{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:09:08Z","timestamp":1785434948509,"version":"3.56.0"},"reference-count":53,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0533100"],"award-info":[{"award-number":["2024ZD0533100"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0533106"],"award-info":[{"award-number":["2024ZD0533106"]}]},{"name":"West China Hospital of Sichuan University","award":["ZYGD23036"],"award-info":[{"award-number":["ZYGD23036"]}]},{"award":["ZYGD23036"],"award-info":[{"award-number":["ZYGD23036"]}],"id":[{"id":"https:\/\/ror.org\/007mrxy13","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004829","name":"Science and Technology Department of Sichuan Province","doi-asserted-by":"publisher","award":["2024YFFK0225"],"award-info":[{"award-number":["2024YFFK0225"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2024YFFK0225"],"award-info":[{"award-number":["2024YFFK0225"]}],"id":[{"id":"https:\/\/ror.org\/04323m874","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pulmonary tuberculosis (TB) is a significant trigger of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), so its timely and accurate diagnosis is essential. Also, the risk factors for TB occurrence in this population remain unclear. This study aimed to evaluate the performance of metagenomic next-generation sequencing (mNGS) for TB diagnosis in AECOPD patients, as well as to identify the associated risk factors. Methods: A retrospective observational cohort of 659 AECOPD patients with suspected pulmonary infection was enrolled. The microbial cell-free nucleic acids in bronchoalveolar lavage fluid samples were extracted and subjected to mNGS detection. The clinical data for each patient were collected from the hospital information system. The statistical analyses were performed with SPSS version 25.0. Results: A total of 170 cases, included for final analyses, were categorized into TB (n = 41), bacterial infection (n = 73), and non-infective control (n = 56) groups. Among these groups, the TB group had the highest intensive care unit (ICU) admission rate (46.34%) and longest median hospital stay (19.50 days) (p &lt; 0.01). For TB diagnosis, mNGS demonstrated a greater sensitivity (86.00%), a lower specificity (93.30%), and a higher area under the curve (AUC, 0.877) than TB-DNA detection (70.21%, 100%, 0.848, respectively) and Xpert Mycobacterium tuberculosis\/rifampicin (MTB\/RIF) assay (63.83%, 100.00%, 0.870, respectively). Notably, mNGS identified the bacterial or viral co-infections in 18.00% of TB cases. Furthermore, the stringently mapped read number determined by mNGS showed a positive correlation with ICU admission rate (r = 0.76) and in-hospital mortality (r = 0.77). The lower body mass index (BMI) and reduced natural killer (NK) cell count were identified as the independent risk factors in the TB group (both p &lt; 0.05). Conclusions: For the diagnosis of pulmonary TB in AECOPD patients, mNGS demonstrated comparable performance to TB-DNA detection and Xpert MTB\/RIF assay, and also mNGS identified co-infections. In addition, a lower BMI and reduced NK cell count were identified as the independent risk factors for TB occurrence in this cohort.<\/jats:p>","DOI":"10.3390\/jcm15124507","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T02:59:31Z","timestamp":1781146771000},"page":"4507","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metagenomic Next-Generation Sequencing for Pulmonary Tuberculosis Diagnosis and Infection Risk Factor Analysis in AECOPD Patients: A Single-Center Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Chao","family":"He","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Clinical Laboratory Medicine Research Center, Sichuan Clinical Research Center for Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Women and Children\u2019s Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Clinical Laboratory Medicine Research Center, Sichuan Clinical Research Center for Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Clinical Laboratory Medicine Research Center, Sichuan Clinical Research Center for Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binwu","family":"Ying","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Clinical Laboratory Medicine Research Center, Sichuan Clinical Research Center for Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S2213-2600(24)00339-4","article-title":"The global burden of COPD: Epidemiology and effect of prevention strategies","volume":"13","author":"Celli","year":"2025","journal-title":"Lancet Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1513\/AnnalsATS.201712-913OC","article-title":"Early Hospital Readmissions after an Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the Nationwide Readmissions Database","volume":"15","author":"Jacobs","year":"2018","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12931-021-01657-4","article-title":"Predictors of mortality in COPD exacerbation cases presenting to the respiratory intensive care unit","volume":"22","author":"Cao","year":"2021","journal-title":"Respir. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/S2213-2600(25)00362-5","article-title":"Multidimensional prognostic risk stratification of COPD exacerbations: The baseline, acuity, and trigger (BAt) model","volume":"14","author":"Aung","year":"2026","journal-title":"Lancet Respir. Med."},{"key":"ref_5","first-page":"00838","article-title":"Global mortality and readmission rates following COPD exacerbation-related hospitalisation: A meta-analysis of 65\u2009945 individual patients","volume":"10","author":"Crutsen","year":"2024","journal-title":"ERJ Open Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jinf.2023.01.012","article-title":"Estimating the contribution of respiratory pathogens to acute exacerbations of COPD using routine data","volume":"86","author":"Sivakumaran","year":"2023","journal-title":"J. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s15010-019-01350-1","article-title":"Bacterial infections in acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"48","author":"Moghoofei","year":"2020","journal-title":"Infection"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e12991","DOI":"10.1111\/jpi.12991","article-title":"Melatonin Rescues Influenza A Virus-Induced Cellular Energy Exhaustion via OMA1-OPA1-S in Acute Exacerbation of COPD","volume":"76","author":"Wei","year":"2024","journal-title":"J. Pineal Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2478\/v10039-010-0031-6","article-title":"Serological evidence of Mycoplasma pneumoniae infection in patients with acute exacerbation of COPD: Analysis of 100 hospitalizations","volume":"55","author":"Papaetis","year":"2010","journal-title":"Adv. Med. Sci."},{"key":"ref_10","unstructured":"World Health Organization (2025). Global Tuberculosis Report 2025, World Health Organization."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.2147\/COPD.S511734","article-title":"Assessing the Causal Relationship between Chronic Obstructive Pulmonary Disease and Tuberculosis: A Mendelian Randomization Study","volume":"20","author":"Wang","year":"2025","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1093\/trstmh\/trab122","article-title":"Risk for development of active tuberculosis in patients with chronic airway disease-a systematic review of evidence","volume":"116","author":"Hamada","year":"2022","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Inghammar, M., Ekbom, A., Engstrom, G., Ljungberg, B., Romanus, V., Lofdahl, C.G., and Egesten, A. (2010). COPD and the risk of tuberculosis--a population-based cohort study. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0010138"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/j.cmi.2023.07.014","article-title":"Update on the diagnosis of tuberculosis","volume":"30","author":"Kontsevaya","year":"2024","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3390\/clinpract14020030","article-title":"Evolution of Laboratory Diagnosis of Tuberculosis","volume":"14","author":"Zaporojan","year":"2024","journal-title":"Clin. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Rabello, E., and de-Paris, F. (2026). Tuberculosis Diagnostic Methods: Clinical Applicability, Implementation Challenges, and Integrated Testing Strategies. Pathogens, 15.","DOI":"10.3390\/pathogens15020142"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chin, K.L., Anibarro, L., Sarmiento, M.E., and Acosta, A. (2023). Challenges and the Way forward in Diagnosis and Treatment of Tuberculosis Infection. Trop. Med. Infect. Dis., 8.","DOI":"10.3390\/tropicalmed8020089"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chen, S., Ouyang, T., Wang, K., Hou, X., Zhang, R., Li, M., Zhang, H., He, Q., Li, X., and Liu, Z. (2025). Application of metagenomic next-generation sequencing in pathogen detection of lung infections. Front. Cell. Infect. Microbiol., 15.","DOI":"10.3389\/fcimb.2025.1513603"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S416","DOI":"10.1093\/cid\/ciaa1516","article-title":"Clinical Utility of In-house Metagenomic Next-generation Sequencing for the Diagnosis of Lower Respiratory Tract Infections and Analysis of the Host Immune Response","volume":"71","author":"Chen","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1186\/s12931-024-02887-y","article-title":"A single-center, retrospective study of hospitalized patients with lower respiratory tract infections: Clinical assessment of metagenomic next-generation sequencing and identification of risk factors in patients","volume":"25","author":"Gao","year":"2024","journal-title":"Respir. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1016\/S2214-109X(22)00456-9","article-title":"Small airways obstruction and its risk factors in the Burden of Obstructive Lung Disease (BOLD) study: A multinational cross-sectional study","volume":"11","author":"Patel","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/S0140-6736(09)61303-9","article-title":"Chronic obstructive pulmonary disease in non-smokers","volume":"374","author":"Salvi","year":"2009","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"210075","DOI":"10.1183\/16000617.0075-2021","article-title":"Systematic review on long-term adverse effects of inhaled corticosteroids in the treatment of COPD","volume":"30","author":"Miravitlles","year":"2021","journal-title":"Eur. Respir. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1378\/chest.13-2137","article-title":"Use of inhaled corticosteroids in patients with COPD and the risk of TB and influenza: A systematic review and meta-analysis of randomized controlled trials. a systematic review and meta-analysis of randomized controlled trials","volume":"145","author":"Dong","year":"2014","journal-title":"Chest"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Huang, T.M., Kuo, K.C., Wang, Y.H., Wang, C.Y., Lai, C.C., Wang, H.C., Chen, L., Yu, C.J., On the behalf of Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE), and Perng, D.-W. (2020). Risk of active tuberculosis among COPD patients treated with fixed combinations of long-acting beta2 agonists and inhaled corticosteroids. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05440-6"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lee, C.H., Lee, M.C., Shu, C.C., Lim, C.S., Wang, J.Y., Lee, L.N., and Chao, K.M. (2013). Risk factors for pulmonary tuberculosis in patients with chronic obstructive airway disease in Taiwan: A nationwide cohort study. BMC Infect. Dis., 13.","DOI":"10.1186\/1471-2334-13-194"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2502244","DOI":"10.1183\/13993003.02244-2025","article-title":"Addressing the global challenges of COPD and asthma: A shared vision from the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) and the Global Initiative for Asthma (GINA)","volume":"67","author":"Halpin","year":"2026","journal-title":"Eur. Respir. J."},{"key":"ref_28","first-page":"24","article-title":"Diagnosis and Management of Community-acquired Pneumonia: An Official American Thoracic Society Clinical Practice Guideline","volume":"212","author":"Jones","year":"2026","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1183\/09031936.00.15121700","article-title":"Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society","volume":"15","author":"Midulla","year":"2000","journal-title":"Eur. Respir. J."},{"key":"ref_30","first-page":"49","article-title":"Update of diagnostic methods in tuberculosis (TB)","volume":"57","author":"Matteo","year":"2025","journal-title":"Rev. Argent. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/S0140-6736(24)02479-6","article-title":"Tuberculosis","volume":"405","author":"Trajman","year":"2025","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1164\/rccm.202410-2096ST","article-title":"Updates on the Treatment of Drug-Susceptible and Drug-Resistant Tuberculosis: An Official ATS\/CDC\/ERS\/IDSA Clinical Practice Guideline","volume":"211","author":"Saukkonen","year":"2025","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Meregildo-Rodriguez, E.D., Asmat-Rubio, M.G., and Vasquez-Tirado, G.A. (2023). Droplet digital PCR vs. quantitative real time-PCR for diagnosis of pulmonary and extrapulmonary tuberculosis: Systematic review and meta-analysis. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1248842"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ijid.2019.09.016","article-title":"Diagnostic accuracy of the new Xpert MTB\/RIF Ultra for tuberculosis disease: A preliminary systematic review and meta-analysis","volume":"90","author":"Zhang","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1186\/s13643-024-02733-8","article-title":"Diagnostic accuracy of metagenomic next-generation sequencing in pulmonary tuberculosis: A systematic review and meta-analysis","volume":"13","author":"You","year":"2024","journal-title":"Syst. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e0156324","DOI":"10.1128\/spectrum.01563-24","article-title":"Integrative study of pulmonary microbiome and clinical diagnosis in pulmonary tuberculosis patients","volume":"13","author":"Sun","year":"2025","journal-title":"Microbiol. Spectr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jinf.2020.08.004","article-title":"Clinical metagenomic sequencing for diagnosis of pulmonary tuberculosis","volume":"81","author":"Shi","year":"2020","journal-title":"J. Infect."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"105185","DOI":"10.1016\/j.micinf.2023.105185","article-title":"Improving the identification and diagnostic efficiency of Metagenomic Next-Generation Sequencing for mycobacterial granuloma on postoperative formalin-fixed paraffin-embedded specimens","volume":"25","author":"Sun","year":"2023","journal-title":"Microbes Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"9970817","DOI":"10.1155\/2021\/9970817","article-title":"Diagnostic Accuracy of Metagenomic Next-Generation Sequencing in Sputum-Scarce or Smear-Negative Cases with Suspected Pulmonary Tuberculosis","volume":"2021","author":"Zhu","year":"2021","journal-title":"BioMed Res. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.2147\/IDR.S350047","article-title":"Metagenomic Next-Generation Sequencing for the Diagnosis of Suspected Opportunistic Infections in People Living with HIV","volume":"15","author":"Xu","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Li, Y., Bian, W., Wu, S., Zhang, J., and Li, D. (2023). Metagenomic next-generation sequencing for Mycobacterium tuberculosis complex detection: A meta-analysis. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1224993"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e0193125","DOI":"10.1128\/spectrum.01931-25","article-title":"Hierarchical integration of mNGS, PCR, and other conventional methods for precision TB diagnostics","volume":"13","author":"Zhao","year":"2025","journal-title":"Microbiol. Spectr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4103\/lungindia.lungindia_273_20","article-title":"Study of respiratory viruses and their coinfection with bacterial and fungal pathogens in acute exacerbation of chronic obstructive pulmonary diseases","volume":"38","author":"Jahan","year":"2021","journal-title":"Lung India"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2355","DOI":"10.1056\/NEJMra0800353","article-title":"Infection in the pathogenesis and course of chronic obstructive pulmonary disease","volume":"359","author":"Sethi","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Forder, A., Zhuang, R., Souza, V.G.P., Brockley, L.J., Pewarchuk, M.E., Telkar, N., Stewart, G.L., Benard, K., Marshall, E.A., and Reis, P.P. (2023). Mechanisms Contributing to the Comorbidity of COPD and Lung Cancer. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24032859"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Russell, T., Formiconi, E., Casey, M., McElroy, M., Mallon, P.W.G., and Gautier, V.W. (2025). Viral Metagenomic Next-Generation Sequencing for One Health Discovery and Surveillance of (Re)Emerging Viruses: A Deep Review. Int. J. Mol. Sci., 26.","DOI":"10.20944\/preprints202509.0238.v1"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1097\/IAE.0000000000003406","article-title":"Metagenomic Next-Generation Sequencing Detects Pathogens in Endophthalmitis Patients","volume":"42","author":"Zhu","year":"2022","journal-title":"Retina"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1159\/000363321","article-title":"Natural killer cells: A coherent model for their functional role in Mycobacterium tuberculosis infection","volume":"7","author":"Esin","year":"2015","journal-title":"J. Innate Immun."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1038\/s44321-024-00106-1","article-title":"LILRB1-HLA-G axis defines a checkpoint driving natural killer cell exhaustion in tuberculosis","volume":"16","author":"Wang","year":"2024","journal-title":"EMBO Mol. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e100","DOI":"10.1093\/cid\/ciaf475","article-title":"Body Mass Index and Incident Tuberculosis in Close Tuberculosis Contacts","volume":"82","author":"Arriaga","year":"2026","journal-title":"Clin. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Choi, H., Yoo, J.E., Han, K., Choi, W., Rhee, S.Y., Lee, H., and Shin, D.W. (2021). Body Mass Index, Diabetes, and Risk of Tuberculosis: A Retrospective Cohort Study. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.739766"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Rajamanickam, A., Munisankar, S., Dolla, C.K., and Babu, S. (2019). Undernutrition is associated with perturbations in T cell-, B cell-, monocyte- and dendritic cell- subsets in latent Mycobacterium tuberculosis infection. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0225611"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"VanValkenburg, A., Kaipilyawar, V., Sarkar, S., Lakshminarayanan, S., Cintron, C., Prakash Babu, S., Knudsen, S., Joseph, N.M., Horsburgh, C.R., and Sinha, P. (2022). Malnutrition leads to increased inflammation and expression of tuberculosis risk signatures in recently exposed household contacts of pulmonary tuberculosis. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.1011166"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4507\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T03:55:58Z","timestamp":1781150158000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4507"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":53,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124507"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124507","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]}}}