- Research article
- Open Access
Mining kidney toxicogenomic data by using gene co-expression modules
© The Author(s). 2016
- Received: 17 December 2015
- Accepted: 29 September 2016
- Published: 10 October 2016
Acute kidney injury (AKI) caused by drug and toxicant ingestion is a serious clinical condition associated with high mortality rates. We currently lack detailed knowledge of the underlying molecular mechanisms and biological networks associated with AKI. In this study, we carried out gene co-expression analyses using DrugMatrix—a large toxicogenomics database with gene expression data from rats exposed to diverse chemicals—and identified gene modules associated with kidney injury to probe the molecular-level details of this disease.
We generated a comprehensive set of gene co-expression modules by using the Iterative Signature Algorithm and found distinct clusters of modules that shared genes and were associated with similar chemical exposure conditions. We identified two module clusters that showed specificity for kidney injury in that they 1) were activated by chemical exposures causing kidney injury, 2) were not activated by other chemical exposures, and 3) contained known AKI-relevant genes such as Havcr1, Clu, and Tff3. We used the genes in these AKI-relevant module clusters to develop a signature of 30 genes that could assess the potential of a chemical to cause kidney injury well before injury actually occurs. We integrated AKI-relevant module cluster genes with protein-protein interaction networks and identified the involvement of immunoproteasomes in AKI. To identify biological networks and processes linked to Havcr1, we determined genes within the modules that frequently co-express with Havcr1, including Cd44, Plk2, Mdm2, Hnmt, Macrod1, and Gtpbp4. We verified this procedure by showing that randomized data did not identify Havcr1 co-expression genes and that excluding up to 10 % of the data caused only minimal degradation of the gene set. Finally, by using an external dataset from a rat kidney ischemic study, we showed that the frequently co-expressed genes of Havcr1 behaved similarly in a model of non-chemically induced kidney injury.
Our study demonstrated that co-expression modules and co-expressed genes contain rich information for generating novel biomarker hypotheses and constructing mechanism-based molecular networks associated with kidney injury.
- Acute kidney injury
- Kidney co-expression modules
- Gene signature
- Frequently co-expressed genes
- AKI pathways
- Cd44 ectodomain
- AKI networks
Acute kidney injury (AKI) is a clinically relevant disorder associated with high rates of morbidity and mortality . It reportedly occurs in ~20 % of hospitalized patients and in 30–60 % of critically ill intensive care patients [2, 3], increases mortality in military-relevant burn causalities , and often progresses to chronic kidney disease . In the United States, the annual costs for hospital-acquired AKI are estimated to be greater than $10 billion , and recent epidemiological studies show a trend towards increasing occurrence of AKI [6–8]. The lack of suitable biomarkers is a major hurdle in timely diagnosis of AKI, especially because drug-induced AKI is often reversible as long as drug use is discontinued.
Functional markers, such as serum creatinine, blood-urea-nitrogen, and the volume of urine output, are currently used to diagnose AKI [2, 9]. These markers have low sensitivity, lack specificity, result in delayed diagnosis, and hence, contribute to poor clinical outcomes [2, 10]. Developing suitable pre-clinical markers that could aid in earlier identification of AKI will also help reduce the cost and time associated with advanced drug development . The Predictive Safety Testing Consortium recently addressed this issue and developed the first U.S. Food and Drug Administration (FDA)-approved AKI biomarker panel for use in pre-clinical studies . While this is a major advance in the field, our current knowledge of molecular mechanisms and networks associated with AKI remains incomplete , and the search for new clinical AKI biomarkers is ongoing [9, 14]. Thus, identifying new molecular-level insights of kidney injury will help us to not only understand the disease process but also to identify new candidate biomarkers.
Extraction of network and pathway information by using in vivo gene expression datasets from thousands of chemical exposures and disease conditions can provide detailed insight into molecular injury mechanisms and identify the corresponding mechanism-based biomarkers [15–20]. The diversity and complexity of the in vivo response require specialized techniques to extract interpretable biological information. Here, we used the Iterative Signature Algorithm (ISA) to generate gene co-expression modules associated with AKI [21, 22]. Co-expressed genes are hypothesized to participate in biological processes and pathways that are linked together, though not necessarily through gene co-regulation. The bi-clustering methodology identifies gene modules that are clustered together under a subset of conditions, such that modules that can be specifically associated with kidney disease conditions can be hypothesized to be linked to kidney injury mechanisms. In this formulation, individual genes can participate in more than one module, because the same gene will respond differently to different stimuli, leading to co-expression with different sets of genes . This is consistent with the concept of a molecular toxicity pathway, in which a limited number of pathways are differentially activated in response to different injury conditions.
We investigated the DrugMatrix toxicogenomics database, which contains chemically induced gene expression changes and associated clinical chemistry and organ-specific histopathology endpoints in male Sprague Dawley rats [24, 25]. The DrugMatrix kidney Affymetrix dataset has ~60 million in vivo gene expression data points associated with diverse chemical exposures. We have previously used DrugMatrix liver data to identify modules and networks associated with liver fibrosis and experimentally validated the identified liver fibrosis gene signature [26–28]. Fielden et al. utilized part of the DrugMatrix kidney data to develop a predictive gene signature for kidney injury , but to our best knowledge, there are no reports on identifying co-expression modules associated with kidney injury from toxicogenomic data. Thus, our goal in this study was to identify co-expression modules associated with AKI. Our study was based on two major hypotheses: 1) a bi-clustering approach should be able to identify toxicity-relevant co-expression modules in an unsupervised manner, and 2) genes consistently co-expressed with known biomarker candidates should identify biological networks associated with kidney injuries. We identified AKI-relevant modules that were activated in chemical exposure conditions causing kidney injury and which contained well-known AKI-relevant genes such as Havcr1, Clu, and Tff3. We used the genes in these modules to 1) generate a signature for predicting kidney injury that performed better than well-known AKI biomarkers, and 2) identify pathways and networks of extracellular matrix (ECM)-receptor interactions, glutathione metabolism, and p53 signaling pathways associated with kidney injury. Our network analysis identified the involvement of immunoproteasomes in AKI. To expand on the knowledge and pathways associated with the well-known AKI gene Havcr1 [also known as the kidney injury molecule-1 (KIM1)], we identified genes that were frequently co-expressed with Havcr1 under conditions that cause kidney injury. We also confirmed that the expression pattern of these genes was present in an independent dataset probing rat kidney injuries due to ischemia, not chemical exposures. These results illustrate the potential of our approach to identify molecular networks associated with toxic injury and as a potential source for biomarkers.
Data collection and preprocessing
We used data from DrugMatrix, a publicly available toxicogenomics database that contains matched gene expression and histopathology data from Sprague Dawley rats after exposure to a range of chemicals at different doses and time intervals . We downloaded the DrugMatrix data from the National Institute of Environmental Health Sciences  server and focused on the kidney data generated using the Affymetrix rat 230 2.0 GeneChip array. We followed the pre-processing protocol as described in our earlier study [26, 31]. Briefly, we used the R/BioConductor package affy to perform robust multi-array average quantile normalization and the BioConductor package ArrayQualityMetrics to assess the quality of the microarray data [32–34]. We renormalized the data after removing 97 arrays that failed on at least one of the three statistical tests in ArrayQualityMetrics and were thus identified as outliers. We used the MAS5calls function in the affy package to obtain the “Present/Absent” calls for each probe set and removed the probe sets that were found to be “Absent” in all replicates across all chemical exposures .
We used the BioConductor genefilter package to remove genes without EntrezIDs or with low variance across chemical exposures . After calculating the average intensity across the replicates of a chemical exposure condition, we computed log-ratios for each gene between treatments and their corresponding controls. In the current analysis, we focused on chemical exposures with greater than 1-day time-points. This resulted in a final log-ratio matrix of 9,222 genes and 220 chemical exposure conditions.
Generation of gene co-expression modules and module clusters
We used the ISA implemented in the R/BioConductor package eisa to generate gene co-expression modules . The three key parameters of this algorithm are 1) starter seeds, 2) gene threshold, and 3) condition threshold. We used the R hierarchical clustering package Hclust along with the dynamicTreeCut package and generated 216 gene clusters . In line with our previous work, random gene sets were added to the hierarchical gene clusters and expanded to ~15,000 gene sets . We used both the hierarchical gene clusters and expanded gene sets as the starter seeds.
The ISA uses gene and condition threshold parameters for module generation. These two parameters affect the size and stringency of the modules; i.e., the higher their values, the smaller and more highly correlated are the modules, whereas the smaller their values, the larger and less-correlated the modules . We varied the parameter combination from 2.0 to 4.0 in increments of 0.5, and used 25 combinations of these two parameters to generate the modules; i.e., for a gene threshold of 2.0, we analyzed the modules at condition thresholds of 2.0, 2.5, 3.0, 3.5, and 4.0. For each threshold combination, we normalized the log-ratio matrix, generated modules, filtered redundant modules, and ensured module robustness by using the ISAnormalize, ISAiterate, ISAunique, and ISAFilterRobust functions, respectively. We filtered out gene modules with more than 200 genes and an intra-module correlation of <0.4. Finally, we merged the modules generated by using all threshold combinations and removed any redundant modules with the ISAunique function. Using this procedure, we generated 137 gene co-expression modules. Additional file 1: Script S1 provides the R script used to generate the ISA modules.
Module cluster characterization
We collected 57 genes with direct evidence of association with AKI from the Comparative Toxicogenomics Database (CTD) , 25 of which mapped to the co-expression modules. We used Fisher’s exact test to calculate the enrichment of these genes in each module cluster. In this process, we identified two module clusters (MC7 and MC11) that were activated in kidney injury conditions and enriched with known AKI-relevant genes. We refer to these two module clusters as the AKI-relevant module clusters and their component genes as the AKI-relevant gene set.
Generation of gene signature to predict kidney injury
We utilized the AKI-relevant gene set and generated gene signatures to predict the future occurrence of kidney injury, using the R package randomForest . Fielden et al. reported chemical exposures that did not show histopathological kidney injury at 5-day exposure but did show kidney injury at 29-day exposure . Our training set, based on these definitions, consisted of 14 nephrotoxic chemical exposures at early time points and 30 non-nephrotoxic chemical exposures . We used the AKI-relevant gene set and developed a random forest-based classifier model, using 1,001 trees and default settings. To analyze model performance, we used the standard model evaluation parameters, such as sensitivity, specificity, and area under the curve (AUC) for the receiver-operator characteristic (ROC) curve. The ROCR package was used to generate the AUC-ROC curve . We generated the final model by using the top 30 genes identified in the initial run. We separately created models with the Havcr1 and Clu genes, using the same parameters as those above. We utilized an independent external dataset from the Toxicogenomics Project-Genomics Assisted Toxicity Evaluation System [TG-GATEs] to evaluate the 30-gene signature . We processed 4- and 8-day high dose kidney exposures from TG-GATEs, using the same procedure as that described above for processing the DrugMatrix dataset.
Functional enrichment analysis
We utilized the AKI-relevant gene set and carried out functional enrichment analyses of Kyoto Encyclopedia of Genes and Genomes (KEGG)/Reactome pathways and Gene Ontology-Biological Process (GO-BP) terms. We used the BioConductor package clusterProfiler with default settings for KEGG and GO-BP enrichment analysis , and the REVIGO webserver with the default semantic similarity measure (SimRel) to cluster and summarize the enriched GO-BP terms . We employed the ReactomePA package for Reactome pathway enrichment analysis .
Protein-protein interaction network analysis
We converted the rat Affymetrix probe IDs to human gene IDs using the BioConductor/R packages annotate and biomaRt . The R script used for the conversion of probe IDs to human gene IDs is provided in additional information (Additional file 3: Script S2). We used the high-confidence human protein-protein interaction (PPI) network with 14,862 unique nodes generated by using interaction detection based on the shuffling approach . We used Cytoscape 3.2.1 to map the AKI-relevant gene set to the PPI network, and extracted the connected component as an AKI-relevant sub-network (AKI-SN) . We first analyzed whether the AKI-SN was obtained by random chance using by two statistical significance tests [26, 50]. Our null hypothesis was that the observed number of nodes (AKI-SNnodes) and edges (AKI-SNedges) in AKI-SN are obtained by random chance. In the first analysis, we randomly selected 158 proteins from the human PPI network 1,000 times and counted the number of nodes (Rnodes) and edges (Redges) of the largest connected component. We calculated the number of times that Rnodes ≥ AKI-SNnodes (Nrandnode). Similarly, we computed the number of times that Redges ≥ AKI-SNedges (Nrandedge). We then calculated the probability of randomly obtaining a sub-network with a number of nodes comparable to that of AKI-SN by P = Nrandnode /1,000, and the probability of randomly obtaining a sub-network with a number of edges comparable to that of AKI-SN by P = Nrandedges /1,000. In the second analysis, we scrambled the human PPI network while preserving the average node degree and mapped AKI-SN nodes to the randomized network. This process was also repeated 1,000 times. As in the first test, we extracted the largest connected component, counted the number of nodes and edges, and calculated the probability of obtaining AKI-SN parameters by random chance.
We next computed the properties of the network, such as its degree and betweenness centrality. In the PPI network, nodes represent proteins and edges represent the interactions/connections between them. The degree represents the number of interactions associated with the protein. Proteins with a large degree are known as hub proteins . Earlier studies have shown that hub proteins tend to be the essential or key protein in the network . The betweenness centrality (also known as traffic) is a measure of the number of shortest paths through the node and represents the capacity of the node to communicate with other components of the network . We used the NetworkAnalyzer option in Cytoscape 3.2.1 to compute the degree and betweenness centrality of the AKI-SN . We used the MCODE program in Cytoscape to identify the most inter-connected nodes in the AKI-SN .
The Ingenuity Pathways Analysis (IPA; QiagenBioinformatics, Redwood City, CA) software package was used to determine the gene-function relationships and sub-anatomical location of the genes and proteins identified in the sub-networks. The genes identified in the sub-network analysis were associated with the disease or function annotations filtered by the search term “renal” in order to determine the gene-to-function relationships in discrete anatomical locations of the kidney. Only PubMed identifications (PMIDs) with significant associations curated by IPA were included in the anatomical mapping.
Identification of frequently co-expressed genes
Of the 137 gene co-expression modules, 21 contained the Havcr1 gene. We created a correlation matrix for each of the 21 modules and selected the 20 % of genes that were most correlated with Havcr1. We counted the number of occurrences of each gene across the list of the 21 most correlated gene sets, and genes that occurred more than twice were denoted as “frequently co-expressed genes.” We tested whether these frequently co-expressed genes could be obtained by random chance. For this, we shuffled the gene labels in the log-ratio matrix and carried out the entire analysis from the ISA module generation to identify frequently co-expressed genes. Subsequently, we analyzed whether the procedure was robust with respect to noise. We repeated the entire analysis excluding either 5 % of the chemical exposures or 10 % of chemical exposures and calculated the genes frequently co-expressed with Havcr1.
We further evaluated the relevance of frequently co-expressed genes with Havcr1, using an external dataset (GSE58438) collected from Gene Expression Omnibus (GEO). In this dataset, ischemic kidney injury was produced by clamping the renal artery . This dataset contains five control replicates and five replicates of animals collected at 1 and 5 days after ischemic kidney injury. We matched the frequently co-expressed genes and calculated the Spearman correlation between the average log-ratios derived from chemical exposures that produced kidney injury in the DrugMatrix database and those derived from this external dataset.
Identification of AKI-relevant modules
Phenotypes and chemical exposure classes used in the analysis of module cluster activation
Kidney-cortex, tubule, necrosis
Epithelial growth factor receptor kinase inhibitors
Estrogen receptor modulators
Enrichment of known acute kidney injury (AKI)-relevant genes in module clusters
No. of genes in module cluster
No. of AKI genes
ALB, AMBP, CYP2C19, CYP2C9, CYP2D6, FABP1, GSTP1
B2M, CD44, GPNMB, G6PD, GSTP1, HAVCR1, TFF3
A2M, CLU, CD44, GPNMB, GAS6, HAVCR1, LCN2, SPP1, TNFRSF12A, TFF3
A2M, EPO, GSTM2, LCN2, SPP1
To our best knowledge, this study is the first module-based analysis of a large public repository of kidney toxicogenomic data. Our unsupervised approach is an advantage in that, unlike standard differential gene expression analysis, co-expression modules are not associated a priori with any injury phenotype. The modules we generated represent a compendium of gene co-expression patterns in rat kidney tissue after exposure to diverse toxicants (Additional file 4: Table S2). We used disease-relevant genes post hoc to prioritize modules rather than following previously published methods that use known disease-relevant genes to guide the co-expression analysis a priori . Our module activation calculations and enrichment analyses did not influence the gene/condition composition of the modules because they were performed after we generated the modules. As such, the module genes, i.e., genes co-expressed with known AKI-relevant genes, can be hypothesized to participate in biological processes/disease mechanisms relevant to kidney-specific injuries. When we analyzed the chemical exposures that define the modules in AKI-relevant module clusters, the results included well-known nephrotoxic chemicals/drugs (e.g., cisplatin, lead-II-acetate, calcitriol, cholecalciferol, netilmicin, vancomycin, and oxaliplatin; Additional file 7: Table S5) . We used the AKI-relevant gene set to carry out two separate analyses: 1) identification of gene signatures by using a supervised classification approach; and 2) identification of the pathways and networks associated with AKI.
Generation of predictive gene signature for AKI
We used the AKI-relevant gene set along with the random forest approach to generate gene signatures that could predict the future onset of AKI. Although the nephrotoxicants in our training data did not show any kidney injury at 3 to 5 days of exposure, they are known to produce kidney injury after 28 days of exposure . Thus, the task is to use the data at early time points to predict the probability of injury before the injury actually occurs. We used the random forest approach to predict the probability of later injury on the basis of the data at early time points. The random forest approach is an ensemble-based decision-tree model that has been widely used in the analysis of omics data [57–60]. The main advantages of this approach are its ability to 1) handle problems with small sample sizes and a large number of variables and 2) provide a measure of variable importance . In the random forest approach, each tree is generated with a random subset of the data and a prediction is made for the left-out data that are not used in the tree generation. This out-of-bag (OOB) testing provides an error estimate and is equivalent to cross-validation analysis . Our random forest approach identified the top 30 genes that provide the best classification accuracy with the variable importance measure (i.e., the mean decrease in accuracy; see Additional file 8: Table S6).
Besides Havcr1, the literature includes reports of associations between the genes in our signature and AKI. Guca2a, a gene that codes for guanylate cyclase 2a, was upregulated in gentamicin-induced kidney toxicity . The protein encoded by gene Ugt2b7 [uridine diphosphate glucuronosyltransferase (UGT)], one of the two most abundantly expressed renal UGTs, is known to play a significant role in glucuronidation of drugs and endogenous mediators associated with inflammation . The gene Ly96 (lymphocyte antigen 96) encodes a protein that interacts with toll-like receptor 4 (TLR4), a key mediator in nephrotoxicity. Tlr4 -/- mice are less prone to ischemic kidney injury than are wild-type littermates [63, 64]. TLRs induce the expression of PVR (also known as CD155), another gene present in our gene signature . TLR4 signaling can lead to activation of interferon regulatory factors (IRFs) . IRF1 promotes inflammation after ischemic AKI . Furthermore, the Map4k4 gene in our signature encodes a kinase involved in the TNF-signaling pathway, which is also known to play a role in kidney injury . Irf6 in our signature is functionally related to TLR4 signaling but has not previously been associated with AKI; it may represent a novel biomarker of kidney injury. Thus, the literature provides supporting evidence that all of the genes in our signature are relevant to predicting kidney injury.
Functional enrichment analysis
KEGG pathway enrichment for the acute kidney injury (AKI)-relevant gene set
Cell adhesion molecules
Cytosolic DNA-sensing pathway
Cysteine and methionine metabolism
p53 signaling pathway
RIG-Ic-like receptor signaling pathway
Metabolism of xenobiotics by cytochrome P450
Reactome pathway enrichment for the acute kidney injury (AKI)-relevant gene set
Extracellular matrix organization
Degradation of the extracellular matrix
Cell junction organization
Gene Ontology (GO)-biological process (BP) term enrichment for acute kidney injury (AKI)-relevant gene seta
Response to virus
Immune system process
Response to external stimulus
Response to stimulus
Response to biotic stimulus
Response to cytokine
Regulation of viral process
Response to interferon-beta
Response to organic substance
Viral genome replication
Response to chemical
Regulation of symbiosis
Cellular response to interferon-beta
Response to interferon-alpha
Glutathione metabolic process
Nucleobase-containing small molecule metabolic process
Positive regulation of cell-killing
PPI network analysis
Next, we identified the highly interconnected regions in AKI-SN (Additional file 14: Figure S2). The most interconnected regions in disease-specific networks have been shown to capture disease-associated candidate genes . The most interconnected region in AKI-SN contained the protein products of genes Psmb8 (LMP7), Psmb9 (LMP2), Psmb10 (MECL1), and Tap1, which are involved in antigen processing and presentation (see the red star and circle in Fig. 6). The proteins of Psmb8, Psmb9, and Psmb10 form the immunoproteasome—an alternative form of the normal constitutive proteasome—which is induced by interferon (IFN)-γ and TNF-α . Immunoproteasomes are more efficient than constitutive proteasomes at eliminating damaged cellular proteins under severe stress or other pathological conditions, and are considered as promising drug targets in certain cancers and auto-immune diseases [93, 94]. Interferon regulatory factor-1 (IRF1) is a transcription factor that regulates the IFN-γ-mediated upregulation of immunoproteasome sub-units . The protein product of the gene Irf1 mapped to the AKI-SN (located in the nucleus region of Fig. 6), and was upregulated together with the immunoproteasome sub-units present in the network. As immunoproteasomes are promising drug targets, we further evaluated the expression of immunoproteasome sub-units across all 220 chemical exposures. We found that immunoproteasomes were upregulated by confirmed nephrotoxicants (e.g., lead-II-acetate, lead-IV-acetate, netilmicin, cisplatin, vancomycin, cholecalciferol, neomycin, gentamicin, and 2-amino-nitro-phenol; Additional file 15: Table S11). Analysis of chemical exposures associated with downregulation of immunoproteasome gene expression showed an interesting class effect: Anticancer drugs such as methotrexate as well as anthracycline anticancer agents, such as doxorubicin, daunorubicin, and epirubicin, were associated with diminished expression of genes related to immunoproteasomes.
The AKI-SN also contained regulatory elements of immunoproteasomes related to the TLR and TNF signaling pathways. The Irf-class of transcription factors are master regulators of TLRs and RIG-1 signaling pathways . Genes of this class (e.g., Irf1, Irf6, and Irf9) mapped to the AKI-SN network in the nucleus. Components SPP1, LBP, and CCL5 of the TLR signaling pathway , located in the extracellular region and plasma membrane, were also upregulated. The presence of the TNF signaling pathway  in our network revealed a sequential connection between TNFRSF1A in the plasma membrane (marked with a blue star in Fig. 6) and BIRC3, RIPK3, and CASP3 in the cytosol. The bulk of these components showed strong upregulation, indicative of a strong and persistent immune and inflammatory response to the chemical insults. Our results are concordant with earlier studies that have documented potential immunoproteasome involvement in patients with IgA nephropathy  and patients rejecting renal transplants .
Frequently co-expressed genes with Havcr1
Publicly available toxicogenomic datasets are valuable resources that help in data mining and identifying networks, mechanisms, and biomarkers associated with a disease. In this analysis, we studied the rat kidney toxicogenomic data from DrugMatrix and identified co-expression modules associated with kidney injury. Our work provides a compendium of kidney co-expression modules and is the first such analysis of kidney toxicogenomic data. We used the co-expression modules to identify a 30-gene signature that predicted the future onset of kidney injury from early gene transcription data. Although some of the genes in our signature are associated with the mechanism of AKI, we also identified genes such as Irf6 as potentially novel candidates for AKI. Systems-level analyses identified pathways and networks associated with AKI. We identified AKI-relevant pathways, such as ECM receptor interaction and the RIG-1 signaling pathway, and showed that co-expression module-based approaches can identify additional information not obtainable by standard differential gene expression analysis. We identified an AKI-relevant protein interaction sub-network that mapped many known genes involved in AKI. Our network analysis revealed the involvement of immunoproteasomes in AKI and identified new genes, such as Isg15 and Anxa7, not previously associated with this disease. Finally, we used our co-expression modules to identify the frequently co-expressed genes with known biomarker Havcr1. Overall, our analyses show the potential utility of using co-expression modules in characterizing molecular mechanisms involved in AKI and identifying novel mechanism-based biomarker candidates.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army or of the U.S. Department of Defense. Citations of commercial organizations or trade names in this report do not constitute an official Department of the Army endorsement or approval of the products or services of these organizations. This paper has been approved for public release with unlimited distribution. The authors were supported by the Military Operational Medicine Research Program and the U.S. Army’s Network Science Initiative, U.S. Army Medical Research and Materiel Command (USAMRMC, http://mrmc.amedd.army.mil), Ft. Detrick, MD.
Availability of data and materials
The data sets supporting the results of this article are included within the article and its additional files.
MDMA, DLI, JDS, and AW conceived and designed the experiments, MDMA performed the experiments, and MDMA, DLI, JDS, and AW wrote the paper. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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