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Enterococcus faecalis
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<h2 id="physiology">Physiology</h2> <p><i>E. faecalis</i> is a <a href="/facts/Motility/Df5BECHL">nonmotile</a> microbe; it <a href="/facts/Fermentation_(biochemistry)/rxaDr28b">ferments</a> <a href="/facts/Glucose/oUSkoLCD">glucose</a> without gas production, and does not produce a <a href="/facts/Catalase/CcJ9r5KG">catalase</a> reaction with <a href="/facts/Hydrogen_peroxide/vju6HBIc">hydrogen peroxide</a>. It produces a reduction of <a href="/facts/Litmus_milk/c32Ck59r">litmus milk</a>, but does not liquefy gelatin. It shows consistent growth throughout nutrient broth which is consistent with being a <a href="/facts/Facultative_anaerobic_organism/YS9tdh8N">facultative anaerobe</a>. It <a href="/facts/Catabolism/CFWUdphX">catabolizes</a> a variety of energy sources, including <a href="/facts/Glycerol/sRQ6NBQQ">glycerol</a>, <a href="/facts/Lactic_acid/BsVRFx7s">lactate</a>, <a href="/facts/Malate/mSbExe77">malate</a>, <a href="/facts/Citric_acid/EgKGQBdl">citrate</a>, <a href="/facts/Arginine/y49Hdf1e">arginine</a>, <a href="/facts/Agmatine/se9wPund">agmatine</a>, and many <a href="/facts/Keto_acids/fsucLHd3">keto acids</a>. Enterococci survive very harsh environments, including extremely alkaline pH (9.6) and salt concentrations. They resist <a href="/facts/Bile_salt/ojTJzf0c">bile salts</a>, <a href="/facts/Detergent/4FLKXR6p">detergents</a>, <a href="/facts/Heavy_metals/Cblmy8qI">heavy metals</a>, <a href="/facts/Ethanol/3lCLfBSP">ethanol</a>, <a href="/facts/Azide/AaJwyv1z">azide</a>, and <a href="/facts/Desiccation/X6IUsM3R">desiccation</a>. They can grow in the range of 10 to 45 °C and survive at temperatures of 60 °C for 30 min.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> </p> <h2 id="metabolism">Metabolism</h2> <p>In clinical settings, <i>E. faecalis</i> displays a relatively conserved metabolic profile compared to other enterococcal species. A recent large-scale study of urinary isolates from ICU patients showed that <i>E. faecalis</i> consistently metabolizes <a href="/facts/Sorbitol/LA9MsjYb">sorbitol</a>, <a href="/facts/Mannitol/CeHJsKMq">mannitol</a>, <a href="/facts/Amygdalin/cHJ48gvn">amygdalin</a> and <a href="/facts/Sucrose/7y1ke94L">sucrose</a> but lacks the ability to utilize <a href="/facts/Arabinose/7WDWSEzV">L-arabinose</a>, <a href="/facts/Melibiose/WdLyk5N5">melibiose</a>, or <a href="/facts/Raffinose/tqwewfyA">raffinose</a>—substrates readily used by <i><a href="/facts/Enterococcus_faecium/Ek2mFsQP">E. faecium</a></i> and <i><a href="/facts/Enterococcus_durans/8WPdMKB5">E. durans</a></i>. This substrate profile provides a reliable metabolic signature that can help distinguish <i>E. faecalis</i> from related species in diagnostic and research contexts.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> </p> <h2 id="pathogenesis">Pathogenesis</h2> <p><i>E. faecalis</i> is found in most healthy individuals, but can cause <a href="/facts/Endocarditis/SlaH14C3">endocarditis</a> and <a href="/facts/Sepsis/n52bkffJ">sepsis</a>, <a href="/facts/Urinary_tract_infection/4NwY9tL0">urinary tract infections</a> (UTIs), <a href="/facts/Meningitis/4m4STzJB">meningitis</a>, and other infections in humans.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a><a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> Several virulence factors are thought to contribute to <i>E. faecalis</i> infections. A <a href="/facts/Plasmid/yf59JVlA">plasmid</a>-encoded <a href="/facts/Hemolysin/VFXR9Exg">hemolysin</a>, called the <a href="/facts/Cytolysin/qFIcH1tf">cytolysin</a>, is important for pathogenesis in animal models of infection, and the cytolysin in combination with high-level <a href="/facts/Gentamicin/QXlbQH79">gentamicin</a> resistance is associated with a five-fold increase in risk of death in human bacteremia patients.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a><a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> A <a href="/facts/Plasmid/yf59JVlA">plasmid</a>-encoded <a href="/facts/Bacterial_adhesin/GXFLgd56">adhesin</a><a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> called "aggregation substance" is also important for virulence in animal models of infection.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> </p><p><i>E. faecalis</i> contains a <a href="/facts/Tyrosine_decarboxylase/IqBCpI9I">tyrosine decarboxylase</a> enzyme capable of decarboxylating <a href="/facts/L-DOPA/4R7qahlh">L-DOPA</a>, a crucial drug in the treatment of <a href="/facts/Parkinson%2527s_disease/xpekKj6x">Parkinson's disease</a>. If L-DOPA is decarboxylated in the <a href="/facts/Gut_microbiome/Xy1IWzSP">gut microbiome</a>, it cannot pass through the <a href="/facts/Blood-brain_barrier/xYzvVwdu">blood-brain barrier</a> and be decarboxylated in the brain to become <a href="/facts/Dopamine/5gNy8Xkd">dopamine</a>.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> </p> <h2 id="antibacterial-resistance">Antibacterial resistance</h2> <h3>Multi drug resistance</h3> <p class="note">Main article: <a href="/facts/Vancomycin-resistant_Enterococcus/PoYxRTLJ">Vancomycin-resistant Enterococcus</a></p> <p><i>E. faecalis</i> is usually resistant to many commonly used <a href="/facts/Antimicrobial/80ECEmvP">antimicrobial</a> agents (<a href="/facts/Aminoglycosides/eNQrtDg0">aminoglycosides</a>, <a href="/facts/Aztreonam/93oksSyf">aztreonam</a> and <a href="/facts/Quinolone_antibiotic/1jRTHzYW">quinolones</a>).<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a> The resistance is mediated by the presence of multiple genes related to drug resistance in the chromosome or plasmid.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> </p><p>Resistance to <a href="/facts/Vancomycin/enHvz4uP">vancomycin</a> in <i>E. faecalis</i> is becoming more common.<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a><a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> Treatment options for vancomycin-resistant <i>E. faecalis</i> include <a href="/facts/Nitrofurantoin/AQv42cqM">nitrofurantoin</a> (in the case of uncomplicated UTIs),<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> <a href="/facts/Linezolid/c6kpn1Yr">linezolid</a>, <a href="/facts/Quinupristin/rq9B5m5o">quinupristin</a>, <a href="/facts/Tigecycline/03JBAmzM">tigecycline</a><a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> and <a href="/facts/Daptomycin/ysvhcyld">daptomycin</a>, although <a href="/facts/Ampicillin/oIodNyBw">ampicillin</a> is preferred if the bacteria are susceptible.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> <a href="/facts/Quinupristin%2fdalfopristin/VqznyJkl">Quinupristin/dalfopristin</a> can be used to treat <i><a href="/facts/Enterococcus_faecium/Ek2mFsQP">Enterococcus faecium</a></i> but not <i>E. faecalis</i>.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> </p><p>In root-canal treatments, <a href="/facts/NaOCl/sp99uHHQ">NaOCl</a> and <a href="/facts/Chlorhexidine/Gyv5LNxf">chlorhexidine</a> (CHX) are used to fight <i>E. faecalis</i> before isolating the canal. However, recent studies determined that NaOCl or CHX showed low ability to eliminate <i>E. faecalis</i>.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> </p> <h3>Development of antibiotic resistance</h3> <p class="note">Main article: <a href="/facts/Enterococcus/fHlRoS0V">Enterococcus § Antibacterial resistance</a></p> <h3>Combined drug therapies</h3> <p>According to one study combined drug therapy has shown some efficacy in cases of severe infections (e.g. <a href="/facts/Endocarditis/SlaH14C3">heart valves infections</a>) against susceptible strains of <i>E. faecalis</i>. <a href="/facts/Ampicillin/oIodNyBw">Ampicillin</a>- and <a href="/facts/Vancomycin/enHvz4uP">vancomycin</a>-sensitive <i><a href="/facts/E._faecalis/66cjKlxr">E. faecalis</a></i> (lacking high-level resistance to <a href="/facts/Aminoglycoside/eNQrtDg0">aminoglycosides</a>) strains can be treated by <a href="/facts/Gentamicin/QXlbQH79">gentamicin</a> and <a href="/facts/Ampicillin/oIodNyBw">ampicillin</a> antibiotics. A less <a href="/facts/Nephrotoxicity/QaWn5pwB">nephrotoxic</a> combination of ampicillin and <a href="/facts/Ceftriaxone/9NpBWG12">ceftriaxone</a> (even though <i>E. faecalis</i> is resistant to cephalosporins, <a href="/facts/Ceftriaxone/9NpBWG12">ceftriaxone</a> is working synergistically with ampicillin) may be used alternatively for ampicillin-susceptible <i>E. faecalis</i>.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> </p><p><a href="/facts/Daptomycin/ysvhcyld">Daptomycin</a> or <a href="/facts/Linezolid/c6kpn1Yr">linezolid</a> may also show efficacy in case ampicillin and vancomycin resistance.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> </p><p>A combination of <a href="/facts/Penicillin/Abo8VQ3p">penicillin</a> and <a href="/facts/Streptomycin/2zqL5HQb">streptomycin</a> therapy was used in the past.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> </p><p><a href="/facts/Tedizolid/JQL5SKhT">Tedizolid</a>, <a href="/facts/Telavancin/MV77t56t">telavancin</a>, <a href="/facts/Dalbavancin/skgNy37M">dalbavancin</a>, and <a href="/facts/Oritavancin/CgEdJ97o">oritavancin</a> antibiotics are FDA approved as treatments against EF.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> </p> <h3>Combination of phage therapy and β-lactam antibiotics</h3> <p>UTIs are among the most common bacterial infections and their treatment is becoming increasingly challenging due to the rise of multidrug-resistant <i>E. faecalis</i> strains. <a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a><a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a>Current UTI treatments rely mainly on antibiotics. One promising alternative is the combination of bacteriophage therapy and β-lactam antibiotics.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> This approach is known as phage-antibiotic synergy (PAS), it has been shown to enhance bacterial elimination, improve biofilm penetration, reduce the emergence of resistant mutants and increase bacterial susceptibility to antibiotics. </p><p>There have been many promising studies about phage-antibiotic synergy with different pathogens such as <i>Pseudomonas aeruginosa</i> or <i>Staphylococcus aureus</i>.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> With <i>E. faecalis</i> there have been fewer studies, but promising results from a recent study by Moryl et al. (2024) demonstrated that the combination on phage therapy and β-lactam antibiotics enhanced treatment outcomes (more efficient bacteria elimination and increased bacterial sensitivity to antibiotics) and decreased resistance development.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> </p><p>More research is still needed to identify optimal phage-antibiotic combinations and treatment protocols, but this could potentially be considered a possible alternative treatment for antibiotic-resistant <i>E. faecalis</i> infections in the future. </p> <h2 id="survival-and-virulence-factors">Survival and virulence factors</h2> <ul><li>Endures prolonged periods of nutritional deprivation</li> <li>Binds to <a href="/facts/Dentin/UMpkJ3UV">dentin</a> and proficiently spreads into dentinal tubules via chain propagation</li> <li>Alters host responses</li> <li>Suppresses the action of <a href="/facts/Lymphocytes/pS2pv2Ma">lymphocytes</a></li> <li>Possesses lytic enzymes, cytolysin, aggregation substance, <a href="/facts/Pheromone/ymEDICw3">pheromones</a>, and <a href="/facts/Lipoteichoic_acid/IVL1qjnm">lipoteichoic acid</a></li> <li>Utilizes <a href="/facts/Serum_(blood)/a22tvug9">serum</a> as a nutritional source</li> <li>Produces extracellular superoxide under selected growth conditions that can generate chromosomal instability in mammalian cells<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a></li> <li>Resists intracanal medicaments (e.g. calcium hydroxide), although a study proposes elimination from root canals after using a mixture of a tetracycline isomer, an acid, and a detergent<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> <ul><li>Maintains pH homeostasis</li> <li>Properties of dentin lessen the effect of calcium hydroxide</li></ul></li> <li>Competes with other cells</li> <li>Forms a <a href="/facts/Biofilm/zg93x2w4">biofilm</a><a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a></li> <li>Activates the host protease plasminogen in a fashion that increases local tissue destruction<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a></li></ul> <h3>DNA repair</h3> <p>In human blood, <i>E. faecalis</i> is subjected to conditions that <a href="/facts/DNA_damage_(naturally_occurring)/CjGTLKGl">damage its DNA</a>, but this damage can be tolerated by the use of <a href="/facts/DNA_repair/hsURuYYq">DNA repair</a> processes.<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a> This damage tolerance depends, in part, on the two protein complex RexAB, encoded by the <i>E. faecalis</i> genome, that is employed in the <a href="/facts/Homologous_recombination/WU0IIVVv">recombinational repair</a> of DNA double-strand breaks.<a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a> </p> <h3>Biofilm formation</h3> <p>The ability of <i>E. faecalis</i> to form <a href="/facts/Biofilm/zg93x2w4">biofilms</a> contributes to its capacity to survive in extreme environments, and facilitates its involvement in persistent bacterial infection, particularly in the case of multi-drug resistant strains.<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a> Biofilm formation in <i>E. faecalis</i> is associated with <a href="/facts/DNA/nB89Iauz">DNA</a> release, and such release has emerged as a fundamental aspect of biofilm formation.<a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> Conjugative <a href="/facts/Plasmid/yf59JVlA">plasmid</a> DNA transfer in <i>E. faecalis</i> is enhanced by the release of peptide <a href="/facts/Sex_pheromone/fcAmVKxG">sex pheromones</a>.<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a> </p> <h2 id="historical">Historical</h2> <p>Prior to 1984, enterococci were members of the genus <i><a href="/facts/Streptococcus/Fx8lJ0nz">Streptococcus</a></i>; thus, <i>E. faecalis</i> was known as <i>Streptococcus faecalis</i>.<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a> </p><p>In 2013, a combination of cold denaturation and NMR spectroscopy was used to show detailed insights into the unfolding of the <i>E. faecalis</i> homodimeric repressor protein CylR2.<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a> </p> <h2 id="genome-structure">Genome structure</h2> <p>The <i>E. faecalis</i> genome consists of 3.22 million base pairs with 3,113 protein-coding genes.<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a> </p> <h2 id="treatment-research">Treatment research</h2> <p><a href="/facts/Glutamate_racemase/JroaMFRb">Glutamate racemase</a>, <a href="/facts/Hydroxymethylglutaryl-CoA_synthase/3fCQAjJQ">hydroxymethylglutaryl-CoA synthase</a>, <a href="/facts/Diphosphomevalonate_decarboxylase/KDTRdD5r">diphosphomevalonate decarboxylase</a>, topoisomerase <a href="/facts/DNA_gyrase/am6WFCM6">DNA gyrase</a> B, <a href="/facts/D-alanine%25E2%2580%2594D-serine_ligase/UgAovdfm">D-alanine—D-serine ligase</a>, <a href="/facts/Alanine_racemase/zvrX9e8o">alanine racemase</a>, <a href="/facts/Phosphate_acetyltransferase/JBYVdvET">phosphate acetyltransferase</a>, <a href="/facts/NADH_peroxidase/1ww8wFYg">NADH peroxidase</a>,Phosphopantetheine adenylyltransferase (PPAT), <a href="/facts/Acyl_carrier_protein/IdGS5IKB">acyl carrier protein</a>, 3‐Dehydroquinate dehydratase and Deoxynucleotide triphosphate triphosphohydrolase are all potential molecules that may be used for treating EF infections.<a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a> </p><p><i>Bacillus haynesii</i> CD223 and <i><a href="/facts/Advenella_mimigardefordensis/re5FPDA6">Advenella mimigardefordensis</a></i> SM421 can inhibit the growth of <i>Enterococcus faecalis.</i><a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a> </p> <h2 id="small-rna">Small RNA</h2> <p><a href="/facts/Bacterial_small_RNA/STb3gjIW">Bacterial small RNAs</a> play important roles in many cellular processes; 11 small RNAs have been experimentally characterised in <i>E. faecalis V583</i> and detected in various growth phases.<a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a> Five of them have been shown to be involved in stress response and virulence.<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a> </p><p>A genome-wide sRNA study suggested that some sRNAs are linked to the antibiotic resistance and stress response in another <i>Enterococcus</i>: <i><a href="/facts/E._faecium/Ek2mFsQP">E. faecium</a></i>.<a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a> </p> <h2 id="swimming-pool-contamination">Swimming pool contamination</h2> <h3>Indicators of recreational water quality</h3> <p>Because <i>E. faecalis</i> is a common fecal bacterium in humans, recreational water facilities (such as swimming pools and beaches that allow visitors to swim in the ocean) often measure the concentrations of <i>E. faecalis</i> to assess the quality of their water. The higher the concentration, the worse the quality of the water. The practice of using <i>E. faecalis</i> as a quality indicator is recommended by the <a href="/facts/World_Health_Organization/YNN3bgug">World Health Organization</a> (WHO) as well as many <a href="/facts/Developed_country/sqwTSDHm">developed countries</a> after multiple studies have reported that higher concentrations of <i>E. faecalis</i> correlate to greater percentages of swimmer illness. This <a href="/facts/Correlation/egkluAEm">correlation</a> exists in both freshwater and marine environments, so measuring <i>E. faecalis</i> concentrations to determine water quality applies to all recreational waters. However, the correlation does not imply that <i>E. faecalis</i> is the ultimate cause of swimmer illnesses. One alternative explanation is that higher levels of <i>E. faecalis</i> correspond to higher levels of <a href="/facts/Human_viruses_in_water/tb1ysB3v">human viruses</a>, which cause sickness in swimmers. Although this claim may sound plausible, there is currently little evidence that establishes the link between <i>E. faecalis</i> and human virus (or other pathogens) levels. Thus, despite the strong correlation between <i>E. faecalis</i> and water quality, more research is needed to determine the <a href="/facts/Causality/Swh496X7">causal relationship</a> of this correlation.<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a> </p> <h3>Human shedding</h3> <p>For recreational waters near or at beaches, <i>E. faecalis</i> can come from multiple sources, such as the sand and <a href="/facts/Human_body/WP1QbDTn">human bodies</a>. Determining the sources of <i>E. faecalis</i> is crucial for controlling <a href="/facts/Water_pollution/SCUhUYqB">water contamination</a>, though often the sources are <a href="/facts/Nonpoint_source_pollution/uQHNGYC4">non-point</a> (for example, human bathers). As such, one study looked at how much <i>E. faecalis</i> is shed from bathers at the beach. The first group of participants immersed themselves in a large pool with <a href="/facts/Seawater/fRBJjbws">marine water</a> for 4 cycles of 15 minutes, both with and without contacting sand beforehand. The result shows a decrease in <i>E. faecalis</i> levels for each cycle, suggesting that people shed the most <a href="/facts/Bacteria/wC8xSCsU">bacteria</a> when they first get into a pool. The second group of participants entered small, individual pools after contact with beach sand, and researchers collected data on how much <i>E. faecalis</i> in the pool came from the sand brought by the participants and how much came from the participants’ shedding. The result shows that <i>E. faecalis</i> from the sand is very small compared to that from human shedding. Although this result may not apply to all sand types, a tentative conclusion is that human shedding is a major <a href="/facts/Nonpoint_source_pollution/uQHNGYC4">non-point source</a> of <i>E. faecalis</i> in recreational waters.<a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a> </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Anti-Q_RNA/EVroySKq">Anti-Q RNA</a></li></ul> <h2 id="external-links">External links</h2> Wikimedia Commons has media related to Enterococcus faecalis. <ul><li><a href="http://bacdive.dsmz.de/index.php?search=5292&submit=Search">Type strain of <i>Enterococcus faecalis</i> at Bac<i>Dive</i> – the Bacterial Diversity Metadatabase</a></li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>de Almeida CV, Taddei A, Amedei A (2018-01-01). "The controversial role of Enterococcus faecalis in colorectal cancer". Therapeutic Advances in Gastroenterology. 11. SAGE Publications: 1756284818783606. doi:10.1177/1756284818783606. 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