Nucleotide Bases: Structure, Types, and Roles in DNA and RNA

By Dr. Zubair Khalid, DVM, MS, PhD ·

Nucleotide Bases: Structure, Types, and Roles in DNA and RNA

Introduction to Nucleotide Bases

Nucleotide bases, also called nitrogenous bases, are nitrogen-containing heterocyclic aromatic compounds that form the fundamental information-coding units of DNA and RNA. Each base is attached to a five-carbon sugar (deoxyribose in DNA, ribose in RNA) and one or more phosphate groups to constitute a nucleotide, the monomeric building block of nucleic acids. The sequence of nucleotide bases along a polynucleotide chain encodes genetic information, and the specific chemical properties of each base—particularly its hydrogen-bonding capacity and aromatic ring structure—determine how genetic information is stored, replicated, and expressed.

The term "nucleotide base" is often used interchangeably with "nitrogenous base" or simply "base," but it is critical to distinguish the base itself from the larger nucleotide molecule. A free base (e.g., adenine) is not a nucleotide; it becomes a nucleoside when covalently linked to a sugar, and a nucleotide when phosphorylated. This distinction is not merely semantic—it has profound implications for metabolism, signaling, and nucleic acid chemistry. For example, ATP (adenosine triphosphate) is a nucleotide whose base is adenine, but the energy-rich phosphate groups, not the base, confer its role in cellular energetics.

The genetic code operates through the precise ordering of four canonical bases in DNA—adenine (A), guanine (G), cytosine (C), and thymine (T)—and four in RNA, where uracil (U) replaces thymine. The information content of nucleic acids arises not from the bases themselves but from their linear arrangement, much as letters form words. This Nucleotide Sequence is read by polymerases during replication and transcription, and by ribosomes during translation. Errors in base identity, whether from replication mistakes or chemical damage, can lead to mutations with consequences ranging from silent to lethal, which is why cells devote elaborate repair systems, such as Nucleotide Excision Repair, to maintaining base integrity.

Chemical Structure of Nucleotide Bases

All nucleotide bases are planar, aromatic heterocycles composed of carbon and nitrogen atoms, with various functional groups (amino, keto, or methyl) attached at specific positions. The aromaticity of the rings—conferred by conjugated double bonds—gives the bases their characteristic ultraviolet (UV) absorption maximum near 260 nm, a property exploited in nucleic acid quantification. The nitrogen atoms in the rings are basic, allowing protonation under acidic conditions, which alters the bases' hydrogen-bonding behavior and UV spectra.

The bases are divided into two structural families: purines and pyrimidines. This classification is fundamental because it dictates base-pairing geometry, metabolic pathways, and the dimensions of the DNA double helix.

Purine Ring Structure

Purines are bicyclic compounds formed by the fusion of a six-membered pyrimidine ring and a five-membered imidazole ring. The purine skeleton consists of nine atoms: five carbons and four nitrogens, numbered 1 through 9. The six-membered ring (positions 1–6) is the pyrimidine portion, and the five-membered ring (positions 7–9) is the imidazole portion. The nitrogen atoms at positions 1, 3, 7, and 9 are chemically significant: N9 is the glycosidic linkage point to the sugar, while N1, N3, and N7 participate in hydrogen bonding or metal ion coordination.

The two purine bases found in nucleic acids are adenine (6-aminopurine) and guanine (2-amino-6-oxopurine). Adenine has an amino group (–NH₂) at position 6; guanine has both an amino group at position 2 and a keto group (=O) at position 6. The presence of these functional groups determines each base's hydrogen-bonding pattern. Purines are larger than pyrimidines—approximately 12 Å in their longest dimension—which is why a purine must always pair with a pyrimidine to maintain the uniform 20 Å diameter of the DNA double helix.

Pyrimidine Ring Structure

Pyrimidines are monocyclic six-membered rings containing four carbons and two nitrogens at positions 1 and 3. The numbering system places N1 as the glycosidic attachment point. The three pyrimidine bases in nucleic acids are cytosine (2-oxo-4-aminopyrimidine), thymine (5-methyl-2,4-dioxopyrimidine), and uracil (2,4-dioxopyrimidine). Cytosine carries an amino group at position 4 and a keto group at position 2. Thymine and uracil both have keto groups at positions 2 and 4; thymine differs from uracil only by a methyl group (–CH₃) at position 5.

The methyl group on thymine is biologically significant. It distinguishes DNA from RNA chemically and provides a means for cells to recognize and repair deaminated cytosines. If cytosine undergoes spontaneous deamination to uracil, the presence of thymine (which also pairs with adenine) in DNA allows repair enzymes to identify the uracil as abnormal and remove it. In RNA, where uracil is the standard base, such deamination events are less consequential because RNA is transient.

The Five Standard Nucleotide Bases

Five bases occur as standard components of nucleic acids. Four are found in DNA (A, G, C, T), and four in RNA (A, G, C, U). Their abbreviations, classifications, and key functional groups are summarized below.

BaseAbbreviationClassKey Functional GroupsFound In
AdenineAPurine6-aminoDNA, RNA
GuanineGPurine2-amino, 6-ketoDNA, RNA
CytosineCPyrimidine2-keto, 4-aminoDNA, RNA
ThymineTPyrimidine2,4-diketo, 5-methylDNA
UracilUPyrimidine2,4-diketoRNA

Adenine (A)

Adenine is a purine with an amino group at position 6. In DNA, it pairs with thymine via two hydrogen bonds; in RNA, it pairs with uracil. Adenine is also a component of several crucial cofactors, including ATP, NAD⁺, FAD, and coenzyme A, where it is present as part of the adenylate moiety. The N9 position of adenine forms the N-glycosidic bond to the sugar in nucleotides. Adenine's UV absorption maximum is 260.5 nm at pH 7.

Guanine (G)

Guanine is a purine with an amino group at position 2 and a keto group at position 6. It pairs with cytosine via three hydrogen bonds, making G–C pairs more stable than A–T pairs (which have only two). This difference in hydrogen bond number contributes to the higher melting temperature of GC-rich DNA. Guanine has the lowest oxidation potential of all four bases, making it the most susceptible to oxidative damage; 8-oxo-guanine is a common mutagenic lesion that mispairs with adenine during replication.

Cytosine (C)

Cytosine is a pyrimidine with a keto group at position 2 and an amino group at position 4. It pairs with guanine via three hydrogen bonds. Cytosine is vulnerable to spontaneous deamination, converting it to uracil at a rate of roughly 100–500 events per cell per day in mammals. If unrepaired, this generates a C→T transition mutation after replication. Cytosine can also be enzymatically modified to 5-methylcytosine, a key epigenetic mark.

Thymine (T)

Thymine is a pyrimidine with keto groups at positions 2 and 4 and a methyl group at position 5. It is found exclusively in DNA, where it pairs with adenine via two hydrogen bonds. The methyl group is the distinguishing feature that allows DNA repair systems to distinguish thymine from deaminated cytosine (uracil). Thymine dimers, formed by UV irradiation, are covalent linkages between adjacent thymines on the same strand; these distort the helix and block replication, necessitating repair by nucleotide excision repair or photolyase.

Uracil (U)

Uracil is a pyrimidine with keto groups at positions 2 and 4, lacking the methyl group found in thymine. It is found in RNA, where it pairs with adenine. Uracil is also a component of several metabolic intermediates, including UDP-glucose in glycogen synthesis and UTP in RNA polymerization. The use of uracil in RNA instead of thymine is thought to reflect RNA's evolutionary antiquity and its more transient, error-tolerant role in the cell.

Base Pairing Rules in DNA and RNA

The specific hydrogen bonding between complementary bases is the molecular basis of genetic information transfer. This pairing is governed by the geometric complementarity of purines and pyrimidines and by the donor/acceptor patterns of their functional groups.

Watson-Crick Base Pairing

In 1953, James Watson and Francis Crick proposed that DNA consists of two antiparallel strands held together by specific hydrogen bonds between bases: adenine pairs with thymine, and guanine pairs with cytosine. This Base Pairing scheme is now termed Watson-Crick base pairing. The key constraints are:

  1. A purine must pair with a pyrimidine to maintain the constant 20 Å diameter of the double helix.
  2. The hydrogen bond donors and acceptors on each base must be complementary—each A–T pair forms two hydrogen bonds, each G–C pair forms three.

In RNA, the same rules apply, except uracil replaces thymine, so A pairs with U. The G–C pair is identical in DNA and RNA.

The specificity of base pairing arises from the arrangement of hydrogen bond donors (e.g., –NH₂, –NH) and acceptors (e.g., =O, ring N) on each base's edge. For example, adenine presents a hydrogen bond acceptor (N1) and a donor (6-NH₂) on its Watson-Crick face, while thymine presents a donor (3-NH) and an acceptor (4-C=O), allowing two complementary hydrogen bonds. Guanine presents a donor (1-NH), an acceptor (2-C=O), and a donor (2-NH₂), which complement cytosine's acceptor (3-N), donor (4-NH₂), and acceptor (2-C=O), respectively.

Hydrogen Bonding Patterns

The hydrogen bonds in base pairs are of the N–H···N and N–H···O types, with bond lengths of approximately 2.8–3.0 Å. The G–C pair, with three hydrogen bonds, is thermodynamically more stable than the A–T pair, which has only two. This difference is reflected in the melting temperature (Tm) of DNA: a 1% increase in GC content raises Tm by roughly 0.4°C under standard conditions (0.15 M NaCl, pH 7.0).

Base pairing is not limited to the canonical Watson-Crick geometry. Hoogsteen base pairing, in which the purine uses its N7 and C6 positions (the "Hoogsteen edge") instead of N1 and C6, can occur under certain conditions, such as in triple helices or in damaged DNA. However, Watson-Crick pairing is the dominant mode in biological double helices.

The fidelity of base pairing is central to DNA replication. DNA polymerases achieve error rates of approximately 10⁻⁵ to 10⁻⁶ per base pair incorporated, largely due to the geometric selection of correct Watson-Crick pairs. The polymerase active site is shaped to accommodate only properly paired bases; mismatches distort the helix and are rejected. Proofreading exonucleases further reduce the error rate to about 10⁻⁸ to 10⁻¹⁰.

Nucleotide vs. Nucleoside vs. Base

The terms "base," "nucleoside," and "nucleotide" are frequently confused, yet they refer to distinct molecular entities with different chemical properties and biological roles.

A nucleotide base (or nitrogenous base) is the isolated heterocyclic ring structure—adenine, guanine, cytosine, thymine, or uracil. It is not covalently attached to any sugar or phosphate. Free bases exist in equilibrium with their protonated forms depending on pH and can be salvaged for nucleotide synthesis via the salvage pathway.

A nucleoside consists of a base covalently linked to a five-carbon sugar via an N-glycosidic bond. In DNA, the sugar is 2-deoxyribose; in RNA, it is ribose. The glycosidic bond is formed between the anomeric carbon (C1') of the sugar and N9 of a purine or N1 of a pyrimidine. Examples include adenosine (adenine + ribose), deoxyadenosine (adenine + deoxyribose), and cytidine (cytosine + ribose). Nucleosides lack phosphate groups and are therefore not charged at physiological pH.

A nucleotide is a nucleoside with one or more phosphate groups esterified to the sugar's 5' hydroxyl (or, less commonly, the 3' hydroxyl). The phosphate group(s) confer a negative charge at physiological pH, making nucleotides water-soluble and capable of participating in phosphodiester bond formation during nucleic acid synthesis. Nucleotides are the monomeric units of DNA and RNA and also serve as energy carriers (ATP, GTP), signaling molecules (cAMP, cGMP), and coenzyme precursors (NAD⁺, FAD).

The relationships are summarized in the table below:

ComponentCompositionExampleCharge at pH 7
BaseHeterocyclic ring onlyAdenineNeutral (or +1 if protonated)
NucleosideBase + sugarAdenosineNeutral
NucleotideBase + sugar + phosphate(s)AMP, ADP, ATPNegative (−1 to −4)

For a visual representation of these relationships, see the Nucleotide Diagram and the Nucleotide Structure entries. The distinction is also covered in Nucleotide Nucleoside.

Modified Nucleotide Bases

Beyond the five canonical bases, nucleic acids contain a diverse array of modified bases that expand their functional repertoire. These modifications are introduced post-synthetically by specific enzymes and play critical roles in gene regulation, RNA processing, and genome stability.

Epigenetic Modifications

The most well-studied modified base is 5-methylcytosine (5-mC), formed by the enzymatic transfer of a methyl group from S-adenosylmethionine (SAM) to the C5 position of cytosine. This reaction is catalyzed by DNA methyltransferases (DNMTs), primarily DNMT1 (maintenance methylation) and DNMT3A/3B (de novo methylation). In mammals, 5-mC occurs predominantly at CpG dinucleotides, and its presence in promoter regions is generally associated with transcriptional repression. Approximately 70–80% of CpG dinucleotides in the human genome are methylated, though CpG islands—GC-rich regions near gene promoters—are typically unmethylated.

5-mC can be further oxidized to 5-hydroxymethylcytosine (5-hmC) by the TET (ten-eleven translocation) enzymes, which is an intermediate in active DNA demethylation and may itself have regulatory functions. 5-hmC is enriched in embryonic stem cells and neurons, suggesting roles in pluripotency and neural function.

Other modified bases in DNA include N6-methyladenine (6-mA), found in bacteria and, at low levels, in eukaryotes, where it may mark actively transcribed genes.

RNA Modifications

RNA contains over 170 distinct modified nucleosides, the most abundant being pseudouridine (Ψ), in which the glycosidic bond is moved from N1 to C5 of uracil. Pseudouridine is formed by pseudouridine synthases and is enriched in tRNA, rRNA, and snRNA, where it stabilizes RNA structure by increasing base stacking and hydrogen bonding. In tRNA, pseudouridine in the TΨC loop contributes to ribosome binding.

Other notable RNA modifications include:

  • N6-methyladenosine (m⁶A): The most common internal modification of mRNA, installed by the METTL3/METTL14 methyltransferase complex and removed by demethylases such as FTO and ALKBH5. m⁶A influences mRNA splicing, export, translation, and stability.
  • Inosine (I): Formed by deamination of adenosine by ADAR (adenosine deaminase acting on RNA) enzymes. Inosine base-pairs with cytosine, and its presence in mRNA can recode codons, leading to protein diversity.
  • 5-methylcytidine (m⁵C) in RNA: Found in tRNA and rRNA, where it stabilizes structure and affects codon recognition.

Modified bases are not merely passive decorations; they are dynamic regulatory marks that respond to environmental cues. The study of these modifications, collectively termed "epigenetics" for DNA and "epitranscriptomics" for RNA, is a rapidly advancing field.

Methods to Study Nucleotide Bases

Identifying and quantifying nucleotide bases is essential for research and clinical diagnostics. Several complementary techniques are used, each with specific strengths and limitations.

Spectrophotometry

Nucleic acids absorb UV light maximally at 260 nm due to the aromatic ring systems of their bases. This property allows rapid quantification of DNA or RNA concentration using the Beer-Lambert law. A typical double-stranded DNA solution with an absorbance of 1.0 at 260 nm contains approximately 50 µg/mL; for single-stranded RNA, the equivalent is 40 µg/mL, and for single-stranded DNA, 33 µg/mL.

The ratio of absorbance at 260 nm to 280 nm (A₂₆₀/A₂₈₀) provides an estimate of purity. Pure DNA has an A₂₆₀/A₂₈₀ ratio of approximately 1.8, while pure RNA has a ratio of approximately 2.0. Lower ratios indicate protein contamination (proteins absorb at 280 nm due to aromatic amino acids). However, spectrophotometry cannot distinguish between individual bases—it reports total nucleic acid content.

High-Performance Liquid Chromatography (HPLC)

HPLC separates individual nucleotides or bases based on their differential partitioning between a mobile phase and a stationary phase. Reversed-phase HPLC, using a C18 column and an ion-pairing agent such as triethylammonium acetate, is commonly employed. Bases are detected by UV absorbance at 254–280 nm, and their identity is confirmed by comparing retention times with known standards.

HPLC is quantitative and can resolve all five standard bases plus many modified bases. For example, to measure 5-methylcytosine content in genomic DNA, the DNA is first digested to individual nucleotides, then separated by HPLC. This approach has been used to quantify global methylation levels in various tissues and cell types. Typical run times are 20–40 minutes, with detection limits in the picomole range.

Next-Generation Sequencing

Next-generation sequencing (NGS) determines the order of bases in a DNA or RNA molecule at massive scale. The most widely used platforms (Illumina sequencing) employ sequencing-by-synthesis: fluorescently labeled nucleotides are incorporated one at a time by a polymerase, and the emitted fluorescence identifies each base. This process generates millions of short reads (typically 150–300 bp) that are aligned to a reference genome to identify variants.

Standard NGS cannot directly detect modified bases because the polymerase reads through them without a distinct signal. However, specialized protocols exist:

  • Bisulfite sequencing: Treatment of DNA with sodium bisulfite converts unmethylated cytosines to uracil (which reads as thymine after PCR), while 5-methylcytosine remains unchanged. Comparing bisulfite-treated and untreated sequences reveals methylation status at single-base resolution.
  • Nanopore sequencing: As DNA passes through a protein nanopore, the ionic current is perturbed differently by each base, including modified bases. Oxford Nanopore Technologies' platforms can directly detect 5-mC, 5-hmC, and other modifications without chemical conversion.

For RNA, direct RNA sequencing with nanopore platforms can identify modified bases such as m⁶A and pseudouridine based on characteristic current signatures.

Common Misconceptions and Pitfalls

Students frequently encounter specific conceptual errors when learning about nucleotide bases. Addressing these directly can prevent confusion in exams and laboratory work.

Base vs. Nucleotide Confusion

The most common error is using "base" and "nucleotide" interchangeably. Remember: a base is only the nitrogenous ring; a nucleotide includes the base, sugar, and phosphate. When asked to draw a nucleotide, you must include all three components. When asked to name the bases in DNA, you list A, G, C, T—not dATP, dGTP, etc. This distinction matters in metabolic contexts: free bases are salvaged by enzymes like hypoxanthine-guanine phosphoribosyltransferase (HGPRT), which adds a ribose-phosphate group to convert them to nucleotides. A deficiency in HGPRT causes Lesch-Nyhan syndrome, illustrating the biological importance of base-to-nucleotide conversion.

Pairing Mistakes

Another frequent error is misremembering the number of hydrogen bonds or the pairing partners. Adenine pairs with thymine (or uracil) via two hydrogen bonds; guanine pairs with cytosine via three. A common mnemonic: "A-T" has two letters and two bonds; "G-C" has three letters and three bonds. Do not pair adenine with cytosine or guanine with thymine—these are mismatches that, if present in DNA, would distort the helix and likely trigger repair.

Also note that base pairing is antiparallel: the 5' end of one strand aligns with the 3' end of the other. When writing sequences, the convention is 5' to 3' left to right, and the complementary strand is written 3' to 5' left to right.

RNA vs. DNA Differences

Students often forget that thymine is absent from RNA and uracil is absent from DNA. The only difference between thymine and uracil is the methyl group at position 5 of thymine. This is not a trivial detail—it underlies the DNA repair mechanism for deaminated cytosines. In RNA, uracil is normal, so deamination of cytosine to uracil in RNA is not recognized as damage.

Another common error is assuming that RNA is single-stranded and DNA is double-stranded. While this is usually true, many RNA viruses have double-stranded RNA genomes, and single-stranded DNA genomes exist in some bacteriophages. The structural differences between DNA and RNA (2'-OH on ribose vs. 2'-H on deoxyribose) are more fundamental than strand number.

Glycosidic Bond Position

The N-glycosidic bond connects the sugar to the base at N9 for purines and N1 for pyrimidines. Students sometimes confuse these positions. Adenine's glycosidic bond is at N9, not N1 or N7. Cytosine's is at N1, not N3. This matters for understanding how nucleoside analogs (e.g., acyclovir for herpes) are designed and how they inhibit viral polymerases.

Frequently Asked Questions

Is a nucleotide a base?

No. A nucleotide is a base plus a sugar plus one or more phosphate groups. The base alone is just the nitrogenous ring structure. A nucleotide is the complete monomer that polymerizes to form DNA or RNA. Think of the base as the "letter" and the nucleotide as the "letter with its carrier"—the sugar-phosphate backbone provides the structural framework, while the base carries the information.

What are the nucleotide bases?

The nucleotide bases are the nitrogen-containing aromatic compounds that form the information-coding portion of nucleotides. The five standard bases are adenine (A), guanine (G), cytosine (C), thymine (T), and uracil (U). DNA contains A, G, C, and T; RNA contains A, G, C, and U.

What are the types of nucleotide bases?

Nucleotide bases are classified into two types based on ring structure: purines and pyrimidines. Purines (adenine and guanine) have a fused two-ring structure (a six-membered pyrimidine ring fused to a five-membered imidazole ring). Pyrimidines (cytosine, thymine, and uracil) have a single six-membered ring. This structural difference is essential for base pairing: a purine always pairs with a pyrimidine to maintain the uniform width of the DNA double helix.

What is the function of nucleotide bases?

Nucleotide bases have three primary functions. First, they store genetic information: the linear sequence of bases in DNA encodes genes, and the sequence in mRNA encodes proteins. Second, they participate in base pairing, which enables DNA replication, transcription, and translation. Third, they are components of energy carriers (ATP, GTP), signaling molecules (cAMP, cGMP), and coenzymes (NAD⁺, FAD, coenzyme A), where the base moiety is essential for recognition by enzymes and receptors.

What are examples of nucleotide bases?

The five standard examples are adenine, guanine, cytosine, thymine, and uracil. Modified bases include 5-methylcytosine (an epigenetic mark in DNA), pseudouridine (the most abundant modified base in RNA), and N6-methyladenosine (a regulatory mark in mRNA). Free bases also exist outside nucleic acids, such as caffeine (1,3,7-trimethylxanthine), which is a purine derivative.

How do nucleotide bases pair in DNA?

In DNA, adenine pairs with thymine via two hydrogen bonds, and guanine pairs with cytosine via three hydrogen bonds. This is called Watson-Crick base pairing. The specificity arises from the complementary arrangement of hydrogen bond donors and acceptors on each base. The two strands of the double helix are antiparallel, meaning one strand runs 5' to 3' and the other 3' to 5'.

Why does RNA use uracil instead of thymine?

RNA uses uracil instead of thymine for two main reasons. First, thymine is chemically more stable than uracil because the methyl group at position 5 protects the ring from spontaneous deamination and oxidative damage. DNA, which must preserve genetic information over the lifetime of an organism, benefits from this stability. RNA is typically transient and is constantly synthesized and degraded, so it can tolerate the less stable uracil. Second, the use of uracil in RNA allows cells to recognize and repair deaminated cytosines in DNA: if cytosine deaminates to uracil, the repair machinery identifies the uracil as abnormal because uracil is not normally present in DNA. This surveillance system would be impossible if thymine were replaced by uracil in DNA.

Key Takeaways

  • Nucleotide bases are nitrogen-containing aromatic heterocycles classified as purines (adenine, guanine) or pyrimidines (cytosine, thymine, uracil).
  • DNA contains A, G, C, T; RNA contains A, G, C, U. The only chemical difference between thymine and uracil is a methyl group at position 5.
  • Watson-Crick base pairing is specific: A pairs with T (or U) via two hydrogen bonds; G pairs with C via three hydrogen bonds. This specificity underlies all genetic information transfer.
  • A base is not a nucleotide: a nucleoside adds a sugar, and a nucleotide adds one or more phosphates. These distinctions are critical for understanding metabolism and nucleic acid chemistry.
  • Modified bases such as 5-methylcytosine and pseudouridine expand the functional repertoire of nucleic acids, playing roles in gene regulation and RNA function.
  • Nucleotide bases absorb UV light at 260 nm, a property used for quantification; HPLC and next-generation sequencing provide base-specific identification.
  • Common student errors include confusing bases with nucleotides, misremembering hydrogen bond numbers, and forgetting that uracil replaces thymine in RNA.

Further Reading

  • Kasuya G et al. Structural insights into the nucleotide base specificity of P2X receptors. Scientific reports. 2017. PubMed 28332633
  • Goncheva MI, Chin D, Heinrichs DE. Nucleotide biosynthesis: the base of bacterial pathogenesis. Trends in microbiology. 2022. PubMed 35074276
  • Furuhata T et al. Highly Conductive Nucleotide Analogue Facilitates Base-Calling in Quantum-Tunneling-Based DNA Sequencing. ACS nano. 2019. PubMed 30888791
  • Patel PH et al. Prokaryotic DNA polymerase I: evolution, structure, and "base flipping" mechanism for nucleotide selection. Journal of molecular biology. 2001. PubMed 11352575
  • Tao R et al. Harnessing nucleotide metabolism to control glycosylase base editing outcomes. Theranostics. 2026. PubMed 41695474
  • Ravindran S. Got mutation? 'Base editors' fix genomes one nucleotide at a time. Nature. 2019. PubMed 31740849

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