High-Grade Prostate Adenocarcinoma in a BRCA2 Germline Mutation Carrier: Precision Oncology and Familial Cascade Testing: a case report

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Abstract Background : Germline mutations in BRCA2 are strongly associated with young age and dangerous prostate cancer due to the lack of homologous recombination (HRD), suggesting a window for targeted therapy and emphasizing the importance of family-oriented genetic screening. Case Presentation: The patient was of Iranian origin. A 43-year-old man presented with locally advanced prostate adenocarcinoma (Gleason 4+4, T3bN0M0) harboring a pathogenic BRCA2 c.6501G>A mutation. He was treated with combined androgen blockade using goserelin, abiraterone, prednisolone, and denosumab, and had PSA reduction from 38 to 2.1 ng/mL over three months. This discovery led to cascade genetic testing in his relatives. Conclusion : This case provides the key role of germline early testing to guide personalized therapy and initiate familial risk management strategies in hereditary prostate cancer.
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High-Grade Prostate Adenocarcinoma in a BRCA2 Germline Mutation Carrier: Precision Oncology and Familial Cascade Testing: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report High-Grade Prostate Adenocarcinoma in a BRCA2 Germline Mutation Carrier: Precision Oncology and Familial Cascade Testing: a case report Yousef VatanParast This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7338087/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Germline mutations in BRCA2 are strongly associated with young age and dangerous prostate cancer due to the lack of homologous recombination (HRD), suggesting a window for targeted therapy and emphasizing the importance of family-oriented genetic screening. Case Presentation: The patient was of Iranian origin. A 43-year-old man presented with locally advanced prostate adenocarcinoma (Gleason 4+4, T3bN0M0) harboring a pathogenic BRCA2 c.6501G>A mutation. He was treated with combined androgen blockade using goserelin, abiraterone, prednisolone, and denosumab, and had PSA reduction from 38 to 2.1 ng/mL over three months. This discovery led to cascade genetic testing in his relatives. Conclusion : This case provides the key role of germline early testing to guide personalized therapy and initiate familial risk management strategies in hereditary prostate cancer. BRCA2 prostate cancer early-onset HRD precision oncology cascade testing familial risk genetic counseling Introduction Prostate cancer can be indolent or aggressive. In young men, aggressive prostate cancer is frequently driven by germline mutations of the DNA damage repair (DDR) genes, primarily BRCA2. Loss of BRCA2 blocks homologous recombination (HR), promoting genomic instability and tumor progression, but at the same time sensitizing tumors to DNA-damaging treatments, including poly(ADP-ribose) polymerase inhibitors (PARPi) and intensified androgen deprivation therapy (ADT). BRCA2 mutations affect not only the patient but also confer significant cancer risk to the family, including prostate, breast, and ovarian malignancies. The National Comprehensive Cancer Network (NCCN) and European Association of Urology (EAU) guidelines now recommend germline testing in men aged less than 55 years with high-grade tumors or relevant family histories. Cascade testing permits early discovery and surveillance in affected relatives. Here, we describe a case of a 43-year-old man whose BRCA2 mutation informed treatment and triggered cascade screening among his relatives. Case Presentation A 43-year-old man presented with 3 months of frequency, urgency, nocturia, lower back pain (chronic), and 7 kg unintentional weight loss. There were no comorbidities. Digital rectal examination revealed an irregular, hard prostate. His serum PSA was 38 ng/mL (normal <4 ng/mL). Family History: Family pedigree is shown in Supplementary Figure S2. He lost his father to metastatic prostate cancer at age 68, and two paternal uncles were diagnosed with prostate cancer in their 50s. No family history of breast or ovarian cancers was reported, suggesting possible male-limited expression in this family. Diagnostics: • img: Multiparametric MRI indicated a PIRADS 5 lesion with extracapsular extension and seminal vesicle invasion. • bx: Transrectal ultrasound-guided biopsy confirmed adenocarcinoma, Gleason score 4+4. • Staging: The CT scan and bone scan were negative for distant metastasis, staging the tumor as T3bN0M0. Genetic Analysis: Next-generation sequencing showed a likely pathogenic BRCA2 variant (c.6501G>A; p.Gly2167Ser), not seen in gnomAD, and listed as likely pathogenic in ClinVar. Therapeutic Intervention Based on the LATITUDE and STAMPEDE trials, the patient was treated with: • Goserelin (Zoladex) 10.8 mg subcutaneously every 12 weeks • Abiraterone acetate 500 mg orally daily • Prednisolone 5 mg daily • Denosumab 120 mg every month, supplemented with calcium and vitamin D Treatment was generally well tolerated with no greater than grade 1 fatigue (CTCAE grade 1), which was managed conservatively. Response at 3 months: • PSA fell to 2.1 ng/mL (94.5% reduction) The PSA response over time is depicted in Supplementary Figure S1. • Body weight became normal at 72 kg (BMI 24) • Symptoms entirely resolved The PSA response over time is depicted in Supplementary Figure S1. Discussion This patient fulfilled a number of criteria for hereditary prostate cancer: age at diagnosis of less than 55, Gleason score ≥ 8, and positive family history. Evidence of a pathogenic BRCA2 mutation is supportive for diagnosis of HRD-associated prostate cancer, which is aggressive and sensitive to intensified AR-targeted therapy. The rapid biochemical and symptomatic response is in line with evidence from LATITUDE and PROfound trials that also revealed positive outcomes among BRCA2 mutation carriers on abiraterone-containing regimens. Familial Implications: In light of the family history and known pathogenic variant, cascade genetic testing was undertaken. No BRCA-related cancers were reported in female relatives then and hence point to male-limited penetrance within this kindred. Previous studies (Pritchard et al., Zhang et al. 2025 ) suggest BRCA2 expression can be predominantly in males in specific pedigrees. Supplementary Figure S2 is the pedigree of the family. Future Directions: NGS of the tumor and PARPi (e.g., olaparib) evaluation are planned if the cancer progresses to CRPC. Follow-up includes PSA monitoring and mpMRI every 6–12 months. Patient-reported outcomes are monitored using the EORTC QLQ-C30 quality-of-life questionnaire. Conclusion This is a demonstration of how presymptomatic germline testing for BRCA2 can inform targeted therapy and prompt cascade screening in families. The patient's strong clinical response and the willingness of his family to have cascade testing demonstrate the role of precision medicine and genetic counseling in the treatment of prostate cancer. Patient Perspective "That PSA decrease lifted me up, and screening my family feels like a step toward their safety." Declarations Ethics Statement He provided written permission for his story to be published, as per institution regulations and the Declaration of Helsinki, with respect to his dignity coming first. Funding The authors confirm that this case report was not supported by any particular grant from a public, commercial, or not-for-profit funding agency. No single grant from any funding agency. Conflict of Interest The author has no conflicts of interest related to the content of this case report. Ethics Approval This report was prepared according to the ethical standards of the institutional research ethics committee and in accordance with the 1964 Helsinki Declaration and its amendments. No ethics approval was required for this individual case report by local regulations. Conducted according to the institutional research committee. Informed Consent Informed written consent was obtained from the patient for publication of this case report and accompanying figures. The patient was assured that identifiers would be removed to ensure anonymity. Patient written informed consent. Author Contributions Yousef VatanParast: Conceptualization, Clinical Data Collection, Review of Genetic Analysis, Writing of Manuscript, Review of Literature, and Final Approval. Acknowledgments The author acknowledges with gratitude the patient and his family for their honesty and courage, and acknowledges the multidisciplinary team of caregivers who were part of this case. Data Availability ‏All data used or analyzed during this research are included in this published article and its supporting supplementary information files. ‏ Corresponding Author : Yousef VatanParast ‏ Email Address : [email protected] ‏ Consent for publication : ‏Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available to the Editor-in-Chief of this journal on request. References Fizazi K, et al. N Engl J Med. 2017;377(4):352-360. James ND, et al. Lancet. 2017;390(10095):747-757. de Bono J, et al. N Engl J Med. 2020;382(22):2091-2102. Giri VN, et al. J Clin Oncol. 2022;40(23):2539-2550. NCCN Guidelines v2.2024. EAU Guidelines 2023. Pritchard CC, et al. N Engl J Med. 2016;375(5):443-453. Zhang L, et al. Eur Urol Oncol 2025 Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterials.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProstate cancer can be indolent or aggressive. In young men, aggressive prostate cancer is frequently driven by germline mutations of the DNA damage repair (DDR) genes, primarily BRCA2. Loss of BRCA2 blocks homologous recombination (HR), promoting genomic instability and tumor progression, but at the same time sensitizing tumors to DNA-damaging treatments, including poly(ADP-ribose) polymerase inhibitors (PARPi) and intensified androgen deprivation therapy (ADT).\u003c/p\u003e \u003cp\u003eBRCA2 mutations affect not only the patient but also confer significant cancer risk to the family, including prostate, breast, and ovarian malignancies. The National Comprehensive Cancer Network (NCCN) and European Association of Urology (EAU) guidelines now recommend germline testing in men aged less than 55 years with high-grade tumors or relevant family histories. Cascade testing permits early discovery and surveillance in affected relatives.\u003c/p\u003e \u003cp\u003eHere, we describe a case of a 43-year-old man whose BRCA2 mutation informed treatment and triggered cascade screening among his relatives.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 43-year-old man presented with 3 months of frequency, urgency, nocturia, lower back pain (chronic), and 7 kg unintentional weight loss. There were no comorbidities. Digital rectal examination revealed an irregular, hard prostate. His serum PSA was 38 ng/mL (normal \u0026lt;4 ng/mL).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFamily History:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFamily pedigree is shown in Supplementary Figure S2.\u003c/p\u003e\n\u003cp\u003eHe lost his father to metastatic prostate cancer at age 68, and two paternal uncles were diagnosed with prostate cancer in their 50s. No family history of breast or ovarian cancers was reported, suggesting possible male-limited expression in this family.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDiagnostics:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e• img: Multiparametric MRI indicated a PIRADS 5 lesion with extracapsular extension and seminal vesicle invasion.\u003c/p\u003e\n\u003cp\u003e• bx: Transrectal ultrasound-guided biopsy confirmed adenocarcinoma, Gleason score 4+4.\u003c/p\u003e\n\u003cp\u003e• Staging: The CT scan and bone scan were negative for distant metastasis, staging the tumor as T3bN0M0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGenetic Analysis:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNext-generation sequencing showed a likely pathogenic BRCA2 variant (c.6501G\u0026gt;A; p.Gly2167Ser), not seen in gnomAD, and listed as likely pathogenic in ClinVar.\u003c/p\u003e\n\u003cp\u003eTherapeutic Intervention\u003c/p\u003e\n\u003cp\u003eBased on the LATITUDE and STAMPEDE trials, the patient was treated with:\u003c/p\u003e\n\u003cp\u003e• Goserelin (Zoladex) 10.8 mg subcutaneously every 12 weeks\u003c/p\u003e\n\u003cp\u003e• Abiraterone acetate 500 mg orally daily\u003c/p\u003e\n\u003cp\u003e• Prednisolone 5 mg daily\u003c/p\u003e\n\u003cp\u003e• Denosumab 120 mg every month, supplemented with calcium and vitamin D\u003c/p\u003e\n\u003cp\u003eTreatment was generally well tolerated with no greater than grade 1 fatigue (CTCAE grade 1), which was managed conservatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eResponse at 3 months:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e• PSA fell to 2.1 ng/mL (94.5% reduction)\u003c/p\u003e\n\u003cp\u003eThe PSA response over time is depicted in Supplementary Figure S1.\u003c/p\u003e\n\u003cp\u003e• Body weight became normal at 72 kg (BMI 24)\u003c/p\u003e\n\u003cp\u003e• Symptoms entirely resolved\u003c/p\u003e\n\u003cp\u003eThe PSA response over time is depicted in Supplementary Figure S1.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis patient fulfilled a number of criteria for hereditary prostate cancer: age at diagnosis of less than 55, Gleason score\u0026thinsp;\u0026ge;\u0026thinsp;8, and positive family history. Evidence of a pathogenic BRCA2 mutation is supportive for diagnosis of HRD-associated prostate cancer, which is aggressive and sensitive to intensified AR-targeted therapy.\u003c/p\u003e \u003cp\u003eThe rapid biochemical and symptomatic response is in line with evidence from LATITUDE and PROfound trials that also revealed positive outcomes among BRCA2 mutation carriers on abiraterone-containing regimens.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFamilial Implications:\u003c/h2\u003e \u003cp\u003eIn light of the family history and known pathogenic variant, cascade genetic testing was undertaken. No BRCA-related cancers were reported in female relatives then and hence point to male-limited penetrance within this kindred. Previous studies (Pritchard et al., Zhang et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) suggest BRCA2 expression can be predominantly in males in specific pedigrees.\u003c/p\u003e \u003cp\u003eSupplementary Figure S2 is the pedigree of the family.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFuture Directions:\u003c/h3\u003e\n\u003cp\u003eNGS of the tumor and PARPi (e.g., olaparib) evaluation are planned if the cancer progresses to CRPC. Follow-up includes PSA monitoring and mpMRI every 6\u0026ndash;12 months. Patient-reported outcomes are monitored using the EORTC QLQ-C30 quality-of-life questionnaire.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis is a demonstration of how presymptomatic germline testing for BRCA2 can inform targeted therapy and prompt cascade screening in families. The patient's strong clinical response and the willingness of his family to have cascade testing demonstrate the role of precision medicine and genetic counseling in the treatment of prostate cancer.\u003c/p\u003e\n\u003cp\u003ePatient Perspective\u003c/p\u003e\n\u003cp\u003e\"That PSA decrease lifted me up, and screening my family feels like a step toward their safety.\"\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHe provided written permission for his story to be published, as per institution regulations and the Declaration of Helsinki, with respect to his dignity coming first.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that this case report was not supported by any particular grant from a public, commercial, or not-for-profit funding agency.\u003c/p\u003e\n\u003cp\u003eNo single grant from any funding agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author has no conflicts of interest related to the content of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis report was prepared according to the ethical standards of the institutional research ethics committee and in accordance with the 1964 Helsinki Declaration and its amendments. No ethics approval was required for this individual case report by local regulations.\u003c/p\u003e\n\u003cp\u003eConducted according to the institutional research committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed written consent was obtained from the patient for publication of this case report and accompanying figures. The patient was assured that identifiers would be removed to ensure anonymity.\u003c/p\u003e\n\u003cp\u003ePatient written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYousef VatanParast: Conceptualization, Clinical Data Collection, Review of Genetic Analysis, Writing of Manuscript, Review of Literature, and Final Approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author acknowledges with gratitude the patient and his family for their honesty and courage, and acknowledges the multidisciplinary team of caregivers who were part of this case.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cu\u003eData Availability\u003c/u\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026rlm;All data used or analyzed during this research are included in this published article and its supporting supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u0026rlm;\u003cstrong\u003eCorresponding Author\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eYousef VatanParast\u003c/p\u003e\n\u003cp\u003e\u0026rlm;\u003cstrong\u003eEmail Address\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003e\u0026rlm;\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u0026rlm;Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available to the Editor-in-Chief of this journal on request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFizazi K, et al. N Engl J Med. 2017;377(4):352-360.\u003c/li\u003e\n\u003cli\u003eJames ND, et al. Lancet. 2017;390(10095):747-757.\u003c/li\u003e\n\u003cli\u003ede Bono J, et al. N Engl J Med. 2020;382(22):2091-2102.\u003c/li\u003e\n\u003cli\u003eGiri VN, et al. J Clin Oncol. 2022;40(23):2539-2550.\u003c/li\u003e\n\u003cli\u003eNCCN Guidelines v2.2024.\u003c/li\u003e\n\u003cli\u003eEAU Guidelines 2023.\u003c/li\u003e\n\u003cli\u003ePritchard CC, et al. N Engl J Med. 2016;375(5):443-453.\u003c/li\u003e\n\u003cli\u003eZhang L, et al. Eur Urol Oncol 2025\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"BRCA2, prostate cancer early-onset, HRD, precision oncology, cascade testing, familial risk, genetic counseling","lastPublishedDoi":"10.21203/rs.3.rs-7338087/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7338087/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eGermline mutations in BRCA2 are strongly associated with young age and dangerous prostate cancer due to the lack of homologous recombination (HRD), suggesting a window for targeted therapy and emphasizing the importance of family-oriented genetic screening.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient was of Iranian origin. A 43-year-old man presented with locally advanced prostate adenocarcinoma (Gleason 4+4, T3bN0M0) harboring a pathogenic BRCA2 c.6501G\u0026gt;A mutation. He was treated with combined androgen blockade using goserelin, abiraterone, prednisolone, and denosumab, and had PSA reduction from 38 to 2.1 ng/mL over three months. This discovery led to cascade genetic testing in his relatives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThis case provides the key role of germline early testing to guide personalized therapy and initiate familial risk management strategies in hereditary prostate cancer.\u003c/p\u003e","manuscriptTitle":"High-Grade Prostate Adenocarcinoma in a BRCA2 Germline Mutation Carrier: Precision Oncology and Familial Cascade Testing: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 05:42:24","doi":"10.21203/rs.3.rs-7338087/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8cc042ee-db24-40d9-ab7a-05d1e24621d8","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-11T11:20:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 05:42:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7338087","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7338087","identity":"rs-7338087","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}

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