Altered Immunity of Laboratory Mice in the Natural Environment Is Associated with Fungal Colonization

Free-living mammals, such as humans and wild mice, display heightened immune activation compared with artificially maintained laboratory mice. These differences are partially attributed to microbial exposure as laboratory mice infected with pathogens exhibit immune profiles more closely resembling t...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Cell host & microbe 2020-05, Vol.27 (5), p.809-822.e6
Hauptverfasser: Yeung, Frank, Chen, Ying-Han, Lin, Jian-Da, Leung, Jacqueline M., McCauley, Caroline, Devlin, Joseph C., Hansen, Christina, Cronkite, Alex, Stephens, Zac, Drake-Dunn, Charlotte, Fulmer, Yi, Shopsin, Bo, Ruggles, Kelly V., Round, June L., Loke, P’ng, Graham, Andrea L., Cadwell, Ken
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 822.e6
container_issue 5
container_start_page 809
container_title Cell host & microbe
container_volume 27
creator Yeung, Frank
Chen, Ying-Han
Lin, Jian-Da
Leung, Jacqueline M.
McCauley, Caroline
Devlin, Joseph C.
Hansen, Christina
Cronkite, Alex
Stephens, Zac
Drake-Dunn, Charlotte
Fulmer, Yi
Shopsin, Bo
Ruggles, Kelly V.
Round, June L.
Loke, P’ng
Graham, Andrea L.
Cadwell, Ken
description Free-living mammals, such as humans and wild mice, display heightened immune activation compared with artificially maintained laboratory mice. These differences are partially attributed to microbial exposure as laboratory mice infected with pathogens exhibit immune profiles more closely resembling that of free-living animals. Here, we examine how colonization by microorganisms within the natural environment contributes to immune system maturation by releasing inbred laboratory mice into an outdoor enclosure. In addition to enhancing differentiation of T cell populations previously associated with pathogen exposure, outdoor release increased circulating granulocytes. However, these “rewilded” mice were not infected by pathogens previously implicated in immune activation. Rather, immune system changes were associated with altered microbiota composition with notable increases in intestinal fungi. Fungi isolated from rewilded mice were sufficient in increasing circulating granulocytes. These findings establish a model to investigate how the natural environment impacts immune development and show that sustained fungal exposure impacts granulocyte numbers. [Display omitted] •Controlled release of lab mice into the wild alters the state of the immune system•Rewilded mice harbor an altered microbiota including increases in intestinal fungi•Fungi from rewilded mice induce granulocyte expansion in laboratory mice Laboratory mice are maintained in artificial conditions that potentially impact immunity. In this issue of Cell Host & Microbe, Yeung et al. (2020) demonstrate that mice released into a wild enclosure display increases in circulating granulocytes that are associated with an altered microbiota, notably expansion of fungi.
doi_str_mv 10.1016/j.chom.2020.02.015
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7276265</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1931312820301232</els_id><sourcerecordid>2383511107</sourcerecordid><originalsourceid>FETCH-LOGICAL-c455t-916091437eb19b3106260426b8f81e14b687ab0bdc969bfa4d99d8367be70eea3</originalsourceid><addsrcrecordid>eNp9kc1u1DAURi0EoqXwAiyQl2wS_JM4sYSQRqMWRhpgA2vLdm46HiV2sZ2phqfHw5QKNqxsyed-95MPQq8pqSmh4t2-trsw14wwUhNWE9o-QZdU8qYSRMinv--04pT1F-hFSntC2pZ09Dm64IwR2XB2iWA1ZYgw4M08L97lIw4j3moTos4hHvFnZwE7j_MO8Bedl6gnfO0PLgY_g894k_AqpWCdziXk3uUdvln8baHWYQre_dTZBf8SPRv1lODVw3mFvt9cf1t_qrZfP27Wq21lm7bNlaSCSNrwDgyVhlMimCANE6Yfewq0MaLvtCFmsFJIM-pmkHLouegMdARA8yv04Zx7t5gZBlsalsLqLrpZx6MK2ql_X7zbqdtwUB3ryq62BLx9CIjhxwIpq9klC9OkPYQlKcZ73lJKSVdQdkZtDClFGB_XUKJOftRenfyokx9FmCp-ytCbvws-jvwRUoD3ZwDKNx0cRJWsA29hcBFsVkNw_8v_BVQtow8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2383511107</pqid></control><display><type>article</type><title>Altered Immunity of Laboratory Mice in the Natural Environment Is Associated with Fungal Colonization</title><source>MEDLINE</source><source>Cell Press Archives</source><source>Elsevier ScienceDirect Journals</source><source>EZB Electronic Journals Library</source><creator>Yeung, Frank ; Chen, Ying-Han ; Lin, Jian-Da ; Leung, Jacqueline M. ; McCauley, Caroline ; Devlin, Joseph C. ; Hansen, Christina ; Cronkite, Alex ; Stephens, Zac ; Drake-Dunn, Charlotte ; Fulmer, Yi ; Shopsin, Bo ; Ruggles, Kelly V. ; Round, June L. ; Loke, P’ng ; Graham, Andrea L. ; Cadwell, Ken</creator><creatorcontrib>Yeung, Frank ; Chen, Ying-Han ; Lin, Jian-Da ; Leung, Jacqueline M. ; McCauley, Caroline ; Devlin, Joseph C. ; Hansen, Christina ; Cronkite, Alex ; Stephens, Zac ; Drake-Dunn, Charlotte ; Fulmer, Yi ; Shopsin, Bo ; Ruggles, Kelly V. ; Round, June L. ; Loke, P’ng ; Graham, Andrea L. ; Cadwell, Ken</creatorcontrib><description>Free-living mammals, such as humans and wild mice, display heightened immune activation compared with artificially maintained laboratory mice. These differences are partially attributed to microbial exposure as laboratory mice infected with pathogens exhibit immune profiles more closely resembling that of free-living animals. Here, we examine how colonization by microorganisms within the natural environment contributes to immune system maturation by releasing inbred laboratory mice into an outdoor enclosure. In addition to enhancing differentiation of T cell populations previously associated with pathogen exposure, outdoor release increased circulating granulocytes. However, these “rewilded” mice were not infected by pathogens previously implicated in immune activation. Rather, immune system changes were associated with altered microbiota composition with notable increases in intestinal fungi. Fungi isolated from rewilded mice were sufficient in increasing circulating granulocytes. These findings establish a model to investigate how the natural environment impacts immune development and show that sustained fungal exposure impacts granulocyte numbers. [Display omitted] •Controlled release of lab mice into the wild alters the state of the immune system•Rewilded mice harbor an altered microbiota including increases in intestinal fungi•Fungi from rewilded mice induce granulocyte expansion in laboratory mice Laboratory mice are maintained in artificial conditions that potentially impact immunity. In this issue of Cell Host &amp; Microbe, Yeung et al. (2020) demonstrate that mice released into a wild enclosure display increases in circulating granulocytes that are associated with an altered microbiota, notably expansion of fungi.</description><identifier>ISSN: 1931-3128</identifier><identifier>EISSN: 1934-6069</identifier><identifier>DOI: 10.1016/j.chom.2020.02.015</identifier><identifier>PMID: 32209432</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Animals ; Aspergillus ; Autophagy-Related Proteins - genetics ; CD8-Positive T-Lymphocytes ; Environment ; Feces - microbiology ; Female ; fungi ; Fungi - genetics ; Fungi - growth &amp; development ; Fungi - isolation &amp; purification ; Fungi - physiology ; Gastrointestinal Microbiome - immunology ; granulocytes ; Granulocytes - immunology ; Immune System ; Intestines - microbiology ; Intestines - pathology ; laboratory mice ; Lymphocytes ; Male ; mesocosm ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; microbiota ; Mycobiome - immunology ; Mycobiome - physiology ; mycobiota ; neutrophils ; Nod2 Signaling Adaptor Protein - genetics ; rewilding ; wild mice</subject><ispartof>Cell host &amp; microbe, 2020-05, Vol.27 (5), p.809-822.e6</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-916091437eb19b3106260426b8f81e14b687ab0bdc969bfa4d99d8367be70eea3</citedby><cites>FETCH-LOGICAL-c455t-916091437eb19b3106260426b8f81e14b687ab0bdc969bfa4d99d8367be70eea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1931312820301232$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32209432$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yeung, Frank</creatorcontrib><creatorcontrib>Chen, Ying-Han</creatorcontrib><creatorcontrib>Lin, Jian-Da</creatorcontrib><creatorcontrib>Leung, Jacqueline M.</creatorcontrib><creatorcontrib>McCauley, Caroline</creatorcontrib><creatorcontrib>Devlin, Joseph C.</creatorcontrib><creatorcontrib>Hansen, Christina</creatorcontrib><creatorcontrib>Cronkite, Alex</creatorcontrib><creatorcontrib>Stephens, Zac</creatorcontrib><creatorcontrib>Drake-Dunn, Charlotte</creatorcontrib><creatorcontrib>Fulmer, Yi</creatorcontrib><creatorcontrib>Shopsin, Bo</creatorcontrib><creatorcontrib>Ruggles, Kelly V.</creatorcontrib><creatorcontrib>Round, June L.</creatorcontrib><creatorcontrib>Loke, P’ng</creatorcontrib><creatorcontrib>Graham, Andrea L.</creatorcontrib><creatorcontrib>Cadwell, Ken</creatorcontrib><title>Altered Immunity of Laboratory Mice in the Natural Environment Is Associated with Fungal Colonization</title><title>Cell host &amp; microbe</title><addtitle>Cell Host Microbe</addtitle><description>Free-living mammals, such as humans and wild mice, display heightened immune activation compared with artificially maintained laboratory mice. These differences are partially attributed to microbial exposure as laboratory mice infected with pathogens exhibit immune profiles more closely resembling that of free-living animals. Here, we examine how colonization by microorganisms within the natural environment contributes to immune system maturation by releasing inbred laboratory mice into an outdoor enclosure. In addition to enhancing differentiation of T cell populations previously associated with pathogen exposure, outdoor release increased circulating granulocytes. However, these “rewilded” mice were not infected by pathogens previously implicated in immune activation. Rather, immune system changes were associated with altered microbiota composition with notable increases in intestinal fungi. Fungi isolated from rewilded mice were sufficient in increasing circulating granulocytes. These findings establish a model to investigate how the natural environment impacts immune development and show that sustained fungal exposure impacts granulocyte numbers. [Display omitted] •Controlled release of lab mice into the wild alters the state of the immune system•Rewilded mice harbor an altered microbiota including increases in intestinal fungi•Fungi from rewilded mice induce granulocyte expansion in laboratory mice Laboratory mice are maintained in artificial conditions that potentially impact immunity. In this issue of Cell Host &amp; Microbe, Yeung et al. (2020) demonstrate that mice released into a wild enclosure display increases in circulating granulocytes that are associated with an altered microbiota, notably expansion of fungi.</description><subject>Animals</subject><subject>Aspergillus</subject><subject>Autophagy-Related Proteins - genetics</subject><subject>CD8-Positive T-Lymphocytes</subject><subject>Environment</subject><subject>Feces - microbiology</subject><subject>Female</subject><subject>fungi</subject><subject>Fungi - genetics</subject><subject>Fungi - growth &amp; development</subject><subject>Fungi - isolation &amp; purification</subject><subject>Fungi - physiology</subject><subject>Gastrointestinal Microbiome - immunology</subject><subject>granulocytes</subject><subject>Granulocytes - immunology</subject><subject>Immune System</subject><subject>Intestines - microbiology</subject><subject>Intestines - pathology</subject><subject>laboratory mice</subject><subject>Lymphocytes</subject><subject>Male</subject><subject>mesocosm</subject><subject>Mice</subject><subject>Mice, Inbred C57BL</subject><subject>Mice, Knockout</subject><subject>microbiota</subject><subject>Mycobiome - immunology</subject><subject>Mycobiome - physiology</subject><subject>mycobiota</subject><subject>neutrophils</subject><subject>Nod2 Signaling Adaptor Protein - genetics</subject><subject>rewilding</subject><subject>wild mice</subject><issn>1931-3128</issn><issn>1934-6069</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAURi0EoqXwAiyQl2wS_JM4sYSQRqMWRhpgA2vLdm46HiV2sZ2phqfHw5QKNqxsyed-95MPQq8pqSmh4t2-trsw14wwUhNWE9o-QZdU8qYSRMinv--04pT1F-hFSntC2pZ09Dm64IwR2XB2iWA1ZYgw4M08L97lIw4j3moTos4hHvFnZwE7j_MO8Bedl6gnfO0PLgY_g894k_AqpWCdziXk3uUdvln8baHWYQre_dTZBf8SPRv1lODVw3mFvt9cf1t_qrZfP27Wq21lm7bNlaSCSNrwDgyVhlMimCANE6Yfewq0MaLvtCFmsFJIM-pmkHLouegMdARA8yv04Zx7t5gZBlsalsLqLrpZx6MK2ql_X7zbqdtwUB3ryq62BLx9CIjhxwIpq9klC9OkPYQlKcZ73lJKSVdQdkZtDClFGB_XUKJOftRenfyokx9FmCp-ytCbvws-jvwRUoD3ZwDKNx0cRJWsA29hcBFsVkNw_8v_BVQtow8</recordid><startdate>20200513</startdate><enddate>20200513</enddate><creator>Yeung, Frank</creator><creator>Chen, Ying-Han</creator><creator>Lin, Jian-Da</creator><creator>Leung, Jacqueline M.</creator><creator>McCauley, Caroline</creator><creator>Devlin, Joseph C.</creator><creator>Hansen, Christina</creator><creator>Cronkite, Alex</creator><creator>Stephens, Zac</creator><creator>Drake-Dunn, Charlotte</creator><creator>Fulmer, Yi</creator><creator>Shopsin, Bo</creator><creator>Ruggles, Kelly V.</creator><creator>Round, June L.</creator><creator>Loke, P’ng</creator><creator>Graham, Andrea L.</creator><creator>Cadwell, Ken</creator><general>Elsevier 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>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200513</creationdate><title>Altered Immunity of Laboratory Mice in the Natural Environment Is Associated with Fungal Colonization</title><author>Yeung, Frank ; Chen, Ying-Han ; Lin, Jian-Da ; Leung, Jacqueline M. ; McCauley, Caroline ; Devlin, Joseph C. ; Hansen, Christina ; Cronkite, Alex ; Stephens, Zac ; Drake-Dunn, Charlotte ; Fulmer, Yi ; Shopsin, Bo ; Ruggles, Kelly V. ; Round, June L. ; Loke, P’ng ; Graham, Andrea L. ; Cadwell, Ken</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-916091437eb19b3106260426b8f81e14b687ab0bdc969bfa4d99d8367be70eea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Animals</topic><topic>Aspergillus</topic><topic>Autophagy-Related Proteins - genetics</topic><topic>CD8-Positive T-Lymphocytes</topic><topic>Environment</topic><topic>Feces - microbiology</topic><topic>Female</topic><topic>fungi</topic><topic>Fungi - genetics</topic><topic>Fungi - growth &amp; development</topic><topic>Fungi - isolation &amp; purification</topic><topic>Fungi - physiology</topic><topic>Gastrointestinal Microbiome - immunology</topic><topic>granulocytes</topic><topic>Granulocytes - immunology</topic><topic>Immune System</topic><topic>Intestines - microbiology</topic><topic>Intestines - pathology</topic><topic>laboratory mice</topic><topic>Lymphocytes</topic><topic>Male</topic><topic>mesocosm</topic><topic>Mice</topic><topic>Mice, Inbred C57BL</topic><topic>Mice, Knockout</topic><topic>microbiota</topic><topic>Mycobiome - immunology</topic><topic>Mycobiome - physiology</topic><topic>mycobiota</topic><topic>neutrophils</topic><topic>Nod2 Signaling Adaptor Protein - genetics</topic><topic>rewilding</topic><topic>wild mice</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yeung, Frank</creatorcontrib><creatorcontrib>Chen, Ying-Han</creatorcontrib><creatorcontrib>Lin, Jian-Da</creatorcontrib><creatorcontrib>Leung, Jacqueline M.</creatorcontrib><creatorcontrib>McCauley, Caroline</creatorcontrib><creatorcontrib>Devlin, Joseph C.</creatorcontrib><creatorcontrib>Hansen, Christina</creatorcontrib><creatorcontrib>Cronkite, Alex</creatorcontrib><creatorcontrib>Stephens, Zac</creatorcontrib><creatorcontrib>Drake-Dunn, Charlotte</creatorcontrib><creatorcontrib>Fulmer, Yi</creatorcontrib><creatorcontrib>Shopsin, Bo</creatorcontrib><creatorcontrib>Ruggles, Kelly V.</creatorcontrib><creatorcontrib>Round, June L.</creatorcontrib><creatorcontrib>Loke, P’ng</creatorcontrib><creatorcontrib>Graham, Andrea L.</creatorcontrib><creatorcontrib>Cadwell, Ken</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cell host &amp; microbe</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yeung, Frank</au><au>Chen, Ying-Han</au><au>Lin, Jian-Da</au><au>Leung, Jacqueline M.</au><au>McCauley, Caroline</au><au>Devlin, Joseph C.</au><au>Hansen, Christina</au><au>Cronkite, Alex</au><au>Stephens, Zac</au><au>Drake-Dunn, Charlotte</au><au>Fulmer, Yi</au><au>Shopsin, Bo</au><au>Ruggles, Kelly V.</au><au>Round, June L.</au><au>Loke, P’ng</au><au>Graham, Andrea L.</au><au>Cadwell, Ken</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Altered Immunity of Laboratory Mice in the Natural Environment Is Associated with Fungal Colonization</atitle><jtitle>Cell host &amp; microbe</jtitle><addtitle>Cell Host Microbe</addtitle><date>2020-05-13</date><risdate>2020</risdate><volume>27</volume><issue>5</issue><spage>809</spage><epage>822.e6</epage><pages>809-822.e6</pages><issn>1931-3128</issn><eissn>1934-6069</eissn><abstract>Free-living mammals, such as humans and wild mice, display heightened immune activation compared with artificially maintained laboratory mice. These differences are partially attributed to microbial exposure as laboratory mice infected with pathogens exhibit immune profiles more closely resembling that of free-living animals. Here, we examine how colonization by microorganisms within the natural environment contributes to immune system maturation by releasing inbred laboratory mice into an outdoor enclosure. In addition to enhancing differentiation of T cell populations previously associated with pathogen exposure, outdoor release increased circulating granulocytes. However, these “rewilded” mice were not infected by pathogens previously implicated in immune activation. Rather, immune system changes were associated with altered microbiota composition with notable increases in intestinal fungi. Fungi isolated from rewilded mice were sufficient in increasing circulating granulocytes. These findings establish a model to investigate how the natural environment impacts immune development and show that sustained fungal exposure impacts granulocyte numbers. [Display omitted] •Controlled release of lab mice into the wild alters the state of the immune system•Rewilded mice harbor an altered microbiota including increases in intestinal fungi•Fungi from rewilded mice induce granulocyte expansion in laboratory mice Laboratory mice are maintained in artificial conditions that potentially impact immunity. In this issue of Cell Host &amp; Microbe, Yeung et al. (2020) demonstrate that mice released into a wild enclosure display increases in circulating granulocytes that are associated with an altered microbiota, notably expansion of fungi.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32209432</pmid><doi>10.1016/j.chom.2020.02.015</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1931-3128
ispartof Cell host & microbe, 2020-05, Vol.27 (5), p.809-822.e6
issn 1931-3128
1934-6069
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7276265
source MEDLINE; Cell Press Archives; Elsevier ScienceDirect Journals; EZB Electronic Journals Library
subjects Animals
Aspergillus
Autophagy-Related Proteins - genetics
CD8-Positive T-Lymphocytes
Environment
Feces - microbiology
Female
fungi
Fungi - genetics
Fungi - growth & development
Fungi - isolation & purification
Fungi - physiology
Gastrointestinal Microbiome - immunology
granulocytes
Granulocytes - immunology
Immune System
Intestines - microbiology
Intestines - pathology
laboratory mice
Lymphocytes
Male
mesocosm
Mice
Mice, Inbred C57BL
Mice, Knockout
microbiota
Mycobiome - immunology
Mycobiome - physiology
mycobiota
neutrophils
Nod2 Signaling Adaptor Protein - genetics
rewilding
wild mice
title Altered Immunity of Laboratory Mice in the Natural Environment Is Associated with Fungal Colonization
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-12T00%3A14%3A46IST&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=Altered%20Immunity%20of%20Laboratory%20Mice%20in%20the%20Natural%20Environment%20Is%20Associated%20with%20Fungal%20Colonization&rft.jtitle=Cell%20host%20&%20microbe&rft.au=Yeung,%20Frank&rft.date=2020-05-13&rft.volume=27&rft.issue=5&rft.spage=809&rft.epage=822.e6&rft.pages=809-822.e6&rft.issn=1931-3128&rft.eissn=1934-6069&rft_id=info:doi/10.1016/j.chom.2020.02.015&rft_dat=%3Cproquest_pubme%3E2383511107%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=2383511107&rft_id=info:pmid/32209432&rft_els_id=S1931312820301232&rfr_iscdi=true