Browsing by Autor "Teddy Quispe"

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Andean Aymara Enriched Genetic Variants Are Beneficial to High Altitude Adaptation of Andean Quechuas Living at 5000 m
(Elsevier BV, 2022) Ricardo Amaru; Emerson Cayo; Julieta Luna; Teddy Quispe; Josef T. Prchal; Jihyun Song
Populations living at high altitude developed distinct evolutionary genetic adaptations allowing them to exist in extreme hypobaric hypoxia condition. Tibetans and Andean highlanders (Aymaras and Quechuas) have inhabited regions over ~4000 m for 44,000 and 14,000 years, respectively (PMID: 28448578, 25342802). Unlike other high-altitude populations, such as Tibetans, Andeans' Aymaras and Quechuas have higher hemoglobin levels. Tibetan genomic analyses revealed evolutionary selected genetic signatures EPAS1, EGLN1 and PKLR genes (PMID:25129147; Song, ASH 2018). However non-DenisovanEPAS1 variants (rs13005507 and rs142764723) are present in Aymaras and Quechuas, and ~56% of Aymaras have Tibetan PKLR variants (Song, ASH 2018). Our whole genome study found that most Aymara evolutionary-enriched genes (BRNIP3, NOS2, SH2B1, and TBX5) are associated with cardiopulmonary development but not with hemoglobin levels (PMID: 29100088); different genomic selection was reported in Andean Quechuas (PMID:23954164). We then found previously unreported Aymara enriched NFKB1 single nucleotide polymorphisms (SNP) by integrative analysis of the Aymaras' genome and transcriptome, this SNP is also enriched in Quechuas but to the lesser degree. Decreased NFKB1 results in increased NF-kB levels leading to NF-kB driven increased inflammation as well as increased HIFs activity (PMID: 26513405) and is associated with high hemoglobin and inflammatory protein and transcript levels in Aymaras (Song, ASH 2018). We studied the presence of Aymara enriched SNPs in Quechua, one of Andean population living in Chorolque (5000 m) and their association with phenotypes at high altitude. We genotyped 5 Aymara enriched SNPs and PKLR (Table) in Quechuas (45 men, 14 women) living in Chorolque (5000 m) mining district, Potosi-Bolivia. All men were smokers while none of women were smokers. We also measured laboratory phenotypes leukocytes, platelets, lymphocytes, monocytes, neutrophils, as well as hemoglobin dissociation p50, SpO2, lactose, hemoglobin and hematocrit to study if genetic variants play a role in changes in these phenotypes. All Aymara enriched allele frequencies in Quechuas were lower than in Aymaras (Table). The allele frequencies of BRINP3, SH2B1, TBX5 in Quechuas were significantly different from those in Aymara, suggesting that Quechuas share some but not all genetic background with Aymaras. Since all men were smokers, we tested smoking effect on these phenotypes. Except hemoglobin and hematocrit levels, other phenotypes were comparable to women without smoking history. BRINP3 SNP positively correlated with SpO2 levels (r=0.2252, p=0.0893), suggesting that this SNP may have a role in delivery oxygen to tissue. PKLR SNP is associated with decreased levels of pyruvate kinase transcript levels, leading to increase 2,3 DPG and shifting hemoglobin dissociation curve to the right (increase of p50) (Song, ASH 2018). However, in these subjects, we did not find association in p50 but positive correlation with SpO2 (r=0.3423, p=0.0082). It suggests that presence of BRINP3 and PKLR SNPs is beneficial to live at low oxygen tension by delivering more oxygen to tissues. Total leukocytes, lymphocytes, and neutrophils were negatively correlated with NFKB1 SNP (r=-0.2349, r=-0.281, and r=-0.1725, respectively) which differed from our previous study of Aymaras at La Paz, suggesting that Quechuas may have different mechanisms in responding to inflammation from Aymaras. None of SNPs were associated with hematocrit and hemoglobin levels in men; however, we could not exclude effect of smoking. In females, NOS2 SNP were positively correlated with both hemoglobin and hematocrit (r=0.5513, p=0.0246). NO (nitric oxide) synthesized by NOS2 inhibits erythropoiesis (PMID: 18282521), suggesting that NOS2 SNP may decrease NO production resulting in inducing erythropoiesis in Quechuas. We conclude that while Quechuas and Aymaras share some genetic variants, but they differ in degree of selection for these SNPs. BRINP3 and PKLR SNPs are helpful to transfer more oxygen to tissues at high altitude. NFKB1 SNPs` inverse correlation with immune cells may provide protective functions in response to increased inflammation at high altitude (PMID: 26855492). Decreased NO production by NOS2 SNP may augment erythropoiesis in Quechuas, resulting in their higher hemoglobin and hematocrit at high altitude compared to Europeans. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal
Atorvastan, Apsirin and Hydorxyurea for an Effective and Low-Cost Treatment in High-Risk Polycythemia Vera
(European Medical Journal, 2022) Ricardo Amaru; Mireya Carrasco; Victor R. Gordeuk; Teddy Quispe; Silvia Mancilla; Daniela Patón; Ariel Amaru
Introduction: Polycythemia vera (PV) treatment focuses on preventing thrombotic events and delaying transformation to myelofibrosis or leukaemia. According to risk stratification, low-risk patients require therapeutic phlebotomy combined with acetylsalicylic acid, whilst the treatment of high-risk patients with PV relies on cytoreductive therapies, employing hydroxyurea (HU), ruxolitinib, or interferons. However, in low- and middle-income countries, the availability and cost of these drugs poses a challenge in treating high-risk patients, so optimising existing resources is required. Method: A prospective longitudinal study aimed to investigate the combination of atorvastatin (ATV), aspirin, and low-dose HU as a therapeutic strategy to treat PV in high-risk patients. The study evaluated the effect of statins on erythroid colony proliferation in vitro, as well as the applicability of ATV (20 mg/day), acetylsalicylic acid (100 mg/day), and hydroxiurea (500 mg/day) in high-risk patients with PV from La Paz, Bolivia, residing at 3,600 metres above sea level. Results: Simvastatin (3.5 μm) inhibited UKE-1 cell (JAK2V617F mutated) proliferation at 33%, and burstforming unit-erythroid colonies from patients with PV at 61%. Patients receiving ATV, aspirin, and low-dose HU displayed a good response and adequate tolerance to treatment (13-years follow-up). No patients experienced myelofibrosis or transformation to leukaemia, and no severe adverse events were observed. Conclusions: This accessible, effective, and low-cost therapeutic strategy could improve adherence to treatment and the overall survival of high-risk patients with PV in resource-limited countries.
Erythroid and Cardiovascular High Altitude-Selected Haplotypes in Andean Aymaras and Tibetans
(Elsevier BV, 2017) Ricardo Amaru; Jihyun Song; N. Scott Reading; Victor R. Gordeuk; Teddy Quispe; Lorna G. Moore; Rasmus Nielsen; Josef T. Prchal
Abstract Humans migrating out of Africa encountered new conditions, including living at high altitude. Tibetans and Andean Aymaras have inhabited regions of 4,000 meters or more for ~44,000 and 14,000 years respectively (Hu et al, PLoS Genet 2017, Rademaker et al, Science 2014). There is a distinct difference in erythroid phenotypes: Aymaras are polycythemic at high altitude, while most Tibetans are not. Mutations providing an advantage in highlanders will improve fitness under hypoxic conditions,including modulation of erythropoiesis through the hypoxia-inducible factor (HIF) pathway. There are few shared, naturally-selected gene regions in Aymaras and Tibetans and these have different phenotypic associations (Bigham et al, Am J Hum Biol 2013). Aymara high-altitude selected haplotypes have not been published. Tibetan EPAS 1 (encoding HIF2a protein) haplotypes in part originated from ancient Denisovans and entered the Tibetan genome through introgression (Huerta-Sanchez et al, Nature 2014). Tibetan variant prolyl hydroxylase 2 (PHD2), a negative regulator of HIFs encoded by EGLN1 gene, encodes in cis both PHD2D4E and PHD2C127S which together have increased activity in hypoxia (Lorenzo et al, Nature Genetics 2014) and, together with a Tibetan EPAS 1 haplotype, protects from high altitude polycythemia (Tashi et al, JMM 2017). We and others previously identified other Tibetans haplotypes that are not unique but are enriched in Tibetans, including a “Tibetan” haplotype of PKLR encoding liver- and red cell-specific pyruvate kinase (PK) (Simonson et al, Science 2010, and Yi et al, Science 2010). We studied Tibetan-enriched haplotypes of EGLN1, EPAS1 and PKLR in 72 Bolivian Andean Aymaras, all residing at 4,000 m, and compared them with 347 Tibetans living at altitudes of 200 m and 4,300 m (Table). We genotyped PHD2D4E and PHD2C127S variants of EGLN1 and 10 Tibetan specific single nucleotide polymorphisms (SNPs) of EPAS1, 5 Denisovan and 5 non-Denisovan, each under different linkage disequilibrium (Hu et all, PLoS Genet 2017), 7 Tibetan enriched PKLR SNPs, and searched for Aymara selected variants by whole genome sequencing. The prevalence of the Tibetan-selected EGLN1 and EPAS1 haplotypes increased with increasing altitude of residence in Tibetans, suggesting a continuous evolutionary advantage (Tashi et al, JMM 2017). Aymaras did not have the PHD2D4E haplotype, and PHD2C127S was found at lower prevalence in heterozygote form. Aymaras shared two of five non-Denisovan EPAS1 SNPs selected in Tibetans; one, rs130005507 G allele, had a similar prevalence to Tibetans, but another, rs142764723 C allele, had a lower prevalence. We report that >90% of Tibetans and ~50% of Aymaras, but only ~10% of Europeans, have the “Tibetan ” PKLR haplotype. Aymara females with homozygous PKLR haplotypes have lower hemoglobins than heterozygotes (p=0.022). Further, the PKLR transcript in reticulocytes decreases with increasing altitude and this progressive decrease is even more pronounced in the “Tibetan” haplotype. We found Aymaras' selected haplotypes encoding BRINP3, NOS2, TBX5 ; these genes are associated with cardiovascular development and function but not hypoxia sensing. They are not enriched in Tibetans. We conclude that Aymara highlanders do not have the Tibetan PHD2D4E mutation or Denisovan-like EPAS1 variants. Furthermore, they share only two of five Tibetan non- Denisovan EPAS1 variants. The absence of these variants in Aymaras supports that Tibetan and Aymara high altitude inhabitants do not have the same ancestry, that they developed different evolutionary adaptations (Bigham et al, Am J Hum Biol 2013), and that Tibetans' EGLN1 and EPAS1 mutations are unique to that part of the world. We hypothesize that decreased PK enzyme activity would be expected to increase 2,3-diphosphoglycerate (2,3-DPG) (as is shown in people with PK enzyme deficiency) and thus be beneficial to high altitude adaptation by progressively augmenting tissue oxygen delivery with increasing altitude. Based on its association with lower hemoglobin in Aymara females, the selected “Tibetan” PKLR haplotype, present in about half of Aymaras, may contribute to their hypoxic adaptation. Additional evaluation of evolutionary selected genes including PKLR, BRINP3, NOS 2, and TBX5 and their functional consequences are in progress with Aymaras living at El Alto (4,150 m), Cochabamba (2,500 m) and Santa Cruz, (416m), Bolivia. Download : Download high-res image (320KB) Download : Download full-size image Disclosures No relevant conflicts of interest to declare.
FILTRO DE AGUA EN LA PREPARACIÓN DE QUIMIOTERAPIA PARA OPTIMIZAR LA BIOSEGURIDAD
(2016) Jeaneth Velarde; Reyna Mamani; Nelly Guarachi; Teddy Quispe; Ricardo Amaru; Heriberto Cuevas
HIPERTENSIÓN ARTERIAL PULMONAR EN PACIENTES CON ERITROCITOSIS PATOLÓGICAS
(2019) Ricardo Amaru; Oscar Vera; Felix Loza; Daniela Patón; Mireya Carrasco; Teddy Quispe
History of Thrombosis at High Altitude Associates With Increased Erythropoietin
(Wiley, 2025) Ricardo Amaru; Josef T. Prchal; Mireya Carrasco; Silvia Mancilla; Teddy Quispe; Julieta Luna; Juan Carlos Valencia; Daniela Patón; Victor R. Gordeuk
In Bolivian Aymara with erythrocytosis, elevated erythropoietin strongly associates with history of thrombosis. Hypoxia and iron deficiency predict elevated erythropoietin, but they do not have a direct relationship with thrombosis history. Source: Artwork by Nadia Gordeuk.
Mayor prevalencia de leucemia eritroide aguda en residentes de gran altitud (4000 m)
(2025) Ricardo Amaru; LF Mamani; Julieta Luna; Teddy Quispe; Javier Valencia; Mireya Carrasco; Daniela Patón; Silvia Mancilla; Aléxia Rodriguez Amaru
Introducción: La leucemia eritroide aguda (LEA) es un subtipo raro y agresivo de leucemia mieloide aguda, asociada a mutaciones bialélicas del gen TP53. La edad media de diagnóstico es 67 años conllevando una proporción hombre:mujer de 2,4:1. La hipoxia y los factores inducibles por hipoxia (HIF) parecen desempeñar un rol en el desarrollo de LEA mediante mecanismos que involucran la diferenciación eritroide, producción de hemoglobina, regulación de eritropoyesis y modificación del microambiente de la médula ósea. Por lo que, para discernir sobre la influencia de la hipoxia en este subtipo de leucemia, es de interés analizar su prevalencia y características en poblaciones residentes a gran altitud. Material y Métodos. Estudio retrospectivo que consideró casos de LMA (n=211) diagnosticados en Bolivia durante el periodo de mayo de 2019 a octubre de 2024, se identificó casos del subtipo LEA (n=15) y se recopiló datos demográficos, hematológicos, morfológicos e inmunofenotípicos. El análisis estadístico contempló categorizar los casos de LMA y subsecuentemente de LEA según la altitud de presentación: 4000m, 2000m y 400m. Resultados. Los casos de LEA en Bolivia correspondieron al 7,5 % entre todos los casos de LMA, la edad media de presentación fue 53 años con predominio en varones (1,5:1). Distribuidos por altitudes, los casos de LEA a 4000 m (n=10) representaron el 14,1 %, significativamente mayor (p=0,01) comparado con el 4,5 % observado en los casos a 2000 m (n=3) y 2,7 % en los casos a 400 m (n=2). Los índices hematológicos de LEA reflejaron hemoglobina media de 7,3 g/dl, leucocitos 10266/ul y plaquetas 82267/ul, sin diferencias epresentativas entre las diferentes altitudes. Los rasgos de médula ósea reflejaron >80% de precursores eritroides prominentes con núcleos grandes e irregulares, cromatina dispersa, 1 a 3 nucléolos alargados, citoplasma profundamente basófilo e intensa actividad mitótica. Las características inmunofenotípicas mostraron clonalidad eritroide 90 % (CD34, CD71, CD105, CD36, CD235) y clonalidad mieloide 1,4 % (CD117, CD34). Conclusiones. El porcentaje de LEA (14,1 %), respecto del total de casos de LMA, está aumentada en la altitud (4000 m). Tal aumento podría deberse al incremento de HIF y Eritropoyetina en ambientes de hipoxia hipobárica.
Novel Form of Alternative Splicing of NFKB1. Its Role in Polycythemia and Adaptation to High Altitude in Andean Aymara
(Elsevier BV, 2018) Jihyun Song; Seonggyun Han; Ricardo Amaru; Teddy Quispe; Dongwook Kim; Jacob E. Crawford; Josef Stehlik; Rasmus Nielsen; Younghee Lee; Josef T. Prchal
Abstract Evolutionary adaptations to high altitude in Tibetans, Ethiopians, and Andean populations of South America have shown that Tibetans and Ethiopians have normal hemoglobin %, while most of Aymara and Quechua of the Andean highlands are polycythemic. Whole genome sequencing (WGS) in Quechua identified enriched SENP1 and ANP32D genes correlating with polycythemia (Zhou et al, Am J Hum Genet. 2013 Sep 5; 93(3): 452-462) but these genes were neither enriched nor segregated with polycythemia in Aymara. Instead, we identified that genes enriched in Aymara are related to regulation of cardiovascular development in high-altitude adapted Andeans, BRINP3, NOS2, and TBX5 (Crawford et al, Am J Hum Genet. 2017 Nov 2;101(5):752-767). To further search for Aymara propensity to polycythemia, we analyzed transcriptomes from Aymara and Europeans living in La Paz, Bolivia (3,639-4,150m) from limited amount of peripheral blood reticulocytes, platelets and granulocytes, but only granulocyte RNA was adequate for unbiased whole transcriptome analyses. In Aymaras, 2,585 genes were upregulated and 365 genes were downregulated (Adjp<0.05, fold difference <-2.0, and >2.0). Many of these modulated genes are involved in inflammatory pathways including B-cell activation (FDR=0.005) and NF-κB signaling pathway (FDR=0.011). We then analyzed differential exon usage in the transcriptome and identified 2,475 genes with alternative splicing events, comprising 1,568 exon skipping, 485 intron retention, 175 alternative 3' splice sites, 144 alternative 5' splice sites, and 902 mutually exclusive exons. These alternative spliced genes were also overrepresented in inflammatory pathways (TNF receptor, IL-1 and IL-23 mediated signaling, and NF-κB signaling). Notably we detected the previously unreported NFKB1 alternate transcripts skipping exon 4 or 5, which lead to the out-of-framed NFKB1 mRNA, generating the truncated nonfunctional NF-κB protein (Figure). Inflammation is a potent suppressor of erythropoiesis and the NF-κB is transcriptional regulator of plethora of inflammatory genes. Further, NF-κB also interacts with erythropoiesis-regulators, hypoxia-inducible factors (HIFs). By the integrative analysis of the Aymara transcriptome and WGS, we identified 46 NFKB1 splicing quantitative trait loci (sQTLs). Among these 46 sQTLs, five single nucleotide polymorphisms (SNP) were in high linkage disequilibrium, and two (rs230511 and rs230504) were more enriched in Aymara (allele frequency: 0.878) (Figure) and within a genomic region where Andeans are genetically differentiated from lowland Native Americans (peak FST = 0.37, peak PBSn1 = 0.31). These sQTLs rs230511 and rs230504 were corelated with two functionally important exon skipping (exon 4 and 5) in NFKB1 as described above. Furthermore, these two SNPs were correlated with higher hemoglobin levels and lower leukocytes; the wild-type NFKB1 transcript inversely correlated with hemoglobin%. We report Aymara have differentially expressed and alternatively spliced transcripts of genes modulating inflammation, particularly NFKB1. This Aymara enriched NFKB1 haplotype variant stands out as a major cause of Aymara adaptation to high altitude, as this truncated nonfunctional NF-κB variant peptide correlates with higher hemoglobin, lower leukocytes and suppresses inflammation. These data indicate that NFKB1 SNPs enriched in Aymara are associated with alternative spliced NFKB1 transcripts which contribute to polycythemia in Aymara. Further evaluation of NF-κB and HIFs' transcriptional activity and their correlation with inflammatory makers, hepcidin and erythroferrone in Aymara and Europeans living at the same high altitude is under way. JS and SH contributed equally to this work. YL and JTP act as equivalent co-senior authors. Figure. Figure. Disclosures No relevant conflicts of interest to declare.
Phenotypic Variations Related to Hypoxic Responses Among Andean Highlanders Living at Different Altitudes (400m, 4000m, 5000m)
(Elsevier BV, 2022) Ricardo Amaru; Emerson Cayo; Teddy Quispe; Juan Carlos Valencia; Daniela Patón; Luis Felipe Mamani; Julieta Luna
Introduction Adaptation to high altitude poses selective evolutionary changes involving multiple and challenging adaptive responses, and one of them deals with the low pressure of oxygen. Native Bolivian Andeans have lived at an average of 3000-5000 m for about 14,000 years, and have developed different erythroid phenotypes compared to other populations living at high altitude (PMID 30781443; PMID 25342802). Although Andeans have developed genetic adaptations related to erythropoiesis regulation (Blood, ASH 2316, 2018) they still undergone with polycythemic states, and those of clinical relevance are often Chronic Mountain Sickness erythrocytosis (CMS-E), secondary erythrocytosis (SE) and polycythemia vera (PV) (Rev Hematol Mex. 2016 Jan;17(1):8-20). Either adaptation or erythrocytosis condition entails important changes in hemoglobin, SpO2, P50 and lactate, so evaluating significant changes among Andeans living at different altitudes as well as the modifications between erythrocytosis patients and healthy highlanders became of interest. Material and method We collected venous blood samples from Bolivian native Andeans born at 4000 m (n=124) but living at 3 different altitudes (400 m, 4000 m, 5000 m), aside from Europeans (n=11) residing at 4000 m. Complete blood count, venous blood gas, and oxygen saturation studies were performed. P50 was measured by using a formula described by Lichtman. Likewise, a differential diagnosis regarding healthy inhabitants and polycythemia patients was performed. Results In healthy Andean inhabitants in different altitudes, the Hb levels increased at increasing altitude (p:0.001), meanwhile SpO2 (p:0.001) and P50 (p:0.001) decreased. No lactate variations among them were observed (Table 1). European subjects at 4000 m in relation to Andean inhabitants at the same altitude displayed higher Hb levels (p: 0.01), without variations in SpO2 and P50, but a significant increased lactate (p: 0.001) (Table 1). When comparing healthy subjects and patients with erythrocytosis (CMS-E, SE, PV) at 4000 m, the latter displayed higher Hb levels (p:0.001), decreased SpO2 (p:0.001), no variations in P50, and increased lactate in CMS-E and SE patients (p:0.01) (Table 2). Similarly, patients with erythrocytosis (CMS-E, SE) at 5000 m, related to healthy subjects at the same altitude, reflected increased Hb (p:0.001), decreased SpO2 (p:0.01), P50 without variations, and increased lactate (p:0.01) (Table 2). Conclusions Native Andeans from Bolivia born at 4000 m but living at different altitudes have variations regarding hematological phenotypes, decreased P50 shifts the hemoglobin dissociation curve to left. Patients with erythrocytosis have distinct phenotypes in relation to healthy subjects characterized by decreased saturation and increased lactate. Higher Hb levels and increased lactate in Europeans living at 4000 m probably due to the different residing time at high altitude, since native Andean inhabited high-altitude regions for many years. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal
Quinolinic Alkaloids from <scp>G</scp>alipea longiflora <scp>K</scp>rause Suppress Production of Proinflammatory Cytokines in vitro and Control Inflammation in vivo upon <scp>L</scp>eishmania Infection in Mice
(Wiley, 2012) Jacqueline Calla-Magariños; Teddy Quispe; A. Giménez; Jóna Freysdóttir; Marita Troye‐Blomberg; Carmen Fernández
An antileishmanial activity of quinolinic alkaloids from Galipea longiflora Krause, known as Evanta, has been demonstrated. We have previously shown that, apart from its leishmanicidal effect, in vitro pretreatment of spleen cells with an alkaloid extract of Evanta (AEE) interfered with the proliferation and interferon-γ production in lymphocytes polyclonally activated either with concanavalin A or anti-CD3. In the present study, we investigated if AEE could interfere with antigen-specific lymphocyte activation. We found that in vitro and in vivo treatment reduced recall lymphocyte responses, as measured by IFN-γ production (55% and 63% reduction compared to untreated cells, respectively). Apart from IFN-γ, the production of IL-12 and TNF was also suppressed. No effects were observed for meglumine antimoniate (SbV), the conventional drug used to treat leishmaniasis. When mice infected with Leishmania braziliensis promastigotes in the hind footpad were treated with AEE, the dynamics of the infection changed and the footpath thickness was efficiently controlled. The parasite load was also reduced but to a lesser extent than upon treatment with SbV. Combined treatment efficiently controlled both the thickness and parasite load as smaller lesions during the entire course of the infection were seen in the mice treated with AEE plus SbV compared with AEE or SbV alone. We discuss the benefits of combined administration of AEE plus SbV.
TERAPIA CELULAR PARA EL TRATAMIENTO DE ÚLCERAS CRÓNICAS
(2016) Ricardo Amaru; Hortencia Miguez; Teddy Quispe; Edwin Quisbert; A. Bruno Miranda; Josué Mamani; Gina Torres; Rosario Peñaloza; Heriberto Cuevas
VALORES DE HEMOGLOBINA EN LA POBLACIÓN DE CHOROLQUE A 5000 MSNM
(2020) Emerson Cayo; Ricardo Amaru; Daniela Patón; Teddy Quispe; Silvia Mansilla; Julieta Luna
VALORES HEMATOLÓGICOS EN MUJERES GESTANTES RESIDENTES A 3.600 MSNM
(2018) Ruben Araoz; Guillermo Álvarez; Ligia Villarroel; Teddy Quispe; Edwin Quisbert; Ricardo Amaru