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Open Access 01-03-2019 | Hypertension | Nephrology - Original Paper

The impact of antihypertensive pharmacotherapy on interplay between protein-bound uremic toxin (indoxyl sulfate) and markers of inflammation in patients with chronic kidney disease

Authors: Tomasz W. Kaminski, Krystyna Pawlak, Malgorzata Karbowska, Beata Znorko, Adrian L. Mor, Michal Mysliwiec, Dariusz Pawlak

Published in: International Urology and Nephrology | Issue 3/2019

Abstract

Purpose

Indoxyl sulfate (IS) is one of the most potent uremic toxins involved in chronic kidney disease (CKD) progression, induction of inflammation, oxidative stress, and cardiovascular diseases occurrence. It is proved that hypertension is a common CVD complication and a major death risk factor as well as contributes for decline in a renal function. The aim of our study was to investigate how implementing of antihypertensive therapy impact IS concentrations and the associations between IS and markers of renal function, inflammation and oxidative stress.

Methods

Study was conducted on 50 patients diagnosed with CKD and hypertension, divided into three groups: without hypotensive therapy (CKD-NONE), hypotensive monotherapy (CKD-MONO), and hypotensive polypharmacotherapy (CKD-POLI), and 18 healthy volunteers. The markers of inflammation [interleukin-6, tumor necrosis factor-alpha (TNF-α), high-sensitive C-reactive protein (hs-CRP), neopterin, ferritin], oxidative status [superoxide dismutase (Cu/Zn-SOD), antibodies against oxidized low-density lipoprotein (oxLDL-abs)], and selectins were determinate using immunoenzymatic methods. IS levels were assayed using high-performance liquid chromatography and other parameters were analysed using routine laboratory techniques. Then cross-sectional analysis was performed.

Results

Elevated levels of IS, indicators of kidney function, markers of inflammation and blood pressure values were observed in each CKD subgroups. There was no effect of antihypertensive therapy on IS levels between studied groups, as well as there was no clear relationship between IS and blood pressure values in each studied group. The positive associations between IS and Cu/Zn SOD, neopterin, hs-CRP, creatinine and neutrophils/lymphocytes ratio were observed in CKD-NONE and CKD-POLI subgroups. Additionally, in CKD-POLI group IS positively correlated with TNF-α, ferritin and neutrophils. In CKD-MONO group, IS was positively related to oxLDL-abs, neopterin, E-selectin and creatinine, whereas it was inversely associated with hs-CRP.

Conclusions

Our study showed for the first time that the antihypertensive therapy has no impact on IS levels in CKD patients with hypertension. However, the introduction of the antihypertensive therapy modified the dependencies between IS and the studied markers of kidney function, inflammation, oxidative stress and hematological parameters that are crucial for mortality and morbidity amongst the CKD patients with hypertension.

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Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C (1999) Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 55:648–658. https://doi.org/10.1046/j.1523-1755.1999.00273.x CrossRefPubMed

Tbahriti HF, Meknassi D, Moussaoui R, Messaoudi A, Zemour L, Kaddous A et al (2013) Inflammatory status in chronic renal failure: the role of homocysteinemia and pro-inflammatory cytokines. World J Nephrol 2:31–37. https://doi.org/10.5527/wjn.v2.i2.31 CrossRefPubMedPubMedCentral

Brooks J, Watson A, Korcsmaros T (2017) Omics approaches to identify potential biomarkers of inflammatory diseases in the focal adhesion complex. Genomics Proteom Bioinform 15:101–109. https://doi.org/10.1016/j.gpb.2016.12.003 CrossRef

Sun J, Axelsson J, Machowska A, Heimburger O, Barany P, Lindholm B et al (2016) Biomarkers of cardiovascular disease and mortality risk in patients with advanced CKD. Clin J Am Soc Nephrol 11:1163–1172. https://doi.org/10.2215/CJN.10441015 CrossRefPubMedPubMedCentral

Slee AD (2012) Exploring metabolic dysfunction in chronic kidney disease. Nutr Metab (Lond) 9:36. https://doi.org/10.1186/1743-7075-9-36 CrossRef

Kaminski T, Michalowska M, Pawlak D (2017) Aryl hydrocarbon receptor (AhR) and its endogenous agonist—indoxyl sulfate in chronic kidney disease. Postepy Hig Med Dosw 30:624–632

Kaminski TW, Pawlak K, Karbowska M, Myśliwiec M, Pawlak D (2017) Indoxyl sulfate - the uremic toxin linking hemostatic system disturbances with the prevalence of cardiovascular disease in patients with chronic kidney disease. BMC Nephrol 18(1):35. https://doi.org/10.1186/s12882-017-0457-1 CrossRefPubMedPubMedCentral

Hung S, Kuo K, Wu C, Tarng D (2017) Indoxyl sulfate: a novel cardiovascular risk factor in chronic kidney disease. J Am Heart Assoc 6:e005022. https://doi.org/10.1161/JAHA.116.005022 CrossRefPubMedPubMedCentral

Karbowska M, Kaminski TW, Znorko B, Domaniewski T, Misztal T, Rusak T et al (2018) Indoxyl sulfate promotes arterial thrombosis in rat model via increased levels of complex TF/VII, PAI-1, platelet activation as well as decreased contents of SIRT1 and SIRT3. Front Physiol 9:1623. https://doi.org/10.3389/fphys.2018.01623 CrossRefPubMedPubMedCentral

10.

Adijiang A, Shimizu H, Higuchi Y, Nishijima F, Niwa T (2011) Indoxyl sulfate reduces klotho expression and promotes senescence in the kidneys of hypertensive rats. J Ren Nutr 21:105–109. https://doi.org/10.1053/j.jrn.2010.10.020 CrossRefPubMed

11.

Yisireyili M, Shimizu H, Saito S, Enomoto A, Nishijima F, Niwa T (2013) Indoxyl sulfate promotes cardiac fibrosis with enhanced oxidative stress in hypertensive rats. Life Sci 92:1180–1185. https://doi.org/10.1016/j.lfs.2013.05.008 CrossRefPubMed

12.

Judd E, Calhoun DA (2015) Management of hypertension in CKD: beyond the guidelines. Adv Chronic Kidney Dis 22:116–122. https://doi.org/10.1053/j.ackd.2014.12.001 CrossRefPubMedPubMedCentral

13.

Locatelli F, Del Vecchio L, Pozzoni P, D’Amico M, Andrulli S (2005) Is it the agent or the blood pressure level that matters for renal and vascular protection in chronic nephropathies? Kidney Int Suppl 93:S15–S19. https://doi.org/10.1111/j.1523-1755.2005.09304.x CrossRef

14.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group (2017) KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7:1–59. https://doi.org/10.1016/j.kisu.2017.04.001 CrossRef

15.

Al Za’abi M, Ali B, Al Toubi M (2013) HPLC-fluorescence method for measurement of the uremic toxin indoxyl sulfate in plasma. J Chromatogr Sci 51:40–43. https://doi.org/10.1093/chromsci/bms103 CrossRefPubMed

16.

Karbowska M, Kaminski TW, Marcinczyk N, Misztal T, Rusak T, Smyk L, Pawlak D (2017) The uremic toxin indoxyl sulfate accelerates thrombotic response after vascular injury in animal models. Toxins (Basel). https://doi.org/10.3390/toxins9070229 CrossRef

17.

Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C et al (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71:1269–1324. https://doi.org/10.1161/HYP.0000000000000066 CrossRefPubMed

18.

Weir MR, Lakkis JI, Jaar B, Rocco MV, Choi MJ, Mattrix-Kramer H et al (2018) Use of renin-angiotensin system blockade in advanced ckd: An NKF-KDOQI controversies report. Am J Kidney. https://doi.org/10.1053/j.ajkd.2018.06.010 CrossRef

19.

Ku E, McCulloch CE, Vittinghoff E, Lin F, Johansen KL (2018) Use of antihypertensive agents and association with risk of adverse outcomes in chronic kidney disease: focus on angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. J Am Heart Assoc 7:e009992. https://doi.org/10.1161/JAHA.118.009992 CrossRefPubMedPubMedCentral

20.

Barreto FC, Barreto DV, Liabeuf S, Meert N, Glorieux G, Temmar M (2009) Serum indoxyl sulfate is associated with vascular disease and mortality in chronic kidney disease patients. Clin J Am Soc Nephrol 4:1551–1558. https://doi.org/10.2215/CJN.03980609 CrossRefPubMedPubMedCentral

21.

Mancia G, Grassi G (2018) Blood pressure targets in type 2 diabetes. Evidence against or in favour of an aggressive approach. Diabetologia 61:517–525. https://doi.org/10.1007/s00125-017-4537-3 CrossRefPubMed

22.

Le DE, Pascotto M, Leong-Poi H, Sari I, Micari A, Kaul S (2013) Anti-inflammatory and pro-angiogenic effects of beta blockers in a canine model of chronic ischemic cardiomyopathy: comparison between carvedilol and metoprolol. Basic Res Cardiol. https://doi.org/10.1007/s00395-013-0384-7 CrossRefPubMedPubMedCentral

23.

Kortekaas KE, Meijer CA, Hinnen JW, Dalman RL, Xu B, Hamming JF et al (2014) ACE inhibitors potently reduce vascular inflammation, results of an open proof-of-concept study in the abdominal aortic aneurysm. PLoS ONE 9:e111952. https://doi.org/10.1371/journal.pone.0111952 CrossRefPubMedPubMedCentral

24.

Komoda H, Inoue T, Node K (2010) Anti-inflammatory properties of azelnidipine, a dihydropyridine-based calcium channel blocker. Clin Exp Hypertens 32:121–128. https://doi.org/10.3109/10641960903254414 CrossRefPubMed

25.

Bartosiewicz J, Kaminski T, Pawlak K, Karbowska M, Tankiewicz-Kwedlo A, Pawlak D (2017) The activation of the kynurenine pathway in a rat model with renovascular hypertension. Exp Biol Med (Maywood) 242:750–761. https://doi.org/10.1177/1535370217693114 CrossRef

26.

Ardiansyah SH, Inagawa Y, Koseki T, Komai M (2011) Regulation of blood pressure and glucose metabolism induced by L-tryptophan in stroke-prone spontaneously hypertensive rats. Nutr Metab (Lond) 8:45. https://doi.org/10.1186/1743-7075-8-45 CrossRef

27.

Castillo-Rodríguez E, Pizarro-Sánchez S, Sanz AB, Ramos AM, Sanchez-Nino MD, Martin-Cleary C et al (2017) Inflammatory cytokines as uremic toxins: “Ni Son Todos Los Que Estan, Ni Estan Todos Los Que Son. Toxins 9:114. https://doi.org/10.3390/toxins9040114 CrossRefPubMedCentral

28.

Vanholder R, Schepers E, Pletinck A, Nagler EV, Glorieux G (2014) The uremic toxicity of indoxyl sulfate and p-cresyl sulfate: a systematic review. J Am Soc Nephrol 25:1897–1907. https://doi.org/10.1681/ASN.2013101062 CrossRefPubMedPubMedCentral

29.

Kamath DY, Xavier D, Sigamani A, Pais P (2015) High sensitivity C-reactive protein (hsCRP) and cardiovascular disease: an Indian perspective. Indian J Med Res 142:261–268. https://doi.org/10.4103/0971-5916.166582 CrossRefPubMedPubMedCentral

30.

Kubo S, Kitamura A, Imano H, Cui R, Yamagagishi K, Umesawa M et al (2016) Serum albumin and high-sensitivity C-reactive protein are independent risk factors of chronic kidney disease in middle-aged Japanese individuals: the circulatory risk in communities study. J Atheroscler Thromb 23:1089–1098. https://doi.org/10.5551/jat.33530 CrossRefPubMedPubMedCentral

31.

Jiménez MC, Rexrode KM, Glynn RJ, Ridker PM, Gaziano JM, Sesso HD (2015) Association between high-sensitivity C-reactive protein and total stroke by hypertensive status among men. J Am Heart Assoc 4:e002073. https://doi.org/10.1161/JAHA.115.002073 CrossRefPubMedPubMedCentral

32.

Arango Duque G, Descoteaux A (2014) Macrophage cytokines: involvement in immunity and infectious diseases. Front Immunol 5:491. https://doi.org/10.3389/fimmu.2014.00491 CrossRefPubMedPubMedCentral

33.

Zhang J, Patel MB, Griffiths R, Mao A, Song Y, Karlovich NS et al (2014) TNF-alpha produced in the kidney contributes to angiotensin II-dependent hypertension. Hypertension 64:1275–1281. https://doi.org/10.1161/HYPERTENSIONAHA.114.03863 CrossRefPubMed

34.

Adesso S, Magnus T, Cuzzocrea S, Campolo M, Rissiek B, Paciello O et al (2017) Indoxyl sulfate affects glial function increasing oxidative stress and neuroinflammation in chronic kidney disease: interaction between astrocytes and microglia. Front Pharmacol 8:370. https://doi.org/10.3389/fphar.2017.00370 CrossRefPubMedPubMedCentral

35.

Su H, Lei CT, Zhang C (2017) Interleukin-6 signaling pathway and its role in kidney disease: an update. Front Immunol 8:405. https://doi.org/10.3389/fimmu.2017.00405 CrossRefPubMedPubMedCentral

36.

Jasiewicz M, Knapp M, Waszkiewicz E, Ptaszynska-Kopczynska K, Szpakowicz A, Sobkowicz B et al (2015) Enhanced IL-6 trans-signaling in pulmonary arterial hypertension and its potential role in disease-related systemic damage. Cytokine 76:187–192. https://doi.org/10.1016/j.cyto.2015.06.018 CrossRefPubMed

37.

Spoto B, Mattace-Raso F, Sijbrands E, Leonardis D, Testa A, Pisano A et al (2015) Association of IL-6 and a functional polymorphism in the IL-6 Gene with cardiovascular events in patients with CKD. Clin J Am Soc Nephrol 10:232–240. https://doi.org/10.2215/CJN.07000714 CrossRefPubMed

38.

Adelibieke Y, Yisireyili M, Ng HY, Saito S, Nishijima F, Niwa T (2014) Indoxyl sulfate induces IL-6 expression in vascular endothelial and smooth muscle cells through OAT3-mediated uptake and activation of AhR/NF-κB pathway. Nephron Exp Nephrol 128:1–8. https://doi.org/10.1159/000365217 CrossRefPubMed

39.

Brull DJ, Montgomery HE, Sanders J, Dhamrait S, Luong L, Rumley A et al (2001) Interleukin-6 gene − 174g> c and − 572g> c promoter polymorphisms are strong predictors of plasma interleukin-6 levels after coronary artery bypass surgery. Arterioscler Thromb Vasc Biol 21:1458–1463. https://doi.org/10.1016/j.atherosclerosis.2004.01.019 CrossRefPubMed

40.

Cirillo P, Pacileo M, DE Rosa S, Calabrò P, Gargiulo A, Angri V (2006) Neopterin induces pro-atherothrombotic phenotype in human coronary endothelial cells. J Thromb Haemost 4:2248–2255. https://doi.org/10.1111/j.1538-7836.2006.02125.x CrossRefPubMed

41.

Avanzas P, Arroyo-Espliguero R, Cosin-Sales J, Quiles J, Zouridakis E, Kaski JC (2004) Prognostic value of neopterin levels in treated patients with hypertension and chest pain but without obstructive coronary artery disease. Am J Cardiol 93:627–629. https://doi.org/10.1016/j.amjcard.2003.11.035 CrossRefPubMed

42.

Chu S, Mao X, Guo H, Wang L, Li Z, Zhang Y (2017) Indoxyl sulfate potentiates endothelial dysfunction via reciprocal role for reactive oxygen species and RhoA/ROCK signaling in 5/6 nephrectomized rats. Free Radic Res 51:237–252. https://doi.org/10.1080/10715762.2017.1296575 CrossRefPubMed

43.

Pawlak K, Pawlak D, Mysliwiec M (2005) Cu/Zn superoxide dismutase plasma levels as a new useful clinical biomarker of oxidative stress in patients with end-stage renal disease. Clin Biochem 38:700–705. https://doi.org/10.1016/j.clinbiochem.2005.02.009 CrossRefPubMed

44.

Miyamoto Y, Iwao Y, Tasaki Y, Sato K, Ishima Y, Watanabe H (2010) The uremic solute indoxyl sulfate acts as an antioxidant against superoxide anion radicals under normal-physiological conditions. FEBS Lett 584:2816–2820. https://doi.org/10.1016/j.febslet.2010.04.046 CrossRefPubMed

45.

Yu M, Jiang M, Chen Y, Zhang S, Zhang W, Yang X et al (2016) Inhibition of macrophage CD36 expression and cellular oxidized low density lipoprotein (oxLDL) accumulation by tamoxifen: a peroxisome proliferator-activated receptor (PPAR)γ-dependent mechanism. J Biol Chem 291:16977–16989. https://doi.org/10.1074/jbc.M116.740092 CrossRefPubMedPubMedCentral

46.

Frostegård J, Wu R, Lemne C, Thulin T, Witztum JL, de Faire U (2003) Circulating oxidized low-density lipoprotein is increased in hypertension. Clin Sci (Lond) 105:615–620. https://doi.org/10.1042/CS20030152 CrossRef

47.

Mironova M, Virella G, Lopes-Virella MF (1996) Isolation and characterization of human antioxidized LDL autoantibodies. Arterioscler Thromb Vasc Biol 16:222–229CrossRefPubMed

48.

Pawlak K, Mysliwiec M, Pawlak D (2012) Oxidized LDL to autoantibodies against oxLDL ratio - the new biomarker associated with carotid atherosclerosis and cardiovascular complications in dialyzed patients. Atherosclerosis 224:252–257CrossRefPubMed

49.

Kim HY, Yoo TH, Hwang Y, Lee GH, Kim B, Jang J (2017) Indoxyl sulfate (IS)-mediated immune dysfunction provokes endothelial damage in patients with end-stage renal disease (ESRD). Sci Rep 7:3057. https://doi.org/10.1038/s41598-017-03130-z CrossRefPubMedPubMedCentral

50.

Bárány P, Divino Filho JC, Bergström J (1997) High C-reactive protein is a strong predictor of resistance to erythropoietin in hemodialysis patients. Am J Kidney Dis 29:565–568CrossRef

51.

Chonchol M, Lippi G, Montagnana M, Muggeo M, Targher G (2008) Association of inflammation with anaemia in patients with chronic kidney disease not requiring chronic dialysis. Nephrol Dial Transplant 23:2879–2883. https://doi.org/10.1093/ndt/gfn109 CrossRefPubMed

52.

Hamano H, Ikeda Y, Watanabe H, Horinouchi Y, Izawa-Ishizawa Y, Imanishi M et al (2017) The uremic toxin indoxyl sulfate interferes with iron metabolism by regulating hepcidin in chronic kidney disease. Nephrol Dial Transplant 33:586–597. https://doi.org/10.1093/ndt/gfx252 CrossRef

53.

Bataille S, Pelletier M, Sallée M, Berland Y, McKay N, Duval A et al (2017) Indole 3-acetic acid, indoxyl sulfate and paracresyl-sulfate do not influence anemia parameters in hemodialysis patients. BMC Nephrol 18:251. https://doi.org/10.1186/s12882-017-0668-5 CrossRefPubMedPubMedCentral

54.

Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L (2016) Iron deficiency anaemia. Lancet 387:907–916. https://doi.org/10.1016/S0140-6736(15)60865-0 CrossRefPubMed

55.

Shah NR, Dumler F (2008) Hypoalbuminaemia—a marker of cardiovascular disease in patients with chronic kidney disease stages II–IV. Int J Med Sci 5:366–370CrossRefPubMedPubMedCentral

56.

Stenvinkel P, Heimbürger O, Paultre F, Diczfalusy U, Wang T, Berglund L (1999) Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 55:1899–1911. https://doi.org/10.1046/j.1523-1755.1999.00422.x CrossRefPubMed

57.

Huang JY, Hsu CW, Yang CW, Hung CC, Huang WH (2016) Role of anuria in the relationship between indoxyl sulfate and anemia in peritoneal dialysis patients. Ther Clin Risk Manag 12:1797–1803. https://doi.org/10.2147/TCRM.S120012 CrossRefPubMedPubMedCentral

58.

Don BR, Kaysen G (2004) Serum albumin: relationship to inflammation and nutrition. Semin Dial 17:432–437. https://doi.org/10.1111/j.0894-0959.2004.17603.x CrossRefPubMed

59.

Shen WC, Liang CJ, Huang TM, Liu CW, Wang SH, Young GH et al (2016) Indoxyl sulfate enhances IL-1β-induced E-selectin expression in endothelial cells in acute kidney injury by the ROS/MAPKs/NFκB/AP-1 pathway. Arch Toxicol 90:2779–2792. https://doi.org/10.1007/s00204-015-1652-0 CrossRefPubMed

60.

Ito S, Osaka M, Edamatsu T, Itoh Y, Yoshida M (2016) Crucial role of the aryl hydrocarbon receptor (AhR) in indoxyl sulfate-induced vascular inflammation. J Atheroscler Thromb 23:960–975. https://doi.org/10.5551/jat.34462 CrossRefPubMedPubMedCentral

61.

Verhaar MC, Beutler JJ, Gaillard CA, Koomans HA, Fijnheer R, Rabelink TJ (1998) Progressive vascular damage in hypertension is associated with increased levels of circulating P-selectin. J Hypertens 16:45–50CrossRef

62.

Lu GY, Xu RJ, Zhang SH, Qiao Q, Shen L, Li M et al (2015) Alteration of circulatory platelet microparticles and endothelial microparticles in patients with chronic kidney disease. Int J Clin Exp Med 8:16704–16708

63.

Otsuka T, Kaneko Y, Sato Y, Kaseda R, Aoyagi R, Yamamoto S et al (2018) Kidney morphological parameters measured using noncontrast-enhanced steady-state free precession MRI with spatially selective inversion recovery pulse correlate with eGFR in patients with advanced CKD. Clin Exp Nephrol 22:45–54. https://doi.org/10.1007/s10157-017-1413-x CrossRefPubMed

64.

Arai Y, Kanda E, Iimori S, Naito S, Noda Y, Sasaki S et al (2018) Low white blood cell count is independently associated with chronic kidney disease progression in the elderly: the CKD-ROUTE study. Clin Exp Nephrol 22:291–298. https://doi.org/10.1007/s10157-017-1441-6 CrossRefPubMed

65.

Solak Y, Yilmaz MI, Sonmez A, Saglam M, Cakir E, Unal HU et al (2013) Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease. Clin Exp Nephrol 17:532–540. https://doi.org/10.1007/s10157-012-0728-x CrossRefPubMed

66.

Okyay GU, Inal S, Oneç K, Er RE, Paşaoğlu O, Paşaoğlu H (2013) Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail 35:29–36. https://doi.org/10.3109/0886022X.2012.734429 CrossRefPubMed

Title: The impact of antihypertensive pharmacotherapy on interplay between protein-bound uremic toxin (indoxyl sulfate) and markers of inflammation in patients with chronic kidney disease
Authors: Tomasz W. Kaminski
Krystyna Pawlak
Malgorzata Karbowska
Beata Znorko
Adrian L. Mor
Michal Mysliwiec
Dariusz Pawlak
Publication date: 01-03-2019
Publisher: Springer Netherlands
Keywords: Hypertension
Chronic Kidney Disease
Hypertension
Published in: International Urology and Nephrology / Issue 3/2019
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-018-02064-3

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