVID-19已经证明了RNA疫苗作为大流行应对工具包的力量。另一种具有大流行潜力的病毒是流感。在未来流感大流行之前进一步开发RNA疫苗将节省时间和生命。由于RNA疫苗需要配方才能进入细胞并诱导抗原表达,本研究的目的是研究最近开发的生物可还原阳离子聚合物pABOL对小鼠和雪貂季节性流感病毒自我扩增RNA (saRNA)疫苗的影响。小鼠和雪貂用pABOL配制的saRNA疫苗免疫,这些疫苗表达H1N1或H3N2流感病毒的血凝素(HA)。免疫后测定血清中结合性和功能性抗体反应。然后通过鼻内接种或接触传播模型直接向动物接种匹配的流感病毒。虽然在小鼠中具有高度的免疫原性,但在雪貂中,pabol配制的saRNA导致了不同的反应。对流感病毒特异性中和抗体水平较高的疫苗有反应的动物对流感病毒感染的保护更强。paol配方的saRNA在雪貂中具有免疫原性,但需要进一步优化RNA疫苗配方和构建,以提高对疫苗的抗体反应的质量和数量。
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引用次数: 1
The past, current and future epidemiological dynamic of SARS-CoV-2. 严重急性呼吸系统综合征冠状病毒2型过去、现在和未来的流行病学动态。
Pub Date : 2022-06-20 eCollection Date: 2022-01-01 DOI: 10.1093/oxfimm/iqac003
François Balloux, Cedric Tan, Leo Swadling, Damien Richard, Charlotte Jenner, Mala Maini, Lucy van Dorp

SARS-CoV-2, the agent of the COVID-19 pandemic, emerged in late 2019 in China, and rapidly spread throughout the world to reach all continents. As the virus expanded in its novel human host, viral lineages diversified through the accumulation of around two mutations a month on average. Different viral lineages have replaced each other since the start of the pandemic, with the most successful Alpha, Delta and Omicron variants of concern (VoCs) sequentially sweeping through the world to reach high global prevalence. Neither Alpha nor Delta was characterized by strong immune escape, with their success coming mainly from their higher transmissibility. Omicron is far more prone to immune evasion and spread primarily due to its increased ability to (re-)infect hosts with prior immunity. As host immunity reaches high levels globally through vaccination and prior infection, the epidemic is expected to transition from a pandemic regime to an endemic one where seasonality and waning host immunization are anticipated to become the primary forces shaping future SARS-CoV-2 lineage dynamics. In this review, we consider a body of evidence on the origins, host tropism, epidemiology, genomic and immunogenetic evolution of SARS-CoV-2 including an assessment of other coronaviruses infecting humans. Considering what is known so far, we conclude by delineating scenarios for the future dynamic of SARS-CoV-2, ranging from the good-circulation of a fifth endemic 'common cold' coronavirus of potentially low virulence, the bad-a situation roughly comparable with seasonal flu, and the ugly-extensive diversification into serotypes with long-term high-level endemicity.

2019年末,新冠肺炎大流行的病原体SARS-CoV-2在中国出现,并迅速传播到世界各地,到达各大洲。随着病毒在其新的人类宿主中扩张,病毒谱系通过平均每月约两个突变的积累而多样化。自疫情开始以来,不同的病毒谱系相互取代,最成功的阿尔法、德尔塔和奥密克戎变异毒株(VoCs)相继席卷全球,达到全球高流行率。阿尔法和德尔塔都没有强大的免疫逃逸特征,它们的成功主要来自于更高的传播性。奥密克戎更容易逃避免疫并传播,这主要是因为它增加了(重新)感染具有先前免疫力的宿主的能力。随着宿主免疫通过疫苗接种和既往感染在全球范围内达到高水平,预计疫情将从大流行状态转变为地方性流行病,季节性和宿主免疫减弱将成为塑造未来严重急性呼吸系统综合征冠状病毒2型谱系动态的主要力量。在这篇综述中,我们考虑了关于严重急性呼吸系统综合征冠状病毒2型的起源、宿主嗜性、流行病学、基因组和免疫遗传进化的大量证据,包括对感染人类的其他冠状病毒的评估。考虑到目前已知的情况,我们通过描绘严重急性呼吸系统综合征冠状病毒2型未来动态的情景得出结论,从第五种可能毒力较低的地方性“普通感冒”冠状病毒的良好传播,到与季节性流感大致相当的糟糕情况,再到丑陋的广泛多样化为具有长期高流行性的血清型。
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引用次数: 0
Long Covid brain fog: a neuroinflammation phenomenon? 长冠脑雾:一种神经炎症现象?
Pub Date : 2022-01-01 DOI: 10.1093/oxfimm/iqac007
Emma Kavanagh

Neuroinflammation is a process triggered by an attack on the immune system. Activation of microglia in response to an immune system challenge can lead to a significant impact on cognitive processes, such as learning, memory and emotional regulation. Long Covid is an ongoing problem, affecting an estimated 1.3 million people within the UK alone, and one of its more significant, and as yet unexplained, symptoms is brain fog. Here, we discuss the potential role of neuroinflammation in Long Covid cognitive difficulties. Inflammatory cytokines have been found to play a significant role in reductions in LTP and LTD, a reduction in neurogenesis, and in dendritic sprouting. The potential behavioural consequences of such impacts are discussed. It is hoped that this article will allow for greater examination of the effects of inflammatory factors on brain function, most particularly in terms of their role in chronic conditions.

神经炎症是由免疫系统受到攻击引发的一个过程。在免疫系统受到挑战时,小胶质细胞的激活会对认知过程产生重大影响,比如学习、记忆和情绪调节。长期新冠肺炎是一个持续存在的问题,仅在英国就影响了大约130万人,其中一个更重要的、尚未解释的症状是脑雾。在这里,我们讨论神经炎症在长期认知困难中的潜在作用。炎性细胞因子已被发现在LTP和LTD的减少、神经发生的减少和树突发芽中发挥重要作用。讨论了这种影响的潜在行为后果。希望这篇文章将允许更深入地研究炎症因子对脑功能的影响,尤其是它们在慢性疾病中的作用。
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引用次数: 2
Is 'Long Covid' similar to 'Long SARS'? “长Covid”与“长SARS”相似吗?
Pub Date : 2022-01-01 DOI: 10.1093/oxfimm/iqac002
John Patcai
Is “Long Covid” similar to “Long SARS” (Severe Acute Respiratory Syndrome)? In 2019, a new pandemic started, and is still ongoing. The causative virus is the only known close relative of the SARS coronavirus (SARS-CoV-1), and is accordingly called SARS-CoV-2. Follow-up for between 2 and 10 years of 50 post SARS patients in a rehabilitation setting led to publications and clinical impressions that are summarized here regarding significant permanent disability for some of these patients. Similarities between permanent symptoms post SARS, and the reported so-far unresolving symptoms of Long Covid are remarkable. This makes it possible to predict that some Long Covid symptoms will be permanent.
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引用次数: 3
Correction to: Molecular mimicry among human proteinase 3 and bacterial antigens: implications for development of c-ANCA associated vasculitis. 更正:人蛋白酶3和细菌抗原之间的分子模拟:c-ANCA相关血管炎发展的意义。
Pub Date : 2022-01-01 DOI: 10.1093/oxfimm/iqac011

[This corrects the article DOI: 10.1093/oxfimm/iqac009.].

[此更正文章DOI: 10.1093/oxfimm/iqac009.]。
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引用次数: 0
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