{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:00:26Z","timestamp":1793638826124,"version":"4.5.1"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background and objectives<\/jats:title><jats:p>Activation of the complement system is involved in the pathogenesis of anti-glomerular basement membrane (anti-GBM) disease. Glomerular deposits of complement 3 (C3) are often detected on kidney biopsies. The primary objective of this study was to analyze the prognostic value of the serum C3 level and the presence of C3 glomerular deposits in patients with anti-GBM disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of 150 single-positive patients with anti-GBM disease diagnosed between 1997 and 2017. Patients were categorized according to the serum C3 level (forming a low C3 (C3&amp;lt;1.23 g\/L) and a high C3 (C3\u22651.23 g\/L) groups) and positivity for C3 glomerular staining (forming the C3+ and C3- groups). The main outcomes were kidney survival and patient survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 150 patients included, 89 (65%) were men. The median [interquartile range (IQR)] age was 45 [26\u201364]. At diagnosis, kidney involvement was characterized by a median [IQR] peak serum creatinine (SCr) level of 578 [298\u2013977] \u00b5mol\/L, and 106 (71%) patients required dialysis. Patients in the low C3 group (72 patients) had more severe kidney disease at presentation, as characterized by higher prevalences of oligoanuria, peak SCr \u2265500 \u00b5mol\/L (69%, vs. 53% in the high C3 group; p=0.03), nephrotic syndrome (42%, vs. 24%, respectively; p=0.02) and fibrous forms on the kidney biopsy (21%, vs. 8%, respectively; p=0.04). Similarly, we observed a negative association between the presence of C3 glomerular deposits (in 52 (41%) patients) and the prevalence of cellular forms (83%, vs. 58% in the C3- group; p=0.003) and acute tubulo-interstitial lesions (60%, vs. 36% in the C3- group; p=0.007). When considering patients not on dialysis at diagnosis, the kidney survival rate at 12 months was poorer in the C3+ group (50% [25-76], vs. 91% [78-100] in the C3- group; p=0.01), with a hazard ratio [95% confidence interval] of 5.71 [1.13-28.85] (p=0.04, after adjusting for SCr).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients with anti-GBM disease, a low serum C3 level and the presence of C3 glomerular deposits were associated with more severe disease and histological kidney involvement at diagnosis. In patients not on dialysis at diagnosis, the presence of C3 deposits was associated with worse kidney survival.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2023.1190394","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T17:55:55Z","timestamp":1688579755000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Prognostic value of complement serum C3 level and glomerular C3 deposits in anti-glomerular basement membrane disease"],"prefix":"10.3389","volume":"14","author":[{"given":"Pauline","family":"Caillard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Vigneau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Halimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Hazzan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Thervet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgane","family":"Heitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Juillard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Audard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Rabant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Hertig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Fran\u00e7ois","family":"Subra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Vuiblet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Guerrot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathilde","family":"Tamain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Essig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Lobbedez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Quemeneur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Legendre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Ganea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-No\u00eblle","family":"Peraldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Vrtovsnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u00eft\u00e9","family":"Daroux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ra\u00effah","family":"Makdassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Choukroun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri","family":"Titeca-Beauport","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1\u221211","DOI":"10.1002\/art.37715","article-title":"2012 Revised international chapel hill consensus conference nomenclature of vasculitides","volume":"65","author":"Jennette","year":"2013","journal-title":"Arthritis Rheum"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1178\u221285","DOI":"10.1681\/ASN.V641178","article-title":"Identification of the alpha 3 chain of type IV collagen as the common autoantigen in antibasement membrane disease and goodpasture syndrome","volume":"6","author":"Kalluri","year":"1995","journal-title":"J Am Soc Nephrol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"445\u221250","DOI":"10.1309\/NPTP4UKV7JU3ELMQ","article-title":"Anti-glomerular basement membrane glomerulonephritis: a morphologic study of 80 cases","volume":"125","author":"Fischer","year":"2006","journal-title":"Am J Clin Pathol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"494\u2212503","DOI":"10.1055\/s-0038-1669413","article-title":"Antiglomerular basement membrane disease","volume":"39","author":"McAdoo","year":"2018","journal-title":"Semin Respir Crit Care Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.7326\/0003-4819-134-11-200106050-00009","article-title":"Long-term outcome of anti\u2013glomerular basement membrane antibody disease treated with plasma exchange and immunosuppression","volume":"134","author":"Levy","year":"2001","journal-title":"Ann Intern Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"129\u221238","DOI":"10.2147\/IJNRD.S326427","article-title":"Epidemiology, impact, and management strategies of anti-glomerular basement membrane disease","volume":"15","author":"Asim","year":"2022","journal-title":"Int J Nephrol Renov Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"814\u221221","DOI":"10.1093\/ndt\/gfu399","article-title":"Predictors of renal and patient outcomes in anti-GBM disease: clinicopathologic analysis of a two-centre cohort","volume":"30","author":"Alchi","year":"2015","journal-title":"Nephrol Dial Transplant"},{"key":"B8","doi-asserted-by":"publisher","first-page":"63\u221272","DOI":"10.2215\/CJN.04290417","article-title":"Predicting outcome in patients with anti-GBM glomerulonephritis","volume":"13","author":"van Daalen","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"24\u22129","DOI":"10.1016\/j.jaut.2016.05.015","article-title":"Outcomes of patients with goodpasture syndrome: a nationwide cohort-based study from the French society of hemapheresis","volume":"73","author":"Huart","year":"2016","journal-title":"J Autoimmun"},{"key":"B10","doi-asserted-by":"publisher","first-page":"403\u22129","DOI":"10.1046\/j.1365-2249.1997.4261438.x","article-title":"Protection against anti-glomerular basement membrane (GBM)-mediated nephritis in C3- and C4-deficient mice","volume":"110","author":"Sheerin","year":"1997","journal-title":"Clin Exp Immunol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2799\u2212803","DOI":"10.1093\/ndt\/13.11.2799","article-title":"Acute nephrotoxic serum nephritis in complement knockout mice: relative roles of the classical and alternate pathways in neutrophil recruitment and proteinuria","volume":"13","author":"H\u00e9bert","year":"1998","journal-title":"Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3980\u22128","DOI":"10.4049\/jimmunol.0901301","article-title":"Both complement and IgG fc receptors are required for development of attenuated antiglomerular basement membrane nephritis in mice","volume":"183","author":"Otten","year":"2009","journal-title":"J Immunol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"172\u22128","DOI":"10.1007\/s10875-012-9772-2","article-title":"Complement activation contributes to the injury and outcome of kidney in human anti-glomerular basement membrane disease","volume":"33","author":"Ma","year":"2013","journal-title":"J Clin Immunol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0091250","article-title":"The alternative pathway of complement activation may be involved in the renal damage of human anti-glomerular basement membrane disease","volume":"9","author":"Ma","year":"2014","journal-title":"PloS One"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.02035","article-title":"Clinical-pathological features and outcome of atypical anti-glomerular basement membrane disease in a Large single cohort","volume":"11","author":"rong","year":"2020","journal-title":"Front Immunol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.929155","article-title":"Relationship between serum complement C3 levels and outcomes among patients with anti-GBM disease","volume":"13","author":"Zhu","year":"2022","journal-title":"Front Immunol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"503\u221216","DOI":"10.1038\/s41577-019-0168-x","article-title":"New insights into the immune functions of complement","volume":"19","author":"Reis","year":"2019","journal-title":"Nat Rev Immunol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"359\u221267","DOI":"10.1038\/nrneph.2017.37","article-title":"Complement in ANCA-associated vasculitis: mechanisms and implications for management","volume":"13","author":"Chen","year":"2017","journal-title":"Nat Rev Nephrol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"229\u221251","DOI":"10.1007\/s12016-019-08774-5","article-title":"The immunopathology of complement proteins and innate immunity in autoimmune disease","volume":"58","author":"Defendi","year":"2020","journal-title":"Clin Rev Allergy Immunol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.599417","article-title":"Treatment of rare inflammatory kidney diseases: drugs targeting the terminal complement pathway","volume":"11","author":"Ort","year":"2020","journal-title":"Front Immunol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"175\u221287","DOI":"10.1016\/j.molimm.2020.10.015","article-title":"Complement-mediated kidney diseases","volume":"128","author":"Poppelaars","year":"2020","journal-title":"Mol Immunol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"123\u221230","DOI":"10.1016\/j.cca.2016.12.017","article-title":"Complement in autoimmune diseases","volume":"465","author":"Vignesh","year":"2017","journal-title":"Clin Chim Acta Int J Clin Chem"},{"key":"B23","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/s11926-021-00984-1","article-title":"A review of complement activation in SLE","volume":"23","author":"Weinstein","year":"2021","journal-title":"Curr Rheumatol Rep"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0158871","article-title":"Low serum complement C3 levels at diagnosis of renal ANCA-associated vasculitis is associated with poor prognosis","volume":"11","author":"Augusto","year":"2016","journal-title":"PloS One"},{"key":"B25","doi-asserted-by":"publisher","first-page":"845\u221252","DOI":"10.1080\/0886022X.2020.1803086","article-title":"Hypocomplementemia is associated with more severe renal disease and worse renal outcomes in patients with ANCA-associated vasculitis: a retrospective cohort study","volume":"42","author":"Chalkia","year":"2020","journal-title":"Ren Fail"},{"key":"B26","doi-asserted-by":"publisher","first-page":"257\u221262","DOI":"10.1007\/s40620-017-0445-3","article-title":"Serum C3 complement levels in ANCA associated vasculitis at diagnosis is a predictor of patient and renal outcome","volume":"31","author":"Crnogorac","year":"2018","journal-title":"J Nephrol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1247\u221252","DOI":"10.1093\/ndt\/gfn586","article-title":"Complement deposition in renal histopathology of patients with ANCA-associated pauci-immune glomerulonephritis","volume":"24","author":"Chen","year":"2009","journal-title":"Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc"},{"key":"B28","doi-asserted-by":"publisher","first-page":"129\u221237","DOI":"10.1038\/ki.2012.313","article-title":"Circulating complement activation in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis","volume":"83","author":"Gou","year":"2013","journal-title":"Kidney Int"},{"key":"B29","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1186\/s13075-015-0656-8","article-title":"Plasma complement factor h is associated with disease activity of patients with ANCA-associated vasculitis","volume":"17","author":"Chen","year":"2015","journal-title":"Arthritis Res Ther"},{"key":"B30","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1186\/s12882-017-0658-7","article-title":"Increased C4 and decreased C3 levels are associated with a poor prognosis in patients with immunoglobulin a nephropathy: a retrospective study","volume":"18","author":"Pan","year":"2017","journal-title":"BMC Nephrol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1186\/s12882-019-1509-5","article-title":"Complement activation products in the circulation and urine of primary membranous nephropathy","volume":"20","author":"Zhang","year":"2019","journal-title":"BMC Nephrol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2756\u221267","DOI":"10.1681\/ASN.2016111179","article-title":"Randomized trial of C5a receptor inhibitor avacopan in ANCA-associated vasculitis","volume":"28","author":"Jayne","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"599\u2212609","DOI":"10.1056\/NEJMoa2023386","article-title":"ADVOCATE study group. avacopan for the treatment of ANCA-associated vasculitis","volume":"384","author":"Jayne","year":"2021","journal-title":"N Engl J Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"gfac296","DOI":"10.1093\/ndt\/gfac296","article-title":"The role of complement in glomerulonephritis\u2013are novel therapies ready for prime time","author":"Cheung","year":"2022","journal-title":"Nephrol Dial Transplant"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1165\u221278","DOI":"10.1016\/j.ekir.2022.02.021","article-title":"The rational use of complement inhibitors in kidney diseases","volume":"7","author":"Fakhouri","year":"2022","journal-title":"Kidney Int Rep"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1628\u221236","DOI":"10.1681\/ASN.2010050477","article-title":"Histopathologic classification of ANCA-associated glomerulonephritis","volume":"21","author":"Berden","year":"2010","journal-title":"J Am Soc Nephrol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1177\u221288","DOI":"10.1016\/j.kint.2018.07.020","article-title":"Development and validation of a renal risk score in ANCA-associated glomerulonephritis","volume":"94","author":"Brix","year":"2018","journal-title":"Kidney Int"},{"key":"B38","doi-asserted-by":"publisher","first-page":"310\u221221","DOI":"10.1055\/s-0031-1279827","article-title":"Alveolar hemorrhage in vasculitis: primary and secondary","volume":"32","author":"Cordier","year":"2011","journal-title":"Semin Respir Crit Care Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"9\u221218","DOI":"10.1038\/nri1994","article-title":"T-Cell regulation: with complements from innate immunity","volume":"7","author":"Kemper","year":"2007","journal-title":"Nat Rev Immunol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"262\u22128","DOI":"10.1111\/j.1365-2249.1995.tb03663.x","article-title":"Analysis of T cell responses to the autoantigen in goodpasture\u2019s disease","volume":"100","author":"Derry","year":"2008","journal-title":"Clin Exp Immunol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1908\u221215","DOI":"10.1681\/ASN.V1291908","article-title":"In goodpasture\u2019s disease, CD4+ T cells escape thymic deletion and are reactive with the autoantigen \u03b13(IV)NC1","volume":"12","author":"Salama","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1685\u221294","DOI":"10.1046\/j.1523-1755.2003.00259.x","article-title":"Regulation by CD25+ lymphocytes of autoantigen-specific T-cell responses in goodpasture\u2019s (anti-GBM) disease","volume":"64","author":"Salama","year":"2003","journal-title":"Kidney Int"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1282\u22129","DOI":"10.1007\/s11427-016-5030-9","article-title":"T Cell infiltration is associated with kidney injury in patients with anti-glomerular basement membrane disease","volume":"59","author":"Hu","year":"2016","journal-title":"Sci China Life Sci"},{"key":"B44","doi-asserted-by":"publisher","first-page":"134\u221242","DOI":"10.1046\/j.1365-2249.1997.4091307.x","article-title":"Mechanisms of T cell-induced glomerular injury in anti-glomeruler basement membrane (GBM) glomerulonephritis in rats","volume":"109","author":"Huang","year":"2003","journal-title":"Clin Exp Immunol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"205873842110393","DOI":"10.1177\/20587384211039391","article-title":"Disease activity prediction and prognosis of anti-GBM nephritis based on T lymphocyte subset ratios","volume":"35","author":"Zhang","year":"2021","journal-title":"Int J Immunopathol Pharmacol janv"},{"key":"B46","doi-asserted-by":"publisher","first-page":"4094\u2212102","DOI":"10.4049\/jimmunol.177.6.4094","article-title":"Complement activation contributes to both glomerular and tubulointerstitial damage in adriamycin nephropathy in mice","volume":"177","author":"Turnberg","year":"2006","journal-title":"J Immunol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"F1171\u221282","DOI":"10.1152\/ajprenal.00165.2019","article-title":"Complement C3 exacerbates renal interstitial fibrosis by facilitating the M1 macrophage phenotype in a mouse model of unilateral ureteral obstruction","volume":"317","author":"Cui","year":"2019","journal-title":"Am J Physiol-Ren Physiol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.01665","article-title":"Prognostic factors in anti-glomerular basement membrane disease: a multicenter study of 119 patients","volume":"10","author":"Marques","year":"2019","journal-title":"Front Immunol"},{"key":"B49","doi-asserted-by":"publisher","first-page":"31\u22127","DOI":"10.1136\/jclinpath-2018-205278","article-title":"Clinicopathological features and outcome of antibody-negative anti-glomerular basement membrane disease","volume":"72","author":"Liang","year":"2019","journal-title":"J Clin Pathol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"897\u2212908","DOI":"10.1016\/j.kint.2016.02.001","article-title":"The clinicopathologic characteristics and outcome of atypical anti-glomerular basement membrane nephritis","volume":"89","author":"Nasr","year":"2016","journal-title":"Kidney Int"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.889185","article-title":"Anti-glomerular basement membrane glomerulonephritis: a study in real life","volume":"9","author":"S\u00e1nchez-Agesta","year":"2022","journal-title":"Front Med"},{"key":"B52","doi-asserted-by":"publisher","first-page":"505\u221214","DOI":"10.1681\/ASN.2022050581","article-title":"Risk stratification to predict renal survival in anti\u2013glomerular basement membrane disease","volume":"34","author":"Floyd","year":"2023","journal-title":"J Am Soc Nephrol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1159\/000523713","article-title":"Predictors of kidney outcomes of anti-glomerular basement membrane disease in a Large Chinese cohort","volume":"53","author":"Jia","year":"2022","journal-title":"Am J Nephrol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2023.1190394\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T17:55:58Z","timestamp":1688579758000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2023.1190394\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,5]]},"references-count":53,"alternative-id":["10.3389\/fimmu.2023.1190394"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2023.1190394","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,5]]},"article-number":"1190394"}}