mAbsPub Date : 2024-01-01Epub Date: 2024-07-01DOI: 10.1080/19420862.2024.2373330
Brian Kelley
{"title":"The history and potential future of monoclonal antibody therapeutics development and manufacturing in four eras.","authors":"Brian Kelley","doi":"10.1080/19420862.2024.2373330","DOIUrl":"10.1080/19420862.2024.2373330","url":null,"abstract":"<p><p>Therapeutic monoclonal antibody (mAb) development and the processes for manufacturing drug substance have evolved since the first approval of the mAb in 1986. As the past is often the prologue to the future, the history of these technologies has been classified here into three eras, leading to speculation about what the next era may hold with regard to development and manufacturing strategies, as well as the potential impacts to patients. The substantial increase in production culture titers and bioreactor production volumes and the availability of large-scale contract manufacturing facilities could translate into improved global access for these therapies and an expansion of indications for therapeutic antibodies.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2373330"},"PeriodicalIF":5.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11218797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Early determination of potential critical quality attributes of therapeutic antibodies in developability studies through surface plasmon resonance-based relative binding activity assessment.","authors":"Shuai Wang, Yanqiu Wang, Zhenzhen Li, Ye Hong, Zhaohui Wang, Jiteng Fan, Qiong Wang, Yuanjie Ge, Xiaofeng Zhao, Guangcun Cheng, Changyan Chen, Yadan Wu, Yayuan Fu","doi":"10.1080/19420862.2024.2374607","DOIUrl":"10.1080/19420862.2024.2374607","url":null,"abstract":"<p><p>Precise measurement of the binding activity changes of therapeutic antibodies is important to determine the potential critical quality attributes (CQAs) in developability assessment at the early stage of antibody development. Here, we report a surface plasmon resonance (SPR)-based relative binding activity method, which incorporates both binding affinity and binding response and allows us to determine relative binding activity of antibodies with high accuracy and precision. We applied the SPR-based relative binding activity method in multiple forced degradation studies of antibody developability assessment. The current developability assessment strategy provided comprehensive, precise characterization of antibody binding activity in the stability studies, enabling us to perform correlation analysis and establish the structure-function relationship between relative binding activity and quality attributes. The impact of a given quality attribute on binding activity could be confidently determined without isolating antibody variants. We identified several potential CQAs, including Asp isomerization, Asn deamidation, and fragmentation. Some potential CQAs affected binding affinity of antibody and resulted in a reduction of binding activity. Certain potential CQAs impaired antibody binding to antigen and led to a loss of binding activity. A few potential CQAs could influence both binding affinity and binding response and cause a substantial decrease in antibody binding activity. Specifically, we identified low abundance Asn33 deamidation in the light chain complementarity-determining region as a potential CQA, in which all the stressed antibody samples showed Asn33 deamidation abundances ranging from 4.2% to 27.5% and a mild binding affinity change from 1.76 nM to 2.16 nM.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2374607"},"PeriodicalIF":5.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11225922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
mAbsPub Date : 2024-01-01Epub Date: 2024-03-18DOI: 10.1080/19420862.2024.2329321
W van der Wulp, W Luu, M E Ressing, J Schuurman, S I van Kasteren, L Guelen, R C Hoeben, B Bleijlevens, M H M Heemskerk
{"title":"Antibody-epitope conjugates deliver immunogenic T-cell epitopes more efficiently when close to cell surfaces.","authors":"W van der Wulp, W Luu, M E Ressing, J Schuurman, S I van Kasteren, L Guelen, R C Hoeben, B Bleijlevens, M H M Heemskerk","doi":"10.1080/19420862.2024.2329321","DOIUrl":"10.1080/19420862.2024.2329321","url":null,"abstract":"<p><p>Antibody-mediated delivery of immunogenic viral CD8<sup>+</sup> T-cell epitopes to redirect virus-specific T cells toward cancer cells is a promising new therapeutic avenue to increase the immunogenicity of tumors. Multiple strategies for viral epitope delivery have been shown to be effective. So far, most of these have relied on a free C-terminus of the immunogenic epitope for extracellular delivery. Here, we demonstrate that antibody-epitope conjugates (AECs) with genetically fused epitopes to the N-terminus of the antibody can also sensitize tumors for attack by virus-specific CD8<sup>+</sup> T cells. AECs carrying epitopes genetically fused at the N-terminus of the light chains of cetuximab and trastuzumab demonstrate an even more efficient delivery of the T-cell epitopes compared to AECs with the epitope fused to the C-terminus of the heavy chain. We demonstrate that this increased efficiency is not caused by the shift in location of the cleavage site from the <i>N</i>- to the C-terminus, but by its increased proximity to the cell surface. We hypothesize that this facilitates more efficient epitope delivery. These findings not only provide additional insights into the mechanism of action of AECs but also broaden the possibilities for genetically fused AECs as an avenue for the redirection of multiple virus-specific T cells toward tumors.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2329321"},"PeriodicalIF":5.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10950288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
mAbsPub Date : 2024-01-01Epub Date: 2024-03-28DOI: 10.1080/19420862.2024.2333436
David Hoffmann, Joschka Bauer, Markus Kossner, Andrew Henry, Anne R Karow-Zwick, Giuseppe Licari
{"title":"Predicting deamidation and isomerization sites in therapeutic antibodies using structure-based <i>in silico</i> approaches.","authors":"David Hoffmann, Joschka Bauer, Markus Kossner, Andrew Henry, Anne R Karow-Zwick, Giuseppe Licari","doi":"10.1080/19420862.2024.2333436","DOIUrl":"10.1080/19420862.2024.2333436","url":null,"abstract":"<p><p>Asparagine (Asn) deamidation and aspartic acid (Asp) isomerization are common degradation pathways that affect the stability of therapeutic antibodies. These modifications can pose a significant challenge in the development of biopharmaceuticals. As such, the early engineering and selection of chemically stable monoclonal antibodies (mAbs) can substantially mitigate the risk of subsequent failure. In this study, we introduce a novel in silico approach for predicting deamidation and isomerization sites in therapeutic antibodies by analyzing the structural environment surrounding asparagine and aspartate residues. The resulting quantitative structure-activity relationship (QSAR) model was trained using previously published forced degradation data from 57 clinical-stage mAbs. The predictive accuracy of the model was evaluated for four different states of the protein structure: (1) static homology models, (2) enhancing low-frequency vibrational modes during short molecular dynamics (MD) runs, (3) a combination of (2) with a protonation state reassignment, and (4) conventional full-atomistic MD simulations. The most effective QSAR model considered the accessible surface area (ASA) of the residue, the pKa value of the backbone amide, and the root mean square deviations of both the alpha carbon and the side chain. The accuracy was further enhanced by incorporating the QSAR model into a decision tree, which also includes empirical information about the sequential successor and the position in the protein. The resulting model has been implemented as a plugin named \"Forecasting Reactivity of Isomerization and Deamidation in Antibodies\" in MOE software, completed with a user-friendly graphical interface to facilitate its use.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2333436"},"PeriodicalIF":5.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140318621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
mAbsPub Date : 2024-01-01Epub Date: 2024-06-06DOI: 10.1080/19420862.2024.2361928
Pawel Dudzic, Dawid Chomicz, Jarosław Kończak, Tadeusz Satława, Bartosz Janusz, Sonia Wrobel, Tomasz Gawłowski, Igor Jaszczyszyn, Weronika Bielska, Samuel Demharter, Roberto Spreafico, Lukas Schulte, Kyle Martin, Stephen R Comeau, Konrad Krawczyk
{"title":"Large-scale data mining of four billion human antibody variable regions reveals convergence between therapeutic and natural antibodies that constrains search space for biologics drug discovery.","authors":"Pawel Dudzic, Dawid Chomicz, Jarosław Kończak, Tadeusz Satława, Bartosz Janusz, Sonia Wrobel, Tomasz Gawłowski, Igor Jaszczyszyn, Weronika Bielska, Samuel Demharter, Roberto Spreafico, Lukas Schulte, Kyle Martin, Stephen R Comeau, Konrad Krawczyk","doi":"10.1080/19420862.2024.2361928","DOIUrl":"10.1080/19420862.2024.2361928","url":null,"abstract":"<p><p>The naïve human antibody repertoire has theoretical access to an estimated > 10<sup>15</sup> antibodies. Identifying subsets of this prohibitively large space where therapeutically relevant antibodies may be found is useful for development of these agents. It was previously demonstrated that, despite the immense sequence space, different individuals can produce the same antibodies. It was also shown that therapeutic antibodies, which typically follow seemingly unnatural development processes, can arise independently naturally. To check for biases in how the sequence space is explored, we data mined public repositories to identify 220 bioprojects with a combined seven billion reads. Of these, we created a subset of human bioprojects that we make available as the AbNGS database (https://naturalantibody.com/ngs/). AbNGS contains 135 bioprojects with four billion productive human heavy variable region sequences and 385 million unique complementarity-determining region (CDR)-H3s. We find that 270,000 (0.07% of 385 million) unique CDR-H3s are highly public in that they occur in at least five of 135 bioprojects. Of 700 unique therapeutic CDR-H3, a total of 6% has direct matches in the small set of 270,000. This observation extends to a match between CDR-H3 and V-gene call as well. Thus, the subspace of shared ('public') CDR-H3s shows utility for serving as a starting point for therapeutic antibody design.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2361928"},"PeriodicalIF":5.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11164219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
mAbsPub Date : 2024-01-01Epub Date: 2024-03-06DOI: 10.1080/19420862.2024.2323706
M Biddle, P Stylianou, M Rekas, A Wright, J Sousa, D Ruddy, M I Stefana, K Kmiecik, A Bandrowski, R A Kahn, C Laflamme, E M Krockow, H S Virk
{"title":"Improving the integrity and reproducibility of research that uses antibodies: a technical, data sharing, behavioral and policy challenge.","authors":"M Biddle, P Stylianou, M Rekas, A Wright, J Sousa, D Ruddy, M I Stefana, K Kmiecik, A Bandrowski, R A Kahn, C Laflamme, E M Krockow, H S Virk","doi":"10.1080/19420862.2024.2323706","DOIUrl":"10.1080/19420862.2024.2323706","url":null,"abstract":"<p><p>Antibodies are one of the most important reagents used in biomedical and fundamental research, used to identify, and quantify proteins, contribute to knowledge of disease mechanisms, and validate drug targets. Yet many antibodies used in research do not recognize their intended target, or recognize additional molecules, compromising the integrity of research findings and leading to waste of resources, lack of reproducibility, failure of research projects, and delays in drug development. Researchers frequently use antibodies without confirming that they perform as intended in their application of interest. Here we argue that the determinants of end-user antibody choice and use are critical, and under-addressed, behavioral drivers of this problem. This interacts with the batch-to-batch variability of these biological reagents, and the paucity of available characterization data for most antibodies, making it more difficult for researchers to choose high quality reagents and perform necessary validation experiments. The open-science company YCharOS works with major antibody manufacturers and knockout cell line producers to characterize antibodies, identifying high-performing renewable antibodies for many targets in neuroscience. This shows the progress that can be made by stakeholders working together. However, their work so far applies to only a tiny fraction of available antibodies. Where characterization data exists, end-users need help to find and use it appropriately. While progress has been made in the context of technical solutions and antibody characterization, we argue that initiatives to make best practice behaviors by researchers more feasible, easy, and rewarding are needed. Global cooperation and coordination between multiple partners and stakeholders will be crucial to address the technical, policy, behavioral, and open data sharing challenges. We offer potential solutions by describing our Only Good Antibodies initiative, a community of researchers and partner organizations working toward the necessary change. We conclude with an open invitation for stakeholders, including researchers, to join our cause.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2323706"},"PeriodicalIF":5.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10936606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140039793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
mAbsPub Date : 2024-01-01Epub Date: 2024-06-07DOI: 10.1080/19420862.2024.2362432
Pauline Malinge, Xavier Chauchet, Jérémie Bourguignon, Nicolas Bosson, Sébastien Calloud, Tereza Bautzova, Marie Borlet, Mette Laursen, Vinardas Kelpsas, Nadia Rose, Franck Gueneau, Ulla Ravn, Giovanni Magistrelli, Nicolas Fischer
{"title":"Structural analysis of light chain-driven bispecific antibodies targeting CD47 and PD-L1.","authors":"Pauline Malinge, Xavier Chauchet, Jérémie Bourguignon, Nicolas Bosson, Sébastien Calloud, Tereza Bautzova, Marie Borlet, Mette Laursen, Vinardas Kelpsas, Nadia Rose, Franck Gueneau, Ulla Ravn, Giovanni Magistrelli, Nicolas Fischer","doi":"10.1080/19420862.2024.2362432","DOIUrl":"10.1080/19420862.2024.2362432","url":null,"abstract":"<p><p>In contrast to natural antibodies that rely mainly on the heavy chain to establish contacts with their cognate antigen, we have developed a bispecific antibody format in which the light chain (LC) drives antigen binding and specificity. To better understand epitope-paratope interactions in this context, we determined the X-ray crystallographic structures of an antigen binding fragment (Fab) in complex with human CD47 and another Fab in complex with human PD-L1. These Fabs contain a κ-LC and a λ-LC, respectively, which are paired with an identical heavy chain (HC). The structural analysis of these complexes revealed the dominant contribution of the LCs to antigen binding, but also that the common HC provides some contacts in both CD47 and PD-L1 Fab complexes. The anti-CD47 Fab was affinity optimized by diversifying complementary-determining regions of the LC followed by phage display selections. Using homology modeling, the contributions of the amino acid modification to the affinity increase were analyzed. Our results demonstrate that, despite a less prominent role in natural antibodies, the LC can mediate high affinity binding to different antigens and neutralize their biological function. Importantly, Fabs containing a common variable heavy (VH) domain enable the generation of bispecific antibodies retaining a truly native structure, maximizing their therapeutic potential.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2362432"},"PeriodicalIF":5.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11164222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
mAbsPub Date : 2024-01-01Epub Date: 2024-07-19DOI: 10.1080/19420862.2024.2379560
Joel Heisler, Daniel Kovner, Saeed Izadi, Jonathan Zarzar, Paul J Carter
{"title":"Modulation of the high concentration viscosity of IgG<sub>1</sub> antibodies using clinically validated Fc mutations.","authors":"Joel Heisler, Daniel Kovner, Saeed Izadi, Jonathan Zarzar, Paul J Carter","doi":"10.1080/19420862.2024.2379560","DOIUrl":"10.1080/19420862.2024.2379560","url":null,"abstract":"<p><p>The self-association of therapeutic antibodies can result in elevated viscosity and create problems in manufacturing and formulation, as well as limit delivery by subcutaneous injection. The high concentration viscosity of some antibodies has been reduced by variable domain mutations or by the addition of formulation excipients. In contrast, the impact of Fc mutations on antibody viscosity has been minimally explored. Here, we studied the effect of a panel of common and clinically validated Fc mutations on the viscosity of two closely related humanized IgG<sub>1,</sub> κ antibodies, omalizumab (anti-IgE) and trastuzumab (anti-HER2). Data presented here suggest that both Fab-Fab and Fab-Fc interactions contribute to the high viscosity of omalizumab, in a four-contact model of self-association. Most strikingly, the high viscosity of omalizumab (176 cP) was reduced 10.7- and 2.2-fold by Fc modifications for half-life extension (M252Y:S254T:T256E) and aglycosylation (N297G), respectively. Related single mutations (S254T and T256E) each reduced the viscosity of omalizumab by ~6-fold. An alternative half-life extension Fc mutant (M428L:N434S) had the opposite effect in increasing the viscosity of omalizumab by 1.5-fold. The low viscosity of trastuzumab (8.6 cP) was unchanged or increased by <math><mo>≤</mo></math>2-fold by the different Fc variants. Molecular dynamics simulations provided mechanistic insight into the impact of Fc mutations in modulating electrostatic and hydrophobic surface properties as well as conformational stability of the Fc. This study demonstrates that high viscosity of some IgG<sub>1</sub> antibodies can be mitigated by Fc mutations, and thereby offers an additional tool to help design future antibody therapeutics potentially suitable for subcutaneous delivery.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2379560"},"PeriodicalIF":5.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
mAbsPub Date : 2024-01-01Epub Date: 2024-07-23DOI: 10.1080/19420862.2024.2381891
Patrizia Murer, Barbara Brannetti, Jean-Michel Rondeau, Laetitia Petersen, Nicole Egli, Simone Popp, Catherine Regnier, Kirsten Richter, Andreas Katopodis, Christoph Huber
{"title":"Discovery and development of ANV419, an IL-2/anti-IL-2 antibody fusion protein with potent CD8+ T and natural killer cell-stimulating capacity for cancer immunotherapy.","authors":"Patrizia Murer, Barbara Brannetti, Jean-Michel Rondeau, Laetitia Petersen, Nicole Egli, Simone Popp, Catherine Regnier, Kirsten Richter, Andreas Katopodis, Christoph Huber","doi":"10.1080/19420862.2024.2381891","DOIUrl":"10.1080/19420862.2024.2381891","url":null,"abstract":"<p><p>Novel engineered IL-2 agonists strive to increase the therapeutic window of aldesleukin (human IL-2) by increasing selectivity toward effector over regulatory T cells and reducing dose-limiting toxicities. Here we describe ANV419, an IL-2/anti-IL2 antibody fusion protein designed for selective IL-2 receptor βγ (IL-2 Rβγ) activation by sterically hindering IL-2 from binding to IL-2 Rα. The fusion protein has an IL-2 connected to the light chain complementarity-determining region (CDR) domain of a humanized antibody that binds to IL-2 at the same epitope as IL-2 Rα. Optimization of the selectivity and pharmacological properties led to the selection of ANV419. ANV419 preferentially expands CD8<sup>+</sup> T cells and natural killer (NK) cells over T<sub>regs</sub> and can be safely administered at doses that elicit strong pharmacodynamic effects and efficacy in mouse tumor models. Its anti-tumor efficacy was enhanced when combined with programmed cell death protein 1 (PD-1) or cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) checkpoint inhibitors. ANV419 also enhances the NK cell killing capacity and increases tumor growth inhibition when used alongside trastuzumab in a Her-2<sup>+</sup> xenograft mouse model. In cynomolgus monkeys, the estimated half-life of ANV419 is 24 h, and doses that induced sustained expansion of effector cells were well tolerated without the severe toxicities typically observed with high-dose IL-2. These data support the clinical development of ANV419 in solid tumors and hematological malignancies as monotherapy and in combination with checkpoint inhibitors or agents that induce antibody-dependent cellular cytotoxicity. ANV419 is currently in Phase 1/2 clinical development and may provide cancer patients with a wider therapeutic window than aldesleukin.</p>","PeriodicalId":18206,"journal":{"name":"mAbs","volume":"16 1","pages":"2381891"},"PeriodicalIF":5.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}