Safety of intravitreally delivered AAV2 vector‐mediated multi‐characteristic opsin genetic construct in wild type beagle dogs

Background A novel adeno‐associated virus 2 (AAV2)‐carried multi‐characteristic opsin (MCO) (MCO‐010) is undergoing several clinical trials as a novel therapeutic modality for the treatment of degenerative retinal diseases including retinitis pigmentosa and Stargardt disease. The present study aimed...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The journal of gene medicine 2024-07, Vol.26 (7), p.e3720-n/a
Hauptverfasser: Mohanty, Samarendra, Batabyal, Subrata, Ayyagari, Ananta, Sharif, Najam A.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page n/a
container_issue 7
container_start_page e3720
container_title The journal of gene medicine
container_volume 26
creator Mohanty, Samarendra
Batabyal, Subrata
Ayyagari, Ananta
Sharif, Najam A.
description Background A novel adeno‐associated virus 2 (AAV2)‐carried multi‐characteristic opsin (MCO) (MCO‐010) is undergoing several clinical trials as a novel therapeutic modality for the treatment of degenerative retinal diseases including retinitis pigmentosa and Stargardt disease. The present study aimed to determine the ocular and systemic safety of MCO‐010 and the AAV2 vehicle in adult Beagle dogs following intravitreal (IVT) injection. Methods The current safety/toxicology studies spanning 13 weeks described here utilized well‐documented techniques to assess the effects of IVT injection of MCO‐010 up to 2.2 × 1011 genome copies (gc) per eye, or the AAV2 capsid (vehicle control) on gross behavioral and immunogenic changes, alterations in body weights, blood biochemistry, hematology, blood coagulation, gross necropsy lesions, organ weight changes and histopathology in the dogs (n = 4 per group; two males and two females per group). Immunohistochemical and functional electroretinogram studies were also conducted to determine MCO expression in the retina and determine any retinal toxicity associated with MCO‐010. Results There were no significant deleterious effects of the MCO‐010 (or the AAV2 at the tested doses) on any of the examined parameters, including the absence of any severe ocular or systemic adverse events. However, as expected, inflammation after IVT delivery of AAV2 and MCO‐010 was observed in the conjunctivae of all groups of animals, although this self‐resolved within 1 week post‐injection. Quantitative immunohistochemical analyses of MCO‐010‐associated mCherry revealed successful delivery of the gene therapy within the inner retina. Conclusions In summary, MCO‐010 demonstrated a favorable safety profile when administered to the eyes of adult Beagle dogs of both sexes at dose levels up to 2.2 × 1011 gc per eye, with no adverse effects observed. This dose was identified as the No Observed Adverse Effect Level (i.e. NOAEL) and guided selection of safe doses for human clinical trials. This study assessed the ocular and systemic safety of intravitreally delivered MCO‐010, an AAV2‐carried multi‐characteristic opsin, in adult Beagle dogs over 13 weeks. Methods included behavioral observation, immunogenic analysis, blood work, necropsy, organ weight assessment, histopathology, immunohistochemistry, and electroretinography. Results showed no biologically significant ocular or systemic adverse effects from intravitreal injection of MCO‐010. Mild transient
doi_str_mv 10.1002/jgm.3720
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3083681256</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3084362023</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2400-60f5af87acdd0aee6d025c36f50442e30b3385c9feb267f32054c4d8c1102493</originalsourceid><addsrcrecordid>eNp1kd1qFDEUx4Mo9kPBJ5CAN95MPfmY2ZnLpWitVLxoKd4N2eRkzZKZbJPMytzpG_iMfZJmbVUoeHU--PHjcP6EvGJwwgD4u816OBELDk_IIas5qziv5dPSQ9dVsmu_HpCjlDYAbNG23XNyIDqQrBHdIfl5qSzmmQZL3Zij2rkcUXk_U4Pe7TCiocvlNac71DnE2x-_BjRO5bIeJp9dWehvKiqdMbqUnaZhm9xI1zjiftJhTDlOOhc9_e68oXneIl2hWnukJqzTC_LMKp_w5UM9Jlcf3l-dfqwuvpydny4vKs0lQNWArZVtF0obAwqxMcBrLRpbg5QcBayEaGvdWVzxZmEFh1pqaVrNGHDZiWPy9l67jeFmwpT7wSWN3qsRw5R6Aa1oWsbrpqBvHqGbMMWxHLenpGg4cPFPqGNIKaLtt9ENKs49g36fSl9S6fepFPT1g3Balff9Bf_EUIDqHigfwvm_ov7T2effwjsG95kv</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3084362023</pqid></control><display><type>article</type><title>Safety of intravitreally delivered AAV2 vector‐mediated multi‐characteristic opsin genetic construct in wild type beagle dogs</title><source>MEDLINE</source><source>Wiley-Blackwell Full Collection</source><creator>Mohanty, Samarendra ; Batabyal, Subrata ; Ayyagari, Ananta ; Sharif, Najam A.</creator><creatorcontrib>Mohanty, Samarendra ; Batabyal, Subrata ; Ayyagari, Ananta ; Sharif, Najam A.</creatorcontrib><description>Background A novel adeno‐associated virus 2 (AAV2)‐carried multi‐characteristic opsin (MCO) (MCO‐010) is undergoing several clinical trials as a novel therapeutic modality for the treatment of degenerative retinal diseases including retinitis pigmentosa and Stargardt disease. The present study aimed to determine the ocular and systemic safety of MCO‐010 and the AAV2 vehicle in adult Beagle dogs following intravitreal (IVT) injection. Methods The current safety/toxicology studies spanning 13 weeks described here utilized well‐documented techniques to assess the effects of IVT injection of MCO‐010 up to 2.2 × 1011 genome copies (gc) per eye, or the AAV2 capsid (vehicle control) on gross behavioral and immunogenic changes, alterations in body weights, blood biochemistry, hematology, blood coagulation, gross necropsy lesions, organ weight changes and histopathology in the dogs (n = 4 per group; two males and two females per group). Immunohistochemical and functional electroretinogram studies were also conducted to determine MCO expression in the retina and determine any retinal toxicity associated with MCO‐010. Results There were no significant deleterious effects of the MCO‐010 (or the AAV2 at the tested doses) on any of the examined parameters, including the absence of any severe ocular or systemic adverse events. However, as expected, inflammation after IVT delivery of AAV2 and MCO‐010 was observed in the conjunctivae of all groups of animals, although this self‐resolved within 1 week post‐injection. Quantitative immunohistochemical analyses of MCO‐010‐associated mCherry revealed successful delivery of the gene therapy within the inner retina. Conclusions In summary, MCO‐010 demonstrated a favorable safety profile when administered to the eyes of adult Beagle dogs of both sexes at dose levels up to 2.2 × 1011 gc per eye, with no adverse effects observed. This dose was identified as the No Observed Adverse Effect Level (i.e. NOAEL) and guided selection of safe doses for human clinical trials. This study assessed the ocular and systemic safety of intravitreally delivered MCO‐010, an AAV2‐carried multi‐characteristic opsin, in adult Beagle dogs over 13 weeks. Methods included behavioral observation, immunogenic analysis, blood work, necropsy, organ weight assessment, histopathology, immunohistochemistry, and electroretinography. Results showed no biologically significant ocular or systemic adverse effects from intravitreal injection of MCO‐010. Mild transient self‐resolving conjunctival inflammation was observed post‐injection. Immunohistochemistry confirmed successful gene delivery to the inner retina. MCO‐010 demonstrated a favorable safety profile while effectively transducing the retina and established no observed adverse effect level (NOAEL) for intravitreal dosing in patients suffering from retinal degenerative diseases.</description><identifier>ISSN: 1099-498X</identifier><identifier>ISSN: 1521-2254</identifier><identifier>EISSN: 1521-2254</identifier><identifier>DOI: 10.1002/jgm.3720</identifier><identifier>PMID: 39041639</identifier><language>eng</language><publisher>England: Wiley Periodicals Inc</publisher><subject>adeno‐associated virus ; Animals ; Blood coagulation ; Clinical trials ; Dependovirus - genetics ; Dogs ; Electroretinography ; Eye diseases ; Female ; Gene therapy ; Genetic Therapy - methods ; Genetic Vectors - administration &amp; dosage ; Genetic Vectors - genetics ; Hematology ; Immunogenicity ; Injection ; intravitreal injection ; Intravitreal Injections ; Male ; MCO‐010 ; multi‐characteristic opsin viral vector ; Necropsy ; Opsins - genetics ; Opsins - metabolism ; Retina ; Retina - metabolism ; Retinitis pigmentosa ; Side effects ; Toxicity</subject><ispartof>The journal of gene medicine, 2024-07, Vol.26 (7), p.e3720-n/a</ispartof><rights>2024 John Wiley &amp; Sons Ltd.</rights><rights>2024 John Wiley &amp; Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2400-60f5af87acdd0aee6d025c36f50442e30b3385c9feb267f32054c4d8c1102493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjgm.3720$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjgm.3720$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39041639$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mohanty, Samarendra</creatorcontrib><creatorcontrib>Batabyal, Subrata</creatorcontrib><creatorcontrib>Ayyagari, Ananta</creatorcontrib><creatorcontrib>Sharif, Najam A.</creatorcontrib><title>Safety of intravitreally delivered AAV2 vector‐mediated multi‐characteristic opsin genetic construct in wild type beagle dogs</title><title>The journal of gene medicine</title><addtitle>J Gene Med</addtitle><description>Background A novel adeno‐associated virus 2 (AAV2)‐carried multi‐characteristic opsin (MCO) (MCO‐010) is undergoing several clinical trials as a novel therapeutic modality for the treatment of degenerative retinal diseases including retinitis pigmentosa and Stargardt disease. The present study aimed to determine the ocular and systemic safety of MCO‐010 and the AAV2 vehicle in adult Beagle dogs following intravitreal (IVT) injection. Methods The current safety/toxicology studies spanning 13 weeks described here utilized well‐documented techniques to assess the effects of IVT injection of MCO‐010 up to 2.2 × 1011 genome copies (gc) per eye, or the AAV2 capsid (vehicle control) on gross behavioral and immunogenic changes, alterations in body weights, blood biochemistry, hematology, blood coagulation, gross necropsy lesions, organ weight changes and histopathology in the dogs (n = 4 per group; two males and two females per group). Immunohistochemical and functional electroretinogram studies were also conducted to determine MCO expression in the retina and determine any retinal toxicity associated with MCO‐010. Results There were no significant deleterious effects of the MCO‐010 (or the AAV2 at the tested doses) on any of the examined parameters, including the absence of any severe ocular or systemic adverse events. However, as expected, inflammation after IVT delivery of AAV2 and MCO‐010 was observed in the conjunctivae of all groups of animals, although this self‐resolved within 1 week post‐injection. Quantitative immunohistochemical analyses of MCO‐010‐associated mCherry revealed successful delivery of the gene therapy within the inner retina. Conclusions In summary, MCO‐010 demonstrated a favorable safety profile when administered to the eyes of adult Beagle dogs of both sexes at dose levels up to 2.2 × 1011 gc per eye, with no adverse effects observed. This dose was identified as the No Observed Adverse Effect Level (i.e. NOAEL) and guided selection of safe doses for human clinical trials. This study assessed the ocular and systemic safety of intravitreally delivered MCO‐010, an AAV2‐carried multi‐characteristic opsin, in adult Beagle dogs over 13 weeks. Methods included behavioral observation, immunogenic analysis, blood work, necropsy, organ weight assessment, histopathology, immunohistochemistry, and electroretinography. Results showed no biologically significant ocular or systemic adverse effects from intravitreal injection of MCO‐010. Mild transient self‐resolving conjunctival inflammation was observed post‐injection. Immunohistochemistry confirmed successful gene delivery to the inner retina. MCO‐010 demonstrated a favorable safety profile while effectively transducing the retina and established no observed adverse effect level (NOAEL) for intravitreal dosing in patients suffering from retinal degenerative diseases.</description><subject>adeno‐associated virus</subject><subject>Animals</subject><subject>Blood coagulation</subject><subject>Clinical trials</subject><subject>Dependovirus - genetics</subject><subject>Dogs</subject><subject>Electroretinography</subject><subject>Eye diseases</subject><subject>Female</subject><subject>Gene therapy</subject><subject>Genetic Therapy - methods</subject><subject>Genetic Vectors - administration &amp; dosage</subject><subject>Genetic Vectors - genetics</subject><subject>Hematology</subject><subject>Immunogenicity</subject><subject>Injection</subject><subject>intravitreal injection</subject><subject>Intravitreal Injections</subject><subject>Male</subject><subject>MCO‐010</subject><subject>multi‐characteristic opsin viral vector</subject><subject>Necropsy</subject><subject>Opsins - genetics</subject><subject>Opsins - metabolism</subject><subject>Retina</subject><subject>Retina - metabolism</subject><subject>Retinitis pigmentosa</subject><subject>Side effects</subject><subject>Toxicity</subject><issn>1099-498X</issn><issn>1521-2254</issn><issn>1521-2254</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kd1qFDEUx4Mo9kPBJ5CAN95MPfmY2ZnLpWitVLxoKd4N2eRkzZKZbJPMytzpG_iMfZJmbVUoeHU--PHjcP6EvGJwwgD4u816OBELDk_IIas5qziv5dPSQ9dVsmu_HpCjlDYAbNG23XNyIDqQrBHdIfl5qSzmmQZL3Zij2rkcUXk_U4Pe7TCiocvlNac71DnE2x-_BjRO5bIeJp9dWehvKiqdMbqUnaZhm9xI1zjiftJhTDlOOhc9_e68oXneIl2hWnukJqzTC_LMKp_w5UM9Jlcf3l-dfqwuvpydny4vKs0lQNWArZVtF0obAwqxMcBrLRpbg5QcBayEaGvdWVzxZmEFh1pqaVrNGHDZiWPy9l67jeFmwpT7wSWN3qsRw5R6Aa1oWsbrpqBvHqGbMMWxHLenpGg4cPFPqGNIKaLtt9ENKs49g36fSl9S6fepFPT1g3Balff9Bf_EUIDqHigfwvm_ov7T2effwjsG95kv</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Mohanty, Samarendra</creator><creator>Batabyal, Subrata</creator><creator>Ayyagari, Ananta</creator><creator>Sharif, Najam A.</creator><general>Wiley Periodicals Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>7TM</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>202407</creationdate><title>Safety of intravitreally delivered AAV2 vector‐mediated multi‐characteristic opsin genetic construct in wild type beagle dogs</title><author>Mohanty, Samarendra ; Batabyal, Subrata ; Ayyagari, Ananta ; Sharif, Najam A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2400-60f5af87acdd0aee6d025c36f50442e30b3385c9feb267f32054c4d8c1102493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>adeno‐associated virus</topic><topic>Animals</topic><topic>Blood coagulation</topic><topic>Clinical trials</topic><topic>Dependovirus - genetics</topic><topic>Dogs</topic><topic>Electroretinography</topic><topic>Eye diseases</topic><topic>Female</topic><topic>Gene therapy</topic><topic>Genetic Therapy - methods</topic><topic>Genetic Vectors - administration &amp; dosage</topic><topic>Genetic Vectors - genetics</topic><topic>Hematology</topic><topic>Immunogenicity</topic><topic>Injection</topic><topic>intravitreal injection</topic><topic>Intravitreal Injections</topic><topic>Male</topic><topic>MCO‐010</topic><topic>multi‐characteristic opsin viral vector</topic><topic>Necropsy</topic><topic>Opsins - genetics</topic><topic>Opsins - metabolism</topic><topic>Retina</topic><topic>Retina - metabolism</topic><topic>Retinitis pigmentosa</topic><topic>Side effects</topic><topic>Toxicity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mohanty, Samarendra</creatorcontrib><creatorcontrib>Batabyal, Subrata</creatorcontrib><creatorcontrib>Ayyagari, Ananta</creatorcontrib><creatorcontrib>Sharif, Najam A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of gene medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mohanty, Samarendra</au><au>Batabyal, Subrata</au><au>Ayyagari, Ananta</au><au>Sharif, Najam A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety of intravitreally delivered AAV2 vector‐mediated multi‐characteristic opsin genetic construct in wild type beagle dogs</atitle><jtitle>The journal of gene medicine</jtitle><addtitle>J Gene Med</addtitle><date>2024-07</date><risdate>2024</risdate><volume>26</volume><issue>7</issue><spage>e3720</spage><epage>n/a</epage><pages>e3720-n/a</pages><issn>1099-498X</issn><issn>1521-2254</issn><eissn>1521-2254</eissn><abstract>Background A novel adeno‐associated virus 2 (AAV2)‐carried multi‐characteristic opsin (MCO) (MCO‐010) is undergoing several clinical trials as a novel therapeutic modality for the treatment of degenerative retinal diseases including retinitis pigmentosa and Stargardt disease. The present study aimed to determine the ocular and systemic safety of MCO‐010 and the AAV2 vehicle in adult Beagle dogs following intravitreal (IVT) injection. Methods The current safety/toxicology studies spanning 13 weeks described here utilized well‐documented techniques to assess the effects of IVT injection of MCO‐010 up to 2.2 × 1011 genome copies (gc) per eye, or the AAV2 capsid (vehicle control) on gross behavioral and immunogenic changes, alterations in body weights, blood biochemistry, hematology, blood coagulation, gross necropsy lesions, organ weight changes and histopathology in the dogs (n = 4 per group; two males and two females per group). Immunohistochemical and functional electroretinogram studies were also conducted to determine MCO expression in the retina and determine any retinal toxicity associated with MCO‐010. Results There were no significant deleterious effects of the MCO‐010 (or the AAV2 at the tested doses) on any of the examined parameters, including the absence of any severe ocular or systemic adverse events. However, as expected, inflammation after IVT delivery of AAV2 and MCO‐010 was observed in the conjunctivae of all groups of animals, although this self‐resolved within 1 week post‐injection. Quantitative immunohistochemical analyses of MCO‐010‐associated mCherry revealed successful delivery of the gene therapy within the inner retina. Conclusions In summary, MCO‐010 demonstrated a favorable safety profile when administered to the eyes of adult Beagle dogs of both sexes at dose levels up to 2.2 × 1011 gc per eye, with no adverse effects observed. This dose was identified as the No Observed Adverse Effect Level (i.e. NOAEL) and guided selection of safe doses for human clinical trials. This study assessed the ocular and systemic safety of intravitreally delivered MCO‐010, an AAV2‐carried multi‐characteristic opsin, in adult Beagle dogs over 13 weeks. Methods included behavioral observation, immunogenic analysis, blood work, necropsy, organ weight assessment, histopathology, immunohistochemistry, and electroretinography. Results showed no biologically significant ocular or systemic adverse effects from intravitreal injection of MCO‐010. Mild transient self‐resolving conjunctival inflammation was observed post‐injection. Immunohistochemistry confirmed successful gene delivery to the inner retina. MCO‐010 demonstrated a favorable safety profile while effectively transducing the retina and established no observed adverse effect level (NOAEL) for intravitreal dosing in patients suffering from retinal degenerative diseases.</abstract><cop>England</cop><pub>Wiley Periodicals Inc</pub><pmid>39041639</pmid><doi>10.1002/jgm.3720</doi><tpages>15</tpages></addata></record>
fulltext fulltext
identifier ISSN: 1099-498X
ispartof The journal of gene medicine, 2024-07, Vol.26 (7), p.e3720-n/a
issn 1099-498X
1521-2254
1521-2254
language eng
recordid cdi_proquest_miscellaneous_3083681256
source MEDLINE; Wiley-Blackwell Full Collection
subjects adeno‐associated virus
Animals
Blood coagulation
Clinical trials
Dependovirus - genetics
Dogs
Electroretinography
Eye diseases
Female
Gene therapy
Genetic Therapy - methods
Genetic Vectors - administration & dosage
Genetic Vectors - genetics
Hematology
Immunogenicity
Injection
intravitreal injection
Intravitreal Injections
Male
MCO‐010
multi‐characteristic opsin viral vector
Necropsy
Opsins - genetics
Opsins - metabolism
Retina
Retina - metabolism
Retinitis pigmentosa
Side effects
Toxicity
title Safety of intravitreally delivered AAV2 vector‐mediated multi‐characteristic opsin genetic construct in wild type beagle dogs
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T19%3A42%3A46IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Safety%20of%20intravitreally%20delivered%20AAV2%20vector%E2%80%90mediated%20multi%E2%80%90characteristic%20opsin%20genetic%20construct%20in%20wild%20type%20beagle%20dogs&rft.jtitle=The%20journal%20of%20gene%20medicine&rft.au=Mohanty,%20Samarendra&rft.date=2024-07&rft.volume=26&rft.issue=7&rft.spage=e3720&rft.epage=n/a&rft.pages=e3720-n/a&rft.issn=1099-498X&rft.eissn=1521-2254&rft_id=info:doi/10.1002/jgm.3720&rft_dat=%3Cproquest_cross%3E3084362023%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3084362023&rft_id=info:pmid/39041639&rfr_iscdi=true