Architectural Modification of Conformal PEG‐Bottlebrush Coatings Minimizes Anti‐PEG Antigenicity While Preserving Stealth Properties
Poly(ethylene glycol) (PEG), a linear polymer known for its “stealth” properties, is commonly used to passivate the surface of biomedical implants and devices, and it is conjugated to biologic drugs to improve their pharmacokinetics. However, its antigenicity is a growing concern. Here, the antigeni...
Gespeichert in:
Veröffentlicht in: | Advanced healthcare materials 2019-04, Vol.8 (8), p.e1801177-n/a |
---|---|
Hauptverfasser: | , , , , , , , , , , , |
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 | 8 |
container_start_page | e1801177 |
container_title | Advanced healthcare materials |
container_volume | 8 |
creator | Joh, Daniel Y. Zimmers, Zackary Avlani, Manav Heggestad, Jacob T. Aydin, Hakan B. Ganson, Nancy Kumar, Shourya Fontes, Cassio M. Achar, Rohan K. Hershfield, Michael S. Hucknall, Angus M. Chilkoti, Ashutosh |
description | Poly(ethylene glycol) (PEG), a linear polymer known for its “stealth” properties, is commonly used to passivate the surface of biomedical implants and devices, and it is conjugated to biologic drugs to improve their pharmacokinetics. However, its antigenicity is a growing concern. Here, the antigenicity of PEG is investigated when assembled in a poly(oligoethylene glycol) methacrylate (POEGMA) “bottlebrush” configuration on a planar surface. Using ethylene glycol (EG) repeat lengths of the POEGMA sidechains as a tunable parameter for optimization, POEGMA brushes with sidechain lengths of two and three EG repeats are identified as the optimal polymer architecture to minimize binding of anti‐PEG antibodies (APAs), while retaining resistance to nonspecific binding by bovine serum albumin and cultured cells. Binding of backbone‐ versus endgroup‐selective APAs to POEGMA brushes is further investigated, and finally the antigenicity of POEGMA coatings is assessed against APA‐positive clinical plasma samples. These results are applied toward fabricating immunoassays on POEGMA surfaces with minimal reactivity toward APAs while retaining a low limit‐of‐detection for the analyte. Taken together, these results offer useful design concepts to reduce the antigenicity of polymer brush‐based surface coatings used in applications involving human or animal matrices.
The antigenicity of poly(oligoethylene glycol) methacrylate (POEGMA) bottlebrushes against anti‐PEG antibodies (APAs) is investigated for conformal POEGMA films grown from planar surfaces. By tuning the number of ethylene glycol (EG) repeats of POEGMA sidechains, it is shown that POEGMA brushes with two or three EG repeats minimize reactivity toward APAs while exhibiting resistance to nonspecific binding. |
doi_str_mv | 10.1002/adhm.201801177 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6819148</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2213748142</sourcerecordid><originalsourceid>FETCH-LOGICAL-c6167-8ea6e281a4be9a8748b6c75c4bd0ee6ac24fcf5c448fbd490ea0e545c681c1763</originalsourceid><addsrcrecordid>eNqFkcFu1DAQhi0EolXplSOKxHkX2-s4zgVp2ZYWqSsqAeJoOc5k4yqxF9spWk4cOfKMPAlTtixwwhePPd_8nvFPyFNG54xS_sK0_TjnlCnKWFU9IMec1XzGZVk_PMSCHpHTlG4oLlkyqdhjcrSgNVU15cfk2zLa3mWweYpmKNahdZ2zJrvgi9AVq-C7EEfMXJ9f_Pj6_VXIeYAmTqnHHGJ-k4q18250XyAVS58dUsj-CjfgnXV5V3zs3QDFdYQE8RZrincZzJB7vApbiNlBekIedWZIcHq_n5APr8_fry5nV28v3qyWVzMrmaxmCowErpgRDdRGVUI10lalFU1LAaSxXHS2w7NQXdOKmoKhUIrS4uCWVXJxQl7udbdTM0JrwWccXG-jG03c6WCc_jfjXa834VajQM2EQoHn9wIxfJogZX0TpuixZ805W2BHTHCk5nvKxpBShO7wAqP6zjx9Z54-mIcFz_7u64D_tgqBeg98xr_c_UdOL88u13_EfwItwqwA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2213748142</pqid></control><display><type>article</type><title>Architectural Modification of Conformal PEG‐Bottlebrush Coatings Minimizes Anti‐PEG Antigenicity While Preserving Stealth Properties</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Joh, Daniel Y. ; Zimmers, Zackary ; Avlani, Manav ; Heggestad, Jacob T. ; Aydin, Hakan B. ; Ganson, Nancy ; Kumar, Shourya ; Fontes, Cassio M. ; Achar, Rohan K. ; Hershfield, Michael S. ; Hucknall, Angus M. ; Chilkoti, Ashutosh</creator><creatorcontrib>Joh, Daniel Y. ; Zimmers, Zackary ; Avlani, Manav ; Heggestad, Jacob T. ; Aydin, Hakan B. ; Ganson, Nancy ; Kumar, Shourya ; Fontes, Cassio M. ; Achar, Rohan K. ; Hershfield, Michael S. ; Hucknall, Angus M. ; Chilkoti, Ashutosh</creatorcontrib><description>Poly(ethylene glycol) (PEG), a linear polymer known for its “stealth” properties, is commonly used to passivate the surface of biomedical implants and devices, and it is conjugated to biologic drugs to improve their pharmacokinetics. However, its antigenicity is a growing concern. Here, the antigenicity of PEG is investigated when assembled in a poly(oligoethylene glycol) methacrylate (POEGMA) “bottlebrush” configuration on a planar surface. Using ethylene glycol (EG) repeat lengths of the POEGMA sidechains as a tunable parameter for optimization, POEGMA brushes with sidechain lengths of two and three EG repeats are identified as the optimal polymer architecture to minimize binding of anti‐PEG antibodies (APAs), while retaining resistance to nonspecific binding by bovine serum albumin and cultured cells. Binding of backbone‐ versus endgroup‐selective APAs to POEGMA brushes is further investigated, and finally the antigenicity of POEGMA coatings is assessed against APA‐positive clinical plasma samples. These results are applied toward fabricating immunoassays on POEGMA surfaces with minimal reactivity toward APAs while retaining a low limit‐of‐detection for the analyte. Taken together, these results offer useful design concepts to reduce the antigenicity of polymer brush‐based surface coatings used in applications involving human or animal matrices.
The antigenicity of poly(oligoethylene glycol) methacrylate (POEGMA) bottlebrushes against anti‐PEG antibodies (APAs) is investigated for conformal POEGMA films grown from planar surfaces. By tuning the number of ethylene glycol (EG) repeats of POEGMA sidechains, it is shown that POEGMA brushes with two or three EG repeats minimize reactivity toward APAs while exhibiting resistance to nonspecific binding.</description><identifier>ISSN: 2192-2640</identifier><identifier>EISSN: 2192-2659</identifier><identifier>DOI: 10.1002/adhm.201801177</identifier><identifier>PMID: 30908902</identifier><language>eng</language><publisher>Germany: Wiley Subscription Services, Inc</publisher><subject>Antibodies ; Antigenicity ; anti‐PEG ; Binding ; biofouling ; Bovine serum albumin ; Brushes ; Coatings ; Immunoassays ; Optimization ; Pharmacokinetics ; Pharmacology ; POEGMA ; Polyethylene glycol ; polymer brushes ; Polymers ; Serum albumin ; Surgical implants</subject><ispartof>Advanced healthcare materials, 2019-04, Vol.8 (8), p.e1801177-n/a</ispartof><rights>2019 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim</rights><rights>2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6167-8ea6e281a4be9a8748b6c75c4bd0ee6ac24fcf5c448fbd490ea0e545c681c1763</citedby><cites>FETCH-LOGICAL-c6167-8ea6e281a4be9a8748b6c75c4bd0ee6ac24fcf5c448fbd490ea0e545c681c1763</cites><orcidid>0000-0003-1301-1836 ; 0000-0002-1569-2228</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fadhm.201801177$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fadhm.201801177$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30908902$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Joh, Daniel Y.</creatorcontrib><creatorcontrib>Zimmers, Zackary</creatorcontrib><creatorcontrib>Avlani, Manav</creatorcontrib><creatorcontrib>Heggestad, Jacob T.</creatorcontrib><creatorcontrib>Aydin, Hakan B.</creatorcontrib><creatorcontrib>Ganson, Nancy</creatorcontrib><creatorcontrib>Kumar, Shourya</creatorcontrib><creatorcontrib>Fontes, Cassio M.</creatorcontrib><creatorcontrib>Achar, Rohan K.</creatorcontrib><creatorcontrib>Hershfield, Michael S.</creatorcontrib><creatorcontrib>Hucknall, Angus M.</creatorcontrib><creatorcontrib>Chilkoti, Ashutosh</creatorcontrib><title>Architectural Modification of Conformal PEG‐Bottlebrush Coatings Minimizes Anti‐PEG Antigenicity While Preserving Stealth Properties</title><title>Advanced healthcare materials</title><addtitle>Adv Healthc Mater</addtitle><description>Poly(ethylene glycol) (PEG), a linear polymer known for its “stealth” properties, is commonly used to passivate the surface of biomedical implants and devices, and it is conjugated to biologic drugs to improve their pharmacokinetics. However, its antigenicity is a growing concern. Here, the antigenicity of PEG is investigated when assembled in a poly(oligoethylene glycol) methacrylate (POEGMA) “bottlebrush” configuration on a planar surface. Using ethylene glycol (EG) repeat lengths of the POEGMA sidechains as a tunable parameter for optimization, POEGMA brushes with sidechain lengths of two and three EG repeats are identified as the optimal polymer architecture to minimize binding of anti‐PEG antibodies (APAs), while retaining resistance to nonspecific binding by bovine serum albumin and cultured cells. Binding of backbone‐ versus endgroup‐selective APAs to POEGMA brushes is further investigated, and finally the antigenicity of POEGMA coatings is assessed against APA‐positive clinical plasma samples. These results are applied toward fabricating immunoassays on POEGMA surfaces with minimal reactivity toward APAs while retaining a low limit‐of‐detection for the analyte. Taken together, these results offer useful design concepts to reduce the antigenicity of polymer brush‐based surface coatings used in applications involving human or animal matrices.
The antigenicity of poly(oligoethylene glycol) methacrylate (POEGMA) bottlebrushes against anti‐PEG antibodies (APAs) is investigated for conformal POEGMA films grown from planar surfaces. By tuning the number of ethylene glycol (EG) repeats of POEGMA sidechains, it is shown that POEGMA brushes with two or three EG repeats minimize reactivity toward APAs while exhibiting resistance to nonspecific binding.</description><subject>Antibodies</subject><subject>Antigenicity</subject><subject>anti‐PEG</subject><subject>Binding</subject><subject>biofouling</subject><subject>Bovine serum albumin</subject><subject>Brushes</subject><subject>Coatings</subject><subject>Immunoassays</subject><subject>Optimization</subject><subject>Pharmacokinetics</subject><subject>Pharmacology</subject><subject>POEGMA</subject><subject>Polyethylene glycol</subject><subject>polymer brushes</subject><subject>Polymers</subject><subject>Serum albumin</subject><subject>Surgical implants</subject><issn>2192-2640</issn><issn>2192-2659</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNqFkcFu1DAQhi0EolXplSOKxHkX2-s4zgVp2ZYWqSsqAeJoOc5k4yqxF9spWk4cOfKMPAlTtixwwhePPd_8nvFPyFNG54xS_sK0_TjnlCnKWFU9IMec1XzGZVk_PMSCHpHTlG4oLlkyqdhjcrSgNVU15cfk2zLa3mWweYpmKNahdZ2zJrvgi9AVq-C7EEfMXJ9f_Pj6_VXIeYAmTqnHHGJ-k4q18250XyAVS58dUsj-CjfgnXV5V3zs3QDFdYQE8RZrincZzJB7vApbiNlBekIedWZIcHq_n5APr8_fry5nV28v3qyWVzMrmaxmCowErpgRDdRGVUI10lalFU1LAaSxXHS2w7NQXdOKmoKhUIrS4uCWVXJxQl7udbdTM0JrwWccXG-jG03c6WCc_jfjXa834VajQM2EQoHn9wIxfJogZX0TpuixZ805W2BHTHCk5nvKxpBShO7wAqP6zjx9Z54-mIcFz_7u64D_tgqBeg98xr_c_UdOL88u13_EfwItwqwA</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Joh, Daniel Y.</creator><creator>Zimmers, Zackary</creator><creator>Avlani, Manav</creator><creator>Heggestad, Jacob T.</creator><creator>Aydin, Hakan B.</creator><creator>Ganson, Nancy</creator><creator>Kumar, Shourya</creator><creator>Fontes, Cassio M.</creator><creator>Achar, Rohan K.</creator><creator>Hershfield, Michael S.</creator><creator>Hucknall, Angus M.</creator><creator>Chilkoti, Ashutosh</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QF</scope><scope>7QP</scope><scope>7QQ</scope><scope>7SC</scope><scope>7SE</scope><scope>7SP</scope><scope>7SR</scope><scope>7T5</scope><scope>7TA</scope><scope>7TB</scope><scope>7TM</scope><scope>7TO</scope><scope>7U5</scope><scope>8BQ</scope><scope>8FD</scope><scope>F28</scope><scope>FR3</scope><scope>H8D</scope><scope>H8G</scope><scope>H94</scope><scope>JG9</scope><scope>JQ2</scope><scope>K9.</scope><scope>KR7</scope><scope>L7M</scope><scope>L~C</scope><scope>L~D</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1301-1836</orcidid><orcidid>https://orcid.org/0000-0002-1569-2228</orcidid></search><sort><creationdate>20190401</creationdate><title>Architectural Modification of Conformal PEG‐Bottlebrush Coatings Minimizes Anti‐PEG Antigenicity While Preserving Stealth Properties</title><author>Joh, Daniel Y. ; Zimmers, Zackary ; Avlani, Manav ; Heggestad, Jacob T. ; Aydin, Hakan B. ; Ganson, Nancy ; Kumar, Shourya ; Fontes, Cassio M. ; Achar, Rohan K. ; Hershfield, Michael S. ; Hucknall, Angus M. ; Chilkoti, Ashutosh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c6167-8ea6e281a4be9a8748b6c75c4bd0ee6ac24fcf5c448fbd490ea0e545c681c1763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Antibodies</topic><topic>Antigenicity</topic><topic>anti‐PEG</topic><topic>Binding</topic><topic>biofouling</topic><topic>Bovine serum albumin</topic><topic>Brushes</topic><topic>Coatings</topic><topic>Immunoassays</topic><topic>Optimization</topic><topic>Pharmacokinetics</topic><topic>Pharmacology</topic><topic>POEGMA</topic><topic>Polyethylene glycol</topic><topic>polymer brushes</topic><topic>Polymers</topic><topic>Serum albumin</topic><topic>Surgical implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Joh, Daniel Y.</creatorcontrib><creatorcontrib>Zimmers, Zackary</creatorcontrib><creatorcontrib>Avlani, Manav</creatorcontrib><creatorcontrib>Heggestad, Jacob T.</creatorcontrib><creatorcontrib>Aydin, Hakan B.</creatorcontrib><creatorcontrib>Ganson, Nancy</creatorcontrib><creatorcontrib>Kumar, Shourya</creatorcontrib><creatorcontrib>Fontes, Cassio M.</creatorcontrib><creatorcontrib>Achar, Rohan K.</creatorcontrib><creatorcontrib>Hershfield, Michael S.</creatorcontrib><creatorcontrib>Hucknall, Angus M.</creatorcontrib><creatorcontrib>Chilkoti, Ashutosh</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Aluminium Industry Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Ceramic Abstracts</collection><collection>Computer and Information Systems Abstracts</collection><collection>Corrosion Abstracts</collection><collection>Electronics & Communications Abstracts</collection><collection>Engineered Materials Abstracts</collection><collection>Immunology Abstracts</collection><collection>Materials Business File</collection><collection>Mechanical & Transportation Engineering Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Solid State and Superconductivity Abstracts</collection><collection>METADEX</collection><collection>Technology Research Database</collection><collection>ANTE: Abstracts in New Technology & Engineering</collection><collection>Engineering Research Database</collection><collection>Aerospace Database</collection><collection>Copper Technical Reference Library</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Materials Research Database</collection><collection>ProQuest Computer Science Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Civil Engineering Abstracts</collection><collection>Advanced Technologies Database with Aerospace</collection><collection>Computer and Information Systems Abstracts Academic</collection><collection>Computer and Information Systems Abstracts Professional</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Advanced healthcare materials</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Joh, Daniel Y.</au><au>Zimmers, Zackary</au><au>Avlani, Manav</au><au>Heggestad, Jacob T.</au><au>Aydin, Hakan B.</au><au>Ganson, Nancy</au><au>Kumar, Shourya</au><au>Fontes, Cassio M.</au><au>Achar, Rohan K.</au><au>Hershfield, Michael S.</au><au>Hucknall, Angus M.</au><au>Chilkoti, Ashutosh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Architectural Modification of Conformal PEG‐Bottlebrush Coatings Minimizes Anti‐PEG Antigenicity While Preserving Stealth Properties</atitle><jtitle>Advanced healthcare materials</jtitle><addtitle>Adv Healthc Mater</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>8</volume><issue>8</issue><spage>e1801177</spage><epage>n/a</epage><pages>e1801177-n/a</pages><issn>2192-2640</issn><eissn>2192-2659</eissn><abstract>Poly(ethylene glycol) (PEG), a linear polymer known for its “stealth” properties, is commonly used to passivate the surface of biomedical implants and devices, and it is conjugated to biologic drugs to improve their pharmacokinetics. However, its antigenicity is a growing concern. Here, the antigenicity of PEG is investigated when assembled in a poly(oligoethylene glycol) methacrylate (POEGMA) “bottlebrush” configuration on a planar surface. Using ethylene glycol (EG) repeat lengths of the POEGMA sidechains as a tunable parameter for optimization, POEGMA brushes with sidechain lengths of two and three EG repeats are identified as the optimal polymer architecture to minimize binding of anti‐PEG antibodies (APAs), while retaining resistance to nonspecific binding by bovine serum albumin and cultured cells. Binding of backbone‐ versus endgroup‐selective APAs to POEGMA brushes is further investigated, and finally the antigenicity of POEGMA coatings is assessed against APA‐positive clinical plasma samples. These results are applied toward fabricating immunoassays on POEGMA surfaces with minimal reactivity toward APAs while retaining a low limit‐of‐detection for the analyte. Taken together, these results offer useful design concepts to reduce the antigenicity of polymer brush‐based surface coatings used in applications involving human or animal matrices.
The antigenicity of poly(oligoethylene glycol) methacrylate (POEGMA) bottlebrushes against anti‐PEG antibodies (APAs) is investigated for conformal POEGMA films grown from planar surfaces. By tuning the number of ethylene glycol (EG) repeats of POEGMA sidechains, it is shown that POEGMA brushes with two or three EG repeats minimize reactivity toward APAs while exhibiting resistance to nonspecific binding.</abstract><cop>Germany</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30908902</pmid><doi>10.1002/adhm.201801177</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0003-1301-1836</orcidid><orcidid>https://orcid.org/0000-0002-1569-2228</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 2192-2640 |
ispartof | Advanced healthcare materials, 2019-04, Vol.8 (8), p.e1801177-n/a |
issn | 2192-2640 2192-2659 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6819148 |
source | Wiley Online Library Journals Frontfile Complete |
subjects | Antibodies Antigenicity anti‐PEG Binding biofouling Bovine serum albumin Brushes Coatings Immunoassays Optimization Pharmacokinetics Pharmacology POEGMA Polyethylene glycol polymer brushes Polymers Serum albumin Surgical implants |
title | Architectural Modification of Conformal PEG‐Bottlebrush Coatings Minimizes Anti‐PEG Antigenicity While Preserving Stealth Properties |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T09%3A42%3A19IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Architectural%20Modification%20of%20Conformal%20PEG%E2%80%90Bottlebrush%20Coatings%20Minimizes%20Anti%E2%80%90PEG%20Antigenicity%20While%20Preserving%20Stealth%20Properties&rft.jtitle=Advanced%20healthcare%20materials&rft.au=Joh,%20Daniel%20Y.&rft.date=2019-04-01&rft.volume=8&rft.issue=8&rft.spage=e1801177&rft.epage=n/a&rft.pages=e1801177-n/a&rft.issn=2192-2640&rft.eissn=2192-2659&rft_id=info:doi/10.1002/adhm.201801177&rft_dat=%3Cproquest_pubme%3E2213748142%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2213748142&rft_id=info:pmid/30908902&rfr_iscdi=true |