{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:09:30Z","timestamp":1778216970411,"version":"3.51.4"},"reference-count":56,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) are promising regenerative treatments for lumbar degenerative disc disease (DDD), but their comparative efficacy is unclear. This systematic review and indirect meta-analysis, conducted according to PRISMA guidelines and the PICOS framework, evaluated their effects on pain, function, and safety. PubMed, Scopus, and Web of Science were systematically searched, yielding 1694 records, of which 21 studies (nine randomized controlled trials [RCTs] and 12 prospective studies) were included. Data were analyzed qualitatively and quantitatively, and risk of bias was assessed using RoB 2 and ROBINS-I. Meta-analyses of randomized controlled trials (RCTs) examined pain and disability at 6 and 12 months using a random-effects model. Indirect comparisons were performed using the Bucher method. Qualitative synthesis showed that PRP consistently reduced pain (often &gt; 50%) and improved function, frequently outperforming corticosteroids. MSCs provided sustained benefits, with follow-up extending up to 72 months in some studies. Quantitative meta-analysis of five RCTs demonstrated that PRP significantly reduced pain at 6 months (mean difference [MD] \u221216.4 mm) and disability (ODI \u221212.7), with effects persisting at 12 months in one study. In contrast, MSCs showed a modest but significant reduction in pain (MD \u22124.3 mm) and minimal functional improvement. Indirect comparisons favored PRP over MSCs at 6 months. Both treatments exhibited favorable safety profiles, with mostly mild and transient adverse events. Overall, PRP appears more effective than MSCs in the short to mid-term, although both therapies are safe. Further high-quality head-to-head RCTs are needed to confirm these findings and define optimal clinical indications.<\/jats:p>","DOI":"10.3390\/ijms27093810","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:28:23Z","timestamp":1777040903000},"page":"3810","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Platelet-Rich Plasma vs. Mesenchymal Stem Cells for Lumbar Disc Degeneration: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7402-4054","authenticated-orcid":false,"given":"Francesca","family":"Salamanna","sequence":"first","affiliation":[{"name":"Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1\/10, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Ghermandi","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6750-9376","authenticated-orcid":false,"given":"Francesca","family":"Veronesi","sequence":"additional","affiliation":[{"name":"Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1\/10, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6327-4653","authenticated-orcid":false,"given":"Veronica","family":"Borsari","sequence":"additional","affiliation":[{"name":"Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1\/10, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8344-7534","authenticated-orcid":false,"given":"Cristiana","family":"Griffoni","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Gasbarrini","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40127 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7843-5969","authenticated-orcid":false,"given":"Gianluca","family":"Giavaresi","sequence":"additional","affiliation":[{"name":"Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1\/10, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","unstructured":"GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the global burden of disease study 2017. Lancet, 392, 1789\u20131858."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/ejp.2190","article-title":"Personalized assessment and management of non-specific low back pain","volume":"28","author":"Wirth","year":"2024","journal-title":"Eur. J. Pain"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kim, H.S., Wu, P.H., and Jang, I.T. (2020). Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21041483"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101482","DOI":"10.1016\/j.neuchi.2023.101482","article-title":"Patient-related risk factors and lifestyle factors for lumbar degenerative disc disease: A systematic review","volume":"69","author":"Hoffeld","year":"2023","journal-title":"Neurochirurgie"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S1001-9294(16)30049-9","article-title":"Etiology for degenerative disc disease","volume":"31","author":"Hemanta","year":"2016","journal-title":"Chin. Med. Sci. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s11914-022-00769-0","article-title":"Genetics of intervertebral disc degeneration","volume":"21","author":"Kleck","year":"2023","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wu, P.H., Kim, H.S., and Jang, I.T. (2020). Intervertebral disc diseases Part 2: A review of the current diagnostic and treatment strategies for intervertebral disc disease. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21062135"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s00264-018-4260-9","article-title":"The relevance of high-intensity zones in degenerative disc disease","volume":"43","author":"Cheung","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1016\/j.ejrad.2015.04.002","article-title":"MR imaging of degenerative disc disease","volume":"84","author":"Farshad","year":"2015","journal-title":"Eur. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.ocl.2011.07.009","article-title":"Management of degenerative disk disease and chronic low back pain","volume":"42","author":"Karppinen","year":"2011","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1007\/s00586-016-4714-y","article-title":"Total disc replacement versus fusion for lumbar degenerative disc disease: A systematic review of overlapping meta-analyses","volume":"26","author":"Ding","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1417600","DOI":"10.3389\/fbioe.2024.1417600","article-title":"Regenerative therapies for lumbar degenerative disc diseases: A literature review","volume":"12","author":"Sono","year":"2024","journal-title":"Front. Bioeng. Biotechnol."},{"key":"ref_13","first-page":"E995","article-title":"Effectiveness of intradiscal regenerative medicine therapies for long-term relief of chronic low back pain: A systematic review and meta-analysis","volume":"27","author":"Manchikanti","year":"2024","journal-title":"Pain Physician"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11916-024-01325-4","article-title":"Biologic therapies for discogenic pain","volume":"29","author":"Lou","year":"2025","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_15","first-page":"e79504","article-title":"Role of platelet-rich plasma (PRP) in the management of stage III and IV degenerative disc disease","volume":"17","author":"Paliaroutas","year":"2025","journal-title":"Cureus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s11684-017-0551-6","article-title":"Platelet-rich plasma: Combinational treatment modalities for musculoskeletal conditions","volume":"12","author":"Andia","year":"2018","journal-title":"Front. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/j.cvsm.2022.02.005","article-title":"Platelet-rich plasma as an orthobiologic: Clinically relevant considerations","volume":"52","author":"Carr","year":"2022","journal-title":"Vet. Clin. N. Am. Small Anim. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1080\/17474086.2021.1860002","article-title":"Evidence-based indications of platelet-rich plasma therapy","volume":"14","author":"Gupta","year":"2021","journal-title":"Expert. Rev. Hematol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1080\/15384101.2020.1863682","article-title":"Bone mesenchymal stem cell-derived extracellular vesicles promote the repair of intervertebral disc degeneration by transferring microRNA-199a","volume":"20","author":"Wen","year":"2021","journal-title":"Cell Cycle"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13287-020-02062-2","article-title":"Uncovering the secretome of mesenchymal stromal cells exposed to healthy, traumatic, and degenerative intervertebral discs: A proteomic analysis","volume":"12","author":"Wangler","year":"2021","journal-title":"Stem Cell Res. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s13287-024-03703-6","article-title":"Adipose-derived stem cell-based optimization strategies for musculoskeletal regeneration: Recent advances and perspectives","volume":"15","author":"Yuan","year":"2024","journal-title":"Stem Cell Res. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.3892\/etm.2021.10866","article-title":"Influence of extracellular nanovesicles derived from adipose-derived stem cells on nucleus pulposus cell from patients with intervertebral disc degeneration","volume":"22","author":"Zhang","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s12257-019-0346-5","article-title":"A brief overview of recent engineering approaches for intervertebral disc regeneration using adipose derived mesenchymal stem cell administration","volume":"26","author":"Kim","year":"2021","journal-title":"Biotechnol. Bioprocess Eng."},{"key":"ref_24","unstructured":"(2025, May 23). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Expanded Reporting Checklist. Available online: https:\/\/www.prisma-statement.org\/prisma-2020-checklist."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_27","first-page":"40","article-title":"meta: An R package for meta-analysis","volume":"7","author":"Schwarzer","year":"2007","journal-title":"R News"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting Meta-Analyses in R with the metafor Package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_29","unstructured":"R Core Team (2024). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_30","first-page":"29","article-title":"Safety and Efficacy of Platelet Rich Plasma for Treatment of Lumbar Discogenic Pain: A Prospective, Multicenter, Randomized, Double-blind Study","volume":"25","author":"Zielinski","year":"2022","journal-title":"Pain Physician"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E725","DOI":"10.36076\/ppj.2023.26.E725","article-title":"Plasma Rich in Growth Factors (PRGF) in the Treatment of Patients With Chronic Cervical and Lumbar Pain: A Prospective Observational Clinical Study","volume":"26","author":"Anitua","year":"2023","journal-title":"Pain Physician"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"FSO794","DOI":"10.2144\/fsoa-2021-0155","article-title":"Low-dose mesenchymal stem cell therapy for discogenic pain: Safety and efficacy results from a 1-year feasibility study","volume":"8","author":"Bates","year":"2022","journal-title":"Future Sci. OA"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1186\/s12967-017-1300-y","article-title":"Treatment of lumbar degenerative disc disease-associated radicular pain with culture-expanded autologous mesenchymal stem cells: A pilot study on safety and efficacy","volume":"15","author":"Centeno","year":"2017","journal-title":"J. Transl. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"622573","DOI":"10.3389\/fmed.2021.622573","article-title":"Autologous BMAC Therapy Improves Spinal Degenerative Joint Disease in Lower Back Pain Patients","volume":"8","author":"Lumbao","year":"2021","journal-title":"Front. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"9617511","DOI":"10.1155\/2022\/9617511","article-title":"Low Back Pain, Disability, and Quality of Life One Year following Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate","volume":"2022","author":"Haines","year":"2022","journal-title":"Stem Cells Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1093\/pm\/pnaa254","article-title":"Intradiscal Platelet-Rich Plasma Injection for Discogenic Low Back Pain and Correlation with Platelet Concentration: A Prospective Clinical Trial","volume":"21","author":"Jain","year":"2020","journal-title":"Pain Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1093\/pm\/pnv053","article-title":"Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial","volume":"17","author":"Levi","year":"2016","journal-title":"Pain Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s00264-015-2886-4","article-title":"Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up","volume":"40","author":"Pettine","year":"2016","journal-title":"Int. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1007\/s00264-017-3560-9","article-title":"Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up","volume":"41","author":"Pettine","year":"2017","journal-title":"Int. Orthop."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"9563693","DOI":"10.1155\/2022\/9563693","article-title":"Intradiscal Autologous Platelet-Rich Plasma Injection for Discogenic Low Back Pain: A Clinical Trial","volume":"2022","author":"Zhang","year":"2022","journal-title":"BioMed Res. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"380","DOI":"10.4184\/asj.2017.11.3.380","article-title":"Intradiscal Injection of Autologous Platelet-Rich Plasma Releasate to Treat Discogenic Low Back Pain: A Preliminary Clinical Trial","volume":"11","author":"Akeda","year":"2017","journal-title":"Asian Spine J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1016\/j.spinee.2025.03.015","article-title":"Efficacy and safety of allogeneic mesenchymal precursor cells with and without hyaluronic acid for treatment of chronic low back pain: A prospective, randomized, double blind, concurrent-controlled 36-month study","volume":"25","author":"Beall","year":"2025","journal-title":"Spine J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"58","DOI":"10.31616\/asj.2023.0115","article-title":"Lumbar Transforaminal Injection of Steroids versus Platelet-Rich Plasma for Prolapse Lumbar Intervertebral Disc with Radiculopathy: A Randomized Double-Blind Controlled Pilot Study","volume":"18","author":"Gupta","year":"2024","journal-title":"Asian Spine J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E65","DOI":"10.36076\/ppj.2024.27.E65","article-title":"The Safety and Effectiveness of Orthobiologic Injections for Discogenic Chronic Low Back Pain: A Multicenter Prospective, Crossover, Randomized Controlled Trial with 12 Months Follow-up","volume":"27","author":"Navani","year":"2024","journal-title":"Pain Physician"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1097\/TP.0000000000001484","article-title":"Intervertebral Disc Repair by Allogeneic Mesenchymal Bone Marrow Cells: A Randomized Controlled Trial","volume":"101","author":"Noriega","year":"2017","journal-title":"Transplantation"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1136\/ard-2024-225771","article-title":"Allogenic bone marrow-derived mesenchymal stromal cell-based therapy for patients with chronic low back pain: A prospective, multicentre, randomised placebo controlled trial (RESPINE study)","volume":"83","author":"Pers","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1007\/s43465-023-00898-3","article-title":"Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar radiculopathy: A Prospective, Double-Blind Randomized Study","volume":"57","author":"Saraf","year":"2023","journal-title":"Indian J. Orthop."},{"key":"ref_48","first-page":"100011","article-title":"Effectiveness of intradiscal platelet rich plasma for discogenic low back pain without Modic changes: A randomized controlled trial","volume":"1","author":"Schepers","year":"2022","journal-title":"Int. Pain Med."},{"key":"ref_49","first-page":"1","article-title":"Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study","volume":"8","author":"Terry","year":"2016","journal-title":"PM&R"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Akeda, K., Ohishi, K., Takegami, N., Sudo, T., Yamada, J., Fujiwara, T., Niimi, R., Matsumoto, T., Nishimura, Y., and Ogura, T. (2022). Platelet-Rich Plasma Releasate versus Corticosteroid for the Treatment of Discogenic Low Back Pain: A Double-Blind Randomized Controlled Trial. J. Clin. Med., 11.","DOI":"10.3390\/jcm11020304"},{"key":"ref_51","first-page":"e8831","article-title":"Systemic Review: Is an Intradiscal Injection of Platelet-Rich Plasma for Lumbar Disc Degeneration Effective?","volume":"12","author":"Hirase","year":"2020","journal-title":"Cureus"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"505","DOI":"10.2147\/JPR.S292335","article-title":"The Effect of Intradiscal Platelet-Rich Plasma Injection for Management of Discogenic Lower Back Pain: A Meta-Analysis","volume":"14","author":"Chang","year":"2021","journal-title":"J. Pain Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1138255","DOI":"10.3389\/fendo.2023.1138255","article-title":"Application of platelet-rich plasma in spinal surgery","volume":"14","author":"Wang","year":"2023","journal-title":"Front. Endocrinol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"210","DOI":"10.17305\/bb.2023.9518","article-title":"Stem cell therapy for degenerative disc disease: Bridging the gap between preclinical promise and clinical potential","volume":"24","author":"Munda","year":"2024","journal-title":"Biomol. Biomed."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ymeth.2015.09.015","article-title":"Mesenchymal stem cells in regenerative medicine: Focus on articular cartilage and intervertebral disc regeneration","volume":"99","author":"Richardson","year":"2016","journal-title":"Methods"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1155357","DOI":"10.3389\/fbioe.2023.1155357","article-title":"Mesenchymal stem cells can improve discogenic pain in patients with intervertebral disc degeneration: A systematic review and meta-analysis","volume":"11","author":"Zhang","year":"2023","journal-title":"Front. Bioeng. Biotechnol."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/9\/3810\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:10:53Z","timestamp":1778213453000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/9\/3810"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":56,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["ijms27093810"],"URL":"https:\/\/doi.org\/10.3390\/ijms27093810","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]}}}