{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T05:27:26Z","timestamp":1764307646218,"version":"3.46.0"},"reference-count":50,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001321","name":"National Research Foundation","doi-asserted-by":"crossref","award":["117829","141929","107249"],"award-info":[{"award-number":["117829","141929","107249"]}],"id":[{"id":"10.13039\/501100001321","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Health and Welfare Sector Education"},{"name":"Training Authority (South Africa), and the University of Limpopo"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Human immunodeficiency virus (HIV) infection remains a major health burden in Sub-Saharan Africa, despite the widespread use of antiretroviral therapy (ART). Oxidative stress contributes to HIV-related comorbidities, including renal dysfunction. However, the role of oxidative stress in kidney impairment among people living with HIV (PLWH) is not fully understood. This cross-sectional study included PLWH on ART (n = 80), PLWH without ART (n = 27), and people not living with HIV (PNLWH) (n = 44). Oxidative stress was measured by serum malondialdehyde (MDA), superoxide dismutase (SOD) and total antioxidant capacity (TAC), while renal function was assessed using cystatin C-based estimated glomerular filtration rate (eGFRcystC). Participants on ART were older (median 43 years) and had higher CD4+ T-cell counts compared to those not on ART. PLWH on ART showed significantly elevated MDA levels compared to PLWH without ART (p &lt; 0.001) and PNLWH (p = 0.001). There was no difference in superoxide dismutase (SOD) and TAC levels among the groups (p = 0.177 and 0.888, respectively). Among PLWH, MDA was higher in those with reduced renal function (eGFRcystC &lt; 90) versus normal function (p &lt; 0.05). In PLWH on ART, SOD activity was significantly lower in mild renal impairment (eGFRcystC 60\u201389) compared to normal function (p = 0.017), but no difference was observed in the TAC levels (p = 0.883). In PLWH on ART, regression analyses indicated no independent association between MDA and renal function decline, while higher SOD activity independently predicted better renal function (adjusted \u03b2 = 2.26, p = 0.042). Oxidative damage accompanied by the inability of the body\u2019s primary antioxidant defenses may be present at the early onset of renal function decline in PLWH. Superoxide dismutase, as an antioxidant defence enzyme, may be a key contributor to renal health in PLWH on ART. Future studies with larger cohorts and longitudinal designs are needed to clarify these relationships emanating from this pilot study.<\/jats:p>","DOI":"10.3390\/ijms262311429","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T11:43:22Z","timestamp":1764157402000},"page":"11429","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Pilot Study on the Potential Pathological Link Between Oxidative Stress Markers and Renal Function in People Living with HIV"],"prefix":"10.3390","volume":"26","author":[{"given":"Joel","family":"Choshi","sequence":"first","affiliation":[{"name":"Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9054-7242","authenticated-orcid":false,"given":"Haskly","family":"Mokoena","sequence":"additional","affiliation":[{"name":"Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5899-4472","authenticated-orcid":false,"given":"Helen C.","family":"Steel","sequence":"additional","affiliation":[{"name":"Department of Immunology, University of Pretoria, Pretoria 0001, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0628-4636","authenticated-orcid":false,"given":"Brian T.","family":"Flepisi","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3224-7433","authenticated-orcid":false,"given":"Kabelo","family":"Mokgalaboni","sequence":"additional","affiliation":[{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Roodepoort 1710, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7769-4528","authenticated-orcid":false,"given":"Wendy N.","family":"Phoswa","sequence":"additional","affiliation":[{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Roodepoort 1710, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3336-5594","authenticated-orcid":false,"given":"Gerald","family":"Maarman","sequence":"additional","affiliation":[{"name":"CARMA: Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town 8000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sihle E.","family":"Mabhida","sequence":"additional","affiliation":[{"name":"Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bongani B.","family":"Nkambule","sequence":"additional","affiliation":[{"name":"School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5965-3610","authenticated-orcid":false,"given":"Phiwayinkosi V.","family":"Dludla","sequence":"additional","affiliation":[{"name":"School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"},{"name":"Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3880, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6719-8512","authenticated-orcid":false,"given":"Sidney","family":"Hanser","sequence":"additional","affiliation":[{"name":"Department of Physiology, School of Medicine, Sefako Makgatho Health Science University, Ga-Rankuwa 0208, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.clindermatol.2024.02.001","article-title":"The global burden of HIV","volume":"42","author":"Payagala","year":"2024","journal-title":"Clin. Dermatol."},{"key":"ref_2","unstructured":"World Health Organisation (2025, March 09). HIV Data and Statistic. Available online: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/hiv\/strategic-information\/hiv-data-and-statistics."},{"key":"ref_3","unstructured":"Statistics South Africa (2025, March 19). Mid-Year Population Estimates, Available online: https:\/\/www.statssa.gov.za\/publications\/P0302\/P03022024.pdf."},{"key":"ref_4","first-page":"1","article-title":"Impact of antiretroviral therapy on kidney disease in HIV infected individuals\u2014A qualitative systematic review","volume":"21","author":"Adnani","year":"2022","journal-title":"J. Int. Assoc. Provid. AIDS Care (JIAPAC)"},{"key":"ref_5","first-page":"5478708","article-title":"Oxidative stress in the pathophysiology of kidney disease: Implications for noninvasive monitoring and identification of biomarkers","volume":"2020","year":"2020","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Choshi, J., Hanser, S., Mabhida, S.E., Mokoena, H., Moetlediwa, M.T., Muvhulawa, N., Sekgala, M.D., Nkambule, B.B., Mchiza, Z.J., and Ndwandwe, D. (2024). A systematic review assessing the association of inflammatory markers with kidney dysfunction in people living with HIV on highly active antiretroviral therapy. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09594-5"},{"key":"ref_7","first-page":"2003","article-title":"Oxidative stress, mitochondrial damage and neurodegenerative diseases","volume":"8","author":"Guo","year":"2013","journal-title":"Neural Regen. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"103","DOI":"10.3109\/1354750X.2012.749302","article-title":"Clinical and research markers of oxidative stress in chronic kidney disease","volume":"18","author":"Tucker","year":"2013","journal-title":"Biomarkers"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"211","DOI":"10.14499\/indonesianjpharm27iss4pp211","article-title":"Ameliorative effects of vitamins C and E on tenofovir\/nevirapine-induced hepatorenal oxidative stress in albino rats","volume":"27","author":"Adikwu","year":"2016","journal-title":"Indones. J. Pharm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1007\/s00467-018-4005-4","article-title":"Oxidative stress in chronic kidney disease","volume":"34","author":"Daenen","year":"2019","journal-title":"Pediatr. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tom\u00e1s-Sim\u00f3, P., D\u2019Marco, L., Romero-Parra, M., Tormos-Mu\u00f1oz, M.C., S\u00e1ez, G., Torregrosa, I., Esta\u00f1-Capell, N., Miguel, A., Gorriz, J.L., and Puchades, M.J. (2021). Oxidative stress in non-dialysis-dependent chronic kidney disease patients. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18157806"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2975256","DOI":"10.1155\/2020\/2975256","article-title":"Plasma protein carbonyls as biomarkers of oxidative stress in chronic kidney disease, dialysis, and transplantation","volume":"2020","author":"Colombo","year":"2020","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vodo\u0161ek Hojs, N., Bevc, S., Ekart, R., and Hojs, R. (2020). Oxidative stress markers in chronic kidney disease with emphasis on diabetic nephropathy. Antioxidants, 9.","DOI":"10.3390\/antiox9100925"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"8852","DOI":"10.3390\/cimb46080523","article-title":"ROS chronicles in HIV infection: Genesis of oxidative stress, associated pathologies, and therapeutic strategies","volume":"46","author":"Harshithkumar","year":"2024","journal-title":"Curr. Issues Mol. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2990","DOI":"10.1002\/jcb.26450","article-title":"Oxidative stress induces renal failure: A review of possible molecular pathways","volume":"119","author":"Yaribeygi","year":"2018","journal-title":"J. Cell. Biochem."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/978-981-13-8871-2_29","article-title":"Oxidative stress and renal fibrosis: Mechanisms and therapies","volume":"1165","author":"Su","year":"2019","journal-title":"Ren. Fibros. Mech. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"107812","DOI":"10.1016\/j.phrs.2025.107812","article-title":"HIV Infection, Antiretroviral Therapy and Vascular Dysfunction: Effects and Mechanisms","volume":"217","author":"Wei","year":"2025","journal-title":"Pharmacol. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1742-6405-3-19","article-title":"The effect of different combination therapies on oxidative stress markers in HIV infected patients in Cameroon","volume":"3","author":"Ngondi","year":"2006","journal-title":"AIDS Res. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.freeradbiomed.2010.12.029","article-title":"Highly active antiretroviral therapy drug combination induces oxidative stress and mitochondrial dysfunction in immortalized human blood\u2013brain barrier endothelial cells","volume":"50","author":"Manda","year":"2011","journal-title":"Free Radic. Biol. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1002\/jcb.25149","article-title":"Mitochondrial and oxidative stress response in HepG2 cells following acute and prolonged exposure to antiretroviral drugs","volume":"116","author":"Nagiah","year":"2015","journal-title":"J. Cell. Biochem."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s12012-015-9314-2","article-title":"Efavirenz causes oxidative stress, endoplasmic reticulum stress, and autophagy in endothelial cells","volume":"16","author":"Kost","year":"2016","journal-title":"Cardiovasc. Toxicol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Seguro, A.C., Gois, P.H.F., and Canale, D. (2018). Vitamin D, Oxidative Stress, and the Antiretroviral Tenofovir. HIV\/AIDS (Oxidative Stress and Dietary Antioxidants), Academic Press.","DOI":"10.1016\/B978-0-12-809853-0.00018-3"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"512","DOI":"10.4314\/ahs.v18i3.7","article-title":"Effect of anti-retroviral therapy on oxidative stress in hospitalized HIV-infected adults with and without TB","volume":"18","author":"Musisi","year":"2018","journal-title":"Afr. Health Sci."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Quaye, O., Kuleape, J.A., Bonney, E.Y., Puplampu, P., and Tagoe, E.A. (2019). Imbalance of antioxidant enzymes activities and trace elements levels in Ghanaian HIV-infected patients. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0220181"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"35","DOI":"10.9734\/ajbgmb\/2022\/v12i4269","article-title":"Assessment of Oxidative Stress Level in HIV\/AIDS Patients on HAART Treatments","volume":"12","author":"Elujoba","year":"2022","journal-title":"Asian J. Biochem. Genet. Mol. Biol."},{"key":"ref_26","first-page":"12389","article-title":"Integrase inhibitor-based antiretroviral treatments decrease oxidative stress caused by HIV infection","volume":"24","author":"Akkoyunlu","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"410","DOI":"10.4314\/ahs.v22i1.50","article-title":"Metabolic syndrome and its components among HIV\/AIDS patients on Antiretroviral Therapy and ART-Na\u00efve Patients at the University of Calabar Teaching Hospital, Calabar, Nigeria","volume":"22","author":"Ojong","year":"2022","journal-title":"Afr. Health Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"9834803","DOI":"10.1155\/2017\/9834803","article-title":"Antiretroviral Therapy Initiation Alters the Redox System of Asymptomatic Hiv-Infected Individuals: A Longitudinal Study","volume":"2017","author":"Tasca","year":"2017","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12981-024-00694-5","article-title":"Factors associated with oxidative stress in virologically suppressed people living with HIV on long-term antiretroviral therapy","volume":"21","author":"Lombardi","year":"2024","journal-title":"AIDS Res. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Hamed, M.A., Aremu, A.O., and Akhigbe, R.E. (2021). Concomitant administration of HAART aggravates anti-Koch-induced oxidative hepatorenal damage via dysregulation of glutathione and elevation of uric acid production. Biomed. Pharmacother., 137.","DOI":"10.1016\/j.biopha.2021.111309"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"157","DOI":"10.4103\/jnsm.jnsm_153_20","article-title":"Selenium Protects against Tenofovir\/Lamivudine\/Efavirenz-Induced Nephrotoxicity in Rats","volume":"5","author":"Adikwu","year":"2022","journal-title":"J. Nat. Sci. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1093\/ndt\/gfg074","article-title":"Oxidative stress in end-stage renal disease: An emerging threat to patient outcome","volume":"18","author":"Locatelli","year":"2003","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3081856","DOI":"10.1155\/2017\/3081856","article-title":"Oxidative stress in hemodialysis patients: A review of the literature","volume":"2017","author":"Liakopoulos","year":"2017","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"F129","DOI":"10.1152\/ajprenal.00024.2011","article-title":"HIV gene expression deactivates redox-sensitive stress response program in mouse tubular cells both in vitro and in vivo 2","volume":"302","author":"Salhan","year":"2012","journal-title":"Am. J. Physiol.-Ren. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.toxrep.2018.09.003","article-title":"Nephrotoxicity and highly active antiretroviral therapy: Mitigating action of Momordica charantia","volume":"5","author":"Offor","year":"2018","journal-title":"Toxicol. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Dennis, J.M., and Witting, P.K. (2017). Protective role for antioxidants in acute kidney disease. Nutrients, 9.","DOI":"10.3390\/nu9070718"},{"key":"ref_37","unstructured":"Mauricio, K.S.S. (2019). HIV\/AIDS: The Mechanisms and Consequences of Oxidative Stress and the Benefits of Antioxidants, PQDT-Global."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"806358","DOI":"10.1155\/2015\/806358","article-title":"Chronic kidney disease influences multiple systems: Describing the relationship between oxidative stress, inflammation, kidney damage, and concomitant disease","volume":"2015","author":"Tucker","year":"2015","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Podkowi\u0144ska, A., and Formanowicz, D. (2020). Chronic kidney disease as oxidative stress-and inflammatory-mediated cardiovascular disease. Antioxidants, 9.","DOI":"10.3390\/antiox9080752"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S1043-6618(02)00320-1","article-title":"Contribution to characterization of oxidative stress in HIV\/AIDS patients","volume":"47","author":"Gil","year":"2003","journal-title":"Pharmacol. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1089\/aid.2009.0062","article-title":"oxidative stress in HIV-infected individuals: A cross-sectional study","volume":"25","author":"Wanchu","year":"2009","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"79","DOI":"10.3855\/jidc.1906","article-title":"Investigation of the levels of oxidative stress parameters in HIV and HIV-TB co-infected patients","volume":"6","author":"Awodele","year":"2012","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8910396","DOI":"10.1155\/2016\/8910396","article-title":"Oxidative stress during HIV infection: Mechanisms and consequences","volume":"2016","author":"Ivanov","year":"2016","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/j.1749-6632.1963.tb13293.x","article-title":"Methodological problems in the study of human populations","volume":"107","author":"Cochran","year":"1963","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_45","unstructured":"Zuma, K. (2025, October 29). The sixth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM VI): 20 Years of Strategic HIV and Public Health Data. Available online: http:\/\/hdl.handle.net\/20.500.11910\/20045."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Choshi, J., Flepisi, B., Mabhida, S.E., Sekgala, M.D., Mokoena, H., Nkambule, B.B., Ndwandwe, D., Mchiza, Z.J., Nqebelele, U., and Kengne, A.P. (2024). Prevalence of chronic kidney disease and associated risk factors among people living with HIV in a rural population of Limpopo Province, South Africa. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1425460"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1007\/s42452-024-06197-2","article-title":"Assessing renal function with the use of cystatin C in a rural cohort of people living with HIV on highly active antiretroviral therapy within the Limpopo Province, South Africa","volume":"6","author":"Choshi","year":"2024","journal-title":"Discov. Appl. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. J. Am. Med. Assoc., 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Estrella, M.M., Jaar, B.G., Cavanaugh, K.L., Fox, C.H., Perazella, M.A., Soman, S.S., Howell, E., Rocco, M.V., and Choi, M.J. (2013). Perceptions and use of the national kidney foundation KDOQI guidelines: A survey of US renal healthcare providers. BMC Nephrol., 14.","DOI":"10.1186\/1471-2369-14-230"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/23\/11429\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T05:23:30Z","timestamp":1764307410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/23\/11429"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":50,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["ijms262311429"],"URL":"https:\/\/doi.org\/10.3390\/ijms262311429","relation":{},"ISSN":["1422-0067"],"issn-type":[{"type":"electronic","value":"1422-0067"}],"subject":[],"published":{"date-parts":[[2025,11,26]]}}}