Pub Date : 2026-02-01Epub Date: 2026-01-09DOI: 10.1152/ajpheart.00646.2025
Anna Quarder, Khaoula Talbi, Hannah Bartmann, Esther Beuke, Constantin von Kaisenberg, Manuel M Vicente, Sara Todorovic, Anette Melk
Sex differences in cardiovascular disease are well documented, with females often considered hormonally protected. However, some differences persist even after menopause, indicating nonhormonal influences. Endothelial dysfunction is an early contributor to cardiovascular disease, with endothelial cell senescence playing a key role. Senescence, an irreversible cell cycle arrest, can be replicative or stress-induced. This study investigates whether sex differences in endothelial senescence exist independent of hormonal influence and vary by stimulus. Senescence was induced by replication or irradiation in female and male human umbilical vein endothelial cells (HUVECs) (up to n = 7 each) cultured under hormone-free conditions. Senescence-associated β-galactosidase (SA-β-Gal) staining; telomere length; quantitative real-time PCR (RT-qPCR) of p21, p14, p16; and crystal violet assays were used to assess senescence. Replicative senescence was analyzed across passages 1-20 and stress-induced senescence 5 days after irradiation. Female HUVECs had a significantly longer replicative lifespan than male cells (P = 0.0012) despite similar proliferation. Telomere attrition occurred faster in male cells (P = 0.0034), with earlier expression of senescence markers. In contrast, after irradiation, female cells exhibited stronger senescence responses, including increased SA-β-Gal staining and elevated p21, p14, and p16 levels. This study identifies sex differences in endothelial cell senescence under hormone-free conditions, pointing to intrinsic cellular factors. Although male cells exhibited earlier senescence under replicative stress, female cells were more vulnerable to stress-induced senescence. Together, these results highlight the importance of sex- and stimulus-specific mechanisms in vascular aging.NEW & NOTEWORTHY This study reveals intrinsic, hormone-independent sex differences in endothelial cell senescence. Female HUVECs exhibit delayed replicative but enhanced stress-induced senescence compared with male cells. These opposing responses highlight that sex-specific mechanisms in vascular aging depend on the type of senescence stimulus. By using hormone-free conditions, the study underscores the importance of intrinsic cellular factors in endothelial biology and suggests that sex should be considered when investigating and targeting vascular aging and disease.
{"title":"Sex and stimulus-specific differences in endothelial cell senescence under hormone-free conditions.","authors":"Anna Quarder, Khaoula Talbi, Hannah Bartmann, Esther Beuke, Constantin von Kaisenberg, Manuel M Vicente, Sara Todorovic, Anette Melk","doi":"10.1152/ajpheart.00646.2025","DOIUrl":"10.1152/ajpheart.00646.2025","url":null,"abstract":"<p><p>Sex differences in cardiovascular disease are well documented, with females often considered hormonally protected. However, some differences persist even after menopause, indicating nonhormonal influences. Endothelial dysfunction is an early contributor to cardiovascular disease, with endothelial cell senescence playing a key role. Senescence, an irreversible cell cycle arrest, can be replicative or stress-induced. This study investigates whether sex differences in endothelial senescence exist independent of hormonal influence and vary by stimulus. Senescence was induced by replication or irradiation in female and male human umbilical vein endothelial cells (HUVECs) (up to <i>n</i> = 7 each) cultured under hormone-free conditions. Senescence-associated β-galactosidase (SA-β-Gal) staining; telomere length; quantitative real-time PCR (RT-qPCR) of <i>p21</i>, <i>p14</i>, <i>p16</i>; and crystal violet assays were used to assess senescence. Replicative senescence was analyzed across <i>passages 1-20</i> and stress-induced senescence 5 days after irradiation. Female HUVECs had a significantly longer replicative lifespan than male cells (<i>P</i> = 0.0012) despite similar proliferation. Telomere attrition occurred faster in male cells (<i>P</i> = 0.0034), with earlier expression of senescence markers. In contrast, after irradiation, female cells exhibited stronger senescence responses, including increased SA-β-Gal staining and elevated <i>p21</i>, <i>p14</i>, and <i>p16</i> levels. This study identifies sex differences in endothelial cell senescence under hormone-free conditions, pointing to intrinsic cellular factors. Although male cells exhibited earlier senescence under replicative stress, female cells were more vulnerable to stress-induced senescence. Together, these results highlight the importance of sex- and stimulus-specific mechanisms in vascular aging.<b>NEW & NOTEWORTHY</b> This study reveals intrinsic, hormone-independent sex differences in endothelial cell senescence. Female HUVECs exhibit delayed replicative but enhanced stress-induced senescence compared with male cells. These opposing responses highlight that sex-specific mechanisms in vascular aging depend on the type of senescence stimulus. By using hormone-free conditions, the study underscores the importance of intrinsic cellular factors in endothelial biology and suggests that sex should be considered when investigating and targeting vascular aging and disease.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H515-H523"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145942020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-31DOI: 10.1152/ajpheart.00976.2025
Mostafa Sabouri, Lunden Friberg, Daniel R Machin
{"title":"Changing beats: new insights from wearable health monitors using sleep and lifestyle factors.","authors":"Mostafa Sabouri, Lunden Friberg, Daniel R Machin","doi":"10.1152/ajpheart.00976.2025","DOIUrl":"10.1152/ajpheart.00976.2025","url":null,"abstract":"","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H497-H498"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-14DOI: 10.1152/ajpheart.00522.2025
Elisabeth Mellott, Desmond Moronge, Gibson Cooper, Kristin Backer, Gabrielle Connor, Mona Elgazzaz, Safia Ogbi, Jessica L Faulkner
Preeclampsia induces adverse cardiovascular outcomes for both mother and offspring. We established a novel leptin-induced mouse model of preeclampsia that induces hypertension, endothelial dysfunction, and fetal growth restriction, which are collectively ablated by endothelial cell mineralocorticoid receptor (MR) deletion. However, literature lacks preclinical evidence to use MR antagonism for preeclamptic patients. We hypothesize that eplerenone improves blood pressure, vascular function, and fetal outcomes in leptin-infused pregnant mice. We infused timed-pregnant Balb/c mice with saline (sham) or leptin via subcutaneous osmotic minipump and administered vehicle or eplerenone from gestation day (GD) 11-18 and GD15-18. We measured mean arterial blood pressure (BP) via radiotelemetry, vascular function in second-order mesenteric arteries by wire myography, and pup/placental weights on GD18. Eplerenone from GD11-18 ablated leptin-induced increases in BP but independently decreased fetal weight and placental efficiency. Eplerenone increased vascular contractility to phenylephrine and increased mRNA expression of NADPH oxidase (NOX) 1 and 2 in the placentas of pregnant mice in the GD11-18 cohort. We observed in our GD15-18 cohort that eplerenone no longer decreased fetal weight or placental efficiency and there was no increase in contractility to phenylephrine. In conclusion, our data suggest that although eplerenone improves leptin-induced hypertension in pregnant mice, eplerenone reduces fetal weight when administered at mid-, but not late-, gestation in pregnant mice.NEW & NOTEWORTHY There are limited advances in the treatment for preeclampsia. Leptin induces preeclampsia dependent on mineralocorticoid receptor (MR) activation; however, there is little preclinical data on the use of MR antagonists in hypertensive pregnancy. When administered at midgestation in hypertensive mouse pregnancy, eplerenone lowers blood pressure, but increases vasoconstriction in mesenteric arteries and reduces fetal growth. When administered later in pregnancy, eplerenone no longer restricts fetal growth or increases vasoconstriction.
{"title":"Eplerenone lowers maternal blood pressure in a model of leptin-induced preeclampsia, but decreases fetal growth when administered mid-, but not late-, gestation.","authors":"Elisabeth Mellott, Desmond Moronge, Gibson Cooper, Kristin Backer, Gabrielle Connor, Mona Elgazzaz, Safia Ogbi, Jessica L Faulkner","doi":"10.1152/ajpheart.00522.2025","DOIUrl":"10.1152/ajpheart.00522.2025","url":null,"abstract":"<p><p>Preeclampsia induces adverse cardiovascular outcomes for both mother and offspring. We established a novel leptin-induced mouse model of preeclampsia that induces hypertension, endothelial dysfunction, and fetal growth restriction, which are collectively ablated by endothelial cell mineralocorticoid receptor (MR) deletion. However, literature lacks preclinical evidence to use MR antagonism for preeclamptic patients. We hypothesize that eplerenone improves blood pressure, vascular function, and fetal outcomes in leptin-infused pregnant mice. We infused timed-pregnant Balb/c mice with saline (sham) or leptin via subcutaneous osmotic minipump and administered vehicle or eplerenone from gestation day (GD) 11-18 and GD15-18. We measured mean arterial blood pressure (BP) via radiotelemetry, vascular function in second-order mesenteric arteries by wire myography, and pup/placental weights on GD18. Eplerenone from GD11-18 ablated leptin-induced increases in BP but independently decreased fetal weight and placental efficiency. Eplerenone increased vascular contractility to phenylephrine and increased mRNA expression of NADPH oxidase (NOX) 1 and 2 in the placentas of pregnant mice in the GD11-18 cohort. We observed in our GD15-18 cohort that eplerenone no longer decreased fetal weight or placental efficiency and there was no increase in contractility to phenylephrine. In conclusion, our data suggest that although eplerenone improves leptin-induced hypertension in pregnant mice, eplerenone reduces fetal weight when administered at mid-, but not late-, gestation in pregnant mice.<b>NEW & NOTEWORTHY</b> There are limited advances in the treatment for preeclampsia. Leptin induces preeclampsia dependent on mineralocorticoid receptor (MR) activation; however, there is little preclinical data on the use of MR antagonists in hypertensive pregnancy. When administered at midgestation in hypertensive mouse pregnancy, eplerenone lowers blood pressure, but increases vasoconstriction in mesenteric arteries and reduces fetal growth. When administered later in pregnancy, eplerenone no longer restricts fetal growth or increases vasoconstriction.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H581-H593"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-19DOI: 10.1152/ajpheart.00950.2025
Yifang Yuan, Joao A C Lima, David Herrington, James D Thomas, R Brandon Stacey, David Zhao, Mario Garcia, Min Pu
Left ventricular (LV) flow state is associated with unfavorable outcome in patient with severe aortic stenosis. However, there is little information on its impact on long-term prognosis in a population without valvular disease. To examine the impact of low-flow state (LFS) on all-cause mortality in multiethnic population, we analyzed 4,398 asymptomatic participants without clinical cardiovascular disease undergoing cardiac magnetic resonance (CMR) in the multiethnic study of atherosclerosis. LV stroke volume index (SVi), LV ejection fraction (LVEF), and myocardial contraction fraction (MCF) were measured. LV flow states were classified as normal flow state (NFS: SVi > 35 mL/m2), low-flow state (LFS, 30-34 mL/m2), and very low-flow state (VLFS: SVi < 30 mL/m2). Clinical data were collected at enrollment. Participants were followed up for a median of 14.2 yr. All-cause and cardiovascular disease mortalities were used as primary endpoints. All-cause mortality was 16.2%, and cardiovascular disease mortality was 3.5%. VLFS and LFS groups had more cardiovascular risk factors and lower cardiac performance than NFS. The relationship between all-cause mortality and SVi was "L-shape" with the "breakpoint" at 33.5 mL/m2 for a statistical significance (P = 0.009). All-cause mortality was significantly associated with LFS after adjusted for age, sex, LVEF, and LV mass index with hazard ratio (HR) 1.81, 95% confidence interval (CI): 1.31-2.49 for VLF and HR: 1.21, 95% CI: 0.95-1.54 for LFS with overall P value 0.001. The highest cardiovascular disease mortality was seen in VLFS. LFS was significantly associated with increased all-cause mortality despite normal LVEF and no valvular disease.NEW & NOTEWORTHY This is the first study demonstrating that low-flow state (LFS) has a significant impact on mortality in multiethnic study of atherosclerosis (MESA) participants with no valvular disease. The study may have a clinical implication since LFS is commonly present in multiethnic population. The current study provides new information on clinical characteristics and myocardial performance of LFS suggesting that further prospective studies to determine whether targeting modifiable risk factors for cardiovascular disease and metabolic syndrome would have any favorable impact on LFS.
严重主动脉瓣狭窄患者左室血流状态与不良预后相关。然而,在没有瓣膜疾病的人群中,很少有关于其对长期预后影响的信息。为了研究LFS对多种族人群全因死亡率的影响,我们分析了4398名无临床心血管疾病的无症状参与者,他们在多种族动脉粥样硬化研究中接受了心脏磁共振(CMR)检查。测量左室脑卒中容积指数(SVi)、LVEF和心肌收缩分数(MCF)。LV流量状态分为正常流量状态(NFS, SVi >35 ml/m2),低流量状态(LFS, 30-34 ml/m2)和极低流量状态(VLFS: SVi 2)。临床资料在入组时收集。参与者的随访时间中位数为14.2年。全因死亡率和心血管疾病死亡率被用作主要终点。全因死亡率为16.2%,心血管疾病死亡率为3.5%。与NFS组相比,VLFS组和LFS组有更多的心血管危险因素和更低的心脏性能。全因死亡率与SVi呈“l”型关系,断点为33.5ml/m2,差异有统计学意义(p=0.009)。经年龄、性别、LVEF和LV质量指数校正后,全因死亡率与LFS显著相关,VLF的风险比(HR)为1.81,95% CI为1.31-2.49,LFS的风险比(HR)为1.21,95% CI为0.95-1.54,总p值为0.001)。VLFS患者心血管疾病死亡率最高。
{"title":"Assessment of impact of low-flow state on long-term outcome in multiethnic population using cardiac magnetic resonance.","authors":"Yifang Yuan, Joao A C Lima, David Herrington, James D Thomas, R Brandon Stacey, David Zhao, Mario Garcia, Min Pu","doi":"10.1152/ajpheart.00950.2025","DOIUrl":"10.1152/ajpheart.00950.2025","url":null,"abstract":"<p><p>Left ventricular (LV) flow state is associated with unfavorable outcome in patient with severe aortic stenosis. However, there is little information on its impact on long-term prognosis in a population without valvular disease. To examine the impact of low-flow state (LFS) on all-cause mortality in multiethnic population, we analyzed 4,398 asymptomatic participants without clinical cardiovascular disease undergoing cardiac magnetic resonance (CMR) in the multiethnic study of atherosclerosis. LV stroke volume index (SVi), LV ejection fraction (LVEF), and myocardial contraction fraction (MCF) were measured. LV flow states were classified as normal flow state (NFS: SVi > 35 mL/m<sup>2</sup>), low-flow state (LFS, 30-34 mL/m<sup>2</sup>), and very low-flow state (VLFS: SVi < 30 mL/m<sup>2</sup>). Clinical data were collected at enrollment. Participants were followed up for a median of 14.2 yr. All-cause and cardiovascular disease mortalities were used as primary endpoints. All-cause mortality was 16.2%, and cardiovascular disease mortality was 3.5%. VLFS and LFS groups had more cardiovascular risk factors and lower cardiac performance than NFS. The relationship between all-cause mortality and SVi was \"L-shape\" with the \"breakpoint\" at 33.5 mL/m<sup>2</sup> for a statistical significance (<i>P</i> = 0.009). All-cause mortality was significantly associated with LFS after adjusted for age, sex, LVEF, and LV mass index with hazard ratio (HR) 1.81, 95% confidence interval (CI): 1.31-2.49 for VLF and HR: 1.21, 95% CI: 0.95-1.54 for LFS with overall <i>P</i> value 0.001. The highest cardiovascular disease mortality was seen in VLFS. LFS was significantly associated with increased all-cause mortality despite normal LVEF and no valvular disease.<b>NEW & NOTEWORTHY</b> This is the first study demonstrating that low-flow state (LFS) has a significant impact on mortality in multiethnic study of atherosclerosis (MESA) participants with no valvular disease. The study may have a clinical implication since LFS is commonly present in multiethnic population. The current study provides new information on clinical characteristics and myocardial performance of LFS suggesting that further prospective studies to determine whether targeting modifiable risk factors for cardiovascular disease and metabolic syndrome would have any favorable impact on LFS.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H642-H647"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-14DOI: 10.1152/ajpheart.00891.2025
Hiroe Toba, Ganesh V Halade, Kristine Y DeLeon-Pennell, Ying Ann Chiao, Andriy Yabluchanskiy, Signe Holm Nielsen, Upendra Chalise, Mediha Becirovic-Agic, Lisandra E de Castro Braz, Merry L Lindsey
Wound healing after myocardial infarction (MI) is a dynamic and multifaceted process that links the molecular alterations induced by or in response to prolonged ischemia with structural and physiological changes to the damaged myocardium. Changes, at the tissue level, are driven by a complex intersection of cellular and molecular mechanisms that operate along a classic wound healing paradigm as an attempt to repair the damaged myocardium and restore cardiac physiology. Maladaptive healing prevents a return to the original homeostasis, rather yielding a myocardium reset to a new homeostatic status that can lead to heart failure due to compromised contractility, increased chamber dilation, and cardiac fibrosis or due to sudden cardiac death resulting from arrhythmias. This review summarizes our current knowledge of how key inflammatory drivers in the myocardium (cardiomyocytes, neutrophils, monocytes/macrophages, fibroblasts, and vascular endothelial cells) respond to molecular signals including cytokines, growth factors, and proteases to coordinate the wound healing process in the mouse model of MI. We also identify knowledge gaps that remain in our understanding of cardiac remodeling that are opportunities for future examinations.
{"title":"Cellular and molecular signals of cardiac wound healing after myocardial infarction.","authors":"Hiroe Toba, Ganesh V Halade, Kristine Y DeLeon-Pennell, Ying Ann Chiao, Andriy Yabluchanskiy, Signe Holm Nielsen, Upendra Chalise, Mediha Becirovic-Agic, Lisandra E de Castro Braz, Merry L Lindsey","doi":"10.1152/ajpheart.00891.2025","DOIUrl":"10.1152/ajpheart.00891.2025","url":null,"abstract":"<p><p>Wound healing after myocardial infarction (MI) is a dynamic and multifaceted process that links the molecular alterations induced by or in response to prolonged ischemia with structural and physiological changes to the damaged myocardium. Changes, at the tissue level, are driven by a complex intersection of cellular and molecular mechanisms that operate along a classic wound healing paradigm as an attempt to repair the damaged myocardium and restore cardiac physiology. Maladaptive healing prevents a return to the original homeostasis, rather yielding a myocardium reset to a new homeostatic status that can lead to heart failure due to compromised contractility, increased chamber dilation, and cardiac fibrosis or due to sudden cardiac death resulting from arrhythmias. This review summarizes our current knowledge of how key inflammatory drivers in the myocardium (cardiomyocytes, neutrophils, monocytes/macrophages, fibroblasts, and vascular endothelial cells) respond to molecular signals including cytokines, growth factors, and proteases to coordinate the wound healing process in the mouse model of MI. We also identify knowledge gaps that remain in our understanding of cardiac remodeling that are opportunities for future examinations.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H594-H609"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-05DOI: 10.1152/ajpheart.00774.2025
Xiaohai Zhou, Zhe Yu, Zeyu Chen, Sylvia M Evans, Ju Chen
Accumulating evidence from human clinical cohorts and animal models indicates that DNA damage plays a pivotal role in the initiation, progression, and severity of cardiomyopathy subtypes. Cardiomyocytes are exposed to continuous mechanical stress due to persistent contractile activity, and this stress is transduced to the nucleus, rendering CMs vulnerable to mechano-transduced DNA damage. CMs are also vulnerable to oxidative stress-induced DNA damage. The DNA damage response (DDR) constitutes a cellular program that integrates lesion sensors, signal transducers, downstream effectors, and repair machineries, thereby governing cell cycle progression and other cell fate decisions. DDR responses have been studied in proliferating cells, whereas adult CMs are withdrawn from the cell cycle, suggesting distinct DDR mechanisms and outcomes may occur in CMs. Although transient DDR activation helps preserve genomic stability in CMs, sustained activation contributes to maladaptive cardiac remodeling, functional decline, and disease progression. Several key DDR components have been identified as potential therapeutic targets, with their inhibition demonstrating cardioprotective effects in various cardiomyopathy models. Moreover, a growing number of novel pathways have emerged as promising avenues for targeting DNA damage and repair signaling in cardiomyopathy. In this review, we discussed molecular mechanisms by which DNA damage and DDR contribute to the onset and progression of cardiomyopathy, and highlight emerging therapeutic strategies aimed at modulating DNA damage and repair pathways to improve cardiac function and clinical outcomes. Understanding how these pathways intersect with cardiomyocyte biology will be essential for translating bench discoveries into durable therapies for patients with cardiomyopathy and heart failure.
{"title":"DNA damage and repair in cardiomyopathy: mechanisms and therapeutic opportunities.","authors":"Xiaohai Zhou, Zhe Yu, Zeyu Chen, Sylvia M Evans, Ju Chen","doi":"10.1152/ajpheart.00774.2025","DOIUrl":"10.1152/ajpheart.00774.2025","url":null,"abstract":"<p><p>Accumulating evidence from human clinical cohorts and animal models indicates that DNA damage plays a pivotal role in the initiation, progression, and severity of cardiomyopathy subtypes. Cardiomyocytes are exposed to continuous mechanical stress due to persistent contractile activity, and this stress is transduced to the nucleus, rendering CMs vulnerable to mechano-transduced DNA damage. CMs are also vulnerable to oxidative stress-induced DNA damage. The DNA damage response (DDR) constitutes a cellular program that integrates lesion sensors, signal transducers, downstream effectors, and repair machineries, thereby governing cell cycle progression and other cell fate decisions. DDR responses have been studied in proliferating cells, whereas adult CMs are withdrawn from the cell cycle, suggesting distinct DDR mechanisms and outcomes may occur in CMs. Although transient DDR activation helps preserve genomic stability in CMs, sustained activation contributes to maladaptive cardiac remodeling, functional decline, and disease progression. Several key DDR components have been identified as potential therapeutic targets, with their inhibition demonstrating cardioprotective effects in various cardiomyopathy models. Moreover, a growing number of novel pathways have emerged as promising avenues for targeting DNA damage and repair signaling in cardiomyopathy. In this review, we discussed molecular mechanisms by which DNA damage and DDR contribute to the onset and progression of cardiomyopathy, and highlight emerging therapeutic strategies aimed at modulating DNA damage and repair pathways to improve cardiac function and clinical outcomes. Understanding how these pathways intersect with cardiomyocyte biology will be essential for translating bench discoveries into durable therapies for patients with cardiomyopathy and heart failure.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H370-H387"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-24DOI: 10.1152/ajpheart.00863.2025
Mostafa Sabouri, Xiangyu Zheng, Bryan J Irwin, Zhuoxin Li, Jennifer Berg Sen, Joseph Bernardo, Daniel R Machin
Inbred C57BL/6 mice are the most widely used laboratory mice in biomedical research. There are two C57BL/6 substrains, C57BL/6J and C57BL/6N, that are often used interchangeably incorrectly. We sought to examine vascular function in C57BL/6J and C57BL/6N mice. We observed lower systolic blood pressure and aortic stiffness in C57BL/6N versus C57BL/6J mice. Although acetylcholine-mediated vasodilation was similar between C57BL/6 substrains, flow-mediated vasodilation was greater in C57BL/6N versus C57BL/6J mice. Aortic structural characteristics were also similar between C57BL/6 substrains. These findings indicate distinct differences in vascular function between C57BL/6 substrains, indicating greater vascular function in C57BL/6N mice. To determine the effect of inbreeding on vascular function in C57BL/6J or C57BL/6N mice, we also measured vascular function in UM-HET3 mice, an outbred genetically diverse strain derived from the C57BL/6 strain. In general, UM-HET3 mice had greater vascular function than either C57BL/6 substrain, demonstrated by lower aortic stiffness, aortic medial cross-sectional area, and aortic collagen content and greater aortic elastin content, acetylcholine-mediated vasodilation, and flow-mediated vasodilation. Notably, systolic blood pressure in C57BL/6N mice was also lower than UM-HET3 mice, whereas aortic elastin content and flow-mediated vasodilation were similar between C57BL/6N and UM-HET3 mice. Importantly, greater vascular function in UM-HET3 mice was not accompanied by greater measurement variability, as coefficient of variation across all measurements was similar between strains. These findings suggest that the greater vascular function in UM-HET3 mice does not come at the expense of measurement variability, making them a viable alternative to inbred mice in biomedical research.NEW & NOTEWORTHY We observed major vascular physiological differences between C57BL/6J and C57BL/6N mice, indicating C57BL/6N mice have greater vascular function. However, in comparison to either C57BL/6 substrain, outbred, genetically diverse UM-HET3 mice have a greater vascular function characterized by lower aortic stiffness and greater endothelial-dependent dilation. A greater vascular function in UM-HET3 mice was not accompanied by more measurement variability, as coefficient of variation across measurements was similar between strains.
{"title":"Inbred C57BL/6J and C57BL/6N mice exhibit differential vascular dysfunction compared with outbred UM-HET3 mice.","authors":"Mostafa Sabouri, Xiangyu Zheng, Bryan J Irwin, Zhuoxin Li, Jennifer Berg Sen, Joseph Bernardo, Daniel R Machin","doi":"10.1152/ajpheart.00863.2025","DOIUrl":"10.1152/ajpheart.00863.2025","url":null,"abstract":"<p><p>Inbred C57BL/6 mice are the most widely used laboratory mice in biomedical research. There are two C57BL/6 substrains, C57BL/6J and C57BL/6N, that are often used interchangeably incorrectly. We sought to examine vascular function in C57BL/6J and C57BL/6N mice. We observed lower systolic blood pressure and aortic stiffness in C57BL/6N versus C57BL/6J mice. Although acetylcholine-mediated vasodilation was similar between C57BL/6 substrains, flow-mediated vasodilation was greater in C57BL/6N versus C57BL/6J mice. Aortic structural characteristics were also similar between C57BL/6 substrains. These findings indicate distinct differences in vascular function between C57BL/6 substrains, indicating greater vascular function in C57BL/6N mice. To determine the effect of inbreeding on vascular function in C57BL/6J or C57BL/6N mice, we also measured vascular function in UM-HET3 mice, an outbred genetically diverse strain derived from the C57BL/6 strain. In general, UM-HET3 mice had greater vascular function than either C57BL/6 substrain, demonstrated by lower aortic stiffness, aortic medial cross-sectional area, and aortic collagen content and greater aortic elastin content, acetylcholine-mediated vasodilation, and flow-mediated vasodilation. Notably, systolic blood pressure in C57BL/6N mice was also lower than UM-HET3 mice, whereas aortic elastin content and flow-mediated vasodilation were similar between C57BL/6N and UM-HET3 mice. Importantly, greater vascular function in UM-HET3 mice was not accompanied by greater measurement variability, as coefficient of variation across all measurements was similar between strains. These findings suggest that the greater vascular function in UM-HET3 mice does not come at the expense of measurement variability, making them a viable alternative to inbred mice in biomedical research.<b>NEW & NOTEWORTHY</b> We observed major vascular physiological differences between C57BL/6J and C57BL/6N mice, indicating C57BL/6N mice have greater vascular function. However, in comparison to either C57BL/6 substrain, outbred, genetically diverse UM-HET3 mice have a greater vascular function characterized by lower aortic stiffness and greater endothelial-dependent dilation. A greater vascular function in UM-HET3 mice was not accompanied by more measurement variability, as coefficient of variation across measurements was similar between strains.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H406-H414"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145817445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-30DOI: 10.1152/ajpheart.00832.2025
Merry L Lindsey, Emily I Chen, Pushkar Shivam, Pius N Nde, David Horn, Santosh Renuse, Amirmansoor Hakimi, B Timothy Baxter, Michael Terrin, Jon S Matsumura, Amadou Gaye, John A Curci
The use of comprehensive unbiased proteomic evaluations coupled with physiological and clinical insight offers the possibility to enhance our understanding of disease mechanisms and identify potential biomarkers for diagnosis and prognosis of cardiovascular disease. In this methods and resources article, we present the methodologies used for a workflow leveraging a high-throughput, large-scale mass spectrometry-based technology for label-free quantitative proteomic profiling coupled with physiological and clinical assessment. Using this approach, we analyzed a total of 505 plasma samples at baseline and 1- and 2-yr follow-up from patients enrolled in the Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial. We successfully identified a dataset comprising over 1,000 distinct proteins. Collecting samples longitudinally provides built-in validation, allowing for direct comparisons within the same patient over time. We provide a comprehensive collection and analytical data plan tailored for such a large dataset, which encompasses data acceptance criteria, integrity checks, and database validation. We also provide methods on statistical testing, temporal cross validation, and biological and clinical validation. This resource outlines a template for similar experiments and development of a robust statistical analysis plan that will limit false positive and false negative identifications to focus on true protein changes that may serve as diagnostic or prognostic indicators.NEW & NOTEWORTHY We describe methods for developing a high-throughput, label-free quantitative proteomics workflow integrated with physiological and clinical assessments to investigate cardiovascular disease mechanisms and identify potential biomarkers. This resource outlines a validated, longitudinal plasma proteomics pipeline-including data quality controls, statistical testing, and biological validation-applied to over 500 samples from the N-TA3CT trial, offering a reproducible framework for future biomarker discovery studies.
{"title":"Comprehensive evaluation of plasma biomarkers in patients with abdominal aortic aneurysm using high-throughput, label-free quantitative proteomic profiling.","authors":"Merry L Lindsey, Emily I Chen, Pushkar Shivam, Pius N Nde, David Horn, Santosh Renuse, Amirmansoor Hakimi, B Timothy Baxter, Michael Terrin, Jon S Matsumura, Amadou Gaye, John A Curci","doi":"10.1152/ajpheart.00832.2025","DOIUrl":"10.1152/ajpheart.00832.2025","url":null,"abstract":"<p><p>The use of comprehensive unbiased proteomic evaluations coupled with physiological and clinical insight offers the possibility to enhance our understanding of disease mechanisms and identify potential biomarkers for diagnosis and prognosis of cardiovascular disease. In this methods and resources article, we present the methodologies used for a workflow leveraging a high-throughput, large-scale mass spectrometry-based technology for label-free quantitative proteomic profiling coupled with physiological and clinical assessment. Using this approach, we analyzed a total of 505 plasma samples at baseline and 1- and 2-yr follow-up from patients enrolled in the Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial. We successfully identified a dataset comprising over 1,000 distinct proteins. Collecting samples longitudinally provides built-in validation, allowing for direct comparisons within the same patient over time. We provide a comprehensive collection and analytical data plan tailored for such a large dataset, which encompasses data acceptance criteria, integrity checks, and database validation. We also provide methods on statistical testing, temporal cross validation, and biological and clinical validation. This resource outlines a template for similar experiments and development of a robust statistical analysis plan that will limit false positive and false negative identifications to focus on true protein changes that may serve as diagnostic or prognostic indicators.<b>NEW & NOTEWORTHY</b> We describe methods for developing a high-throughput, label-free quantitative proteomics workflow integrated with physiological and clinical assessments to investigate cardiovascular disease mechanisms and identify potential biomarkers. This resource outlines a validated, longitudinal plasma proteomics pipeline-including data quality controls, statistical testing, and biological validation-applied to over 500 samples from the N-TA<sup>3</sup>CT trial, offering a reproducible framework for future biomarker discovery studies.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H000"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-24DOI: 10.1152/ajpheart.00759.2025
Eleonora Solari, Cristiana Marcozzi, Daniela Negrini, Andrea Moriondo
The present study investigates the impact of intraluminal valves on lymph transport in rat diaphragmatic collecting vessels, with the aim of clarifying their role in intrinsically driven lymph flow. Using ex vivo fluorescent microsphere tracking and micropuncture techniques, lymph flow, pressure gradients, and hydraulic resistance were quantified in valved and nonvalved segments. Key findings revealed that valves significantly increased lymph velocity (approximately 1,617 µm/s) through their narrower functional section (∼14.4% of vessel cross section) compared with nonvalved segments (∼210 µm/s). The presence of valves required higher pressure gradients (4.15 ± 0.57 cmH2O vs. 2.16 ± 0.27 cmH2O in nonvalved segments) but markedly increased net lymph flow (68.0 ± 4.2% vs. 45.7 ± 3.7% of forward flow across valved and nonvalved tracts, respectively) by limiting reverse movement even if biased toward an open state. Despite increasing hydraulic resistance, lymph flow remained laminar, and valves optimized net lymph progression, particularly in larger vessels, where the ratio of net flow to forward flow was independent of vessel size. These results quantify and highlight the pivotal role of intraluminal valves in facilitating efficient, unidirectional net lymph transport, even under low-pressure, oscillatory flow conditions, by adapting to the unique hydraulic properties of the diaphragmatic lymphatic network.NEW & NOTEWORTHY This work quantifies the effect that intraluminal valves exert onto the intrinsic lymph flow in an ex vivo preparation of rat diaphragm. By means of particle tracking analysis and intraluminal hydraulic pressure measurements, the added pressure gradient due to the valve, its functional section and the positive effect on net lymph flow have been carefully measured in a quasiphysiological state, revealing that the open-biased state of the valve is the key to net lymph progression.
本研究探讨了腔内瓣膜对大鼠膈集血管淋巴运输的影响,旨在阐明其在内在驱动淋巴流动中的作用。利用离体荧光微球跟踪和微穿刺技术,对有瓣和无瓣节段的淋巴流量、压力梯度和水力阻力进行量化。主要研究结果显示,与非瓣膜段(~210 μm/s)相比,瓣膜通过更窄的功能部分(约占血管横截面的14.4%)显著提高了淋巴速度(约1617 μm/s)。瓣膜的存在需要更高的压力梯度(无瓣膜段4.15±0.57 cmH2O vs. 2.16±0.27 cmH2O),但通过限制反向运动,即使倾向于开放状态,也显著增加净淋巴流量(有瓣膜和无瓣膜段的正向流量分别为68.0±4.2% vs. 45.7±3.7%)。尽管水力阻力增加,淋巴流动仍保持层流,阀门优化了净淋巴进展,特别是在较大的血管中,其中净流量与前流的比例与血管大小无关。这些结果量化并强调了腔内阀在促进高效、单向网状淋巴运输方面的关键作用,即使在低压、振荡流量条件下,通过适应膈淋巴网络的独特水力特性。
{"title":"The \"useful\" hindrance to flow: quantification of intraluminal valves effect on lymph flow driven by intrinsic mechanism in the diaphragmatic lymphatic network.","authors":"Eleonora Solari, Cristiana Marcozzi, Daniela Negrini, Andrea Moriondo","doi":"10.1152/ajpheart.00759.2025","DOIUrl":"10.1152/ajpheart.00759.2025","url":null,"abstract":"<p><p>The present study investigates the impact of intraluminal valves on lymph transport in rat diaphragmatic collecting vessels, with the aim of clarifying their role in intrinsically driven lymph flow. Using ex vivo fluorescent microsphere tracking and micropuncture techniques, lymph flow, pressure gradients, and hydraulic resistance were quantified in valved and nonvalved segments. Key findings revealed that valves significantly increased lymph velocity (approximately 1,617 µm/s) through their narrower functional section (∼14.4% of vessel cross section) compared with nonvalved segments (∼210 µm/s). The presence of valves required higher pressure gradients (4.15 ± 0.57 cmH<sub>2</sub>O vs. 2.16 ± 0.27 cmH<sub>2</sub>O in nonvalved segments) but markedly increased net lymph flow (68.0 ± 4.2% vs. 45.7 ± 3.7% of forward flow across valved and nonvalved tracts, respectively) by limiting reverse movement even if biased toward an open state. Despite increasing hydraulic resistance, lymph flow remained laminar, and valves optimized net lymph progression, particularly in larger vessels, where the ratio of net flow to forward flow was independent of vessel size. These results quantify and highlight the pivotal role of intraluminal valves in facilitating efficient, unidirectional net lymph transport, even under low-pressure, oscillatory flow conditions, by adapting to the unique hydraulic properties of the diaphragmatic lymphatic network.<b>NEW & NOTEWORTHY</b> This work quantifies the effect that intraluminal valves exert onto the intrinsic lymph flow in an ex vivo preparation of rat diaphragm. By means of particle tracking analysis and intraluminal hydraulic pressure measurements, the added pressure gradient due to the valve, its functional section and the positive effect on net lymph flow have been carefully measured in a quasiphysiological state, revealing that the open-biased state of the valve is the key to net lymph progression.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H388-H403"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145817454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-17DOI: 10.1152/ajpheart.00227.2025
Bence Hegyi, Logan R J Bailey, Juliana Mira Hernandez, Christopher Y Ko, Erin Y Shen, Julie Bossuyt, Jennifer M Davis, Donald M Bers
Heart failure (HF) with preserved ejection fraction (HFpEF) comprises heterogeneous clinical phenotypes and variable comorbidities. Recent two-hit translational animal models, including the hypertensive, nitrosative-stressed mice fed with high-fat diet and l-NG-nitroarginine methyl ester (HFD + l-NAME) and the obese-diabetic leptin receptor-deficient db/db mice with excess aldosterone (db/db + Aldo), may phenocopy select subgroups of HFpEF. We systematically compared mechanisms of excitation-contraction coupling (ECC), electrophysiology, and gene transcription in these preclinical HFpEF models and between sexes, including morphometry, echocardiography, cellular electrophysiology, intracellular Ca2+ imaging, and RNA-sequencing. The multiorgan HFpEF phenotype showed key differences between the two models: db/db + Aldo mice were markedly obese, had severe hyperglycemia and hepatomegaly, whereas male HFD + l-NAME mice had more pronounced cardiac hypertrophy. Diastolic dysfunction (quantified as echocardiographic E/e') was more severe in db/db + Aldo mice and worse in females, whereas females showed milder diastolic dysfunction in HFD + l-NAME. Marked proarrhythmic action potential (AP) changes (prolonged AP duration, increased short-term variability, and reduced alternans threshold) occurred in db/db + Aldo (in both sexes), whereas these AP changes were less severe in male HFD + l-NAME and absent in female HFD + l-NAME. In line with these findings, differential ionic current and Ca2+ handling changes occurred between these two HFpEF models and between sexes. RNA-sequencing revealed highly distinctive gene expression profiles between HFpEF models. We conclude that marked differences exist in cardiomyocyte ECC, electrophysiology, and gene expression between HFD + l-NAME and db/db + Aldo mice and between sexes. This indicates that a combination of translational HFpEF models that mimic select HFpEF sub-phenogroups are critical to better understand HFpEF mechanisms for therapeutic drug development.NEW & NOTEWORTHY Excitation-Ca2+ signaling-contraction coupling (ECC) mechanisms are fundamental to heart function. ECC mechanisms are differentially altered in murine models of heart failure with preserved ejection fraction (HFpEF) by dominant disease pathology and sex. Diastolic dysfunction is more pronounced in diabetic-obese HFpEF mice (worse in females) than in hypertensive-obese HFpEF mice (female sex is protective). Diabetic-obese mice and primarily hypertensive-obese HFpEF mice exhibit differential ECC alterations and largely distinctive transcription changes, providing mechanistic insights into HFpEF sub-phenogroups.
{"title":"Excitation-contraction coupling, cardiomyocyte electrophysiology, and transcriptome profiles in two HFpEF murine models: etiology and sex-dependent differences.","authors":"Bence Hegyi, Logan R J Bailey, Juliana Mira Hernandez, Christopher Y Ko, Erin Y Shen, Julie Bossuyt, Jennifer M Davis, Donald M Bers","doi":"10.1152/ajpheart.00227.2025","DOIUrl":"10.1152/ajpheart.00227.2025","url":null,"abstract":"<p><p>Heart failure (HF) with preserved ejection fraction (HFpEF) comprises heterogeneous clinical phenotypes and variable comorbidities. Recent two-hit translational animal models, including the hypertensive, nitrosative-stressed mice fed with high-fat diet and l-<i>N</i><sup>G</sup>-nitroarginine methyl ester (HFD + l-NAME) and the obese-diabetic leptin receptor-deficient <i>db/db</i> mice with excess aldosterone (<i>db/db</i> + Aldo), may phenocopy select subgroups of HFpEF. We systematically compared mechanisms of excitation-contraction coupling (ECC), electrophysiology, and gene transcription in these preclinical HFpEF models and between sexes, including morphometry, echocardiography, cellular electrophysiology, intracellular Ca<sup>2+</sup> imaging, and RNA-sequencing. The multiorgan HFpEF phenotype showed key differences between the two models: <i>db/db</i> + Aldo mice were markedly obese, had severe hyperglycemia and hepatomegaly, whereas male HFD + l-NAME mice had more pronounced cardiac hypertrophy. Diastolic dysfunction (quantified as echocardiographic <i>E/e</i>') was more severe in <i>db/db</i> + Aldo mice and worse in females, whereas females showed milder diastolic dysfunction in HFD + l-NAME. Marked proarrhythmic action potential (AP) changes (prolonged AP duration, increased short-term variability, and reduced alternans threshold) occurred in <i>db/db</i> + Aldo (in both sexes), whereas these AP changes were less severe in male HFD + l-NAME and absent in female HFD + l-NAME. In line with these findings, differential ionic current and Ca<sup>2+</sup> handling changes occurred between these two HFpEF models and between sexes. RNA-sequencing revealed highly distinctive gene expression profiles between HFpEF models. We conclude that marked differences exist in cardiomyocyte ECC, electrophysiology, and gene expression between HFD + l-NAME and <i>db/db</i> + Aldo mice and between sexes. This indicates that a combination of translational HFpEF models that mimic select HFpEF sub-phenogroups are critical to better understand HFpEF mechanisms for therapeutic drug development.<b>NEW & NOTEWORTHY</b> Excitation-Ca<sup>2+</sup> signaling-contraction coupling (ECC) mechanisms are fundamental to heart function. ECC mechanisms are differentially altered in murine models of heart failure with preserved ejection fraction (HFpEF) by dominant disease pathology and sex. Diastolic dysfunction is more pronounced in diabetic-obese HFpEF mice (worse in females) than in hypertensive-obese HFpEF mice (female sex is protective). Diabetic-obese mice and primarily hypertensive-obese HFpEF mice exhibit differential ECC alterations and largely distinctive transcription changes, providing mechanistic insights into HFpEF sub-phenogroups.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H348-H366"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}