Section: Infectious Disease & Epidemiology

Metagenomics and Environmental DNA (eDNA) Analysis

The Origins and Core Principles of Metagenomics and Environmental DNA (eDNA) Analysis

Introduction to Metagenomics and eDNA

Metagenomics and environmental DNA (eDNA) analysis are transformative approaches in modern biology that have revolutionized our understanding of microbial communities and their interactions with the environment. These methodologies allow researchers to study the genetic material recovered directly from environmental samples, bypassing the need for culturing organisms in the laboratory. This capability is particularly crucial given that a significant proportion of microorganisms are not easily culturable. The origins of these fields are deeply rooted in the need to understand complex ecosystems and the organisms that inhabit them, with applications spanning ecology, medicine, and environmental science.

Historical Context and Development

The concept of metagenomics emerged in the late 20th century, driven by advances in sequencing technologies and computational biology. Initially, the study of microbial communities relied heavily on culture-based methods, which were limited by the inability to culture many microorganisms. The advent of polymerase chain reaction (PCR) and sequencing technologies in the 1980s and 1990s enabled the direct analysis of genetic material from environmental samples, laying the groundwork for metagenomics. This approach was further refined with the development of high-throughput sequencing technologies, which allowed for the comprehensive analysis of entire microbial communities.

Environmental DNA analysis, a subset of metagenomics, focuses on the detection and analysis of DNA from environmental samples such as soil, water, and air. The concept of eDNA is not new; however, its application has expanded significantly with technological advancements. eDNA analysis provides a non-invasive method to monitor biodiversity and assess environmental changes, making it a valuable tool for conservation biology and ecological studies.

Core Principles of Metagenomics

At its core, metagenomics involves the extraction of DNA from an environmental sample, followed by sequencing and analysis to identify the organisms present and their functional potential. The process can be divided into several key steps:

  1. Sample Collection and DNA Extraction: The first step involves collecting environmental samples from the site of interest, such as soil, water, or sediment. DNA is then extracted from these samples using methods that minimize contamination and maximize yield.

  2. Sequencing: High-throughput sequencing technologies, such as Illumina or Oxford Nanopore, are employed to sequence the extracted DNA. These technologies provide large volumes of data, capturing the genetic diversity of the microbial community.

  3. Bioinformatics Analysis: The vast amount of sequencing data generated requires robust bioinformatics tools for analysis. This involves assembling the sequences, annotating genes, and identifying the taxonomic composition and functional capabilities of the community. Tools such as euka, as discussed in sources and, utilize pangenomic reference graphs and maximum-likelihood frameworks for accurate taxonomic identification and abundance estimation.

  4. Interpretation and Application: The final step involves interpreting the data to gain insights into the ecological roles of the community, their interactions, and potential applications in areas such as bioremediation, health, and agriculture.

Core Principles of eDNA Analysis

Environmental DNA analysis shares several principles with metagenomics but is distinct in its focus on detecting DNA from macro-organisms in addition to microorganisms. The core principles include:

  1. Non-Invasive Sampling: eDNA analysis allows for the detection of organisms without the need for physical capture or observation. This is particularly useful for studying rare or elusive species.

  2. PCR and Metabarcoding: Traditional eDNA studies often rely on PCR amplification of specific genetic markers, such as the 16S rRNA gene for bacteria or mitochondrial DNA for animals. Metabarcoding involves sequencing these amplified regions to identify species present in the sample.

  3. Metagenomic Approaches: As highlighted in source, metagenomic approaches can circumvent biases introduced by PCR amplification. By analyzing the complete set of genetic material, researchers can obtain a more accurate representation of the community and identify bioindicators for environmental quality assessments.

  4. Data Analysis and Interpretation: Similar to metagenomics, eDNA analysis requires sophisticated bioinformatics tools to process and interpret the data. The identification of taxa and estimation of their abundance are crucial for applications in biodiversity monitoring and ecological research.

Biological Mechanisms and Methodological Considerations

The success of metagenomics and eDNA analysis hinges on understanding the biological mechanisms that govern DNA persistence and degradation in the environment. Factors such as temperature, pH, and microbial activity can influence DNA stability and recovery from environmental samples. Moreover, the methodologies employed must account for these factors to ensure accurate and reliable results.

In the context of ancient environmental DNA (aeDNA), as explored in sources and, the challenges are compounded by the degradation and fragmentation of DNA over time. Tools like euka address these challenges by leveraging pangenomic reference graphs and robust statistical frameworks to improve taxonomic resolution and abundance estimation in aeDNA studies.

Conclusion

Metagenomics and environmental DNA analysis represent powerful methodologies for exploring the genetic diversity and ecological dynamics of microbial communities. The origins of these fields are rooted in the quest to overcome the limitations of traditional microbiological methods, with technological advancements paving the way for their widespread application. The core principles of these approaches, from sample collection to data interpretation, are underpinned by a deep understanding of biological mechanisms and methodological considerations. As these fields continue to evolve, they hold immense potential for advancing our knowledge of ecosystems and informing conservation and management strategies on a global scale.

Applications of Metagenomics and eDNA in Biodiversity and Ecosystem Monitoring

The advent of metagenomics and environmental DNA (eDNA) technologies has revolutionized the field of biodiversity and ecosystem monitoring. These methodologies allow for the non-invasive sampling of genetic material from environmental samples such as soil, water, and air, providing a comprehensive snapshot of the biodiversity in a given ecosystem. This section delves into the applications of these technologies, examining the methodologies, biological mechanisms, and the broader context in which they operate.

Methodologies in Metagenomics and eDNA

Metagenomics involves the direct genetic analysis of genomes contained within an environmental sample. This approach bypasses the need for culturing organisms, thereby enabling the study of microbial communities in their natural environments. The primary method employed in metagenomics is Next-Generation Sequencing (NGS), which allows for the rapid sequencing of large amounts of DNA, providing insights into the composition and function of microbial communities.

Environmental DNA (eDNA) analysis, on the other hand, focuses on the genetic material shed by organisms into their environment. This DNA can come from various sources, including skin cells, feces, and bodily fluids. eDNA methodologies typically involve the collection of environmental samples, extraction of DNA, and subsequent analysis using techniques such as quantitative PCR (qPCR) or NGS. These techniques are particularly useful for detecting rare or elusive species, as they can provide evidence of a species' presence without the need for direct observation or capture.

One of the significant advancements in eDNA methodologies is the development of SiMSen-Seq, a protocol adapted from clinical research for ultrasensitive mutation detection using sequencing. SiMSen-Seq employs molecular barcoding to track individual DNA templates, which helps in correcting polymerase-induced errors and quantification biases. This method enhances the sensitivity of eDNA analysis, allowing for more accurate detection of low-frequency variants, which is crucial for identifying rare species within vast ecosystems.

Biological Mechanisms and Context

The biological mechanisms underlying metagenomics and eDNA analysis are rooted in the fundamental principles of molecular biology and genetics. The ability to extract and analyze DNA from environmental samples relies on the stability of DNA molecules in various environmental conditions. DNA can persist in the environment for varying lengths of time depending on factors such as temperature, pH, and microbial activity. This persistence allows researchers to detect both contemporary and historical biodiversity.

In the context of biodiversity monitoring, these technologies provide a powerful tool for assessing the health and composition of ecosystems. Metagenomics can reveal the diversity of microbial communities, which play critical roles in ecosystem functions such as nutrient cycling, decomposition, and primary production. By understanding the composition and dynamics of these communities, researchers can infer the ecological processes occurring within an ecosystem and identify potential threats to its stability.

eDNA analysis extends these capabilities to macro-organisms, offering a non-invasive method for monitoring species presence and distribution. This is particularly valuable in aquatic environments, where traditional survey methods can be logistically challenging and invasive. The ability to detect rare or non-indigenous species (NIS) is a significant advantage of eDNA analysis, as these species can have profound impacts on ecosystem structure and function.

Applications in Biodiversity and Ecosystem Monitoring

The applications of metagenomics and eDNA in biodiversity and ecosystem monitoring are vast and varied. These technologies are employed in a range of contexts, from conservation biology to environmental management and policy-making.

Conservation Biology

In conservation biology, metagenomics and eDNA are used to monitor species diversity and abundance, assess habitat quality, and evaluate the effectiveness of conservation interventions. For instance, the detection of rare or endangered species through eDNA analysis can inform conservation strategies and prioritize areas for protection. The ability to detect intraspecific variability, as demonstrated by SiMSen-Seq, can also aid in population genetic studies, providing insights into the genetic health of populations and their adaptive potential.

Invasive Species Management

The early detection of invasive species is crucial for preventing their establishment and mitigating their impacts. eDNA analysis offers a rapid and sensitive method for detecting NIS, allowing for timely management interventions. The SiMSen-Seq protocol, for example, has been shown to detect rare NIS in marine environments, highlighting its potential for enhancing marine biodiversity assessments and conservation efforts.

Ecosystem Health Assessment

Metagenomics and eDNA can also be used to assess ecosystem health by monitoring changes in community composition and detecting the presence of indicator species. These technologies can provide early warning signs of environmental stressors, such as pollution or climate change, enabling proactive management responses. By integrating metagenomic data with other environmental parameters, researchers can develop comprehensive models of ecosystem function and resilience.

Policy and Environmental Management

The insights gained from metagenomics and eDNA analysis can inform environmental policy and management decisions. For example, data on species distributions and community dynamics can guide the designation of protected areas and the development of management plans. Furthermore, these technologies can support compliance with international biodiversity agreements, such as the Convention on Biological Diversity, by providing robust data on biodiversity status and trends.

Challenges and Future Directions

Despite their potential, the application of metagenomics and eDNA in biodiversity and ecosystem monitoring is not without challenges. Issues such as data interpretation, standardization of methodologies, and the integration of genetic data with ecological and environmental information need to be addressed. The development of standardized protocols and bioinformatics tools will be crucial for ensuring the reliability and comparability of results across studies.

Future directions in this field may involve the integration of metagenomic and eDNA data with other 'omics' technologies, such as transcriptomics and proteomics, to provide a more holistic understanding of ecosystem function. Advances in sequencing technologies and bioinformatics will continue to enhance the sensitivity and resolution of these analyses, opening up new possibilities for biodiversity and ecosystem monitoring.

In conclusion, metagenomics and eDNA represent powerful tools for advancing our understanding of biodiversity and ecosystem dynamics. By providing detailed insights into the composition and function of biological communities, these technologies have the potential to transform conservation practices and environmental management, ultimately contributing to the sustainable stewardship of our planet's natural resources.

Challenges and Limitations in Metagenomic and eDNA Data Interpretation

The interpretation of metagenomic and environmental DNA (eDNA) data is fraught with a variety of challenges and limitations that stem from both the inherent complexities of biological systems and the technical constraints of current methodologies. These challenges are particularly pronounced in the context of ancient environmental DNA (aeDNA), where the degradation and contamination of samples further complicate analysis. This section delves into the multifaceted issues encountered in metagenomic and eDNA data interpretation, examining the methodologies, biological mechanisms, and contextual factors that contribute to these challenges.

Methodological Challenges

Taxonomic Identification and Abundance Estimation

One of the primary challenges in metagenomic and eDNA analysis is the accurate identification and quantification of taxa present in environmental samples. Traditional methods often rely on the mapping of DNA sequences to reference databases, followed by taxonomic identification. However, this approach can be limited by the completeness and accuracy of the reference databases themselves. For instance, the tool euka, as discussed in sources [1] and [2], addresses some of these limitations by using a taxonomy-based pangenome graph of reference genomes, which allows for more robust assignment of DNA sequences. This method is particularly advantageous for aeDNA, where sparse data is a common issue. Despite these advancements, the challenge remains that many existing methods are not designed to handle large metagenomic datasets effectively, often resulting in imprecise abundance estimates.

PCR Amplification Bias

In eDNA metabarcoding, which is commonly used for environmental assessments, the reliance on PCR amplification of specific gene fragments, such as the 16S rRNA gene, can introduce significant biases. These biases arise from differential amplification efficiencies among taxa, leading to distorted abundance patterns and potentially spurious bioindicator identifications [3]. Metagenomic approaches, which capture the entire set of genetic material from a sample, offer a way to circumvent these biases. However, they come with their own set of challenges, including the need for more sophisticated computational tools and greater computational resources.

Biological Mechanisms and Contextual Challenges

Degradation and Contamination

The biological nature of eDNA, particularly aeDNA, presents unique challenges due to the degradation and contamination of samples over time. DNA degradation can result in fragmented sequences that are difficult to map accurately to reference genomes, while contamination from modern DNA can lead to false positives in taxonomic identification. Tools like euka have been developed to address these issues by providing robust taxonomic profiling even in the presence of sparse data, as demonstrated by their ability to detect taxa with an average of 50 reads aligning [1][2]. Nonetheless, the interpretation of ancient samples remains a complex task that requires careful consideration of these biological factors.

Environmental Variability

Environmental variability adds another layer of complexity to eDNA data interpretation. Factors such as temperature, pH, and salinity can affect both the preservation of DNA in the environment and the efficiency of DNA extraction and amplification processes. This variability can lead to inconsistencies in data interpretation across different studies or even within the same study over time. For instance, the assessment of environmental impacts at salmon aquaculture installations using bacterial bioindicators revealed that only a few bioindicators were common to both metabarcoding and metagenomic methods, highlighting the influence of environmental conditions on data interpretation [3].

Technical and Computational Limitations

Data Volume and Complexity

The sheer volume and complexity of data generated by metagenomic analyses pose significant challenges for data interpretation. High-throughput sequencing technologies can produce vast amounts of data, requiring advanced computational tools and algorithms for processing and analysis. The development of tools like euka, which is reported to be ten times faster than existing quantification tools, represents a step forward in addressing these computational challenges [2]. However, the need for continuous improvement in computational methods remains, particularly as sequencing technologies continue to evolve and generate even larger datasets.

Reference Database Limitations

The accuracy of metagenomic and eDNA analyses is heavily dependent on the quality and comprehensiveness of reference databases. Many existing databases are biased towards well-studied organisms, leaving gaps in the representation of less-characterized taxa. This limitation can lead to misidentification or underestimation of certain taxa in environmental samples. The expansion of reference databases to include a wider range of genomes, as proposed for future versions of tools like euka, is crucial for improving the reliability of taxonomic identification and abundance estimation [1][2].

Conclusion

In conclusion, the interpretation of metagenomic and eDNA data is a complex and challenging task that requires careful consideration of methodological, biological, and technical factors. While advancements in tools and methodologies, such as those exemplified by euka, have made significant strides in addressing some of these challenges, there remains a need for ongoing research and development to fully realize the potential of metagenomic and eDNA analyses. As the field continues to evolve, collaboration between researchers, institutions like the WHO and NCBI, and the development of comprehensive reference databases will be essential in overcoming the current limitations and enhancing the accuracy and reliability of environmental DNA studies.

Integrative Approaches: Combining Metagenomics and eDNA with Other Biological Data

The advent of metagenomics and environmental DNA (eDNA) analysis has revolutionized our understanding of microbial communities and their roles in various ecosystems. However, the complexity of these communities and the vast amounts of data generated necessitate integrative approaches that combine metagenomic and eDNA data with other biological datasets to provide a more comprehensive understanding of ecological dynamics. This section delves into the methodologies, biological mechanisms, and contextual applications of integrating metagenomics and eDNA with additional biological data.

Methodological Frameworks for Data Integration

The integration of metagenomics and eDNA with other biological data is a multifaceted process that involves several methodological frameworks. High-throughput sequencing technologies have enabled the collection of vast amounts of data, but the challenge lies in effectively integrating these datasets to extract meaningful insights. One approach is the use of bioinformatics pipelines that streamline the processing and analysis of sequencing data. For instance, the Pipeline for Environmental DNA Metabarcoding Analysis (PEMA) was developed to address computational challenges in eDNA metabarcoding, facilitating the identification of biodiversity and community structure.

Bioinformatics methods also play a crucial role in integrating metagenomic data with other omics technologies, such as transcriptomics, proteomics, and metabolomics. These integrative approaches allow researchers to move beyond the identification of taxa (the "who") to understanding the functional roles and interactions within microbial communities (the "what" and "where"). The development of genome-scale metabolic networks (GEMs) is one such example, enabling the inference of metabolic interactions among different taxa and providing insights into the endurance and composition of microbial assemblages.

Biological Mechanisms and Context

Understanding the biological mechanisms underlying microbial community dynamics requires a holistic approach that considers multiple levels of biological organization. Metagenomics and eDNA provide snapshots of the genetic diversity within a community, but integrating these data with other biological datasets can reveal the functional roles and interactions that drive ecosystem processes. For example, the integration of metagenomic data with environmental parameters, such as salinity and oxygen concentration, allows researchers to identify key functions supporting life in extreme environments, as demonstrated in studies of hypersaline marshes.

The integration of metagenomics and eDNA with other biological data also facilitates the identification of novel species and the reconstruction of metagenome-assembled genomes (MAGs). This approach provides insights into the evolutionary relationships and ecological roles of previously uncharacterized taxa, contributing to a more comprehensive understanding of microbial diversity and function. Moreover, the use of data integration techniques and text mining methods enables the retrieval of knowledge from vast amounts of published literature, uncovering potential associations between microbial taxa, their functions, and environmental contexts.

Challenges and Opportunities

While the integration of metagenomics and eDNA with other biological data holds great promise, it also presents several challenges. One of the primary challenges is the computational complexity associated with processing and analyzing large, multidimensional datasets. The development of efficient bioinformatics tools and workflows is essential to address these challenges and enable the seamless integration of diverse data types. For instance, the use of Multiphase Monte Carlo Sampling algorithms in the dingo Python library facilitates the exploration of flux values in genome-scale metabolic models, providing a computationally feasible approach to studying metabolic interactions.

Another challenge is the need for standardized databases and ontologies that facilitate data sharing and interoperability. The establishment of community standards and the development of comprehensive knowledge bases, such as the PREGO knowledge-base, are critical for enabling optimal accessibility and usage of integrated datasets. These efforts are supported by authoritative organizations such as the National Center for Biotechnology Information (NCBI), which provides extensive resources for the annotation and analysis of genomic data.

Despite these challenges, the integration of metagenomics and eDNA with other biological data offers numerous opportunities for advancing our understanding of microbial ecology. By combining data from multiple sources, researchers can gain a more holistic view of ecosystem dynamics and uncover the complex interactions that drive microbial community structure and function. This integrative approach also has practical applications in fields such as environmental monitoring, conservation biology, and biotechnology, where a comprehensive understanding of microbial communities can inform decision-making and management strategies.

Conclusion

The integration of metagenomics and eDNA with other biological data represents a paradigm shift in microbial ecology, moving from reductionist approaches to more holistic frameworks that capture the complexity of ecological systems. By leveraging advanced bioinformatics tools and data integration techniques, researchers can unravel the intricate networks of interactions that underpin microbial community dynamics and ecosystem processes. As the field continues to evolve, the development of standardized methodologies and collaborative efforts among researchers will be essential for realizing the full potential of integrative approaches in metagenomics and eDNA analysis.

Future Directions and Innovations in Metagenomics and eDNA Research

Introduction

The field of metagenomics and environmental DNA (eDNA) analysis has seen a remarkable evolution, driven by advances in sequencing technologies and computational methodologies. These advances have enabled researchers to delve deeper into the genetic makeup of complex microbial communities and environmental samples, providing insights into biodiversity, ecosystem functions, and evolutionary processes. As we look to the future, several exciting directions and innovations are poised to further transform this field, enhancing our understanding of the natural world and our ability to monitor and manage ecosystems.

Advances in Computational Tools and Methodologies

One of the most promising areas of innovation in metagenomics and eDNA research is the development of advanced computational tools and methodologies. The complexity of metagenomic data, characterized by vast amounts of sequence information from diverse organisms, necessitates sophisticated analytical approaches. Traditional methods often struggle with the challenges of taxonomic identification and abundance estimation, particularly in ancient environmental DNA (aeDNA) samples [4]. The introduction of tools like euka represents a significant leap forward in this regard. Euka leverages a taxonomy-based pangenome graph of reference genomes, enabling robust assignment of DNA sequences and accurate abundance estimation through a maximum-likelihood framework [4]. This approach not only improves taxonomic profiling accuracy but also demonstrates robustness to sparse data, a common issue in aeDNA analysis [4].

Future innovations in computational tools are likely to focus on enhancing the scalability and precision of these methodologies. As the volume of metagenomic data continues to grow, driven by high-throughput sequencing technologies, there is a pressing need for tools that can efficiently process large datasets without compromising accuracy. Machine learning and artificial intelligence (AI) are expected to play a pivotal role in this context, offering the potential to automate and optimize various stages of data analysis, from sequence alignment to functional annotation.

Integration of Multi-Omics Approaches

The integration of multi-omics approaches is another exciting frontier in metagenomics and eDNA research. By combining data from genomics, transcriptomics, proteomics, and metabolomics, researchers can gain a more comprehensive understanding of microbial communities and their functional roles within ecosystems. This holistic perspective is particularly valuable for elucidating the complex interactions between organisms and their environments, as well as for identifying key metabolic pathways and regulatory networks.

The application of multi-omics approaches in eDNA research holds promise for advancing our understanding of ecosystem dynamics and resilience. For instance, integrating metagenomic data with metabolomic profiles can reveal how microbial communities respond to environmental changes, such as shifts in nutrient availability or climate conditions. Such insights are crucial for predicting the impacts of environmental stressors on biodiversity and ecosystem services, and for informing conservation and management strategies.

Expansion of Reference Databases

The accuracy and reliability of metagenomic and eDNA analyses are heavily dependent on the quality and comprehensiveness of reference databases. Currently, many reference databases are biased towards well-studied organisms, leaving significant gaps in our knowledge of microbial diversity. Expanding these databases to include a broader range of taxa, particularly those from understudied environments, is a critical priority for the field.

Efforts to expand reference databases are likely to benefit from international collaborations and initiatives aimed at cataloging global biodiversity. Organizations such as the World Health Organization (WHO), the World Organisation for Animal Health (WOAH), and the National Center for Biotechnology Information (NCBI) play a crucial role in coordinating these efforts and providing platforms for data sharing and integration. In addition, advances in sequencing technologies, such as long-read sequencing, are expected to facilitate the assembly of high-quality reference genomes, even for complex and repetitive regions.

Applications in Environmental Monitoring and Conservation

Metagenomics and eDNA analysis hold significant potential for revolutionizing environmental monitoring and conservation efforts. By providing a non-invasive means of assessing biodiversity and ecosystem health, these approaches offer a powerful tool for tracking changes in species distributions, detecting invasive species, and monitoring the impacts of human activities on natural habitats.

In the future, the application of eDNA analysis in environmental monitoring is likely to become more widespread, driven by improvements in sampling techniques and analytical methodologies. For example, the development of portable sequencing devices and field-deployable eDNA kits could enable real-time monitoring of ecosystems, providing timely data for decision-making and management interventions. Moreover, the integration of eDNA data with remote sensing technologies and geographic information systems (GIS) could offer new insights into spatial patterns of biodiversity and ecosystem processes.

Challenges and Ethical Considerations

Despite the exciting prospects for metagenomics and eDNA research, several challenges and ethical considerations must be addressed to ensure the responsible and sustainable use of these technologies. One of the key challenges is the interpretation of complex metagenomic data, which requires a deep understanding of ecological and evolutionary principles. Misinterpretation of data can lead to incorrect conclusions and potentially harmful management decisions.

Ethical considerations also arise in the context of data sharing and privacy. As metagenomic datasets often contain sensitive information about the genetic makeup of organisms and ecosystems, it is essential to establish clear guidelines and policies for data access and use. This includes ensuring that indigenous and local communities are involved in decision-making processes and that their rights and knowledge are respected.

Conclusion

The future of metagenomics and eDNA research is bright, with numerous innovations and advancements on the horizon. As computational tools become more sophisticated, multi-omics approaches are integrated, and reference databases are expanded, our ability to explore and understand the complexity of life on Earth will be greatly enhanced. These developments hold the potential to transform environmental monitoring and conservation efforts, providing new insights and solutions for addressing the pressing challenges of biodiversity loss and ecosystem degradation. However, to fully realize these benefits, it is crucial to address the associated challenges and ethical considerations, ensuring that the application of these technologies is guided by principles of responsibility, sustainability, and inclusivity.

References

[1] euka: Robust tetrapodic and arthropodic taxa detection from modern and ancient environmental DNA using pangenomic reference graphs. DOI: 10.1111/2041-210X.14214

[2] euka: Robust detection of eukaryotic taxa from modern and ancient environmental DNA using pangenomic reference graphs. DOI: 10.1101/2023.04.04.535531

[3] Exploiting taxonomic information from metagenomes to infer bacterial bioindicators and environmental quality at salmon aquaculture installations.. DOI: 10.1016/j.marpolbul.2025.118173

[4] euka: Robust tetrapodic and arthropodic taxa detection from modern and ancient environmental DNA using pangenomic reference graphs. DOI: 10.1111/2041-210X.14214


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