1.Pathological Types,Expression of Mismatch Repair Protein,Human Epidermal Growth Factor Receptor 2,and Pan-TRK,and Eostein-Barr Virus Infection in Patients With Colorectal Cancer Resected in Tibet.
Han-Huan LUO ; Zhen HUO ; BIANBAZHAXI ; Qian WANG ; DUOBULA ; NIMAZHUOMA ; Zhen DA ; Ping-Ping GUO
Acta Academiae Medicinae Sinicae 2023;45(3):422-428
		                        		
		                        			
		                        			Objective To study the pathological types,expression of mismatch repair protein,human epidermal growth factor receptor 2(HER2),and Pan-TRK,and Epstein-Barr virus(EBV)infection in patients with colorectal cancer resected in Tibet. Methods A total of 79 patients with colorectal cancer resected in Tibet Autonomous Region People's Hospital from December 2013 to July 2021 were enrolled in this study.The clinical and pathological data of the patients were collected.The expression of mismatch repair protein,HER2,and Pan-TRK was detected by immunohistochemical(IHC)staining,and detection of HER2 gene by fluorescence in situ hybridization(FISH)in the patients with HER2 IHC results of 2+ or above.EBV was detected by in situ hybridization with EBV-encoded small RNA. Results A total of 79 colorectal cancer patients were included in this study,with the male-to-female ratio of 1.26:1 and the mean age of(57.06±12.74)years(24-83 years).Among them,4 patients received preoperative neoadjuvant therapy.Colonic cancer and rectal cancer occurred in 57(57/79,72.15%,including 31 and 26 in the right colon and left colon,respectively)and 22(22/79,27.85%)patients,respectively.The maximum diameter of tumor varied within the range of 1-20 cm,with the mean of(6.61±3.33)cm.Among the 79 colorectal cancer patients,75(75/79,94.94%)patients showed adenocarcinoma.Lymph node metastasis occurred in 12(12/21,57.14%)out of the 21 patients with severe tumor budding,13(13/23,56.52%)out of the 23 patients with moderate tumor budding,and 2(2/31,6.45%)out of the 31 patients with mild tumor budding,respectively.The lymph node metastasis rate showed differences between the patients with severe/moderate tumor budding and the patients with mild tumor budding(all P<0.001).The IHC staining showed that mismatch repair protein was negative in 10(10/65,15.38%)patients,including 5 patients with both MSH2 and MSH6 negative,4 patients with both MLH1 and PMS2 negative,and 1 patient with MSH6 negative.Pan-TRK was negative in 65 patients.The IHC results of HER2 showed 0 or 1+ in 60 patients and 2+ in 5 patients.FISH showed no positive signal in the 5 patients with HER2 IHC results of 2+.The detection with EBV-encoded small RNA showed positive result in 1(1/65,1.54%)patient. Conclusions Non-specific adenocarcinoma of the right colon is the most common in the patients with colorectal cancer resected in Tibet,and 15% of the patients showed mismatch repair protein defects.EBV-associated colorectal carcer is rare,Pan-TRK expression and HER2 gene amplification are seldom.The colorectal cancer patients with moderate and severe tumor budding are more likely to have lymph node metastasis.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Adenocarcinoma
		                        			;
		                        		
		                        			Biomarkers, Tumor/genetics*
		                        			;
		                        		
		                        			Colorectal Neoplasms/pathology*
		                        			;
		                        		
		                        			DNA Mismatch Repair
		                        			;
		                        		
		                        			DNA-Binding Proteins/genetics*
		                        			;
		                        		
		                        			Epstein-Barr Virus Infections/diagnosis*
		                        			;
		                        		
		                        			Herpesvirus 4, Human/metabolism*
		                        			;
		                        		
		                        			In Situ Hybridization, Fluorescence
		                        			;
		                        		
		                        			Lymphatic Metastasis
		                        			;
		                        		
		                        			Tibet
		                        			;
		                        		
		                        			Young Adult
		                        			;
		                        		
		                        			Aged, 80 and over
		                        			
		                        		
		                        	
2.Association of status of mismatch repair protein expression and EB virus infection with clinicopathological parameters in 886 gastric adenocarcinoma patients.
Ying LIU ; Feng Lin ZANG ; Zhi Qiang QIU ; Yu Hong GUO ; Ye LUO ; Lin SUN ; Shuai ZHAO ; Bing SHAO ; Han LIANG ; Yan SUN
Chinese Journal of Gastrointestinal Surgery 2021;24(5):440-448
		                        		
		                        			
		                        			Objective: To analyze the expression of mismatch repair (MMR) protein and the EB virus infection in gastric adenocarcinoma, and to examine the association of MMR expression and EB virus infection with clinicopathological parameters. Methods: A case-control study was performed. Clinicopathological data of patients who was pathologically diagnosed as gastric adenocarcinoma, received radical gastrectomy and had complete clinicopathological data from August 2017 to April 2020 in Tianjin Medical University Cancer Institute and Hospital were retrospectively collected and analyzed. The immunohistochemistry (IHC) of MMR proteins and in situ hybridization (ISH) of Epstein-Barr virus encoded RNA (EBER) were reviewed. The associations of MMR and EBER results with clinicopathological parameters were analyzed. The main observations of the study were MMR and EBER expression, and association of MMR and EBER results with clinicopathological parameters. Results: Eight hundred and eighty-six patients were enrolled, including 98 patients who received preoperative neoadjuvant chemoradiotherapy. Of 886 patients, 613 (69.2%) were males and the median age was 60 (22-83) years; 831 (93.8%) were mismatch repair proficiency (pMMR), and 55 (6.2%) were mismatch repair deficiency (dMMR). In dMMR group, 47 cases (85.5%) had the deficiency of both MLH1 and PMS2, 1 case (1.8%) had the deficiency of both MSH2 and MSH6, 4 cases (7.3%) had the deficiency only in PMS2, 2 cases (3.6%) had the deficiency only in MSH6, and 1 case (1.8%) had the deficiency only in MSH2. The deficiency rates of PMS2, MLH1, MSH6 and MSH2 were 5.8% (51/886), 5.3% (47/886), 0.3% (3/886) and 0.2% (2/886), respectively. Among the 871 cases with EBER results, 4.9% (43/871) were positive EBER. Univariate analysis showed that dMMR was more frequently detected in female patients (χ(2)=10.962, P=0.001), cancer locating in the antrum (χ(2)=9.336,P=0.020), Lauren intestinal type (χ(2)=9.718, P=0.018), stage T3 (χ(2)=25.866, P<0.001) and TNM stage II (χ(2)=15.470, P=0.002). The ratio of dMMR was not significantly associated with age, tumor differentiation, histological type, lymph node metastasis, distant metastasis or Her-2 immunohistochemical score (all P>0.05). Compared with negative EBER, positive EBER was more frequent in male patients (χ(2)=9.701, P=0.002), cancer locating in gastric fundus and corpus (χ(2)=17.964, P<0.001), gastric cancer with lymphoid stroma (χ(2)=744.073, P<0.001) and poorly differentiated cancer (χ(2)=13.739, P=0.010). Positive EBER was not significantly associated with age, depth of invasion, lymph node metastasis, distant metastasis, TNM stage or Her-2 immunohistochemical score (all P>0.05). In addition, all dMMR cases were EBER negative, and all cases of positive EBER were pMMR. Conclusions: The positive EB virus status is mutually exclusive with dMMR, indicating that different molecular subtypes of gastric adenocarcinoma are involved in different molecular pathways in tumorigenesis and progression. The overlapping of dMMR or positive EBER status and positive Her-2 expression is found in some cases of gastric adenocarcinoma. Patients with gastric adenocarcinoma after radical surgery should be tested for MMR status if they are female, the tumor locates in gastric antrum, the TNM staging is stage II or T3, or if the Lauren classification is intestinal type. And if patients are male, the tumor locates in the gastric fundus and corpus, the cancer is lymphoid stroma, or poor differentiated, the expression of EBER should be detected. Results of our study may provide evidence for further decision-making of clinical treatment.
		                        		
		                        		
		                        		
		                        			Adenocarcinoma
		                        			;
		                        		
		                        			Case-Control Studies
		                        			;
		                        		
		                        			DNA Mismatch Repair
		                        			;
		                        		
		                        			Epstein-Barr Virus Infections
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Herpesvirus 4, Human
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Mismatch Repair Endonuclease PMS2/metabolism*
		                        			;
		                        		
		                        			MutL Protein Homolog 1/genetics*
		                        			;
		                        		
		                        			MutS Homolog 2 Protein/metabolism*
		                        			;
		                        		
		                        			Retrospective Studies
		                        			;
		                        		
		                        			Stomach Neoplasms
		                        			
		                        		
		                        	
3.Performance of the Real-Q EBV Quantification Kit for Epstein-Barr Virus DNA Quantification in Whole Blood.
Hee Jae HUH ; Jong Eun PARK ; Ji Youn KIM ; Sun Ae YUN ; Myoung Keun LEE ; Nam Yong LEE ; Jong Won KIM ; Chang Seok KI
Annals of Laboratory Medicine 2017;37(2):147-150
		                        		
		                        			
		                        			There has been increasing interest in standardized and quantitative Epstein-Barr virus (EBV) DNA testing for the management of EBV disease. We evaluated the performance of the Real-Q EBV Quantification Kit (BioSewoom, Korea) in whole blood (WB). Nucleic acid extraction and real-time PCR were performed by using the MagNA Pure 96 (Roche Diagnostics, Germany) and 7500 Fast real-time PCR system (Applied Biosystems, USA), respectively. Assay sensitivity, linearity, and conversion factor were determined by using the World Health Organization international standard diluted in EBV-negative WB. We used 81 WB clinical specimens to compare performance of the Real-Q EBV Quantification Kit and artus EBV RG PCR Kit (Qiagen, Germany). The limit of detection (LOD) and limit of quantification (LOQ) for the Real-Q kit were 453 and 750 IU/mL, respectively. The conversion factor from EBV genomic copies to IU was 0.62. The linear range of the assay was from 750 to 10⁶ IU/mL. Viral load values measured with the Real-Q assay were on average 0.54 log₁₀ copies/mL higher than those measured with the artus assay. The Real-Q assay offered good analytical performance for EBV DNA quantification in WB.
		                        		
		                        		
		                        		
		                        			DNA, Viral/*blood/metabolism
		                        			;
		                        		
		                        			Epstein-Barr Virus Infections/diagnosis/virology
		                        			;
		                        		
		                        			Herpesvirus 4, Human/*genetics/isolation & purification
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Limit of Detection
		                        			;
		                        		
		                        			Reagent Kits, Diagnostic
		                        			;
		                        		
		                        			Real-Time Polymerase Chain Reaction
		                        			
		                        		
		                        	
4.Automated Nucleic Acid Extraction Systems for Detecting Cytomegalovirus and Epstein-Barr Virus Using Real-Time PCR: A Comparison Study Between the QIAsymphony RGQ and QIAcube Systems.
Hanah KIM ; Mina HUR ; Ji Young KIM ; Hee Won MOON ; Yeo Min YUN ; Hyun Chan CHO
Annals of Laboratory Medicine 2017;37(2):129-136
		                        		
		                        			
		                        			BACKGROUND: Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are increasingly important in immunocompromised patients. Nucleic acid extraction methods could affect the results of viral nucleic acid amplification tests. We compared two automated nucleic acid extraction systems for detecting CMV and EBV using real-time PCR assays. METHODS: One hundred and fifty-three whole blood (WB) samples were tested for CMV detection, and 117 WB samples were tested for EBV detection. Viral nucleic acid was extracted in parallel by using QIAsymphony RGQ and QIAcube (Qiagen GmbH, Germany), and real-time PCR assays for CMV and EBV were performed with a Rotor-Gene Q real-time PCR cycler (Qiagen). Detection rates for CMV and EBV were compared, and agreements between the two systems were analyzed. RESULTS: The detection rate of CMV and EBV differed significantly between the QIAsymphony RGQ and QIAcube systems (CMV, 59.5% [91/153] vs 43.8% [67/153], P=0.0005; EBV, 59.0% [69/117] vs 42.7% [50/117], P=0.0008). The two systems showed moderate agreement for CMV and EBV detection (kappa=0.43 and 0.52, respectively). QIAsymphony RGQ showed a negligible correlation with QIAcube for quantitative EBV detection. QIAcube exhibited EBV PCR inhibition in 23.9% (28/117) of samples. CONCLUSIONS: Automated nucleic acid extraction systems have different performances and significantly affect the detection of viral pathogens. The QIAsymphony RGQ system appears to be superior to the QIAcube system for detecting CMV and EBV. A suitable sample preparation system should be considered for optimized nucleic acid amplification in clinical laboratories.
		                        		
		                        		
		                        		
		                        			Automation
		                        			;
		                        		
		                        			Cytomegalovirus/*genetics/isolation & purification
		                        			;
		                        		
		                        			Cytomegalovirus Infections/diagnosis/*virology
		                        			;
		                        		
		                        			DNA, Viral/*blood/isolation & purification/metabolism
		                        			;
		                        		
		                        			Herpesvirus 4, Human/*genetics/isolation & purification
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Reagent Kits, Diagnostic
		                        			;
		                        		
		                        			Real-Time Polymerase Chain Reaction
		                        			
		                        		
		                        	
5.Research Advances in Target Genes of Epstein-Barr Virus-encoded MicroRNAs.
Liwei GAO ; Junhong AI ; Zhengde XIE ; Kunling SHEN
Chinese Journal of Virology 2016;32(2):229-234
		                        		
		                        			
		                        			The Epstein-Barr virus (EBV) is a gamma herpes virus associated with several types of malignancies. The EBV encodes viral microRNAs (miRNAs) that can target genes within cells. The EBV participates in signal transduction as well as the proliferation and differentiation of cells. How the target genes and functions of EBV-encoded miRNAs contribute to the pathogenesis of EBV is an important research topic. Some target genes have been validated since EBV-encoded miRNAs were discovered and, in this article, we summarize them and their functions.
		                        		
		                        		
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Epstein-Barr Virus Infections
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			metabolism
		                        			;
		                        		
		                        			virology
		                        			;
		                        		
		                        			Herpesvirus 4, Human
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			physiology
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			MicroRNAs
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			metabolism
		                        			;
		                        		
		                        			RNA, Viral
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			metabolism
		                        			
		                        		
		                        	
6.Diffuse large B-cell lymphoma with aberrant expression of CD56: a clinicopathologic and immunohistochemical study.
Jianchao WANG ; Wenyan ZHANG ; Wenshuang DING ; Limin GAO ; Jiaqi YAN ; Dianying LIAO ; Sha ZHAO ; Weiping LIU
Chinese Journal of Pathology 2016;45(2):78-82
OBJECTIVETo study the clinicopathologic features and significance of aberrant CD56 expression in diffuse large B-cell lymphoma (DLBCL).
METHODSThe clinical and pathologic profiles of 10 cases of DLBCL with aberrant expression of CD56 were investigated. Immunohistochemical staining, in-situ hybridization for Epstein-Barr virus encoded RNA and gene rearrangement for IgH and Igκ were carried out.
RESULTSThere were 6 male and 4 female patients. The medium age of patients was 46 years. All of them presented with extranodal lymphoma involvement, with gastrointestinal tract being the commonest site (5/10). Histologic examination showed that most of the atypical lymphoid cells were centroblast-like and demonstrated a diffuse growth pattern. Apoptosis and necrosis were identified in some cases. Immunohistochemical study showed that the tumor cells were positive for CD20 or CD79α and aberrantly expressed CD56. Five cases had the GCB phenotype while the remaining cases had the non-GCB phenotype, according to Hans classification. Bcl-6 was positive in most cases (9/10). All cases showed a high proliferation index by Ki-67. The tumor cells were negative for CD3ε, CD138 and granzyme B. In-situ hybridization for Epstein-Barr virus encoded RNA was performed in 7 cases and none of them showed positive signals. IgH gene rearranged bands were detected in 4 cases (4/6) and Igκ was detected in 3 cases (3/6). Follow-up data were available in 8 patients. Two patients died of disease progression within 5 to 13 months after diagnosis and the other 6 patients were alive 8 to 60 months after therapy.
CONCLUSIONSDLBCL with aberrant expression of CD56 is rare. Most of them present with extranodal involvement, show high frequency of bcl-6 expression and high proliferation index. The patients often have good response to chemotherapy.
Antigens, CD20 ; metabolism ; Apoptosis ; CD56 Antigen ; metabolism ; CD79 Antigens ; metabolism ; Disease Progression ; Female ; Gene Rearrangement ; Granzymes ; metabolism ; Herpesvirus 4, Human ; genetics ; Humans ; Immunophenotyping ; In Situ Hybridization ; Lymphoma, Large B-Cell, Diffuse ; genetics ; metabolism ; pathology ; Male ; Middle Aged ; Necrosis ; Phenotype ; Proto-Oncogene Proteins c-bcl-6 ; metabolism ; RNA, Viral ; analysis
7.Epstein-Barr Virus and Gastric Cancer Risk: A Meta-analysis With Meta-regression of Case-control Studies.
Journal of Preventive Medicine and Public Health 2016;49(2):97-107
		                        		
		                        			
		                        			OBJECTIVES: Research on how the risk of gastric cancer increases with Epstein-Barr virus (EBV) infection is lacking. In a systematic review that investigated studies published until September 2014, the authors did not calculate the summary odds ratio (SOR) due to heterogeneity across studies. Therefore, we include here additional studies published until October 2015 and conduct a meta-analysis with meta-regression that controls for the heterogeneity among studies. METHODS: Using the studies selected in the previously published systematic review, we formulated lists of references, cited articles, and related articles provided by PubMed. From the lists, only case-control studies that detected EBV in tissue samples were selected. In order to control for the heterogeneity among studies, subgroup analysis and meta-regression were performed. RESULTS: In the 33 case-control results with adjacent non-cancer tissue, the total number of test samples in the case and control groups was 5280 and 4962, respectively. In the 14 case-control results with normal tissue, the total number of test samples in case and control groups was 1393 and 945, respectively. Upon meta-regression, the type of control tissue was found to be a statistically significant variable with regard to heterogeneity. When the control tissue was normal tissue of healthy individuals, the SOR was 3.41 (95% CI, 1.78 to 6.51; I-squared, 65.5%). CONCLUSIONS: The results of the present study support the argument that EBV infection increases the risk of gastric cancer. In the future, age-matched and sex-matched case-control studies should be conducted.
		                        		
		                        		
		                        		
		                        			Case-Control Studies
		                        			;
		                        		
		                        			DNA, Viral/analysis/metabolism
		                        			;
		                        		
		                        			Databases, Factual
		                        			;
		                        		
		                        			Epstein-Barr Virus Infections/*pathology/virology
		                        			;
		                        		
		                        			Herpesvirus 4, Human/genetics/isolation & purification/*pathogenicity
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Odds Ratio
		                        			;
		                        		
		                        			Stomach Neoplasms/*pathology/virology
		                        			
		                        		
		                        	
8.Pediatric B-cell Lymphoma, Unclassifiable, With Intermediate Features Between Those of Diffuse Large B-cell Lymphoma and Burkitt Lymphoma: A Report of Two Cases.
Shanxiang ZHANG ; David WILSON ; Magdalena CZADER
Annals of Laboratory Medicine 2015;35(2):254-256
		                        		
		                        			
		                        			No abstract available.
		                        		
		                        		
		                        		
		                        			Adolescent
		                        			;
		                        		
		                        			Antineoplastic Combined Chemotherapy Protocols/therapeutic use
		                        			;
		                        		
		                        			Burkitt Lymphoma/*pathology
		                        			;
		                        		
		                        			Child, Preschool
		                        			;
		                        		
		                        			Cyclophosphamide/therapeutic use
		                        			;
		                        		
		                        			Doxorubicin/therapeutic use
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Gene Rearrangement
		                        			;
		                        		
		                        			Herpesvirus 4, Human/metabolism
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Immunohistochemistry
		                        			;
		                        		
		                        			Lymphoma, B-Cell/*diagnosis/drug therapy
		                        			;
		                        		
		                        			Lymphoma, Large B-Cell, Diffuse/*pathology
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Prednisone/therapeutic use
		                        			;
		                        		
		                        			Proto-Oncogene Proteins c-myc/genetics
		                        			;
		                        		
		                        			Tomography, X-Ray Computed
		                        			;
		                        		
		                        			Vincristine/therapeutic use
		                        			;
		                        		
		                        			Viral Matrix Proteins/immunology/metabolism
		                        			
		                        		
		                        	
9.Epstein-Barr virus latent genes.
Myung Soo KANG ; Elliott KIEFF
Experimental & Molecular Medicine 2015;47(1):e131-
		                        		
		                        			
		                        			Latent Epstein-Barr virus (EBV) infection has a substantial role in causing many human disorders. The persistence of these viral genomes in all malignant cells, yet with the expression of limited latent genes, is consistent with the notion that EBV latent genes are important for malignant cell growth. While the EBV-encoded nuclear antigen-1 (EBNA-1) and latent membrane protein-2A (LMP-2A) are critical, the EBNA-leader proteins, EBNA-2, EBNA-3A, EBNA-3C and LMP-1, are individually essential for in vitro transformation of primary B cells to lymphoblastoid cell lines. EBV-encoded RNAs and EBNA-3Bs are dispensable. In this review, the roles of EBV latent genes are summarized.
		                        		
		                        		
		                        		
		                        			Epstein-Barr Virus Infections/complications/virology
		                        			;
		                        		
		                        			Epstein-Barr Virus Nuclear Antigens/genetics/metabolism
		                        			;
		                        		
		                        			*Genes, Viral
		                        			;
		                        		
		                        			Herpesvirus 4, Human/*physiology
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			MicroRNAs/genetics
		                        			;
		                        		
		                        			Neoplasms/etiology
		                        			;
		                        		
		                        			Protein Binding
		                        			;
		                        		
		                        			RNA, Viral/genetics
		                        			;
		                        		
		                        			Viral Matrix Proteins/genetics/metabolism
		                        			;
		                        		
		                        			*Virus Latency
		                        			
		                        		
		                        	
10.Novel Association of Killer Cell Immunoglobulin-like Receptor Genes with EBV-infectious Diseases in Children.
Li HUO ; ; Ming Yan JIANG ; Qiang LI ; Yi Ping ZHU ;
Biomedical and Environmental Sciences 2015;28(4):303-307
		                        		
		                        			
		                        			Killer cell immunoglobulin-like receptors (KIRs) which are mainly expressed on natural killer (NK) cells are implicated in many virus infections. However, it is unclear whether or not KIRs are associated with susceptibility to Epstein-Barr virus (EBV) infection related diseases. Therefore, the purpose of our study was to investigate possible correlation between polymorphisms of KIR genes and infectious mononucleosis (IM)/EBV-associated hemophagocytic lymphohistiocytosis (EBV-HLH). The polymorphisms of KIR genes were detected by polymerase chain reaction with sequence-specific primers (PCR-SSP). The results would contribute to clarify the association of KIRs with EBV induced diseases, and provide new insights into the role of NK cells and innate immune response against viral infections and/or subsequent progression.
		                        		
		                        		
		                        		
		                        			Case-Control Studies
		                        			;
		                        		
		                        			Child
		                        			;
		                        		
		                        			Child, Preschool
		                        			;
		                        		
		                        			China
		                        			;
		                        		
		                        			Disease Progression
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Herpesvirus 4, Human
		                        			;
		                        		
		                        			physiology
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Immunity, Innate
		                        			;
		                        		
		                        			Infectious Mononucleosis
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			virology
		                        			;
		                        		
		                        			Killer Cells, Natural
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			metabolism
		                        			;
		                        		
		                        			Lymphohistiocytosis, Hemophagocytic
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			virology
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Polymerase Chain Reaction
		                        			;
		                        		
		                        			Polymorphism, Genetic
		                        			;
		                        		
		                        			Receptors, KIR
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			metabolism
		                        			
		                        		
		                        	
            
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