{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T04:19:23Z","timestamp":1761797963562,"version":"build-2065373602"},"reference-count":59,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Parathyroid gland disorders, including secondary hyperparathyroidism, have emerged as significant endocrine complications in people living with HIV (PLWHIV). This narrative review synthesises recent evidence on the prevalence, mechanisms, and clinical implications of parathyroid dysfunction in PLWHIV. HIV infection, combined antiretroviral therapy (cART), and immune activation contribute to parathyroid dysfunction, with cART regimens, particularly Tenofovir Disoproxil Fumarate (TDF), exacerbating these disturbances by altering the calcium and parathyroid hormone (PTH) dynamics. Studies show that PTH levels in PLWHIV on TDF were significantly elevated compared to those on non-TDF-based cART regimens. Histopathological studies highlight a higher prevalence of parathyroid hyperplasia in PLWHIV, often linked to chronic deficiencies in calcium, magnesium, and vitamin D, as well as immune dysregulation. The dysfunction observed ranges from inappropriate elevation of PTH levels to hypoparathyroidism, leading to rapid bone density loss and an increased fracture risk. Despite the fact that HIV is a condition associated with high malignancy, parathyroid malignancy is a very rare issue. Despite the growing recognition of these complications, routine screening for PTH and bone health remains inadequate in standard clinical HIV care. This review advocates for incorporating routine monitoring of serum PTH, calcium, phosphate, and vitamin D levels, especially in those on TDF-based cART. Early detection of subclinical parathyroid dysfunction can prevent complications such as secondary hyperparathyroidism and neuromuscular symptoms. Clinicians should be aware of atypical biochemical presentations, such as elevated PTH with normal calcium, which may indicate cART-induced dysregulation, improving patient management and outcomes.<\/jats:p>","DOI":"10.3390\/metabo15110704","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T03:44:39Z","timestamp":1761795879000},"page":"704","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Narrative Review on Parathyroid Gland Disorders in Individuals Living with HIV: An Update"],"prefix":"10.3390","volume":"15","author":[{"given":"Ahmed","family":"Hassan","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Alexandria University, Alexandria 5424041, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yashar","family":"Mashayekhi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic, Leicester University Hospital, Leicester LE1 5WW, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ridwan","family":"Hashi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Norforlk and Norwich University Hospital, Norwich NR4 7UY, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Musaab","family":"Ahmed","sequence":"additional","affiliation":[{"name":"College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dushyant","family":"Mital","sequence":"additional","affiliation":[{"name":"Department of Blood Borne Virus and HIV, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8045-6996","authenticated-orcid":false,"given":"Mohamed H.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK"},{"name":"Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK"},{"name":"Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1210\/clinem\/dgaa113","article-title":"Hypoparathyroidism","volume":"105","author":"Bilezikian","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/nrendo.2017.104","article-title":"Primary hyperparathyroidism","volume":"14","author":"Walker","year":"2017","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.beem.2018.05.004","article-title":"Familial hypocalciuric hypercalcemia and related disorders","volume":"32","author":"Lee","year":"2018","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ahmed, M., Mital, D., Abubaker, N.E., Panourgia, M., Owles, H., Papadaki, I., and Ahmed, M.H. (2023). Bone Health in People Living with HIV\/AIDS: An Update of Where We Are and Potential Future Strategies. Microorganisms, 11.","DOI":"10.3390\/microorganisms11030789"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"179","DOI":"10.4103\/ijstd.IJSTD_32_20","article-title":"An evaluation of the metabolic needs of people living with HIV\/AIDS in Milton Keynes: A growing cohort","volume":"44","author":"Halai","year":"2023","journal-title":"Indian J. Sex. Transm. Dis. AIDS"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1007\/s00198-018-4794-0","article-title":"Diagnosis, prevention, and treatment of bone fragility in people living with HIV: A position statement from the Swiss Association against Osteoporosis","volume":"30","author":"Biver","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1093\/cid\/cix753","article-title":"Vitamin D3 supplementation increases spine bone mineral density in adolescents and young adults with HIV on tenofovir disoproxil fumarate: A randomised, placebo-controlled trial","volume":"66","author":"Havens","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1017\/S0007114525000509","article-title":"The association between 25-hydroxyvitamin D and parathyroid hormone in adolescents living with HIV in southern Africa: A cross-sectional study","volume":"133","author":"Madanhire","year":"2025","journal-title":"Br. J. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e115832","DOI":"10.5812\/semj.115832","article-title":"Hypoparathyroidism after COVID-19 pneumonia","volume":"22","author":"Dianatfar","year":"2021","journal-title":"Shiraz E-Med. J."},{"key":"ref_10","first-page":"249","article-title":"Parathyroid disorders","volume":"88","author":"Michels","year":"2013","journal-title":"Am. Fam. Physician"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1359\/jbmr.2001.16.1.2","article-title":"Bone and mineral metabolism in human immunodeficiency virus infection","volume":"16","author":"Heufelder","year":"2001","journal-title":"J. Bone Miner. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1159\/000184212","article-title":"Symptomatic hypoparathyroidism in acquired immunodeficiency syndrome","volume":"42","author":"Lehmann","year":"1994","journal-title":"Horm. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/S0039-6060(96)80044-4","article-title":"Expression and function of a CD4-like molecule in parathyroid tissue","volume":"120","author":"Hellman","year":"1996","journal-title":"Surgery"},{"key":"ref_14","first-page":"1701","article-title":"Altered parathyroid gland function in severely immunocompromised patients infected with human immunodeficiency virus","volume":"79","author":"Jaeger","year":"1994","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101119","DOI":"10.1016\/j.bonr.2021.101119","article-title":"Severe hypocalcemia due to hypoparathyroidism associated with HIV: A case report","volume":"15","author":"Gulden","year":"2021","journal-title":"Bone Rep."},{"key":"ref_16","first-page":"8270936","article-title":"Severe symptomatic hypocalcemia from HIV related hypoparathyroidism","volume":"2018","author":"Sandhu","year":"2018","journal-title":"Case Rep. Endocrinol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"364146","DOI":"10.1155\/2014\/364146","article-title":"Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients","volume":"2014","author":"Cherqaoui","year":"2014","journal-title":"J. Thyroid. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1001\/jama.1984.03350090028018","article-title":"Autopsy findings in the acquired immune deficiency syndrome","volume":"252","author":"Welch","year":"1984","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1089\/aid.2011.0052","article-title":"Early changes in parathyroid hormone concentrations in HIV-infected patients initiating antiretroviral therapy with tenofovir","volume":"28","author":"Padilla","year":"2012","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_20","first-page":"496","article-title":"Tenofovir-linked hyperparathyroidism is independently associated with the presence of vitamin D de-ficiency","volume":"54","author":"Rosenvinge","year":"2010","journal-title":"Am. J. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1089\/aid.2009.0308","article-title":"Short communication: Inadequate vitamin D exacerbates parathyroid hormone elevations in tenofovir users","volume":"26","author":"Childs","year":"2010","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Klassen, K., Martineau, A.R., Wilkinson, R.J., Cooke, G., Courtney, A.P., and Hickson, M. (2012). The effect of tenofovir on Vitamin D metabolism in HIV-infected adults is dependent on sex and eth-nicity. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0044845"},{"key":"ref_23","first-page":"6069131","article-title":"Tenofovir disoproxil fumarate is associated with a set-point variation in the calcium-parathyroid hor-mone-vitamin D axis: Results from a German cohort","volume":"2018","author":"Noe","year":"2018","journal-title":"Adv. Pharmacol. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1055\/s-0043-125073","article-title":"Secondary Hyperparathyroidism in HIV-Infected Patients in Central Europe","volume":"50","author":"Noe","year":"2018","journal-title":"Horm. Metab. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"200","DOI":"10.2174\/1570162X20666220322101839","article-title":"Inadequate PTH Response to Hypocalcemia in People Living with HIV","volume":"20","author":"Noe","year":"2022","journal-title":"Curr. HIV Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1097\/QAD.0000000000002238","article-title":"Switching tenofovir disoproxil fumarate to tenofovir alafenamide results in a significant decline in parathyroid hormone levels: Uncovering the mechanism of tenofovir disoproxil fumarate-related bone loss?","volume":"33","author":"Thielen","year":"2019","journal-title":"AIDS"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.biopha.2017.11.037","article-title":"High parathyroid hormone concentration in tenofovir-treated patients are due to inhibition of calcium-sensing receptor activity","volume":"97","author":"Mingione","year":"2018","journal-title":"Biomed. Pharmacother."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Li, H., Yuan, S., Liao, M., Tan, S., Zheng, J., Wan, L., Tu, Y., Yang, M., and Gao, J. (2025). Effects of HIV exposure on anemia and vitamin D nutritional status in children aged 6\u201324 months: A hospital-based cross-sectional study. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-87101-9"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"18890","DOI":"10.1074\/jbc.M110.206110","article-title":"Hormonally active vitamin D3 (1\u03b1,25-dihydroxycholecalciferol) triggers autophagy in human macro-phages that inhibits HIV-1 infection","volume":"286","author":"Campbell","year":"2011","journal-title":"J. Biol. Chem."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Loaiza, J.D., G\u00f3mez, J.F., Mu\u00f1oz-Escudero, D., Gonzalez, S.M., Eubank, T.K., Rugeles, M.T., Rodr\u00edguez-Perea, A.L., and Aguilar-Jimenez, W. (2025). Vitamin D decreases susceptibility of CD4+ T cells to HIV infection by reducing AKT phosphorylation and glucose uptake. Biomolecules, 15.","DOI":"10.3390\/biom15030432"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/bcpt.12641","article-title":"Drug-Mediated Gene Regulation of Vitamin D3 Metabolism in Primary Human Dermal Fibroblasts","volume":"120","author":"Norlin","year":"2017","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"O43","DOI":"10.1186\/1758-2652-13-S4-O43","article-title":"Vitamin D and clinical disease progression in HIV infection: Results from the EuroSIDA study","volume":"13","author":"Viard","year":"2010","journal-title":"J. Int. AIDS Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"52","DOI":"10.2174\/1570162X18666200106150806","article-title":"Vitamin D and calcium supplement attenuate bone loss among HIV-infected patients receiving tenofovir disoproxil fumarate\/emtricitabine\/efavirenz: An open-label, randomized controlled trial","volume":"18","author":"Boontanondha","year":"2020","journal-title":"Curr. HIV Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1080\/15284336.2018.1525841","article-title":"Bone mass preservation with high-dose cholecalciferol and dietary calcium in HIV patients following antiretroviral therapy. Is it possible?","volume":"19","author":"Mela","year":"2018","journal-title":"HIV Clin. Trials"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"815","DOI":"10.7326\/M14-1409","article-title":"Vitamin D and Calcium Attenuate Bone Loss with Antiretroviral Therapy Initiation","volume":"162","author":"Overton","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1007\/s00223-022-00946-4","article-title":"Osteoporosis and HIV Infection","volume":"110","author":"Biver","year":"2022","journal-title":"Calcif. Tissue Int."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ahmed, M.H., Ahmed, F., Abu-Median, A.-B., Panourgia, M., Owles, H., Ochieng, B., Ahamed, H., Wale, J., Dietsch, B., and Mital, D. (2023). HIV and an Ageing Population\u2014What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions. Microorganisms, 11.","DOI":"10.3390\/microorganisms11102426"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Jamshaid, M., Heidari, A., Hassan, A., Mital, D., Pearce, O., Panourgia, M., and Ahmed, M.H. (2024). Bone Loss and Fractures in Post-Menopausal Women Living with HIV: A Narrative Review. Pathogens, 13.","DOI":"10.3390\/pathogens13090811"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Mashayekhi, Y., Amadi-Livingstone, C., Timamy, A., Eish, M., Attia, A., Panourgia, M., Mital, D., Pearce, O., and Ahmed, M.H. (2025). Narrative Review on the Management of Neck of Femur Fractures in People Living with HIV: Challenges, Complications, and Long-Term Outcomes. Microorganisms, 13.","DOI":"10.3390\/microorganisms13071530"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1373\/clinchem.2009.125906","article-title":"25-hydroxyvitamin D assays: The quest for accuracy","volume":"55","author":"Carter","year":"2009","journal-title":"Clin. Chem."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Bikle, D.D., and Schwartz, J. (2019). Vitamin D binding protein, total and free vitamin D levels in different physiological and pathophysio-logical conditions. Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00317"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Ben-Eltriki, M., Gayle, E.J., Paras, J.M., Nyame-Addo, L., Chhabra, M., and Deb, S. (2024). Vitamin D in Melanoma: Potential Role of Cytochrome P450 Enzymes. Life, 14.","DOI":"10.3390\/life14040510"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2165","DOI":"10.1097\/QAD.0b013e32801022eb","article-title":"Antiretroviral therapy and the prevalence of osteopenia\/osteoporosis: Confounding role of phosphate and PTH","volume":"20","author":"Brown","year":"2006","journal-title":"AIDS"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s00198-020-05584-w","article-title":"Longitudinal change in bone mineral density among Chinese individuals with HIV after initiation of antiretroviral therapy","volume":"32","author":"Guo","year":"2020","journal-title":"Osteoporos. Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1152\/physrev.00012.2014","article-title":"Magnesium in Man: Implications for Health and Disease","volume":"95","author":"Hoenderop","year":"2015","journal-title":"Physiol. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1007\/s00467-012-2350-2","article-title":"Disorders of calcium and magnesium balance: A physiology-based approach","volume":"28","author":"Hoorn","year":"2012","journal-title":"Pediatr. Nephrol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"81","DOI":"10.4081\/idr.2017.7265","article-title":"Patterns of vitamin D, parathyroid hormone and c-terminal telopeptide of collagen type 1 in Cauca-sian and African descent HIV-infected populations in Central Europe","volume":"9","author":"Noe","year":"2017","journal-title":"Infect. Dis. Rep."},{"key":"ref_48","first-page":"735","article-title":"Hypocalcaemia in HIV infection and AIDS","volume":"50","author":"Kuehn","year":"1999","journal-title":"Clin. Endocrinol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1093\/cid\/cir968","article-title":"Vitamin D3 decreases parathyroid hormone in HIV-infected youth being treated with tenofovir: A randomized, placebo-controlled trial","volume":"54","author":"Havens","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_50","first-page":"485307","article-title":"Prevalence and Factors Associated with Vitamin D Deficiency and Hyperparathyroidism in HIV-Infected Patients Treated in Barcelona","volume":"12","author":"Lerma","year":"2012","journal-title":"ISRN AIDS"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1097\/QAD.0000000000002541","article-title":"Investigating the effect of antiretroviral switch to tenofovir alafenamide on lipid profiles in people living with HIV","volume":"34","author":"Lacey","year":"2020","journal-title":"AIDS"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Bi, X., Liu, F., Zhang, X., Wang, H., Ye, Z., Yun, K., Huang, X., Ding, H., Geng, W., and Xu, J. (2022). Vitamin D and calcium supplementation reverse tenofovir-caused bone mineral density loss in people taking ART or PrEP: A systematic review and meta-analysis. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.749948"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Schinas, G., Schinas, I., Ntampanlis, G., Polyzou, E., Gogos, C., and Akinosoglou, K. (2024). Bone disease in HIV: Need for early diagnosis and prevention. Life, 14.","DOI":"10.3390\/life14040522"},{"key":"ref_54","unstructured":"Stone, B.J. (2019). Fracture Risk Assessment in People Living with HIV Infection. [Ph.D. Thesis, University of Sheffield]."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/jbm4.10055","article-title":"The Hidden Burden of Fractures in People Living with HIV","volume":"2","author":"Premaor","year":"2018","journal-title":"JBMR Plus"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Wang, Y., Huang, X., Wu, Y., Li, A., Tian, Y., Ren, M., Li, Z., Zhang, T., Wu, H., and Wang, W. (2021). Increased Risk of Vitamin D Deficiency Among HIV-Infected Individuals: A Systematic Review and Meta-Analysis. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.722032"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"P233","DOI":"10.1186\/1758-2652-13-S4-P233","article-title":"High plasma levels of parathyroid hormone (PTH) are associated with an increased cardiovascular risk among HIV-infected subjects","volume":"13","author":"Spagnuolo","year":"2010","journal-title":"J. Int. AIDS Soc."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1016\/j.clinthera.2021.12.012","article-title":"Effects of Vitamin D Supplementation on Bone Health and Bone-related Parameters in HIV-infected Patients: A Systematic Review and Meta-analysis","volume":"44","author":"Rezamand","year":"2022","journal-title":"Clin. Ther."},{"key":"ref_59","first-page":"623","article-title":"Adolescent Medicine Trials Network for HIV\/AIDS Interventions (ATN) 117 and 109 study teams. Tenofovir disoproxil fumarate appears to disrupt the relationship of vitamin D and parathyroid hormone","volume":"23","author":"Havens","year":"2017","journal-title":"Antivir. Ther."}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/15\/11\/704\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T04:15:00Z","timestamp":1761797700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/15\/11\/704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,29]]},"references-count":59,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["metabo15110704"],"URL":"https:\/\/doi.org\/10.3390\/metabo15110704","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,29]]}}}