{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:16:40Z","timestamp":1791227800439,"version":"4.1.0"},"reference-count":54,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Psoriasis is a chronic immune-mediated inflammatory disease increasingly recognized as a systemic disorder associated with significant metabolic and cardiovascular comorbidities. Among these, obesity (defined as BMI &gt; 30 kg\/m2) plays a pivotal role, acting both as a risk factor for psoriasis development and as a modifier of disease severity, clinical phenotype, and therapeutic response. The relationship between psoriasis and obesity is bidirectional and sustained by shared inflammatory and metabolic pathways. This review aims to provide a comprehensive and updated synthesis of the epidemiological association between psoriasis and obesity, to elucidate the underlying pathophysiological mechanisms, and to discuss the clinical and therapeutic implications of excess body weight in psoriasis management. Methods: A narrative review of the literature was conducted, including epidemiological studies, mechanistic research, clinical trials, and real-world evidence addressing the interplay between psoriasis and obesity. Relevant data were identified from peer-reviewed publications focusing on inflammatory pathways, metabolic dysfunction, cardiovascular risk, and treatment outcomes in obese patients with psoriasis. The graphical figures included in this manuscript were created with the assistance of a large language model\u2013based image-generation tool, ChatGPT-5 by OpenAI, using author-defined prompts. The prompts requested schematic medical illustrations summarizing the pathophysiological links between obesity and psoriasis, including adipose tissue dysfunction, adipokine imbalance, systemic inflammation, and activation of the IL-23\/Th17 axis. For the therapeutic algorithm, the prompt requested a stepwise clinical flowchart for obese patients with psoriasis, including BMI assessment, comorbidity screening, universal weight-management measures, psoriasis severity stratification, obesity-adapted biologic selection, and management of suboptimal response. The generated images were subsequently reviewed, edited, and approved by the authors to ensure scientific accuracy, clarity, and consistency with the manuscript content. Results: Epidemiological evidence consistently demonstrates a higher prevalence of obesity among patients with psoriasis, with obesity independently associated with increased disease severity. Shared mechanisms include adipose tissue\u2013driven cytokine production, dysregulated adipokine secretion, insulin resistance, endothelial dysfunction, and activation of the IL-23\/Th17 axis, collectively contributing to systemic inflammation and accelerated atherogenesis. Obesity negatively impacts the efficacy, pharmacokinetics, and long-term drug survival of conventional systemic agents and biologic therapies, leading to suboptimal clinical outcomes. Conclusions: Obesity is a key determinant of psoriasis burden, influencing disease expression, comorbidities, and therapeutic response. Integrating weight reduction strategies into personalized psoriasis management may improve both dermatological outcomes and overall cardiometabolic health, supporting a holistic approach to patient care.<\/jats:p>","DOI":"10.3390\/jcm15114302","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:25:31Z","timestamp":1780399531000},"page":"4302","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Psoriasis in Obese Patients: Pathophysiological Interactions, Clinical Consequences, and Therapeutic Implications"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0669-5366","authenticated-orcid":false,"given":"Gustavo","family":"Almeida-Silva","sequence":"first","affiliation":[{"name":"Department of Dermatology, Hospital de Santa Maria, Unidade Local de Sa\u00fade Santa Maria, 1649-035 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0221-7193","authenticated-orcid":false,"given":"Joana","family":"Antunes","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital de Santa Maria, Unidade Local de Sa\u00fade Santa Maria, 1649-035 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Dermatology University Clinic, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Filipe","sequence":"additional","affiliation":[{"name":"Dermatology University Clinic, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/S0140-6736(14)61909-7","article-title":"Psoriasis","volume":"386","author":"Boehncke","year":"2015","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1038\/jid.2010.103","article-title":"Psoriasis and systemic inflammatory diseases: Potential mechanistic links between skin disease and co-morbid conditions","volume":"130","author":"Davidovici","year":"2010","journal-title":"J. Investig. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.clindermatol.2017.09.005","article-title":"Psoriasis and the metabolic syndrome","volume":"36","author":"Gisondi","year":"2018","journal-title":"Clin. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e54","DOI":"10.1038\/nutd.2012.26","article-title":"The association between psoriasis and obesity: A systematic review and meta-analysis of observational studies","volume":"2","author":"Armstrong","year":"2012","journal-title":"Nutr. Diabetes"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1001\/archinte.167.15.1670","article-title":"Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses\u2019 Health Study II","volume":"167","author":"Setty","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.0022-202X.2005.23681.x","article-title":"Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: Results from an Italian case-control study","volume":"125","author":"Naldi","year":"2005","journal-title":"J. Investig. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1111\/j.1468-3083.2010.03647.x","article-title":"Circulating adipokine levels in Portuguese patients with psoriasis vulgaris according to body mass index, severity and therapy","volume":"24","author":"Coimbra","year":"2010","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"116","DOI":"10.5114\/reum\/162995","article-title":"Effect of low-calorie diet on psoriasis severity index, triglycerides, liver enzymes, and quality of life in psoriatic patients with non-alcoholic fatty liver disease","volume":"61","author":"Ismail","year":"2023","journal-title":"Reumatologia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1111\/jdv.70247","article-title":"Impact of weight-loss interventions on psoriasis severity: A systematic review and meta-analysis","volume":"40","author":"Morrow","year":"2025","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e391","DOI":"10.1111\/jdv.19617","article-title":"Awareness of obesity among patients with psoriasis","volume":"38","author":"Bellinato","year":"2024","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Karampinis, E., Goudouras, G., Ntavari, N., Bogdanos, D.P., Roussaki-Schulze, A.V., and Zafiriou, E. (2023). Serum vitamin D levels can be predictive of psoriasis flares up after COVID-19 vaccination: A retrospective case control study. Front Med., 10.","DOI":"10.3389\/fmed.2023.1203426"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.1002\/ski2.33","article-title":"Psychosocial aspects of obesity in adults with psoriasis: A systematic review","volume":"1","author":"Pavlova","year":"2021","journal-title":"Skin. Health Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"14076","DOI":"10.1038\/s41598-017-14292-1","article-title":"High fat diet exacerbates murine psoriatic dermatitis by increasing the number of IL-17-producing \u03b3\u03b4 T cells","volume":"7","author":"Nakamizo","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_14","first-page":"CD011972","article-title":"Lifestyle changes for treating psoriasis","volume":"7","author":"Ko","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamadermatol.2018.1412","article-title":"Dietary Recommendations for Adults with Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review","volume":"154","author":"Ford","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1016\/j.jaad.2020.02.044","article-title":"Joint American Academy of Dermatology\u2013National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies","volume":"82","author":"Menter","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.jaad.2024.12.016","article-title":"The association between obesity and efficacy of psoriasis therapies: An expert consensus panel","volume":"92","author":"Burshtein","year":"2025","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1111\/1346-8138.14270","article-title":"Effectiveness of and factors associated with clinical response to methotrexate under daily life conditions in Asian patients with psoriasis: A retrospective cohort study","volume":"45","author":"Pongparit","year":"2018","journal-title":"J. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.3945\/ajcn.2008.26427","article-title":"Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: A randomized, controlled, investigator-blinded clinical trial","volume":"88","author":"Gisondi","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1093\/bjd\/ljad004","article-title":"BADBIR Study Group. Effectiveness and persistence of acitretin, ciclosporin, fumaric acid esters and methotrexate for patients with moderate-to-severe psoriasis: A cohort study from BADBIR","volume":"188","author":"Alabas","year":"2023","journal-title":"Br. J. Dermatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s40261-021-01080-z","article-title":"Impact of Body Mass Index on the Efficacy of Biological Therapies in Patients with Psoriasis: A Real-World Study","volume":"41","author":"Pirro","year":"2021","journal-title":"Clin. Drug Investig."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.jaad.2007.11.011","article-title":"The effect of weight on the efficacy of biologic therapy in patients with psoriasis","volume":"58","author":"Clark","year":"2008","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1002\/psp4.12182","article-title":"Evaluating Dosage Optimality for Tofacitinib, an Oral Janus Kinase Inhibitor, in Plaque Psoriasis, and the Influence of Body Weight","volume":"6","author":"Hutmacher","year":"2017","journal-title":"CPT Pharmacomet. Syst. Pharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1111\/j.1468-3083.2011.04065.x","article-title":"Obesity and psoriasis: Body weight and body mass index influence the response to biological treatment","volume":"25","author":"Puig","year":"2011","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1111\/bjd.18981","article-title":"Drug survival of adalimumab, ustekinumab and secukinumab in patients with psoriasis: A prospective cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR)","volume":"183","author":"Yiu","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1001\/jamadermatol.2013.722","article-title":"Effect of weight loss on the severity of psoriasis: A randomized clinical study","volume":"149","author":"Jensen","year":"2013","journal-title":"JAMA Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1111\/bjd.18327","article-title":"Comparable efficacy and safety of brodalumab in obese and nonobese patients with psoriasis: Analysis of two randomized controlled trials","volume":"182","author":"Hsu","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S0140-6736(21)00126-4","article-title":"Bimekizumab efficacy and safety in moderate to severe plaque psoriasis (BE READY): A multicentre, double-blind, placebo-controlled, randomised withdrawal phase 3 trial","volume":"397","author":"Gordon","year":"2021","journal-title":"Lancet"},{"key":"ref_29","first-page":"e259","article-title":"Off-label biologic regimens of IL-17A inhibitors for psoriasis","volume":"40","author":"Kim","year":"2025","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/bjd.19866","article-title":"Five-year efficacy and safety of tildrakizumab in patients with moderate-to-severe psoriasis who respond at week 28: Pooled analyses of two randomized phase III clinical trials (reSURFACE 1 and reSURFACE 2)","volume":"185","author":"Thaci","year":"2021","journal-title":"Br. J. Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1001\/jamadermatol.2020.0723","article-title":"Efficacy and Safety of Continuous Risankizumab Therapy vs Treatment Withdrawal in Patients With Moderate to Severe Plaque Psoriasis: A Phase 3 Randomized Clinical Trial","volume":"156","author":"Blauvelt","year":"2020","journal-title":"JAMA Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1111\/bjd.17454","article-title":"Safety of guselkumab in patients with moderate-to-severe psoriasis treated through 100 weeks: A pooled analysis from the randomized VOYAGE 1 and VOYAGE 2 studies","volume":"180","author":"Reich","year":"2019","journal-title":"Br. J. Dermatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/14712598.2024.2325547","article-title":"Tildrakizumab: The value of a personalized and flexible approach for treating moderate-to-severe plaque psoriasis in patients with high body weight or high disease burden","volume":"24","author":"Dapavo","year":"2024","journal-title":"Expert Opin. Biol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"400","DOI":"10.23736\/S0392-0488.20.06643-2","article-title":"Tofacitinib for the treatment of psoriasis and psoriatic arthritis","volume":"155","author":"Ighani","year":"2020","journal-title":"G. Ital. Dermatol. Venereol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1111\/jdv.13702","article-title":"Tofacitinib versus etanercept or placebo in patients with moderate to severe chronic plaque psoriasis: Patient-reported outcomes from a Phase 3 study","volume":"30","author":"Valenzuela","year":"2016","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"adv00545","DOI":"10.2340\/00015555-3846","article-title":"Effectiveness of Apremilast in Real Life in Patients with Psoriasis: A Longitudinal Study","volume":"101","author":"Malara","year":"2021","journal-title":"Acta Derm. Venereol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jdin.2024.02.016","article-title":"Diabetes and obesity burden and improvements in cardiometabolic parameters in patients with psoriasis or psoriatic arthritis receiving apremilast in a real-world setting","volume":"16","author":"Cavanaugh","year":"2024","journal-title":"JAAD Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1093\/rheumatology\/keab474","article-title":"Effect of the phosphodiesterase 4 inhibitor apremilast on cardiometabolic outcomes in psoriatic disease-results of the Immune Metabolic Associations in Psoriatic Arthritis study","volume":"61","author":"Ferguson","year":"2022","journal-title":"Rheumatology"},{"key":"ref_39","first-page":"678","article-title":"Cardiometabolic Effects of Apremilast in Patients With Psoriatic Arthritis: A Prospective Cohort Study","volume":"52","author":"Hansildaar","year":"2025","journal-title":"J. Rheumatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"5074","DOI":"10.1093\/rheumatology\/keaf277","article-title":"Exploring the impact of conventional and targeted DMARDs on body weight in patients with PsA","volume":"64","author":"Mehta","year":"2025","journal-title":"Rheumatology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jaad.2022.07.002","article-title":"Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: Efficacy and safety results from the 52-week, randomized, double-blinded, placebo-controlled phase 3 POETYK PSO-1 trial","volume":"88","author":"Armstrong","year":"2023","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1001\/jamadermatol.2024.4688","article-title":"Safety and Efficacy of Deucravacitinib in Moderate to Severe Plaque Psoriasis for Up to 3 Years: An Open-Label Extension of Randomized Clinical Trials","volume":"161","author":"Armstrong","year":"2025","journal-title":"JAMA Dermatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1111\/jdv.19925","article-title":"Deucravacitinib in moderate-to-severe plaque psoriasis: Pooled safety and tolerability over 52\u2009weeks from two phase 3 trials (POETYK PSO-1 and PSO-2)","volume":"38","author":"Strober","year":"2024","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/1346-8138.70137","article-title":"Two-Year Real-World Effectiveness of Deucravacitinib 6\u2009mg in Psoriasis: A Single-Center Analysis Stratified by Body Mass Index or Age in a Japanese Cohort","volume":"53","author":"Okabe","year":"2026","journal-title":"J. Dermatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1111\/bjd.14947","article-title":"Efficacy and safety of LAS41008 (dimethyl fumarate) in adults with moderate-to-severe chronic plaque psoriasis: A randomized, double-blind, Fumaderm\u00ae\u2014And placebo-controlled trial (BRIDGE)","volume":"176","author":"Mrowietz","year":"2017","journal-title":"Br. J. Dermatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"adv4526","DOI":"10.2340\/actadv.v103.4526","article-title":"Dimethyl Fumarate Treatment in Patients with Moderate-to-Severe Psoriasis: A 52-week Real-life Study","volume":"103","author":"Gnesotto","year":"2023","journal-title":"Acta Derm. Venereol."},{"key":"ref_47","first-page":"463","article-title":"Dimethyl Fumarate Treatment for Psoriasis in Real-World Clinical Practice: An Analysis from the Swiss Registry","volume":"241","author":"Maul","year":"2025","journal-title":"Dermatology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/jdv.15922","article-title":"Quality of life outcomes in adults with moderate-to-severe plaque psoriasis treated with dimethylfumarate (DMF): A post hoc analysis of the BRIDGE study","volume":"34","author":"Loewe","year":"2020","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/s00228-025-03898-4","article-title":"GLP-1 receptor agonists: Emerging therapeutic potential in psoriasis management\u2014Current evidence and future outlook","volume":"81","author":"Atiquzzaman","year":"2025","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1111\/jdv.20694","article-title":"The effects of GLP-1RA on inflammatory skin diseases: A comprehensive review","volume":"39","author":"Paschou","year":"2025","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/bjd.12886","article-title":"Improvement of psoriasis during glucagon-like peptide-1 analogue therapy in type 2 diabetes is associated with decreasing dermal \u03b3\u03b4 T-cell number: A prospective case-series study","volume":"171","author":"Buysschaert","year":"2014","journal-title":"Br. J. Dermatol."},{"key":"ref_52","first-page":"e460","article-title":"Tirzepatide in obese patients with psoriasis on biological therapy: Is this a window of opportunity?","volume":"40","author":"Gisondi","year":"2025","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1093\/bjd\/ljaf346","article-title":"Glucagon-like peptide-1 receptor agonists and reduced mortality, cardiovascular and psychiatric risks in patients with psoriasis: A large-scale cohort study","volume":"194","author":"Olbrich","year":"2026","journal-title":"Br. J. Dermatol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"103864","DOI":"10.1016\/j.autrev.2025.103864","article-title":"Glucagon-Like Peptide-1 (GLP-1) receptor agonists in rheumatology: A review of current evidence and future directions","volume":"24","author":"Bilgin","year":"2025","journal-title":"Autoimmun. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4302\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:56:39Z","timestamp":1780401399000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":54,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114302"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114302","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]}}}