Loading…

Aspirin Affects MDA-MB-231 Vesicle Production and Their Capacity to Induce Fibroblasts towards a Pro-Invasive State

Long-term administration of aspirin (ASA, acetylsalicylic acid) in oncogenic patients has been related to a reduction in cancer risk incidence, but its precise mechanism of action is unclear. The activation of cancer-associated fibroblasts (CAFs) is a key element in tumor progression and can be trig...

Full description

Saved in:
Bibliographic Details
Published in:International journal of molecular sciences 2023-07, Vol.24 (15), p.12020
Main Authors: Louback, Rafaela de Assiz, Martins-Cardoso, Karina, Tinoco, Luzineide W, Collino, Federica, de Barros, Ana Paula D N, Fortuna-Costa, Anneliese, Monteiro, Robson Q, Rossi, Maria Isabel Doria, Lindoso, Rafael Soares
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c439t-6cecaa926b13369fecda352cb3c545daff91cabdf40ac50cd55bb1754f01cdbf3
container_end_page
container_issue 15
container_start_page 12020
container_title International journal of molecular sciences
container_volume 24
creator Louback, Rafaela de Assiz
Martins-Cardoso, Karina
Tinoco, Luzineide W
Collino, Federica
de Barros, Ana Paula D N
Fortuna-Costa, Anneliese
Monteiro, Robson Q
Rossi, Maria Isabel Doria
Lindoso, Rafael Soares
description Long-term administration of aspirin (ASA, acetylsalicylic acid) in oncogenic patients has been related to a reduction in cancer risk incidence, but its precise mechanism of action is unclear. The activation of cancer-associated fibroblasts (CAFs) is a key element in tumor progression and can be triggered by cancer-derived extracellular vesicles (EVs). Targeting the communication between cancer cells and the surrounding tumor microenvironment (TME) may control cancer progression. Our aim was to investigate the effect of ASA on breast cancer cells, focusing on EV secretion and their effect on the biological properties of CAFs. As a result, ASA was shown to reduce the amount and alter the size distribution of EVs produced by MDA-MB-231 tumor cells. Fibroblasts stimulated with EVs derived from MDA-MB-231 treated with ASA (EV-ASA) showed a lower expression of alpha-smooth muscle actin (α-SMA), matrix metalloproteinase-2 (MMP2) but not fibroblast activation protein (FAP) in respect to the ones stimulated with EVs from untreated breast cancer cells (EV-CTR). Furthermore, invasion assays using a three-dimensional (3D) fibroblast spheroid model showed reduced MDA-MB-231 invasion towards fibroblast spheroids pretreated with EV-ASA as compared to spheroids prepared with EV-CTR-stimulated fibroblasts. This suggests that ASA partially inhibits the ability of tumor EVs to stimulate CAFs to promote cancer invasion. In conclusion, ASA can interfere with tumor communication by reducing EV secretion by breast tumor cells as well as by interfering with their capacity to stimulate fibroblasts to become CAFs.
doi_str_mv 10.3390/ijms241512020
format article
fullrecord <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10419278</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A760515551</galeid><sourcerecordid>A760515551</sourcerecordid><originalsourceid>FETCH-LOGICAL-c439t-6cecaa926b13369fecda352cb3c545daff91cabdf40ac50cd55bb1754f01cdbf3</originalsourceid><addsrcrecordid>eNptkktvEzEUhUcIREthyRZZYsNmip8z8QoNgUKkViBR2Fp3_GgdzdjBdoL673HUUhqEvLDl-51zfa3TNC8JPmVM4rd-PWfKiSAUU_yoOSac0hbjrn_84HzUPMt5jTFlVMinzRHrRSeZZMdNHvLGJx_Q4JzVJaOLD0N78b6ljKAfNns9WfQ1RbPVxceAIBh0eW19QkvYgPblBpWIVqHWLTrzY4rjBLnalPgLkskI9up2FXaQ_c6ibwWKfd48cTBl--JuP2m-n328XH5uz798Wi2H81ZzJkvbaasBJO1Gwlgn6_MMMEH1yLTgwoBzkmgYjeMYtMDaCDGOpBfcYaLN6NhJ8-7Wd7MdZ2u0DSXBpDbJz5BuVASvDivBX6uruFMEcyJpv6gOb-4cUvy5tbmo2WdtpwmCjdus6EJgRjouREVf_4Ou4zaFOl-luMSC827xl7qCySofXKyN9d5UDX2HBRFCkEqd_oeqy9jZ6xis8_X-QNDeCnSKOSfr7ockWO1jog5iUvlXD3_mnv6TC_YbRG64bA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2849054468</pqid></control><display><type>article</type><title>Aspirin Affects MDA-MB-231 Vesicle Production and Their Capacity to Induce Fibroblasts towards a Pro-Invasive State</title><source>Open Access: PubMed Central</source><source>Publicly Available Content (ProQuest)</source><creator>Louback, Rafaela de Assiz ; Martins-Cardoso, Karina ; Tinoco, Luzineide W ; Collino, Federica ; de Barros, Ana Paula D N ; Fortuna-Costa, Anneliese ; Monteiro, Robson Q ; Rossi, Maria Isabel Doria ; Lindoso, Rafael Soares</creator><creatorcontrib>Louback, Rafaela de Assiz ; Martins-Cardoso, Karina ; Tinoco, Luzineide W ; Collino, Federica ; de Barros, Ana Paula D N ; Fortuna-Costa, Anneliese ; Monteiro, Robson Q ; Rossi, Maria Isabel Doria ; Lindoso, Rafael Soares</creatorcontrib><description>Long-term administration of aspirin (ASA, acetylsalicylic acid) in oncogenic patients has been related to a reduction in cancer risk incidence, but its precise mechanism of action is unclear. The activation of cancer-associated fibroblasts (CAFs) is a key element in tumor progression and can be triggered by cancer-derived extracellular vesicles (EVs). Targeting the communication between cancer cells and the surrounding tumor microenvironment (TME) may control cancer progression. Our aim was to investigate the effect of ASA on breast cancer cells, focusing on EV secretion and their effect on the biological properties of CAFs. As a result, ASA was shown to reduce the amount and alter the size distribution of EVs produced by MDA-MB-231 tumor cells. Fibroblasts stimulated with EVs derived from MDA-MB-231 treated with ASA (EV-ASA) showed a lower expression of alpha-smooth muscle actin (α-SMA), matrix metalloproteinase-2 (MMP2) but not fibroblast activation protein (FAP) in respect to the ones stimulated with EVs from untreated breast cancer cells (EV-CTR). Furthermore, invasion assays using a three-dimensional (3D) fibroblast spheroid model showed reduced MDA-MB-231 invasion towards fibroblast spheroids pretreated with EV-ASA as compared to spheroids prepared with EV-CTR-stimulated fibroblasts. This suggests that ASA partially inhibits the ability of tumor EVs to stimulate CAFs to promote cancer invasion. In conclusion, ASA can interfere with tumor communication by reducing EV secretion by breast tumor cells as well as by interfering with their capacity to stimulate fibroblasts to become CAFs.</description><identifier>ISSN: 1422-0067</identifier><identifier>ISSN: 1661-6596</identifier><identifier>EISSN: 1422-0067</identifier><identifier>DOI: 10.3390/ijms241512020</identifier><identifier>PMID: 37569393</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Apoptosis ; Aspirin ; Breast cancer ; Cardiovascular disease ; Cells ; Fibroblasts ; Health aspects ; Metastasis ; MicroRNAs ; Scientific equipment and supplies industry ; Tumors</subject><ispartof>International journal of molecular sciences, 2023-07, Vol.24 (15), p.12020</ispartof><rights>COPYRIGHT 2023 MDPI AG</rights><rights>2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 by the authors. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c439t-6cecaa926b13369fecda352cb3c545daff91cabdf40ac50cd55bb1754f01cdbf3</cites><orcidid>0000-0002-1299-6242 ; 0000-0002-5260-2332 ; 0000-0001-8366-0343 ; 0000-0002-3619-7701 ; 0000-0002-7297-0781</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2849054468/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2849054468?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,882,25734,27905,27906,36993,36994,44571,53772,53774,74875</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37569393$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Louback, Rafaela de Assiz</creatorcontrib><creatorcontrib>Martins-Cardoso, Karina</creatorcontrib><creatorcontrib>Tinoco, Luzineide W</creatorcontrib><creatorcontrib>Collino, Federica</creatorcontrib><creatorcontrib>de Barros, Ana Paula D N</creatorcontrib><creatorcontrib>Fortuna-Costa, Anneliese</creatorcontrib><creatorcontrib>Monteiro, Robson Q</creatorcontrib><creatorcontrib>Rossi, Maria Isabel Doria</creatorcontrib><creatorcontrib>Lindoso, Rafael Soares</creatorcontrib><title>Aspirin Affects MDA-MB-231 Vesicle Production and Their Capacity to Induce Fibroblasts towards a Pro-Invasive State</title><title>International journal of molecular sciences</title><addtitle>Int J Mol Sci</addtitle><description>Long-term administration of aspirin (ASA, acetylsalicylic acid) in oncogenic patients has been related to a reduction in cancer risk incidence, but its precise mechanism of action is unclear. The activation of cancer-associated fibroblasts (CAFs) is a key element in tumor progression and can be triggered by cancer-derived extracellular vesicles (EVs). Targeting the communication between cancer cells and the surrounding tumor microenvironment (TME) may control cancer progression. Our aim was to investigate the effect of ASA on breast cancer cells, focusing on EV secretion and their effect on the biological properties of CAFs. As a result, ASA was shown to reduce the amount and alter the size distribution of EVs produced by MDA-MB-231 tumor cells. Fibroblasts stimulated with EVs derived from MDA-MB-231 treated with ASA (EV-ASA) showed a lower expression of alpha-smooth muscle actin (α-SMA), matrix metalloproteinase-2 (MMP2) but not fibroblast activation protein (FAP) in respect to the ones stimulated with EVs from untreated breast cancer cells (EV-CTR). Furthermore, invasion assays using a three-dimensional (3D) fibroblast spheroid model showed reduced MDA-MB-231 invasion towards fibroblast spheroids pretreated with EV-ASA as compared to spheroids prepared with EV-CTR-stimulated fibroblasts. This suggests that ASA partially inhibits the ability of tumor EVs to stimulate CAFs to promote cancer invasion. In conclusion, ASA can interfere with tumor communication by reducing EV secretion by breast tumor cells as well as by interfering with their capacity to stimulate fibroblasts to become CAFs.</description><subject>Apoptosis</subject><subject>Aspirin</subject><subject>Breast cancer</subject><subject>Cardiovascular disease</subject><subject>Cells</subject><subject>Fibroblasts</subject><subject>Health aspects</subject><subject>Metastasis</subject><subject>MicroRNAs</subject><subject>Scientific equipment and supplies industry</subject><subject>Tumors</subject><issn>1422-0067</issn><issn>1661-6596</issn><issn>1422-0067</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNptkktvEzEUhUcIREthyRZZYsNmip8z8QoNgUKkViBR2Fp3_GgdzdjBdoL673HUUhqEvLDl-51zfa3TNC8JPmVM4rd-PWfKiSAUU_yoOSac0hbjrn_84HzUPMt5jTFlVMinzRHrRSeZZMdNHvLGJx_Q4JzVJaOLD0N78b6ljKAfNns9WfQ1RbPVxceAIBh0eW19QkvYgPblBpWIVqHWLTrzY4rjBLnalPgLkskI9up2FXaQ_c6ibwWKfd48cTBl--JuP2m-n328XH5uz798Wi2H81ZzJkvbaasBJO1Gwlgn6_MMMEH1yLTgwoBzkmgYjeMYtMDaCDGOpBfcYaLN6NhJ8-7Wd7MdZ2u0DSXBpDbJz5BuVASvDivBX6uruFMEcyJpv6gOb-4cUvy5tbmo2WdtpwmCjdus6EJgRjouREVf_4Ou4zaFOl-luMSC827xl7qCySofXKyN9d5UDX2HBRFCkEqd_oeqy9jZ6xis8_X-QNDeCnSKOSfr7ockWO1jog5iUvlXD3_mnv6TC_YbRG64bA</recordid><startdate>20230727</startdate><enddate>20230727</enddate><creator>Louback, Rafaela de Assiz</creator><creator>Martins-Cardoso, Karina</creator><creator>Tinoco, Luzineide W</creator><creator>Collino, Federica</creator><creator>de Barros, Ana Paula D N</creator><creator>Fortuna-Costa, Anneliese</creator><creator>Monteiro, Robson Q</creator><creator>Rossi, Maria Isabel Doria</creator><creator>Lindoso, Rafael Soares</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1299-6242</orcidid><orcidid>https://orcid.org/0000-0002-5260-2332</orcidid><orcidid>https://orcid.org/0000-0001-8366-0343</orcidid><orcidid>https://orcid.org/0000-0002-3619-7701</orcidid><orcidid>https://orcid.org/0000-0002-7297-0781</orcidid></search><sort><creationdate>20230727</creationdate><title>Aspirin Affects MDA-MB-231 Vesicle Production and Their Capacity to Induce Fibroblasts towards a Pro-Invasive State</title><author>Louback, Rafaela de Assiz ; Martins-Cardoso, Karina ; Tinoco, Luzineide W ; Collino, Federica ; de Barros, Ana Paula D N ; Fortuna-Costa, Anneliese ; Monteiro, Robson Q ; Rossi, Maria Isabel Doria ; Lindoso, Rafael Soares</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-6cecaa926b13369fecda352cb3c545daff91cabdf40ac50cd55bb1754f01cdbf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Apoptosis</topic><topic>Aspirin</topic><topic>Breast cancer</topic><topic>Cardiovascular disease</topic><topic>Cells</topic><topic>Fibroblasts</topic><topic>Health aspects</topic><topic>Metastasis</topic><topic>MicroRNAs</topic><topic>Scientific equipment and supplies industry</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Louback, Rafaela de Assiz</creatorcontrib><creatorcontrib>Martins-Cardoso, Karina</creatorcontrib><creatorcontrib>Tinoco, Luzineide W</creatorcontrib><creatorcontrib>Collino, Federica</creatorcontrib><creatorcontrib>de Barros, Ana Paula D N</creatorcontrib><creatorcontrib>Fortuna-Costa, Anneliese</creatorcontrib><creatorcontrib>Monteiro, Robson Q</creatorcontrib><creatorcontrib>Rossi, Maria Isabel Doria</creatorcontrib><creatorcontrib>Lindoso, Rafael Soares</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest - Health &amp; Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Proquest Research Library</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of molecular sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Louback, Rafaela de Assiz</au><au>Martins-Cardoso, Karina</au><au>Tinoco, Luzineide W</au><au>Collino, Federica</au><au>de Barros, Ana Paula D N</au><au>Fortuna-Costa, Anneliese</au><au>Monteiro, Robson Q</au><au>Rossi, Maria Isabel Doria</au><au>Lindoso, Rafael Soares</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Aspirin Affects MDA-MB-231 Vesicle Production and Their Capacity to Induce Fibroblasts towards a Pro-Invasive State</atitle><jtitle>International journal of molecular sciences</jtitle><addtitle>Int J Mol Sci</addtitle><date>2023-07-27</date><risdate>2023</risdate><volume>24</volume><issue>15</issue><spage>12020</spage><pages>12020-</pages><issn>1422-0067</issn><issn>1661-6596</issn><eissn>1422-0067</eissn><abstract>Long-term administration of aspirin (ASA, acetylsalicylic acid) in oncogenic patients has been related to a reduction in cancer risk incidence, but its precise mechanism of action is unclear. The activation of cancer-associated fibroblasts (CAFs) is a key element in tumor progression and can be triggered by cancer-derived extracellular vesicles (EVs). Targeting the communication between cancer cells and the surrounding tumor microenvironment (TME) may control cancer progression. Our aim was to investigate the effect of ASA on breast cancer cells, focusing on EV secretion and their effect on the biological properties of CAFs. As a result, ASA was shown to reduce the amount and alter the size distribution of EVs produced by MDA-MB-231 tumor cells. Fibroblasts stimulated with EVs derived from MDA-MB-231 treated with ASA (EV-ASA) showed a lower expression of alpha-smooth muscle actin (α-SMA), matrix metalloproteinase-2 (MMP2) but not fibroblast activation protein (FAP) in respect to the ones stimulated with EVs from untreated breast cancer cells (EV-CTR). Furthermore, invasion assays using a three-dimensional (3D) fibroblast spheroid model showed reduced MDA-MB-231 invasion towards fibroblast spheroids pretreated with EV-ASA as compared to spheroids prepared with EV-CTR-stimulated fibroblasts. This suggests that ASA partially inhibits the ability of tumor EVs to stimulate CAFs to promote cancer invasion. In conclusion, ASA can interfere with tumor communication by reducing EV secretion by breast tumor cells as well as by interfering with their capacity to stimulate fibroblasts to become CAFs.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>37569393</pmid><doi>10.3390/ijms241512020</doi><orcidid>https://orcid.org/0000-0002-1299-6242</orcidid><orcidid>https://orcid.org/0000-0002-5260-2332</orcidid><orcidid>https://orcid.org/0000-0001-8366-0343</orcidid><orcidid>https://orcid.org/0000-0002-3619-7701</orcidid><orcidid>https://orcid.org/0000-0002-7297-0781</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1422-0067
ispartof International journal of molecular sciences, 2023-07, Vol.24 (15), p.12020
issn 1422-0067
1661-6596
1422-0067
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10419278
source Open Access: PubMed Central; Publicly Available Content (ProQuest)
subjects Apoptosis
Aspirin
Breast cancer
Cardiovascular disease
Cells
Fibroblasts
Health aspects
Metastasis
MicroRNAs
Scientific equipment and supplies industry
Tumors
title Aspirin Affects MDA-MB-231 Vesicle Production and Their Capacity to Induce Fibroblasts towards a Pro-Invasive State
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-20T09%3A39%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Aspirin%20Affects%20MDA-MB-231%20Vesicle%20Production%20and%20Their%20Capacity%20to%20Induce%20Fibroblasts%20towards%20a%20Pro-Invasive%20State&rft.jtitle=International%20journal%20of%20molecular%20sciences&rft.au=Louback,%20Rafaela%20de%20Assiz&rft.date=2023-07-27&rft.volume=24&rft.issue=15&rft.spage=12020&rft.pages=12020-&rft.issn=1422-0067&rft.eissn=1422-0067&rft_id=info:doi/10.3390/ijms241512020&rft_dat=%3Cgale_pubme%3EA760515551%3C/gale_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c439t-6cecaa926b13369fecda352cb3c545daff91cabdf40ac50cd55bb1754f01cdbf3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2849054468&rft_id=info:pmid/37569393&rft_galeid=A760515551&rfr_iscdi=true