Phage display identification of CD100 in human atherosclerotic plaque macrophages and foam cells

Atherosclerosis is a complex disease in which vessels develop plaques comprising dysfunctional endothelium, monocyte derived lipid laden foam cells and activated lymphocytes. Considering that humans and animal models of the disease develop quite distinct plaques, we used human plaques to search for proteins that could be used as markers of human atheromas. Phage display peptide libraries were probed to fresh human carotid plaques, and a bound phage homologous to plexin B1, a high affinity receptor for CD100, was identified. CD100 is a member of the semaphorin family expressed by most hematopoietic cells and particularly by activated T cells. CD100 expression was analyzed in human plaques and normal samples. CD100 mRNA and protein were analyzed in cultured monocytes, macrophages and foam cells. The effects of CD100 in oxLDL-induced foam cell formation and in CD36 mRNA abundance were evaluated. Human atherosclerotic plaques showed strong labeling of CD100/SEMA4D. CD100 expression was further demonstrated in peripheral blood monocytes and in in vitro differentiated macrophages and foam cells, with diminished CD100 transcript along the differentiation of these cells. Incubation of macrophages with CD100 led to a reduction in oxLDL-induced foam cell formation probably through a decrease of CD36 expression, suggesting for the first time an atheroprotective role for CD100 in the human disease. Given its differential expression in the numerous foam cells and macrophages of the plaques and its capacity to decrease oxLDL engulfment by macrophages we propose that CD100 may have a role in atherosclerotic plaque development, and may possibly be employed in targeted treatments of these atheromas.

Ovariectomized OVA-sensitized mice display increased frequency of CD4+Foxp3+ T regulatory cells in the periphery

It is well established that female sex hormones have a pivotal role in inflammation. For instance, our group has previously reported that estradiol has proinflammatory actions during allergic lung response in animal models. Based on these findings, we have decided to further investigate whether T regulatory cells are affected by female sex hormones absence after ovariectomy. We evaluated by flow cytometry the frequencies of CD4+Foxp3+ T regulatory cells (Tregs) in central and peripheral lymphoid organs, such as the thymus, spleen and lymph nodes. Moreover, we have also used the murine model of allergic lung inflammation a to evaluate how female sex hormones would affect the immune response in vivo. To address that, ovariectomized or sham operated female Balb/c mice were sensitized or not with ovalbumin 7 and 14 days later and subsequently challenged twice by aerosolized ovalbumin on day 21. Besides the frequency of CD4+Foxp3+ T regulatory cells, we also measured the cytokines IL-4, IL-5, IL-10, IL-13 and IL-17 in the bronchoalveolar lavage from lungs of ovalbumine challenged groups. Our results demonstrate that the absence of female sex hormones after ovariectomy is able to increase the frequency of Tregs in the periphery. As we did not observe differences in the thymus-derived natural occurring Tregs, our data may indicate expansion or conversion of peripheral adaptive Tregs. In accordance with Treg suppressive activity, ovariectomized and ovalbumine-sensitized and challenged animals had significantly reduced lung inflammation. This was observed after cytokine analysis of lung explants showing significant reduction of pro-inflammatory cytokines, such as IL-4, IL-5, IL-13 and IL-17, associated to increased amount of IL-10. In summary, our data clearly demonstrates that OVA sensitization 7 days after ovariectomy culminates in reduced lung inflammation, which may be directly correlated with the expansion of Tregs in the periphery and further higher IL-10 secretion in the lungs.

Display Caotico. Mutazioni nell'arte del mostrare dagli anni Sessanta ad oggi

La mostra è diventata un nuovo paradigma della cultura contemporanea. Sostenuta da proprie regole e da una grammatica complessa produce storie e narrazioni. La presente ricerca di dottorato si struttura come un ragionamento critico sulle strategie del display contemporaneo, tentando di dimostrare, con strumenti investigativi eterogenei, assumendo fonti eclettiche e molteplici approcci disciplinari - dall'arte contemporanea, alla critica d'arte, la museologia, la sociologia, l'architettura e gli studi curatoriali - come il display sia un modello discorsivo di produzione culturale con cui il curatore si esprime. La storia delle esposizioni del XX secolo è piena di tentativi di cambiamento del rapporto tra lo sviluppo di pratiche artistiche e la sperimentazione di un nuovo concetto di mostra. Nei tardi anni Sessanta l’ingresso, nella scena dell’arte, dell’area del concettuale, demolisce, con un azzeramento radicale, tutte le convenzioni della rappresentazione artistica del dopoguerra, ‘teatralizzando’ il medium della mostra come strumento di potere e introducendo un nuovo “stile di presentazione” dei lavori, un display ‘dematerializzato” che rovescia le classiche relazioni tra opera, artista, spazio e istituzione, tra un curatore che sparisce (Siegelaub) e un curatore super-artista (Szeemann), nel superamento del concetto tradizionale di mostra stessa, in cui il lavoro del curatore, in quanto autore creativo, assumeva una propria autonomia strutturale all’interno del sistema dell’arte. Lo studio delle radici di questo cambiamento, ossia l’emergere di due tipi di autorialità: il curatore indipendente e l’artista che produce installazioni, tra il 1968 e il 1972 (le mostre di Siegelaub e Szeemann, la mimesi delle pratiche artistiche e curatoriali di Broodthaers e la tensione tra i due ruoli generata dalla Critica Istituzionale) permette di inquadrare teoricamente il fenomeno. Uno degli obbiettivi della ricerca è stato anche affrontare la letteratura critica attraverso una revisione/costruzione storiografica sul display e la storia delle teorie e pratiche curatoriali - formalizzata in modo non sistematico all'inizio degli anni Novanta, a partire da una rilettura retrospettiva della esperienze delle neoavanguardie – assumendo materiali e metodologie provenienti, come già dichiarato, da ambiti differenti, come richiedeva la composizione sfaccettata e non fissata dell’oggetto di studio, con un atteggiamento che si può definire comparato e post-disciplinare. Il primo capitolo affronta gli anni Sessanta, con la successione sistematica dei primi episodi sperimentali attraverso tre direzioni: l’emergere e l’affermarsi del curatore come autore, la proliferazione di mostre alternative che sovvertivano il formato tradizionale e le innovazioni prodotte dagli artisti organizzatori di mostre della Critica Istituzionale. Esponendo la smaterializzazione concettuale, Seth Siegelaub, gallerista, critico e impresario del concettuale, ha realizzato una serie di mostre innovative; Harald Szeemann crea la posizione indipendente di exhibition maker a partire When attitudes become forms fino al display anarchico di Documenta V; gli artisti organizzatori di mostre della Critica Istituzionale, soprattutto Marcel Broodhthears col suo Musée d’Art Moderne, Départment des Aigles, analizzano la struttura della logica espositiva come opera d’arte. Nel secondo capitolo l’indagine si sposta verso la scena attivista e alternativa americana degli anni Ottanta: Martha Rosler, le pratiche community-based di Group Material, Border Art Workshop/Taller de Arte Fronterizo, Guerrilla Girls, ACT UP, Art Workers' Coalition che, con proposte diverse elaborano un nuovo modello educativo e/o partecipativo di mostra, che diventa anche terreno del confronto sociale. La mostra era uno svincolo cruciale tra l’arte e le opere rese accessibili al pubblico, in particolare le narrazioni, le idee, le storie attivate, attraverso un originale ragionamento sulle implicazioni sociali del ruolo del curatore che suggeriva punti di vista alternativi usando un forum istituzionale. Ogni modalità di display stabiliva relazioni nuove tra artisti, istituzioni e audience generando abitudini e rituali diversi per guardare la mostra. Il potere assegnato all’esposizione, creava contesti e situazioni da agire, che rovesciavano i metodi e i formati culturali tradizionali. Per Group Material, così come nelle reading-room di Martha Rosler, la mostra temporanea era un medium con cui si ‘postulavano’ le strutture di rappresentazione e i modelli sociali attraverso cui, regole, situazioni e luoghi erano spesso sovvertiti. Si propongono come artisti che stanno ridefinendo il ruolo della curatela (significativamente scartano la parola ‘curatori’ e si propongono come ‘organizzatori’). La situazione cambia nel 1989 con la caduta del muro di Berlino. Oltre agli sconvolgimenti geopolitici, la fine della guerra fredda e dell’ideologia, l’apertura ai flussi e gli scambi conseguenti al crollo delle frontiere, i profondi e drammatici cambiamenti politici che coinvolgono l’Europa, corrispondono al parallelo mutamento degli scenari culturali e delle pratiche espositive. Nel terzo capitolo si parte dall’analisi del rapporto tra esposizioni e Late Capitalist Museum - secondo la definizione di Rosalind Krauss - con due mostre cruciali: Le Magiciens de la Terre, alle origini del dibattito postcoloniale e attraverso il soggetto ineffabile di un’esposizione: Les Immatériaux, entrambe al Pompidou. Proseguendo nell’analisi dell’ampio corpus di saggi, articoli, approfondimenti dedicati alle grandi manifestazioni internazionali, e allo studio dell’espansione globale delle Biennali, avviene un cambiamento cruciale a partire da Documenta X del 1997: l’inclusione di lavori di natura interdisciplinare e la persistente integrazione di elementi discorsivi (100 days/100 guests). Nella maggior parte degli interventi in materia di esposizioni su scala globale oggi, quello che viene implicitamente o esplicitamente messo in discussione è il limite del concetto e della forma tradizionale di mostra. La sfida delle pratiche contemporanee è non essere più conformi alle tre unità classiche della modernità: unità di tempo, di spazio e di narrazione. L’episodio più emblematico viene quindi indagato nel terzo capitolo: la Documenta X di Catherine David, il cui merito maggiore è stato quello di dichiarare la mostra come format ormai insufficiente a rappresentare le nuove istanze contemporanee. Le quali avrebbero richiesto - altrimenti - una pluralità di modelli, di spazi e di tempi eterogenei per poter divenire un dispositivo culturale all’altezza dei tempi. La David decostruisce lo spazio museale come luogo esclusivo dell’estetico: dalla mostra laboratorio alla mostra come archivio, l’evento si svolge nel museo ma anche nella città, con sottili interventi di dissimulazione urbana, nel catalogo e nella piattaforma dei 100 giorni di dibattito. Il quarto capitolo affronta l’ultima declinazione di questa sperimentazione espositiva: il fenomeno della proliferazione delle Biennali nei processi di globalizzazione culturale. Dalla prima mostra postcoloniale, la Documenta 11 di Okwui Enwezor e il modello delle Platforms trans-disciplinari, al dissolvimento dei ruoli in uno scenario post-szeemanniano con gli esperimenti curatoriali su larga scala di Sogni e conflitti, alla 50° Biennale di Venezia. Sono analizzati diversi modelli espositivi (la mostra-arcipelago di Edouard Glissant; il display in crescita di Zone of Urgency come estetizzazione del disordine metropolitano; il format relazionale e performativo di Utopia Station; il modello del bric à brac; la “Scuola” di Manifesta 6). Alcune Biennali sono state sorprendentemente autoriflessive e hanno consentito un coinvolgimento più analitico con questa particolare forma espressiva. Qual è l'impatto sulla storia e il dibattito dei sistemi espositivi? Conclusioni: Cos’è la mostra oggi? Uno spazio sotto controllo, uno spazio del conflitto e del dissenso, un modello educativo e/o partecipativo? Una piattaforma, un dispositivo, un archivio? Uno spazio di negoziazione col mercato o uno spazio di riflessione e trasformazione? L’arte del display: ipotesi critiche, prospettive e sviluppi recenti.

Andamenti temporali, display comportamentali, attività respiratoria e profili endocrini in Odobenus rosmarus presso l'Oceanogràfic di Valencia

Il presente studio è stato progettato e articolato includendo tre approcci disciplinari sviluppati parallelamente al fine di ottenere dati etologici, endocrinologici, e respiratori riguardo cinque esemplari di trichecho del pacifico (Odobenus rosmarus) ospitati presso l’Oceanografic di Valencia. Il periodo di campionamento si è sviluppato in un lasso di tempo di 12 settimane durante le quali sono stati raccolti dati riguardo i tre ambiti di studio. La raccolta di dati etologici è stata effettuata per mezzo di supporto video il quale ha permesso di generare un totale di 72 ore di filmato. Attraverso l’analisi del materiale multimediale è stato possibile elaborare un catalogo comportamentale con annesso un catalogo video atto alla semplificazione di riconoscimento dei vari moduli comportamentali; la revisione della documentazione video è stata effettuata mediante il software Noldus “Observer 5.0” che si è resa necessaria per la quantificazione dei singoli comportamenti osservati durante il periodo di studio. Succesivamente i dati ottenuti sono stati sottoposti ad analisi statistica al fine di poter valutare le differenze e le analogie comportamentali dei due soggetti principali nell’arco della singola giornata e durante le dodici settimane di analisi. In concomitanza col campionamento video, si è proceduto ialla raccolta dei dati relativi ai pattern respiratori al fine di valutare la durata delle apnee in ambiente controllato. In seguito è stato effettuato un approccio endocrinologico al fine di valutare la possibilità di rilevare e quantificare glucorticoidi quali cortisolo, testosterone e progesterone presenti nei campioni. Si è ricorso alla raccolta di materiale salivare in alternativa al campionamento ematico in modo da stabilire l’effettiva efficacia del metodo. I campioni sono stati poi processati mediante RIA e i livelli ormonali ottenuti sono stati utilizzati per effettuare una comparazione con il manifestarsi dei moduli comportamentali osservati è analizzarne le correlazioni presenti e osservarne gli effetti sull’espressione etologica.

Toward optimal display of physiologic status in critical care: I. Recreating bedside displays from archived physiologic data

BACKGROUND: Physiologic data display is essential to decision making in critical care. Current displays echo first-generation hemodynamic monitors dating to the 1970s and have not kept pace with new insights into physiology or the needs of clinicians who must make progressively more complex decisions about their patients. The effectiveness of any redesign must be tested before deployment. Tools that compare current displays with novel presentations of processed physiologic data are required. Regenerating conventional physiologic displays from archived physiologic data is an essential first step. OBJECTIVES: The purposes of the study were to (1) describe the SSSI (single sensor single indicator) paradigm that is currently used for physiologic signal displays, (2) identify and discuss possible extensions and enhancements of the SSSI paradigm, and (3) develop a general approach and a software prototype to construct such "extended SSSI displays" from raw data. RESULTS: We present Multi Wave Animator (MWA) framework-a set of open source MATLAB (MathWorks, Inc., Natick, MA, USA) scripts aimed to create dynamic visualizations (eg, video files in AVI format) of patient vital signs recorded from bedside (intensive care unit or operating room) monitors. Multi Wave Animator creates animations in which vital signs are displayed to mimic their appearance on current bedside monitors. The source code of MWA is freely available online together with a detailed tutorial and sample data sets.

DARPins recognizing the tumor-associated antigen EpCAM selected by phage and ribosome display and engineered for multivalency

Designed Ankyrin Repeat Proteins (DARPins) represent a novel class of binding molecules. Their favorable biophysical properties such as high affinity, stability and expression yields make them ideal candidates for tumor targeting. Here, we describe the selection of DARPins specific for the tumor-associated antigen epithelial cell adhesion molecule (EpCAM), an approved therapeutic target on solid tumors. We selected DARPins from combinatorial libraries by both phage display and ribosome display and compared their binding on tumor cells. By further rounds of random mutagenesis and ribosome display selection, binders with picomolar affinity were obtained that were entirely monomeric and could be expressed at high yields in the cytoplasm of Escherichia coli. One of the binders, denoted Ec1, bound to EpCAM with picomolar affinity (K(d)=68 pM), and another selected DARPin (Ac2) recognized a different epitope on EpCAM. Through the use of a variety of bivalent and tetravalent arrangements with these DARPins, the off-rate on cells was further improved by up to 47-fold. All EpCAM-specific DARPins were efficiently internalized by receptor-mediated endocytosis, which is essential for intracellular delivery of anticancer agents to tumor cells. Thus, using EpCAM as a target, we provide evidence that DARPins can be conveniently selected and rationally engineered to high-affinity binders of various formats for tumor targeting.

GDNF family ligands display distinct action profiles on cultured GABAergic and serotonergic neurons of rat ventral mesencephalon

Glial-cell-line-derived neurotrophic factor (GDNF), neurturin (NRTN), artemin (ARTN) and persephin (PSPN), known as the GDNF family ligands (GFLs), influence the development, survival and differentiation of cultured dopaminergic neurons from ventral mesencephalon (VM). Detailed knowledge about the effects of GFLs on other neuronal populations in the VM is essential for their potential application as therapeutic molecules for Parkinson's disease. Hence, in a comparative study, we investigated the effects of GFLs on cell densities and morphological differentiation of gamma-aminobutyric acid-immunoreactive (GABA-ir) and serotonin-ir (5-HT-ir) neurons in primary cultures of E14 rat VM. We observed that all GFLs [10 ng/ml] significantly increased GABA-ir cell densities (1.6-fold) as well as neurite length/neuron. However, only GDNF significantly increased the number of primary neurites/neuron, and none of the GFLs affected soma size of GABA-ir neurons. In contrast, only NRTN treatment significantly increased 5-HT-ir cells densities at 10 ng/ml (1.3-fold), while an augmentation was seen for GDNF and PSPN at 100 ng/ml (2.4-fold and 1.7-fold, respectively). ARTN had no effect on 5-HT-ir cell densities. Morphological analysis of 5-HT-ir neurons revealed a significant increase of soma size, number of primary neurites/neuron and neurite length/neuron after GDNF exposure, while PSPN only affected soma size, and NRTN and ARTN failed to exert any effect. In conclusion, we identified GFLs as effective neurotrophic factors for VM GABAergic and serotonergic neurons, demonstrating characteristic individual action profiles emphasizing their important and distinct roles during brain development.

Diel variation in a dynamic sexual display and its association with female mate-searching behaviour

Dynamic sexual signals often show a diel rhythm and may vary substantially with time of day. Diel and short-term fluctuations in such sexual signals pose a puzzle for condition capture models of mate choice, which assume a female preference for male traits that reliably reflect a male's quality. Here we experimentally manipulated the food supply of individual male field crickets Gryllus campestris in their natural habitat in two consecutive seasons to determine (i) the effect of male nutritional condition on the fine-scaled variation of diel investment in acoustic signalling and (ii) the temporal association between the diel variation in male signalling and female mate-searching behaviour. Overall food-supplemented males signalled more often, but the effect was only visible during the daytime. In the evening and the night, signal output was still high but the time spent signalling was unrelated to a male's nutritional condition. Females' mate-searching behaviour also showed a diel rhythm with peak activity during the afternoon, when differences among calling males were highest, and where signal output reliably reflects male quality. These findings suggest that males differing in nutritional condition may optimize their investment in signalling in relation to time of day as to maximize mating success.

Simple virtual reality display of fetal volume ultrasound

Three-dimensional (3D) ultrasound volume acquisition, analysis and display of fetal structures have enhanced their visualization and greatly improved the general understanding of their anatomy and pathology. The dynamic display of volume data generally depends on proprietary software, usually supplied with the ultrasound system, and on the operator's ability to maneuver the dataset digitally. We have used relatively simple tools and an established storage, display and manipulation format to generate non-linear virtual reality object movies of prenatal images (including moving sequences and 3D-rendered views) that can be navigated easily and interactively on any current computer. This approach permits a viewing or learning experience that is superior to watching a linear movie passively.

Pollinator responses to variation in floral display and flower size in dioecious Sagittaria latifolia (Alismataceae)

In animal-pollinated plants with unisexual flowers, sexual dimorphism in floral traits may be the consequence of pollinator-mediated selection. Experimental investigations of the effects of variation in flower size and floral display on pollinator visitation can provide insights into the evolution of floral dimorphism in dioecious plants. Here, we investigated pollinator responses to experimental arrays of dioecious Sagittaria latifolia in which we manipulated floral display and flower size. We also examined whether there were changes in pollinator visitation with increasing dimorphism in flower size. In S. latifolia, males have larger flowers and smaller floral displays than females. Visitation by pollinators, mainly flies and bees, was more frequent for male than for female inflorescences and increased with increasing flower size, regardless of sex. The number of insect visits per flower decreased with increasing floral display in males but remained constant in females. Greater sexual dimorphism in flower size increased visits to male inflorescences but had no influence on the number of visits to female inflorescences. These results suggest that larger flower sizes would be advantageous to both females and males, and no evidence was found that females suffer from increased flower-size dimorphism. Small daily floral displays may benefit males by allowing extended flowering periods and greater opportunities for effective pollen dispersal.

Engineered fibrin matrices for functional display of cell membrane-bound growth factor-like activities: study of angiogenic signaling by ephrin-B2

With the rapid increase in approaches to pro- or anti-angiogenic therapy, new and effective methodologies for administration of cell-bound growth factors will be required. We sought to develop the natural hydrogel matrix fibrin as platform for extensive interactions and continuous signaling by the vascular morphogen ephrin-B2 that normally resides in the plasma membrane and requires multivalent presentation for ligation and activation of Eph receptors on apposing endothelial cell surfaces. Using fibrin and protein engineering technology to induce multivalent ligand presentation, a recombinant mutant ephrin-B2 receptor binding domain was covalently coupled to fibrin networks at variably high densities. The ability of fibrin-bound ephrin-B2 to act as ligand for endothelial cells was preserved, as demonstrated by a concomitant, dose-dependent increase of endothelial cell binding to engineered ephrin-B2-fibrin substrates in vitro. The therapeutic relevance of ephrin-B2-fibrin implant matrices was demonstrated by a local angiogenic response in the chick embryo chorioallontoic membrane evoked by the local and prolonged presentation of matrix-bound ephrin-B2 to tissue adjacing the implant. This new knowledge on biomimetic fibrin vehicles for precise local delivery of membrane-bound growth factor signals may help to elucidate specific biological growth factor function, and serve as starting point for development of new treatment strategies.

Class-switzched B cells display response to therapeutic B-cell depletion in rheumatoid arthritis

Introduction Reconstitution of peripheral blood (PB) B cells after therapeutic depletion with the chimeric anti-CD20 antibody rituximab (RTX) mimics lymphatic ontogeny. In this situation, the repletion kinetics and migratory properties of distinct developmental B-cell stages and their correlation to disease activity might facilitate our understanding of innate and adaptive B-cell functions in rheumatoid arthritis (RA). Methods Thirty-five 'RTX-naïve' RA patients with active arthritis were treated after failure of tumour necrosis factor blockade in an open-label study with two infusions of 1,000 mg RTX. Prednisone dose was tapered according to clinical improvement from a median of 10 mg at baseline to 5 mg at 9 and 12 months. Conventional disease-modifying antirheumatic drugs were kept stable. Subsets of CD19+ B cells were assessed by flow cytometry according to their IgD and CD27 surface expression. Their absolute number and relative frequency in PB were followed every 3 months and were determined in parallel in synovial tissue (n = 3) or synovial fluid (n = 3) in the case of florid arthritis. Results Six of 35 patients fulfilled the European League Against Rheumatism criteria for moderate clinical response, and 19 others for good clinical response. All PB B-cell fractions decreased significantly in number (P < 0.001) after the first infusion. Disease activity developed independently of the total B-cell number. B-cell repopulation was dominated in quantity by CD27-IgD+ 'naïve' B cells. The low number of CD27+IgD- class-switched memory B cells (MemB) in the blood, together with sustained reduction of rheumatoid factor serum concentrations, correlated with good clinical response. Class-switched MemB were found accumulated in flaring joints. Conclusions The present data support the hypothesis that control of adaptive immune processes involving germinal centre-derived, antigen, and T-cell-dependently matured B cells is essential for successful RTX treatment.

Renal allografts with IF/TA display distinct expression profiles of metzincins and related genes

Chronic renal allograft injury is often reflected by interstitial fibrosis (IF) and tubular atrophy (TA) without evidence of specific etiology. In most instances, IF/TA remains an irreversible disorder, representing a major cause of long-term allograft loss. As members of the protease family metzincins and functionally related genes are involved in fibrotic and sclerotic processes of the extracellular matrix (ECM), we hypothesized their deregulation in IF/TA. Gene expression and protein level analyses using allograft biopsies with and without Banff'05 classified IF/TA illustrated their deregulation. Expression profiles of these genes differentiated IF/TA from Banff'05 classified Normal biopsies in three independent microarray studies and demonstrated histological progression of IF/TA I to III. Significant upregulation of matrix metalloprotease-7 (MMP-7) and thrombospondin-2 (THBS-2) in IF/TA biopsies and sera was revealed in two independent patient sets. Furthermore, elevated THBS-2, osteopontin (SPP1) and beta-catenin may play regulatory roles on MMP. Our findings further suggest that deregulated ECM remodeling and possibly epithelial to mesenchymal transition (EMT) are implicated in IF/TA of kidney transplants, and that metzincins and related genes play an important role in these processes. Profiling of these genes may be used to complement IF/TA diagnosis and to disclose IF/TA progression in kidney transplant recipients.