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Article ; Online: The Authors Reply.

Fontana, Marianna / Martinez-Naharro, Ana / Chacko, Liza / Rowczenio, Dorota / Gilbertson, Janet A / Whelan, Carol J / Strehina, Svetla / Lane, Thirusha / Moon, James C / Hutt, David F / Kellman, Peter / Petrie, Aviva / Hawkins, Philip N / Gillmore, Julian D

JACC. Cardiovascular imaging

2021 Volume 14, Issue 4, Page(s) 882–883

Language	English
Publishing date	2021-03-12
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2021.02.003
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Article ; Online: Prognostic importance of the 6 min walk test in light chain (AL) amyloidosis.

Cohen, Oliver C / Sathyanath, Ananth / Petrie, Aviva / Ravichandran, Sriram / Law, Steven / Manwani, Richa / Foard, Darren / Sachchithanantham, Sajitha / Mahmood, Shameem / Martinez-Naharro, Ana / Fontana, Marianna / Whelan, Carol J / Hawkins, Philip N / Lachmann, Helen J / Gillmore, Julian D / Wechalekar, Ashutosh D

Heart (British Cardiac Society)

2022 Volume 108, Issue 20, Page(s) 1616–1622

Abstract: Objectives: In AL amyloidosis, organ response assessment is based on surrogates (eg, cardiac biomarkers). An objective functional test, such as the 6 min walk test (6MWT), capturing overall clinical improvement, is required. We aimed to evaluate the ... ...

Abstract	Objectives: In AL amyloidosis, organ response assessment is based on surrogates (eg, cardiac biomarkers). An objective functional test, such as the 6 min walk test (6MWT), capturing overall clinical improvement, is required. We aimed to evaluate the prognostic impact of the 6MWT at baseline and change following chemotherapy. Methods: This study evaluated the outcomes of patients who enrolled in a prospective observational study at the UK National Amyloidosis Centre (2012-2017). Patients underwent comprehensive assessments inclusive of blood testing, echocardiogram and 6MWT at baseline and annually thereafter. Results: In total, 799 patients were included within the study. Median baseline 6 min walk distance (6MWD) was 362 m (IQR: 231 m). 6MWD progressively decreased with worsening cardiac disease stage (458 m, 404 m, 331 m and 168 m for cardiac Mayo stages I, II, IIIa and IIIb, respectively (p<0.0001)). In patients with a baseline 6MWT of ≥350 m, the median overall survival was not reached (vs 30.0 (95% CI 23.2 to 36.8) months if <350 m and 5.0 (95% CI 2.8 to 7.2) months if unable to attempt 6MWT (p<0.0001). Following chemotherapy, only patients in a complete haematological response improved their 6MWD by 12 months (p=0.001). Improvement in 6MWD prolonged survival in patients with cardiac amyloidosis (p=0.005). Conclusion: The 6MWT is prognostic in AL amyloidosis. A baseline distance of ≥350 m independently predicts better survival. These data suggest that 6MWT has utility in AL amyloidosis for baseline prognosis and assessing response.
MeSH term(s)	Amyloidosis ; Biomarkers ; Humans ; Immunoglobulin Light-chain Amyloidosis/diagnosis ; Prognosis ; Walk Test
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-09-26
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2021-320703
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Article ; Online: Antibody-Associated Reversal of ATTR Amyloidosis-Related Cardiomyopathy.

Fontana, Marianna / Gilbertson, Janet / Verona, Guglielmo / Riefolo, Mattia / Slamova, Ivana / Leone, Ornella / Rowczenio, Dorota / Botcher, Nicola / Ioannou, Adam / Patel, Rishi K / Razvi, Yousuf / Martinez-Naharro, Ana / Whelan, Carol J / Venneri, Lucia / Duhlin, Amanda / Canetti, Diana / Ellmerich, Stephan / Moon, James C / Kellman, Peter /

Al-Shawi, Raya / McCoy, Laura / Simons, J Paul / Hawkins, Philip N / Gillmore, Julian D

The New England journal of medicine

2023 Volume 388, Issue 23, Page(s) 2199–2201

MeSH term(s)	Humans ; Amyloid Neuropathies, Familial/complications ; Amyloid Neuropathies, Familial/drug therapy ; Amyloidosis ; Antibodies/immunology ; Antibodies/therapeutic use ; Cardiomyopathies/drug therapy ; Cardiomyopathies/etiology ; Cardiomyopathies/immunology ; Prealbumin
Chemical Substances	Antibodies ; Prealbumin
Language	English
Publishing date	2023-06-06
Publishing country	United States
Document type	Letter
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc2304584
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Article ; Online: The experience of hereditary apolipoprotein A-I amyloidosis at the UK National Amyloidosis Centre.

Cohen, Oliver C / Blakeney, Iona J / Law, Steven / Ravichandran, Sriram / Gilbertson, Janet / Rowczenio, Dorota / Mahmood, Shameem / Sachchithanantham, Sajitha / Wisniowski, Brendan / Lachmann, Helen J / Whelan, Carol J / Martinez-Naharro, Ana / Fontana, Marianna / Hawkins, Philip N / Gillmore, Julian D / Wechalekar, Ashutosh D

Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis

2022 Volume 29, Issue 4, Page(s) 237–244

Abstract: Introduction: Hereditary apolipoprotein A-I (AApoAI) amyloidosis is a rare heterogeneous disease with variable age of onset and organ involvement. There are few series detailing the natural history and outcomes of solid organ transplantation across a ... ...

Abstract	Introduction: Hereditary apolipoprotein A-I (AApoAI) amyloidosis is a rare heterogeneous disease with variable age of onset and organ involvement. There are few series detailing the natural history and outcomes of solid organ transplantation across a range of causative APOA1 gene mutations. Methods: We identified all patients with AApoAI amyloidosis who presented to the National Amyloidosis Centre (NAC) between 1986 and 2019. Results: In total, 57 patients with 14 different APOA1 mutations were identified including 18 patients who underwent renal transplantation (5 combined liver-kidney (LKT) and 2 combined heart-kidney (HKT) transplants). Median age of presentation was 43 years and median time from presentation to referral was 3 (0-31 years). Involvement of the kidneys, liver and heart by amyloid was detected in 81%, 67% and 28% of patients, respectively. Renal amyloidosis was universal in association with the most commonly identified variant (Gly26Arg, Conclusions: AApoAI amyloidosis is a slowly progressive disease that is challenging to diagnose. The outcomes of transplantation are encouraging and graft survival is excellent.
MeSH term(s)	Humans ; Adult ; Apolipoprotein A-I/genetics ; Apolipoprotein A-I/metabolism ; Amyloidosis/diagnosis ; Amyloidosis, Familial/diagnosis ; Amyloidosis, Familial/genetics ; Amyloidosis, Familial/surgery ; Kidney/metabolism ; Amyloid ; United Kingdom
Chemical Substances	Apolipoprotein A-I ; Amyloid
Language	English
Publishing date	2022-05-03
Publishing country	England
Document type	Journal Article
ZDB-ID	1205246-2
ISSN	1744-2818 ; 1350-6129
ISSN (online)	1744-2818
ISSN	1350-6129
DOI	10.1080/13506129.2022.2070741
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Zs.A 4114: Show issues

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Article ; Online: Autologous stem cell transplantation vs bortezomib based chemotheraphy for the first-line treatment of systemic light chain amyloidosis in the UK.

Sharpley, Faye A / Manwani, Richa / Petrie, Aviva / Mahmood, Shameem / Sachchithanantham, Sajitha / Lachmann, Helen J / Martinez De Azcona Naharro, Ana / Gillmore, Julian D / Whelan, Carol J / Fontana, Marianna / Cohen, Oliver / Hawkins, Philip N / Wechalekar, Ashutosh D

European journal of haematology

2021 Volume 106, Issue 4, Page(s) 537–545

Abstract: Objectives: The benefit of autologous stem cell transplantation (ASCT) in the treatment of light chain (AL) amyloidosis requires re-evaluation in the modern era. This retrospective case-matched study compares ASCT to bortezomib for the treatment of ... ...

Abstract	Objectives: The benefit of autologous stem cell transplantation (ASCT) in the treatment of light chain (AL) amyloidosis requires re-evaluation in the modern era. This retrospective case-matched study compares ASCT to bortezomib for the treatment of patients with AL amyloidosis. Methods: Newly diagnosed patients with AL amyloidosis treated with ASCT or bortezomib between 2001 and 2018 were identified. Patients were excluded if the time from diagnosis to treatment exceeded 12 months. Patients were matched on a 1:1 basis, using a propensity-matched scoring approach. Results: A total of 136 propensity score-matched patients were included (ASCT n = 68, bortezomib n = 68). There was no significant difference in overall survival at two years (P = .908, HR: 0.95, CI: 0.41-2.20). For ASCT vs bortezomib: overall haematological response rate at 6 months was 90.6% vs 92.5%; organ response at 12 months: cardiac (70.0% vs 54%, P > .999), renal (74% vs 24%, P = .463) liver (21% vs 22%, P = .048); median progression-free survival (50 vs 42 months P = .058, HR: 0.61, CI: 0.37-1.02) and time to next treatment (68 vs 45 months, P = .145, HR: 0.61, CI: 0.31-1.19). More patients required treatment in the bortezomib group compared to ASCT group at 24 months (41 vs 23, Chi-squared P = .004) and 48 months (57 vs 41, Chi-squared P = .004). Conclusions: This small retrospective study suggests that there is no clear survival advantage of ASCT over bortezomib therapy. A prospective randomised controlled trial evaluating ASCT in AL amyloidosis is critically needed.
MeSH term(s)	Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Bortezomib/administration & dosage ; Disease Management ; Female ; Hematopoietic Stem Cell Transplantation/adverse effects ; Hematopoietic Stem Cell Transplantation/methods ; Humans ; Immunoglobulin Light-chain Amyloidosis/diagnosis ; Immunoglobulin Light-chain Amyloidosis/mortality ; Immunoglobulin Light-chain Amyloidosis/therapy ; Male ; Middle Aged ; Prognosis ; Retreatment ; Transplantation, Autologous ; Treatment Outcome ; United Kingdom
Chemical Substances	Bortezomib (69G8BD63PP)
Language	English
Publishing date	2021-01-27
Publishing country	England
Document type	Journal Article ; Meta-Analysis
ZDB-ID	392482-8
ISSN	1600-0609 ; 0902-4441
ISSN (online)	1600-0609
ISSN	0902-4441
DOI	10.1111/ejh.13582
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Article ; Online: Deep phenotyping of p.(V142I)-associated variant transthyretin amyloid cardiomyopathy: Distinct from wild-type transthyretin amyloidosis?

Razvi, Yousuf / Ioannou, Adam / Patel, Rishi K / Chacko, Liza / Karia, Nina / Riefolo, Mattia / Porcari, Aldostefano / Rauf, Muhammad Umaid / Starr, Neasa / Ganesananthan, Sashiananthan / Blakeney, Iona / Kaza, Nandita / Filisetti, Stefano / Bolhuis, Roos Eline / Rowczenio, Dorota / Gilbertson, Janet / Hutt, David / Mahmood, Shameem / Lachmann, Helen J /

Wechalekar, Ashutosh D / Kotecha, Tushar / Knight, Daniel S / Coghlan, John G / Petrie, Aviva / Whelan, Carol J / Venneri, Lucia / Martinez-Naharro, Ana / Hawkins, Phillip / Fontana, Marianna / Gillmore, Julian D

European journal of heart failure

2024 Volume 26, Issue 2, Page(s) 383–393

Abstract: Aims: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. A total of 3-4% of individuals of African descent carry a TTR gene mutation encoding the p.(V142I) variant, a powerful risk factor for development ...

Abstract	Aims: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. A total of 3-4% of individuals of African descent carry a TTR gene mutation encoding the p.(V142I) variant, a powerful risk factor for development of variant ATTR-CM (ATTRv-CM); this equates to 1.6 million carriers in the United States. We undertook deep phenotyping of p.(V142I)-ATTRv-CM and comparison with wild-type ATTR-CM (ATTRwt-CM). Methods and results: A retrospective study of 413 patients with p.(V142I) ATTRv-CM who attended the UK National Amyloidosis Centre (NAC) was conducted. Patients underwent evaluation at time of diagnosis, including clinical, echocardiography, and biomarker analysis; a subgroup had cardiac magnetic resonance (CMR) imaging. A total of 413 patients with ATTRwt-CM, matched for independent predictors of prognosis (age, NAC Stage, decade of first presentation), were used as a comparator group. At time of diagnosis, patients with ATTRv-CM had significant functional impairment by New York Heart Association classification (NHYA class ≥ III; 38%) and 6-min walk test distance (median 276 m). Median 5-year survival in ATTRv-CM patients was 31 versus 59 months in matched patients with ATTRwt-CM (p < 0.001). Patients with ATTRv-CM had significant impairment of functional parameters by echocardiography including biventricular impairment, high burden of regurgitant valvular disease and low cardiac output. Multivariable analysis revealed the prognostic importance of right ventricular dysfunction. CMR and histological analysis revealed myocyte atrophy and widespread myocardial infiltration in ATTRv-CM. Conclusion: p.(V142I)-ATTRv-CM has an aggressive phenotype characterized by myocyte loss and widespread myocardial infiltration which may account for frequent biventricular failure and poor prognosis in this ATTR-CM genotypic subgroup.
MeSH term(s)	Humans ; Prealbumin/genetics ; Retrospective Studies ; Cardiomyopathies/diagnosis ; Cardiomyopathies/genetics ; Heart Failure/genetics ; Amyloid Neuropathies, Familial/diagnosis ; Amyloid Neuropathies, Familial/genetics
Chemical Substances	Prealbumin
Language	English
Publishing date	2024-01-28
Publishing country	England
Document type	Journal Article
ZDB-ID	1483672-5
ISSN	1879-0844 ; 1388-9842
ISSN (online)	1879-0844
ISSN	1388-9842
DOI	10.1002/ejhf.3088
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Article ; Online: Life-saving implantable cardioverter defibrillator therapy in cardiac AL amyloidosis.

Patel, Ketna S / Hawkins, Philip N / Whelan, Carol J / Gillmore, Julian D

BMJ case reports

2014 Volume 2014

Abstract: Cardiac involvement is the main determinant of prognosis in systemic monoclonal immunoglobulin light chain (AL) amyloidosis. Ventricular arrhythmias and sudden cardiac death are not uncommon. The electrical events that precede sudden death, and their ... ...

Abstract	Cardiac involvement is the main determinant of prognosis in systemic monoclonal immunoglobulin light chain (AL) amyloidosis. Ventricular arrhythmias and sudden cardiac death are not uncommon. The electrical events that precede sudden death, and their potential to be treated effectively, remain undefined. There are no European guidelines for the use of implantable cardioverter defibrillator (ICD) in amyloidosis. ICDs in general are not usually offered to patients with a life expectancy of less than 1 year. We describe a patient who presented with cardiac AL amyloidosis who underwent prophylactic ICD implantation for the prevention of sudden cardiac death during treatment with chemotherapy, in whom life-threatening ventricular arrhythmia was successfully terminated over a 3-year period.
MeSH term(s)	Amyloid/metabolism ; Amyloidosis/complications ; Amyloidosis/diagnosis ; Amyloidosis/metabolism ; Arrhythmias, Cardiac/etiology ; Arrhythmias, Cardiac/prevention & control ; Brugada Syndrome ; Cardiac Conduction System Disease ; Cardiomyopathies/etiology ; Cardiomyopathies/prevention & control ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control ; Defibrillators, Implantable ; Female ; Heart/physiopathology ; Heart Conduction System/abnormalities ; Humans ; Immunoglobulin Light Chains/metabolism ; Immunoglobulin Light-chain Amyloidosis ; Middle Aged ; Prognosis ; Tachycardia, Ventricular/etiology ; Tachycardia, Ventricular/prevention & control
Chemical Substances	Amyloid ; Immunoglobulin Light Chains
Language	English
Publishing date	2014-12-22
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2014-206600
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Article ; Online: The impact and importance of achieving a complete haematological response prior to renal transplantation in AL amyloidosis.

Cohen, Oliver C / Law, Steven / Lachmann, Helen J / Sharpley, Faye / Ravichandran, Sriram / Mahmood, Shameem / Sachchithanantham, Sajitha / Whelan, Carol J / De Azcona Naharro, Ana Martinez / Fontana, Marianna / Hawkins, Philip N / Gillmore, Julian D / Wechalekar, Ashutosh D

Blood cancer journal

2020 Volume 10, Issue 5, Page(s) 60

MeSH term(s)	Follow-Up Studies ; Humans ; Immunoglobulin Light Chains/blood ; Immunoglobulin Light-chain Amyloidosis/blood ; Immunoglobulin Light-chain Amyloidosis/therapy ; Kidney Transplantation/methods ; Progression-Free Survival ; Treatment Outcome
Chemical Substances	Immunoglobulin Light Chains
Language	English
Publishing date	2020-05-22
Publishing country	United States
Document type	Letter
ZDB-ID	2600560-8
ISSN	2044-5385 ; 2044-5385
ISSN (online)	2044-5385
ISSN	2044-5385
DOI	10.1038/s41408-020-0325-2
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Article ; Online: Reduction in CMR Derived Extracellular Volume With Patisiran Indicates Cardiac Amyloid Regression.

Fontana, Marianna / Martinez-Naharro, Ana / Chacko, Liza / Rowczenio, Dorota / Gilbertson, Janet A / Whelan, Carol J / Strehina, Svetla / Lane, Thirusha / Moon, James / Hutt, David F / Kellman, Peter / Petrie, Aviva / Hawkins, Philip N / Gillmore, Julian D

JACC. Cardiovascular imaging

2020 Volume 14, Issue 1, Page(s) 189–199

Abstract: Objectives: The purpose of this study was to determine the effect of patisiran on the cardiac amyloid load as measured by cardiac magnetic resonance and extracellular volume (ECV) mapping in cases of transthyretin cardiomyopathy (ATTR-CM).: Background! ...

Abstract	Objectives: The purpose of this study was to determine the effect of patisiran on the cardiac amyloid load as measured by cardiac magnetic resonance and extracellular volume (ECV) mapping in cases of transthyretin cardiomyopathy (ATTR-CM). Background: Administration of patisiran, a TTR-specific small interfering RNA (siRNA), has been shown to benefit neuropathy in patients with hereditary ATTR amyloidosis, but its effect on ATTR-CM remains uncertain. Methods: Patisiran was administered to 16 patients with hereditary ATTR-CM who underwent assessment protocols at the UK National Amyloidosis Centre. Twelve of those patients concomitantly received diflunisal as a "TTR-stabilizing" drug. Patients underwent serial monitoring using cardiac magnetic resonance, echocardiography, cardiac biomarkers, bone scintigraphy, and 6-min walk tests (6MWTs). Findings of amyloid types and extracellular volumes were compared with those of 16 patients who were retrospectively matched based on cardiac magnetic resonance results. Results: Patisiran was well tolerated. Median serum TTR knockdown among treated patients was 86% (interquartile range [IQR]: 82% to 90%). A total of 82% of cases showed >80% knockdown. Patisiran therapy was typically associated with a reduction in ECV (adjusted mean difference between groups: -6.2% [95% confidence interval [CI]: -9.5% to -3.0%]; p = 0.001) accompanied by a fall in N-terminal pro-B-type natriuretic peptide concentrations (adjusted mean difference between groups: -1,342 ng/l [95% CI: -2,364 to -322]; p = 0.012); an increase in 6MWT distances (adjusted mean differences between groups: 169 m [95% CI: 57 to 2,80]; p = 0.004) after 12 months of therapy; and a median reduction in cardiac uptake by bone scintigraphy of 19.6% (IQR: 9.8% to 27.1%). Conclusions: Reductions in ECV by cardiac magnetic resonance provided evidence for ATTR cardiac amyloid regression in a proportion of patients receiving patisiran.
MeSH term(s)	Amyloid Neuropathies, Familial ; Humans ; Predictive Value of Tests ; RNA, Small Interfering ; Retrospective Studies ; Tomography, X-Ray Computed
Chemical Substances	RNA, Small Interfering ; patisiran (50FKX8CB2Y)
Language	English
Publishing date	2020-10-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2020.07.043
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Article ; Online: The value of screening biopsies in light-chain (AL) and transthyretin (ATTR) amyloidosis.

Cohen, Oliver C / Sharpley, Faye / Gilbertson, Janet A / Wechalekar, Ashutosh D / Sachchithanantham, Sajitha / Mahmood, Shameem / Whelan, Carol J / Martinez-Naharro, Ana / Fontana, Marianna / Lachmann, Helen J / Hawkins, Philip N / Gillmore, Julian D

European journal of haematology

2020 Volume 105, Issue 3, Page(s) 352–356

Abstract: Introduction: Systemic amyloidosis is a histological diagnosis, often achieved via critical organ biopsy. Screening biopsies represent a low-risk approach to diagnosis.: Objectives and methods: All patients with systemic AL and ATTR amyloidosis who ... ...

Abstract	Introduction: Systemic amyloidosis is a histological diagnosis, often achieved via critical organ biopsy. Screening biopsies represent a low-risk approach to diagnosis. Objectives and methods: All patients with systemic AL and ATTR amyloidosis who underwent abdominal fat aspiration (AFA) and either a bone marrow (BM) or gastrointestinal (GI) biopsy at the UK National Amyloidosis Centre (2006-2019) were identified. We sought to determine diagnostic sensitivity in relation to whole body amyloid burden, amyloid type and organ involvement. Results: Diagnostic sensitivity established in 471 patients with AL (n = 321) and ATTR (n = 150) amyloidosis, respectively, was 73.2% and 27.3% for AFA (P< .001), 59.7% and 42.2% for BM (P< .001), and 74.6% and 44.6% for GI biopsy (P< .001). ATTR amyloid deposits were detected in 35.4% BMs and 33.3% of GI biopsies when AFA did not demonstrate amyloid. In AL amyloidosis, sensitivity of combined AFA and BM biopsy in AL amyloidosis was 82.9%. There was a strong association between whole body amyloid burden and sensitivity of each screening biopsy method. The diagnostic sensitivity of screening biopsies ranged from 80.0% to 90.5% for patients with a large amyloid load on Conclusion: Performing both AFA and BM biopsy should be considered in suspected AL amyloidosis to substantially reduce the clinical risk associated with critical organ biopsy. The sensitivity of screening biopsies in ATTR amyloidosis is poor.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Amyloid/metabolism ; Amyloid Neuropathies, Familial/diagnosis ; Amyloid Neuropathies, Familial/etiology ; Amyloid Neuropathies, Familial/metabolism ; Biopsy/methods ; Biopsy/standards ; Clinical Decision-Making ; Disease Management ; Female ; Humans ; Immunoglobulin Light-chain Amyloidosis/diagnosis ; Immunoglobulin Light-chain Amyloidosis/etiology ; Immunoglobulin Light-chain Amyloidosis/metabolism ; Immunohistochemistry ; Male ; Mass Screening/methods ; Mass Screening/standards ; Middle Aged ; Sensitivity and Specificity
Chemical Substances	Amyloid
Language	English
Publishing date	2020-06-23
Publishing country	England
Document type	Journal Article
ZDB-ID	392482-8
ISSN	1600-0609 ; 0902-4441
ISSN (online)	1600-0609
ISSN	0902-4441
DOI	10.1111/ejh.13458
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