{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:46:24Z","timestamp":1791960384124,"version":"4.3.4"},"reference-count":80,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Toxicol"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1007\/s12012-026-10211-x","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:36:07Z","timestamp":1791826567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toxic Metals and Metalloids Exposure and the Gut-Cardiometabolic Axis: A Narrative Review of Microbiome Dysbiosis, Gut Barrier Dysfunction, and Metabolic Inflammation"],"prefix":"10.1007","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5802-2291","authenticated-orcid":false,"given":"Ahmed Farid","family":"Gadelmawla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Hosny","family":"El-Farargy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal A.","family":"Alsubaiei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najat Y.","family":"AlSejari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myriam Ramadan","family":"Sharara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza A.","family":"Abdul-Hafez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Elmorsy","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed W.","family":"Hageen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah M.","family":"Alharran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"And\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilbert S.","family":"Aronow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"10211_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2025.179785","volume":"987","author":"S Kotnala","year":"2025","unstructured":"Kotnala, S., Tiwari, S., Nayak, A., Bhushan, B., Chandra, S., Medeiros, C. R., et al. (2025). Impact of heavy metal toxicity on the human health and environment. Science of the Total Environment, 987, Article 179785. https:\/\/doi.org\/10.1016\/j.scitotenv.2025.179785","journal-title":"Science of the Total Environment"},{"key":"10211_CR2","doi-asserted-by":"publisher","DOI":"10.3390\/molecules28186620","volume":"28","author":"AE Charkiewicz","year":"2023","unstructured":"Charkiewicz, A. E., Omeljaniuk, W. J., Nowak, K., Garley, M., & Nikli\u0144ski, J. (2023). Cadmium toxicity and health effects\u2014A brief summary. Molecules, 28, Article 6620. https:\/\/doi.org\/10.3390\/molecules28186620","journal-title":"Molecules"},{"key":"10211_CR3","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.643972","volume":"12","author":"M Balali-Mood","year":"2021","unstructured":"Balali-Mood, M., Naseri, K., Tahergorabi, Z., Khazdair, M. R., & Sadeghi, M. (2021). Toxic mechanisms of five heavy metals: Mercury, lead, chromium, cadmium, and arsenic. Frontiers in Pharmacology, 12, Article 643972. https:\/\/doi.org\/10.3389\/fphar.2021.643972","journal-title":"Frontiers in Pharmacology"},{"key":"10211_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-025-00750-4","volume":"44","author":"M Rezazadegan","year":"2025","unstructured":"Rezazadegan, M., Forootani, B., Hoveyda, Y., Rezazadegan, N., & Amani, R. (2025). Major heavy metals and human gut microbiota composition: A systematic review with nutritional approach. Journal of Health, Population, and Nutrition, 44, Article 21. https:\/\/doi.org\/10.1186\/s41043-025-00750-4","journal-title":"Journal of Health, Population, and Nutrition"},{"key":"10211_CR5","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1161\/CIRCRESAHA.123.323617","volume":"134","author":"Z Pan","year":"2024","unstructured":"Pan, Z., Gong, T., & Liang, P. (2024). Heavy Metal Exposure and Cardiovascular Disease. Circulation Research, 134, 1160\u20131178. https:\/\/doi.org\/10.1161\/CIRCRESAHA.123.323617","journal-title":"Circulation Research"},{"key":"10211_CR6","doi-asserted-by":"publisher","DOI":"10.1530\/MAH-23-0015","volume":"2","author":"S Ghosh","year":"2023","unstructured":"Ghosh, S., Nukavarapu, S. P., & Jala, V. R. (2023). Effects of heavy metals on gut barrier integrity and gut microbiota. Microbiota and Host, 2, Article e230015. https:\/\/doi.org\/10.1530\/MAH-23-0015","journal-title":"Microbiota and Host"},{"issue":"1","key":"10211_CR7","doi-asserted-by":"publisher","first-page":"14675","DOI":"10.1038\/s41598-021-94174-9","volume":"11","author":"S Bolan","year":"2021","unstructured":"Bolan, S., Seshadri, B., Keely, S., Kunhikrishnan, A., Bruce, J., Grainge, I., et al. (2021). Bioavailability of arsenic, cadmium, lead and mercury as measured by intestinal permeability. Scientific Reports, 11, 14675. https:\/\/doi.org\/10.1038\/s41598-021-94174-9","journal-title":"Scientific Reports"},{"key":"10211_CR8","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1448388","volume":"11","author":"Q Zhu","year":"2024","unstructured":"Zhu, Q., Chen, B., Zhang, F., Zhang, B., Guo, Y., Pang, M., et al. (2024). Toxic and essential metals: Metabolic interactions with the gut microbiota and health implications. Frontiers in Nutrition, 11, Article 1448388. https:\/\/doi.org\/10.3389\/fnut.2024.1448388","journal-title":"Frontiers in Nutrition"},{"key":"10211_CR9","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1007\/s11739-023-03262-3","volume":"18","author":"D Rosendo-Silva","year":"2023","unstructured":"Rosendo-Silva, D., Viana, S., Carvalho, E., Reis, F., & Matafome, P. (2023). Are gut dysbiosis, barrier disruption, and endotoxemia related to adipose tissue dysfunction in metabolic disorders? Overview of the mechanisms involved. Internal and Emergency Medicine, 18, 1287\u2013302. https:\/\/doi.org\/10.1007\/s11739-023-03262-3","journal-title":"Internal and Emergency Medicine"},{"key":"10211_CR10","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17207618","volume":"17","author":"Z Al Bander","year":"2020","unstructured":"Al Bander, Z., Nitert, M. D., Mousa, A., & Naderpoor, N. (2020). The gut microbiota and inflammation: An overview. International Journal of Environmental Research and Public Health, 17, Article 7618. https:\/\/doi.org\/10.3390\/ijerph17207618","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"10211_CR11","doi-asserted-by":"publisher","DOI":"10.21542\/gcsp.2025.3","author":"R Abdulaal","year":"2025","unstructured":"Abdulaal, R., Tlaiss, Y., Jammal, F., Moussbah, T. H., Tarchichi, A., Hteit, A., et al. (2025). The role of microbiome dysbiosis in cardiovascular disease: Mechanisms and therapeutic implications. Global Cardiology Science & Practice. https:\/\/doi.org\/10.21542\/gcsp.2025.3","journal-title":"Global Cardiology Science & Practice"},{"key":"10211_CR12","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1038\/s41371-022-00698-6","volume":"36","author":"SK Masenga","year":"2022","unstructured":"Masenga, S. K., Hamooya, B., Hangoma, J., Hayumbu, V., Ertuglu, L. A., Ishimwe, J., et al. (2022). Recent advances in modulation of cardiovascular diseases by the gut microbiota. Journal of Human Hypertension, 36, 952\u20139. https:\/\/doi.org\/10.1038\/s41371-022-00698-6","journal-title":"Journal of Human Hypertension"},{"key":"10211_CR13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecoenv.2019.110130","volume":"190","author":"X Lin","year":"2020","unstructured":"Lin, X., Zhao, J., Zhang, W., He, L., Wang, L., Chang, D., et al. (2020). Acute oral methylmercury exposure perturbs the gut microbiome and alters gut-brain axis related metabolites in rats. Ecotoxicology and Environmental Safety, 190, Article 110130. https:\/\/doi.org\/10.1016\/j.ecoenv.2019.110130","journal-title":"Ecotoxicology and Environmental Safety"},{"key":"10211_CR14","doi-asserted-by":"publisher","first-page":"5424","DOI":"10.1038\/s41467-018-07803-9","volume":"9","author":"M Coryell","year":"2018","unstructured":"Coryell, M., McAlpine, M., Pinkham, N. V., McDermott, T. R., & Walk, S. T. (2018). The gut microbiome is required for full protection against acute arsenic toxicity in mouse models. Nature Communications, 9, 5424. https:\/\/doi.org\/10.1038\/s41467-018-07803-9","journal-title":"Nature Communications"},{"key":"10211_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecoenv.2022.114430","volume":"249","author":"SE George","year":"2023","unstructured":"George, S. E., Devereux, R., James, J., Wan, Y., Diamond, G. L., Bradham, K. D., et al. (2023). Dietary lead modulates the mouse intestinal microbiome: Subacute exposure to lead acetate and lead contaminated soil. Ecotoxicology and Environmental Safety, 249, Article 114430. https:\/\/doi.org\/10.1016\/j.ecoenv.2022.114430","journal-title":"Ecotoxicology and Environmental Safety"},{"key":"10211_CR16","doi-asserted-by":"publisher","first-page":"563","DOI":"10.33963\/KP.a2023.0115","volume":"81","author":"F Violi","year":"2023","unstructured":"Violi, F., Nocella, C., Bartimoccia, S., Castellani, V., Carnevale, R., Pignatelli, P., et al. (2023). Gut dysbiosis-derived low-grade endotoxemia: A common basis for liver and cardiovascular disease. Kardiologia Polska, 81, 563\u201371. https:\/\/doi.org\/10.33963\/KP.a2023.0115","journal-title":"Kardiologia Polska"},{"key":"10211_CR17","doi-asserted-by":"publisher","DOI":"10.3390\/nu17233787","volume":"17","author":"E Kilic","year":"2025","unstructured":"Kilic, E., & Basaran, P. (2025). Dietary fatty acids modulate gut microbiota-derived trimethylamine-N-oxide: Potential mechanisms and future perspective. Nutrients, 17, Article 3787. https:\/\/doi.org\/10.3390\/nu17233787","journal-title":"Nutrients"},{"key":"10211_CR18","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s12012-026-10142-7","volume":"26","author":"AF Gadelmawla","year":"2026","unstructured":"Gadelmawla, A. F., Alsubaiei, A. A., AlSejari, N. Y., Alkuwaiti, M. A., Mahafdah, B., Abdul-Hafez, H. A., et al. (2026). Interpretable Machine Learning in Heavy Metal-Associated Cardiovascular and Metabolic Disease: A Review of Current Methodologies, Toxicological Insights, and Clinical Implications. Cardiovascular Toxicology, 26, 64. https:\/\/doi.org\/10.1007\/s12012-026-10142-7","journal-title":"Cardiovascular Toxicology"},{"key":"10211_CR19","doi-asserted-by":"publisher","DOI":"10.1007\/s12012-026-10178-9","volume":"26","author":"AF Gadelmawla","year":"2026","unstructured":"Gadelmawla, A. F., El-Farargy, S. H., Alsubaiei, A. A., AlSejari, N. Y., Hekal, M., Abdul-Hafez, H. A., et al. (2026). Toxic metal-essential trace element imbalance in cardiometabolic disease: Ferroptosis as a mechanistic link between environmental exposure and vascular injury. Cardiovascular Toxicology, 26, Article 101. https:\/\/doi.org\/10.1007\/s12012-026-10178-9","journal-title":"Cardiovascular Toxicology"},{"key":"10211_CR20","doi-asserted-by":"publisher","first-page":"333","DOI":"10.3390\/toxics13050333","volume":"13","author":"M Mititelu","year":"2025","unstructured":"Mititelu, M., Neac\u0219u, S. M., Busnatu \u0218tefan, S., Scafa-Udri\u0219te, A., Andronic, O., L\u0103craru, A-E., et al. (2025). Assessing Heavy Metal Contamination in Food: Implications for Human Health and Environmental Safety. Toxics, 13, 333. https:\/\/doi.org\/10.3390\/toxics13050333","journal-title":"Toxics"},{"key":"10211_CR21","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2024.120457","volume":"265","author":"MW Sultan","year":"2025","unstructured":"Sultan, M. W., Qureshi, F., Ahmed, S., Kamyab, H., Rajendran, S., Ibrahim, H., et al. (2025). A comprehensive review on arsenic contamination in groundwater: Sources, detection, mitigation strategies and cost analysis. Environmental Research, 265, Article 120457. https:\/\/doi.org\/10.1016\/j.envres.2024.120457","journal-title":"Environmental Research"},{"key":"10211_CR22","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.enceco.2023.02.001","volume":"5","author":"K Raj","year":"2023","unstructured":"Raj, K., & Das, A. P. (2023). Lead pollution: Impact on environment and human health and approach for a sustainable solution. Environmental Chemistry and Ecotoxicology, 5, 79\u201385. https:\/\/doi.org\/10.1016\/j.enceco.2023.02.001","journal-title":"Environmental Chemistry and Ecotoxicology"},{"key":"10211_CR23","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-30988-z","volume":"13","author":"J Kim","year":"2023","unstructured":"Kim, J., Song, H., Lee, J., Kim, Y. J., Chung, H. S., Yu, J. M., et al. (2023). Smoking and passive smoking increases mortality through mediation effect of cadmium exposure in the United States. Scientific Reports, 13, Article 3878. https:\/\/doi.org\/10.1038\/s41598-023-30988-z","journal-title":"Scientific Reports"},{"key":"10211_CR24","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-026-01238-5","volume":"45","author":"AAA Ibrahim","year":"2023","unstructured":"Ibrahim, A. A. A., El-Farargy, S. H., Saad, N. E., Elnaggar, M. Y., Abbas, O., Shahin, A. M., et al. (2023). Sociodemographic determinants of smoking among Jordanian men: Insights from the 2023 demographic and health survey. Journal of Health, Population, and Nutrition, 45, Article 73. https:\/\/doi.org\/10.1186\/s41043-026-01238-5","journal-title":"Journal of Health, Population, and Nutrition"},{"key":"10211_CR25","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192316006","volume":"19","author":"AC Olufemi","year":"2022","unstructured":"Olufemi, A. C., Mji, A., & Mukhola, M. S. (2022). Potential health risks of lead exposure from early life through later life: Implications for public health education. International Journal of Environmental Research and Public Health, 19, Article 16006. https:\/\/doi.org\/10.3390\/ijerph192316006","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"10211_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.hazadv.2025.100608","volume":"17","author":"P Rasin","year":"2025","unstructured":"Rasin, P., V, A. A., Basheer, S. M., Haribabu, J., Santibanez, J. F., Garrote, C. A., et al. (2025). Exposure to cadmium and its impacts on human health: A short review. Journal of Hazardous Materials Advances, 17, Article 100608. https:\/\/doi.org\/10.1016\/j.hazadv.2025.100608","journal-title":"Journal of Hazardous Materials Advances"},{"key":"10211_CR27","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1093\/toxsci\/kfw046","volume":"151","author":"J Wu","year":"2016","unstructured":"Wu, J., Wen, X. W., Faulk, C., Boehnke, K., Zhang, H., Dolinoy, D. C., et al. (2016). Perinatal Lead Exposure Alters Gut Microbiota Composition and Results in Sex-specific Bodyweight Increases in Adult Mice. Toxicological Sciences, 151, 324\u2013333. https:\/\/doi.org\/10.1093\/toxsci\/kfw046","journal-title":"Toxicological Sciences"},{"key":"10211_CR28","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1289\/EHP360","volume":"125","author":"Q Ba","year":"2017","unstructured":"Ba, Q., Li, M., Chen, P., Huang, C., Duan, X., Lu, L., et al. (2017). Sex-dependent effects of cadmium exposure in early life on gut microbiota and fat accumulation in mice. Environmental Health Perspectives, 125, 437\u201346. https:\/\/doi.org\/10.1289\/EHP360","journal-title":"Environmental Health Perspectives"},{"key":"10211_CR29","doi-asserted-by":"publisher","first-page":"1219729","DOI":"10.3389\/fvets.2023.1219729","volume":"10","author":"S Liu","year":"2023","unstructured":"Liu, S., Deng, X., Li, Z., Zhou, W., Wang, G., Zhan, J., et al. (2023). Environmental cadmium exposure alters the internal microbiota and metabolome of Sprague\u2013Dawley rats. Frontiers in Veterinary Science, 10, 1219729. https:\/\/doi.org\/10.3389\/fvets.2023.1219729","journal-title":"Frontiers in Veterinary Science"},{"key":"10211_CR30","doi-asserted-by":"publisher","first-page":"14422","DOI":"10.1021\/acs.est.8b04457","volume":"52","author":"M Calatayud","year":"2018","unstructured":"Calatayud, M., Xiong, C., Du Laing, G., Raber, G., Francesconi, K., & Van De Wiele, T. (2018). Salivary and gut microbiomes play a significant role in in vitro oral bioaccessibility, biotransformation, and intestinal absorption of arsenic from food. Environmental Science & Technology, 52, 14422\u201335. https:\/\/doi.org\/10.1021\/acs.est.8b04457","journal-title":"Environmental Science & Technology"},{"key":"10211_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2020.114580","volume":"263","author":"H Chi","year":"2020","unstructured":"Chi, H., Hou, Y., Li, G., Zhang, Y., Coulon, F., & Cai, C. (2020). In vitro model insights into the role of human gut microbiota on arsenic bioaccessibility and its speciation in soils. Environmental Pollution, 263, Article 114580. https:\/\/doi.org\/10.1016\/j.envpol.2020.114580","journal-title":"Environmental Pollution"},{"key":"10211_CR32","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1289\/ehp.1307759","volume":"122","author":"SSC DC.Rubin","year":"2014","unstructured":"DC.Rubin, S. S. C., Alava, P., Zekker, I., Du Laing, G., & Van De Wiele, T. (2014). Arsenic Thiolation and the Role of Sulfate-Reducing Bacteria from the Human Intestinal Tract. Environmental Health Perspectives, 122, 817\u2013822. https:\/\/doi.org\/10.1289\/ehp.1307759","journal-title":"Environmental Health Perspectives"},{"key":"10211_CR33","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1007\/s40495-019-00206-4","volume":"5","author":"M Coryell","year":"2019","unstructured":"Coryell, M., Roggenbeck, B. A., & Walk, S. T. (2019). The Human Gut Microbiome\u2019s Influence on Arsenic Toxicity. Curr Pharmacol Rep, 5, 491\u2013504. https:\/\/doi.org\/10.1007\/s40495-019-00206-4","journal-title":"Curr Pharmacol Rep"},{"key":"10211_CR34","doi-asserted-by":"publisher","DOI":"10.1128\/mSphere.00021-21","volume":"6","author":"M Leclerc","year":"2021","unstructured":"Leclerc, M., Harrison, M. C., Storck, V., Planas, D., Amyot, M., & Walsh, D. A. (2021). Microbial diversity and mercury methylation activity in periphytic biofilms at a run-of-river hydroelectric dam and constructed wetlands. mSphere, 6, Article e00021-21. https:\/\/doi.org\/10.1128\/mSphere.00021-21","journal-title":"mSphere"},{"key":"10211_CR35","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.toxlet.2015.11.022","volume":"242","author":"SE Rothenberg","year":"2016","unstructured":"Rothenberg, S. E., Keiser, S., Ajami, N. J., Wong, M. C., Gesell, J., Petrosino, J. F., et al. (2016). The role of gut microbiota in fetal methylmercury exposure: Insights from a pilot study. Toxicology Letters, 242, 60\u20137. https:\/\/doi.org\/10.1016\/j.toxlet.2015.11.022","journal-title":"Toxicology Letters"},{"key":"10211_CR36","doi-asserted-by":"publisher","first-page":"2399","DOI":"10.1007\/s00204-023-03548-7","volume":"97","author":"GL Coe","year":"2023","unstructured":"Coe, G. L., Krout, I. N., Munro-Ehrlich, M., Beamish, C. R., Vorojeikina, D., Colman, D. R., et al. (2023). Assessing the role of the gut microbiome in methylmercury demethylation and elimination in humans and gnotobiotic mice. Archives of Toxicology, 97, 2399\u2013418. https:\/\/doi.org\/10.1007\/s00204-023-03548-7","journal-title":"Archives of Toxicology"},{"key":"10211_CR37","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1080\/153765291009804","volume":"15","author":"RK Upreti","year":"2005","unstructured":"Upreti, R. K., Shrivastava, R., Kannan, A., & Chaturvedi, U. C. (2005). A Comparative Study on Rat Intestinal Epithelial Cells and Resident Gut Bacteria: (I) Effect of Hexavalent Chromium. Toxicology Mechanisms and Methods, 15, 331\u2013338. https:\/\/doi.org\/10.1080\/153765291009804","journal-title":"Toxicology Mechanisms and Methods"},{"key":"10211_CR38","doi-asserted-by":"publisher","DOI":"10.1016\/j.chemosphere.2021.132556","volume":"288","author":"W Hao","year":"2022","unstructured":"Hao, W., Hao, C., Wu, C., Xu, Y., & Jin, C. (2022). Aluminum induced intestinal dysfunction via mechanical, immune, chemical and biological barriers. Chemosphere, 288, Article 132556. https:\/\/doi.org\/10.1016\/j.chemosphere.2021.132556","journal-title":"Chemosphere"},{"key":"10211_CR39","doi-asserted-by":"publisher","DOI":"10.1016\/j.taap.2020.115155","volume":"403","author":"S Medina","year":"2020","unstructured":"Medina, S., Lauer, F. T., Castillo, E. F., Bolt, A. M., Ali, A.-M., Liu, K. J., et al. (2020). Exposures to uranium and arsenic alter intraepithelial and innate immune cells in the small intestine of male and female mice. Toxicology and Applied Pharmacology, 403, Article 115155. https:\/\/doi.org\/10.1016\/j.taap.2020.115155","journal-title":"Toxicology and Applied Pharmacology"},{"key":"10211_CR40","doi-asserted-by":"publisher","first-page":"3057","DOI":"10.1002\/jsfa.13197","volume":"104","author":"N Wang","year":"2024","unstructured":"Wang, N., Gao, X., Huo, Y., Li, Y., Cheng, F., & Zhang, Z. (2024). Lead exposure aggravates glucose metabolism disorders through gut microbiota dysbiosis and intestinal barrier damage in high-fat diet\u2010fed mice. Journal of the Science of Food and Agriculture, 104, 3057\u201368. https:\/\/doi.org\/10.1002\/jsfa.13197","journal-title":"Journal of the Science of Food and Agriculture"},{"key":"10211_CR41","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1186\/s12302-024-01038-w","volume":"36","author":"G Li","year":"2024","unstructured":"Li, G., Chi, H., Hou, Y., Williams, P. N., Liu, Z., & Cai, C. (2024). Accurate bioaccessibility assessment of soil heavy metals by combining their speciation and in vitro model with human gut microbiota. Environ Sci Eur, 36, 209. https:\/\/doi.org\/10.1186\/s12302-024-01038-w","journal-title":"Environ Sci Eur"},{"key":"10211_CR42","doi-asserted-by":"publisher","first-page":"8823","DOI":"10.1038\/s41598-020-65449-4","volume":"10","author":"X Chen","year":"2020","unstructured":"Chen, X., Singh, A., & Kitts, D. D. (2020). In-vitro bioaccessibility and bioavailability of heavy metals in mineral clay complex used in natural health products. Scientific Reports, 10, 8823. https:\/\/doi.org\/10.1038\/s41598-020-65449-4","journal-title":"Scientific Reports"},{"key":"10211_CR43","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2021.116943","volume":"279","author":"N Yin","year":"2021","unstructured":"Yin, N., Zhao, Y., Wang, P., Du, H., Yang, M., Han, Z., et al. (2021). Effect of gut microbiota on in vitro bioaccessibility of heavy metals and human health risk assessment from ingestion of contaminated soils. Environmental Pollution, 279, Article 116943. https:\/\/doi.org\/10.1016\/j.envpol.2021.116943","journal-title":"Environmental Pollution"},{"key":"10211_CR44","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1289\/ehp.1307429","volume":"122","author":"K Lu","year":"2014","unstructured":"Lu, K., Abo, R. P., Schlieper, K. A., Graffam, M. E., Levine, S., Wishnok, J. S., et al. (2014). Arsenic exposure perturbs the gut microbiome and its metabolic profile in mice: An integrated metagenomics and metabolomics analysis. Environmental Health Perspectives, 122, 284\u201391. https:\/\/doi.org\/10.1289\/ehp.1307429","journal-title":"Environmental Health Perspectives"},{"key":"10211_CR45","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2024.109017","volume":"192","author":"Z Peng","year":"2024","unstructured":"Peng, Z., Liao, Y., Yang, W., & Liu, L. (2024). Metal(loid)-gut microbiota interactions and microbiota-related protective strategies: A review. Environment International, 192, Article 109017. https:\/\/doi.org\/10.1016\/j.envint.2024.109017","journal-title":"Environment International"},{"key":"10211_CR46","doi-asserted-by":"publisher","DOI":"10.3390\/biom13101549","volume":"13","author":"Y Tizabi","year":"2023","unstructured":"Tizabi, Y., Bennani, S., El Kouhen, N., Getachew, B., & Aschner, M. (2023). Interaction of heavy metal lead with gut microbiota: Implications for autism spectrum disorder. Biomolecules, 13, Article 1549. https:\/\/doi.org\/10.3390\/biom13101549","journal-title":"Biomolecules"},{"key":"10211_CR47","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2025.1516010","volume":"15","author":"M Shabani","year":"2025","unstructured":"Shabani, M., Ghoshehy, A., Mottaghi, A. M., Chegini, Z., Kerami, A., Shariati, A., et al. (2025). The relationship between gut microbiome and human diseases: Mechanisms, predisposing factors and potential intervention. Frontiers in Cellular and Infection Microbiology, 15, Article 1516010. https:\/\/doi.org\/10.3389\/fcimb.2025.1516010","journal-title":"Frontiers in Cellular and Infection Microbiology"},{"key":"10211_CR48","doi-asserted-by":"publisher","first-page":"649","DOI":"10.3390\/vetsci10110649","volume":"10","author":"X Wang","year":"2023","unstructured":"Wang, X., Mi, J., Yang, K., & Wang, L. (2023). Environmental Cadmium Exposure Perturbs Gut Microbial Dysbiosis in Ducks. Veterinary Sciences, 10, 649. https:\/\/doi.org\/10.3390\/vetsci10110649","journal-title":"Veterinary Sciences"},{"key":"10211_CR49","doi-asserted-by":"publisher","DOI":"10.3390\/antiox15020175","volume":"15","author":"X Wu","year":"2026","unstructured":"Wu, X., Mu, B., Li, G., Du, R., & Park, S. (2026). Gut microbial composition, oxidative stress, and immunity in metabolic disease: Toward personalized interventions. Antioxidants, 15, Article 175. https:\/\/doi.org\/10.3390\/antiox15020175","journal-title":"Antioxidants"},{"key":"10211_CR50","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1080\/17474124.2017.1343143","volume":"11","author":"M Vancamelbeke","year":"2017","unstructured":"Vancamelbeke, M., & Vermeire, S. (2017). The intestinal barrier: A fundamental role in health and disease. Expert Review of Gastroenterology & Hepatology, 11, 821\u2013834. https:\/\/doi.org\/10.1080\/17474124.2017.1343143","journal-title":"Expert Review of Gastroenterology & Hepatology"},{"key":"10211_CR51","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1006\/taap.1998.8589","volume":"155","author":"E Duizer","year":"1999","unstructured":"Duizer, E., Gilde, A. J., Versantvoort, C. H. M., & Groten, J. P. (1999). Effects of Cadmium Chloride on the Paracellular Barrier Function of Intestinal Epithelial Cell Lines. Toxicology and Applied Pharmacology, 155, 117\u2013126. https:\/\/doi.org\/10.1006\/taap.1998.8589","journal-title":"Toxicology and Applied Pharmacology"},{"key":"10211_CR52","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1039\/c9mt00144a","volume":"11","author":"GM Chiocchetti","year":"2019","unstructured":"Chiocchetti, G. M., V\u00e9lez, D., & Devesa, V. (2019). Inorganic arsenic causes intestinal barrier disruption. Metallomics, 11, 1411\u20138. https:\/\/doi.org\/10.1039\/c9mt00144a","journal-title":"Metallomics"},{"key":"10211_CR53","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines10020289","volume":"10","author":"C Stolfi","year":"2022","unstructured":"Stolfi, C., Maresca, C., Monteleone, G., & Laudisi, F. (2022). Implication of intestinal barrier dysfunction in gut dysbiosis and diseases. Biomedicines, 10, Article 289. https:\/\/doi.org\/10.3390\/biomedicines10020289","journal-title":"Biomedicines"},{"key":"10211_CR54","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms8020211","volume":"8","author":"Y Liu","year":"2020","unstructured":"Liu, Y., Li, Y., Xia, Y., Liu, K., Ren, L., & Ji, Y. (2020). The dysbiosis of gut microbiota caused by low-dose cadmium aggravate the injury of mice liver through increasing intestinal permeability. Microorganisms, 8, Article 211. https:\/\/doi.org\/10.3390\/microorganisms8020211","journal-title":"Microorganisms"},{"key":"10211_CR55","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.594150","volume":"11","author":"S Mohammad","year":"2021","unstructured":"Mohammad, S., & Thiemermann, C. (2021). Role of metabolic endotoxemia in systemic inflammation and potential interventions. Frontiers in Immunology, 11, Article 594150. https:\/\/doi.org\/10.3389\/fimmu.2020.594150","journal-title":"Frontiers in Immunology"},{"key":"10211_CR56","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1701504","volume":"16","author":"CG Nikolaidis","year":"2025","unstructured":"Nikolaidis, C. G., Gyriki, D., Stavropoulou, E., Karlafti, E., Didangelos, T., Tsigalou, C., et al. (2025). Targeting the TLR4 axis with microbiota-oriented interventions and innovations in diabetes therapy: A narrative review. Frontiers in Immunology, 16, Article 1701504. https:\/\/doi.org\/10.3389\/fimmu.2025.1701504","journal-title":"Frontiers in Immunology"},{"key":"10211_CR57","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.metabol.2016.12.009","volume":"68","author":"JMG Gomes","year":"2017","unstructured":"Gomes, J. M. G., Costa, J. D. A., & Alfenas, R. D. C. G. (2017). Metabolic endotoxemia and diabetes mellitus: A systematic review. Metabolism, 68, 133\u201344. https:\/\/doi.org\/10.1016\/j.metabol.2016.12.009","journal-title":"Metabolism"},{"key":"10211_CR58","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2023.1120168","volume":"10","author":"Y Zhang","year":"2023","unstructured":"Zhang, Y., Zhu, X., Yu, X., Nov\u00e1k, P., Gui, Q., & Yin, K. (2023). Enhancing intestinal barrier efficiency: A novel metabolic diseases therapy. Frontiers in Nutrition, 10, Article 1120168. https:\/\/doi.org\/10.3389\/fnut.2023.1120168","journal-title":"Frontiers in Nutrition"},{"key":"10211_CR59","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1038\/s41569-022-00737-2","volume":"20","author":"F Violi","year":"2023","unstructured":"Violi, F., Cammisotto, V., Bartimoccia, S., Pignatelli, P., Carnevale, R., & Nocella, C. (2023). Gut-derived low-grade endotoxaemia, atherothrombosis and cardiovascular disease. Nature Reviews. Cardiology, 20, 24\u201337. https:\/\/doi.org\/10.1038\/s41569-022-00737-2","journal-title":"Nature Reviews. Cardiology"},{"key":"10211_CR60","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1007\/s13238-018-0549-0","volume":"9","author":"Z Wang","year":"2018","unstructured":"Wang, Z., & Zhao, Y. (2018). Gut microbiota derived metabolites in cardiovascular health and disease. Protein & Cell, 9, 416\u201331. https:\/\/doi.org\/10.1007\/s13238-018-0549-0","journal-title":"Protein & Cell"},{"key":"10211_CR61","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2021.1897212","volume":"13","author":"A Nogal","year":"2021","unstructured":"Nogal, A., Valdes, A. M., & Menni, C. (2021). The role of short-chain fatty acids in the interplay between gut microbiota and diet in cardio-metabolic health. Gut Microbes, 13, Article 1897212. https:\/\/doi.org\/10.1080\/19490976.2021.1897212","journal-title":"Gut Microbes"},{"key":"10211_CR62","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1093\/nutrit\/nuad042","volume":"82","author":"NHT Pham","year":"2024","unstructured":"Pham, N. H. T., Joglekar, M. V., Wong, W. K. M., Nassif, N. T., Simpson, A. M., & Hardikar, A. A. (2024). Short-chain fatty acids and insulin sensitivity: A systematic review and meta-analysis. Nutrition Reviews, 82, 193\u2013209. https:\/\/doi.org\/10.1093\/nutrit\/nuad042","journal-title":"Nutrition Reviews"},{"key":"10211_CR63","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.cmet.2012.12.011","volume":"17","author":"BJ Bennett","year":"2013","unstructured":"Bennett, B. J., Vallim, T., Wang, Z., Shih, D. M., Meng, Y., Gregory, J., et al. (2013). Trimethylamine-N-oxide, a metabolite associated with atherosclerosis, exhibits complex genetic and dietary regulation. Cell Metabolism, 17, 49\u201360. https:\/\/doi.org\/10.1016\/j.cmet.2012.12.011","journal-title":"Cell Metabolism"},{"key":"10211_CR64","doi-asserted-by":"publisher","first-page":"1085041","DOI":"10.3389\/fendo.2023.1085041","volume":"14","author":"J Zhen","year":"2023","unstructured":"Zhen, J., Zhou, Z., He, M., Han, H-X., Lv, E-H., Wen, P-B., et al. (2023). The gut microbial metabolite trimethylamine N-oxide and cardiovascular diseases. Frontiers In Endocrinology, 14, 1085041. https:\/\/doi.org\/10.3389\/fendo.2023.1085041","journal-title":"Frontiers In Endocrinology"},{"key":"10211_CR65","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61101767","volume":"61","author":"O Amaritei","year":"2025","unstructured":"Amaritei, O., Mierlan, O. L., Dinu, C. A., Chiscop, I., Matei, M. N., Gutu, C., et al. (2025). TMAO and cardiovascular disease: Exploring its potential as a biomarker. Medicina, 61, Article 1767. https:\/\/doi.org\/10.3390\/medicina61101767","journal-title":"Medicina"},{"key":"10211_CR66","doi-asserted-by":"publisher","DOI":"10.1186\/s12986-025-01051-7","volume":"23","author":"M Abavisani","year":"2025","unstructured":"Abavisani, M., Sajjadi, S. M., Ebadpour, N., Karav, S., & Sahebkar, A. (2025). Gut microbiota\u2013cholesterol crosstalk in cardiovascular diseases: Mechanisms, metabolites, and therapeutic modulation. Nutrition & Metabolism, 23, Article 4. https:\/\/doi.org\/10.1186\/s12986-025-01051-7","journal-title":"Nutrition & Metabolism"},{"key":"10211_CR67","doi-asserted-by":"publisher","DOI":"10.31083\/RCM44050","volume":"27","author":"L Xu","year":"2026","unstructured":"Xu, L., Yang, H., He, C., Zhang, H., Jiang, Z., Zhang, Y., et al. (2026). Bile acids: The contribution of the gut microbiota to atherosclerosis. Reviews in Cardiovascular Medicine, 27, Article 44050. https:\/\/doi.org\/10.31083\/RCM44050","journal-title":"Reviews in Cardiovascular Medicine"},{"key":"10211_CR68","doi-asserted-by":"publisher","DOI":"10.3390\/nu17071247","volume":"17","author":"R Cedillo-Flores","year":"2025","unstructured":"Cedillo-Flores, R., Cuevas-Budhart, M. A., Cavero-Redondo, I., Kappes, M., \u00c1vila-D\u00edaz, M., & Paniagua, R. (2025). Impact of gut microbiome modulation on uremic toxin reduction in chronic kidney disease: A systematic review and network meta-analysis. Nutrients, 17, Article 1247. https:\/\/doi.org\/10.3390\/nu17071247","journal-title":"Nutrients"},{"key":"10211_CR69","doi-asserted-by":"publisher","DOI":"10.3390\/toxins10070287","volume":"10","author":"MT Velasquez","year":"2018","unstructured":"Velasquez, M. T., Centron, P., Barrows, I., Dwivedi, R., & Raj, D. S. (2018). Gut microbiota and cardiovascular uremic toxicities. Toxins, 10, Article 287. https:\/\/doi.org\/10.3390\/toxins10070287","journal-title":"Toxins"},{"key":"10211_CR70","doi-asserted-by":"publisher","DOI":"10.3390\/ijms241310705","volume":"24","author":"M Dubsky","year":"2023","unstructured":"Dubsky, M., Veleba, J., Sojakova, D., Marhefkova, N., Fejfarova, V., & Jude, E. B. (2023). Endothelial dysfunction in diabetes mellitus: New insights. International Journal of Molecular Sciences, 24, Article 10705. https:\/\/doi.org\/10.3390\/ijms241310705","journal-title":"International Journal of Molecular Sciences"},{"key":"10211_CR71","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.cdtm.2020.02.005","volume":"6","author":"A Yang","year":"2020","unstructured":"Yang, A., Lo, K., Zheng, T., Yang, J., Bai, Y., Feng, Y., et al. (2020). Environmental heavy metals and cardiovascular diseases: Status and future direction. Chronic Diseases and Translational Medicine, 6, 251\u20139. https:\/\/doi.org\/10.1016\/j.cdtm.2020.02.005","journal-title":"Chronic Diseases and Translational Medicine"},{"key":"10211_CR72","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1161\/CIRCRESAHA.120.316242","volume":"127","author":"M Witkowski","year":"2020","unstructured":"Witkowski, M., Weeks, T. L., & Hazen, S. L. (2020). Gut Microbiota and Cardiovascular Disease. Circulation Research, 127, 553\u2013570. https:\/\/doi.org\/10.1161\/CIRCRESAHA.120.316242","journal-title":"Circulation Research"},{"key":"10211_CR73","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.3390\/nu12102982","volume":"12","author":"BJH Verhaar","year":"2020","unstructured":"Verhaar, B. J. H., Prodan, A., Nieuwdorp, M., & Muller, M. (2020). Gut Microbiota in Hypertension and Atherosclerosis: A Review. Nutrients, 12, 2982. https:\/\/doi.org\/10.3390\/nu12102982","journal-title":"Nutrients"},{"key":"10211_CR74","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k3310","author":"R Chowdhury","year":"2018","unstructured":"Chowdhury, R., Ramond, A., O\u2019Keeffe, L. M., Shahzad, S., Kunutsor, S. K., Muka, T., et al. (2018). Environmental toxic metal contaminants and risk of cardiovascular disease: Systematic review and meta-analysis. BMJ. https:\/\/doi.org\/10.1136\/bmj.k3310","journal-title":"BMJ"},{"key":"10211_CR75","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1097\/CM9.0000000000000696","volume":"133","author":"P-X Wang","year":"2020","unstructured":"Wang, P-X., Deng, X-R., Zhang, C-H., & Yuan, H-J. (2020). Gut microbiota and metabolic syndrome. Chinese Medical Journal, 133, 808\u2013816. https:\/\/doi.org\/10.1097\/CM9.0000000000000696","journal-title":"Chinese Medical Journal"},{"key":"10211_CR76","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-039541","volume":"11","author":"JH Ji","year":"2021","unstructured":"Ji, J. H., Jin, M. H., Kang, J.-H., Lee, S. I., Lee, S., Kim, S.-H., et al. (2021). Relationship between heavy metal exposure and type 2 diabetes: A large-scale retrospective cohort study using occupational health examinations. BMJ Open, 11, Article e039541. https:\/\/doi.org\/10.1136\/bmjopen-2020-039541","journal-title":"BMJ Open"},{"key":"10211_CR77","doi-asserted-by":"publisher","DOI":"10.3390\/toxics11080670","volume":"11","author":"AC Martins","year":"2023","unstructured":"Martins, A. C., Ferrer, B., Tinkov, A. A., Caito, S., Deza-Ponzio, R., Skalny, A. V., et al. (2023). Association between heavy metals, metalloids and metabolic syndrome: New insights and approaches. Toxics, 11, Article 670. https:\/\/doi.org\/10.3390\/toxics11080670","journal-title":"Toxics"},{"key":"10211_CR78","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.biochi.2015.06.020","volume":"124","author":"NE Boutagy","year":"2016","unstructured":"Boutagy, N. E., McMillan, R. P., Frisard, M. I., & Hulver, M. W. (2016). Metabolic endotoxemia with obesity: Is it real and is it relevant? Biochimie, 124, 11\u201320. https:\/\/doi.org\/10.1016\/j.biochi.2015.06.020","journal-title":"Biochimie"},{"key":"10211_CR79","doi-asserted-by":"publisher","DOI":"10.3390\/nu12030859","volume":"12","author":"MCW Myhrstad","year":"2020","unstructured":"Myhrstad, M. C. W., Tunsj\u00f8, H., Charnock, C., & Telle-Hansen, V. H. (2020). Dietary fiber, gut microbiota, and metabolic regulation\u2014current status in human randomized trials. Nutrients, 12, Article 859. https:\/\/doi.org\/10.3390\/nu12030859","journal-title":"Nutrients"},{"key":"10211_CR80","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms10122507","volume":"10","author":"J Fu","year":"2022","unstructured":"Fu, J., Zheng, Y., Gao, Y., & Xu, W. (2022). Dietary fiber intake and gut microbiota in human health. Microorganisms, 10, Article 2507. https:\/\/doi.org\/10.3390\/microorganisms10122507","journal-title":"Microorganisms"}],"container-title":["Cardiovascular Toxicology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12012-026-10211-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12012-026-10211-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12012-026-10211-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:02:35Z","timestamp":1791957755000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12012-026-10211-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":80,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10211"],"URL":"https:\/\/doi.org\/10.1007\/s12012-026-10211-x","relation":{},"ISSN":["1530-7905","1559-0259"],"issn-type":[{"value":"1530-7905","type":"print"},{"value":"1559-0259","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"assertion":[{"value":"31 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflict of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Ethics Approval and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors did not use any artificial intelligence tool in any of the study processes.","order":4,"name":"Ethics","label":"Artificial Intelligence","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"128"}}