{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T05:39:26Z","timestamp":1775885966447,"version":"3.50.1"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":37,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Commun"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>While treatment with nirmatrelvir\/ritonavir or molnupiravir is effective in lowering the rate of severe COVID-19, the effectiveness of these antivirals in reducing the risk of cardiovascular outcomes, especially among the hospitalized population, remains largely unknown. In this study, we assessed the real-world\u00a0effectiveness of nirmatrelvir\/ritonavir and molnupiravir on short- and long-term cardiovascular complications of COVID-19 using a target trial emulation design. Two target trials of COVID-19 antivirals were emulated by using a territory-wide, population-based, retrospective cohort of hospitalized patients in Hong Kong. Nine cardiovascular outcomes were evaluated in both short-term (day 0\u201321) and long-term (day 22\u2013365) post-SARS-CoV-2 infection. Compared with the control\u00a0group, the use of nirmatrelvir\/ritonavir was associated with a significantly lower one-year risk of cardiovascular mortality, composite cardiovascular complications, major adverse cardiac events, cerebrovascular disorders, dysrhythmia, ischemic heart disease, and other cardiac disorders following infection. Molnupiravir use was associated with a short-term risk reduction in cardiovascular complications, but only a marginal risk reduction in long-term cardiovascular mortality among other complications. This study demonstrated the effectiveness of nirmatrelvir\/ritonavir in reducing the risks of short- and long-term cardiovascular complications following a SARS-CoV-2 infection among the hospitalized population. Our findings suggested health-related benefits of prescribing nirmatrelvir\/ritonavir over molnupiravir against severe cardiovascular post-acute sequelae of COVID-19 in the long term.<\/jats:p>","DOI":"10.1038\/s41467-025-67776-4","type":"journal-article","created":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T04:45:14Z","timestamp":1766292314000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of nirmatrelvir\/ritonavir and molnupiravir in reducing the risk of short-term and long-term cardiovascular complications of COVID-19: a target trial emulation study"],"prefix":"10.1038","volume":"17","author":[{"given":"Zihao","family":"Guo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuchen","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5996-2927","authenticated-orcid":false,"given":"Guozhang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine Min","family":"Jia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1101-2045","authenticated-orcid":false,"given":"Christopher","family":"Boyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huwen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conglu","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2103-8377","authenticated-orcid":false,"given":"Chi Tim","family":"Hung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie Ho Kwan","family":"Yam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsz Yu","family":"Chow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8722-6149","authenticated-orcid":false,"given":"Shi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3778-7068","authenticated-orcid":false,"given":"Kehang","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aimin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0525-6772","authenticated-orcid":false,"given":"Chris Ka Pun","family":"Mok","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4382-2445","authenticated-orcid":false,"given":"David SC","family":"Hui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1721-9450","authenticated-orcid":false,"given":"Eng Kiong","family":"Yeoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5610-1298","authenticated-orcid":false,"given":"Ka Chun","family":"Chong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,21]]},"reference":[{"key":"67776_CR1","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1056\/NEJMoa2118542","volume":"386","author":"J Hammond","year":"2022","unstructured":"Hammond, J. et al. EPIC-HR Investigators. Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N. Engl. J. Med. 386, 1397\u20131408 (2022).","journal-title":"N. Engl. J. Med."},{"key":"67776_CR2","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1056\/NEJMoa2204919","volume":"387","author":"R Arbel","year":"2022","unstructured":"Arbel, R. et al. Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge. N. Engl. J. Med. 387, 790\u2013798 (2022).","journal-title":"N. Engl. J. Med."},{"key":"67776_CR3","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1016\/S1473-3099(22)00507-2","volume":"22","author":"CKH Wong","year":"2022","unstructured":"Wong, C. K. H. et al. Real-world effectiveness of early molnupiravir or nirmatrelvir-ritonavir in hospitalised patients with COVID-19 without supplemental oxygen requirement on admission during Hong Kong\u2019s omicron BA.2 wave: a retrospective cohort study. Lancet Infect. Dis. 22, 1681\u20131693 (2022).","journal-title":"Lancet Infect. Dis."},{"key":"67776_CR4","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1001\/jamainternmed.2023.0743","volume":"183","author":"Y Xie","year":"2023","unstructured":"Xie, Y., Choi, T. & Al-Aly, Z. Association of Treatment With Nirmatrelvir and the Risk of Post-COVID-19 Condition. JAMA Intern Med. 183, 554\u2013564 (2023).","journal-title":"JAMA Intern Med."},{"key":"67776_CR5","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.7326\/M23-1394","volume":"176","author":"GN Ioannou","year":"2023","unstructured":"Ioannou, G. N. et al. Effectiveness of Nirmatrelvir-Ritonavir Against the Development of Post-COVID-19 Conditions Among U.S. Veterans: A Target Trial Emulation. Ann. Intern. Med. 176, 1486\u20131497 (2023).","journal-title":"Ann. Intern. Med."},{"key":"67776_CR6","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.1038\/s41591-024-03173-6","volume":"30","author":"Z Al-Aly","year":"2024","unstructured":"Al-Aly, Z. et al. Long COVID science, research and policy. Nat. Med. 30, 2148\u20132164 (2024).","journal-title":"Nat. Med."},{"key":"67776_CR7","doi-asserted-by":"publisher","first-page":"1648","DOI":"10.1161\/CIRCULATIONAHA.120.046941","volume":"141","author":"KJ Clerkin","year":"2020","unstructured":"Clerkin, K. J. et al. COVID-19 and Cardiovascular Disease. Circulation 141, 1648\u20131655 (2020).","journal-title":"Circulation"},{"key":"67776_CR8","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","volume":"28","author":"Y Xie","year":"2022","unstructured":"Xie, Y., Xu, E., Bowe, B. & Al-Aly, Z. Long-term cardiovascular outcomes of COVID-19. Nat. Med. 28, 583\u2013590 (2022).","journal-title":"Nat. Med."},{"key":"67776_CR9","doi-asserted-by":"publisher","first-page":"2406","DOI":"10.1038\/s41591-022-02001-z","volume":"28","author":"E Xu","year":"2022","unstructured":"Xu, E., Xie, Y. & Al-Aly, Z. Long-term neurologic outcomes of COVID-19. Nat. Med. 28, 2406\u20132415 (2022).","journal-title":"Nat. Med."},{"key":"67776_CR10","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-024-03331-0","volume":"22","author":"W Wang","year":"2024","unstructured":"Wang, W. et al. Paxlovid use is associated with lower risk of cardiovascular diseases in COVID-19 patients with autoimmune rheumatic diseases: a retrospective cohort study. BMC Med. 22, 117 (2024).","journal-title":"BMC Med."},{"key":"67776_CR11","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae756","volume":"12","author":"IA Strohbehn","year":"2024","unstructured":"Strohbehn, I. A. et al. The Effect of Nirmatrelvir-Ritonavir on Short- and Long-term Adverse Outcomes From COVID-19 Among Patients With Kidney Disease: A Propensity Score-Matched Study. Open Forum Infect. Dis. 12, ofae756 (2024).","journal-title":"Open Forum Infect. Dis."},{"key":"67776_CR12","unstructured":"RECOVER-VITAL: Platform Protocol to Measure the Effects of Antiviral Therapies on Long COVID Symptoms (RECOVER-VITAL). Clinicaltrials.gov. [cited 2025 Oct 17]. Available from: https:\/\/clinicaltrials.gov\/study\/NCT05595369."},{"key":"67776_CR13","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1016\/S1473-3099(25)00073-8","volume":"25","author":"M Sawano","year":"2025","unstructured":"Sawano, M. et al. Nirmatrelvir-ritonavir versus placebo-ritonavir in individuals with long COVID in the USA (PAX LC): a double-blind, randomised, placebo-controlled, phase 2, decentralised trial. Lancet Infect. Dis. 25, 936\u2013946 (2025).","journal-title":"Lancet Infect. Dis."},{"key":"67776_CR14","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1001\/jamainternmed.2024.2007","volume":"184","author":"LN Geng","year":"2024","unstructured":"Geng, L. N. et al. Nirmatrelvir-ritonavir and symptoms in adults with postacute sequelae of SARS-CoV-2 infection: The STOP-PASC randomized clinical trial: The STOP-PASC randomized clinical trial. JAMA Intern Med. 184, 1024\u20131034 (2024).","journal-title":"JAMA Intern Med."},{"key":"67776_CR15","unstructured":"Canadian Adaptive Platform Trial of Treatments for COVID-19 in Community Settings (CanTreatCOVID). Clinicaltrials.gov. [cited 2025 Oct 17]. Available from: https:\/\/clinicaltrials.gov\/study\/NCT05614349."},{"key":"67776_CR16","doi-asserted-by":"crossref","unstructured":"Yu, Q. et al. Risk factors for long-term cardiovascular post-acute sequelae of COVID-19 infection: A nested case-control study in Hong Kong. npj Cardiovasc Health. 1, 10 (2024).","DOI":"10.1038\/s44325-024-00011-z"},{"key":"67776_CR17","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.28992","volume":"95","author":"TH Liu","year":"2023","unstructured":"Liu, T. H. et al. Effectiveness of oral antiviral agents on long-term cardiovascular risk in nonhospitalized patients with COVID-19: A multicenter matched cohort study. J. Med. Virol. 95, e28992 (2023).","journal-title":"J. Med. Virol."},{"key":"67776_CR18","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/S0140-6736(22)02597-1","volume":"401","author":"CC Butler","year":"2023","unstructured":"Butler, C. C. et al. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial. Lancet 401, 281\u2013293 (2023).","journal-title":"Lancet"},{"key":"67776_CR19","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1056\/NEJMoa2116044","volume":"386","author":"A Jayk Bernal","year":"2022","unstructured":"Jayk Bernal, A. et al. MOVe-OUT Study Group. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N. Engl. J. Med. 386, 509\u2013520 (2022).","journal-title":"N. Engl. J. Med."},{"key":"67776_CR20","doi-asserted-by":"publisher","first-page":"505","DOI":"10.7326\/M22-3057","volume":"176","author":"EYF Wan","year":"2023","unstructured":"Wan, E. Y. F. et al. Effectiveness of molnupiravir and nirmatrelvir-ritonavir in hospitalized patients with COVID-19: A target trial emulation study. Ann. Intern Med. 176, 505\u2013514 (2023).","journal-title":"Ann. Intern Med."},{"key":"67776_CR21","doi-asserted-by":"publisher","first-page":"807","DOI":"10.7326\/M22-3565","volume":"176","author":"KL Bajema","year":"2023","unstructured":"Bajema, K. L. et al. Effectiveness of COVID-19 Treatment With Nirmatrelvir-Ritonavir or Molnupiravir Among U.S. Veterans: Target Trial Emulation Studies With One-Month and Six-Month Outcomes. Ann. Intern. Med. 176, 807\u2013816 (2023).","journal-title":"Ann. Intern. Med."},{"key":"67776_CR22","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2025.2469648","volume":"14","author":"Y Wei","year":"2025","unstructured":"Wei, Y. et al. Effectiveness of nirmatrelvir\/ritonavir and molnupiravir on post-COVID-19 outcomes among outpatients: a target trial emulation investigation. Emerg. Microbes Infect. 14, 2469648 (2025).","journal-title":"Emerg. Microbes Infect."},{"key":"67776_CR23","doi-asserted-by":"publisher","first-page":"e074572","DOI":"10.1136\/bmj-2022-074572","volume":"381","author":"Y Xie","year":"2023","unstructured":"Xie, Y., Choi, T. & Al-Aly, Z. Molnupiravir and risk of post-acute sequelae of covid-19: cohort study. BMJ. 381, e074572 (2023).","journal-title":"BMJ"},{"key":"67776_CR24","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.28648","volume":"95","author":"Z Guo","year":"2023","unstructured":"Guo, Z. et al. Comparing the incubation period, serial interval, and infectiousness profile between SARS-CoV-2 Omicron and Delta variants. J. Med. Virol. 95, e28648 (2023).","journal-title":"J. Med. Virol."},{"key":"67776_CR25","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.13.06017","volume":"13","author":"KC Chong","year":"2023","unstructured":"Chong, K. C. et al. Changes in all-cause and cause-specific excess mortality before and after the Omicron outbreak of COVID-19 in Hong Kong. J. Glob. Health 13, 06017 (2023).","journal-title":"J. Glob. Health"},{"key":"67776_CR26","volume":"58","author":"K Li","year":"2025","unstructured":"Li, K. et al. Post-pandemic excess mortality of COVID-19 in Hong Kong: a retrospective study. Lancet Reg. Health West Pac. 58, 101554 (2025).","journal-title":"Lancet Reg. Health West Pac."},{"key":"67776_CR27","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.jclinepi.2016.04.014","volume":"79","author":"MA Hern\u00e1n","year":"2016","unstructured":"Hern\u00e1n, M. A., Sauer, B. C., Hern\u00e1ndez-D\u00edaz, S., Platt, R. & Shrier, I. Specifying a target trial prevents immortal time bias and other self-inflicted injuries in observational analyses. J. Clin. Epidemiol. 79, 70\u201375 (2016).","journal-title":"J. Clin. Epidemiol."},{"key":"67776_CR28","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/aje\/kwv254","volume":"183","author":"MA Hern\u00e1n","year":"2016","unstructured":"Hern\u00e1n, M. A. & Robins, J. M. Using big data to emulate a target trial when a randomized trial is not available: Table 1. Am. J. Epidemiol. 183, 758\u2013764 (2016).","journal-title":"Am. J. Epidemiol."},{"key":"67776_CR29","doi-asserted-by":"publisher","first-page":"e087179","DOI":"10.1136\/bmj-2025-087179","volume":"390","author":"AG Cashin","year":"2025","unstructured":"Cashin, A. G. et al. Transparent reporting of observational studies emulating a target trial: the TARGET Statement. BMJ. 390, e087179 (2025).","journal-title":"BMJ"},{"key":"67776_CR30","first-page":"00217","volume":"S1473-3099","author":"H Wang","year":"2024","unstructured":"Wang, H. et al. Association of nirmatrelvir-ritonavir with post-acute sequelae and mortality in patients admitted to hospital with COVID-19: a retrospective cohort study. Lancet Infect. Dis. S1473-3099, 00217\u20132 (2024).","journal-title":"Lancet Infect. Dis."},{"key":"67776_CR31","first-page":"00224","volume":"S2665-9913","author":"G Lin","year":"2024","unstructured":"Lin, G. et al. Association of nirmatrelvir-ritonavir with post-acute sequelae and mortality among patients who are immunocompromised with COVID-19 in Hong Kong: a retrospective cohort study. Lancet Rheumatol. S2665-9913, 00224\u201300228 (2024).","journal-title":"Lancet Rheumatol."},{"key":"67776_CR32","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2024.2421397","volume":"13","author":"H Wang","year":"2024","unstructured":"Wang, H. et al. COVID-19 vaccination modified the effect of nirmatrelvir-ritonavir on post-acute mortality and rehospitalization: a retrospective cohort study. Emerg. Microbes Infect. 13, 2421397 (2024).","journal-title":"Emerg. Microbes Infect."},{"key":"67776_CR33","doi-asserted-by":"crossref","unstructured":"Lin. G. et al. Short- and long-term comparative effectiveness of nirmatrelvir\/ritonavir and molnupiravir in asthma patients: a cohort study. Respir. Res. 26, 75 (2025).","DOI":"10.1186\/s12931-025-03156-2"},{"key":"67776_CR34","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1038\/s41586-021-03553-9","volume":"594","author":"Z Al-Aly","year":"2021","unstructured":"Al-Aly, Z., Xie, Y. & Bowe, B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature 594, 259\u2013264 (2021).","journal-title":"Nature"},{"key":"67776_CR35","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102000","volume":"60","author":"ICH Lam","year":"2023","unstructured":"Lam, I. C. H. et al. Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK. EClinicalMedicine 60, 102000 (2023).","journal-title":"EClinicalMedicine"},{"key":"67776_CR36","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1093\/ije\/dyaa057","volume":"49","author":"C Maringe","year":"2020","unstructured":"Maringe, C. et al. Reflection on modern methods: trial emulation in the presence of immortal-time bias. Assessing the benefit of major surgery for elderly lung cancer patients using observational data. Int. J. Epidemiol. 49, 1719\u20131729 (2020).","journal-title":"Int. J. Epidemiol."},{"key":"67776_CR37","unstructured":"Fact sheet for healthcare providers: emergency use authorization for Paxlovid\u2122. Fda.gov. [cited 2025 Jun 20]. Available from: https:\/\/www.fda.gov\/media\/155050\/download."},{"key":"67776_CR38","unstructured":"Fact sheet for healthcare providers: emergency use authorization for Lagevrio\u2122 (molnupiravir) capsules. Fda.gov. [cited 2025 Jun 20]. Available from: https:\/\/www.fda.gov\/media\/155054\/download."},{"key":"67776_CR39","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.70461","volume":"13","author":"CE Gaber","year":"2024","unstructured":"Gaber, C. E. et al. De-mystifying the clone-censor-weight method for causal research using observational data: A primer for cancer researchers. Cancer Med. 13, e70461 (2024).","journal-title":"Cancer Med."},{"key":"67776_CR40","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1093\/aje\/kwq439","volume":"173","author":"MJ Funk","year":"2011","unstructured":"Funk, M. J. et al. Doubly robust estimation of causal effects. Am. J. Epidemiol. 173, 761\u2013767 (2011).","journal-title":"Am. J. Epidemiol."},{"key":"67776_CR41","doi-asserted-by":"publisher","first-page":"2125","DOI":"10.1001\/jama.2024.4970","volume":"331","author":"PC Austin","year":"2024","unstructured":"Austin, P. C., Ibrahim, M. & Putter, H. Accounting for competing risks in clinical research. JAMA. 331, 2125\u20132126 (2024).","journal-title":"JAMA"},{"key":"67776_CR42","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1161\/CIRCULATIONAHA.115.017719","volume":"133","author":"PC Austin","year":"2016","unstructured":"Austin, P. C., Lee, D. S. & Fine, J. P. Introduction to the analysis of survival data in the presence of competing risks. Circulation 133, 601\u2013609 (2016).","journal-title":"Circulation"},{"key":"67776_CR43","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","volume":"94","author":"JP Fine","year":"1999","unstructured":"Fine, J. P. & Gray, R. J. A proportional hazards model for the subdistribution of a competing risk. J. Am. Stat. Assoc. 94, 496 (1999).","journal-title":"J. Am. Stat. Assoc."}],"container-title":["Nature Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41467-025-67776-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41467-025-67776-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41467-025-67776-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T13:55:18Z","timestamp":1769522118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41467-025-67776-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,21]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["67776"],"URL":"https:\/\/doi.org\/10.1038\/s41467-025-67776-4","relation":{},"ISSN":["2041-1723"],"issn-type":[{"value":"2041-1723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,21]]},"assertion":[{"value":"11 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1031"}}