Search Results (365)

Microplastics (MPs) and nanoplastics (NPs) have become pervasive environmental contaminants, raising growing concern regarding their potential accumulation within the human body and associated health risks. MP particles can translocate into systemic circulation and multiple organs, necessitating a comprehensive evaluation of current human biomonitoring data. This comprehensive review aimed to synthesize current evidence on the occurrence, distribution, detection technologies, exposure reduction and potential health implications of microplastics in human biological samples. The reviewed literature confirms the presence of microplastics in blood, placenta, amniotic fluid, umbilical cord blood, breast milk, semen, urine, and selected tissues including cardiovascular, renal, and reproductive samples. Detection frequencies in some matrices exceeded 70–90%, with polymer types such as polyethylene, polypropylene, polystyrene, and polyethylene terephthalate most commonly identified. Reported particle sizes ranged from nanometer-scale fragments to particles over 100 µm, indicating both systemic circulation and potential tissue retention. Spectroscopic techniques such as μFTIR and μRaman dominate polymer identification, while thermoanalytical approaches such as Py-GC/MS provide quantitative polymer confirmation. Emerging evidence suggests associations with oxidative stress, inflammatory responses, endothelial dysfunction, and impaired reproductive parameters, although causal relationships remain uncertain due to methodological heterogeneity and limited longitudinal data. This review provides an integrated overview of current human exposure evidence, identifies analytical gaps, and highlights the urgent need for harmonized detection frameworks and longitudinal risk assessment studies to inform public health policy and future biomonitoring strategies. Full article

Osteoarthritis (OA) is a prevalent degenerative joint disorder characterized by cartilage degradation, synovial inflammation, and osteophyte formation, yet effective therapies that alter disease progression remain absent. Mesenchymal stem cell-derived exosomes (MSC-EXOs), as a cell-free regenerative medicine strategy, have shown great potential in the treatment of osteoarthritis. In this study, we successfully isolated and purified exosomes derived from human umbilical cord mesenchymal stem cells using a scalable tangential flow filtration (TFF)–chromatography platform and evaluated their therapeutic effects on OA model induced by anterior cruciate ligament transection (ACLT). OARSI scores were significantly reduced compared with the ACLT group (p < 0.01). Exosomes administration markedly reduced osteophyte formation, preserved cartilage structure, enhanced collagen II expression (p < 0.01), and suppressed MMP13-mediated matrix degradation (p < 0.05) compared with the ACLT group. The treatment also significantly decreased pro-inflammatory cytokines, indicating alleviation of the inflammatory microenvironment. Transcriptomic profiling further revealed genes and pathways potentially associated with exosome treatment. These findings suggest that hUC-MSC-EXOs isolated and purified using TFF–chromatography exert robust chondroprotective and immunomodulatory effects, supporting their potential as an effective cell-free therapeutic candidate for OA. Full article

Critical-sized bone defects lack spontaneous healing capacity. While mesenchymal stem cell-derived exosomes (sEVs) are promising osteoinductive agents, their rapid in vivo clearance limits their free-form efficacy. Here, we fabricated a nano-hydroxyapatite/chitosan (nHA/CTS) composite scaffold as a protective, sustained-delivery platform for human umbilical cord blood-derived mesenchymal stem cell exosomes (HUCB-MSCs-exos) to accelerate bone repair. The 3D porous CTS/10% nHA scaffold exhibited excellent cytocompatibility and a degradation rate commensurate with new bone ingrowth. Critically, it enabled a biphasic exosome release profile—an initial burst followed by a 14-day sustained release (89.73% cumulative release). In vitro, HUCB-MSCs-exos significantly promoted the proliferation, migration, and osteogenic differentiation of bone marrow-derived MSCs, as demonstrated by enhanced alkaline phosphatase activity and matrix mineralization. In a rabbit condylar defect model (5 mm diameter), the CTS/10% nHA-exo scaffold achieved a 57.44 ± 8.42% healing rate at two months, nearly two-fold greater than the scaffold-only group (29.33 ± 6.94%). Histological and immunohistochemical analyses at two months confirmed the formation of mature, well-vascularized trabecular bone, accompanied by robust expression of late-stage osteogenic markers (OCN and OPN). These findings demonstrate that the CTS/10% nHA scaffold synergistically integrates osteoconductive structural guidance with exosome-mediated osteoinductive paracrine signaling, providing a compelling and translatable strategy for critical-sized bone-defect management. Full article

In recent years, bisphenol F (BPF) and bisphenol S (BPS) have been used in several everyday products to replace bisphenol A (BPA), since exposure to BPA has been associated with the development of several pathologies. However, recent studies have also been associating exposure to BPA substitutes with the development of various pathologies, including cardiovascular diseases, and the safety of BPA substitutes for human health has been questioned. Thus, this study aimed to investigate and compare BPA, BPF and BPS effects on arterial tone and to explore the mechanisms involved. The results suggest that BPA, BPS and BPF exert non-genomic and endothelium-independent relaxant effects on arteries and smooth muscle cells from the umbilical cord. Regarding genomic effects, the results suggest that BPA, BPF, and BPS disrupted the primary mechanisms underlying HUA relaxation by interfering with the cGMP signaling pathway and modulating the Ca²⁺ channels activity. Moreover, these results suggest that BPF alters the vasorelaxant response more than BPA and BPS. Therefore, replacing BPA with its substitutes does not appear to be beneficial for human cardiovascular health. Thus, in the future, the vascular effects of these bisphenols should be further evaluated to clarify their modes of action and future implications for maternal-fetal health. Full article

Neonicotinoid insecticides (NEOs) are widely used globally, leading to human exposure including pregnant women, and may pose risks of neurocognitive toxicity. In this study, we analyzed 114 mother–child pairs from the Guangxi Zhuang birth cohort. Umbilical cord plasma concentrations of 10 NEOs were measured using ultra-high-performance liquid chromatography–mass spectrometry (UPLC–MS), and child neurocognitive development was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) and the Ages and Stages Questionnaire, Third Edition (ASQ-3). NEOs were frequently detected, with detection rates ranging from 15.8% to 96.5%, and dinotefuran (DIN) showed the highest prevalence. Prenatal exposure to several NEOs was associated with lower neurocognitive scores. Specifically, DIN and clothianidin (CLO) exposure were associated with lower Full-Scale Intelligence Quotient (FSIQ), while thiacloprid (THIA) exposure was linked to poorer communication performance. In addition, imidacloprid (IMI) and THIA exposure were associated with reduced gross motor function, and thiamethoxam (TMX) was further associated with reduced fine motor development. Mixed exposure analysis suggested a negative but non-significant association between overall NEO exposure and FSIQ or fine motor outcomes. These findings suggest a potential association between prenatal exposure to NEOs and neurocognitive development in preschool children, highlighting the need for further research to inform public health strategies. Full article

Introduction: With age and injury, the infiltration of fat in the paraspinal muscles can cause degeneration, disorganizing the structural integrity of the connective tissue and causing lower back pain (LBP). Human umbilical cord tissue allografts (UCTAs) have a collagen-rich matrix with various extracellular matrix (ECM) components that can replace damaged connective tissue. The objective of this paper is to analyze the preliminary findings from an observational repository on UCTAs for the supplementation of degenerated tissue in thoracic and lumbar paraspinal muscles refractory to standard conservative methods through patient-reported scales. Materials and Methods: A total of 117 patients from an observational repository were identified with paraspinal muscle degeneration. Patients received one to three applications of UCTAs; outcomes were tracked using the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMaster University Arthritis Index (WOMAC), and the Quality-of-Life Scale (QOLS). Results: All groups showed positive improvement in the NPRS and WOMAC scales. Multi-application groups revealed statistically significant differences in the analyses. No adverse events or complications were reported. Discussion: Limitations included a lack of a control group, non-standardized application protocol, and the increase in recall and response bias due to using patient-reported measures. Conclusions: This pilot investigation presents the preliminary effectiveness necessary in hypothesis generation for continued research through randomized controlled trials to validate efficacy, establish optimal dosage protocols, and compare UCTAs to other conservative interventions. Full article

Background/Objectives: High-altitude pulmonary edema (HAPE) remains a serious condition with limited preventive options. This study evaluated the prophylactic protective effects of nebulized human umbilical cord mesenchymal stem cell-derived extracellular vesicles (hUC-MSC-EVs) in a rat model of hypobaric hypoxia-induced lung injury and explored potential mechanistic clues, with a focus on oxidative stress and TEK/Tie2 signaling. Methods: Rats were exposed to hypobaric hypoxia (47 kPa; 9.7% O₂) for 72 h and received prophylactic nebulized hUC-MSC-EVs (300 μg/rat). Lung injury was evaluated by histopathology, wet-to-dry ratio, and bronchoalveolar lavage fluid (BALF) protein concentration. Invasive pulmonary function indices were measured using a forced oscillation system. BALF cytokines (TNF-α, IL-6, and IL-10), reactive oxygen species (ROS), and TEK/Tie2 expression in lung tissue were assessed. In addition, transcriptome sequencing (RNA-seq) was performed to characterize global transcriptional changes. N-acetylcysteine (NAC), a classical antioxidant, was included as an auxiliary mechanistic intervention to assess the association of ROS with TEK/Tie2 changes. Results: Compared with hypoxia controls, prophylactic nebulized hUC-MSC-EVs reduced histopathological injury, pulmonary edema, and barrier leakage, and improved pulmonary function indices. hUC-MSC-EV intervention also attenuated inflammatory responses in BALF, with decreased TNF-α and IL-6 and increased IL-10. Hypobaric hypoxia increased ROS accumulation and decreased TEK/Tie2 expression, whereas nebulized hUC-MSC-EVs reduced ROS and partially preserved TEK/Tie2 expression. NAC pretreatment similarly reduced ROS and was accompanied by Tie2 preservation. Conclusions: Prophylactic nebulized hUC-MSC-EVs mitigated hypobaric hypoxia-induced lung injury, accompanied by reduced oxidative stress, improved vascular barrier integrity, and preservation of TEK/Tie2 expression. These findings support nebulized hUC-MSC-EVs as a potential lung-targeted prophylactic strategy for hypobaric hypoxia-induced lung injury and suggest that ROS imbalance may be associated with Tie2 preservation. Full article

Regenerative medicine is becoming more widely integrated with longevity-oriented and preventive care as populations age and chronic degenerative diseases burden healthcare systems. Mesenchymal stem cell (MSC) therapies have progressed from experimental interventions to approved products, yet scalability, safety, cost, and regulatory complexity constrain widespread implementation in medical wellness contexts. The predominant therapeutic effects of MSCs are mediated via paracrine mechanisms, leading to cell-free approaches based on the MSC secretome—a complex mixture of bioactive factors including all types of biomolecules and assemblies thereof, such as exosomes. These acellular products offer compelling advantages: multiple batches from single-donor sources, standardized dosing, reduced allogeneic cell risks, and shorter outpatient-compatible administration. Preclinical and clinical data indicate that secretome-based products exert potent regenerative effects in osteoarthritis, chronic wounds, stroke, traumatic brain injury, and neurodegenerative diseases. This review examines the evolution from cell-based to cell-free regenerative strategies, focusing on human umbilical cord Wharton’s jelly MSC secretome for precision longevity medicine. It compares MSC therapies with secretome- and exosome-based formulations across mechanistic, manufacturing, safety, practical and regulatory dimensions. Regional perspectives highlight Southeast Asia, and especially Thailand, as an emerging regenerative-longevity hub. Finally, it outlines the preventive patient journey integrating cell-free interventions within multi-modal programs aimed at extending healthspan. Full article

Small extracellular vesicles (sEVs) derived from mesenchymal stem cells (MSCs) are emerging as potent acellular therapeutics; however, their rapid clearance hinders their clinical translation. To address this issue, 3D-bioprinted genipin-crosslinked gelatin (GECL) was engineered for human health. GECL hydrogels were functionalised with human umbilical cord MSC-derived sEVs (hUCMSC-sEVs) to create a bioactive wound-healing platform. These hydrogels demonstrated favourable physicochemical, mechanical, and biodegradable properties while providing an extracellular matrix (ECM)-mimetic environment conducive to tissue regeneration. MSCs were isolated from the umbilical cords, and their small extracellular vesicles (sEVs) were extracted and incorporated into gelatin-based hydrogels via 3D bioprinting. These sEV-loaded scaffolds were embedded in full-thickness wounds in mice, and healing was evaluated through macroscopic observation, histological analysis, collagen deposition, and angiogenesis assessment. Compared with the untreated controls, both the hydrogel-only (B) and sEV-loaded hydrogel (BE) groups significantly accelerated in vivo wound healing. Notably, the BE group achieved complete wound closure within 14 days, restoring the skin architecture, which closely resembled the native tissue with well-organised epidermal and dermal layers, optimal thickness, and skin appendages. Histological and ultrastructural assessments revealed an increased collagen type I deposition, a reduced α-smooth muscle actin (α-SMA) expression, and a robust neovascularisation. The TEM revealed tight junctions and active cellular infiltration, indicating scaffold integration and functional remodelling. Immunohistochemistry further revealed an upregulated CD31 expression with a balanced α-smooth muscle actin (α-SMA) expression, reflecting coordinated angiogenesis and myofibroblast regulation. These results highlight sEV-functionalised GECL hydrogels as robust and clinically translatable acellular therapeutic green products for accelerated wound closure and functional skin regeneration, advancing the fields of regenerative medicine and life expectancy. Full article

Background: Cutaneous radiation injury arises when ionizing radiation disrupts epidermal barrier integrity, triggering persistent DNA damage, oxidative stress, and senescence-associated inflammatory signaling that drive extracellular matrix degradation and impaired regeneration. Clinical burden is rising due to dose-intensified radiotherapy, but also due to an increased use of energy-based aesthetic procedures that elicit radiation-like dermal injury. Dermal fibroblasts exhibit marked sensitivity to ionizing radiation and rapidly acquire senescence-associated secretory phenotypes that suppress collagen biosynthesis and promote chronic inflammation, underpinning the need for regenerative treatments that restore tissue homeostasis and regenerative competence. Mesenchymal stem cell–derived exosomes have emerged as a promising therapeutic strategy in this setting, with increasing preclinical evidence demonstrating their capacity to attenuate oxidative stress, enhance DNA damage-repair pathways, and normalize fibroblast metabolic function. Methods: In this study, we examine the expression profiles for 14 radiation response–associated genes of irradiated human dermal fibroblasts that were treated with bone marrow and umbilical cord MSC-derived exosomes at different timepoints using quantitative RT-PCR analysis. We also explore functional relationships among these genes through interaction network analysis, and outline a framework to organize pathway-level transcriptional responses to irradiation and exosome treatment. Results: MSC-derived exosome treatment was associated with attenuated early damage response signaling at 24 h, followed by increased expression of genes associated with DNA repair and oxidative stress recovery at intermediate timepoints. Exosome-treated cells also exhibited transcriptional changes consistent with modulation of cell-cycle regulatory pathways and reduced expression of pro-inflammatory markers by 5 d. These findings suggest that MSC-derived exosomes influence the temporal organization of the fibroblast transcriptional response to ionizing radiation and may contribute to molecular programs associated with tissue recovery following ionizing radiation exposure. Full article

DRG adhesion is a key pathological feature of failed back surgery syndrome and a major cause of neuropathic pain. DRG, or epidural adhesion, commonly results from spinal surgery, leakage of disk material into the epidural space, or inflammation. To better mimic this clinical condition, we developed a novel and reliable animal model of DRG adhesion-induced neuropathic pain. Using this model, we investigated the therapeutic potential and underlying mechanisms of CLARIX FLO, a sterile, particulate human amniotic membrane and umbilical cord tissue product. Our results demonstrate that CLARIX FLO exerts significant analgesic and anti-inflammatory effects in the DRG adhesion model. The application of CLARIX FLO to the injured DRG markedly attenuated mechanical allodynia. CLARIX FLO treatment also reduced outer sheath thickening, suppressed the inflammatory microenvironment, and decreased hypersensitivity of isolectin B4-positive neurons. Mechanistically, CD44 was identified as a potential downstream mediator of CLARIX FLO. Furthermore, a high dose of HC-HA/PTX3, the key bioactive component of CLARIX FLO, effectively reversed mechanical allodynia and inflammation. Notably, CLARIX FLO inhibited the overexpression of TNF-α and TRPV1 adhering to the DRG. In this study, we demonstrated that CLARIX FLO effectively alleviates DRG adhesion-induced neuropathic pain through a CD44–TRPV1-dependent mechanism. Full article

Background: Glucocorticoids (GCs) are a key pathogenic factor in steroid-induced avascular necrosis of the femoral head (SANFH). GCs can directly damage bone microvascular endothelial cells (BMECs), leading to impaired intraosseous blood supply. Recent studies suggest the Hippo signaling pathway may be involved in the pathogenesis of SANFH; however, its role in vascular endothelial repair and angiogenesis remains unclear. This study aims to investigate the therapeutic effects of human umbilical cord mesenchymal stem cells (hUC-MSCs) on SANFH, with a particular focus on their protective or reparative mechanisms on BMECs. Methods: In vivo, a SANFH mouse model is established and divided into NC, MPS, and hUC-MSCs groups, followed by Micro-CT imagin, hematoxylin and eosin (HE) staining and immunohistochemistry (IHC) (n = 8 per group). In vitro, BMECs are divided into NC, dexamethasone (Dex), hUC-MSCs, and Fer-1 groups to analyze cellular biological behaviors. Target protein expression is assessed using Western blotting and immunofluorescence microscopy. Ferroptosis-related markers are detected via biochemical assays. Mitochondrial ultrastructural changes are observed using transmission electron microscopy. Results: In vivo, the MPS group exhibited significant bone cavitation, sparse trabeculae, and disrupted trabecular architecture in the femoral head. The hUC-MSCs group showed marked improvement in bone microstructure, HE staining showed a significant decrease in the empty lacunae rate in the femoral head, and IHC results revealed markedly increased expression of cluster of differentiation 31 (CD31) and vascular endothelial growth factor (VEGF). In vitro, Dex stimulation suppressed BMECs proliferation. In Dex-treated cells, levels of intracellular reactive oxygen species (ROS), lipid peroxides, ferrous ion (Fe²⁺), malondialdehyde (MDA), acyl-CoA synthetase long chain family member 4 (ACSL4) and nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) were all increased, while expression of glutathione (GSH) and glutathione Peroxidase 4 (GPX4) was reduced. Transmission electron microscopy revealed plasma membrane rupture and reduction or loss of mitochondrial cristae. Furthermore, Dex promoted Hippo-mediated phosphorylation of Yes-associated protein (YAP)/Transcriptional coactivator with PDZ-binding motif (TAZ), upregulated NOX4 expression, and suppressed CD31 and VEGF expression. Following hUC-MSCs treatment, BMECs demonstrated enhanced proliferation, migration, and tube-forming capacity. Cellular GSH and GPX4 levels increased, antioxidant capacity was restored, peroxide accumulation decreased, and cells were protected from ferroptosis-effects comparable to those in the Fer-1 group. Additionally, hUC-MSCs inhibited YAP/TAZ phosphorylation and promoted elevated expression of CD31 and VEGF. Conclusions: These findings suggest that hUC-MSCs may attenuate Dex-induced ferroptosis in BMECs, enhance BMEC migration and angiogenesis, and improve femoral head microstructure in SANFH through modulation of the Hippo-YAP/TAZ signaling pathway. This study provides novel insights into the therapeutic potential of hUC-MSCs for SANFH. Full article

Background: Chronic liver fibrosis is a progressive pathological condition characterized by excessive extracellular matrix deposition and architectural remodeling, which may ultimately lead to cirrhosis and liver failure. Although mesenchymal stem cells (MSCs) exhibit antifibrotic and immunomodulatory properties, their therapeutic effects in established chronic liver fibrosis remain incompletely defined. This study aimed to evaluate the biochemical, hematological, and histopathological effects of MSC therapy in a chronic thioacetamide-induced liver fibrosis model. Methods: A controlled preclinical experimental study was conducted using rats with liver fibrosis induced by intraperitoneal thioacetamide administration for 24 weeks. Animals were allocated into three groups: control, untreated fibrosis, and fibrosis treated with MSCs derived from human umbilical cord tissue after fibrosis establishment. Serum biochemical markers, hematological parameters, and liver histopathology were assessed. Fibrosis severity was evaluated using hematoxylin–eosin and Masson’s trichrome staining and graded according to the METAVIR scoring system. Results: Thioacetamide exposure induced chronic liver injury characterized by marked elevations in serum transaminases, reduced albumin and total protein levels, hematological alterations, and early-to-intermediate fibrosis stages (METAVIR F1–F2). MSC-treated animals exhibited approximately 40–45% reductions in transaminase levels, partial recovery of hepatic synthetic function, and attenuation of hematological alterations. Histopathological analysis demonstrated a reduction in fibrotic burden and limitation of fibrogenic progression within METAVIR F1–F2 stages. Conclusions: MSC therapy partially mitigates biochemical, hematological, and histopathological alterations associated with chronic thioacetamide-induced liver fibrosis, supporting its potential as a modulatory strategy to attenuate fibrogenic progression and stabilize liver function rather than as a curative intervention. Full article

Background: The extracellular matrix (ECM) plays a central role in the mechanical strength and functional integration of tissue-engineered matrix (TEM), particularly in cardiovascular and load-bearing applications. Mesenchymal stromal cells (MSCs) from different sources may vary in their ECM-forming potential. Methods: In this study, adipose-derived (hADMSC), bone marrow-derived (hBMSC), and umbilical cord-derived MSCs (hUCMSC) were compared with human dermal fibroblasts (HDFBs) as a reference. Cells were seeded onto polyglycolic acid (PGA)/poly-4-hydroxybutyrate (P4HB) scaffolds and cultured for 3 weeks under static or hydrodynamic conditions using orbital shaking. TEM development was assessed macroscopically, histologically (using H&E and Masson’s trichrome stains), and by polarized light microscopy (Picrosirius Red), alongside biochemical assays that quantified DNA, glycosaminoglycan (GAGs), and hydroxyproline (HYP). Results: Hydrodynamically stimulated culture consistently improved ECM deposition across all groups. TEMs exposed to hydrodynamic stimulation (hydrodynamic conditions) were thicker, more uniformly filled, and exhibited increased collagen deposition compared with static TEMs, which remained thinner and showed persistent scaffold remnants. Polarized light analysis demonstrated that dynamic loading promoted collagen maturation in all groups, as evidenced by an increased prevalence of thick, birefringent collagen fibers indicative of mature collagen. Biochemical analyses showed that HDFB-derived TEMs produced the highest total collagen and ECM content under both static and hydrodynamic conditions; however, these matrices remained comparatively thin and densely packed. In contrast, MSC-derived TEMs formed thicker and more spatially distributed ECM in response to hydrodynamic stimulation. Conclusion: Among the MSC sources, hUCDMSC-derived TEMs exhibited the most advanced collagen maturation and the most uniform collagen distribution under hydrodynamically stimulated culture, whereas hADMSC-derived TEMs showed the greatest matrix thickening and volumetric ECM expansion with intermediate collagen maturation. hBMSC-derived TEMs displayed clear responsiveness to hydrodynamic stimulation but remained limited in overall collagen deposition and fiber maturation. These findings underscore that both hydrodynamic stimulation and cell source are critical not only for maximizing ECM deposition, but also for ensuring physiologically relevant collagen maturation and matrix organization in grafts suitable for clinical translation. Full article

Is it reasonable to use allogeneic mesenchymal stem cells (MSCs) therapy for thin endometrium and recurrent implantation failure? Thin endometrium (TE) and recurrent implantation failure (RIF) are associated with poor reproductive outcomes. Single-cell RNA sequencing (scRNA-seq) shows that such pathologies involve functional impairment of endometrial stromal, vascular, immune cells rather than reductions in cell numbers. MSCs exert regenerative and immunomodulatory effects and are proposed as candidates for endometrial repair. scRNA-seq studies indicate that TE and RIF are characterized by stromal progenitor dysfunction, impaired angiogenesis, immune dysregulation, and cellular senescence, providing a biological rationale for investigating allogeneic MSC-based therapies. scRNA-seq studies of human endometrium in patients with TE and RIF are reviewed alongside experimental and clinical studies evaluating autologous and allogeneic MSCs, with particular emphasis on umbilical cord-derived MSCs. Transcriptomic analyses consistently demonstrate reduced proliferation and decidualization of endometrial stromal cells, suppression of angiogenesis, immune dysregulation, and activation of senescence-associated genes. Preclinical studies show that MSC administration restores endometrial structure, vascularization, and receptivity markers. Early clinical studies suggest potential benefit, although data remain limited and heterogeneous due to non-randomized studies. Allogeneic MSCs are promising as therapy, but further studies on mechanisms and clinical validation are needed. Full article