{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:20:41Z","timestamp":1783344041578,"version":"3.54.6"},"reference-count":49,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universiti Malaya Research Excellence Grant","award":["UMREG007-2023"],"award-info":[{"award-number":["UMREG007-2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Plasmodium knowlesi infections can progress rapidly to life-threatening complications, such as acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), which are driven by the ability of the zoonotic parasite to rapidly replicate towards high parasitemia and the cytoadherence properties of the infected erythrocytes (IRBCs). This study evaluated the anti-parasitic and vasoprotective potential of Annona muricata (soursop) leaf ethanol extract against P. knowlesi. In vitro assays using the P. knowlesi A1-H.1 reference strain revealed significant blood stage schizogony inhibition (IC50: 9.65 \u00b5g\/mL), specifically targeting the trophozoites. The anti-parasitic activity was concentrated in the &lt;30 kDa subfraction of the extract. Washout assays confirmed that the effect was parasitostatic rather than parasiticidal, where the malaria parasites underwent developmental arrest but remained morphologically normal and resumed growth post-removal. Furthermore, priming human endothelial cell lines with the extract significantly reduced IRBC\u2013endothelial binding. These results demonstrate that A. muricata extract exerts a dual-action effect by arresting P. knowlesi asexual replication and inhibiting IRBC\u2013endothelial cytoadherence. While clinical translation would require exhaustive standardization and chemotypic profiling due to the natural variability of plant compositions, these findings provide a foundational academic framework for the potential of A. muricata leaf extract in mitigating severe knowlesi malaria complications.<\/jats:p>","DOI":"10.3390\/tropicalmed11070184","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T10:43:11Z","timestamp":1783334591000},"page":"184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethanolic Leaf Extract of Annona muricata Pauses Plasmodium knowlesi Schizogony and Reduces Binding of Infected Red Blood Cells to Endothelial Cells"],"prefix":"10.3390","volume":"11","author":[{"given":"Yi-Jun","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon Xue-Zhen","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joo-Yie","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed-Nur-Iman","family":"Mohammed-Syafiei","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad-Nasreen","family":"Suhaimi","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siti-Nursyazziana","family":"Nordin","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9288-7328","authenticated-orcid":false,"given":"Shin-Yee","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5780-6564","authenticated-orcid":false,"given":"Hazel Anne","family":"Tabo","sequence":"additional","affiliation":[{"name":"Biological Sciences Department, College of Science and Computer Studies, De La Salle University-Dasmari\u00f1as City, Cavite 4115, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2730-7788","authenticated-orcid":false,"given":"Polrat","family":"Wilairatana","sequence":"additional","affiliation":[{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10140, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0116-1888","authenticated-orcid":false,"given":"Tadesse","family":"Hailu","sequence":"additional","affiliation":[{"name":"Department of Medical Parasitology and Entomology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar P.O. Box 79, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veeranoot","family":"Nissapatorn","sequence":"additional","affiliation":[{"name":"Futuristic Science Research Center, School of Science, World Union for Herbal Drug Discovery (WUHeDD), Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, 222 Thaiburi, Thasala District, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7324-5792","authenticated-orcid":false,"given":"Wenn-Chyau","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"},{"name":"A*STAR Infectious Diseases Labs (A*IDL), Agency for Science, Technology and Research (A*STAR), Singapore 138648, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s12936-022-04131-8","article-title":"Plasmodium knowlesi: The game changer for malaria eradication","volume":"21","author":"Lee","year":"2022","journal-title":"Malar. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1475-2875-7-52","article-title":"Bionomics of Anopheles latens in Kapit, Sarawak, Malaysian Borneo in relation to the transmission of zoonotic simian malaria parasite Plasmodium knowlesi","volume":"7","author":"Tan","year":"2008","journal-title":"Malar. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/1475-2875-11-213","article-title":"Entomologic investigation of Plasmodium knowlesi vectors in Kuala Lipis, Pahang, Malaysia","volume":"11","author":"Jiram","year":"2012","journal-title":"Malar. J."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Braima, K.A., Sum, J.S., Ghazali, A.R., Muslimin, M., Jeffery, J., Lee, W.C., Shaker, M.R., Elamin, A.E., Jamaiah, I., and Lau, Y.L. (2013). Is there a risk of suburban transmission of malaria in Selangor, Malaysia?. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0077924"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Lau, Y.L., Lee, W.C., Chen, J., Zhong, Z., Jian, J., Amir, A., Cheong, F.W., Sum, J.S., and Fong, M.Y. (2016). Draft genomes of Anopheles cracens and Anopheles maculatus: Comparison of simian malaria and human malaria vectors in Peninsular Malaysia. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0157893"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/1475-2875-12-88","article-title":"Hyperparasitaemic human Plasmodium knowlesi infection with atypical morphology in Peninsular Malaysia","volume":"12","author":"Lee","year":"2013","journal-title":"Malar. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1128\/CMR.00079-12","article-title":"Human infections and detection of Plasmodium knowlesi","volume":"26","author":"Singh","year":"2013","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lee, W.C., Shahari, S., Nguee, S.Y.T., Lau, Y.L., and Renia, L. (2022). Cytoadherence properties of Plasmodium knowlesi-infected erythrocytes. Front. Immunol., 12.","DOI":"10.3389\/fmicb.2021.804417"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"151615","DOI":"10.1016\/j.semnephrol.2025.151615","article-title":"Acute kidney injury in non-falciparum malaria","volume":"45","author":"Anstey","year":"2025","journal-title":"Semin. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Phong, Z.Y., Chin, J.Y., Ng, Y.L., Zakaria, N.I., Athirah-Azman, S.N., Kosaisavee, V., Renia, L., and Lee, W.C. (2025). The role of periostin (OSF-2) in the cytoadherence phenomena mediated by malaria parasites. Front. Cell. Infect. Microbiol., 15.","DOI":"10.3389\/fcimb.2025.1599872"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Naserrudin, N.A., Hod, R., Jeffree, M.S., Ahmed, K., and Hassan, M.R. (2022). The emerging threat of Plasmodium knowlesi malaria infection: A concept paper on the vulnerable factors in human. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19074419"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12936-024-04844-y","article-title":"Triple artemisinin-based combination therapy (TACT): Advancing malaria control and eradication efforts","volume":"23","author":"Kokori","year":"2024","journal-title":"Malar. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.pt.2016.09.002","article-title":"The treatment of Plasmodium knowlesi malaria","volume":"33","author":"Barber","year":"2017","journal-title":"Trends Parasitol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"257","DOI":"10.2478\/s11686-019-00036-w","article-title":"Ethanol extracts from Thai plants have anti-Plasmodium and anti-Toxoplasma activities in vitro","volume":"64","author":"Leesombun","year":"2019","journal-title":"Acta Parasitol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mutakin, M., Fauziati, R., Fadhilah, F.N., Zuhrotun, A., Amalia, R., and Hadisaputri, Y.E. (2022). Pharmacological activities of soursop (Annona muricata Lin.). Molecules, 27.","DOI":"10.3390\/molecules27041201"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8736555","DOI":"10.1155\/adpp\/8736555","article-title":"Enhanced antimalarial efficacy of Annona muricata leaf extract combined with artesunate, chloroquine, and pyrimethamine in Plasmodium berghei-infected ICR mice","volume":"2025","author":"Sarakul","year":"2025","journal-title":"Adv. Pharmacol. Pharm. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"359","DOI":"10.31883\/pjfns\/112654","article-title":"Antioxidant activity of extracts of Soursop (Annona muricata L.) leaves, fruit pulps, peels, and seeds","volume":"69","author":"Orak","year":"2019","journal-title":"Pol. J. Food Nutr. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Nsor, O.O., Alabi, B.A., Badejo, J.A., Afolabi, F., Nku-Ekpang, O.A., and Iwalewa, E.O. (2024). Soursop leaf extract and fractions protects against L-NAME-induced hypertension and hyperlipidemia. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1437101"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1073\/pnas.1216457110","article-title":"Adaptation of the genetically tractable malaria pathogen Plasmodium knowlesi to continuous culture in human erythrocytes","volume":"110","author":"Moon","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ng, Y.L., Lee, W.C., Lau, Y.L., and Fong, M.Y. (2023). The impact of geographical variation in Plasmodium knowlesi apical membrane protein 1 (PkAMA-1) on invasion dynamics of P. knowlesi. Trop. Med. Infect. Dis., 8.","DOI":"10.3390\/tropicalmed8010056"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Chin, J.Y., Mohammed-Syafiei, M.N., Lim, Y.J., Chong, G.X., Suhaimi, M.N., Phong, Z.Y., Ng, Y.L., Lau, Y.L., Sam, I.C., and Renia, L. (2025). Effect of periostin (OSF-2) on phagocytosis of Plasmodium-infected erythrocytes. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1728562"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e06976","DOI":"10.1016\/j.heliyon.2021.e06976","article-title":"Potential anti-Acanthamoeba and anti-adhesion activities of Annona muricata and Combretum trifoliatum extracts and their synergistic effects in combination with chlorhexidine against Acanthamoeba triangularis trophozoites and cysts","volume":"7","author":"Mitsuwan","year":"2021","journal-title":"Heliyon"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s00203-021-02701-z","article-title":"Antibacterial, antibiofilm, and anti-adhesion activities of Piper betle leaf extract against avian pathogenic Escherichia coli","volume":"204","author":"Kulnanan","year":"2021","journal-title":"Arch. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5170","DOI":"10.1128\/AAC.00682-13","article-title":"Field-based flow cytometry for ex vivo characterization of Plasmodium vivax and P. falciparum antimalarial sensitivity","volume":"57","author":"Russell","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1093\/jac\/dku326","article-title":"Methylene blue inhibits the asexual development of vivax malaria parasites from a region of increasing chloroquine resistance","volume":"70","author":"Suwanarusk","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.4269\/ajtmh.21-1229","article-title":"Rosetting responses of Plasmodium-infected erythrocytes to antimalarials","volume":"106","author":"Lee","year":"2022","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1186\/1475-2875-11-325","article-title":"Optimizing the HRP-2 in vitro malaria drug susceptibility assay using a reference clone to improve comparisons of Plasmodium falciparum field isolates","volume":"11","author":"Rutvisuttinunt","year":"2012","journal-title":"Malar. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"103680","DOI":"10.1016\/j.ebiom.2021.103680","article-title":"Plasmodium falciparum rosetting protects schizonts against artemisinin","volume":"73","author":"Lee","year":"2021","journal-title":"eBioMedicine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0140-6736(78)90365-3","article-title":"Drug sensitivity of Plasmodium falciparum: An in-vitro microtechnique","volume":"1","author":"Rieckmann","year":"1978","journal-title":"Lancet"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e51546","DOI":"10.7554\/eLife.51546","article-title":"Plasmodium-infected erythrocytes induce secretion of IGFBP7 to form type II rosettes and escape phagocytosis","volume":"9","author":"Lee","year":"2020","journal-title":"eLife"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Das, S., Basu, H., Korde, R., Tewari, R., and Sharma, S. (2012). Arrest of nuclear division in Plasmodium through blockage of erythrocyte surface exposed ribosomal protein P2. PLoS Pathog., 8.","DOI":"10.1371\/annotation\/913cb443-4033-4841-8666-1d348949a010"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e0021625","DOI":"10.1128\/mbio.00216-25","article-title":"SUN-domain proteins of the malaria parasite Plasmodium falciparum are essential for proper nuclear division and DNA repair","volume":"16","author":"Goyal","year":"2025","journal-title":"mBio"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11449","DOI":"10.1038\/ncomms11449","article-title":"An essential malaria protein defines the architecture of blood-stage and transmission-stage parasites","volume":"7","author":"Absalon","year":"2016","journal-title":"Nat. Commun."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"17017","DOI":"10.1038\/nmicrobiol.2017.17","article-title":"Plasmodium falciparum CRK4 directs continuous rounds of DNA replication during schizogony","volume":"2","author":"Ganter","year":"2017","journal-title":"Nat. Microbiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Voss, Y., Klaus, S., Guizetti, J., and Ganter, M. (2023). Plasmodium schizogony, a chronology of the parasite\u2019s cell cycle in the blood stage. PLoS Pathog., 19.","DOI":"10.1371\/journal.ppat.1011157"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"42066","DOI":"10.1074\/jbc.M202860200","article-title":"Protein farnesyltransferase and protein prenylation in Plasmodium falciparum","volume":"277","author":"Chakrabarti","year":"2002","journal-title":"J. Biol. Chem."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5176","DOI":"10.1021\/jm800113p","article-title":"Potent, Plasmodium-selective farnesyltransferase inhibitors that arrest the growth of malaria parasites: Structure-activity relationships of ethylenediamine-analogue scaffolds and homology model validation","volume":"51","author":"Fletcher","year":"2008","journal-title":"J. Med. Chem."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Awad, A.M., Kumar, P., Ismail-Fitry, M.R., Jusoh, S., Ab Aziz, M.F., and Sazili, A.Q. (2021). Green extraction of bioactive compounds from plant biomass and their application in meat as natural antioxidant. Antioxidants, 10.","DOI":"10.3390\/antiox10091465"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"131918","DOI":"10.1016\/j.foodchem.2021.131918","article-title":"Influence of the extraction method on the recovery of bioactive phenolic compounds from food industry by-products","volume":"378","author":"Romero","year":"2022","journal-title":"Food Chem."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Lee, J.E., Jayakody, J.T.M., Kim, J.I., Jeong, J.W., Choi, K.M., Kim, T.S., Seo, C., Azimi, I., Hyun, J.M., and Ryu, B.M. (2024). The influence of solvent choice on the extraction of bioactive compounds from Asteraceae: A comparative review. Foods, 13.","DOI":"10.3390\/foods13193151"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"105044","DOI":"10.1016\/j.fbio.2024.105044","article-title":"Partitioning of proteins and small molecular weight compounds from Alfalfa juice during ultrafiltration","volume":"62","author":"Tanambell","year":"2024","journal-title":"Food Biosci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1826170","DOI":"10.1155\/2018\/1826170","article-title":"Anticancer properties of Graviola (Annona muricata): A comprehensive mechanistic review","volume":"2018","author":"Rady","year":"2018","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Lee, W.C., Russell, B., and Renia, L. (2019). Sticking for a cause: The falciparum malaria parasites cytoadherence paradigm. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.01444"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"112263","DOI":"10.1016\/j.biopha.2021.112263","article-title":"Non-targeted metabolomics characterization of Annona muricata leaf extracts with anti-angiogenic activity","volume":"144","author":"Cardenas","year":"2021","journal-title":"Biomed. Pharmacother."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Marrero, A.D., Quesada, A.R., Martinez-Poveda, B., Medina, M.A., and Cardenas, C. (2023). A proteomic study of the bioactivity of Annona muricata leaf extracts in HT-1080 fibrosarcoma cells. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241512021"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Zubaidi, S.N., Qadi, W.S.M., Maarof, S., Mohmad Misnan, N., Mohammad Noor, H.S., Hamezah, H.S., Baharum, S.N., Rosli, N., Jam, F.A., and Al-Olayan, E. (2023). Assessing the acute toxicological effects of Annona muricata leaf ethanol extract on rats: Biochemical, histopathological, and metabolomics analyses. Toxics, 11.","DOI":"10.3390\/toxics11080688"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1086\/605439","article-title":"Clinical and laboratory features of human Plasmodium knowlesi infection","volume":"49","author":"Daneshvar","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"100513","DOI":"10.1016\/j.ijregi.2024.100513","article-title":"Severe knowlesi malaria with acute neurocognitive impairment: A case report","volume":"14","author":"Gunawan","year":"2025","journal-title":"IJID Reg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/jphp.13182","article-title":"The safety and tolerability of Annona muricata leaf extract: A systematic review","volume":"72","author":"Chan","year":"2020","journal-title":"J. Pharm. Pharmacol."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/7\/184\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:58:44Z","timestamp":1783342724000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/7\/184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":49,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["tropicalmed11070184"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed11070184","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]}}}