{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:07:19Z","timestamp":1774969639427,"version":"3.50.1"},"reference-count":125,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FEDER\u2014Fundo Europeu de Desenvolimento Regional through COMPETE 2020\u2014Operational Programme for Competitiveness and Internationalization"},{"name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, in a framework of the projects in CINTESIS, R&D Unit","award":["UIDB\/4255\/2020"],"award-info":[{"award-number":["UIDB\/4255\/2020"]}]},{"name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, in a framework of the projects in CINTESIS, R&D Unit","award":["UIDB\/4255\/2020"],"award-info":[{"award-number":["UIDB\/4255\/2020"]}]},{"name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, in a framework of the projects in CINTESIS, R&D Unit","award":["\u201cRISE\u2014LA\/P\/0053\/2020.\u201d"],"award-info":[{"award-number":["\u201cRISE\u2014LA\/P\/0053\/2020.\u201d"]}]},{"name":"FCT and FEDER","award":["IF\/00092\/2014\/CP1255\/CT0004"],"award-info":[{"award-number":["IF\/00092\/2014\/CP1255\/CT0004"]}]},{"name":"FCT and FEDER","award":["2024.18026.PEX"],"award-info":[{"award-number":["2024.18026.PEX"]}]},{"name":"FCT and FEDER","award":["PRR-09\/C06-834I07\/2024.P11721"],"award-info":[{"award-number":["PRR-09\/C06-834I07\/2024.P11721"]}]},{"name":"Chair in Onco-Innovation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Chlamydia trachomatis (CT) remains the most commonly reported bacterial sexually transmitted infection (STI) globally, with particularly high incidence among adolescents and young adults. In Europe, CT cases have continued to rise over the past decade, despite ongoing public health efforts in prevention and screening. Screening coverage, however, remains inconsistent across countries. CT infections are often asymptomatic, especially in women, yet can lead to serious CT-related reproductive complications if left untreated, including pelvic inflammatory disease (PID), tubal factor infertility, and ectopic pregnancy. Emerging evidence highlights the cervicovaginal microbiota as a key factor influencing susceptibility to STIs, including CT infection, its progression, and associated outcomes. A Lactobacillus-dominated microbiota, particularly L. crispatus, is well-known to be a protective factor against CT acquisition, whereas vaginal dysbiosis, characterized by a depletion of these species and an overgrowth of anaerobes, such as Gardnerella vaginalis, Atopobium vaginae, and Prevotella spp., has been linked to increased CT acquisition risk, reduced immune control, and impaired infection resolution. Interaction between microbial communities and host immunity may modulate whether CT infections spontaneously clear, persist, or progress into pathological conditions. This review explores the natural history of CT genital infection in women, emphasizing the role of cervicovaginal dysbiosis in disease progression and reproductive sequelae. By integrating current knowledge about resident cervicovaginal microbes, host-microbe interaction, and CT-related reproductive outcomes, we discuss how microbiota-targeted strategies, including probiotic or microbiome-modulating strategies, may complement current CT prevention, diagnosis, and treatment approaches.<\/jats:p>","DOI":"10.3390\/ijms262110635","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:15:14Z","timestamp":1762175714000},"page":"10635","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Disrupted Cervicovaginal Microbiota: Its Role in Chlamydia\u00a0trachomatis Genital Infection and Associated Reproductive Outcomes"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6525-1551","authenticated-orcid":false,"given":"Rafaela","family":"Rodrigues","sequence":"first","affiliation":[{"name":"PerMed Research Group, RISE-Health, Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Pl\u00e1cido da Costa, 4200-450 Porto, Portugal"},{"name":"Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Le\u00e7a do Balio, Portugal"}]},{"given":"Ana Rita","family":"Silva","sequence":"additional","affiliation":[{"name":"PerMed Research Group, RISE-Health, Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Le\u00e7a do Balio, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0708-6874","authenticated-orcid":false,"given":"Carlos","family":"Sousa","sequence":"additional","affiliation":[{"name":"PerMed Research Group, RISE-Health, Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Le\u00e7a do Balio, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1283-1042","authenticated-orcid":false,"given":"Nuno","family":"Vale","sequence":"additional","affiliation":[{"name":"PerMed Research Group, RISE-Health, Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Pl\u00e1cido da Costa, 4200-450 Porto, Portugal"},{"name":"Laboratory of Personalized Medicine, Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Pl\u00e1cido da Costa, 4200-450 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","unstructured":"Mohseni, M., Sung, S., and Takov, V. (2025). Chlamydia, StatPearls Publishing LLC."},{"key":"ref_2","unstructured":"European Centre for Disease Prevention and Control (2025). STI Cases Continue to Rise Across Europe, ECDC. Available online: https:\/\/www.ecdc.europa.eu\/en\/news-events\/sti-cases-continue-rise-across-europe."},{"key":"ref_3","unstructured":"European Centre for Disease Prevention and Control (2025). Chlamydia. ECDC. Annual Epidemiological Report for 2023, ECDC. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/chlamydia-annual-epidemiological-report-2023."},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention (2025, May 23). Sexually Transmitted Infections Surveillance, Available online: https:\/\/www.cdc.gov\/sti-statistics\/annual\/index.html."},{"key":"ref_5","unstructured":"Centers for Disease Control and Prevention (2025, May 23). National Overview of STIs in 2023, Available online: https:\/\/www.cdc.gov\/sti-statistics\/media\/pdfs\/2025\/09\/2023_STI_Surveillance_Report_FINAL_508.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1177\/09564624251323678","article-title":"2025 European guideline on the management of Chlamydia trachomatis infections","volume":"36","author":"White","year":"2025","journal-title":"Int. J. STD AIDS"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rodrigues, R., Marques, L., Vieira-Baptista, P., Sousa, C., and Vale, N. (2022). Therapeutic Options for Chlamydia trachomatis Infection: Present and Future. Antibiotics, 11.","DOI":"10.3390\/antibiotics11111634"},{"key":"ref_8","unstructured":"World Health Organization (2022). Global Health Sector Strategies on, Respectively, HIV, Viral Hepatitis and Sexually Transmitted Infections for the Period 2022\u20132030, WHO. Available online: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/strategies\/global-health-sector-strategies."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Rodrigues, R., Sousa, C., and Vale, N. (2022). Chlamydia trachomatis as a Current Health Problem: Challenges and Opportunities. Diagnostics, 12.","DOI":"10.3390\/diagnostics12081795"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/OLQ.0000000000001357","article-title":"The Estimated Lifetime Medical Cost of Chlamydia, Gonorrhea, and Trichomoniasis in the United States, 2018","volume":"48","author":"Kumar","year":"2021","journal-title":"Sex. Transm. Dis."},{"key":"ref_11","first-page":"2024.12.16.24319070","article-title":"Prevalence of chlamydia, gonorrhoea, and trichomoniasis among male and female general populations in sub-Saharan Africa from 2000-2024: A systematic review and meta-regression analysis","volume":"83","author":"Michalow","year":"2024","journal-title":"medRxiv"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1136\/sti.2007.026930","article-title":"Costs and health consequences of chlamydia management strategies among pregnant women in sub-Saharan Africa","volume":"83","author":"Romoren","year":"2007","journal-title":"Sex. Transm. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Rodrigues, R., Sousa, C., and Vale, N. (2024). Deciphering the Puzzle: Literature Insights on Chlamydia trachomatis-Mediated Tumorigenesis, Paving the Way for Future Research. Microorganisms, 12.","DOI":"10.3390\/microorganisms12061126"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Rodrigues, R., Sousa, C., Barros, A., and Vale, N. (2025). Chlamydia trachomatis: From Urogenital Infections to the Pathway of Infertility. Genes, 16.","DOI":"10.3390\/genes16020205"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S121","DOI":"10.1093\/infdis\/jiab017","article-title":"Chlamydia trachomatis, Pelvic Inflammatory Disease, and Epithelial Ovarian Cancer","volume":"224","author":"Paavonen","year":"2021","journal-title":"J. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Morhason-Bello, I., Kim, K., Bello, Y., Zheng, Y., Oyerinde, S., Idowu, O.C., Pav\u00f3n, M.\u00c1., Baisley, K., Wang, J., and Fowotade, A. (2025). Assessment of Relative Contributions of Lifestyle, Behavioral and Biological Risk Factors for Cervical Human Papillomavirus Infections in Female Sex Workers. Viruses, 17.","DOI":"10.3390\/v17040485"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.cell.2024.12.011","article-title":"Cervicovaginal microbiome and natural history of Chlamydia trachomatis in adolescents and young women","volume":"188","author":"Usyk","year":"2025","journal-title":"Cell"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"93","DOI":"10.15698\/mic2025.04.848","article-title":"Influence of cervicovaginal microbiota on Chlamydia trachomatis infection dynamics","volume":"12","author":"Hand","year":"2025","journal-title":"Microb. Cell"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Di Pietro, M., Filardo, S., Simonelli, I., Pasqualetti, P., and Sessa, R. (2022). Cervicovaginal Microbiota Composition in Chlamydia trachomatis Infection: A Systematic Review and Meta-Analysis. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23179554"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4680","DOI":"10.1073\/pnas.1002611107","article-title":"Vaginal microbiome of reproductive-age women","volume":"108","author":"Ravel","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100051","DOI":"10.1016\/j.humic.2018.11.002","article-title":"Exhaustive repertoire of human vaginal microbiota","volume":"11","author":"Diop","year":"2019","journal-title":"Hum. Microbiome J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s40168-015-0094-5","article-title":"The vocabulary of microbiome research: A proposal","volume":"3","author":"Marchesi","year":"2015","journal-title":"Microbiome"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Auriemma, R.S., Scairati, R., Del Vecchio, G., Liccardi, A., Verde, N., Pirchio, R., Pivonello, R., Ercolini, D., and Colao, A. (2021). The Vaginal Microbiome: A Long Urogenital Colonization Throughout Woman Life. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.686167"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1038\/s41392-025-02152-8","article-title":"Population-level analyses identify host and environmental variables influencing the vaginal microbiome","volume":"10","author":"Qin","year":"2025","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12934-020-01464-4","article-title":"Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health","volume":"19","author":"Chee","year":"2020","journal-title":"Microb. Cell Factories"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lehtoranta, L., Ala-Jaakkola, R., Laitila, A., and Maukonen, J. (2022). Healthy Vaginal Microbiota and Influence of Probiotics Across the Female Life Span. Front. Microbiol., 13.","DOI":"10.3389\/fmicb.2022.819958"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.resmic.2017.04.001","article-title":"The role of lactic acid production by probiotic Lactobacillus species in vaginal health","volume":"168","author":"Tachedjian","year":"2017","journal-title":"Res. Microbiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s40168-022-01337-5","article-title":"Lactic acid from vaginal microbiota enhances cervicovaginal epithelial barrier integrity by promoting tight junction protein expression","volume":"10","author":"Jesaveluk","year":"2022","journal-title":"Microbiome"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Aldunate, M., Srbinovski, D., Hearps, A.C., Latham, C.F., Ramsland, P.A., Gugasyan, R., Cone, R.A., and Tachedjian, G. (2015). Antimicrobial and immune modulatory effects of lactic acid and short chain fatty acids produced by vaginal microbiota associated with eubiosis and bacterial vaginosis. Front. Physiol., 6.","DOI":"10.3389\/fphys.2015.00164"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Delgado-Diaz, D.J., Tyssen, D., Hayward, J.A., Gugasyan, R., Hearps, A.C., and Tachedjian, G. (2019). Distinct Immune Responses Elicited From Cervicovaginal Epithelial Cells by Lactic Acid and Short Chain Fatty Acids Associated With Optimal and Non-optimal Vaginal Microbiota. Front. Cell. Infect. Microbiol., 9.","DOI":"10.3389\/fcimb.2019.00446"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Vagios, S., and Mitchell, C.M. (2021). Mutual Preservation: A Review of Interactions Between Cervicovaginal Mucus and Microbiota. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.676114"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Valenti, P., Rosa, L., Capobianco, D., Lepanto, M.S., Schiavi, E., Cutone, A., Paesano, R., and Mastromarino, P. (2018). Role of Lactobacilli and Lactoferrin in the Mucosal Cervicovaginal Defense. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.00376"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Heczko, P.B., Giemza, M., Ponikiewska, W., and Strus, M. (2024). Importance of Lactobacilli for Human Health. Microorganisms, 12.","DOI":"10.20944\/preprints202409.1438.v1"},{"key":"ref_34","first-page":"2024.11.26.625070","article-title":"Diversity in women and their vaginal microbiota","volume":"24","author":"Ahannach","year":"2025","journal-title":"Trends Microbiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Dong, W., Wang, S., Wang, X., Xu, G., Liu, Q., Li, Z., Lv, N., Pan, Y., Xiong, Q., and Liu, D. (2024). Characteristics of Vaginal Microbiota of Women of Reproductive Age with Infections. Microorganisms, 12.","DOI":"10.3390\/microorganisms12051030"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Amabebe, E., and Anumba, D.O.C. (2018). The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Front. Med., 5.","DOI":"10.3389\/fmed.2018.00181"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1113\/JP271694","article-title":"The vaginal microbiota, host defence and reproductive physiology","volume":"595","author":"Smith","year":"2017","journal-title":"J. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mirmonsef, P., Hotton, A.L., Gilbert, D., Gioia, C.J., Maric, D., Hope, T.J., Landay, A.L., and Spear, G.T. (2016). Glycogen Levels in Undiluted Genital Fluid and Their Relationship to Vaginal pH, Estrogen, and Progesterone. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153553"},{"key":"ref_39","first-page":"457","article-title":"Vaginal microflora in postmenopausal women on hormone replacement therapy","volume":"49","author":"Gupta","year":"2006","journal-title":"Indian J. Pathol. Microbiol."},{"key":"ref_40","first-page":"001751","article-title":"Interplay of the microbiome and antifungal therapy in recurrent vulvovaginal candidiasis (RVVC): A narrative review","volume":"72","author":"Khan","year":"2023","journal-title":"J. Med. Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"127628","DOI":"10.1016\/j.micres.2024.127628","article-title":"A molecular view on the interference established between vaginal Lactobacilli and pathogenic Candida species: Challenges and opportunities for the development of new therapies","volume":"281","author":"Pedro","year":"2024","journal-title":"Microbiol. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e03501","DOI":"10.1128\/spectrum.03501-23","article-title":"Vaginal fungi are associated with treatment-induced shifts in the vaginal microbiota and with a distinct genital immune profile","volume":"12","author":"Armstrong","year":"2024","journal-title":"Microbiol. Spectr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3793","DOI":"10.1007\/s00203-021-02414-3","article-title":"Vaginal microbiome: Normalcy vs dysbiosis","volume":"203","author":"Saraf","year":"2021","journal-title":"Arch. Microbiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"104617","DOI":"10.1016\/j.micpath.2020.104617","article-title":"Cervicovaginal microbiota dysbiosis correlates with HPV persistent infection","volume":"152","author":"Qingqing","year":"2021","journal-title":"Microb. Pathog."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1089\/aid.2018.0304","article-title":"The Evolving Facets of Bacterial Vaginosis: Implications for HIV Transmission","volume":"35","author":"McKinnon","year":"2019","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/s41564-022-01083-2","article-title":"Towards a deeper understanding of the vaginal microbiota","volume":"7","author":"France","year":"2022","journal-title":"Nat. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/s41522-023-00471-8","article-title":"A manifold-based framework for studying the dynamics of the vaginal microbiome","volume":"9","author":"Borenstein","year":"2023","journal-title":"npj Biofilms Microbiomes"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1146\/annurev-micro-092611-150157","article-title":"Vaginal microbiome: Rethinking health and disease","volume":"66","author":"Ma","year":"2012","journal-title":"Annu. Rev. Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1186\/s40168-020-00934-6","article-title":"VALENCIA: A nearest centroid classification method for vaginal microbial communities based on composition","volume":"8","author":"France","year":"2020","journal-title":"Microbiome"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Valeriano, V.D., Lahtinen, E., Hwang, I.-C., Zhang, Y., Du, J., and Schuppe-Koistinen, I. (2024). Vaginal dysbiosis and the potential of vaginal microbiome-directed therapeutics. Front. Microbiomes, 3.","DOI":"10.3389\/frmbi.2024.1363089"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1038\/mi.2015.86","article-title":"Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier","volume":"9","author":"Borgdorff","year":"2016","journal-title":"Mucosal Immunol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1093\/cid\/ciac938","article-title":"Non-Lactobacillus-Dominant and Polymicrobial Vaginal Microbiomes Are More Common in Younger South African Women and Predictive of Increased Risk of Human Immunodeficiency Virus Acquisition","volume":"76","author":"Wang","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Ziklo, N., Vidgen, M.E., Taing, K., Huston, W.M., and Timms, P. (2018). Dysbiosis of the Vaginal Microbiota and Higher Vaginal Kynurenine\/Tryptophan Ratio Reveals an Association with Chlamydia trachomatis Genital Infections. Front. Cell. Infect. Microbiol., 8.","DOI":"10.3389\/fcimb.2018.00001"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"7926","DOI":"10.1038\/s41598-022-12007-9","article-title":"The vaginal microbiome and the risk of preterm birth: A systematic review and network meta-analysis","volume":"12","author":"Gudnadottir","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1007\/s40618-022-01752-3","article-title":"Human genital tracts microbiota: Dysbiosis crucial for infertility","volume":"45","author":"Venneri","year":"2022","journal-title":"J. Endocrinol. Invest."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Han, Y., Liu, Z., and Chen, T. (2021). Role of Vaginal Microbiota Dysbiosis in Gynecological Diseases and the Potential Interventions. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.643422"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Kwon, M.S., and Lee, H.K. (2022). Host and Microbiome Interplay Shapes the Vaginal Microenvironment. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.919728"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1038\/nri3819","article-title":"The role of sex hormones in immune protection of the female reproductive tract","volume":"15","author":"Wira","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_59","first-page":"331","article-title":"Unraveling the Dynamics of the Human Vaginal Microbiome","volume":"89","author":"Nunn","year":"2016","journal-title":"Yale J. Biol. Med."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Dong, M., Dong, Y., Bai, J., Li, H., Ma, X., Li, B., Wang, C., Li, H., Qi, W., and Wang, Y. (2023). Interactions between microbiota and cervical epithelial, immune, and mucus barrier. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1124591"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.chom.2018.01.013","article-title":"Cervicovaginal Microbiota and Reproductive Health: The Virtue of Simplicity","volume":"23","author":"Anahtar","year":"2018","journal-title":"Cell Host Microbe"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Jury, B., Fleming, C., Huston, W.M., and Luu, L.D.W. (2023). Molecular pathogenesis of Chlamydia trachomatis. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1281823"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"9250","DOI":"10.1038\/s41467-024-53443-7","article-title":"Specialized contact sites regulate the fusion of chlamydial inclusion membranes","volume":"15","author":"Linton","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Lyu, H., Tang, H., Feng, Y., Hu, S., Wang, Y., Zhou, L., Huang, S., Li, J., Zhu, H., and He, X. (2024). Incidence and spontaneous clearance of gonorrhea and chlamydia infections among men who have sex with men: A prospective cohort study in Zhuhai, China. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1348686"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1093\/infdis\/jiad155","article-title":"Natural Clearance of Chlamydia trachomatis Infection Is Associated With Distinct Differences in Cervicovaginal Metabolites","volume":"228","author":"Jordan","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/OLQ.0000000000001905","article-title":"A Narrative Review on Spontaneous Clearance of Urogenital Chlamydia trachomatis: Host, Microbiome, and Pathogen-Related Factors","volume":"51","author":"Klasner","year":"2024","journal-title":"Sex. Transm. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Wang, X., Wu, H., Fang, C., and Li, Z. (2024). Insights into innate immune cell evasion by Chlamydia trachomatis. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1289644"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e0006324","DOI":"10.1128\/iai.00063-24","article-title":"Recognition of Chlamydia trachomatis by Toll-like receptor 9 is altered during persistence","volume":"92","author":"Diallo","year":"2024","journal-title":"Infect. Immun."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1128\/CMR.00105-13","article-title":"Genital Chlamydia trachomatis: Understanding the roles of innate and adaptive immunity in vaccine research","volume":"27","author":"Vasilevsky","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"ftab012","DOI":"10.1093\/femspd\/ftab012","article-title":"Immunopathogenesis of genital Chlamydia infection: Insights from mouse models","volume":"79","author":"Dockterman","year":"2021","journal-title":"Pathog. Dis."},{"key":"ref_71","first-page":"e00513","article-title":"Tryptophan Availability during Persistence of Chlamydia trachomatis Directly Impacts Expression of Chlamydial Cell Division Proteins","volume":"91","year":"2023","journal-title":"Infect. Immun."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Wang, L., Hou, Y., Yuan, H., and Chen, H. (2022). The role of tryptophan in Chlamydia trachomatis persistence. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.931653"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Hatch, N.D., and Ouellette, S.P. (2020). Inhibition of tRNA Synthetases Induces Persistence in Chlamydia. Infect. Immun., 88.","DOI":"10.1128\/IAI.00943-19"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1093\/infdis\/jix240","article-title":"Lower Levels of Cervicovaginal Tryptophan Are Associated With Natural Clearance of Chlamydia in Women","volume":"215","author":"Jordan","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1128\/IAI.68.3.1457-1464.2000","article-title":"Chlamydial development is adversely affected by minor changes in amino acid supply, blood plasma amino acid levels, and glucose deprivation","volume":"68","author":"Harper","year":"2000","journal-title":"Infect. Immun."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Mandel, C.G., Sanchez, S.E., Monahan, C.C., Phuklia, W., and Omsland, A. (2024). Metabolism and physiology of pathogenic bacterial obligate intracellular parasites. Front. Cell. Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1284701"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e0048322","DOI":"10.1128\/iai.00483-22","article-title":"A Member of an Ancient Family of Bacterial Amino Acids Transporters Contributes to Chlamydia Nutritional Virulence and Immune Evasion","volume":"91","author":"Banerjee","year":"2023","journal-title":"Infect. Immun."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Nie, C., He, T., Zhang, W., Zhang, G., and Ma, X. (2018). Branched Chain Amino Acids: Beyond Nutrition Metabolism. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19040954"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1017\/S000711450769936X","article-title":"Amino acids and immune function","volume":"98","author":"Li","year":"2007","journal-title":"Br. J. Nutr."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.immuni.2019.09.020","article-title":"Western Diet and the Immune System: An Inflammatory Connection","volume":"51","author":"Christ","year":"2019","journal-title":"Immunity"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"5170","DOI":"10.1128\/IAI.67.10.5170-5175.1999","article-title":"Acid production by vaginal flora in vitro is consistent with the rate and extent of vaginal acidification","volume":"67","author":"Boskey","year":"1999","journal-title":"Infect. Immun."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Zalambani, C., Rizzardi, N., Marziali, G., Foschi, C., Morselli, S., Djusse, M.E., Naldi, M., Fato, R., Calonghi, N., and Marangoni, A. (2023). Role of D(\u2212)-Lactic Acid in Prevention of Chlamydia trachomatis Infection in an In Vitro Model of HeLa Cells. Pathogens, 12.","DOI":"10.3390\/pathogens12070883"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Chen, H., Min, S., Wang, L., Zhao, L., Luo, F., Lei, W., Wen, Y., Luo, L., Zhou, Q., and Peng, L. (2022). Lactobacillus Modulates Chlamydia Infectivity and Genital Tract Pathology in vitro and in vivo. Front. Microbiol., 13.","DOI":"10.3389\/fmicb.2022.877223"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.ijmm.2014.04.006","article-title":"Effects of vaginal lactobacilli in Chlamydia trachomatis infection","volume":"304","author":"Mastromarino","year":"2014","journal-title":"Int. J. Med. Microbiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1136\/sextrans-2017-053346","article-title":"Vaginal microbiota composition and association with prevalent Chlamydia trachomatis infection: A cross-sectional study of young women attending a STI clinic in France","volume":"94","author":"Tamarelle","year":"2018","journal-title":"Sex. Transm. Infect."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Aiyar, A., Quayle, A.J., Buckner, L.R., Sherchand, S.P., Chang, T.L., Zea, A.H., Martin, D.H., and Belland, R.J. (2014). Influence of the tryptophan-indole-IFN\u03b3 axis on human genital Chlamydia trachomatis infection: Role of vaginal co-infections. Front. Cell. Infect. Microbiol., 4.","DOI":"10.3389\/fcimb.2014.00072"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"ftae019","DOI":"10.1093\/femspd\/ftae019","article-title":"Restriction and evasion: A review of IFN\u03b3-mediated cell-autonomous defense pathways during genital Chlamydia infection","volume":"82","author":"Reitano","year":"2024","journal-title":"Pathog. Dis."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Kaiser Julienne, C., and Heinrichs David, E. (2018). Branching Out: Alterations in Bacterial Physiology and Virulence Due to Branched-Chain Amino Acid Deprivation. mBio, 9.","DOI":"10.1128\/mBio.01188-18"},{"key":"ref_89","first-page":"e00057-25","article-title":"Cervicovaginal microbial features predict Chlamydia trachomatis spread to the upper genital tract of infected women","volume":"93","author":"Jeong","year":"2025","journal-title":"bioRxiv"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Escorcia Mora, P., Valbuena, D., and Diez-Juan, A. (2025). The Role of the Gut Microbiota in Female Reproductive and Gynecological Health: Insights into Endometrial Signaling Pathways. Life, 15.","DOI":"10.3390\/life15050762"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Wang, Y., Wang, X., Zhu, M., Ge, L., Liu, X., Su, K., Chen, Z., and Zhao, W. (2022). The Interplay Between Cervicovaginal Microbial Dysbiosis and Cervicovaginal Immunity. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.857299"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.3390\/applmicrobiol3040089","article-title":"The Vaginal Microbiome during Pregnancy in Health and Disease","volume":"3","author":"Mendz","year":"2023","journal-title":"Appl. Microbiol."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Biagioli, V., Matera, M., Ramenghi, L.A., Falsaperla, R., and Striano, P. (2025). Microbiome and Pregnancy Dysbiosis: A Narrative Review on Offspring Health. Nutrients, 17.","DOI":"10.3390\/nu17061033"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Gerede, A., Nikolettos, K., Vavoulidis, E., Margioula-Siarkou, C., Petousis, S., Giourga, M., Fotinopoulos, P., Salagianni, M., Stavros, S., and Dinas, K. (2024). Vaginal Microbiome and Pregnancy Complications: A Review. J. Clin. Med., 13.","DOI":"10.20944\/preprints202406.0233.v1"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Cocomazzi, G., De Stefani, S., Del Pup, L., Palini, S., Buccheri, M., Primiterra, M., Sciannam\u00e8, N., Faioli, R., Maglione, A., and Baldini, G.M. (2023). The Impact of the Female Genital Microbiota on the Outcome of Assisted Reproduction Treatments. Microorganisms, 11.","DOI":"10.3390\/microorganisms11061443"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1038\/s41591-019-0450-2","article-title":"The vaginal microbiome and preterm birth","volume":"25","author":"Fettweis","year":"2019","journal-title":"Nat. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s40168-016-0203-0","article-title":"The vaginal microbiota, human papillomavirus infection and cervical intraepithelial neoplasia: What do we know and where are we going next?","volume":"4","author":"Mitra","year":"2016","journal-title":"Microbiome"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Fr\u0105szczak, K., Barczy\u0144ski, B., and Kondracka, A. (2022). Does Lactobacillus Exert a Protective Effect on the Development of Cervical and Endometrial Cancer in Women?. Cancers, 14.","DOI":"10.3390\/cancers14194909"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Gillet, E., Meys, J.F., Verstraelen, H., Bosire, C., De Sutter, P., Temmerman, M., and Broeck, D.V. (2011). Bacterial vaginosis is associated with uterine cervical human papillomavirus infection: A meta-analysis. BMC Infect. Dis., 11.","DOI":"10.1186\/1471-2334-11-10"},{"key":"ref_100","first-page":"743","article-title":"Vaginal microbiomes and ovarian cancer: A review","volume":"10","author":"Xu","year":"2020","journal-title":"Am. J. Cancer Res."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1016\/S1470-2045(19)30340-7","article-title":"Association between the cervicovaginal microbiome, BRCA1 mutation status, and risk of ovarian cancer: A case-control study","volume":"20","author":"Reisel","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"36225","DOI":"10.18632\/oncotarget.16717","article-title":"The ovarian cancer oncobiome","volume":"8","author":"Banerjee","year":"2017","journal-title":"Oncotarget"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s10020-021-00295-2","article-title":"The role of the microbiome in ovarian cancer: Mechanistic insights into oncobiosis and to bacterial metabolite signaling","volume":"27","author":"Sipos","year":"2021","journal-title":"Mol. Med."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.tjog.2023.09.018","article-title":"The role of probiotics in women\u2019s health: An update narrative review","volume":"63","author":"Wu","year":"2024","journal-title":"Taiwan. J. Obstet. Gynecol."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Santacroce, L., Palmirotta, R., Bottalico, L., Charitos, I.A., Colella, M., Topi, S., and Jirillo, E. (2023). Crosstalk between the Resident Microbiota and the Immune Cells Regulates Female Genital Tract Health. Life, 13.","DOI":"10.3390\/life13071531"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"29024","DOI":"10.1038\/srep29024","article-title":"Lactobacillus crispatus inhibits the infectivity of Chlamydia trachomatis elementary bodies, in vitro study","volume":"6","author":"Nardini","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Tuniyazi, M., and Zhang, N. (2023). Possible Therapeutic Mechanisms and Future Perspectives of Vaginal Microbiota Transplantation. Microorganisms, 11.","DOI":"10.20944\/preprints202305.0258.v1"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1093\/infdis\/jiad142","article-title":"Bacterial Vaginosis and Spontaneous Clearance of Chlamydia trachomatis in the Longitudinal Study of Vaginal Flora","volume":"228","author":"Brown","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.jgg.2021.03.019","article-title":"Cervicovaginal microbiome dynamics after taking oral probiotics","volume":"48","author":"Chen","year":"2021","journal-title":"J. Genet. Genom."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"127787","DOI":"10.1016\/j.micres.2024.127787","article-title":"The microbial revolution: Unveiling the benefits of vaginal probiotics and prebiotics","volume":"286","author":"Pagar","year":"2024","journal-title":"Microbiol. Res."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Morselli, S., Ceccarani, C., Djusse, M.E., Laghi, L., Camboni, T., Consolandi, C., Foschi, C., Severgnini, M., and Marangoni, A. (2024). Anti-chlamydial activity of vaginal fluids: New evidence from an in vitro model. Front. Cell. Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1403782"},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Barrientos-Dur\u00e1n, A., Fuentes-L\u00f3pez, A., de Salazar, A., Plaza-D\u00edaz, J., and Garc\u00eda, F. (2020). Reviewing the Composition of Vaginal Microbiota: Inclusion of Nutrition and Probiotic Factors in the Maintenance of Eubiosis. Nutrients, 12.","DOI":"10.3390\/nu12020419"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"101037","DOI":"10.1016\/j.lanmic.2024.101037","article-title":"Effect of the vaginal live biotherapeutic LACTIN-V (Lactobacillus crispatus CTV-05) on vaginal microbiota and genital tract inflammation among women at high risk of HIV acquisition in South Africa: A phase 2, randomised, placebo-controlled trial","volume":"6","author":"Hemmerling","year":"2025","journal-title":"Lancet Microbe"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"e01548-19","DOI":"10.1128\/mBio.01548-19","article-title":"The Cervicovaginal Microbiota-Host Interaction Modulates Chlamydia trachomatis Infection","volume":"10","author":"Edwards","year":"2019","journal-title":"mBio"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"R81","DOI":"10.1530\/JME-21-0238","article-title":"Female reproductive dysfunctions and the gut microbiota","volume":"69","author":"Chadchan","year":"2022","journal-title":"J. Mol. Endocrinol."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Quaranta, G., Sanguinetti, M., and Masucci, L. (2019). Fecal Microbiota Transplantation: A Potential Tool for Treatment of Human Female Reproductive Tract Diseases. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.02653"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Ansari, A., Son, D., Hur, Y.M., Park, S., You, Y.A., Kim, S.M., Lee, G., Kang, S., Chung, Y., and Lim, S. (2023). Lactobacillus Probiotics Improve Vaginal Dysbiosis in Asymptomatic Women. Nutrients, 15.","DOI":"10.3390\/nu15081862"},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Romeo, M., D\u2019Urso, F., Ciccarese, G., Di Gaudio, F., and Broccolo, F. (2024). Exploring Oral and Vaginal Probiotic Solutions for Women\u2019s Health from Puberty to Menopause: A Narrative Review. Microorganisms, 12.","DOI":"10.3390\/microorganisms12081614"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"720","DOI":"10.62347\/IGWR5474","article-title":"Lactobacillus as probiotics: Opportunities and challenges for potential benefits in female reproductive health","volume":"16","author":"Vidhate","year":"2024","journal-title":"Am. J. Transl. Res."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s00404-024-07611-1","article-title":"The effectiveness of vaginal microbiota transplantation for vaginal dysbiosis and bacterial vaginosis: A scoping review","volume":"310","author":"Luo","year":"2024","journal-title":"Arch. Gynecol. Obs."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"106277","DOI":"10.1016\/j.ijantimicag.2021.106277","article-title":"Dysbiosis of the rat vagina is efficiently rescued by vaginal microbiota transplantation or probiotic combination","volume":"57","author":"Chen","year":"2021","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_122","first-page":"101189","article-title":"Boosting vaccine effectiveness: The groundbreaking role of probiotics","volume":"16","author":"Abavisani","year":"2024","journal-title":"J. Agric. Food Res."},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Ciabattini, A., Olivieri, R., Lazzeri, E., and Medaglini, D. (2019). Role of the Microbiota in the Modulation of Vaccine Immune Responses. Front. Microbiol., 10.","DOI":"10.3389\/fmicb.2019.01305"},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Inic-Kanada, A., Stojanovic, M., Marinkovic, E., Becker, E., Stein, E., Lukic, I., Djokic, R., Schuerer, N., Hegemann, J.H., and Barisani-Asenbauer, T. (2016). A Probiotic Adjuvant Lactobacillus rhamnosus Enhances Specific Immune Responses after Ocular Mucosal Immunization with Chlamydial Polymorphic Membrane Protein C. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0157875"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s40168-024-01828-7","article-title":"Vaginal Lactobacillus crispatus persistence following application of a live biotherapeutic product: Colonization phenotypes and genital immune impact","volume":"12","author":"Armstrong","year":"2024","journal-title":"Microbiome"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/21\/10635\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:25:02Z","timestamp":1762176302000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/21\/10635"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":125,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["ijms262110635"],"URL":"https:\/\/doi.org\/10.3390\/ijms262110635","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}