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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Infect. Microbiol.</journal-id>
<journal-title>Frontiers in Cellular and Infection Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Infect. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">2235-2988</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fcimb.2025.1630865</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Cellular and Infection Microbiology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Safe and efficient transportation of clinical samples for molecular detection of African swine fever virus</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Rempel</surname>
<given-names>Jordan</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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</contrib>
<contrib contrib-type="author">
<name>
<surname>Onyilagha</surname>
<given-names>Chukwunonso</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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</contrib>
<contrib contrib-type="author">
<name>
<surname>Goonewardene</surname>
<given-names>Kalhari</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2535403/overview"/>
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<contrib contrib-type="author" corresp="yes">
<name>
<surname>Ambagala</surname>
<given-names>Aruna</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
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</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>National Centre for Foreign Animal Disease, Canadian Food Inspection Agency</institution>, <addr-line>Winnipeg, MB</addr-line>,&#xa0;<country>Canada</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba</institution>, <addr-line>Winnipeg, MB</addr-line>,&#xa0;<country>Canada</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary</institution>, <addr-line>Calgary, AB</addr-line>,&#xa0;<country>Canada</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1229099/overview">Anuj Ahuja</ext-link>, NewYork-Presbyterian, United States</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/840092/overview">Mary-Louise Penrith</ext-link>, University of Pretoria, South Africa</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1840956/overview">Tridib Rajkhowa</ext-link>, Central Agricultural University, India</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Aruna Ambagala, <email xlink:href="mailto:aruna.ambagala@inspectionn.gc.ca">aruna.ambagala@inspectionn.gc.ca</email>
</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>22</day>
<month>09</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<volume>15</volume>
<elocation-id>1630865</elocation-id>
<history>
<date date-type="received">
<day>29</day>
<month>05</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>29</day>
<month>08</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2025 Rempel, Onyilagha, Goonewardene and Ambagala.</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Rempel, Onyilagha, Goonewardene and Ambagala</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>African swine fever (ASF) continues to devastate swine populations across the globe. The causative agent, ASF virus (ASFV), is very stable and can remain infectious over long periods of time especially in contaminated blood and tissue samples. Therefore, the transport of clinical samples from the field to diagnostic laboratories requires special precautions to reduce the risk of spreading the disease. Inactivation of ASFV in the clinical samples prior to transporting to the lab eliminates the risk and the requirement of higher biosafety facilities to perform ASF diagnostics. This study evaluated the use of a commercial molecular transport medium (MTM) to inactivate ASFV and stabilize the viral DNA in cell culture and clinical samples collected from pigs inoculated with different ASFV strains. In all the sample types tested, complete inactivation of ASFV was observed, without affecting the subsequent detection of ASFV genomic material by real time polymerase chain reaction (real time PCR). The MTM preserved the stability of ASFV genomic material eliminating the need to refrigerate clinical samples. The data shows that the MTM can be used reliably to ensure safety and stability of routine clinical samples such as whole blood, spleen swabs and alternative sample types such as oral fluid, allowing expansion and streamlining ASF molecular diagnostics.</p>
</abstract>
<kwd-group>
<kwd>African swine fever</kwd>
<kwd>ASFV</kwd>
<kwd>inactivation</kwd>
<kwd>MTM</kwd>
<kwd>transport</kwd>
<kwd>nucleic acid stability</kwd>
<kwd>oral fluid</kwd>
</kwd-group>
<contract-sponsor id="cn001">Canadian Food Inspection Agency<named-content content-type="fundref-id">10.13039/100009837</named-content>
</contract-sponsor>
<counts>
<fig-count count="4"/>
<table-count count="1"/>
<equation-count count="1"/>
<ref-count count="40"/>
<page-count count="10"/>
<word-count count="5245"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Veterinary and Zoonotic Infection</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<label>1</label>
<title>Introduction</title>
<p>African swine fever virus (ASFV) is a large double-stranded DNA virus of the <italic>Asfarviridae</italic> family. ASFV causes African swine fever (ASF), a lethal hemorrhagic disease in domestic and wild Eurasian pigs (<xref ref-type="bibr" rid="B12">Dixon et&#xa0;al., 2019</xref>). ASFV is stable and remain infectious for a long period of time when protected in organic material and stored at lower temperatures (<xref ref-type="bibr" rid="B24">Mazur-Panasiuk et&#xa0;al., 2019</xref>). ASFV persists in blood for over a year at 4&#xb0;C, and multiple weeks in pork products (<xref ref-type="bibr" rid="B14">Fischer et&#xa0;al., 2020</xref>). ASF emerged from ancient animal wildlife reservoirs in East Africa where it was first reported in Kenya in 1921, and since then it has been reported in over 80 countries across Africa, Americas, Asia, and Europe (<xref ref-type="bibr" rid="B11">Dixon et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B22">Li et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B38">WOAH, 2024</xref>). Transmission of ASFV can occur with direct contact between pigs by oral-nasal route, and indirectly via materials or feed contaminated with infected blood or other secretions, including feces, urine, and saliva (<xref ref-type="bibr" rid="B29">Penrith and Vosloo, 2009</xref>; <xref ref-type="bibr" rid="B16">Guinat et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B12">Dixon et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B24">Mazur-Panasiuk et&#xa0;al., 2019</xref>). Outbreaks of ASF can lead to considerable economic and domestic product losses in affected countries, as well as devastating impacts in rural regions that heavily rely on pork and pork products as a major part of their income and food security (<xref ref-type="bibr" rid="B39">You et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B19">Jean-Pierre et&#xa0;al., 2022</xref>). Currently, there is no cure for ASF. There have been promising strides towards an effective vaccine, however, no globally accepted vaccine is available for ASF. Therefore, implementation of basic biosecurity and early detection are crucial for combatting this dreadful disease in order to reduce the need for containment and elimination of infected and at-risk animals (<xref ref-type="bibr" rid="B12">Dixon et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B24">Mazur-Panasiuk et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B11">Dixon et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B13">Fernandez-Colorado et&#xa0;al., 2024</xref>).</p>
<p>ASF is characterized by fever, lethargy, loss of appetite and hemorrhages. It cannot be differentiated from other hemorrhagic diseases in pigs by either clinical signs or post-mortem examinations. Hence laboratory confirmation is critical. Real time polymerase chain reaction (PCR) is the most specific and sensitive assay currently available for rapid detection of ASFV genomic material in clinical samples, however it requires specific instruments, additional infrastructure, and highly skilled staff. Therefore, the samples from ASF suspected animals need to be delivered to a central laboratory for testing.</p>
<p>Whole blood is the ideal sample type from live pigs, and recent work has shown that spleen swabs rather than whole tissue homogenates could prove an effective sample type for ASFV detection in deceased pigs (<xref ref-type="bibr" rid="B7">Cafariello et&#xa0;al., 2024</xref>). The transport of clinical samples to the central laboratories presents a risk of spreading the infection and often requires maintaining cold chain during transportation to preserve the sample integrity. Maintaining cold chain adds extra costs and complications, especially for the countries with limited resources (<xref ref-type="bibr" rid="B35">Waldrup and Conger, 2002</xref>; <xref ref-type="bibr" rid="B28">Olsen, 2013</xref>). We recently showed that the spleen swabs are more sensitive than spleen tissue homogenates for ASFV genome detection (<xref ref-type="bibr" rid="B7">Cafariello et&#xa0;al., 2024</xref>). Spleen swabs can be easily collected and sent to diagnostic laboratories and processed quickly without the need for homogenization, and therefore suitable for high throughput detection. In another study, we have shown that swine oral fluid is a convenient and cost-effective sample type for the early detection of ASF (<xref ref-type="bibr" rid="B15">Goonewardene et&#xa0;al., 2021</xref>). Oral fluid collection is simple and straightforward and therefore can be performed by the farmers and submitted to diagnostic laboratory. However, unlike whole blood and spleen swabs, oral fluids are often contaminated with feces, soil, and feed particles, and therefore immediate refrigeration after collection is required to obtain reliable results.</p>
<p>PrimeStore<sup>&#xae;</sup> molecular transport medium (MTM) is a commercially available reagent that contains ethanol, n-lauroylsarcosine, and guanidine thiocyanate, which lyse the cells and viruses while denaturing proteins such as nucleases, reducing degradation of nucleic acids (<xref ref-type="bibr" rid="B25">McGookin, 1985</xref>; <xref ref-type="bibr" rid="B26">Molina-Moya et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B9">Daum and Fischer, 2021</xref>; <xref ref-type="bibr" rid="B36">Welch et&#xa0;al., 2024</xref>). Following treatment with MTM, nucleic acid can be extracted by routine extraction methods including manual spin columns or automated magnetic bead extraction. MTM has been authorized by the Food and Drug Administration (FDA) for collection of samples suspected of containing Influenza A virus, and <italic>Mycobacterium tuberculosis</italic> (<xref ref-type="bibr" rid="B9">Daum and Fischer, 2021</xref>). Additional work has been done to demonstrate that MTM is able to inactivate Newcastle disease, eastern equine encephalitis, foot-and-mouth disease, bovine viral diarrhea, swinepox, vaccinia, Monkeypox, and SARS-CoV2 viruses (<xref ref-type="bibr" rid="B26">Molina-Moya et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B9">Daum and Fischer, 2021</xref>; <xref ref-type="bibr" rid="B3">Blacksell et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B36">Welch et&#xa0;al., 2024</xref>). To our knowledge, the ability of MTM to inactivate ASFV has not been reported. In this study, we evaluated the ability of MTM to inactivate ASFV and stabilize the ASFV nucleic acid in cell culture supernatant and clinical samples.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<label>2</label>
<title>Materials and methods</title>
<sec id="s2_1">
<label>2.1</label>
<title>Cells</title>
<p>For virus propagation and titration, highly ASFV-susceptible immortalized porcine kidney macrophage (IPKM) cell line was used (<xref ref-type="bibr" rid="B23">Masujin et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B20">Kameyama et&#xa0;al., 2022</xref>). IPKM cells develop clear cytopathic effect when infected with ASFV and the detection limit of the assay is almost identical to that of the porcine alveolar macrophage based classical hemadsorption assay. IPKM cells were maintained and passaged in Dulbecco&#x2019;s modified Eagle medium (DMEM), high glucose, supplemented with 10% (v/v) non-irradiated fetal bovine serum (FBS), 2% (v/v) 200mM L-Glutamine, 1.1% (v/v) sodium pyruvate, 1% (v/v) Pen/Strep, 10&#xb5;g/mL bovine insulin, 25&#xb5;M monothioglycerol, and 0.022% (v/v) Fungicin (complete medium) in cell culture plates and flasks by the National Center for Foreign Animal Disease Reagent Development Unit (NCFAD-RDU). Cells were incubated at 37&#xb0;C with 5% CO<sub>2</sub> with complete medium for maintenance conditions. For infections, they were seeded 48 hours prior to use and infected at 90% confluency.</p>
</sec>
<sec id="s2_2">
<label>2.2</label>
<title>Samples</title>
<p>Cell culture supernatants containing ASFV strains belonging to three different p72 genotypes and archived whole blood, spleen, and oral fluid samples collected from pigs infected with different ASFV strains were used (<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>). Cell culture supernatants were prepared by propagating the virus in primary pig leukocytes (PPLs) followed by titration on primary alveolar macrophages (PAMs) as previously described (<xref ref-type="bibr" rid="B1">Ambagala et&#xa0;al., 2024</xref>).</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Description of the types of samples and the viruses used in the study.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" align="center">Sample type</th>
<th valign="middle" align="center">Virus used</th>
<th valign="middle" align="center">p72 genotype</th>
<th valign="middle" align="center">Virulence</th>
<th valign="middle" align="center">Reference</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center">Culture sup.</td>
<td valign="middle" align="center">ASFV Dom. Republic DR84</td>
<td valign="middle" align="center">II</td>
<td valign="middle" align="center">Moderate</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B32">Schambow et&#xa0;al., 2025</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Culture sup.</td>
<td valign="middle" align="center">ASFV Vietnam VNUA/rASFV/VP1/2023</td>
<td valign="middle" align="center">I/II</td>
<td valign="middle" align="center">High</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B21">Le et&#xa0;al., 2024</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Culture sup.</td>
<td valign="middle" align="center">ASFV Uganda/DA11121-36</td>
<td valign="middle" align="center">IX</td>
<td valign="middle" align="center">**</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B27">Okwasiimire et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Culture sup.</td>
<td valign="middle" align="center">ASFV Zambia/2019-SLNP-24</td>
<td valign="middle" align="center">VIII</td>
<td valign="middle" align="center">High</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B8">Chambaro et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Blood/Culture sup.</td>
<td valign="middle" align="center">ASFV Georgia 2007/1</td>
<td valign="middle" align="center">II</td>
<td valign="middle" align="center">High</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B31">Rowlands et&#xa0;al., 2008</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Blood/Culture sup.</td>
<td valign="middle" align="center">ASFV Nigeria RV502</td>
<td valign="middle" align="center">II</td>
<td valign="middle" align="center">High</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B2">Ambagala et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Blood</td>
<td valign="middle" align="center">ASFV Ghana Akuse</td>
<td valign="middle" align="center">I</td>
<td valign="middle" align="center">High</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B30">Rai et&#xa0;al., 2024</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Culture sup.</td>
<td valign="middle" align="center">ASFV Lillie</td>
<td valign="middle" align="center">XX</td>
<td valign="middle" align="center">High</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B5">Boshoff et&#xa0;al., 2007</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Spleen swabs</td>
<td valign="middle" align="center">ASFV Estonia 2014</td>
<td valign="middle" align="center">II</td>
<td valign="middle" align="center">Moderate</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B40">Zani et&#xa0;al., 2018</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Oral fluid/Blood/Culture sup.</td>
<td valign="middle" align="center">ASFV Malta&#x2019;78</td>
<td valign="middle" align="center">I</td>
<td valign="middle" align="center">Moderate</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B37">Wilkinson et&#xa0;al., 1980</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Culture sup.</td>
<td valign="middle" align="center">ASFV OURT 88/3</td>
<td valign="middle" align="center">I</td>
<td valign="middle" align="center">Low</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B4">Boinas et&#xa0;al., 2004</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Culture sup.</td>
<td valign="middle" align="center">ASFV-G-&#x394;MGF-DMAC</td>
<td valign="middle" align="center">II</td>
<td valign="middle" align="center">Low</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B10">Diep et&#xa0;al., 2025</xref>)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>**Virulence unknown.</p>
</fn>
<fn>
<p>Culture sup: cell culture supernatant.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="s2_3">
<label>2.3</label>
<title>Molecular transport medium</title>
<p>PrimeStore<sup>&#xae;</sup> MTM was purchased from Longhorn Vaccines and Diagnostics, LLC, Bethesda, MD, stored at room temperature and used as recommended (three parts of MTM to one part of sample, incubated for 60 minutes) unless otherwise noted.</p>
</sec>
<sec id="s2_4">
<label>2.4</label>
<title>Detergent removal and cytotoxicity testing</title>
<p>To reduce the cytotoxicity of MTM, Pierce<sup>&#xae;</sup> detergent removal spin columns (Thermo Fisher Scientific, Waltham, MA, USA. Catalog number 87778) were used according to the manufacturer&#x2019;s instructions. Briefly, the bottoms of the columns were snapped off, placed into sterile 15 mL falcon tubes, and centrifuged 1,000 x g for 2 minutes at room temperature to remove storage buffer. Columns were then washed 3 times with 2 mL of sterile Dulbecco&#x2019;s phosphate buffered saline (D-PBS), and centrifuged at 1,000 x g for 2 minutes at room temperature. Columns were then placed in a new 15 mL falcon tube, and 500 &#xb5;L of the samples treated with either D-PBS or MTM was added to the columns, allowed to sit for at least 1 minute, then centrifuged at 1,000 x g for 2 minutes at room temperature.</p>
<p>The removal of cytotoxicity was assessed using the CyQUANT&#x2122; MTT Cell Viability Assay (Thermofisher Scientific, Catalog number V13154). D-MEM high glucose medium supplemented with 1% (v/v) 5mg/mL gentamicin was used as the diluent. One part diluent was added to 3 parts of MTM, vortexed for 10 seconds, and half of the volume was subjected to detergent removal process, while the other half was used as is. The two treatments were serially diluted (from 10<sup>&#x2212;1</sup> to 10<sup>-8</sup>) in diluent. Cell culture medium was removed from 96-well IPKM plates, and 50 &#xb5;L of dilutions were added to the plates, with 8 replicates per dilution. Plates were incubated at 37&#xb0;C with 5% CO<sub>2</sub> for 1 hour, and 200 &#xb5;L of complete medium was added to each well. Plates were then incubated at 37&#xb0;C with 5% CO<sub>2</sub> for 48 hours, after which the medium was removed. Plates were washed 2 times with 200 &#xb5;L warm D-PBS, and 100 &#xb5;L of fresh complete medium, free of phenol-red, was added to each well. MTT substrate was then reconstituted in 1 mL of sterile D-PBS, and 10 &#xb5;L was added to each well, and the plates were incubated at 37&#xb0;C with 5% CO<sub>2</sub> for 4 hours. After the incubation, 100&#xb5;L of the SDS-HCL solution was added to each well, mixed by pipetting and plates were incubated at 37&#xb0;C with 5% CO<sub>2</sub> for another 4 hours. Each well was mixed again by pipetting, and absorbance was read at 570nm using SpectraMax Plus 384 Microplate Reader (Molecular Devices). The absorbance of the wells without cells were averaged and subtracted from all other wells as background. The absorbance of untreated control cells was averaged and used as 100% viable cells for the corresponding plate. Replicates for each treatment were then averaged, and cell viability was calculated as shown below.</p>
<disp-formula>
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</mml:math>
</disp-formula>
</sec>
<sec id="s2_5">
<label>2.5</label>
<title>Virus Titration</title>
<p>To evaluate virus titer reduction after the MTM treatment, IPKM cells grown to 90% confluency in 96-well tissue culture plates were used. The samples containing ASFV treated with either D-PBS or MTM were passed through the detergent removal spin columns as described above, and the eluate was serially diluted (10-fold) in DMEM high glucose medium supplemented with 1% (v/v) 5mg/mL gentamicin up to 10<sup>-8</sup>. Just before virus inoculation, cell culture medium was removed from the 96-well plates, and each well was inoculated with 50 &#xb5;L of serially diluted samples. Plates were then incubated at 37&#xb0;C with 5% CO<sub>2</sub> for 1 hour, after which 150&#xb5;L of complete cell culture medium was added to each well, and plates were incubated at 37&#xb0;C with 5% CO<sub>2</sub>. Plates were observed daily up to 7 days for cytopathic effect (CPE), after which virus TCID<sub>50</sub> was calculated. Titrations were performed in duplicate. Virus titer reduction in MTM treated samples was compared to the controls treated with D-PBS.</p>
</sec>
<sec id="s2_6">
<label>2.6</label>
<title>Virus Isolation</title>
<p>For virus isolation, IPKM cells grown to 90% confluency in T25 flasks were used. The cell culture medium was removed from the T25 flasks, and 0.5 mL of the above prepared 10-fold diluted eluate was added to each flask. The flasks were then incubated at 37&#xb0;C with 5% CO<sub>2</sub> for 1 hour with gentle rocking every 15 minutes; after the 1-hour incubation, the flasks were topped off with 4.5 mL complete medium. The flasks were incubated at 37&#xb0;C with 5% CO<sub>2</sub> for up to 7 days and observed daily for CPE. On the 7<sup>th</sup> day, the flasks were frozen at -70&#xb0;C for minimum of 4 hours before being placed in 37&#xb0;C incubator to thaw. The contents of the flask were transferred into a 15 mL falcon tube, centrifuged at 2,000 x g for 20 minutes at 4&#xb0;C, and the supernatant was used for nucleic acid extraction for ASFV real time PCR, and for the next passage following the same procedure, up to 3 passages.</p>
</sec>
<sec id="s2_7">
<label>2.7</label>
<title>Evaluation of MTM on the stability of ASFV nucleic acid</title>
<p>Cell culture supernatant, pig blood, and oral fluids containing different ASFV strains (<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>) were treated with MTM or D-PBS. Spleen swabs were collected in duplicates with sterile polyester-tipped applicator swabs (Puritan #25-806- 1PD, Puritan Medical Products, Falmouth, ME, USA) as described previously (<xref ref-type="bibr" rid="B7">Cafariello et&#xa0;al., 2024</xref>). The collected swabs were placed into 2 mL clear cryovials containing 1.25 mL of sterile D-PBS, and the excess lengths of the swabs were snapped off. The cryovials were then closed and vortexed for 10 seconds; the duplicates were pooled, vortexed briefly, and then aliquoted for treatment with either MTM or D-PBS. Treated samples were then aliquoted into separate tubes for incubation at either room temperature or 4&#xb0;C, and nucleic acid was extracted at 0, 3-, 7-, 14-, and 21-days following incubations.</p>
</sec>
<sec id="s2_8">
<label>2.8</label>
<title>Nucleic acid extraction and real time PCR for detection of ASFV genomic material</title>
<p>ASFV genomic material was extracted using MagMax&#x2122; Pathogen DNA/RNA kit (Thermofisher Scientific Cat. No. 4462359) and Kingfisher Apex purification system (Thermo Fisher). For nucleic acid extraction, 55 &#xb5;L of blood or cell culture amplified virus was used; 200 &#xb5;L of spleen swabs or oral fluids was used as per the NCFAD low cell count nucleic acid extraction protocol. Tignon ASFV real time PCR assay, which targets a highly conserved region of the ASFV p72 open reading frame was used for ASFV genome detection and quantification (<xref ref-type="bibr" rid="B34">Tignon et&#xa0;al., 2011</xref>). Beta-actin real time PCR was used as the internal control for the samples and all assays were run on Bio-Rad CFX96 Touch Real-Time PCR Detection System (Bio-Rad, Mississauga, ON, Canada), using recommended cycling conditions for TaqMan&#x2122; Fast Virus 1-Step Master Mix, up to 40 cycles. Cycle threshold (Ct) values were determined by regression analysis (CFX Maestro Software for CFX Real-Time PCR Instruments, Bio-Rad) of a positive control plasmid, and the cutoff threshold was assigned based on this value for all samples in the plate. Samples with Ct values 35.44 and below were considered positive; samples with Ct values ranging from 35.45 to 39.99 were considered suspicious, while samples with Ct values of 40 and above were considered negative.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<label>3</label>
<title>Results and discussion</title>
<sec id="s3_1">
<label>3.1</label>
<title>MTM-induced IPKM cytotoxicity can be reduced by detergent removal spin columns</title>
<p>Viability of IPKM cells after the addition of MTM treated samples was evaluated using the CyQUANT&#x2122; MTT Cell Viability Assay and visually under a light microscope. When the IPKM cells were exposed to 10-fold diluted MTM treated sample, all the cells were killed (0% viability) by 48 hours (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>). In contrast, IPKM cells exposed to 10-fold diluted, detergent purified MTM treated sample, showed ~80% viability. When samples treated with MTM were diluted 100-fold, and no detergent removal columns were used, IPKM cells showed 50% viability, but at 1,000-fold dilutions and higher, MTM was not toxic to the IPKM cells, and the cells appeared healthy and remained as an intact monolayer until the end of the experiment at 48 hours.</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>The detergent spin columns reduce cytotoxicity associated with MTM. Cell viability was assessed using the MTT assay, where cells were treated (48 hours) with varying concentrations of MTM with or without the use of detergent removal columns. Absorbance was measured at 570nm, and replicates were averaged to determine cell viability. The figure shows the percentage of viable cells relative to untreated cell controls. Error bars represent the standard deviation between replicates.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-15-1630865-g001.tif">
<alt-text content-type="machine-generated">Graph showing MTM treated IPKM cell viability via MTT assay. The y-axis represents cell viability percentage, and the x-axis shows log10 dilution. Two lines represent conditions: circles for no detergent removal and squares for with detergent removal. The latter maintains higher cell viability across dilutions, with viability peaking around 100%. Error bars indicate variability.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s3_2">
<label>3.2</label>
<title>MTM at the recommended ratio, completely inactivates ASFV within 10 minutes</title>
<p>To demonstrate that MTM at the recommended concentration (1 part sample to 3 parts of MTM, and a minimum incubation period of 60 minutes) can completely inactivate ASFV, cell culture amplified highly virulent ASFV Georgia 2007/1 was used. MTM treatment reduced the titers of ASFV Georgia 2007/1 below the limit of detection (LOD, 10<sup>1.80</sup> TCID<sub>50</sub> calculated based on improved K&#xe4;rber method) in virus titration assay, (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2A</bold>
</xref>).</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>ASFV titer reduction in cell culture supernatant following MTM treatment. Cell culture amplified ASFV Georgia 2007/1 was treated with molecular transport medium (+MTM) or PBS control (+PBS) at varying ratios for 10, 30, or 60 minutes. <bold>(A)</bold> MTM reduced ASFV titer below the limit of detection in as little as 10 minutes at a ratio of 1-part virus to 3-parts MTM. <bold>(B)</bold> The same was seen with 1 part virus to 2 parts MTM at 10, 30, and 60 minutes. <bold>(C)</bold> At 1 part virus to 1-part MTM, ASFV titer was below the limit of detection after 30 and 60 minutes, but after 10 minutes there was still live virus that was seen with viral titration. <bold>(D)</bold> Complete viral inactivation was confirmed by viral isolation over three passages, and real time PCR data showed no detectable viral genomic material at second passage with all MTM treated samples, except for 10 minutes with 1-part virus to 1-part MTM, which had similar levels of genomic material detected at each passage, indicating consistent viral growth. Significance was determined using Student&#x2019;s t-test ***<italic>p&lt;</italic> 0.001; ****<italic>p&lt;</italic> 0.0001; ND, not detected.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-15-1630865-g002.tif">
<alt-text content-type="machine-generated">Graphs A, B, and C compare virus titers in Log10 TCID&#x2085;&#x2080;/mL after contact with PBS and MTM for 10, 30, and 60 minutes at different virus-to-MTM ratios. A table (D) shows RT-PCR Ct values for passages under MTM and PBS treatments. Bars indicate significant differences in virus inactivation with MTM across all conditions.</alt-text>
</graphic>
</fig>
<p>Under field conditions, maintaining the exact sample to MTM ratio (1:3) could be challenging during sampling; therefore, we evaluated the ability of MTM to inactivate ASFV at different sample to MTM ratios (1:2 and 1:1). To determine the minimum time to inactivate ASFV at those ratios, the samples were incubated for 10-, 30-, and 60-minutes. Sample treatment with 1:3 and 1:2 sample to MTM ratios reduced virus titers to below the limit of detection in the virus titration assay within 10 min (<xref ref-type="fig" rid="f2">
<bold>Figures&#xa0;2A, B</bold>
</xref>). When MTM was added to sample at a 1:1 ratio, more than 5-log titer reduction was observed; however, live virus was present at very low levels after the 10 minutes treatment (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2C</bold>
</xref>). ASFV was isolated from those samples after the first passage on T25 flasks and the virus continued to grow in subsequent passages, indicating the inability of MTM to completely inactivate ASFV at 1:1 under 10 minutes, while conversely, no virus was isolated in samples treated with increased MTM ratios, or prolonged exposure time with MTM in any subsequent passages (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2D</bold>
</xref>). All samples treated with D-PBS had stable Ct values, and showed CPE at every passage, indicating continual viral growth in these samples.</p>
<p>Each treatment was done in duplicate and therefore virus isolation was carried out only on the samples incubated for 10 and 60 minutes to manage the resources.</p>
</sec>
<sec id="s3_3">
<label>3.3</label>
<title>MTM inactivation of ASFV is not strain- or sample type-specific</title>
<p>To determine if MTM completely inactivates ASFV strains other than ASFV Georgia 2007/1, 6 additional cell culture amplified ASFV strains were treated with MTM for 60 min. MTM treatment reduced the virus titers to undetectable levels (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3A</bold>
</xref>), indicating that MTM can inactivate not only the historic p72 genotype II ASFV Georgia 2007/1 strain, but also more recent ASFV genotype II strains such as Vietnam VNUA/rASFV/VP1/2023, Nigeria RV502, Dominican Republic DR84, and genotype IX ASFV Uganda/DA11121-36, and genotype VIII ASFV Zambia/2019-SLNP-24.</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Inactivation of different ASFV genotypes in cell culture and clinical samples. ASFV samples were treated with MTM (+MTM) or PBS control (+PBS) at 3:1 ratio for 60 minutes. <bold>(A)</bold> MTM inactivated ASFV below the limit of detection, up to 5-log titer reduction, regardless of genotype. <bold>(B)</bold> Whole blood samples from pigs experimentally infected with ASFV Georgia 2007/1 were treated with MTM, and in all cases, MTM reduced ASFV titers below the limit of detection. <bold>(C)</bold> Spleen swabs from 4 different pigs experimentally infected with ASFV Estonia 2014 were treated with MTM, and in all cases, MTM reduced ASFV titers below the limit of detection <bold>(D)</bold> To Ensure complete viral inactivation, MTM treated samples were passaged 3 times on IPKM cells, and at second and third passage, no genomic material could be detected in any samples treated with MTM, indicating complete viral inactivation. Statistical significance was determined using Student&#x2019;s t-test ****<italic>p&lt;</italic> 0.0001; ND, not detected; D.R, Dominican Republic; S.S., spleen swabs.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-15-1630865-g003.tif">
<alt-text content-type="machine-generated">Bar chats and a table displaying ASFV titers and RT-PCR Ct values for different genotypes and sample types. Charts (A, B, C) compare TCID50/ml levels of ASFV with +PBS and +MTM across different genotypes and sample types, showing significant titer reduction with +MTM treatment. The table (D) lists Ct values for ASFV strains from various sources, showing non-detectable levels with MTM and specific values with PBS across all passages.</alt-text>
</graphic>
</fig>
<p>Whole blood (EDTA) is the best clinical sample for early detection of ASF. Pigs infected with highly virulent strains develop viremia and the virus titers in the blood can reach up to 10<sup>9</sup> HAD<sub>50</sub>/mL (<xref ref-type="bibr" rid="B18">Jaing et&#xa0;al., 2017</xref>). Such a high virus titer makes it the ideal sample for ASFV genome detection but also considered extremely risky during transportation from the field to central laboratories. The ability to inactivate live virus in blood eliminates the risk of transporting samples with high titered virus. To determine if MTM can inactivate ASFV in whole blood, samples collected at the peak of viremia from three different pigs infected with highly virulent ASFV Georgia 2007/1 were treated with MTM (1-part virus to 3-part MTM) or D-PBS and subjected to virus titration and isolation. All three blood samples, when treated with MTM, showed reduced viral titers below the LOD (&gt;4-log titer reduction) compared to the D-PBS treated controls (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3B</bold>
</xref>).</p>
<p>In addition to the whole blood, the ability of MTM to inactivate ASFV in spleen swabs was also evaluated using the spleen swabs collected from four pigs that succumbed to the naturally attenuated ASFV Estonia 2014 (genotype II). Spleen swabs treated with MTM showed a titer reduction ranging from &gt;2-log to &gt;3-log (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3C</bold>
</xref>). All sample types were also passaged 3 times in IPKM cells. In all cases, no CPE was observed or genomic material detected in the cell culture amplified virus, whole blood, and spleen swab samples treated with MTM by the third passage, unlike the D-PBS treated control samples that had consistent CPE and decreasing or stable Ct values. (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3D</bold>
</xref>).</p>
</sec>
<sec id="s3_4">
<label>3.4</label>
<title>MTM stabilizes ASFV nucleic acid in clinical samples</title>
<p>The ability to transport inactivated ASFV samples to central laboratories at room temperature with no deleterious effect on ASFV nucleic acid is critical for reliable results. We assessed the ability of MTM to stabilize ASFV genomic DNA at room temperature and 4&#xb0;C. In this study, 10 cell culture amplified virus samples, 10 porcine spleen swab samples, 9 blood samples, and 8 oral fluid samples containing ASFV were tested at 0, 3, 7, 14 and 21 days after treatment. Nucleic acid was extracted at indicated time points and subjected to ASFV real time PCR. The real time PCR results from cell culture amplified virus were stable at all time points, with no significant change of Ct values during the time course. There was also no change when samples were stored at room temperature or 4&#xb0;C, with or without MTM (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4A</bold>
</xref>). The same pattern was observed with blood, with no significant change in Ct values between the samples treated with MTM or D-PBS (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4B</bold>
</xref>). Interestingly, infected blood samples treated with MTM consistently showed lower Ct values at every time point compared to their D-PBS treated counterparts; although the exact reason for this is unclear, we speculate that this could be a result of MTM lysing the infected cells in the blood prior to the lysing step during extraction, which may increase nucleic acid extraction yield.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>MTM stabilizes ASFV genomic material in multiple sample types. Cell culture supernatant containing ASFV Lillie, OURT 88, Malta 78&#x2019;, Georgia 2007/1, Nigeria RV502, ASFV-G-&#x394;MGF-DMAC or Dom. Republic DR84 <bold>(A)</bold>, whole blood containing ASFV Nigeria RV502 or Ghana Akuse <bold>(B)</bold>, spleen swabs containing ASFV Estonia 2014 <bold>(C)</bold> and oral fluid containing ASFV Malta 78&#x2019; <bold>(D)</bold> were treated with MTM (+MTM) or D-PBS (+PBS). Nucleic acid was extracted and subjected to ASFV real time PCR and the Ct values of MTM treated samples were compared to that treated with PBS. The data show MTM stabilizes ASFV genomic material in clinical samples specially in oral fluids at room temperature. Significance was determined using Student&#x2019;s t-test **<italic>p&lt;</italic> 0.01; ***<italic>p&lt;</italic> 0.001, ns, not significant.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-15-1630865-g004.tif">
<alt-text content-type="machine-generated">Graph shows CT values for ASFV at different temperatures over 21 days. Panels A-D display results for cell culture, blood, spleen swabs, and oral fluids at room temperature and 4&#xb0;C. MTM and PBS treatments are compared with statistical significance marked as ns, **, and ***. A negative threshold is indicated for oral fluids.</alt-text>
</graphic>
</fig>
<p>Spleen swabs treated with MTM did show adequate stability at both room temperature and 4&#xb0;C, however swabs treated with D-PBS were not as stable, showing up to 2 Ct values increase after 21 days at room temperature compared to the MTM treated counterparts (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4C</bold>
</xref>). Though this was not a statistically significant difference, there was a gradual loss of detectable ASFV genomic material over the time course; should we have started with a sample with a high Ct value, this could have resulted in a loss of detectable genomic material after a prolonged period. When the swabs were stored at 4&#xb0;C in D-PBS, the average Ct value change was less than 1 over the time course, indicating that there was no loss of ASFV genome integrity for real time PCR detection.</p>
<p>Oral fluids indicated significantly improved stability of samples when treated with MTM at room temperature. After 21 days at room temperature, the D-PBS samples saw an average increase of over 3 Ct values, with some values beyond the negative threshold and not detectable by real time PCR. When looking at oral fluids at 4&#xb0;C, samples treated with D-PBS were more stable compared to room temperature, but on average there was still a decrease of nearly 2 Ct values at the end of the time course (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4D</bold>
</xref>). All samples treated with MTM varied by less than 1 Ct value on average at room temperature and 4&#xb0;C. For cell amplified virus, infected blood, and spleen swabs, there was no significant difference when treated with D-PBS in both temperature conditions. The most significant increase in stability was seen with oral fluids at room temperature when treated with MTM compared to D-PBS. This could have been partly due to the unclean complex nature of oral fluid matrix compared to other simpler sample matrices used here. Swine oral fluids contain a spread of microbial diversity, some of which may produce extracellular deoxyribonucleases, thereby degrading DNA and reducing detectable levels of genomic material (<xref ref-type="bibr" rid="B33">Sumby et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B17">Hattab et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B6">Buiatte et&#xa0;al., 2024</xref>). Since MTM denatures proteins such as DNAses, and inactivates a range of infectious pathogens, it is likely inactivating most of the microbial contaminants found in the swine oral fluids, thereby inhibiting the degradation of the genomic material and increasing overall stability.</p>
</sec>
</sec>
<sec id="s4" sec-type="conclusions">
<label>4</label>
<title>Conclusions</title>
<p>In this study, we have shown that a commercially available molecular transport medium, PrimeStore&#x2122; MTM, at the recommended concentration, completely inactivates ASFV in different clinical materials and preserves the nucleic acid for subsequent detection by real time PCR. We also showed that MTM effectively inactivates ASFV, regardless of the genotype, and maintains the nucleic acid stability at ambient temperatures, especially with samples heavily contaminated with bacteria, such as oral fluids. Whole blood and oral fluid can be added to MTM at 1:3 ratio and spleen swabs can be collected in a tube containing PBS and diluted in MTM at 1:3 ratio. When using spleen swabs, there is increased assay sensitivity compared to spleen homogenates (<xref ref-type="bibr" rid="B7">Cafariello et&#xa0;al., 2024</xref>); therefore, spleen swabs can be collected during postmortems in the field, added to MTM, and shipped to the central laboratories for ASFV genome detection. The swabs can be processed immediately upon arrival for quick result turnaround time.</p>
<p>Complete inactivation of ASFV in clinical samples eliminates the risk of transporting clinical samples containing live ASFV across ASF-free areas, and the ability to ship the samples at ambient temperature eliminates the need to maintain cold chain during transportation and storage. The ability to transport and store clinical samples at ambient temperatures until laboratory testing is finalized reduces the financial constraints that come with cold chain storage. Since MTM completely inactivates ASFV, the samples can also be processed at BSL2 laboratories allowing decentralization of front-line molecular testing (real time PCR) during an ASF outbreak, decreasing the reporting time and increasing the overall laboratory testing capacity.</p>
<p>In addition to clinical samples, MTM can also be used to prepare safe and stable interlaboratory proficiency panels for molecular detection of ASF. MTM treatment will allow transport of proficiency panels at room temperature, thereby significantly reducing the shipping cost, which is one of the biggest challenges faced by countries with limited resources.</p>
<p>The main limitation of MTM treatment of clinicals samples is that the treated sample can&#x2019;t be used for virus isolation. At the beginning of an ASF incursion, virus isolation is critical for the determination of hemadsorption (HAD) phenotype and the pathotype of the virus. Therefore, MTM treatment is not ideal to use on the samples (for virus isolation) collected during surveillance or initial suspicion of an ASF incursion. However, once an ASF outbreak is declared, the use of MTM to treat the clinical samples collected at affected farms would allow safe, reliable, and low-cost transport of clinical samples from the field, further decentralizing, expanding, and streamlining ASF molecular diagnostics.</p>
<p>In this study solid tissues (lymph nodes, spleen etc.) were not evaluated since the penetration of MTM into the tissues may vary depending on the type, density and size of the tissues, however it warrants further investigation.</p>
</sec>
</body>
<back>
<sec id="s5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors upon request, without undue reservation.</p>
</sec>
<sec id="s6" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The samples used in this study were collected from animal experiments conducted under AUD C-19-012, C-21-003, C-22-001, and CC-22-008 approved by the Animal Care Committee at the Canadian Science Centre for Human and Animal Health. All animal studies were conducted under the guidelines of the Canadian Council for Animal Care.</p>
</sec>
<sec id="s7" sec-type="author-contributions">
<title>Author contributions</title>
<p>JR: Methodology, Software, Investigation, Writing &#x2013; original draft, Visualization, Data curation, Formal Analysis. CO: Investigation, Writing &#x2013; review &amp; editing, Formal Analysis, Supervision. KG: Writing &#x2013; review &amp; editing, Formal Analysis, Supervision, Investigation. AA: Project administration, Funding acquisition, Supervision, Writing &#x2013; review &amp; editing, Formal Analysis, Resources, Methodology, Conceptualization.</p>
</sec>
<sec id="s8" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research and/or publication of this article. This work was supported by the CFIA ASF supplementary funds.</p>
</sec>
<ack>
<title>Acknowledgments</title>
<p>Authors like to thank Dr. Takehiro Kokuho at the National Institute of Animal Health, National Agriculture and Food Research Organization, Japan, for sharing the immortalized porcine kidney macrophage (IPKM) cell line, and the reagent development unit at the National Centre for Foreign Animal Disease, Winnipeg for maintaining and providing the cells to conduct virus isolation and titration.</p>
</ack>
<sec id="s9" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s10" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declare that no Generative AI was used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
</sec>
<sec id="s11" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
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