{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T07:31:43Z","timestamp":1772177503259,"version":"3.50.1"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"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. Oncol."],"abstract":"<jats:p>\n                    Lactic acidosis is common in the ICU, but malignancy-associated type B lactic acidosis mediated by the clinical Warburg effect (CWE) is uncommon and easily missed when infection or organ dysfunction dominates the presentation. We report a 35-year-old man with a month of fever and progressive dyspnea who presented with persistent hyperlactatemia (peak 15.46 mmol\/L) and markedly elevated LDH despite stable hemodynamics. Imaging revealed generalized lymphadenopathy, multifocal osteolytic lesions, and bilateral pleural effusions; infectious studies were unrevealing apart from chronic hepatitis B. Cervical node biopsy (CD30\n                    <jats:sup>+<\/jats:sup>\n                    , ALK-L\n                    <jats:sup>+<\/jats:sup>\n                    , EMA\n                    <jats:sup>+<\/jats:sup>\n                    ; Ki-67 ~80%; EBER\u2013; pan-B\/T and epithelial markers negative) established ALK-positive anaplastic large-cell lymphoma. In the absence of shock or sustained hypoperfusion, CWE\/type B lactic acidosis was diagnosed. An etoposide-containing CHOP variant (ECHOP\/CHOEP, days 1\u20135) was initiated with parallel continuous renal replacement therapy (CVVHDF) to stabilize acid\u2013base and electrolytes as a bridge to chemotherapy. Lactate declined from 13.30 mmol\/L immediately before chemotherapy to 2.88 mmol\/L by day 3, 1.33 mmol\/L by day 8, and normalized (0.6 mmol\/L) by day 17, closely tracking clinical improvement. The patient was extubated, CRRT discontinued, transferred out of the ICU, and discharged; chemotherapy-related myelosuppression and ICU-acquired weakness were managed with G-CSF, transfusions, and early rehabilitation, and a femoral deep-vein thrombosis was treated with anticoagulation. A focused review of 18 recent case reports (2021\u20132025) suggests that timely, standardized antitumor therapy is frequently followed by a rapid, time-locked fall in lactate, whereas the absence of definitive oncologic treatment portends uniformly poor short-term outcomes. This case underscores that, in hemodynamically stable patients with refractory hyperlactatemia, early consideration of CWE and prompt tumor-directed therapy\u2014supported by targeted organ support such as CRRT\u2014offer the most reliable path to metabolic reversal and recovery.\n                  <\/jats:p>","DOI":"10.3389\/fonc.2026.1744202","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:25:09Z","timestamp":1772169909000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent lactic acidosis in ALK-positive anaplastic large cell lymphoma: a case report and literature review"],"prefix":"10.3389","volume":"16","author":[{"given":"Haoru","family":"Jin","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Organ Tansplantation, Guangzhou Institute of Respiratory Health","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Center for Respiratory Medicine","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Clinical Research Center for Respiratory Disease","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, State Key Laboratory of Respiratory Disease","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhibin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Organ Tansplantation, Guangzhou Institute of Respiratory Health","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Center for Respiratory Medicine","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Clinical Research Center for Respiratory Disease","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, State Key Laboratory of Respiratory Disease","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Organ Tansplantation, The First Affiliated Hospital of Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Ai","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Organ Tansplantation, Guangzhou Institute of Respiratory Health","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Center for Respiratory Medicine","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Clinical Research Center for Respiratory Disease","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, State Key Laboratory of Respiratory Disease","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiangwei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Organ Tansplantation, Guangzhou Institute of Respiratory Health","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Center for Respiratory Medicine","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Clinical Research Center for Respiratory Disease","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, State Key Laboratory of Respiratory Disease","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Guangzhou Chest Hospital","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongbei","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Organ Tansplantation, Guangzhou Institute of Respiratory Health","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Center for Respiratory Medicine","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Clinical Research Center for Respiratory Disease","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, State Key Laboratory of Respiratory Disease","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peicong","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Organ Tansplantation, Guangzhou Institute of Respiratory Health","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Center for Respiratory Medicine","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Clinical Research Center for Respiratory Disease","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, State Key Laboratory of Respiratory Disease","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Organ Tansplantation, Guangzhou Institute of Respiratory Health","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Center for Respiratory Medicine","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, National Clinical Research Center for Respiratory Disease","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Surgery, State Key Laboratory of Respiratory Disease","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1309483","article-title":"Lactic acidosis","volume":"371","author":"Kraut","year":"2014","journal-title":"New Engl J Med"},{"key":"B3","first-page":"1","volume-title":"Clinical and Biochemical Aspects of Lactic Acidosis","author":"Cohen","year":"1976"},{"key":"B4","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s13613-019-0563-2","article-title":"Diagnosis and management of metabolic acidosis: guidelines from a French expert panel","volume":"9","author":"Jung","year":"2019","journal-title":"Ann Intensive Care"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2019-233068","article-title":"Type B lactic acidosis: a rare oncological emergency","volume":"13","author":"Liu","year":"2020","journal-title":"BMJ Case Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e6948","DOI":"10.1002\/ccr3.6948","article-title":"Leukemic phase as the initial presentation of ALK-positive anaplastic large-cell lymphoma complicated by lactic acidosis","volume":"11","author":"Nakagawa","year":"2023","journal-title":"Clin Case Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3000605211067749","DOI":"10.1177\/03000605211067749","article-title":"Type B lactic acidosis associated with diffuse large B-cell lymphoma and the Warburg effect","volume":"50","author":"Wang","year":"2022","journal-title":"J Int Med Res"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2024.06.026","article-title":"100 years of the Warburg effect: A cancer metabolism endeavor","volume":"187","author":"Fendt","year":"2024","journal-title":"Cell"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-cancerbio-062822-120857","article-title":"Deciphering the Warburg effect: metabolic reprogramming, epigenetic remodeling, and cell dedifferentiation","volume":"8","author":"Li","year":"2024","journal-title":"Annu Rev Cancer Biol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2025.02.008","article-title":"Lactate: A key regulator of the immune response","volume":"58","author":"Llibre","year":"2025","journal-title":"Immunity"},{"key":"B11","doi-asserted-by":"publisher","first-page":"3561","DOI":"10.1038\/s41467-024-47900-6","article-title":"HBO1 catalyzes lysine lactylation and mediates histone H3K9la to regulate gene transcription","volume":"15","author":"Niu","year":"2024","journal-title":"Nat Commun"},{"key":"B12","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/s13613-023-01192-z","article-title":"Clinical Warburg effect in lymphoma patients admitted to intensive care unit","volume":"13","author":"Chaba","year":"2023","journal-title":"Ann Intensive Care"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20011101)92:9<2237::AID-CNCR1569>3.0.CO;2-9","article-title":"Lactic acidosis: a metabolic complication of hematologic Malignancies: case report and review of the literature","volume":"92","author":"Sillos","year":"2001","journal-title":"Cancer"},{"key":"B14","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1186\/s13256-023-04079-6","article-title":"Clinical presentation of Warburg effect in aggressive lymphoma: a case report","volume":"17","author":"Cao","year":"2023","journal-title":"J Med Case Rep"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1100\/tsw.2011.125","article-title":"Type B lactic acidosis secondary to Malignancy: case report, review of published cases, insights into pathogenesis, and prospects for therapy","volume":"11","author":"Ruiz","year":"2011","journal-title":"ScientificWorldJournal"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e1600200","DOI":"10.1126\/sciadv.1600200","article-title":"Fundamentals of cancer metabolism","volume":"2","author":"DeBerardinis","year":"2016","journal-title":"Sci Adv"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/jha2.176","article-title":"Lactic acidosis and hypoglycemia as markers of disease progression of multiple myeloma: A case report","volume":"2","author":"Ziegler","year":"2021","journal-title":"EJHaem"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.58768","article-title":"Clinical Warburg effect in a patient with mantle cell lymphoma: A case report","volume":"16","author":"Patel","year":"2024","journal-title":"Cureus"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.60985","article-title":"Severe lactic acidosis and hypoglycemia associated with Burkitt lymphoma and the Warburg effect","volume":"16","author":"Khanal","year":"2024","journal-title":"Cureus"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.26557","article-title":"An oncological emergency: severe type B lactic acidosis from Warburg effect in diffuse large B-cell lymphoma","volume":"14","author":"Sanivarapu","year":"2022","journal-title":"Cureus"},{"key":"B21","doi-asserted-by":"publisher","first-page":"7021123","DOI":"10.1155\/2023\/7021123","article-title":"Type B lactic acidosis in a patient with mantle cell lymphoma","volume":"2023","author":"Nzenwa","year":"2023","journal-title":"Case Rep Crit Care"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.14737","article-title":"Burkitt lymphoma and lactic acidosis: A case report and review of the literature","volume":"9","author":"Looyens","year":"2021","journal-title":"Physiol Rep"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1159\/000517658","article-title":"Refractory hyperlactatemia and hypoglycemia in an adult with non-Hodgkin\u2019s lymphoma: A case report and review of the Warburg effect","volume":"14","author":"Al Maqrashi","year":"2021","journal-title":"Case Rep Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.4450-24","article-title":"Diffuse large B-cell lymphoma with severe lactic acidosis and liver failure: A case report and literature review","volume":"64","author":"Yamazaki","year":"2025","journal-title":"Internal Med (Tokyo Japan)"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2023-257154","article-title":"B-cell hepatosplenic lymphoma presenting in adult patient after spontaneous splenic rupture followed by severe persistent hypoglycaemia: type B lactic acidosis and acute liver failure","volume":"16","author":"Moen","year":"2023","journal-title":"BMJ Case Rep"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.6296","article-title":"Mutant TP53 driving the Warburg Effect in Mantle Cell lymphoma","volume":"10","author":"Kliebhan","year":"2022","journal-title":"Clin Case Rep"},{"key":"B27","doi-asserted-by":"publisher","first-page":"69","DOI":"10.3892\/ol.2024.14815","article-title":"Successful management of type B lactic acidosis in metastatic cervical neuroendocrine carcinoma: A case report","volume":"29","author":"Tang","year":"2025","journal-title":"Oncol letters"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.40563","article-title":"Refractory lactic acidosis and hypoglycemia in a patient with metastatic esophageal cancer due to the Warburg effect","volume":"15","author":"Karki","year":"2023","journal-title":"Cureus"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.69422","article-title":"Primary retrovesical leiomyosarcoma: A case report","volume":"16","author":"Rudy","year":"2024","journal-title":"Cureus"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.62932","article-title":"Impact of primary tumor resection on type B lactic acidosis in a case of metastatic colon cancer","volume":"16","author":"Cheleng","year":"2024","journal-title":"Cureus"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.84806","article-title":"A metabolic storm: clinical Warburg effect in poorly differentiated colorectal adenocarcinoma","volume":"17","author":"Aly","year":"2025","journal-title":"Cureus"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.78762","article-title":"Persistent lactic acidosis portending a poor prognosis in extensive metastatic signet ring cell carcinoma of the cecum","volume":"17","author":"Yokokawa","year":"2025","journal-title":"Cureus"},{"key":"B33","doi-asserted-by":"publisher","first-page":"103627","DOI":"10.1016\/j.ebiom.2021.103627","article-title":"Lactate in the tumour microenvironment: From immune modulation to therapy","volume":"73","author":"Wang","year":"2021","journal-title":"EBioMedicine"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.it.2022.10.005","article-title":"Lactic acid and lactate: revisiting the physiological roles in the tumor microenvironment","volume":"43","author":"Apostolova","year":"2022","journal-title":"Trends Immunol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"216837","DOI":"10.1016\/j.canlet.2024.216837","article-title":"The emerging role of lactate in tumor microenvironment and its clinical relevance","volume":"590","author":"Chen","year":"2024","journal-title":"Cancer Lett"},{"key":"B36","doi-asserted-by":"publisher","first-page":"100740","DOI":"10.1016\/j.omto.2023.100740","article-title":"Targeting the lactic acid metabolic pathway for antitumor therapy","volume":"31","author":"Li","year":"2023","journal-title":"Mol Ther Oncolytics"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3390\/metabo16010075","article-title":"Lactic acid in tumour biology","volume":"16","author":"Cruz","year":"2026","journal-title":"Metabolites"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.7861\/clinmed.2023-0391","article-title":"Lactic acidosis in a patient with cancer","volume":"23","author":"Oseguera","year":"2023","journal-title":"Clin Med (London England)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.kint.2019.08.023","article-title":"L-lactic acidosis: pathophysiology, classification, and causes; emphasis on biochemical and metabolic basis","volume":"97","author":"Kamel","year":"2020","journal-title":"Kidney Int"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1007\/s00063-023-01028-5","article-title":"What is new and different in the 2021 Surviving Sepsis Campaign guidelines","volume":"118","author":"Prescott","year":"2023","journal-title":"Medizinische Klinik Intensivmedizin und Notfallmedizin"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-025-06691-6","article-title":"Lactic acidosis as the initial presentation of lymphoma: A case report and integrated analysis of clinical characteristics and prognostic factors","volume":"118","author":"Zhang","year":"2025","journal-title":"Ann Hematol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.70824","article-title":"Tumor-associated lactic acidosis and early death in patients with lymphoma","volume":"14","author":"Atamna","year":"2025","journal-title":"Cancer Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1186\/s13054-016-1403-5","article-title":"The value of blood lactate kinetics in critically ill patients: a systematic review","volume":"20","author":"Vincent","year":"2016","journal-title":"Crit Care (London England)"},{"key":"B44","doi-asserted-by":"publisher","first-page":"197","DOI":"10.15441\/ceem.15.025","article-title":"The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study","volume":"2","author":"Sterling","year":"2015","journal-title":"Clin Exp Emergency Med"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2021.12.002","article-title":"The ECHELON-2 Trial: 5-year results of a randomized, phase III study of brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma","volume":"33","author":"Horwitz","year":"2022","journal-title":"Ann Oncol Off J Eur Soc Med Oncol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"21","DOI":"10.12703\/r\/12-21","article-title":"ALK-positive anaplastic large cell lymphoma in adults","volume":"12","author":"Gromowsky","year":"2023","journal-title":"Faculty Rev"},{"key":"B47","doi-asserted-by":"publisher","first-page":"112984","DOI":"10.12703\/r\/12-21","article-title":"Efficacy and safety of crizotinib in ALK-positive systemic anaplastic large-cell lymphoma in children, adolescents, and adult patients: results of the French AcS\u00e9-crizotinib trial","volume":"191","author":"Brugi\u00e8res","year":"2023","journal-title":"Eur J Cancer (Oxford England: 1990)"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2402419","article-title":"Brigatinib in ALK-positive ALCL after failure of brentuximab vedotin","volume":"390","author":"Veleanu","year":"2024","journal-title":"New Engl J Med"},{"key":"B49","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1056\/NEJMc2216086","article-title":"Early active mobilization during mechanical ventilation in the ICU","volume":"388","author":"Ely","year":"2023","journal-title":"New Engl J Med"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/j.chstcc.2023.100038","article-title":"Early mobilization in the ICU","volume":"388","author":"Rawal","year":"2024","journal-title":"CHEST Crit Care"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.01757","article-title":"Hepatitis B virus screening and management for patients with cancer prior to therapy: ASCO provisional clinical opinion update","volume":"38","author":"Hwang","year":"2020","journal-title":"J Clin Oncol"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v29.i33.4942","article-title":"Prevention and management of hepatitis B virus reactivation in patients with hematological Malignancies in the targeted therapy era","volume":"29","author":"Mak","year":"2023","journal-title":"World J gastroenterol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1744202\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:25:10Z","timestamp":1772169910000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1744202\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":52,"alternative-id":["10.3389\/fonc.2026.1744202"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1744202","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]},"article-number":"1744202"}}