Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 14 de 14
Filter
1.
Mol Biol Evol ; 40(7)2023 Jul 05.
Article in English | MEDLINE | ID: mdl-37402639

ABSTRACT

Social networks can influence the ecology of gut bacteria, shaping the species composition of the gut microbiome in humans and other animals. Gut commensals evolve and can adapt at a rapid pace when colonizing healthy hosts. Here, we aimed at assessing the impact of host-to-host bacterial transmission on Escherichia coli evolution in the mammalian gut. Using an in vivo experimental evolution approach in mice, we found a transmission rate of 7% (±3% 2× standard error [2SE]) of E. coli cells per day between hosts inhabiting the same household. Consistent with the predictions of a simple population genetics model of mutation-selection-migration, the level of shared events resulting from within host evolution is greatly enhanced in cohoused mice, showing that hosts undergoing the same diet and habit are not only expected to have similar microbiome species compositions but also similar microbiome evolutionary dynamics. Furthermore, we estimated the rate of mutation accumulation of E. coli to be 3.0 × 10-3 (±0.8 × 10-3 2SE) mutations/genome/generation, irrespective of the social context of the regime. Our results reveal the impact of bacterial migration across hosts in shaping the adaptive evolution of new strains colonizing gut microbiomes.


Subject(s)
Gastrointestinal Microbiome , Microbiota , Humans , Animals , Mice , Biological Evolution , Escherichia coli/genetics , Microbiota/genetics , Gastrointestinal Microbiome/genetics , Mutation , Mammals/microbiology , Bacteria
2.
Bioessays ; 45(8): e2300063, 2023 08.
Article in English | MEDLINE | ID: mdl-37353919

ABSTRACT

How much bacterial evolution occurs in our intestines and which factors control it are currently burning questions. The formation of new ecotypes, some of which capable of coexisting for long periods of time, is highly likely in our guts. Horizontal gene transfer driven by temperate phages that can perform lysogeny is also widespread in mammalian intestines. Yet, the roles of mutation and especially lysogeny as key drivers of gut bacterial adaptation remain poorly understood. The mammalian gut contains hundreds of bacterial species, each with many strains and ecotypes, whose abundance varies along the lifetime of a host. A continuous high input of mutations and horizontal gene transfer events mediated by temperate phages drives that diversity. Future experiments to study the interaction between mutations that cause adaptation in microbiomes and lysogenic events with different costs and benefits will be key to understand the dynamic microbiomes of mammals. Also see the video abstract here: https://youtu.be/Zjqsiyb5Pk0.


Subject(s)
Bacteriophages , Gastrointestinal Microbiome , Animals , Prophages/genetics , Domestication , Ecotype , Lysogeny , Bacteriophages/genetics , Bacteria/genetics , Mammals
3.
Mol Biol Evol ; 38(8): 3220-3234, 2021 07 29.
Article in English | MEDLINE | ID: mdl-33830249

ABSTRACT

Antibiotic resistance often generates defects in bacterial growth called fitness cost. Understanding the causes of this cost is of paramount importance, as it is one of the main determinants of the prevalence of resistances upon reducing antibiotics use. Here we show that the fitness costs of antibiotic resistance mutations that affect transcription and translation in Escherichia coli strongly correlate with DNA breaks, which are generated via transcription-translation uncoupling, increased formation of RNA-DNA hybrids (R-loops), and elevated replication-transcription conflicts. We also demonstrated that the mechanisms generating DNA breaks are repeatedly targeted by compensatory evolution, and that DNA breaks and the cost of resistance can be increased by targeting the RNase HI, which specifically degrades R-loops. We further show that the DNA damage and thus the fitness cost caused by lack of RNase HI function drive resistant clones to extinction in populations with high initial frequency of resistance, both in laboratory conditions and in a mouse model of gut colonization. Thus, RNase HI provides a target specific against resistant bacteria, which we validate using a repurposed drug. In summary, we revealed key mechanisms underlying the fitness cost of antibiotic resistance mutations that can be exploited to specifically eliminate resistant bacteria.


Subject(s)
DNA Breaks , Drug Resistance, Bacterial/genetics , Genetic Fitness , Ribonuclease H/genetics , Animals , Biological Evolution , DNA Replication , Escherichia coli , Mice
4.
Commun Integr Biol ; 13(1): 89-96, 2020 Jun 24.
Article in English | MEDLINE | ID: mdl-33014261

ABSTRACT

The ecology and environment of the microbes that inhabit the mammalian intestine undergoes several changes as the host ages. Here, we ask if the selection pressure experienced by a new strain colonizing the aging gut differs from that in the gut of young adults. Using experimental evolution in mice after a short antibiotic treatment, as a model for a common clinical situation, we show that a new colonizing E. coli strain rapidly adapts to the aging gut via both mutation accumulation and bacteriophage-mediated horizontal gene transfer (HGT). The pattern of evolution of E. coli in aging mice is characterized by a larger number of transposable element insertions and intergenic mutations compared to that in young mice, which is consistent with the gut of aging hosts harboring a stressful and iron limiting environment.

5.
Proc Natl Acad Sci U S A ; 116(36): 17906-17915, 2019 09 03.
Article in English | MEDLINE | ID: mdl-31431529

ABSTRACT

Bacteria evolve by mutation accumulation in laboratory experiments, but tempo and mode of evolution in natural environments are largely unknown. Here, we study the ubiquitous natural process of host colonization by commensal bacteria. We show, by experimental evolution of Escherichia coli in the mouse intestine, that the ecology of the gut controls the pace and mode of evolution of a new invading bacterial strain. If a resident E. coli strain is present in the gut, the invading strain evolves by rapid horizontal gene transfer (HGT), which precedes and outweighs evolution by accumulation of mutations. HGT is driven by 2 bacteriophages carried by the resident strain, which cause an epidemic phage infection of the invader. These dynamics are followed by subsequent evolution by clonal interference of genetically diverse lineages of phage-carrying (lysogenic) bacteria. We show that the genes uptaken by HGT enhance the metabolism of specific gut carbon sources and provide a fitness advantage to lysogenic invader lineages. A minimal dynamical model explains the temporal pattern of phage epidemics and the complex evolutionary outcome of phage-mediated selection. We conclude that phage-driven HGT is a key eco-evolutionary driving force of gut colonization-it accelerates evolution and promotes genetic diversity of commensal bacteria.


Subject(s)
Escherichia coli/genetics , Gene Transfer, Horizontal , Intestinal Mucosa/metabolism , Intestinal Mucosa/microbiology , Mutation , Algorithms , Animals , Bacteriophages/physiology , Biological Evolution , Escherichia coli/virology , Gastrointestinal Microbiome , Genome, Bacterial , Genomics , Mice , Models, Biological , Symbiosis
6.
Curr Opin Microbiol ; 38: 114-121, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28591676

ABSTRACT

Hundreds of different bacterial species inhabit our intestines and contribute to our health status, with significant loss of species diversity typically observed in disease conditions. Within each microbial species a great deal of diversity is hidden and such intra-specific variation is also key to the proper homeostasis between the host and its microbial inhabitants. Indeed, it is at this level that new mechanisms of antibiotic resistance emerge and pathogenic characteristics evolve. Yet, our knowledge on intra-species variation in the gut is still limited and an understanding of the evolutionary mechanisms acting on it is extremely reduced. Here we review recent work that has begun to reveal that adaptation of commensal bacteria to the mammalian intestine may be fast and highly repeatable, and that the time scales of evolutionary and ecological change can be very similar in these ecosystems.


Subject(s)
Bacteria/genetics , Evolution, Molecular , Gastrointestinal Tract/microbiology , Adaptation, Biological , Animals , Mice , Symbiosis
7.
Microb Drug Resist ; 22(1): 97-101, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26366835

ABSTRACT

The introduction of the 7-valent pneumococcal conjugate vaccine in Portugal resulted in reduced carriage in children by vaccine-type strains and an increased carriage of three major antibiotic-resistant clones, ST2191, ST276, and ST63 expressing capsules 6A, 19A, and 15A, respectively. Pneumococcal otitis media (OM), a frequent infection among preschool age children, is often associated with viral coinfection. To evaluate the ability of these three antibiotic-resistant clones to cause disease, we used an infant mouse model of influenza virus pneumococcal coinfection. The 6A and 19A clonal types induced OM, while 15A induced pneumococcal pneumonia and bloodstream infection, suggesting potential for invasive disease.


Subject(s)
Coinfection/microbiology , Coinfection/virology , Otitis Media/microbiology , Otitis Media/virology , Pneumococcal Infections/microbiology , Pneumococcal Infections/virology , Streptococcus pneumoniae/pathogenicity , Animals , Anti-Bacterial Agents/pharmacology , Carrier State/immunology , Carrier State/microbiology , Carrier State/virology , Clone Cells/drug effects , Clone Cells/immunology , Coinfection/drug therapy , Coinfection/immunology , Disease Models, Animal , Drug Resistance, Bacterial/immunology , Heptavalent Pneumococcal Conjugate Vaccine/immunology , Mice , Mice, Inbred C57BL , Orthomyxoviridae/pathogenicity , Orthomyxoviridae Infections/virology , Otitis Media/drug therapy , Otitis Media/immunology , Pneumococcal Infections/drug therapy , Pneumococcal Infections/immunology , Pneumococcal Vaccines/immunology , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Pneumococcal/microbiology , Pneumonia, Pneumococcal/virology , Portugal , Serotyping , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/immunology , Vaccines, Conjugate/immunology
8.
PLoS One ; 8(9): e74867, 2013.
Article in English | MEDLINE | ID: mdl-24069360

ABSTRACT

We used mouse models of pneumococcal colonization and disease combined with full genome sequencing to characterize three major drug resistant clones of S. pneumoniae that were recovered from the nasopharynx of PCV7-immunized children in Portugal. The three clones--serotype 6A (ST2191), serotype 15A (ST63) and serotype 19A (ST276) carried some of the same drug resistance determinants already identified in nasopharyngeal isolates from the pre-PCV7 era. The three clones were able to colonize efficiently the mouse nasopharyngeal mucosa where populations of these pneumococci were retained for as long as 21 days. During this period, the three clones were able to asymptomatically invade the olfactory bulbs, brain, lungs and the middle ear mucosa and established populations in these tissues. The virulence potential of the three clones was poor even at high inoculum (10(5) CFU per mouse) concentrations in the mouse septicemia model and was undetectable in the pneumonia model. Capsular type 3 transformants of clones 6A and 19A prepared in the laboratory produced lethal infection at low cell concentration (10(3) CFU per mouse) but the same transformants became impaired in their potential to colonize, indicating the importance of the capsular polysaccharide in both disease and colonization. The three clones were compared to the genomes of 56 S. pneumoniae strains for which sequence information was available in the public databank. Clone 15A (ST63) only differed from the serotype 19F clone G54 in a very few genes including serotype so that this clone may be considered the product of a capsular switch. While no strain with comparable degree of similarity to clone 19A (ST276) was found among the sequenced isolates, by MLST this clone is a single locust variant (SLV) of Denmark14-ST230 international clone. Clone 6A (ST2191) was most similar to the penicillin resistant Hungarian serotype 19A clone.


Subject(s)
Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/immunology , Streptococcus pneumoniae/genetics , Streptococcus pneumoniae/immunology , Vaccines, Conjugate/immunology , Animals , Bacterial Capsules/immunology , Bacterial Capsules/metabolism , Disease Models, Animal , Drug Resistance, Bacterial/genetics , Female , Genome, Bacterial , Genome-Wide Association Study , Mice , Phylogeny , Pneumococcal Infections/microbiology , Pneumococcal Infections/mortality , Pneumococcal Vaccines/genetics , Polymorphism, Genetic , Sequence Analysis, DNA , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/pathogenicity , Virulence
9.
PLoS One ; 7(11): e47983, 2012.
Article in English | MEDLINE | ID: mdl-23144841

ABSTRACT

Two multidrug resistant strains of Streptococcus pneumoniae - SV35-T23 (capsular type 23F) and SV36-T3 (capsular type 3) were recovered from the nasopharynx of two adult patients during an outbreak of pneumococcal disease in a New York hospital in 1996. Both strains belonged to the pandemic lineage PMEN1 but they differed strikingly in virulence when tested in the mouse model of IP infection: as few as 1000 CFU of SV36 killed all mice within 24 hours after inoculation while SV35-T23 was avirulent.Whole genome sequencing (WGS) of the two isolates was performed (i) to test if these two isolates belonging to the same clonal type and recovered from an identical epidemiological scenario only differed in their capsular genes? and (ii) to test if the vast difference in virulence between the strains was mostly - or exclusively - due to the type III capsule. WGS demonstrated extensive differences between the two isolates including over 2500 single nucleotide polymorphisms in core genes and also differences in 36 genetic determinants: 25 of which were unique to SV35-T23 and 11 unique to strain SV36-T3. Nineteen of these differences were capsular genes and 9 bacteriocin genes.Using genetic transformation in the laboratory, the capsular region of SV35-T23 was replaced by the type 3 capsular genes from SV36-T3 to generate the recombinant SV35-T3* which was as virulent as the parental strain SV36-T3* in the murine model and the type 3 capsule was the major virulence factor in the chinchilla model as well. On the other hand, a careful comparison of strains SV36-T3 and the laboratory constructed SV35-T3* in the chinchilla model suggested that some additional determinants present in SV36 but not in the laboratory recombinant may also contribute to the progression of middle ear disease. The nature of this determinants remains to be identified.


Subject(s)
Bacteremia/microbiology , Bacterial Capsules/genetics , Genes, Bacterial , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/genetics , Adult , Animals , Animals, Outbred Strains , Chinchilla , Drug Resistance, Multiple, Bacterial , Female , Genome, Bacterial , High-Throughput Nucleotide Sequencing , Humans , Mice , Phenotype , Polymorphism, Single Nucleotide , Sequence Analysis, DNA , Streptococcus pneumoniae/pathogenicity , Virulence
10.
J Clin Microbiol ; 49(4): 1369-75, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21270219

ABSTRACT

To estimate the invasive disease potential of serotypes and clones circulating in Portugal before extensive use of the seven-valent pneumococcal conjugate vaccine, we analyzed 475 invasive isolates recovered from children and adults and 769 carriage isolates recovered from children between 2001 and 2003. Isolates were serotyped and genotyped by pulsed-field gel electrophoresis, and a selection of isolates were also characterized by multilocus sequence typing. We found that the diversities of serotypes and genotypes of pneumococci responsible for invasive infections and carriage were identical and that most carried clones could also be detected as causes of invasive disease. Their ability to do so, however, varied substantially. Serotypes 1, 3, 4, 5, 7F, 8, 9N, 9L, 12B, 14, 18C, and 20 were found to have an enhanced propensity to cause invasive disease, while serotypes 6A, 6B, 11A, 15B/C, 16F, 19F, 23F, 34, 35F, and 37 were associated with carriage. In addition, significant differences in invasive disease potential between clones sharing the same serotype were found among several serotypes, namely, 3, 6A, 6B, 11A, 14, 19A, 19F, 22F, 23F, 34, and NT. This heterogeneous behavior of the clones was found irrespective of the serotype's overall invasive disease potential. Our results highlight the importance of the genetic background when analyzing the invasive disease potential of certain serotypes and provide an important baseline for its monitoring following conjugate vaccine use. Continuous surveillance should be maintained, and current research should focus on uncovering the genetic determinants that contribute to the heterogeneity of invasive disease potential of clones sharing the same serotype.


Subject(s)
Carrier State/epidemiology , Carrier State/microbiology , Pneumococcal Infections/epidemiology , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/pathogenicity , Adolescent , Adult , Bacterial Typing Techniques , Child , Child, Preschool , Electrophoresis, Gel, Pulsed-Field , Genotype , Heptavalent Pneumococcal Conjugate Vaccine , Humans , Infant , Molecular Typing , Multilocus Sequence Typing , Pneumococcal Vaccines/administration & dosage , Pneumococcal Vaccines/immunology , Portugal/epidemiology , Serotyping , Streptococcus pneumoniae/genetics , Streptococcus pneumoniae/isolation & purification
11.
Vaccine ; 28(19): 3445-52, 2010 Apr 26.
Article in English | MEDLINE | ID: mdl-20197144

ABSTRACT

The impact of the 7-valent pneumococcal conjugate vaccine (PCV7) on the pneumococcal flora has been mostly studied without evaluating multiple colonization and the mechanism(s) leading to serotype replacement. These issues are addressed here, while assessing the effect of a single PCV7 dose. A group of children received one PCV7 dose just after nasopharyngeal sampling, with the control receiving no vaccine and both groups being sampled again a month later. Up to 10 pneumococcal isolates were recovered per colonized child-1224 isolates were serotyped and representative ones characterized by pulsed-field gel electrophoresis. In vaccinated children, serotype replacement between vaccine (VT) and non-vaccine (NVT) types occurred in single and multiple carriers, and VTs were less prone to be de novo acquired. NVT unmasking was only detected in the vaccinated group. One month after vaccination with a single dose, PCV7 prevents VT de novo acquisition and promotes NVT unmasking.


Subject(s)
Bacterial Typing Techniques , Carrier State/epidemiology , Carrier State/prevention & control , Pneumococcal Infections/epidemiology , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/immunology , Streptococcus pneumoniae/classification , Child, Preschool , Cluster Analysis , DNA Fingerprinting , Electrophoresis, Gel, Pulsed-Field , Female , Genotype , Heptavalent Pneumococcal Conjugate Vaccine , Humans , Infant , Male , Nasopharynx/microbiology , Pneumococcal Vaccines/administration & dosage , Serotyping , Streptococcus pneumoniae/isolation & purification
12.
Microbiology (Reading) ; 152(Pt 2): 367-376, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16436425

ABSTRACT

The authors aimed to get insights into the population structure of non-(sero)typable pneumococci (NTPn), a specific group of natural atypical pneumococci whose identification is often difficult, and which has remained insufficiently studied. A total of 265 presumptive NTPn, isolated between 1997 and 2003 from the nasopharynx of children, were characterized. Strains were confirmed to be pneumococci on the basis of bile solubility, and PCR detection or Southern blotting hybridization of lytA and psaA, genes ubiquitous in this species. Multilocus sequence typing (MLST) was used to exclude two isolates that gave ambiguous results. Non-typability was confirmed by the Quellung reaction using Omniserum. A total of 213 isolates were considered to be true NTPn. The molecular analysis of the true NTPn by PFGE and MLST showed that this population was genetically diverse, although a dominant cluster, accounting for 66 % of the isolates, was identified. Antimicrobial resistance was observed in most genetic backgrounds, and multidrug resistance to penicillin, erythromycin, clindamycin, tetracycline and sulfamethoxazole-trimethoprim was associated with strains belonging to the dominant cluster. Comparison with PFGE fingerprints and sequence types of large collections of serotypable strains showed that the genetic backgrounds of all but two NTPn were different from those found in serotypable strains. In addition, we found that NTPn strains with similar genetic backgrounds to those identified in our study had been isolated from disease sources in other countries. These observations seem to indicate that NTPn have diverse genetic backgrounds and may have evolved as a distinct group of pneumococcal isolates.


Subject(s)
Carrier State/epidemiology , Pneumococcal Infections/epidemiology , Serotyping , Streptococcus pneumoniae/isolation & purification , Anti-Bacterial Agents/pharmacology , Carrier State/microbiology , Child , Child Day Care Centers , Child, Preschool , Drug Resistance, Multiple, Bacterial , Electrophoresis, Gel, Pulsed-Field , Humans , Nasopharynx/microbiology , Phylogeny , Pneumococcal Infections/microbiology , Prevalence , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/genetics
13.
J Clin Microbiol ; 43(9): 4696-703, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16145129

ABSTRACT

In this study, 61 drug-resistant Streptococcus pneumoniae strains were characterized by multilocus sequence typing (MLST). These strains were representatives of 26 major clones (defined using pulsed-field gel electrophoresis) accounting for 93% of the 1,285 drug-resistant Streptococcus pneumoniae isolates recovered from the nasopharynges of healthy children attending day-care centers in Lisbon during 2001 to 2003. Using MLST, 13 of the 26 clones were found to be identical or closely related to 11 Pneumococcal Molecular Epidemiology Network (PMEN) clones, 4 clones were found to be unique as there were no identical or highly related allelic profiles deposited in the MLST database, and the remaining 9 clones had sequence types that matched or differed at a single or double locus from allelic profiles available in the MLST database. These nine clones were of serotypes 33F, 10A, 19A, 19F, 6A, 20, 24F, and 3, one was nontypeable, and, by MLST, they were found to be identical or highly related to isolates from disease origin that were dispersed internationally. Since the majority of these clones had serotypes that are not included in the 7-valent conjugate pneumococcal vaccine, monitoring of these clones is important for surveying their possible spread in the future. We propose the inclusion of these novel international clones in the PMEN.


Subject(s)
Carrier State/epidemiology , Child Day Care Centers , Drug Resistance, Bacterial , Pneumococcal Infections/epidemiology , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Carrier State/microbiology , Child , Child, Preschool , Electrophoresis, Gel, Pulsed-Field , Humans , Infant , Microbial Sensitivity Tests , Nasopharynx/microbiology , Pneumococcal Infections/microbiology , Portugal/epidemiology , Serotyping , Streptococcus pneumoniae/genetics
14.
Pediatr Infect Dis J ; 24(3): 243-52, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15750461

ABSTRACT

AIMS: Prospective study to evaluate the impact of the 7-valent pneumococcal conjugate vaccine (Prevenar) on the nasopharyngeal (NP) carriage of drug-resistant Streptococcus pneumoniae (DRPn), by healthy children attending day-care centers (ages 6 months-6 years). METHODS: Vaccinees (238 children) who received vaccine and controls (457 children) were followed for carriage of total S. pneumoniae and DRPn and for the serotypes and genetic backgrounds of DRPn during 6 consecutive sampling periods between May 2001 and February 2003. RESULTS: We detected no significant differences between vaccinees and the control group in the total carriage rate of Pn (average, 68%) or in the frequency of carriage of DRPn (average, 38%), including the frequency of penicillin-nonsusceptible strains (average, 24%). In contrast, there was a decline in the carriage of DRPn with vaccine serotypes which was compensated by the appearance and gradual increase in the frequency of DRPn expressing unusual serotypes (6A, 10A, 15A and 15C, 19A, 23A, 33F) which were not present in the vaccine as well as an increase in nontypable strains. The majority of the DRPn with unusual serotypes showed different pulsed field gel electrophoresis patterns indicating replacement of the original resistant flora by other clonal types of drug-resistant bacteria. Antibiotic consumption and the frequency of respiratory tract infections were similar among the vaccinees and controls. CONCLUSIONS: Pneumococcal vaccination did not change the frequency of carriage of drug-resistant strains being the initially dominant vaccine serotypes replaced by others expressing nonvaccine serotypes. Reduction in the carriage of DRPn may require a combination of the conjugate vaccine and a decrease in antibiotic pressure.


Subject(s)
Carrier State/immunology , Meningococcal Vaccines/administration & dosage , Pneumococcal Infections/immunology , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/administration & dosage , Streptococcus pneumoniae/immunology , Age Distribution , Carrier State/epidemiology , Case-Control Studies , Child Day Care Centers , Child, Preschool , Drug Resistance, Bacterial , Female , Heptavalent Pneumococcal Conjugate Vaccine , Humans , Incidence , Male , Meningococcal Vaccines/immunology , Nasopharynx/microbiology , Pneumococcal Infections/epidemiology , Pneumococcal Vaccines/immunology , Portugal/epidemiology , Probability , Reference Values , Risk Factors , Sampling Studies , Sex Distribution , Streptococcus pneumoniae/isolation & purification , Urban Population , Vaccines, Conjugate/administration & dosage , Vaccines, Conjugate/immunology
SELECTION OF CITATIONS
SEARCH DETAIL
...