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Topic:Immune System

The immune system in horses is a complex network of cells, tissues, and organs that work together to protect the body from pathogens, such as bacteria, viruses, and parasites. This system includes both innate and adaptive immune responses, which function to identify and eliminate foreign invaders. The innate immune response provides an immediate, non-specific defense, while the adaptive immune response involves a more targeted and long-lasting protection through the production of antibodies. Key components of the equine immune system include white blood cells, such as lymphocytes and macrophages, as well as various signaling molecules like cytokines. This page compiles peer-reviewed research studies and scholarly articles that explore the structure, function, and regulation of the immune system in horses, with an emphasis on understanding its role in maintaining equine health and its response to diseases.
Science-in-brief: Clinical highlights from 50th Congress of the South African Equine Veterinary Association 2017.
Equine veterinary journal    April 8, 2017   Volume 49, Issue 3 266-268 doi: 10.1111/evj.12678
Miller SM, Spargo KE.No abstract available
From skeletal muscle to stem cells: an innovative and minimally-invasive process for multiple species.
Scientific reports    April 6, 2017   Volume 7, Issue 1 696 doi: 10.1038/s41598-017-00803-7
Ceusters J, Lejeune JP, Sandersen C, Niesten A, Lagneaux L, Serteyn D.Bone marrow and adipose tissue represent the two most commonly exploited sources of adult mesenchymal stem cells for musculoskeletal applications. Unfortunately the sampling of bone marrow and fat tissue is invasive and does not always lead to a sufficient number of cells. The present study describes a novel sampling method based on microbiopsy of skeletal muscle in man, pigs, dogs and horses. The process includes explant of the sample, Percoll density gradient for isolation and subsequent culture of the cells. We further characterized the cells and identified their clonogenic and immunomodula...
Genomic structure of the horse major histocompatibility complex class II region resolved using PacBio long-read sequencing technology.
Scientific reports    March 31, 2017   Volume 7 45518 doi: 10.1038/srep45518
Viļuma A, Mikko S, Hahn D, Skow L, Andersson G, Bergström TF.The mammalian Major Histocompatibility Complex (MHC) region contains several gene families characterized by highly polymorphic loci with extensive nucleotide diversity, copy number variation of paralogous genes, and long repetitive sequences. This structural complexity has made it difficult to construct a reliable reference sequence of the horse MHC region. In this study, we used long-read single molecule, real-time (SMRT) sequencing technology from Pacific Biosciences (PacBio) to sequence eight Bacterial Artificial Chromosome (BAC) clones spanning the horse MHC class II region. The final asse...
Corticosteroids and Immune Suppressive Therapies in Horses.
The Veterinary clinics of North America. Equine practice    March 23, 2017   Volume 33, Issue 1 17-27 doi: 10.1016/j.cveq.2016.11.008
Leclere M.Immune suppressive therapies target exaggerated and deleterious responses of the immune system. Triggered by exogenous or endogenous factors, these improper responses can lead to immune or inflammatory manifestations, such as urticaria, equine asthma, or autoimmune and immune-mediated diseases. Glucocorticoids are the most commonly used immune suppressive drugs and the only ones supported by robust evidence of clinical efficacy in equine medicine. In some conditions, combining glucocorticoids with other pharmacologic and nonpharmacologic treatments, such as azathioprine, antihistamine, broncho...
Mapping B lymphocytes as major reservoirs of naturally occurring latent equine herpesvirus 5 infection.
The Journal of general virology    March 20, 2017   Volume 98, Issue 3 461-470 doi: 10.1099/jgv.0.000668
Mekuria ZH, El-Hage C, Ficorilli NP, Washington EA, Gilkerson JR, Hartley CA.Equine herpesvirus 5 (EHV5) is a commonly detected gammaherpesvirus, which, along with the closely related EHV2, constitute the only two known percaviruses that infect horses. Apart from detection in horse populations worldwide and the recent publication of the whole genome, there is little known about the biology and pathogenesis of this virus, with many assumptions made by parallels with EHV2. The long-term survival of gammaherpesviruses within infected hosts involves the establishment and maintenance of latency in selected cell and tissues types, particularly lymphocytes. A latent gammaherp...
Immune protection against reinfection with nonprimate hepacivirus.
Proceedings of the National Academy of Sciences of the United States of America    March 8, 2017   Volume 114, Issue 12 E2430-E2439 doi: 10.1073/pnas.1619380114
Pfaender S, Walter S, Grabski E, Todt D, Bruening J, Romero-Brey I, Gather T, Brown RJ, Hahn K, Puff C, Pfankuche VM, Hansmann F, Postel A, Becher P....Hepatitis C virus (HCV) displays a restricted host species tropism and only humans and chimpanzees are susceptible to infection. A robust immunocompetent animal model is still lacking, hampering mechanistic analysis of virus pathogenesis, immune control, and prophylactic vaccine development. The closest homolog of HCV is the equine nonprimate hepacivirus (NPHV), which shares similar features with HCV and thus represents an animal model to study hepacivirus infections in their natural hosts. We aimed to dissect equine immune responses after experimental NPHV infection and conducted challenge ex...
Alterations in Intestinal Permeability: The Role of the “Leaky Gut” in Health and Disease.
Journal of equine veterinary science    March 7, 2017   Volume 52 10-22 doi: 10.1016/j.jevs.2017.02.009
Stewart AS, Pratt-Phillips S, Gonzalez LM.All species, including horses, suffer from alterations that increase intestinal permeability. These alterations, also known as "leaky gut," may lead to severe disease as the normal intestinal barrier becomes compromised and can no longer protect against harmful luminal contents including microbial toxins and pathogens. Leaky gut results from a variety of conditions including physical stressors, decreased blood flow to the intestine, inflammatory disease, and pathogenic infections, among others. Several testing methods exist to diagnose these alterations in both a clinical and research setting....
Encysted cyathostomin larvae in foals – progression of stages and the effect of seasonality.
Veterinary parasitology    February 20, 2017   Volume 236 108-112 doi: 10.1016/j.vetpar.2017.02.013
Nielsen MK, Lyons ET.Cyathostomins (small strongyles) are ubiquitous in grazing horses and are known pathogens as cause of larval cyathostominosis. As part of their life cycle, cyathostomin larvae invade the mucosal walls of the large intestines and undergo encystment. Newly ingested third stage larvae are known to undergo arrested development and this can lead to an accumulation of encysted burdens over the course of a grazing season. It is believed that the host immune system plays a significant role in triggering this arrestment. Little is known about the development and progression of larval stages in foals th...
Immune-Mediated Muscle Diseases of the Horse.
Veterinary pathology    January 27, 2017   Volume 55, Issue 1 68-75 doi: 10.1177/0300985816688755
Durward-Akhurst SA, Valberg SJ.In horses, immune-mediated muscle disorders can arise from an overzealous immune response to concurrent infections or potentially from an inherent immune response to host muscle antigens. Streptococcus equi ss. equi infection or vaccination can result in infarctive purpura hemorrhagica (IPH) in which vascular deposition of IgA-streptococcal M protein complexes produces ischemia and complete focal infarction of skeletal muscle and internal organs. In Quarter Horse-related breeds with immune-mediated myositis, an apparent abnormal immune response to muscle antigens results in upregulation of maj...
Evaluation of a Chemiluminescent Immunoassay for Measurement of Equine Insulin.
Journal of veterinary internal medicine    January 26, 2017   Volume 31, Issue 2 568-574 doi: 10.1111/jvim.14657
Carslake HB, Pinchbeck GL, McGowan CM.Many diagnostic tests for insulin dysregulation use reference intervals established with an insulin radioimmunoassay (RIA) that is no longer available. A chemiluminescent immunoassay (CLIA) is commonly used for the measurement of serum insulin concentration in clinical practice but requires further validation, especially at clinically relevant reference intervals. Objective: To evaluate the CLIA for measurement of equine insulin and compare it to the previously validated, but now unavailable RIA. Methods: Equine serum samples (n = 78) from clinical and experimental studies. Methods: In this ex...
Expression of Toll-like receptors 2, 4 and 6 in different cell populations of the equine endometrium.
Veterinary immunology and immunopathology    January 22, 2017   Volume 185 7-13 doi: 10.1016/j.vetimm.2017.01.002
Schöniger S, Gräfe H, Schoon HA.Subfertility in mares is mainly caused by endometrial diseases. Alterations of Toll-like receptors (TLRs) are associated with endometrial disorders in women. This study investigated TLRs 2, 4 and 6 in the equine endometrium. Endometria of 21 mares were examined by histology, PCR and immunohistochemistry. Tissues from 2 mares were considered normal. The remaining showed endometritis, endometrosis and/or angiosclerosis. TLRs 2, 4 and 6 were expressed as transcripts and proteins in all endometria. Immunohistochemistry detected TLRs 2, 4 and 6 in mast cells, luminal and glandular epithelial cells,...
Autologous and Allogeneic Equine Mesenchymal Stem Cells Exhibit Equivalent Immunomodulatory Properties In Vitro.
Stem cells and development    January 12, 2017   Volume 26, Issue 7 503-511 doi: 10.1089/scd.2016.0266
Colbath AC, Dow SW, Phillips JN, McIlwraith CW, Goodrich LR.The use of allogeneic bone marrow-derived mesenchymal stem cells (BMDMSCs) may provide an effective alternative to autologous BMDMSCs for treatment of equine musculoskeletal injuries. However, concerns have been raised regarding the potential safety and effectiveness of allogeneic BMDMSCs. We conducted studies to assess the immunological properties of equine allogeneic BMDMSCs compared with those of autologous BMDMSCs. For assessment of inherent immunogenicity, the relative ability of allogeneic and autologous BMDMSCs to stimulate spontaneous proliferation of equine lymphocytes was compared. T...
Clinical Implications and Hospital Outcome of Immune-Mediated Myositis in Horses.
Journal of veterinary internal medicine    January 2, 2017   Volume 31, Issue 1 170-175 doi: 10.1111/jvim.14637
Hunyadi L, Sundman EA, Kass PH, Williams DC, Aleman M.Immune-mediated myositis (IMM) is a cause of rhabdomyolysis, stiffness, and muscle atrophy predominantly affecting Quarter horses. Limited information is available with regard to outcome, prognostic indicators, and associations with concurrent diseases. Objective: To report outcomes and associations between outcome and clinical and laboratory parameters, and presence of concurrent illness. Methods: Sixty-eight horses; 52 Quarter horses and related breeds and 16 other breeds. Methods: Retrospective cohort study (1991-2014). Medical records of horses with histological diagnosis of IMM were revie...
Allogeneic major histocompatibility complex-mismatched equine bone marrow-derived mesenchymal stem cells are targeted for death by cytotoxic anti-major histocompatibility complex antibodies.
Equine veterinary journal    December 13, 2016   Volume 49, Issue 4 539-544 doi: 10.1111/evj.12647
Berglund AK, Schnabel LV.Allogeneic mesenchymal stem cells (MSCs) are a promising cell source for treating musculoskeletal injuries in horses. Controversy exists, however, over whether major histocompatibility complex (MHC)-mismatched MSCs are recognised by the recipient immune system and targeted for death by a cytotoxic antibody response. Objective: To determine if cytotoxic anti-MHC antibodies generated in vivo following MHC-mismatched MSC injections are capable of initiating complement-dependent cytotoxicity of MSCs. Methods: Experimental controlled study. Methods: Antisera previously collected at Days 0, 7, 14 an...
Allelic Variation in CXCL16 Determines CD3+ T Lymphocyte Susceptibility to Equine Arteritis Virus Infection and Establishment of Long-Term Carrier State in the Stallion.
PLoS genetics    December 8, 2016   Volume 12, Issue 12 e1006467 doi: 10.1371/journal.pgen.1006467
Sarkar S, Bailey E, Go YY, Cook RF, Kalbfleisch T, Eberth J, Chelvarajan RL, Shuck KM, Artiushin S, Timoney PJ, Balasuriya UB.Equine arteritis virus (EAV) is the causative agent of equine viral arteritis (EVA), a respiratory, systemic, and reproductive disease of horses and other equid species. Following natural infection, 10-70% of the infected stallions can become persistently infected and continue to shed EAV in their semen for periods ranging from several months to life. Recently, we reported that some stallions possess a subpopulation(s) of CD3+ T lymphocytes that are susceptible to in vitro EAV infection and that this phenotypic trait is associated with long-term carrier status following exposure to the virus. ...
Characterization of the cervical mucus plug in mares.
Reproduction (Cambridge, England)    November 14, 2016   Volume 153, Issue 2 197-210 doi: 10.1530/REP-16-0396
Loux SC, Scoggin KE, Troedsson MH, Squires EL, Ball BA.The cervical mucus plug (CMP) is believed to play an integral role in the maintenance of pregnancy in the mare, primarily by inhibiting microbial entry. Unfortunately, very little is known about its composition or origin. To determine the proteomic composition of the CMP, we collected CMPs from mares (n = 4) at 9 months of gestation, and proteins were subsequently analyzed by nano-LC-MS/MS. Results were searched against EquCab2.0, and proteomic pathways were predicted by Ingenuity Pathway Analysis. Histologic sections of the CMP were stained with H&E and PAS. To identify the origin of ...
In Vitro effects of tamoxifen on equine neutrophils.
Research in veterinary science    November 6, 2016   Volume 110 60-64 doi: 10.1016/j.rvsc.2016.11.003
Borlone C, Morales N, Henriquez C, Folch H, Olave C, Sarmiento J, Uberti B, Moran G.Neutrophils participate in innate immunity as the first line of host defense against microorganisms. However, exacerbated neutrophil activity can be harmful to surrounding tissues; this is important in a range of diseases, including allergic asthma and chronic obstructive pulmonary disease in humans, and equine asthma (also known as recurrent airway obstruction (RAO). Tamoxifen (TX) is a non-steroidal estrogen receptor modulator with effects on cell growth and survival. Previous preliminary studies showed that TX treatment in horses with induced acute pulmonary inflammation promoted early apop...
Equine Airway Mast Cells are Sensitive to Cell Death Induced by Lysosomotropic Agents.
Scandinavian journal of immunology    November 4, 2016   Volume 85, Issue 1 30-34 doi: 10.1111/sji.12502
Wernersson S, Riihimäki M, Pejler G, Waern I.Mast cells are known for their detrimental effects in various inflammatory conditions. Regimens that induce selective mast cell apoptosis may therefore be of therapeutic significance. Earlier studies have demonstrated that murine- and human-cultured mast cells are highly sensitive to apoptosis induced by the lysosomotropic agent LeuLeuOMe (LLME). However, the efficacy of lysosomotropic agents for inducing apoptosis of in vivo-derived airway mast cells and the impact on mast cells in other species have not been assessed. Here we addressed whether lysosomotropic agents can induce cell death of ...
Ectopic Trophoblast Allografts in the Horse Resist Destruction by Secondary Immune Responses.
Biology of reproduction    October 19, 2016   Volume 95, Issue 6 135 doi: 10.1095/biolreprod.115.137851
Brosnahan MM, Silvela EJ, Crumb J, Miller DC, Erb HN, Antczak DF.Invasive trophoblast from Day 34 horse conceptuses survives in extrauterine sites in allogeneic recipients that are immunologically naive to donor major histocompatibility complex class I antigens. The ectopic trophoblast retains its in utero characteristics, including similar lifespan, physiologic effect of its secreted product (equine chorionic gonadotropin) upon the recipient's ovaries, and induction of host immune responses. Immunologic memory has not been considered previously in this experimental system. We hypothesized that primary exposure to ectopic trophoblast would affect the recipi...
Immune-modulating properties of horse milk administered to mice sensitized to cow milk.
Journal of dairy science    October 19, 2016   Volume 99, Issue 12 9395-9404 doi: 10.3168/jds.2016-11499
Fotschki J, Szyc AM, Laparra JM, Markiewicz LH, Wróblewska B.The aim of this study was to examine immune adaptive changes, the expression of innate biomarkers and variations in intestinal microbiota composition after horse-milk administration in BALB/c mice, which were sensitized intraperitoneally using cow β-lactoglobulin and α-casein with aluminum adjuvant. We measured serum antibody IgE levels and the expression of MCP-1, IL-4, and TNF-α in duodenal samples. Changes in immune cell populations in peripheral blood were quantified using flow cytometry, and intestinal microbiota composition was assessed using real-time PCR. We found that horse-milk ad...
Expression of T helper cell-associated inflammatory mediator mRNAs in cells of bronchoalveolar lavage fluid samples and oxygen concentration in arterial blood samples from healthy horses exposed to hyperbaric oxygen.
American journal of veterinary research    September 27, 2016   Volume 77, Issue 10 1148-1156 doi: 10.2460/ajvr.77.10.1148
Looijen MG, New DJ, Fischer CD, Dardari R, Irwin KM, Berezowski CJ, Bond SL, Léguillette R.OBJECTIVE To evaluate the mRNA expression of T helper (Th)1, Th2, and Th17 cell-associated inflammatory mediators in cells of bronchoalveolar lavage fluid samples collected from healthy horses exposed to hyperbaric oxygen (HBO) and to monitor blood oxygen concentration during and following HBO therapy. ANIMALS 8 healthy horses. PROCEDURES In a randomized controlled crossover design study, each horse was exposed (beginning day 1) to 100% oxygen at a maximum of 3 atmospheres absolute (304 kPa) daily for 10 days or ambient air at atmospheric pressure in the HBO chamber for an equivalent amount of...
Cytokine and chemokine profiles of aqueous humor and serum in horses with uveitis measured using multiplex bead immunoassay analysis.
Veterinary immunology and immunopathology    September 27, 2016   Volume 182 43-51 doi: 10.1016/j.vetimm.2016.09.008
Curto E, Messenger KM, Salmon JH, Gilger BC.To determine whether horses with clinically diagnosed Equine Recurrent Uveitis (ERU) and those with Leptospirosis infection have a specific cytokine profile in their aqueous humor (AH) and serum that differs from horses with uveitis secondary to other ocular inflammatory processes and from horses with normal eyes. Methods: Twenty-five client-owned horses with uveitis that were presented to the North Carolina State University Ophthalmology Service, and four University-owned horses without history or clinical signs of ocular disease. Methods: Samples of AH and serum were obtained from horses wit...
Preliminary evaluation of a dual antigen ELISA to distinguish vaccinated from Leptospira infected horses.
The Veterinary record    September 20, 2016   Volume 179, Issue 22 574 doi: 10.1136/vr.103686
Velineni S, Timoney JF.Immunogenic proteins of Leptospira interrogans serovar Pomona type kennewicki (Lk) including Sph1, LigA, Hsp15 and LipL45 (Qlp42) are up-regulated in infected horses but are undetectable or expressed in trace amounts on cultured organisms. In contrast, LipL32 is abundant on cultured Lk and elicits infection antibody responses. The aim of this study was to develop an ELISA based on LipL32 or Lk sonicate and host-induced proteins to differentiate vaccine from infection serum antibody. IgG specific for recombinant Sph1, LigA, Lk90 (LigA; 379-1225 a.a), Hsp15, LipL45 and LipL32 of Lk were assayed ...
Secretory immunoglobulin A and immunoglobulin G in horse saliva.
Veterinary immunology and immunopathology    September 9, 2016   Volume 180 59-65 doi: 10.1016/j.vetimm.2016.09.001
Palm AE, Wattle O, Lundström T, Wattrang E.This study aimed to increase the knowledge on salivary antibodies in the horse since these constitute an important part of the immune defence of the oral cavity. For that purpose assays to detect horse immunoglobulin A (IgA) including secretory IgA (SIgA) were set up and the molecular weights of different components of the horse IgA system were estimated. Moreover, samples from 51 clinically healthy horses were tested for total SIgA and IgG amounts in saliva and relative IgG3/5 (IgG(T)) and IgG4/7 (IgGb) content were tested in serum and saliva. Results showed a mean concentration of 74μg SIgA...
Intramuscular Transplantation of Allogeneic Mesenchymal Stromal Cells Derived from Equine Umbilical Cord.
International journal of stem cells    August 31, 2016   Volume 9, Issue 2 239-249 doi: 10.15283/ijsc16011
Dias MC, Landim-Alvarenga FD, de Moraes CN, da Costa LD, Geraldini CM, de Vasconcelos Machado VM, Maia L.Mesenchymal stromal cells (MSCs) have great therapeutic potential, particularly in the process of tissue repair and immunomodulation through the secretion of biomolecules. Thus, the aim of this study was to evaluate the hypothesis that intramuscular transplantation of allogeneic MSCs obtained from equine umbilical cord (UC-MSCs) is safe, demonstrating that this is a suitable source of stem cells for therapeutic use. Results: For this, UC-MSCs were cultured, characterized and cryopreserved for future transplantation in six healthy mares. On day 0, transplantation of three million UC-MSCs dilute...
Identification, characterization and bioactivity of tumor necrosis factor (TNF)-related apoptosis-inducing ligand from Equus caballus.
Developmental and comparative immunology    August 31, 2016   Volume 67 340-349 doi: 10.1016/j.dci.2016.08.018
Ma L, Sang M, Zhang J, Zhang S.Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is a member of the TNF superfamily and plays multifunctional roles in the immune system. In the present study, a homolog of TRAIL from the Mongolian horse (named ecTRAIL) was identified and characterized. The 870-bp open reading frame encodes a polypeptide of 289 amino acid residues with a predicted molecular weight of 33.47 kDa and pI of 8.47. The genomic structure of ecTRAIL shares a five-exon/six-intron arrangement similar to its orthologs. Multiple alignments show that ecTRAIL is a type II transmembrane protein with a t...
Macrophage effector responses of horses are influenced by expression of CD154.
Veterinary immunology and immunopathology    August 26, 2016   Volume 180 40-44 doi: 10.1016/j.vetimm.2016.08.001
Sponseller BA, Clark SK, Gilbertie J, Wong DM, Hepworth K, Wiechert S, Chandramani P, Sponseller BT, Alcott CJ, Bellaire B, Petersen AC, Jones DE.Reactive intermediates contribute to innate immunity by providing phagocytes with a mechanism of defense against bacteria, viruses and parasites. To better characterize the role of CD154 in the production of reactive intermediates, we cloned and expressed recombinant equine CD154 (reqCD154) in Chinese Hamster Ovary (CHO). In co-culture experiments, CHO cells ectopically expressing reqCD154 elicited superoxide production in monocyte-derived macrophages (MDM). Collectively, our results indicate that regulation of CD154 expression plays a role in innate host defenses.
RNA expression of TLR10 in normal equine tissues.
BMC research notes    July 19, 2016   Volume 9 353 doi: 10.1186/s13104-016-2161-9
Tarlinton RE, Alder L, Moreton J, Maboni G, Emes RD, Tötemeyer S.Toll like receptors are one of the major innate immune system pathogen recognition systems. There is little data on the expression of the TLR10 member of this family in the horse. Results: This paper describes the genetic structure of the Equine TLR10 gene and its RNA expression in a range of horse tissues. It describes the phylogenetic analysis of the Equine TLR1,6,10,2 annotations in the horse genome, firmly identifying them in their corresponding gene clades compared to other species and firmly placing the horse gene with other TLR10 genes from odd-toed ungulates. Additional 3' transcript e...
Gingival Toll-like receptor and cytokine messenger RNA levels in equine periodontitis and oral health.
Equine veterinary journal    July 12, 2016   Volume 49, Issue 3 294-299 doi: 10.1111/evj.12597
Kennedy R, Lappin DF, Dixon PM, Bennett D, Riggio MP.Equine periodontitis is a common and painful condition. However, the disease often goes unnoticed by owners and is thus a major welfare concern. The aetiopathogenesis of the condition remains poorly understood and has been investigated in few studies. The innate immune system is known to play an important role in human periodontitis, but its role in equine periodontitis has not been examined. Objective: To quantify the messenger (m)RNA levels of Toll-like receptors (TLRs) and cytokines in gingival tissue from orally healthy horses and those affected by periodontitis. Methods: Observational stu...
Major Histocompatibility Complex I and II Expression and Lymphocytic Subtypes in Muscle of Horses with Immune-Mediated Myositis.
Journal of veterinary internal medicine    June 28, 2016   Volume 30, Issue 4 1313-1321 doi: 10.1111/jvim.14371
Durward-Akhurst SA, Finno CJ, Barnes N, Shivers J, Guo LT, Shelton GD, Valberg SJ.Major histocompatibility complex (MHC) I and II expression is not normally detected on sarcolemma, but is detected with lymphocytic infiltrates in immune-mediated myositis (IMM) of humans and dogs and in dysferlin-deficient muscular dystrophy. Objective: To determine if sarcolemmal MHC is expressed in active IMM in horses, if MHC expression is associated with lymphocytic subtype, and if dysferlin is expressed in IMM. Methods: Twenty-one IMM horses of Quarter Horse-related breeds, 3 healthy and 6 disease controls (3 pasture myopathy, 3 amylase-resistant polysaccharide storage myopathy [PSSM]). ...
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