{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:02:29Z","timestamp":1790863349086,"version":"4.1.0"},"reference-count":58,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality globally. Increasing evidence identifies the gut microbiota as one of the major regulators of cardiovascular health, leading to the concept of the gut\u2013heart axis. Metabolites from microbiota serve as key mediators linking intestinal microbial activity with vascular and metabolic processes. This comprehensive narrative review was conducted using PubMed and Scopus databases, focusing on studies published between 2015 and 2025, along with selected seminal studies, to show the role of gut microbiota and its metabolites in CVD. Microbial metabolites exert various important and often opposing effects on cardiovascular physiology. Trimethylamine N-oxide (TMAO), derived from dietary choline and carnitine metabolism, promotes atherosclerosis through endothelial dysfunction, inflammation, foam cell formation, impaired cholesterol transport, and enhanced platelet reactivity. In contrast, short-chain fatty acids (SCFAs), produced by microbial fermentation of dietary fibers, exert protective effects by reducing inflammation, improving endothelial function, and maintaining intestinal barrier integrity by G protein coupled receptor activation and histone deacetylase inhibition. Disruption of gut barrier function facilitates lipopolysaccharide translocation, contributing to systemic inflammation and cardiometabolic risk. Bile acids further modulate cardiovascular processes through FXR and TGR5 signaling pathways; this influences lipid metabolism and inflammatory responses. Dietary patterns, including the Mediterranean diet and dietary diversity in T\u00fcrkiye, play a central role in shaping microbiota composition and metabolite balance. The gut\u2013heart axis represents a complex and dynamic process in which microbiota-derived metabolites exert a critical influence on cardiovascular health and disease. Modulation of the gut microbiome through dietary interventions, microbiota-targeted therapies, and emerging personalized strategies offers promising avenues for the prevention and management of CVDs. Future research should focus on microbiome-based precision approaches and large-scale clinical validation to facilitate translation into clinical practice.<\/jats:p>","DOI":"10.3390\/ijms27188311","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:18:26Z","timestamp":1790860706000},"page":"8311","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Gut\u2013Heart Axis in Cardiovascular Disease: Microbial Metabolites, Mediterranean and Traditional Turkish Dietary Patterns, and Personalized Medicine"],"prefix":"10.3390","volume":"27","author":[{"given":"Melih Erol","family":"Ceyhan","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Istanbul Atlas University, 34408 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gentiana","family":"Mehmeti","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Teresa 47, 1000 Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8092-3617","authenticated-orcid":false,"given":"Sude Nazli","family":"Cukurova","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Istanbul Atlas University, 34408 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8893-2926","authenticated-orcid":false,"given":"\u015eeyma","family":"D\u00fcm\u00fcr","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, 34408 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101622","DOI":"10.1016\/j.cpcardiol.2023.101622","article-title":"Global Cardiovascular Diseases Death Rate Prediction","volume":"48","author":"Gaidai","year":"2023","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_2","unstructured":"World Health Organization (2026, July 10). Cardiovascular Diseases (CVDs). Available online: https:\/\/www.who.int\/health-topics\/cardiovascular-diseases."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Rahman, M.M., Islam, F., -Or-Rashid, M.H., Al Mamun, A., Rahaman, S., Islam, M., Meem, A.F.K., Sutradhar, P.R., Mitra, S., and Mimi, A.A. (2022). The Gut Microbiota (Microbiome) in Cardiovascular Disease and Its Therapeutic Regulation. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.903570"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2752","DOI":"10.1097\/MS9.0000000000001744","article-title":"Unlocking the gut-heart axis: Exploring the role of gut microbiota in cardiovascular health and disease","volume":"86","author":"Shariff","year":"2024","journal-title":"Ann. Med. Surg. (Lond.)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"H923","DOI":"10.1152\/ajpheart.00376.2019","article-title":"The gut microbiome and cardiovascular disease: Current knowledge and clinical potential","volume":"317","author":"Ahmad","year":"2019","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/nature09922","article-title":"Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease","volume":"472","author":"Wang","year":"2011","journal-title":"Nature"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/j.amjmed.2021.03.016","article-title":"Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial","volume":"134","author":"Wilcox","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"19076","DOI":"10.1038\/srep19076","article-title":"Associations of gut-flora-dependent metabolite trimethylamine-N-oxide, betaine and choline with non-alcoholic fatty liver disease in adults","volume":"6","author":"Chen","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_9","first-page":"301","article-title":"Trimethylamine N-oxide (TMAO) in human health","volume":"20","author":"Gatarek","year":"2021","journal-title":"EXCLI J."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Arumugam, M.K., Paal, M.C., Donohue, T.M., Ganesan, M., Osna, N.A., and Kharbanda, K.K. (2021). Beneficial Effects of Betaine: A Comprehensive Review. Biology, 10.","DOI":"10.3390\/biology10060456"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1016\/j.cell.2022.04.004","article-title":"Atherosclerosis: Recent developments","volume":"185","author":"Lusis","year":"2022","journal-title":"Cell"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1038\/s41419-024-07166-8","article-title":"Inflammation in atherosclerosis: Pathophysiology and mechanisms","volume":"15","author":"Ajoolabady","year":"2024","journal-title":"Cell Death Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9217","DOI":"10.1007\/s00253-019-10142-4","article-title":"Amelioration of TMAO through probiotics and its potential role in atherosclerosis","volume":"103","author":"Din","year":"2019","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Shanmugham, M., Bellanger, S., and Leo, C.H. (2023). Gut-Derived Metabolite, Trimethylamine-N-oxide (TMAO) in Cardio-Metabolic Diseases: Detection, Mechanism, and Potential Therapeutics. Pharmaceuticals, 16.","DOI":"10.3390\/ph16040504"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"936","DOI":"10.17305\/bb.2023.8893","article-title":"The roles of trimethylamine-N-oxide in atherosclerosis and its potential therapeutic aspect: A literature review","volume":"23","author":"Oktaviono","year":"2023","journal-title":"Biomol. Biomed."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s13105-023-00984-y","article-title":"Trimethylamine N-oxide promotes oxidative stress and lipid accumulation in macrophage foam cells via the Nrf2\/ABCA1 pathway","volume":"80","author":"Luo","year":"2024","journal-title":"J. Physiol. Biochem."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Canyelles, M., Tondo, M., Ced\u00f3, L., Farr\u00e0s, M., Escol\u00e0-Gil, J.C., and Blanco-Vaca, F. (2018). Trimethylamine N-Oxide: A Link among Diet, Gut Microbiota, Gene Regulation of Liver and Intestine Cholesterol Homeostasis and HDL Function. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19103228"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1186\/s12964-023-01219-9","article-title":"Short-chain fatty acids in diseases","volume":"21","author":"Zhang","year":"2023","journal-title":"Cell Commun. Signal."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Parada Venegas, D., De la Fuente, M.K., Landskron, G., Gonz\u00e1lez, M.J., Quera, R., Dijkstra, G., Harmsen, H.J.M., Faber, K.N., and Hermoso, M.A. (2019). Short Chain Fatty Acids (SCFAs)-Mediated Gut Epithelial and Immune Regulation and Its Relevance for Inflammatory Bowel Diseases. Front. Immunol., 10, Erratum in Front. Immunol.\u00a02019, 10, 1486. https:\/\/doi.org\/10.3389\/fimmu.2019.01486.","DOI":"10.3389\/fimmu.2019.01486"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Du, Y., He, C., An, Y., Huang, Y., Zhang, H., Fu, W., Wang, M., Shan, Z., Xie, J., and Yang, Y. (2024). The Role of Short Chain Fatty Acids in Inflammation and Body Health. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25137379"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kopczy\u0144ska, J., and Kowalczyk, M. (2024). The potential of short-chain fatty acid epigenetic regulation in chronic low-grade inflammation and obesity. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1380476"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Li, M., van Esch, B.C.A.M., Henricks, P.A.J., Folkerts, G., and Garssen, J. (2018). The Anti-inflammatory Effects of Short Chain Fatty Acids on Lipopolysaccharide- or Tumor Necrosis Factor \u03b1-Stimulated Endothelial Cells via Activation of GPR41\/43 and Inhibition of HDACs. Front. Pharmacol., 9.","DOI":"10.3389\/fphar.2018.00533"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Feng, Y., and Xu, D. (2023). Short-chain fatty acids are potential goalkeepers of atherosclerosis. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1271001"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Tonch-Cerbu, A.-K., Boicean, A.-G., Stoia, O.-M., and Teodoru, M. (2025). Gut Microbiota-Derived Metabolites in Atherosclerosis: Pathways, Biomarkers, and Targets. Int. J. Mol. Sci., 26.","DOI":"10.20944\/preprints202508.0492.v1"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s12276-018-0126-x","article-title":"Mechanisms regulating intestinal barrier integrity and its pathological implications","volume":"50","author":"Chelakkot","year":"2018","journal-title":"Exp. Mol. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s11739-023-03374-w","article-title":"Gut microbiota, intestinal permeability, and systemic inflammation: A narrative review","volume":"19","author":"Petito","year":"2024","journal-title":"Intern Emerg. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s40168-018-0441-4","article-title":"Gut-dependent microbial translocation induces inflammation and cardiovascular events after ST-elevation myocardial infarction","volume":"6","author":"Zhou","year":"2018","journal-title":"Microbiome"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1042\/CS20180087","article-title":"Imbalance of gut microbiome and intestinal epithelial barrier dysfunction in patients with high blood pressure","volume":"132","author":"Kim","year":"2018","journal-title":"Clin. Sci. (Lond.)"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1053\/j.gastro.2017.01.055","article-title":"Bile Acid Control of Metabolism and Inflammation in Obesity, Type 2 Diabetes, Dyslipidemia, and Nonalcoholic Fatty Liver Disease","volume":"152","author":"Tailleux","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/MOG.0000000000000156","article-title":"Bile acids as metabolic regulators","volume":"31","author":"Li","year":"2015","journal-title":"Curr. Opin. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Mori, H., Svegliati Baroni, G., Marzioni, M., Di Nicola, F., Santori, P., Maroni, L., Abenavoli, L., and Scarpellini, E. (2022). Farnesoid X Receptor, Bile Acid Metabolism, and Gut Microbiota. Metabolites, 12.","DOI":"10.3390\/metabo12070647"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1016\/j.apsb.2021.12.011","article-title":"Bile acid coordinates microbiota homeostasis and systemic immunometabolism in cardiometabolic diseases","volume":"12","author":"Guan","year":"2022","journal-title":"Acta Pharm. Sin. B"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1017\/S0954422421000081","article-title":"Circulating bile acids as a link between the gut microbiota and cardiovascular health: Impact of prebiotics, probiotics and polyphenol-rich foods","volume":"35","author":"Pushpass","year":"2022","journal-title":"Nutr. Res. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e70024","DOI":"10.1002\/cph4.70024","article-title":"Microbiota in Gut-Heart Axis: Metabolites and Mechanisms in Cardiovascular Disease","volume":"15","author":"Kondapalli","year":"2025","journal-title":"Compr. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Barber, T.M., Kabisch, S., Pfeiffer, A.F.H., and Weickert, M.O. (2023). The Effects of the Mediterranean Diet on Health and Gut Microbiota. Nutrients, 15.","DOI":"10.3390\/nu15092150"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1186\/s12967-024-05175-x","article-title":"Impact of fundamental components of the Mediterranean diet on the microbiota composition in blood pressure regulation","volume":"22","author":"Zambrano","year":"2024","journal-title":"J. Transl. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13073-022-01015-z","article-title":"The effects of the Green-Mediterranean diet on cardiometabolic health are linked to gut microbiome modifications: A randomized controlled trial","volume":"14","author":"Rinott","year":"2022","journal-title":"Genome Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Sold\u00e1n, M., Argal\u00e1\u0161ov\u00e1, \u013d., Hadvinov\u00e1, L., Galileo, B., and Babjakov\u00e1, J. (2024). The Effect of Dietary Types on Gut Microbiota Composition and Development of Non-Communicable Diseases: A Narrative Review. Nutrients, 16.","DOI":"10.3390\/nu16183134"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2927","DOI":"10.1017\/S1368980023001957","article-title":"Evaluation of the Turkey Nutrition and Health Surveys according to the mediterranean adequacy index and sustainability through water footprints","volume":"26","author":"Ayten","year":"2023","journal-title":"Public Health Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Clemente-Su\u00e1rez, V.J., Beltr\u00e1n-Velasco, A.I., Redondo-Fl\u00f3rez, L., Mart\u00edn-Rodr\u00edguez, A., and Tornero-Aguilera, J.F. (2023). Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review. Nutrients, 15.","DOI":"10.3390\/nu15122749"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Beam, A., Clinger, E., and Hao, L. (2021). Effect of Diet and Dietary Components on the Composition of the Gut Microbiota. Nutrients, 13.","DOI":"10.3390\/nu13082795"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Gao, Y., Liu, Y., Ma, T., Liang, Q., Sun, J., Wu, X., Song, Y., Nie, H., Huang, J., and Mu, G. (2025). Fermented Dairy Products as Precision Modulators of Gut Microbiota and Host Health: Mechanistic Insights, Clinical Evidence, and Future Directions. Foods, 14.","DOI":"10.3390\/foods14111946"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1016\/j.csbj.2022.03.028","article-title":"Diet-gut microbiota interactions on cardiovascular disease","volume":"20","author":"Zhang","year":"2022","journal-title":"Comput. Struct. Biotechnol. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jtcme.2021.09.006","article-title":"Modulation of gut microbiota by foods and herbs to prevent cardiovascular diseases","volume":"13","author":"Panyod","year":"2023","journal-title":"J. Tradit. Complement. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1038\/s41591-020-01223-3","article-title":"The gut microbiome modulates the protective association between a Mediterranean diet and cardiometabolic disease risk","volume":"27","author":"Wang","year":"2021","journal-title":"Nat. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1038\/s41586-022-04567-7","article-title":"Environmental factors shaping the gut microbiome in a Dutch population","volume":"604","author":"Gacesa","year":"2022","journal-title":"Nature"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.molmed.2023.07.002","article-title":"The global human gut microbiome: Genes, lifestyles, and diet","volume":"29","author":"Parizadeh","year":"2023","journal-title":"Trends Mol. Med."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Lu, Y., Zhang, Y., Zhao, X., Shang, C., Xiang, M., Li, L., and Cui, X. (2022). Microbiota-derived short-chain fatty acids: Implications for cardiovascular and metabolic disease. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.900381"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"bbab061","DOI":"10.1093\/bib\/bbab061","article-title":"Multi-omics approaches for revealing the complexity of cardiovascular disease","volume":"22","author":"Doran","year":"2021","journal-title":"Brief. Bioinform."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1038\/s41591-022-01686-6","article-title":"Metabolomic and microbiome profiling reveals personalized risk factors for coronary artery disease","volume":"28","author":"Bar","year":"2022","journal-title":"Nat. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2323237","DOI":"10.1080\/19490976.2024.2323237","article-title":"Advancing lifelong precision medicine for cardiovascular diseases through gut microbiota modulation","volume":"16","author":"Shi","year":"2024","journal-title":"Gut Microbes"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Oniszczuk, A., Oniszczuk, T., Gancarz, M., and Szyma\u0144ska, J. (2021). Role of Gut Microbiota, Probiotics and Prebiotics in the Cardiovascular Diseases. Molecules, 26.","DOI":"10.3390\/molecules26041172"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1161\/CIRCRESAHA.120.316242","article-title":"Gut microbiota and cardiovascular disease","volume":"127","author":"Witkowski","year":"2020","journal-title":"Circ. Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"102649","DOI":"10.1016\/j.ebiom.2020.102649","article-title":"The gut microbiome in coronary artery disease and heart failure: Current knowledge and future directions","volume":"52","author":"Andersen","year":"2020","journal-title":"eBioMedicine"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s13040-024-00356-2","article-title":"Assessment of the causal relationship between gut microbiota and cardiovascular diseases: A bidirectional Mendelian randomization analysis","volume":"17","author":"Dai","year":"2024","journal-title":"BioData Min."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"5843","DOI":"10.1038\/s41467-023-39824-4","article-title":"Evidence of a causal and modifiable relationship between kidney function and circulating trimethylamine N-oxide","volume":"14","author":"Andrikopoulos","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1936379","DOI":"10.1080\/19490976.2021.1936379","article-title":"Gut microbiome and its meta-omics perspectives: Profound implications for cardiovascular diseases","volume":"13","author":"Xu","year":"2021","journal-title":"Gut Microbes"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Busnelli, M., Manzini, S., and Chiesa, G. (2020). The Gut Microbiota Affects Host Pathophysiology as an Endocrine Organ: A Focus on Cardiovascular Disease. Nutrients, 12.","DOI":"10.3390\/nu12010079"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/18\/8311\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:25:09Z","timestamp":1790861109000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/18\/8311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":58,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["ijms27188311"],"URL":"https:\/\/doi.org\/10.3390\/ijms27188311","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]}}}