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Effect of Liraglutide on Microbiome in Obesity

Primary Purpose

Obesity, Weight Loss, Microbiome

Status
Unknown status
Phase
Phase 4
Locations
Italy
Study Type
Interventional
Intervention
Liraglutide 6 MG/ML [Saxenda]
Placebo
Sponsored by
Federico II University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Obesity focused on measuring obesity, liraglutide, gut microbiome

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Informed consent obtained before any trial-related activities. Trial-related activities are any procedures that are carried out as part of the trial, including activities to determine suitability for the trial;
  2. Age ≥ 18 years and < 65 years at the time of signing informed consent;
  3. Body mass index (BMI) ≥ 30 kg/m2
  4. Stable body weight during the previous 3 months (< 5 kg self-reported weight change).

Exclusion Criteria:

General Safety

  1. Current or history of treatment with medications that may cause significant weight gain for at least 3 months before this trial;
  2. Current use or use within three months before this trial of GLP-1 receptor agonist, pramlintide, sibutramine, orlistat, zonisamide, topiramate or phentermine;
  3. Type 1 diabetes;
  4. Type 2 diabetes;
  5. Obesity related to endocrine diseases;
  6. Hepatic Failure (AST and/or ALT >3 times upper limit of normal and/or Total Bilirubin >1.7 upper limit of normal)
  7. End stage renal disease (eGFR < 30 ml/min/1.73 m2 ) or chronic or intermittent haemodialysis or peritoneal dialysis
  8. History or presence of chronic pancreatitis
  9. Presence of acute pancreatitis within the past 180 days prior to the day of screening
  10. Personal or first degree relative(s) history of multiple endocrine neoplasia type 2 or medullary thyroid carcinoma
  11. Presence or history of malignant neoplasms within the past 5 years prior to the day of screening
  12. Severe psychiatric disorder which in the investigator's opinion could compromise compliance with the protocol
  13. Known or suspected hypersensitivity to trial product(s) or related products
  14. Previous participation in this trial. Participation is defined as randomisation
  15. Receipt of any investigational medicinal product within 30 days before screening
  16. Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using a highly effective contraceptive method i.e.:

    • patients who use combined hormonal contraceptives (containing estreogen and progesterone) associated with inhibition of ovulation or oral, intravaginal that transdermal;
    • patients who use hormonal contraceptives based only progesterone that inhibit ovulation, whether oral, injectable or implantable
    • patients with placement of IUD (intrauterine device)
    • patients with positioning of hormone releasing intrauterine systems
    • patients with bilateral tubal occlusion
    • patients with vasectomized partner
    • patients who practice sexual abstinence
  17. Any disorder, unwillingness or inability, which in the investigator's opinion, might jeopardise the subject's safety or compliance with the protocol
  18. Previous surgical treatment for obesity (excluding liposuction >1 year before trial entry); 19 ) Inflammatory bowel diseases; 20 ) recent antibiotic therapy ( within 30 days before screening)

Cardiovascular- related

  • Any of the following: myocardial infarction, stroke, hospitalisation for unstable angina pectoris or transient ischaemic attack within the past 60 days prior to the day of screening
  • Planned coronary, carotid or peripheral artery revascularisation known on the day of screening;
  • Presently classified as being in New York Heart Association (NYHA) Class IV heart failure

Sites / Locations

  • "Federico II" University of Naples, Department of Clinical and Molecular Endocrinology and OncologyRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Active drug

Placebo

Arm Description

Liraglutide is administered once daily by subcutaneous injections with the pen-injector, either in the abdomen, thigh or upper arm. Injections can be done at any time of day irrespective of meals. Subjects will be instructed to escalate the liraglutide dose to 3.0 mg/day over a 4 week period following an initial dose of 0.6 mg/day and weekly dose escalation steps of 0.6 mg/day.

Placebo is administered once daily by subcutaneous injections with the pen-injector, either in the abdomen, thigh or upper arm. Injections can be done at any time of day irrespective of meals. Subjects will be instructed to escalate the placebo dose to 3.0 mg/day over a 4 week period following an initial dose of 0.6 mg/day and weekly dose escalation steps of 0.6 mg/day.

Outcomes

Primary Outcome Measures

Change in gut microbiome composition assessed by Firmicutes-to-Bacteroidetes ratio using Quantitative polymerase chain reaction (PCR)
The liraglutide treatment effect on gut microbiome composition quantified as Firmicutes-to-Bacteroidetes ratio by Quantitative polymerase chain reaction (PCR)

Secondary Outcome Measures

Change in body weight (kg) assessed by scale
The liraglutide treatment effect on weight ( kg) assessed by scale
Change in body weight (kg) that will be combined with height (m) to report BMI (kg/m^2) where kg is a person's weight in kilograms and m2 is a person's height in metres squared
The liraglutide treatment effect on body weight (kg) that will be combined with height (m) to report BMI (kg/m^2) where kg is a person's weight in kilograms and m2 is a person's height in metres squared
Change in body composition assessed by Bioelectrical impedance analysis (BIA)
The liraglutide treatment effect on body composition assessed by BIA
Change in hormonal regulation of appetite assessed by ghrelin levels
The liraglutide treatment effect on hormonal regulation of appetite assessed by ghrelin levels
Change in hormonal regulation of hunger suppression assessed by cholecystokinin levels
The liraglutide treatment effect on hormonal regulation of hunger suppression assessed by cholecystokinin levels
Change in hormonal regulation of appetite assessed by polipeptide YY levels
The liraglutide treatment effect on hormonal regulation of appetite assessed by polipeptide YY levels
Change in hormonal regulation of weight assessed by leptin levels
The liraglutide treatment effect on hormonal regulation of weight assessed by leptin levels
Change in low grade inflammation assessed by C-reactive protein levels
The liraglutide treatment effect on low grade inflammation assessed by C-reactive protein levels
Change in low grade inflammation assessed by erythrocyte sedimentation rate (ESR) levels
The liraglutide treatment effect on low grade inflammation assessed by ESR levels
Change in low grade inflammation assessed by interleukin- 1 (IL- 1) levels
The liraglutide treatment effect on low grade inflammation assessed by IL- 1 levels
Change in low grade inflammation assessed by interleukin- 6 (IL- 6) levels
The liraglutide treatment effect on low grade inflammation assessed by IL- 6 levels
Change in low grade inflammation assessed by interleukin- 10 (IL- 10) levels
The liraglutide treatment effect on low grade inflammation assessed by IL- 10 levels
Change in low grade inflammation assessed by Tumor Necrosis Factor -α (TNF-α) levels
The liraglutide treatment effect on low grade inflammation assessed by TNF-α levels
Change in low grade inflammation assessed by monocyte chemotactic protein - 1 (MCP-1) levels
The liraglutide treatment effect on low grade inflammation assessed by MCP-1 levels
Change in lipid profile assessed by total cholesterol levels
The liraglutide treatment effect on lipid profile assessed by total cholesterol levels
Change in lipid profile assessed by LDL cholesterol levels
The liraglutide treatment effect on lipid profile assessed by LDL cholesterol levels
Change in lipid profile assessed by HDL cholesterol levels
The liraglutide treatment effect on lipid profile assessed by HDL cholesterol levels
Change in lipid profile assessed by triglycerides levels
The liraglutide treatment effect on lipid profile assessed by triglycerides levels
Change in insulin resistance assessed by Matsuda Index
The liraglutide treatment effect on insulin resistance assessed by Matsuda Index
Change in insulin resistance assessed by homeostasis model assessment - insulin resistance (HOMA-IR) Index
The liraglutide treatment effect on insulin resistance assessed by HOMA-IR Index

Full Information

First Posted
July 8, 2019
Last Updated
August 18, 2019
Sponsor
Federico II University
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1. Study Identification

Unique Protocol Identification Number
NCT04046822
Brief Title
Effect of Liraglutide on Microbiome in Obesity
Official Title
Could Gut Microbiome Contribute to the Therapeutic Effect of Liraglutide 3.0 mg? A Randomized Double Blind Placebo Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Unknown status
Study Start Date
January 9, 2019 (Actual)
Primary Completion Date
January 9, 2020 (Anticipated)
Study Completion Date
April 30, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Federico II University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
The purpose of the trial is to assess whether the beneficial effect of liraglutide on weight is mediated by changes in the composition of the intestinal Microbiome. The main mechanisms of action of liraglutide were traced to a reduction in the secretion of glucagon and slowing gastric emptying resulting in decreased appetite and body weight. It also seems that liraglutide is capable of increasing the satiety signals thanks to a dual mechanism of stimulation and inhibition induced by medication. Pomc neurons (opiomelacortin) present in hypothalamic arcuate nuclei, stimulated by liraglutide, glucagon-like peptide- 1 (GLP-1) receptor expressed by inhibiting intensely appetite. At the same time through the GABAergic neuronal activity is inhibited neuropeptide Y(NPY) deputies to the production of orexins that are powerful promoters of appetite. Alterations in the composition of the human gut microbiome occur in metabolic disorders such as obesity, diabetes. Liraglutide has been reported to switch microbiome composition towards lean-related bacterial phylotypes in animal studies. This leads to hypothesize that the switch of microbiome by liraglutide may be one of the mechanisms through which liraglutide may exert its effect. In particular the investigators hypothesize that liraglutide could restore a healthy microbiome or at least improve the microbiome composition through slowing gastrointestinal motility. Moreover, the liraglutide-related change of microbiome could be an additional mechanism that contribute to the beneficial metabolic effect of liraglutide. To test this hypothesis the investigators will investigate if there will be any change of gut microbiome assessed as Firmicutes-to-Bacteroidetes ratio after liraglutide treatment. In order to understand if the change of gut microbiome after liraglutide treatment occurs as an association or contributes to the effect of liraglutide ,the investigators will correlate the Firmicutes-to-Bacteroidetes ratios with the changes of Body Mass Index, Body Composition, appetite parameters, chronic inflammation parameters, lipid profile and insulin resistance. All the subjects will follow the same diet in order to avoid any bias.
Detailed Description
This is a randomized, double-blind, parallel group, placebo-controlled trial comparing liraglutide 3.0 mg with placebo both administered subcutaneously once-daily in subjects with established obesity. Subjects will be randomised in a 1:1 ratio to receive either liraglutide 3.0 mg or placebo as an adjunct to standard-of-care.All baseline assessments will be done prior to administration of the first dose of trial product while all the follow up assessments will be done at the end of the trial. Dose escalation of liraglutide/placebo will take place during the first 4 weeks after randomisation as described. All subjects will aim at reaching the recommended target dose of 3.0 mg liraglutide once-daily or the corresponding volume of placebo. In this trial approximately 70 subjects will be randomly assigned to trial product.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity, Weight Loss, Microbiome
Keywords
obesity, liraglutide, gut microbiome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
70 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Active drug
Arm Type
Active Comparator
Arm Description
Liraglutide is administered once daily by subcutaneous injections with the pen-injector, either in the abdomen, thigh or upper arm. Injections can be done at any time of day irrespective of meals. Subjects will be instructed to escalate the liraglutide dose to 3.0 mg/day over a 4 week period following an initial dose of 0.6 mg/day and weekly dose escalation steps of 0.6 mg/day.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo is administered once daily by subcutaneous injections with the pen-injector, either in the abdomen, thigh or upper arm. Injections can be done at any time of day irrespective of meals. Subjects will be instructed to escalate the placebo dose to 3.0 mg/day over a 4 week period following an initial dose of 0.6 mg/day and weekly dose escalation steps of 0.6 mg/day.
Intervention Type
Drug
Intervention Name(s)
Liraglutide 6 MG/ML [Saxenda]
Other Intervention Name(s)
Saxenda
Intervention Description
Liraglutide is administered once daily by subcutaneous injections with the pen-injector, either in the abdomen, thigh or upper arm. Injections can be done at any time of day irrespective of meals. Subjects will be instructed to escalate the liraglutide dose to 3.0 mg/day over a 4 week period following an initial dose of 0.6 mg/day and weekly dose escalation steps of 0.6 mg/day.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Saline Injection
Intervention Description
Placebo is administered once daily by subcutaneous injections with the pen-injector, either in the abdomen, thigh or upper arm. Injections can be done at any time of day irrespective of meals. Subjects will be instructed to escalate the placebo dose to 3.0 mg/day over a 4 week period following an initial dose of 0.6 mg/day and weekly dose escalation steps of 0.6 mg/day.
Primary Outcome Measure Information:
Title
Change in gut microbiome composition assessed by Firmicutes-to-Bacteroidetes ratio using Quantitative polymerase chain reaction (PCR)
Description
The liraglutide treatment effect on gut microbiome composition quantified as Firmicutes-to-Bacteroidetes ratio by Quantitative polymerase chain reaction (PCR)
Time Frame
Change from baseline in gut microbiome composition at weeks 5 (visit 7)
Secondary Outcome Measure Information:
Title
Change in body weight (kg) assessed by scale
Description
The liraglutide treatment effect on weight ( kg) assessed by scale
Time Frame
Change from baseline in body weight at weeks 5 (visit 7)
Title
Change in body weight (kg) that will be combined with height (m) to report BMI (kg/m^2) where kg is a person's weight in kilograms and m2 is a person's height in metres squared
Description
The liraglutide treatment effect on body weight (kg) that will be combined with height (m) to report BMI (kg/m^2) where kg is a person's weight in kilograms and m2 is a person's height in metres squared
Time Frame
Change from baseline in body mass index at weeks 5 (visit 7)
Title
Change in body composition assessed by Bioelectrical impedance analysis (BIA)
Description
The liraglutide treatment effect on body composition assessed by BIA
Time Frame
Change from baseline in body composition at weeks 5 (visit 7)
Title
Change in hormonal regulation of appetite assessed by ghrelin levels
Description
The liraglutide treatment effect on hormonal regulation of appetite assessed by ghrelin levels
Time Frame
Change from baseline in ghrelin levels at weeks 5 (visit 7)
Title
Change in hormonal regulation of hunger suppression assessed by cholecystokinin levels
Description
The liraglutide treatment effect on hormonal regulation of hunger suppression assessed by cholecystokinin levels
Time Frame
Change from baseline in cholecystokinin levels at weeks 5 (visit 7)
Title
Change in hormonal regulation of appetite assessed by polipeptide YY levels
Description
The liraglutide treatment effect on hormonal regulation of appetite assessed by polipeptide YY levels
Time Frame
Change from baseline in polipeptide YY levels at weeks 5 (visit 7)
Title
Change in hormonal regulation of weight assessed by leptin levels
Description
The liraglutide treatment effect on hormonal regulation of weight assessed by leptin levels
Time Frame
Change from baseline in leptin levels at weeks 5 (visit 7)
Title
Change in low grade inflammation assessed by C-reactive protein levels
Description
The liraglutide treatment effect on low grade inflammation assessed by C-reactive protein levels
Time Frame
Change from baseline in C-reactive protein levels at weeks 5 (visit 7)
Title
Change in low grade inflammation assessed by erythrocyte sedimentation rate (ESR) levels
Description
The liraglutide treatment effect on low grade inflammation assessed by ESR levels
Time Frame
Change from baseline in ESR levels at weeks 5 (visit 7)
Title
Change in low grade inflammation assessed by interleukin- 1 (IL- 1) levels
Description
The liraglutide treatment effect on low grade inflammation assessed by IL- 1 levels
Time Frame
Change from baseline in IL- 1 levels at weeks 5 (visit 7)
Title
Change in low grade inflammation assessed by interleukin- 6 (IL- 6) levels
Description
The liraglutide treatment effect on low grade inflammation assessed by IL- 6 levels
Time Frame
Change from baseline in IL- 6 levels at weeks 5 (visit 7)
Title
Change in low grade inflammation assessed by interleukin- 10 (IL- 10) levels
Description
The liraglutide treatment effect on low grade inflammation assessed by IL- 10 levels
Time Frame
Change from baseline in IL- 10 levels at weeks 5 (visit 7)
Title
Change in low grade inflammation assessed by Tumor Necrosis Factor -α (TNF-α) levels
Description
The liraglutide treatment effect on low grade inflammation assessed by TNF-α levels
Time Frame
Change from baseline in TNF-α levels at weeks 5 (visit 7)
Title
Change in low grade inflammation assessed by monocyte chemotactic protein - 1 (MCP-1) levels
Description
The liraglutide treatment effect on low grade inflammation assessed by MCP-1 levels
Time Frame
Change from baseline in MCP-1 levels at weeks 5 (visit 7)
Title
Change in lipid profile assessed by total cholesterol levels
Description
The liraglutide treatment effect on lipid profile assessed by total cholesterol levels
Time Frame
Change from baseline in total cholesterol levels at weeks 5 (visit 7)
Title
Change in lipid profile assessed by LDL cholesterol levels
Description
The liraglutide treatment effect on lipid profile assessed by LDL cholesterol levels
Time Frame
Change from baseline in LDL cholesterol levels at weeks 5 (visit 7)
Title
Change in lipid profile assessed by HDL cholesterol levels
Description
The liraglutide treatment effect on lipid profile assessed by HDL cholesterol levels
Time Frame
Change from baseline in HDL cholesterol levels at weeks 5 (visit 7)
Title
Change in lipid profile assessed by triglycerides levels
Description
The liraglutide treatment effect on lipid profile assessed by triglycerides levels
Time Frame
Change from baseline in triglycerides levels at weeks 5 (visit 7)
Title
Change in insulin resistance assessed by Matsuda Index
Description
The liraglutide treatment effect on insulin resistance assessed by Matsuda Index
Time Frame
Change from baseline in insulin resistance assessed by Matsuda Index at weeks 5 (visit 7)
Title
Change in insulin resistance assessed by homeostasis model assessment - insulin resistance (HOMA-IR) Index
Description
The liraglutide treatment effect on insulin resistance assessed by HOMA-IR Index
Time Frame
Change from baseline in insulin resistance assessed by HOMA-IR Index at weeks 5 (visit 7)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Informed consent obtained before any trial-related activities. Trial-related activities are any procedures that are carried out as part of the trial, including activities to determine suitability for the trial; Age ≥ 18 years and < 65 years at the time of signing informed consent; Body mass index (BMI) ≥ 30 kg/m2 Stable body weight during the previous 3 months (< 5 kg self-reported weight change). Exclusion Criteria: General Safety Current or history of treatment with medications that may cause significant weight gain for at least 3 months before this trial; Current use or use within three months before this trial of GLP-1 receptor agonist, pramlintide, sibutramine, orlistat, zonisamide, topiramate or phentermine; Type 1 diabetes; Type 2 diabetes; Obesity related to endocrine diseases; Hepatic Failure (AST and/or ALT >3 times upper limit of normal and/or Total Bilirubin >1.7 upper limit of normal) End stage renal disease (eGFR < 30 ml/min/1.73 m2 ) or chronic or intermittent haemodialysis or peritoneal dialysis History or presence of chronic pancreatitis Presence of acute pancreatitis within the past 180 days prior to the day of screening Personal or first degree relative(s) history of multiple endocrine neoplasia type 2 or medullary thyroid carcinoma Presence or history of malignant neoplasms within the past 5 years prior to the day of screening Severe psychiatric disorder which in the investigator's opinion could compromise compliance with the protocol Known or suspected hypersensitivity to trial product(s) or related products Previous participation in this trial. Participation is defined as randomisation Receipt of any investigational medicinal product within 30 days before screening Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using a highly effective contraceptive method i.e.: patients who use combined hormonal contraceptives (containing estreogen and progesterone) associated with inhibition of ovulation or oral, intravaginal that transdermal; patients who use hormonal contraceptives based only progesterone that inhibit ovulation, whether oral, injectable or implantable patients with placement of IUD (intrauterine device) patients with positioning of hormone releasing intrauterine systems patients with bilateral tubal occlusion patients with vasectomized partner patients who practice sexual abstinence Any disorder, unwillingness or inability, which in the investigator's opinion, might jeopardise the subject's safety or compliance with the protocol Previous surgical treatment for obesity (excluding liposuction >1 year before trial entry); 19 ) Inflammatory bowel diseases; 20 ) recent antibiotic therapy ( within 30 days before screening) Cardiovascular- related Any of the following: myocardial infarction, stroke, hospitalisation for unstable angina pectoris or transient ischaemic attack within the past 60 days prior to the day of screening Planned coronary, carotid or peripheral artery revascularisation known on the day of screening; Presently classified as being in New York Heart Association (NYHA) Class IV heart failure
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Annamaria Colao, MD
Phone
00390817462132
Email
colao@unina.it
Facility Information:
Facility Name
"Federico II" University of Naples, Department of Clinical and Molecular Endocrinology and Oncology
City
Naples
ZIP/Postal Code
80131
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Annamaria Colao
Phone
00390817462132
Email
colao@unina.it

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
15831718
Citation
Eckburg PB, Bik EM, Bernstein CN, Purdom E, Dethlefsen L, Sargent M, Gill SR, Nelson KE, Relman DA. Diversity of the human intestinal microbial flora. Science. 2005 Jun 10;308(5728):1635-8. doi: 10.1126/science.1110591. Epub 2005 Apr 14.
Results Reference
background
PubMed Identifier
26912499
Citation
Patterson E, Ryan PM, Cryan JF, Dinan TG, Ross RP, Fitzgerald GF, Stanton C. Gut microbiota, obesity and diabetes. Postgrad Med J. 2016 May;92(1087):286-300. doi: 10.1136/postgradmedj-2015-133285. Epub 2016 Feb 24.
Results Reference
background
PubMed Identifier
27048547
Citation
Dinan TG, Cryan JF. Mood by microbe: towards clinical translation. Genome Med. 2016 Apr 6;8(1):36. doi: 10.1186/s13073-016-0292-1.
Results Reference
background
PubMed Identifier
28648835
Citation
Nakatani Y, Maeda M, Matsumura M, Shimizu R, Banba N, Aso Y, Yasu T, Harasawa H. Effect of GLP-1 receptor agonist on gastrointestinal tract motility and residue rates as evaluated by capsule endoscopy. Diabetes Metab. 2017 Oct;43(5):430-437. doi: 10.1016/j.diabet.2017.05.009. Epub 2017 Jun 23.
Results Reference
background
PubMed Identifier
15505215
Citation
Backhed F, Ding H, Wang T, Hooper LV, Koh GY, Nagy A, Semenkovich CF, Gordon JI. The gut microbiota as an environmental factor that regulates fat storage. Proc Natl Acad Sci U S A. 2004 Nov 2;101(44):15718-23. doi: 10.1073/pnas.0407076101. Epub 2004 Oct 25.
Results Reference
background

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Effect of Liraglutide on Microbiome in Obesity

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