{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:37:18Z","timestamp":1790293038839,"version":"4.1.0"},"reference-count":51,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Scientific Research (KAKENHI) in Japan","award":["18 K08204"],"award-info":[{"award-number":["18 K08204"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) can occasionally trigger thrombotic microangiopathy (TMA). Cytomegalovirus (CMV) may be reactivated during intensive immunosuppressive therapy for AAV and cause TMA. Therefore, we aimed to evaluate the clinical features of and the association between vascular endothelial injury markers and TMA due to CMV in patients with AAV. A 61-year-old female was diagnosed with AAV and severe kidney injury. Immunosuppressive therapy gradually improved her symptoms and laboratory findings. However, 2 weeks after induction therapy initiation, she exhibited altered consciousness, a significant decrease in platelet count, and hemolytic anemia, resulting in a TMA diagnosis. Plasma exchange did not improve TMA findings and routine screening test revealed CMV infection. Ganciclovir injection improved the infection and TMA findings. Consequently, we diagnosed her with CMV-induced TMA. Both AAV and CMV may induce severe vascular endothelial injury, potentially leading to TMA development. CMV-induced TMA should be considered when TMA develops during induction therapy against AAV. Moreover, of the three serum markers of vascular injury\u2014serum sulfatides, soluble thrombomodulin, and pentraxin 3\u2014serum sulfatides may be associated with the development of TMA, and a high level of soluble thrombomodulin may be associated with the development of CMV viremia during the clinical course of AAV.<\/jats:p>","DOI":"10.3390\/ijms25020812","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T04:38:51Z","timestamp":1704775131000},"page":"812","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Investigation of Clinical Features and Association between Vascular Endothelial Injury Markers and Cytomegalovirus Infection Associated with Thrombotic Microangiopathy in Patients with Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: Case-Based Research"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7500-6769","authenticated-orcid":false,"given":"Takayuki","family":"Nimura","sequence":"first","affiliation":[{"name":"Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Aomura","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6209-7683","authenticated-orcid":false,"given":"Makoto","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinori","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Yamaka","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takero","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Metabolic Regulation, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"},{"name":"Center for Medical Education and Training, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-3836","authenticated-orcid":false,"given":"Naoki","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Global Medical Research Promotion, Shinshu University Graduate School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"},{"name":"International Relations Office, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"},{"name":"Research Center for Social Systems, Shinshu University, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ehara","sequence":"additional","affiliation":[{"name":"Department of Pathology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8077-891X","authenticated-orcid":false,"given":"Yuji","family":"Kamijo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"m1070","DOI":"10.1136\/bmj.m1070","article-title":"ANCA associated vasculitis","volume":"369","author":"Hunter","year":"2020","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1007\/s10067-011-1838-7","article-title":"Estimation of BVAS in patients with microscopic polyangitis in Japan","volume":"30","author":"Itabashi","year":"2011","journal-title":"Clin. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1007\/s10238-022-00915-z","article-title":"Predictors of poor prognosis in ANCA-associated vasculitis (AAV): A single-center prospective study of inpatients in China","volume":"23","author":"Gao","year":"2023","journal-title":"Clin. Exp. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/ijlh.13954","article-title":"Diagnosis and treatment of thrombotic microangiopathy","volume":"44","author":"Thompson","year":"2022","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.2215\/CJN.00120115","article-title":"Association of serum C3 concentration and histologic signs of thrombotic microangiopahty with outcomes among patients with ANCA-associated renal vasculitis","volume":"10","author":"Manenti","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e4871","DOI":"10.1097\/MD.0000000000004871","article-title":"Antineutrophilic cytoplasmic antibody-associated vasculitis with hypocomplementemia has a higher incidence of serious organ damage and poor prognosis","volume":"95","author":"Fukui","year":"2016","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1093\/ndt\/gft220","article-title":"Atypical haemolytic uraemic syndrome with underlying glomerulopatheis. A case series and a review of the literature","volume":"28","author":"Maneti","year":"2013","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Harada, M., Iwabuchi, R., Yamaguchi, A., Aomura, D., Yamada, Y., Sonoda, K., Kamimura, Y., Hashimoto, K., and Kamijo, Y. (2023). Predictive Factors of Cytomegalovirus Viremia during the Clinical Course of Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Single Center Observational Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010351"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1080\/00365540410027175","article-title":"Thrombotic microangiopathy and hypothermia in an HIV-positive patient: Importance of cytomegalovirus infection","volume":"36","author":"Rerolle","year":"2004","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1186\/2047-783X-14-S4-268","article-title":"Clinical implications of serum thrombomodulin in PR3-ANCA-associated vasculitis","volume":"14","author":"Zycinska","year":"2009","journal-title":"Eur. J. Med. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"575890","DOI":"10.3389\/fimmu.2020.575890","article-title":"Thrombomodulin as a Physiological Modulator of Intravascular Injury","volume":"11","author":"Nakazawa","year":"2020","journal-title":"Front Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/03009742.2022.2045790","article-title":"Pentraxin-3\u2014A potential biomarker in ANCA-associated vasculitis","volume":"52","author":"Jonasdottir","year":"2023","journal-title":"Scand. J. Rheumatol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Harada, M., Nakajima, T., Yamada, Y., Aomura, D., Yamaguchi, A., Sonoda, K., Tanaka, N., Hashimoto, K., and Kamijo, Y. (2022). Serum Sulfatide Levels as a Biomarker of Active Glomerular Lesion in Patients with Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Single Center Pilot Study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030762"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"369","DOI":"10.2491\/jjsth.28.369","article-title":"Diagnostic criteria for DIC by the Japanese Society on Thrombosis and Hemostasis-2017 edition","volume":"28","author":"Wada","year":"2017","journal-title":"Jpn. J. Thromb. Hemost."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"275","DOI":"10.2169\/naika.105.275","article-title":"Atypical posterior reversible encephalopathy syndrome (PRES) and thrombotic microangiopathy (TMA) in a hemodialysis patient with ANCA-associated vasculitis","volume":"105","author":"Sakai","year":"2016","journal-title":"Nihon Naika Gakkai Zasshi."},{"key":"ref_16","first-page":"e11665","article-title":"Thrombotic microangiopathy and venous thrombosis in a patient with anti-neutrophil cytoplasmic antibody-associated vasculitis","volume":"12","author":"Duong","year":"2020","journal-title":"Cereus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s00296-018-4228-5","article-title":"Thrombotic microangiopathy in a patient with eosinophilic granulomatosis with polyangiitis: Case-based review","volume":"39","author":"Badiola","year":"2019","journal-title":"Rheumatol. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1007\/s00467-011-1862-5","article-title":"Concomitant thrombotic thrombocytopenic purpura and ANCA-associated vasculitis in an adolescent","volume":"26","author":"Agrawal","year":"2011","journal-title":"Pediatr. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"68","DOI":"10.3904\/kjim.1998.13.1.68","article-title":"A case of Wegener\u2019s granulomatosis complicated by diffuse pulmonary hemorrhage and thrombotic thrombocytopenic purpura","volume":"13","author":"Lim","year":"1998","journal-title":"Korean J. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.2169\/internalmedicine.49.3135","article-title":"Successful treatment with rituximab in a patient with TTP secondary to severe ANCA-associated vasculitis","volume":"49","author":"Asamiya","year":"2010","journal-title":"Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1093\/ndt\/13.7.1818","article-title":"Coincidence of haemolytic uraemic syndrome and c-ANCA-associated rapidly progressive glomerulonephritis","volume":"13","author":"Stefanidis","year":"1998","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"643","DOI":"10.3109\/s10165-008-0107-3","article-title":"Successful treatment of thrombotic thrombocytopenic purpura with repeated plasma exchange in a patient with microscopic polyangitis","volume":"18","author":"Nagai","year":"2008","journal-title":"Mod. Rheumatol."},{"key":"ref_23","first-page":"279","article-title":"Successful treatment for thrombotic thrombocytopenic purpura complicated with myeloperoxidase anti-neutrophil cytoplasmic autoantibody-associated vasculitis","volume":"3","author":"Yamauchi","year":"2010","journal-title":"NDT Plus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.semarthrit.2012.10.007","article-title":"Anti-glomerular basement membrane antibody disease treated with rituximab: A case-based review","volume":"42","author":"Syeda","year":"2013","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.2169\/internalmedicine.46.0050","article-title":"Wegener\u2019s granulomatosis complicated by intestinal ulcer due to cytomegalovirus infection and by thrombotic thrombocytopenic purpura","volume":"46","author":"Yamazaki","year":"2007","journal-title":"Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1093\/mrcr\/rxac029","article-title":"Anti-neutrophil cytoplasmic antibody-associated vasculitis complicated by thrombotic microangiopathy with posterior reversible encephalopathy syndrome successfully treated with eculizumab: A case report","volume":"6","author":"Kitamura","year":"2022","journal-title":"Mod. Rheumatol. Case Rep."},{"key":"ref_27","first-page":"8750306","article-title":"Systemic Lupus Erythematosus (SLE) with Acute Nephritis, Antineutrophil Cytoplasmic Antibody- (ANCA-) Associated Vasculitis, and Thrombotic Thrombocytopenic Purpura (TTP): A Rare Case Report with Literature Review","volume":"2019","author":"Farshad","year":"2019","journal-title":"Case Rep. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e1943","DOI":"10.1097\/MD.0000000000001943","article-title":"Eosinophilic Granulomatosis with Polyangiitis with Thrombotic Microangiopathy: Is Simultaneous Systemic Lupus Erythematosus Associated With Clinical Manifestations?: A Case Report and Review of the Literature","volume":"94","author":"Fukui","year":"2015","journal-title":"Medicine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1007\/s10157-010-0312-1","article-title":"Thrombotic thrombocytopenic purpura in a patient with rapidly progressive glomerulonephritis with both anti-glomerular basement membrane antibodies and myeloperoxidase anti-neutrophil cytoplasmic antibodies","volume":"14","author":"Watanabe","year":"2010","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"305","DOI":"10.5414\/CNP64305","article-title":"Thrombotic thrombocytopenic purpura associated with polyarteritis nodosa","volume":"64","author":"Fujisaki","year":"2005","journal-title":"Clin. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.jcyt.2014.02.010","article-title":"The clinical and financial burden of pre-emptive management of cytomegalovirus disease after allogeneic stem cell transplantation-implications for preventative treatment approaches","volume":"16","author":"Jain","year":"2014","journal-title":"Cytotherapy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1016\/j.bbmt.2015.07.019","article-title":"Cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation is associated with a reduced risk of relapse in patients with acute myeloid leukemia who survived to day 100 after transplantation: The Japan society for hematopoietic cell transplantation transplantation-related complication working group","volume":"21","author":"Takenaka","year":"2015","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1034\/j.1399-3062.2003.00019.x","article-title":"Thrombotic microangiopathy and cytomegalovirus in liver transplant recipients: A case-based review","volume":"5","author":"Ramasubbu","year":"2003","journal-title":"Transpl. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1097\/00007890-199806270-00018","article-title":"Thrombotic microangiopathy in association with cytomegalovirus infection in a renal transplant patient: A new treatment strategy","volume":"65","author":"Jeejeebhoy","year":"1998","journal-title":"Transplantation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1159\/000321328","article-title":"De novo thrombotic microangiopathy induced by cytomegalovirus infection leading to renal allograft loss","volume":"32","author":"Keyzer","year":"2010","journal-title":"Am. J. Nephrol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5144\/1658-3876.2011.51","article-title":"Viral-associated thrombotic microangiopathies","volume":"4","year":"2011","journal-title":"Hematol. Oncol. Stem Cell Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2955","DOI":"10.1161\/hc4901.100383","article-title":"Role for sulfatides in platelet aggregation","volume":"104","author":"Merten","year":"2001","journal-title":"Circulation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1194\/jlr.R026682","article-title":"Role of sulfatide in normal and pathological cells and tissues","volume":"53","author":"Takahashi","year":"2012","journal-title":"J. Lipid Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1111\/j.1445-5994.2011.02703.x","article-title":"Case of anti-glomerular basement membrane antibody-induced glomerulonephritis with cytomegalovirus-induced thrombotic microangiopathy","volume":"42","author":"Shiraishi","year":"2012","journal-title":"Intern. Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.2215\/CJN.01380217","article-title":"Anti-glomerular basement membrane disease","volume":"12","author":"MacAdoo","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"H1585","DOI":"10.1152\/ajpheart.00096.2013","article-title":"Thrombomodulin and the vascular endothelium: Insights into functional, regulatory, and therapeutic aspects","volume":"304","author":"Martin","year":"2013","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s11926-021-00980-5","article-title":"Blood biomarkers for monitoring and prognosis of large vessel vasculitides","volume":"23","author":"Tombetti","year":"2021","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1002\/jmv.23354","article-title":"Review: Viral infections and mechanisms of thrombosis and bleeding","volume":"84","author":"Goeijenbier","year":"2012","journal-title":"J. Med. Virol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.5114\/aoms.2014.47828","article-title":"Thrombosis associated with acute cytomegalovirus infection: A narrative review","volume":"10","author":"Sherman","year":"2014","journal-title":"Arch. Med. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1086\/314829","article-title":"Review: Infectious diseases and coagulation disorders","volume":"180","author":"Suharti","year":"1999","journal-title":"J. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1080\/14397595.2018.1551264","article-title":"Risk factors for Cytomegalovirus disease with cytomegalovirus re-activation in patients with rheumatic disease","volume":"30","author":"Kaneshita","year":"2020","journal-title":"Mod. Rheumatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"20926","DOI":"10.1038\/s41598-022-25451-4","article-title":"Risk factors associated with cytomegalovirus reactivation in patients receiving immunosuppressive therapy for rheumatic diseases: A retrospective study","volume":"12","author":"Shimada","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1007\/s00296-022-05196-z","article-title":"Clinical significance of cytomegalovirus (CMV) pp65 antigenemia in the prediction of CMV infection during immunosuppressive therapy for rheumatic disease","volume":"43","author":"Suga","year":"2023","journal-title":"Rheumatol. Int."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ab.2006.12.024","article-title":"Establishment of a quantitative, qualitative, and high-throughput analysis of sulfatides from small amounts of sera by matrix-assisted laser desorption ionization-time of flight mass spectrometry","volume":"362","author":"Li","year":"2007","journal-title":"Anal. Biochem."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"823","DOI":"10.3389\/fimmu.2019.00823","article-title":"Pentraxin 3 in cardiovascular disease","volume":"10","author":"Ristagno","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics","volume":"48","author":"Kanda","year":"2013","journal-title":"Bone Marrow Transplant."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/2\/812\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:42:44Z","timestamp":1760103764000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/2\/812"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,9]]},"references-count":51,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["ijms25020812"],"URL":"https:\/\/doi.org\/10.3390\/ijms25020812","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,9]]}}}