{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T19:18:15Z","timestamp":1777663095069,"version":"3.51.4"},"reference-count":55,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Background: The tumor microenvironment offers a new perspective in gynecologic oncology. In ovarian cancer, numerous preclinical studies, especially organoid models, have highlighted cellular, immune, and biochemical mechanisms. Beyond these sophisticated findings, more practical aspects require attention, such as the role of vaginal microbiota, which represents an interplay between external agents and internal genitalia, and its potential profiling role in early detection beyond the promise of microbiota-targeted therapies. Objectives: This review aims to assess whether such a correlation is speculative or scientifically grounded. Methods: A focused literature search was conducted on vaginal microbiota and its correlation with ovarian cancer to define the current state of knowledge. Results: Mixed outcomes have been reported, yet there is a rational and scientific basis supporting further investigation. Clinical approaches increasingly consider vaginal microbiota as relevant. However, we have to say that most available evidence is still preliminary and largely preclinical to set realistic expectations for readers. Although additional studies are needed, emerging insights highlight its importance and practical implications. We present a diagnostic\u2013therapeutic management flowchart summarizing current evidence). Discussion: Most links between the vaginal microbiota and ovarian cancer are correlational rather than causal. The idea that microbes ascend from the vagina to the ovaries is proposed but still definitely not demonstrated. Confounding factors like age, hormones, and BRCA status complicate interpretation, and ovarian cancer itself could secondarily alter the microbiota. Mechanistic studies and longitudinal data are still needed to clarify whether dysbiosis contributes to carcinogenesis or is merely a consequence. As gynecologists, we summarize key aspects and emphasize to colleagues the importance of incorporating these findings into daily clinical practice. Vaginal dysbiosis should be considered not only a local imbalance but also a potential strategy for primary cancer prevention. Conclusions: Future research on the tumor microenvironment and vaginal microbiota will expand scientific knowledge and guide innovative preventive and therapeutic strategies.<\/jats:p>","DOI":"10.3390\/cells14201590","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T05:48:21Z","timestamp":1760420901000},"page":"1590","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Relationship Between the Vaginal Microbiota and the Ovarian Cancer Microenvironment: A Journey from Ideas to Insights"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7848-0329","authenticated-orcid":false,"given":"Stefano","family":"Restaino","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health, Obstetrics and Gynecology Clinic, University Hospital of Udine, 33100 Udine, Italy"},{"name":"PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0644-0301","authenticated-orcid":false,"given":"Giulia","family":"Pellecchia","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Obstetrics and Gynecology Clinic, University Hospital of Udine, 33100 Udine, Italy"},{"name":"Department of Medicine (DMED), University of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8257-0618","authenticated-orcid":false,"given":"Martina","family":"Arcieri","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Obstetrics and Gynecology Clinic, University Hospital of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5299-8197","authenticated-orcid":false,"given":"Eva","family":"Pericolini","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8373-8569","authenticated-orcid":false,"given":"Giorgio","family":"Bogani","sequence":"additional","affiliation":[{"name":"Gynaecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8098-9204","authenticated-orcid":false,"given":"Alice","family":"Poli","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child 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Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Tascini","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinic, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenza","family":"Driul","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Obstetrics and Gynecology Clinic, University Hospital of Udine, 33100 Udine, Italy"},{"name":"Department of Medicine (DMED), University of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Biasioli","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Obstetrics and Gynecology Clinic, University Hospital of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4720-5663","authenticated-orcid":false,"given":"Vito Andrea","family":"Capozzi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Parma, 43125 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9023-282X","authenticated-orcid":false,"given":"Carlo","family":"Ronsini","sequence":"additional","affiliation":[{"name":"Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione \u201cG. 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Rev. Clin. Oncol."},{"key":"ref_2","first-page":"e70242","article-title":"Study of the Role of the Tumor Microenvironment in Ovarian Cancer (MICO): A Prospective Monocentric Trial","volume":"8","author":"Arcieri","year":"2025","journal-title":"Cancer Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/LGT.0000000000000646","article-title":"The Vaginal Microbiome: IV. The Role of Vaginal Microbiome in Reproduction and in Gynecologic Cancers","volume":"26","author":"Ventolini","year":"2022","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"546","DOI":"10.3390\/jpm11060546","article-title":"The Female Reproductive Tract Microbiome-Implications for Gynecologic Cancers and Personalized Medicine","volume":"11","author":"Rizzo","year":"2021","journal-title":"J. Pers. Med."},{"key":"ref_5","first-page":"743","article-title":"Vaginal microbiomes and ovarian cancer: A review","volume":"10","author":"Xu","year":"2020","journal-title":"Am. J. Cancer Res."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Stabile, G., Doria, A., Bruno, M., D\u2019indinosante, M., Gallotta, V., Fanfani, F., Scambia, G., Restaino, S., Vizzielli, G., and Carlucci, S. (2024). The Role of the Endometrial Microbiota in Endometrial Cancer: A Systematic Review of the Literature. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237135"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e11574","DOI":"10.7717\/peerj.11574","article-title":"Shifts in gut and vaginal microbiomes are associated with cancer recurrence time in women with ovarian cancer","volume":"9","author":"Jacobson","year":"2021","journal-title":"PeerJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1126\/science.1223490","article-title":"Interactions between the microbiota and the immune system","volume":"336","author":"Hooper","year":"2012","journal-title":"Science"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1586\/14737140.2015.992785","article-title":"Cancer and the microbiome: Potential applications as new tumor biomarker","volume":"15","author":"Shahanavaj","year":"2015","journal-title":"Expert Rev. Anticancer. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1126\/science.aaa4972","article-title":"Cancer and the microbiota","volume":"348","author":"Garrett","year":"2015","journal-title":"Science"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1136\/gutjnl-2019-318556","article-title":"International Cancer Microbiome Consortium consensus statement on the role of the human microbiome in carcinogenesis","volume":"68","author":"Scott","year":"2019","journal-title":"Gut"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e28898","DOI":"10.1002\/jmv.28898","article-title":"Association between vaginal microbiota and the progression of ovarian cancer","volume":"95","author":"Li","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"36225","DOI":"10.18632\/oncotarget.16717","article-title":"The ovarian cancer oncobiome","volume":"8","author":"Banerjee","year":"2017","journal-title":"Oncotarget"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gulve, N., and Rudel, T. (2019). Chlamydia trachomatis and human herpesvirus 6 infections in ovarian cancer\u2014Casual or causal?. PLoS Pathog., 15.","DOI":"10.1371\/journal.ppat.1008055"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cazzaniga, M., Cardinali, M., Di Pierro, F., and Bertuccioli, A. (2022). Ovarian Microbiota, Ovarian Cancer and the Underestimated Role of HPV. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232416019"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zhao, X., Liu, Z., and Chen, T. (2023). Potential Role of Vaginal Microbiota in Ovarian Cancer Carcinogenesis, Progression and Treatment. Pharmaceutics, 15.","DOI":"10.3390\/pharmaceutics15030948"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"132ra52","DOI":"10.1126\/scitranslmed.3003605","article-title":"Temporal dynamics of the human vaginal microbiota","volume":"4","author":"Gajer","year":"2012","journal-title":"Sci. Transl. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1038\/ismej.2007.12","article-title":"Differences in the composition of vaginal microbial communities found in healthy Caucasian and black women","volume":"1","author":"Zhou","year":"2007","journal-title":"ISME J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1007\/s10096-012-1570-5","article-title":"Viral and bacterial aetiologies of epithelial ovarian cancer","volume":"31","author":"Shanmughapriya","year":"2012","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"677","DOI":"10.14336\/AD.2017.0607","article-title":"Ovarian Cancer Management in the Oldest Old: Improving Outcomes and Tailoring Treatments","volume":"8","author":"Tortorella","year":"2017","journal-title":"Aging Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/S1470-2045(19)30406-1","article-title":"Of microbes and women: BRCA1, vaginal microbiota, and ovarian cancer","volume":"20","author":"Verstraelen","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3892\/ol.2023.13739","article-title":"Vaginal and tumor microbiomes in gynecological cancer (Review)","volume":"25","author":"Han","year":"2023","journal-title":"Oncol. Lett."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1006\/gyno.1996.0316","article-title":"Prevalence of mycoplasma conserved DNA in malignant ovarian cancer detected using sensitive PCR-ELISA","volume":"63","author":"Chan","year":"1996","journal-title":"Gynecol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1007\/s12602-019-09596-9","article-title":"Modulatory Role of Vaginal-Isolated Lactococcus lactis on the Expression of miR-21, miR-200b, and TLR-4 in CAOV-4 Cells and In Silico Revalidation","volume":"12","author":"Saadat","year":"2020","journal-title":"Probiotics Antimicrob. Proteins."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e13781","DOI":"10.1111\/aji.13781","article-title":"Metabolic signature for a dysbiotic microbiome in the female genital tract: A systematic review and meta-analysis","volume":"90","author":"Gill","year":"2023","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Yu, T., Gao, S., Jin, F., Yan, B., Wang, W., and Wang, Z. (2024). Characteristics of the vaginal microbiota and vaginal metabolites in women with cervical dysplasia. Front. Cell. Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1457216"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3073","DOI":"10.1158\/1078-0432.CCR-23-2934","article-title":"Cervicovaginal Metabolome and Tumor Characteristics for Endometrial Cancer Detection and Risk Stratification","volume":"30","author":"Lorentzen","year":"2024","journal-title":"Clin. Cancer Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1530\/ERC-15-0192","article-title":"Glutamine promotes ovarian cancer cell proliferation through the mTOR\/S6 pathway","volume":"22","author":"Yuan","year":"2015","journal-title":"Endocr. Relat. Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1038\/sj.cdd.4401073","article-title":"T cell apoptosis by tryptophan catabolism","volume":"9","author":"Fallarino","year":"2002","journal-title":"Cell Death Differ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3190","DOI":"10.4049\/jimmunol.0903670","article-title":"An interaction between kynurenine and the aryl hydrocarbon receptor can generate regulatory T cells","volume":"185","author":"Mezrich","year":"2010","journal-title":"J. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1002\/jso.24490","article-title":"Arginine-Dual roles as an onconutrient and immunonutrient","volume":"115","author":"Albaugh","year":"2017","journal-title":"J. Surg. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1038\/s41568-018-0050-3","article-title":"Polyamine metabolism and cancer: Treatments, challenges and opportunities","volume":"18","author":"Casero","year":"2018","journal-title":"Nat. Rev. Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Chen, C., Wang, Z., and Qin, Y. (2022). Connections between metabolism and epigenetics: Mechanisms and novel anti-cancer strategy. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.935536"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Zhou, Z., Feng, Y., Xie, L., Ma, S., Cai, Z., and Ma, Y. (2024). Alterations in gut and genital microbiota associated with gynecological diseases: A systematic review and meta-analysis. Reprod. Biol. Endocrinol., 22.","DOI":"10.1186\/s12958-024-01184-z"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1038\/nature11550","article-title":"Diversity, stability and resilience of the human gut microbiota","volume":"489","author":"Lozupone","year":"2012","journal-title":"Nature"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1038\/nature10213","article-title":"Human nutrition, the gut microbiome and the immune system","volume":"474","author":"Kau","year":"2011","journal-title":"Nature"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1038\/nature06244","article-title":"The Human Microbiome Project","volume":"449","author":"Turnbaugh","year":"2007","journal-title":"Nature"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1038\/s41575-018-0061-2","article-title":"You are what you eat: Diet, health and the gut microbiota","volume":"16","author":"Zmora","year":"2019","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.ygyno.2015.04.036","article-title":"The vaginal and gastrointestinal microbiomes in gynecologic cancers: A review of applications in etiology, symptoms and treatment","volume":"138","author":"Chase","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1016\/j.biocel.2013.06.021","article-title":"Muscle wasting: The gut microbiota as a new therapeutic target?","volume":"45","author":"Bindels","year":"2013","journal-title":"Int. J. Biochem. Cell Biol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"6829","DOI":"10.1128\/IAI.00286-06","article-title":"Toll-like receptors differentially regulate CC and CXC chemokines in skeletal muscle via NF-kappaB and calcineurin","volume":"74","author":"Boyd","year":"2006","journal-title":"Infect. Immun."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1093\/jnci\/89.23.1763","article-title":"Biology of cachexia","volume":"89","author":"Tisdale","year":"1997","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Bindels, L.B., Beck, R., Schakman, O., Martin, J.C., De Backer, F., Sohet, F.M., Dewulf, E.M., Pachikian, B.D., Neyrinck, A.M., and Thissen, J.P. (2012). Restoring specific lactobacilli levels decreases inflammation and muscle atrophy markers in an acute leukemia mouse model. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0037971"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"146083","DOI":"10.1016\/j.gene.2021.146083","article-title":"Altered cervicovaginal microbiota in premenopausal ovarian cancer patients","volume":"811","author":"Morikawa","year":"2022","journal-title":"Gene"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"205","DOI":"10.61186\/ibj.3846","article-title":"Anticancer Effect of Enterococcus faecium, Isolated from Vaginal Fluid, on Ovarian Cancer Cells","volume":"27","author":"Pourmollaei","year":"2023","journal-title":"Iran. Biomed. J."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Kim, K., Lee, M., Shin, Y., Lee, Y., and Kim, T.J. (2025). Optimizing Cancer Treatment Through Gut Microbiome Modulation. Cancers, 17.","DOI":"10.3390\/cancers17071252"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Yan, J., Yang, L., Ren, Q., Zhu, C., Du, H., Wang, Z., Qi, Y., Xian, X., and Chen, D. (2024). Gut microbiota as a biomarker and modulator of anti-tumor immunotherapy outcomes. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1471273"},{"key":"ref_48","first-page":"1141","article-title":"Modulation of gut microbiota in targeted cancer therapy: Insights on the EGFR\/VEGF\/KRAS pathways","volume":"21","author":"Gong","year":"2024","journal-title":"Cancer Biol. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"680","DOI":"10.2174\/0113892010353600241109132441","article-title":"Therapeutic Modulation of the Microbiome in Oncology: Current Trends and Future Directions","volume":"26","author":"Saraswat","year":"2025","journal-title":"Curr. Pharm. Biotechnol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1016\/S1470-2045(19)30340-7","article-title":"Association between the cervicovaginal microbiome, BRCA1 mutation status, and risk of ovarian cancer: A case-control study","volume":"20","author":"Reisel","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Capozzi, V.A., Incognito, G.G., Scarpelli, E., Palumbo, M., Randazzo, C.L., Pino, A., La Verde, M., Ronsini, C., Riemma, G., and Gaiano, M. (2024). Exploring the Relationship between Ovarian Cancer and Genital Microbiota: A Systematic Review and Meta-Analysis. J. Pers. Med., 14.","DOI":"10.3390\/jpm14040351"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1136\/ijgc-2022-003911","article-title":"Diagnostic accuracy of mutational analysis along the M\u00fcllerian tract to detect ovarian cancer","volume":"32","author":"Pijnenborg","year":"2022","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Osazuwa-Peters, O.L., Deveaux, A., Muehlbauer, M.J., Ilkayeva, O., Bain, J.R., Keku, T., Berchuck, A., Huang, B., Ward, K., and Kuliszewski, M.G. (2024). Racial Differences in Vaginal Fluid Metabolites and Association with Systemic Inflammation Markers among Ovarian Cancer Patients: A Pilot Study. Cancers, 16.","DOI":"10.3390\/cancers16071259"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1038\/s41585-020-0286-z","article-title":"The microbiome and gynaecological cancer development, prevention and therapy","volume":"17","author":"Ilhan","year":"2020","journal-title":"Nat. Rev. Urol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Zhou, B., Sun, C., Huang, J., Xia, M., Guo, E., Li, N., Lu, H., Shan, W., Wu, Y., and Li, Y. (2019). The biodiversity Composition of Microbiome in Ovarian Carcinoma Patients. Sci. Rep., 9.","DOI":"10.1038\/s41598-018-38031-2"}],"container-title":["Cells"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-4409\/14\/20\/1590\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T09:02:26Z","timestamp":1760518946000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-4409\/14\/20\/1590"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,13]]},"references-count":55,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["cells14201590"],"URL":"https:\/\/doi.org\/10.3390\/cells14201590","relation":{},"ISSN":["2073-4409"],"issn-type":[{"value":"2073-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,13]]}}}