{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:21:50Z","timestamp":1783351310042,"version":"3.54.6"},"reference-count":56,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"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>Background\/Objectives: Cardiovascular involvement drives morbidity and mortality in systemic lupus erythematosus (SLE). Echocardiography has limited predictive value for long-term outcomes, and subclinical right ventricular (RV) remodeling is poorly characterized. Metabolic dysregulation may influence immune activation and myocardial injury. This study investigates whether baseline metabolomic profiles are associated with longitudinal RV changes and disease progression in SLE. Methods: In this prospective, single-center study, patients with established SLE and no known cardiac disease underwent baseline clinical assessment, plasma metabolomic profiling, and advanced echocardiography, including 3D RV analysis. Echocardiography was repeated after 6 years. Metabolomics was performed using NMR spectroscopy and GC\u2013MS. Disease progression was assessed via the SLICC\/ACR damage index (SDI), defining clinical stability as \u0394SDI = 0 and worsening as \u0394SDI \u2265 1. Results: Twenty-five patients completed the follow-up (88% female; mean age 51 \u00b1 13 years). Despite normal echocardiographic values, subtle but significant RV changes were observed, remaining within reference ranges, including mild declines in fractional area change and septal longitudinal strain (p &lt; 0.05). Clinically worsened patients showed reduced TAPSE, while stable patients had slight increases (p &lt; 0.05). Multivariate metabolomic analysis distinguished stable from worsened patients (R2Y = 0.772; Q2 = 0.483), primarily driven by higher 2-aminoheptanedioic acid values in those with progression (p &lt; 0.05), along with trends toward higher fumarate and lower fructose and glucopyranose. Conclusions: Baseline metabolomic and advanced echocardiographic profiling may identify SLE patients at risk of disease progression. Longitudinal echocardiography enables monitoring of subtle RV changes, supporting personalized surveillance to detect early subclinical trajectories before overt dysfunction develops.<\/jats:p>","DOI":"10.3390\/metabo16020131","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:52:21Z","timestamp":1770979941000},"page":"131","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Metabolomic Signatures and Advanced Echocardiography Highlight Clinical Risk and Early Cardiac Changes in Systemic Lupus Erythematosus: Six-Year Follow-Up"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6876-5083","authenticated-orcid":false,"given":"Nicola","family":"Campana","sequence":"first","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0908-3645","authenticated-orcid":false,"given":"Michele","family":"Migliari","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Deidda","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3725-7614","authenticated-orcid":false,"given":"Martino","family":"Deidda","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2407-7435","authenticated-orcid":false,"given":"Luca","family":"Fazzini","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmario","family":"Usai","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2269-0439","authenticated-orcid":false,"given":"Giulia","family":"Costanzo","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3538-0050","authenticated-orcid":false,"given":"Antonio","family":"Noto","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0750-4837","authenticated-orcid":false,"given":"Cristina","family":"Piras","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5768-391X","authenticated-orcid":false,"given":"Davide","family":"Firinu","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Del Giacco","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0606-4959","authenticated-orcid":false,"given":"Luigi","family":"Atzori","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2823-1797","authenticated-orcid":false,"given":"Christian","family":"Cadeddu Dessalvi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s00281-022-00922-y","article-title":"Cardiovascular disease risk and pathogenesis in systemic lupus erythematosus","volume":"44","author":"Oliveira","year":"2022","journal-title":"Semin. Immunopathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/joim.13557","article-title":"Systemic lupus erythematosus and cardiovascular disease","volume":"293","year":"2023","journal-title":"J. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.jacc.2021.02.029","article-title":"Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus","volume":"77","author":"Yafasova","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Blachut, D., Mazurkiewicz, M., Schulz, M., Cie\u015bla, J., Przywara-Chowaniec, B., and Tomasik, A. (2025). Update: Heart Failure in Systemic Lupus Erythematosus. Appl. Sci., 15.","DOI":"10.3390\/app15031590"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1177\/09612033231226352","article-title":"Right ventricular-pulmonary arterial coupling ratio derived from 3-dimensional echocardiography predicts outcomes in systemic lupus erythematosus-associated pulmonary arterial hypertension patients","volume":"33","author":"Lan","year":"2024","journal-title":"Lupus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1177\/09612033241266990","article-title":"Cardiac involvement in systemic lupus erythematosus: Interest of 2D global longitudinal strain","volume":"33","author":"Chourabi","year":"2024","journal-title":"Lupus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1016\/j.jacc.2023.09.819","article-title":"Novel Imaging Approaches to Cardiac Manifestations of Systemic Inflammatory Diseases: JACC Scientific Statement","volume":"82","author":"Weber","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Guzm\u00e1n-Mart\u00ednez, G., and Mara\u00f1\u00f3n, C. (2022). Immune mechanisms associated with cardiovascular disease in systemic lupus erythematosus: A path to potential biomarkers. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.974826"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaut.2017.05.008","article-title":"Cardiovascular disease in systemic lupus erythematosus: A comprehensive update","volume":"82","author":"Giannelou","year":"2017","journal-title":"J. Autoimmun."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/s41392-025-02168-0","article-title":"Systemic lupus erythematosus: Updated insights on the pathogenesis, diagnosis, prevention and therapeutics","volume":"10","author":"Dai","year":"2025","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1177\/0961203319833786","article-title":"Three-dimensional echocardiographic evaluation of the right ventricle in patients with uncomplicated systemic lupus erythematosus","volume":"28","author":"Buonauro","year":"2019","journal-title":"Lupus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1007\/s00431-023-04936-y","article-title":"A deeper look into the functions of right ventricle using three-dimensional echocardiography: The forgotten ventricle in children with systemic lupus erythematosus","volume":"182","author":"Rakha","year":"2023","journal-title":"Eur. J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.echo.2005.10.018","article-title":"Right Heart Function in Systemic Lupus Erythematosus: Insights from Myocardial Doppler Tissue Imaging","volume":"19","author":"Gin","year":"2006","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1016\/j.ultrasmedbio.2022.12.010","article-title":"Quantitative Assessment of Right Ventricular Function in Patients with Systemic Lupus Erythematosus Using the Novel Non-invasive Pressure\u2013Strain Loop","volume":"49","author":"Fan","year":"2023","journal-title":"Ultrasound Med. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.1093\/rheumatology\/kead646","article-title":"Systemic lupus erythematosus patients have unique changes in serum metabolic profiles across age associated with cardiometabolic risk","volume":"63","author":"Jury","year":"2024","journal-title":"Rheumatology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Duarte-Delgado, N.P., Bello-Gualtero, J.M., Fern\u00e1ndez-\u00c1vila, D.G., Romero-S\u00e1nchez, C., Cacciatore, S., Cala, M.P., and Rodr\u00edguez Camacho, L.S. (2025). Metabolic Alterations in Colombian Women with Rheumatoid Arthritis and Systemic Lupus Erythematosus Reveal Potential Lipid Biomarkers Associated with Inflammation and Cardiovascular Risk. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26104527"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1002\/art.42925","article-title":"A Multiomic Analysis to Identify Drivers of Subclinical Vascular Disease in Systemic Lupus Erythematosus","volume":"76","author":"Oliveira","year":"2024","journal-title":"Arthritis Rheumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1038\/s41584-025-01267-0","article-title":"Immunometabolism in systemic lupus erythematosus","volume":"21","author":"Kaplan","year":"2025","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1007\/s11897-024-00687-5","article-title":"Genetic Biomarkers in Heart Failure: From Gene Panels to Polygenic Risk Scores","volume":"21","author":"Figueiral","year":"2024","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Fazzini, L., Caggiari, L., Deidda, M., Onnis, C., Saba, L., Mercuro, G., and Cadeddu Dessalvi, C. (2022). Metabolomic Profiles on Antiblastic Cardiotoxicity: New Perspectives for Early Diagnosis and Cardioprotection. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226745"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"353","DOI":"10.2217\/ijr.14.25","article-title":"Metabolomics in rheumatic diseases","volume":"9","author":"Alonso","year":"2014","journal-title":"Int. J. Clin. Rheumtol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Capozzi, A., Manganelli, V., Riitano, G., Caissutti, D., Longo, A., Garofalo, T., Sorice, M., and Misasi, R. (2023). Advances in the Pathophysiology of Thrombosis in Antiphospholipid Syndrome: Molecular Mechanisms and Signaling through Lipid Rafts. J. Clin. Med., 12.","DOI":"10.3390\/jcm12030891"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1093\/cei\/uxae079","article-title":"Antibody profiles in the mosaic of \u2018seronegative\u2019 APS syndrome","volume":"218","author":"Truglia","year":"2024","journal-title":"Clin. Exp. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s13075-020-02264-2","article-title":"Caution in studying and interpreting the lupus metabolome","volume":"22","author":"Zhang","year":"2020","journal-title":"Arthritis Res. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1161\/ATVBAHA.120.315321","article-title":"Serum Metabolomic Signatures Can Predict Subclinical Atherosclerosis in Patients with Systemic Lupus Erythematosus","volume":"41","author":"Coelewij","year":"2021","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/art.1780390303","article-title":"The development and initial validation of the Systemic Lupus International Collaborating Clinics\/American College of Rheumatology damage index for systemic lupus erythematosus","volume":"39","author":"Gladman","year":"1996","journal-title":"Arthritis Rheum."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1002\/art.34473","article-title":"Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus","volume":"64","author":"Petri","year":"2012","journal-title":"Arthritis Rheum."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1136\/annrheumdis-2018-214819","article-title":"2019 European League Against Rheumatism\/American College of Rheumatology classification criteria for systemic lupus erythematosus","volume":"78","author":"Aringer","year":"2019","journal-title":"Ann. Rheum. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1177\/0961203310366572","article-title":"Disease activity and damage accrual during the early disease course in a multinational inception cohort of patients with systemic lupus erythematosus","volume":"19","author":"Nossent","year":"2010","journal-title":"Lupus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1002\/art.20548","article-title":"Systemic lupus erythematosus in three ethnic groups. XIX. Natural history of the accrual of the American College of Rheumatology criteria prior to the occurrence of criteria diagnosis","volume":"51","author":"McGwin","year":"2004","journal-title":"Arthritis Rheum."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1136\/annrheumdis-2013-205171","article-title":"Factors associated with damage accrual in patients with systemic lupus erythematosus: Results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort","volume":"74","author":"Bruce","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography","volume":"32","author":"Mitchell","year":"2018","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1161\/CIRCULATIONAHA.107.751354","article-title":"Real-time 3-dimensional echocardiography: An integral component of the routine echocardiographic examination in adult patients?","volume":"119","author":"Sugeng","year":"2009","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"490.e7","DOI":"10.1016\/j.crad.2019.03.005","article-title":"A closer look at right ventricular 3D volume quantification by transthoracic echocardiography and cardiac MRI","volume":"74","author":"Greiner","year":"2019","journal-title":"Clin. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1093\/ehjci\/jev309","article-title":"New speckle-tracking algorithm for right ventricular volume analysis from three-dimensional echocardiographic data sets: Validation with cardiac magnetic resonance and comparison with the previous analysis tool","volume":"17","author":"Muraru","year":"2016","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1161\/CIRCIMAGING.113.000706","article-title":"Age-, body size-, and sex-specific reference values for right ventricular volumes and ejection fraction by three-dimensional echocardiography: A multicenter echocardiographic study in 507 healthy volunteers","volume":"6","author":"Maffessanti","year":"2013","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1016\/j.jcmg.2020.04.016","article-title":"Value of 3D Versus 2D Speckle-Tracking Echocardiography for RV Strain Measurement: Validation with Cardiac Magnetic Resonance","volume":"13","author":"Li","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1093\/ehjci\/jeac022","article-title":"Right ventricular longitudinal strain in the clinical routine: A state-of-the-art review","volume":"23","author":"Muraru","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.jcmg.2022.11.009","article-title":"Measurement Accuracy of Right Ventricular Parameters Using 3D Echocardiography: Study-Level Meta-Analysis","volume":"16","author":"Kitano","year":"2023","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1038\/s41598-018-36415-y","article-title":"Metabolomic fingerprint of coronary blood in STEMI patients depends on the ischemic time and inflammatory state","volume":"9","author":"Deidda","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Barberini, L., Noto, A., Fattuoni, C., Satta, G., Zucca, M., Cabras, M.G., Mura, E., and Cocco, P. (2019). The Metabolomic Profile of Lymphoma Subtypes: A Pilot Study. Molecules, 24.","DOI":"10.3390\/molecules24132367"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.echo.2025.01.006","article-title":"Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography","volume":"38","author":"Mukherjee","year":"2025","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_44","first-page":"e39284","article-title":"Systemic Lupus Erythematosus and Cardiovascular Diseases: A Systematic Review","volume":"15","author":"Nor","year":"2023","journal-title":"Cureus"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e2461610","DOI":"10.1001\/jamanetworkopen.2024.61610","article-title":"Incidence and Factors Associated with Recurrent Pericarditis in Lupus","volume":"8","author":"Kim","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"20220051","DOI":"10.1515\/bmc-2022-0051","article-title":"Exploring cardiovascular implications in systemic lupus erythematosus: A holistic analysis of complications, diagnostic criteria, and therapeutic modalities, encompassing pharmacological and adjuvant approaches","volume":"15","author":"Dawi","year":"2024","journal-title":"Biomol. Concepts"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1002\/art.40671","article-title":"Early Detection of Silent Myocardial Impairment in Drug-Naive Patients with New-Onset Systemic Lupus Erythematosus: A Three-Center Prospective Study","volume":"70","author":"Guo","year":"2018","journal-title":"Arthritis Rheumatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1177\/0961203317731533","article-title":"Cardiovascular magnetic resonance detects silent heart disease missed by echocardiography in systemic lupus erythematosus","volume":"27","author":"Mavrogeni","year":"2018","journal-title":"Lupus"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Huang, L., Wang, X., Yuan, Y., Wu, A., Tang, L., Huang, C., Yu, L., and Lin, Q. (2025). Evaluation of subclinical myocardial involvement in systemic lupus erythematosus using multiparametric cardiac magnetic resonance imaging. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-025-05033-8"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Kono, M., Yoshida, N., and Tsokos, G.C. (2021). Amino Acid Metabolism in Lupus. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.623844"},{"key":"ref_51","unstructured":"(2026, January 26). Human Metabolome Database: Showing Metabocard for 2-Aminoheptanedioic Acid (HMDB0034252). Available online: https:\/\/hmdb.ca\/metabolites\/HMDB0034252."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"469","DOI":"10.4158\/EP08331.RAR","article-title":"Glucocorticoid-induced hyperglycemia","volume":"15","author":"Clore","year":"2009","journal-title":"Endocr. Pract."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1042\/BJ20112142","article-title":"Mitochondrial stress causes increased succination of proteins in adipocytes in response to glucotoxicity","volume":"445","author":"Frizzell","year":"2012","journal-title":"Biochem. J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.tibs.2024.05.003","article-title":"Functional implications of fumarate-induced cysteine succination","volume":"49","author":"Guberovic","year":"2024","journal-title":"Trends Biochem. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1161\/CIRCRESAHA.121.318241","article-title":"Cardiac Energy Metabolism in Heart Failure","volume":"128","author":"Lopaschuk","year":"2021","journal-title":"Circ. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1093\/eurjhf\/hfr173","article-title":"Targeting myocardial substrate metabolism in heart failure: Potential for new therapies","volume":"14","author":"Ardehali","year":"2012","journal-title":"Eur. J. Heart Fail."}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/2\/131\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:59:36Z","timestamp":1771232376000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/2\/131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":56,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["metabo16020131"],"URL":"https:\/\/doi.org\/10.3390\/metabo16020131","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}