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Potential Biomarkers of Therapeutic Response to ECP in Solid Organ Transplantation. 实体器官移植对ECP治疗反应的潜在生物标志物。
IF 1.9
Transplantation Direct Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001817
Hendrik Veltman, Eva Martinez-Caceres, Maria Iglesias-Escudero
{"title":"Potential Biomarkers of Therapeutic Response to ECP in Solid Organ Transplantation.","authors":"Hendrik Veltman, Eva Martinez-Caceres, Maria Iglesias-Escudero","doi":"10.1097/TXD.0000000000001817","DOIUrl":"10.1097/TXD.0000000000001817","url":null,"abstract":"<p><p>One of the major hurdles in solid organ transplantation is graft rejection, which must be prevented with lifelong general immunosuppression. However, modern maintenance immunosuppression is accompanied by serious side effects, such as an increased risk of infection and malignancies. The search for alternative therapies specifically controlling allogeneic responses is fueling renewed interest in extracorporeal photopheresis (ECP). Despite guideline indications for ECP in cardiothoracic transplantation, potential applications in liver and kidney transplantation have not been adequately investigated. Presently, limited understanding of the pharmacodynamic effects of ECP and lack of consensus biomarkers are hindering the development of standardized multiparametric assays to assess patient responses. This review explores current knowledge about immune responses after ECP in transplant recipients and collates a set of biomarkers associated with favorable treatment responses.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1817"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extracorporeal Photopheresis Stimulates Tissue Repair after Transplantation. 体外光再生刺激移植后组织修复。
IF 1.9
Transplantation Direct Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001812
Fabiola Arella, Hans J Schlitt, Paloma Riquelme
{"title":"Extracorporeal Photopheresis Stimulates Tissue Repair after Transplantation.","authors":"Fabiola Arella, Hans J Schlitt, Paloma Riquelme","doi":"10.1097/TXD.0000000000001812","DOIUrl":"10.1097/TXD.0000000000001812","url":null,"abstract":"<p><p>Extracorporeal photopheresis (ECP) is a safe and effective therapy with long-established indications in treating T cell-mediated immune diseases, including steroid refractory graft-versus-host disease and chronic rejection after heart or lung transplantation. The ECP procedure involves collecting autologous peripheral blood leucocytes that are driven into apoptosis before being reinfused intravenously. ECP acts primarily through in situ exposure of recipient dendritic cells and macrophages to apoptotic cells, which then suppress inflammation, promote specific regulatory T-cell responses, and retard fibrosis. Here, we explore the idea that macrophages exposed to apoptotic cell components from photopheresates acquire a tissue-reparative capacity that could be exploited therapeutically. Specifically, we consider innovative applications of ECP in resolving tissue injury after liver transplantation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1812"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ECP-induced Apoptosis: How Noninflammatory Cell Death Counterbalances Ischemia/Reperfusion Injury. ecp诱导的细胞凋亡:非炎性细胞死亡如何平衡缺血/再灌注损伤。
IF 1.9
Transplantation Direct Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001816
Julia Stępień, Elke Eggenhofer
{"title":"ECP-induced Apoptosis: How Noninflammatory Cell Death Counterbalances Ischemia/Reperfusion Injury.","authors":"Julia Stępień, Elke Eggenhofer","doi":"10.1097/TXD.0000000000001816","DOIUrl":"10.1097/TXD.0000000000001816","url":null,"abstract":"<p><p>Extracorporeal photopheresis (ECP) is a therapeutic procedure that is increasingly recognized for its efficacy in treating immune-mediated diseases, including transplant rejection. Its main mechanism is ex vivo apoptosis induction in leukocytes from patients by incubation with 8-methoxypsoralen and irradiation with ultraviolet A light. The process involves DNA cross-linking, which leads to a cascade of events within the cell and ultimately to apoptosis induction. Although ECP has been used for almost 40 y, there remain many questions about its immunological mechanisms and therapeutic potential. Here, we review current knowledge about mechanisms of apoptosis induction in subsets of peripheral blood mononuclear cells and interactions of apoptotic leukocytes with immune cells. We also highlight the challenges of reproducibly inducing cell death in a clinical manufacturing procedure and propose innovative ways to improve and quality-control ECP photopheresates.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1816"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
exTra Mini-review Series on ECP in Transplantation. 移植中ECP的迷你回顾系列。
IF 1.9
Transplantation Direct Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001860
James A Hutchinson, Edward K Geissler
{"title":"exTra Mini-review Series on ECP in Transplantation.","authors":"James A Hutchinson, Edward K Geissler","doi":"10.1097/TXD.0000000000001860","DOIUrl":"10.1097/TXD.0000000000001860","url":null,"abstract":"","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1860"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extracorporeal Photopheresis in Lung Transplantation: Present Applications and Emerging Research. 体外光再生在肺移植中的应用和新研究。
IF 1.9
Transplantation Direct Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001831
Sophia Alemanno, Peter Jaksch, Alberto Benazzo
{"title":"Extracorporeal Photopheresis in Lung Transplantation: Present Applications and Emerging Research.","authors":"Sophia Alemanno, Peter Jaksch, Alberto Benazzo","doi":"10.1097/TXD.0000000000001831","DOIUrl":"10.1097/TXD.0000000000001831","url":null,"abstract":"<p><p>Extracorporeal photopheresis (ECP) is an immunomodulatory therapy currently used as an add-on treatment for the prevention and management of organ rejection in lung transplantation. Thanks to its immunomodulatory properties and its ability to reduce the need for immunosuppressive therapies, ECP presents a promising therapeutic option, especially for high-risk patients with comorbidities, infections, or malignancies. This review provides a comprehensive overview of the current indications, clinical experience, and ongoing research surrounding the use of ECP in lung transplantation. Additionally, it delves into the current understanding of the mechanism of action of ECP, its potential role in lung transplantation, and the limitations identified in existing studies. By highlighting these aspects, the review aims to lay the groundwork for future research, which could further elucidate the mechanisms underlying this promising therapy and contribute to the standardization of therapeutic protocols.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1831"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extracorporeal Photopheresis: Does It Have a Potential Place Among Cell-based Therapies? 体外光化学:它在细胞疗法中有潜在的地位吗?
IF 1.9
Transplantation Direct Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001808
Panagiotis Parsonidis, Thomas Wekerle
{"title":"Extracorporeal Photopheresis: Does It Have a Potential Place Among Cell-based Therapies?","authors":"Panagiotis Parsonidis, Thomas Wekerle","doi":"10.1097/TXD.0000000000001808","DOIUrl":"10.1097/TXD.0000000000001808","url":null,"abstract":"<p><p>Extracorporeal photopheresis (ECP) is a therapeutic intervention for modulating immune responses using an autologous apoptotic cell-based product, known as a photopheresate. The process of generating photopheresates offers attractive possibilities for manipulating distinct leukocyte subsets to either augment or dampen immune responses, depending on the disease context. This review discusses current uses of ECP as a cell-based therapy and introduces possible strategies to enhance the potency of photopheresates. In Europe, ECP is regulated under the European Union Tissue Directive, but innovative applications in solid organ transplantation, including modifications of the procedure, may force its reclassification as an Advanced Therapy Medicinal Product. Such modifications might include loading dendritic cells with antigens, polarizing dendritic cells toward immunogenic or tolerogenic states, or genetically manipulating leukocyte subsets. In conclusion, although ECP is a long-established, safe, and effective therapy, the more rigorous standards applied to Advanced Therapy Medicinal Product manufacture could help to ensure the quality of photopheresates applied to solid organ transplant recipients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1808"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring the Role of Extracorporeal Photopheresis in Kidney Transplant Management. 探讨体外光移植术在肾移植管理中的作用。
IF 1.9
Transplantation Direct Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001809
Michael Nicoli, Jordi Rovira, Fritz Diekmann
{"title":"Exploring the Role of Extracorporeal Photopheresis in Kidney Transplant Management.","authors":"Michael Nicoli, Jordi Rovira, Fritz Diekmann","doi":"10.1097/TXD.0000000000001809","DOIUrl":"10.1097/TXD.0000000000001809","url":null,"abstract":"<p><p>Extracorporeal photopheresis (ECP) is emerging as an apoptotic cell-based therapy that suppresses alloimmunity, promotes donor-specific regulation, and reduces the need for conventional maintenance immunosuppression. ECP therapy is associated with regulatory T-cell proliferation, anti-inflammatory effects, and reduction of anti-HLA antibodies, making ECP a possible alternative or adjunct treatment for preventing and treating transplant rejection. Presently, we have a limited understanding of the mechanisms of ECP action, and clinical evidence for efficacy in kidney transplantation is sparse. Promising results in acute cellular or antibody-mediated rejection were reported, but beneficial effects in chronic settings are less evident. The absence of reliable markers for patient stratification and therapeutic monitoring further complicates its application. Working with the European Union-funded exTra network, our group is studying the therapeutic action of ECP in kidney transplantation with the ultimate goal of conducting a large multicenter study to standardize and harmonize treatment indications and approaches.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1809"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Potential Impact of Extracorporeal Photopheresis on Trained Immunity and Organ Transplant Acceptance. 体外光造血对训练免疫和器官移植接受的潜在影响。
IF 1.9
Transplantation Direct Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001835
Clémentine Tocco, Jordi Ochando
{"title":"Potential Impact of Extracorporeal Photopheresis on Trained Immunity and Organ Transplant Acceptance.","authors":"Clémentine Tocco, Jordi Ochando","doi":"10.1097/TXD.0000000000001835","DOIUrl":"10.1097/TXD.0000000000001835","url":null,"abstract":"<p><p>Extracorporeal photopheresis (ECP) is a well-established, safe, and effective immunomodulatory therapy currently used in clinics to decrease T cell-mediated immunity in various disorders, including autoimmune diseases and chronic rejection in organ transplantation. Although the ECP procedure has been shown to induce apoptotic cells that are reintroduced into the patient at the end of the treatment, the precise tolerogenic mechanisms mediated by ECP are not fully understood. Previous in vitro studies have demonstrated that early apoptotic cells express annexins on their cell surface, which suppress myeloid cell activation on stimulation with bacterial lipopolysaccharide through Toll-like receptors. Mechanistically, annexins prevent the upregulation of costimulatory molecules (CD40 and CD86) and decrease the secretion of proinflammatory cytokines (tumor necrosis factor and interferon-γ) through nuclear factor kappa B signaling pathways, altogether inhibiting antigen-specific T-cell responses in vivo. In human and mouse bone marrow-derived macrophages, binding of annexin to Dectin-1, a c-type lectin receptor, promotes peripheral tolerance through the spleen tyrosine kinase signaling pathway and NADPH oxidase 2 downstream activation. In animal models, the synergistic activation of Dectin-1 and Toll-like receptor 4 by damage-associated molecular patterns in graft-infiltrating monocytes leads to the induction of trained immunity. Because trained immunity prevents long-term allograft survival in organ transplant recipients, we hypothesize pretreatment with ECP represents a potential unexplored therapeutic option to favor transplantation tolerance. Specifically, ECP may serve as a prophylactic therapy to prevent trained immunity in contexts involving the activation of the Dectin-1 pathway.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1835"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Platelet Activation on Lung Function During Ex Vivo Lung Perfusion, Lung Transplantation, and the Role of Antiplatelet Therapy: A Narrative Review. 体外肺灌注、肺移植过程中血小板活化对肺功能的影响及抗血小板治疗的作用:综述。
IF 1.9
Transplantation Direct Pub Date : 2025-08-22 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001855
Ryaan El-Andari, Jimmy J H Kang, Nicholas M Fialka, Jason Weatherald, Parnian Alavi, Nadia Jahroudi, Darren H Freed, Jayan Nagendran
{"title":"Platelet Activation on Lung Function During Ex Vivo Lung Perfusion, Lung Transplantation, and the Role of Antiplatelet Therapy: A Narrative Review.","authors":"Ryaan El-Andari, Jimmy J H Kang, Nicholas M Fialka, Jason Weatherald, Parnian Alavi, Nadia Jahroudi, Darren H Freed, Jayan Nagendran","doi":"10.1097/TXD.0000000000001855","DOIUrl":"10.1097/TXD.0000000000001855","url":null,"abstract":"<p><strong>Background: </strong>Ischemia/reperfusion injury after lung transplantation is a significant cause of morbidity. In the realm of ex vivo lung perfusion (EVLP), inflammation, edema formation, and reduced compliance have limited the durability of EVLP. Previous evidence has suggested that platelet activation and thrombosis may play a role in both conditions.</p><p><strong>Methods: </strong>A literature search of PubMed and Embase was conducted, including all articles describing all human or animal investigations of platelet activation or the use of antiplatelet agents in the settings of EVLP or lung transplantation. Articles published from database inception to July 15, 2024, were analyzed.</p><p><strong>Results: </strong>In total, 9 studies were included in the review. Studies on EVLP have found an association between platelet activation and adverse effects on lung function, whereas in lung transplantation, platelet activation appears to play a role in primary graft dysfunction. In both settings, the inhibition of platelets ameliorated these effects.</p><p><strong>Conclusions: </strong>Platelet activation in EVLP and lung transplantation results in distal arterial thrombosis and has been associated with graft dysfunction. The use of antiplatelet agents in the included studies was associated with reduced lung injury and improved lung function on EVLP or during lung transplantation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1855"},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Timing of Transplant Surgery and Its Impact on Short- and Long-term Outcome After Renal Transplantation. 移植手术时机及其对肾移植术后短期和长期预后的影响。
IF 1.9
Transplantation Direct Pub Date : 2025-08-22 eCollection Date: 2025-09-01 DOI: 10.1097/TXD.0000000000001762
Katharina T Stellrecht, Clara Daschner, Justus J C Windeler, Matthias Jung, Urs Benck, Peter Schnülle, Thomas Singer, Andreas L H Gerken, Stanislav Vershenya, Michael Keese, Kay Schwenke, Berthold Hocher, Bernd Krüger, Babak Yazdani, Anna-Isabelle Kälsch, Jan Jochims, Bernhard K Krämer
{"title":"Timing of Transplant Surgery and Its Impact on Short- and Long-term Outcome After Renal Transplantation.","authors":"Katharina T Stellrecht, Clara Daschner, Justus J C Windeler, Matthias Jung, Urs Benck, Peter Schnülle, Thomas Singer, Andreas L H Gerken, Stanislav Vershenya, Michael Keese, Kay Schwenke, Berthold Hocher, Bernd Krüger, Babak Yazdani, Anna-Isabelle Kälsch, Jan Jochims, Bernhard K Krämer","doi":"10.1097/TXD.0000000000001762","DOIUrl":"10.1097/TXD.0000000000001762","url":null,"abstract":"<p><strong>Background: </strong>Literature reports higher error rates in professions such as police officers and nurses during night shifts. Additionally, there is evidence of a higher rate of surgical complications and mortality rate if surgery is performed at night. Currently, kidney transplantations are performed at any time of day to minimize the cold ischemia time. Recent studies investigating the outcomes of kidney transplantation in relation to daytime have produced varying results.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from all patients who received a deceased donor kidney transplant at the University Medical Center Mannheim between January 1, 1997, and January 31, 2015. All recipients were followed for 2.5 y after the last kidney transplant. Daytime was divided into 2 categories: day (from 8 am to 7:59 pm) and night (from 8 pm to 7:59 am). Four operation intervals were defined on the basis of incision and suturing time (day/day, day/night, night/night, and night/day). Endpoints of primary interest were surgical complications, delayed onset of renal function requiring renal replacement therapy, transplant failure, and death.</p><p><strong>Results: </strong>We analyzed 363 patients who underwent kidney transplantation during our study period. The incidence of surgical complications tended to be higher at night (<i>P</i> = 0.054). Rates of wound infections were significantly higher when the operation started at night (<i>P</i> = 0.018). The rate of wound infections (<i>P</i> = 0.007; Fisher test) and the incidence of DFG type 2 (<i>P</i> = 0.002) were highest in the night/day operation interval. The analysis of graft loss and patient survival showed no significant difference between day- and nighttime surgery but a positive trend toward operation started during the daytime.</p><p><strong>Conclusions: </strong>In summary, the effect of the timing of transplant surgery on long- and short-term outcomes of kidney transplantation appears to be rather minor. Hence, reducing cold ischemia time should be the primary goal to improve the outcome of kidney transplantation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 9","pages":"e1762"},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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