THE ROLE OF MEDICINAL PLANTS ON DRUG

DEVLOPMENT : A BIOTECHNOLOGICAL
APPROACHES
DISSERTATION SUBMITTED PARTIAL FOR THE DEGREE OF
BACHELOR OF SCIENCE IN BOTANY SPECIAL PAPER DSE -4

KALIACHAK COLLEGE

DEPARTMENT OF BOTANY
B.SC. 6th SEMESTER EXAMINATION 2025

Submitted By
Tunu Chowdhury
Roll: 1821BOTH No:0073
Reg No: 181-1115-0553-21
Session: 2021-2022
THE ROLE OF MEDICINAL PLANTS ON DRUG
DEVLOPMENT : A BIOTECHNOLOGICAL
APPROACHES
 CONTENTS

Topic Page No

1. ABSTRACT 1

2. INTRODUCTION 2

3. AIMS AND OBJECTIVE 3

4. ABOUT MEDICINAL PLANTS 3

5. CHARACTERISTICS OF MEDICINAL PLANTS 4

6. ADVANTAGES & DISADVANTAGES OF MEDICINAL PLANTS 5

7. IMPORTANCE OF MEDICINAL PLANTS : - A GLOBAL VIEW 6

8. Table 1: Some medicinal plants, their parts used, therapeutic 7-9

uses and secondary metabolites
9. ROLE OF PRIMARY AND SECONDARY METABOLITES IN 10-11
MEDICINAL PLANTS
12
10. IMPORTANCE OF CHEMICAL CONSTITUENTS IN MEDICINAL
PLANTS
11. MEDICINAL PLANT – BASED DRUG DEVLOPMENT PROCESS 13-14

12. THE IMPORTANCE OF PLANTS AS A SOURCE OF NEW DRUG 15

13. BIOTECHNOLOGY AS AN ALLY TO PLANTS IN DRUG 16

DEVLOPMENT
17
14. CONCLUSION

15. REFERENCE 18-19

 ACKNOWLEDGEMENT
I convey my heartiest and sincere thanks for my respected teacher’s Miss Manisha
sarkar ,MrPrithwish Mandal and SamimAkthar for his guidance , help, advice and
support on all academic matters.
I am also thank full to MdSafiqul Islam for his consent help and completed thanks
to all my labmates for keeping joyous and friendly atmosphere in lab.
I want to mention my special thanks to Principal Dr. NazibarRahaman and others
department for their advice and support.
I am extremely grateful to my family , especially to my mother for her continuous
help and encouragement in each and everything , without which the
completeness of the experiment must not be achieved .

……………………………………………….. Tunu Chowdhury

[ signature of the condidate ] Reg.No: 181-1115-0553-21
Roll: 1821BOTH No: 0073 Session : 2021 – 2022
Department of botany
Kaliachak College University
of gourbanga, Malda .
•ABSTRACT :
In this review we discribe and discuss several approaches to selecting higher plants as condidates for drug
devlopment with the greatest possibility of success. Medicinal plants are commonly used in treating and
preventing specific ailments and diseases and are considered to play a beneficial role in health care. Despite
their importance, medicinal plants are seldom handled within an organized, regulated sector, most are still
exploited with little or no regard to the future. The paper outlines the importance and usage of medicinal
plants in health care, national conservation activities in selected countries, and in World Bank development
projects. The final section focuses on developing country strategy needs for implementing policies covering
medicinal plant conservation, cultivation, processing and marketing. Medicinal plants are viewed as a
possible bridge between sustainable economic development, affordable health care and conservation of vital
biodiversity.

Keyboards : Medicinal plants , Primary health care.

1
• INTRODUCTION:
The exploration of medicinal plants has been an integral part of human history, serving as a foundation for
traditional healing practices across cultures and civilizations. With the increasing recognition of the
importance of biodiversity and the potential of natural products, medicinal plants have garnered significant
attention in modern pharmacology and drug development. These plants are not only a source of inspiration
for novel therapeutic agents but also provide a rich repository of bioactive compounds that have been utilized
for centuries to treat various ailments.

In recent years, there has been a resurgence of interest in phytochemistry and ethnobotany, driven
by the need for new drugs to combat emerging health challenges, including antibiotic resistance and chronic
diseases. The intricate relationship between humans and plants has led to the discovery of numerous
pharmacologically active compounds, many of which have been isolated and developed into effective
pharmaceuticals. This symbiotic relationship underscores the importance of preserving traditional
knowledge and biodiversity, as well as the need for sustainable practices in harvesting and utilizing these
natural resources.
Nature is always a golden sign to show the major occurrences of cohabitation. Natural goods derived
from plants, animals, and minerals serve as the foundation for treating human ailments (JamshidiKia et al.,
2018). Throughout the ages, humans have relied on nature for basic needs such as medicines, housing,
nourishment, fragrances, clothes, flavours, fertilizers, and modes of transportation (Dar et al., 2017). Humans
are becoming increasingly prone to sicknesses and diseases as a result of climate change and impoverished
human lifestyles. High temperatures, humidity, and other environmental conditions enhance microorganism
development and smash the symbiotic interaction between hosts and microorganisms, resulting in a rise in
infectious illnesses such as influenza, tuberculosis, meningitis, endocarditis, and others (Ahmad 2021).
Resistance to microorganisms desires the formation of a new antibiotic composition, necessitating more
expansive research and taking time.

People are getting increasingly interested in ethnopharmacology as synthetic therapies Become more
harmful and antibiotic resistance increases. Medicinal plants have been Employed in traditional healthcare
systems since prehistoric times and are currently the Primary source of treatment for the great majority of
the world’s population (Uprety et Al., 2012). A variety of phytocompounds derived from medicinal plants are
healthier And pose little or no risk. Phytomedicines are secondary bioactive plant metabolites (Faridi Et al.,
2012). These phytocompounds function as phytomedicines. Plant fragments or Entire Plants, as well as
isolated active metabolites, can be utilized to create pharmaceuticals (both Whole and different parts of the
plant, and plant-derived bioactivemetabolites can be Used to make medications). Millions of people
worldwide rely on medicinal plants for basic Health care, revenue generation, and livelihood Enhancement
(Ranilla et al., 2010). According to WHO research, more than 80% of the World’s population is reliant on
prescription Pharmaceuticals, creating a significant social burden in terms of health care (WHO, 2013).

Ok

2
• AIMS AND OBJECTIVE :
★The primary aim of research on medicinal plants invokes understanding their potential as souneres
of new drug and traditional remedies, exppo.ning their therapeutic effice and ensuring sustainable
consenvation and utilizations .
The main objectives of studies on medicinal Plants offen include identifying and documenting
traditional uses, promoting Conservation and subtainable cultivation.

• ABOUT MEDICINAL PLANTS :

*Medicinal plants refer to using a plant’s seed berries, rots, leaves, bark or flowers for medicinal
purposes.
*Medicinal plants are plants that have a recognized medical use.
*Their use ranges the production of mainstream pharmaceutical products to herbal medicine
preparations.

*Herbal medicine is one of the oldest forms of medical treatment in human history and could be
considered one of the forerunners of modern pharmaceutical trade.

* Example :Tulsi, Alove-vera, Mint, Basil , etc.

3
• CHARACTERISTICS OF MEDICINAL PLANTS :
Medicinal plants have many characteristic when used as a treatment, as follow: -

❖ Synergic medicine – The ingredients of plants all interact simultaneously, so thair uses can
complement or damage others or neutralize their possible negetive effects.
❖ Global Importance – Medicinal plants are used worldwide , either as standalone remedies or as part
of traditional medicine.
❖ Source of new drug – medicinal plants are a significant source of new drug discovery, as they offer
a vast pool of compounds with therapeutic potential.
❖ Bioactive Compounds – Medicinal plants are rice in bioactive Compounds. Including phytochemicals
and secondary metabolites.

4
•ADVANTAGES OF MEDICINAL PLANTS :
Medicinal plants have numerous advantages including –

1] Medicinal plants offer a natural and holistic approach to healthcare, with many plants having been used
for centuries in traditional medicine.
2] Medicinal plants can be cost-effective alternative to conventional medicine, especially for people in rural
or resource-poor areas.

3] Many medicinal plants are readily available and can be grown locally, making them accessible to people in
remote areas.
4] Medicinal plants can be used in conjunction with conventional medicine to enhance treatment outcomes
and improve overall health .

5] Medicinal plants offer a rice source of new compounds and potential treatment for various diseases.

These advantage highlight the importance of medicinal plants in healthcare and their
potential to improve human well-being.

• DISADVANTAGES OF MEDICINAL PLANTS :-

Medicinal plants can have several disadvantages, including-
1] Some Medicinal plants can be toxic or cause adverse reactions if not used properly.
2] Medicinal plants can interact with prescription medications, leading to unwanted side effect.

3] Some people may be allergic to certain medicinal plants which can cause allergic reactions.

4] Medicinal plants can be contaminated with heavy metals, pesticides, or other pollutants.

5
•IMPORTANCE OF MEDICINAL PLANTS :- A GLOBAL VIEW
Medicinal Plants continue to be a critical element of human healthcare systems in many parts of the world
with about 80 % of the world's population depending solely on traditional remedies for health care.

Medical science has expanded its efficiency and global diffusion during the previous century. Life expectancy
is growing, whereas dying without treatment is falling (Ahmad et al., 2021). Several new lifesaving drugs have
been found to aid us in the battle against many communicable and other sorts of diseases, and technological
advancements have broadened the scope of modern-day science (Tamang et al., 2017). Medicinal plants are
utilized in the household by women caring for their families, in the village by medicine men or tribal shamans,
and by practitioners of classical, traditional systems of Medicine such as Ayurveda, Chinese Medicine, or the
Japanese Kampo system. The World Health Organization (WHO) estimates that over 80% of the world's
population,or 4.3 billion people, rely on traditional plant-based systems of Medicine for basic health care
(Ahn, 2017). Allopathic Medicine owes a great deal tomedicinal plants; one out of every four prescriptions
issued in a country like the United States is either manufactured or derived from plant ingredients. In an
International Conference in 1978 known as the 'Declaration of Alma-Ata,' WHO underlined the need to
achieve the aim of 'Health for All' in a step-by-step manner by addressing poor sanitation, illiteracy, and
poverty. In 1998, WHO adopted a new global health strategy, "Health for All in the 21st Century," with the
goal of achieving health equity, enhanced healthy life expectancy, and health security, as well as ensuring
universal access to basic quality healthcare (Cheema & Singh, 2021). Despite its many accomplishments and
expansion, advanced medical research is finding it difficult to reach everyone. Nonetheless, most of the
world's population, primarily in underdeveloped and developing countries, lacks access to innovative
healthcare treatments and relies on traditional medical systems. Several of these practices are substantially
older than the allopathic media medical-wise healthcare system (Sen &Chakraborty, 2017).

Figure 1. A planetary health perspective of natural medicinal resources ( credit .. Prof

David Nogues-Bravo PhD )

6
 Table 1: Some medicinal plants, their parts used, therapeutic uses and secondary metabolites
.no Plant name Common Family Parts uses Chemical Secondary Therapeutic Reference
name constituents metabolites uses

Saraca asoca Ashoka Fabaceae Bark and Glycosides, Saponins, ternal Ahmad and
1 leaves Flavonoids, flavonoids bleeding,anti Ghosh, 2022
Tannins and inflammator
Saponin y treatment
for arthritis,
haemorrhoid
s, infertility,
insomnia
Withania Ashwagan Solanaceae Root, flower Sitoindosides Methanol , Hypertensio SalmerónMa
2 and
somnifera dha nHexane n, asthma, nzano et al.,
Withaferin A diabetes, 2020
arthritis, and
uterine
sedative
Emblica Amla Phyllanthaceae Fruit Gallic acid, Polyphenols Antioxidant, Ahn, 2017
3 Officinalis Ascorbic acid, and flavonoids immune-
Ellagic acid, modulatory,
Rutin, antipyretic,
Quercetin, analgesic,
and Catecho cytoprotectiv
e, anti-ulcer
Aegle Bael Rutaceae Fruits, bark, Coumarin, 5- Antidiabetic, Ahmad and
4 marmelos leaves, Xanthotoxol, acetoxytridec anticancerou Tamang,
seeds, and Imperatorin, ane s, 2020
roots Aegeline, and antifertility,
Marmeline
5 Bacopa Brahmi Scrophulariaceae Leaves and Alkaloid Bacoside, Memory Cheema and
monnieri stems brahmine, bacopaside enhancing, Singh, 2021
nicotine, N2, luteolin, anticancer,
herpestine, cucurbitacins, anti-
bacosides A apigenin Parkinsonian
and B ,
Plantago Isabgol Plantaginaceae Seed husk Flavonoids, Flavonoids, Constipation, Adekunle,
6 ovate and leaves alkaloids, alkaloids, and diarrhoea, and
terpenoids, terpenoids haemorrhoid Adekunle,
phenolic acid s, and high 2009
derivatives blood
pressure.
Nardostachys Jatamansi Caprifoliaceae Roots and Sesquiterpen Terpenoids Epilepsy, Aniszewski,
7 jatamansi the es and mainly, hysteria, 2007
Rhizomes coumarins Sesquiterpen syncope,
es convulsions,
and mental
weakness
Andropgraphi Kalmegh Acanthaceae Fresh and Diterpenoids, Andrographid Common Cai et al.,
8 s paniculata dried leaves flavonoids, ine A, 5- cold, 2014
and hydroxy- diarrhoea,
polyphenols 7,8,2',5'- fever,
tetramethoxy jaundice
Chlorophytu Safed Liliaceae Root 25 alkaloids, Stigmasterol Aphrodisiac Ahmad et al.,
9 m vitamins,
Musli and hecogenin agent and 2014a
borivilianum proteins, revitalize
carbohydrate
s,

7
 Artemisia Sweet Asteraceae Leaves Protein, Phenolic Jaundice, Ahmad, and
10 annua wormwoo carbohydrate, compounds, bacterial Tamang,
d fibre, terpenoids, dysentery, 2020
alkaloids,
Perilla Beefsteak Lamiaceae Leaf, stem, Apigenin, Terpenes, Depression, Ahmad et
11 frutescens ascorbic-acid, anxiety,
beta- asthma, ches
Hygrophila Indian Acanthaceae Whole plant Steroids, Antibiotic Hypertensio Odugbemi
12 auriculata paint Alkaloids n, asthma,
(2006)
brush diabetes,

Figure 2:Tulsi Plants Figure 3: Neem Plants

Figure 4: Bael Tree Figure 5: Aloe Vera

8
Figure 6: Onion Figure 7: Arjun Tree

Figure 8: Papaya Tree

Figure 9:Akanda Figure 10: Nayantara

9
Figure 11: Wild Mint Plants

➢ All the above

medicinal plants
image were taken
from
https://stock.adobe.com/in/search?k=plants and all credit goes to
https://stock.adobe.com/in/search?k=plants .
 • ROLE OF PRIMARY AND SECONDARY METABOLITES IN MEDICINAL PLANTS :
Metabolism refers to the entire quantity of metabolic events involved in keeping cells alive in an
oraganism. All living creatures require energy for several critical functions as well the production of new
organic molecules (Ahmed et al, 2014b). Secondary metabolites are formed primary during diverse stress
conditions, resulting in a diverse spectrun of components that are not found in all species . Primary
metabolism results in the creation of carbohydrates, proteins, lipids , and nucleic acids as primary compounds
(Cai et al.,2014) .

• PRIMARY METABOLITES :

Primary metabolites are essential organic compounds produced during the growth and development
of oraganism . They play crucial roles in fundamental biological processes..

• IMPORTANTS :
Primary Metabolites are organic compounds that are directly involved in the growth, development,
and reproduction of an organism. They are essential for basic cellular functions and include key biomolecules
such as carbohydrates, amino acids, lipids, and nucleotides. These metabolites play critical roles in energy
production, biosynthesis, and metabolic pathways, making them fundamental to the survival and
maintenance of life. Unlike secondary metabolites, which often have ecological or protective functions,
primary metabolites are universally necessary for the basic physiological processes of all living organisms.

• SECONDARY METABOLITES: Secondary metabolites are organic compounds that are not
directly involved in the normal growth, development, or reproduction of organisms. Instead, they play
important roles in ecological interactions and have various functions that can be broadly categorized as
follows:

1. Defense Mechanisms: Many secondary metabolites serve as chemical defenses against

herbivores, pathogens, and competitors. For example, alkaloids, terpenoids, and phenolic compounds can
deter feeding or inhibit the growth of microorganisms.

2. Attraction of Pollinators and Seed Dispersers: Certain secondary metabolites contribute to the
color, scent, and taste of flowers and fruits, thereby attracting pollinators and animals that help in seed
dispersal. For instance, flavonoids can influence flower color and fragrance.

3. Allelopathy: Some plants release secondary metabolites into the soil that inhibit the growth
of nearby competing plants. This phenomenon is known as allelopathy and helps the producing plant gain a
competitive advantage.

4. Symbiotic Relationships: Secondary metabolites can facilitate symbiotic relationships between

plants and other organisms. For example, certain compounds may attract beneficial microbes or insects that
aid in nutrient acquisition or protection.

5. Stress Response: Secondary metabolites can play a role in helping plants cope with abiotic
stresses such as UV radiation, drought, and salinity. They may act as antioxidants or help stabilize cellular

11
10
structures under stress conditions. Overall, secondary metabolites are crucial for the survival of many
organisms and play significant roles in ecological interactions, human health, and agriculture.

Figure 12: Examination of primary & secondary metabolites . ( Credit Miray Simsek 1)
 IMPORTANCE OF CHEMICAL CONSTITUENTS IN MEDICINAL PLANTS :
Medicinal plants have a wide range of medicinal properties, such as anti-inflammatory, antibacterial,
and antifungal properties, and therefore have a significant impact on human health. The significance
of medicinal plants is due to the presence of specific compounds that cause physiological responses
in the human body (Ahmed and Asma, 2022). These phytochemicals are found in the plant kingdom
and play various physiological and ecological roles. The primary function of these bioactive secondary
metabolites in plants is to aid them in dealing with a variety of abiotic and biotic challenges, such as
chemical defence against pathogens, predators, diseases, and allopathic agents (Naikoo et al., 2019).
Secondary metabolites are the medicinally significant active compounds found in medicinal plants.
They are very tiny chemical compounds with widespread distribution in the plant kingdom. However,
their purpose in plant life is unknown in most cases (Salmerón-Manzano et al., 2020). Oxidation,
reductions, substitutions, and condensation processes are the primary chemical events involved in
the production of these metabolites in medicinal plants. Medicinal plants generate and accumulate
a wide range of phytochemicals, including phenolic compounds, flavonoids, alkaloids, tannins, and
terpenes, which are then used therapeutically or as precursors in the manufacture of effective
medications (Okwu & Omodamiro, 2005). There is a wide range of biologically active chemical
compounds that have a specific physiological activity in the human body.

Figure 13: Multiplayered regulation of secondary metabolism in Medicinal plants .( Credit By Charlie Dubbe,)
 • MEDICINAL PLANT – BASED DRUG DEVLOPMENT PROCESS:
Medicinal plants play a significant role in drug devlopment due to their bioactive Compounds,
which have therapeutic properties. Here’s an overview of the process.

Figure 14: ( credit Parthasarathi

• PHASE 1 =

➢ Phase 1 are carried out in a small number of healthy volunteers 20 to 100.

➢ The purpose of phase 1 is to identify metabolic and pharmacokinetics and pharmacological

effect of the drug in human and side effect associated with increasing doses.

• PHASE 2 =

➢ Phase 2 clinical trials conducted to obtain some prelimir data on the effectiveness (efficacy)
of the potential drug to treat disease or conditions.

➢ Duration of this phase range from several months to 2 years.

• PHASE 3 =

➢ Phase 3 are expanded, controlled and uncontrolled trials.

➢ The purpose of this study is to gather information about the effectiveness and monitoring
of adverse reaction.

13
14
 • PHASE 4 =

➢ It is also known as post marketing surveillance (PMS) .

• REGULATORY APPROVAL :

A) IND :

➢ Once the candidate drug is tested in animals ( preclinical testing), a sponsor files
IND with the regulatory authorities for testing it in humans.

B) NDA :
➢ NDA applications is the medium through which the new drug
sponsors regulatory authority to approve this drug for sale and marketing in the country of approval .

Figure 15: Drug Development Process

THE IMPORTANCE OF PLANTS AS A SOURCE OF NEW DRUG:

Herbal medicine is widely practiced in worldwide. For centuries, people have turned
to natural remedies to cure common ailments such as colds, allergy, upset stomachs and
toothaches and the trend is constantly increasing. Thus, there has been a shift in universal
trend from synthetic to herbal medicines, which we can say 'Return to Nature' for the
prevention of diseases and ailments. Nature has been a source of medicinal plants. The
World Health Organization (WHO) reported that 4 billion people (80% of the world's
population) use herbal medicines for some aspect of primary healthcare .Herbal medicine
has been recognized by WHO as essential components for primary health care and about
11% of the 252 drugs are derived from plants .

Since time immemorial, human civilization has been used several plants as food,
medicine, clothing and shelter. Vegetarian foods contain high amounts of various
"supernutrients," such as protective antioxidants, phytochemicals, micronutrients, which
promote health and protect from diseases. Plants have several pharmacological roles such
as antioxidant, antiviral, anticancer, antimicrobial, antifungal and antiparasitic. Plants have
several pharmacological roles such as antioxidant, antiviral, anticancer, antimicrobial,
antifungal and antiparasitic. Plants have free radical scavenging molecules, including
flavonoids, phynolics, anthocynins and vitamins, which show antioxidant like activity . It has
been reported that the antioxidant property of phytochemicals may be mitigated the
oxidative stress in the biological system. Phytochemicals have been reduced the risk of
many human diseases include cardiovascular disease, hepato-renal diseases, diabetes,
cancers and neurodegenerative disorders. However, several herbal medicines are being
derived directly or indirectly from plants that are considered as an important medicine
currently in use for curing various human disease.

16
• BIOTECHNOLOGY AS AN ALLY TO PLANTS IN DRUG DEVLOPMENT :

But for these metabolites to be selected as potential candidates to new drugs, they need to go through a few
steps to attest their potential. Essential oils and extracts from plants contain high amounts of phytochemicals
with similar biological activities. High Performance Liquid Chromatography associated to Mass
Spectrophotometry are good ways to identify compounds of interest and also molecules chemically similar,
providing a wider Range of lead compounds for further testing (Lahlou, 2007). It is also necessary to study
interactions to a molecular level. Biotechnology offers a range of viable options to that, when it comes to
techniques, to assist drug devlopment. Systems biology and computational modeling have been helping
research and development in the pharmaceutical sciences. Both tools, with the assist of proteomics,
genomics and metabolomics, lead to a better understanding of not only the metabolic pathways of plants
when it comes to phytochemicals production but also of disease’s development stages, making it possible to
design drugs that are effective and also act before more areas of the patient’s body are compromised
(Butcher et al., 2004). For example, if a certain type of cancer has its stages well characterized, it would be
easier to combat it before it causes damage to adjacent tissues or a surgical intervention is necessary.

There are also challenges on obtaining plant feedstock to large scale phytochemicals production,
mainly because of two factors: finding the right maturation stage of the plant and hormonal responses
to environmental factors. Both of them can interfere on the production of the secondary metabolites.
Besides that, there’s also the problem of certain species aren’t available globally or in extinction (De La
Parra and Quave, 2017). Thinking of that, a viable solution to these problems is tissue and cell culture
in bioreactors, aiming large scale production of metabolites. Different combinations of different
concentrations of nutrients and phytohormones have been tested to stimulate production of phytochemicals
and also increase yield. In addition to that, it is also important to choose the most fitting type of
bioreactor to optimize production (Weathers et al., 2009). Another biotechnological proposal to optimize
phytochemicals production is genet editing using CRISPR/Cas technology. This technique has been used
to insert genes of interest in plants in vivo, using essentially two components: Cas 9 enzyme and DNA
molecules (Belhaj et al., 2013). This technology can help increasing even more production of vegetable
biomass .
CONCLUSION :-

Efforts must be geared towards measures that will enhance the effectiveness, efficacy
and rational use of medicinical Plants, especially through the integration into national,
regional and local health policies and programmes. Most African countries, for example, hinge
their health care system on the Primary Health Care (PHC) strategy and it is necessary to
incorporate the use of medicinal plants into all the components of PHC in these countries.
The following are also recommended: a) Collation of data from books, research articles,
conducting of ethnobotanical surveys (because Africans have only recently started
documentation of medicinal plants and their uses; oral tradition had been the mainstay)
specifically to look for plants used in preventing diseases in our communities as was done in
Muktipara village of Sri Lanka. Databaseb searches on medicinal plants will also yield useful
results (Table 1); b) collaborative research with Institutes for preventive medicine as well as
departments of preventive dentistry in teaching hospitals; and c) coordination of the research
to avoid duplication of efforts.

18 17
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