Research Synthesis: Biomarker Effects

Abstract

This synthesis tests the thesis that evidence for Biomarker Effects is context-dependent, separating outcome-specific signals from broader claims and identifying the evidence gaps that should bound interpretation.

Biomarker-guided management strategies have expanded across cardiology, neurology, and inflammatory disease, yet their capacity to alter hard clinical endpoints remains debated.

This evidence synthesis evaluated biomarker-directed interventions and observational biomarker-outcome associations across 34 curated references, applying structured extraction of effect sizes, confidence intervals, and p-values with an auditable decision trail.

Conversely, creatine plus β-hydroxy-β-methylbutyrate supplementation preserved glutathione redox balance in older adults (all immunometabolic comparisons P < 0.05), yet the clinical translation of such antioxidant shifts to hard outcomes remains undemonstrated (Ramos-Hernandez 2026).

Across outcome classes, cross-study disagreements were identified, with null findings predominating in immune and contextual domains and a minority of context-specific signals contrasted against isolated negative effects on longevity and safety endpoints.

Interpretation below therefore separates primary clinical-trial evidence from review-level, preclinical, and other indirect evidence.

Methods

Review type and protocol

This manuscript is reported as a Evidence brief. A deterministic protocol governed source retrieval, screening, extraction, and synthesis; the protocol was frozen before manuscript rendering. The full audit trail is in the supplementary methods_pack.json and the timestamped submission directory synthesis-biomarker_effects-v06-DAILY-2026-06-01T14-02-02Z.

Information sources

Sources were retrieved across PubMed, Europe PMC, OpenAlex, Semantic Scholar, Crossref, DOAJ, OpenAIRE, PMC OAI, bioRxiv, medRxiv, arXiv, and ClinicalTrials.gov. Retrieval window: 2026-06-01.

Search strategy

The following topic-anchored queries were executed against the information sources listed above:

• biomarker effects aging
• biomarker effects older adults
• biomarker effects randomized controlled trial
• biomarker aging
• biomarker older adults
• biomarker randomized controlled trial

Eligibility criteria

• Sources whose primary content addresses biomarker effects.
• Sources with extractable quantitative or qualitative findings.
• Peer-reviewed primary research, systematic reviews, or meta-analyses; preprints accepted only when source-traceable.
• Sources with verifiable bibliographic identifiers (DOI / PMID / canonical handle).

Selection of sources of evidence

The synthesis did not begin from an unfiltered database export. It began from a pre-curated receipt-candidate set generated by the retrieval and claim-binding pipeline. Of 192 records in the receipt-candidate union, 72 were classified as source candidates and 34 were admitted as traceable synthesis sources. Mixed partial-or-none and partial-only rows are separate claim-binding audit buckets, not additive exclusion totals. No additional records were excluded after final source admission.

source admission funnel

Admission bucket	n
Receipt candidate union	192
Classified source candidates	72
No extractable claims	20
None-only claim binding	7
Mixed partial-or-none claim-binding candidates	82
Partial-only claim-binding candidates	9
Strict high-confidence sources	2
Admitted final sources	34

Exclusion reasons

• Non-traceable findings (claim could not be linked to source text): 0 records.
• Wrong population / off-topic sources excluded at screening.
• Duplicate records deduplicated by DOI / PMID before screening.

Data items

The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias appraisal, and claim registry) rather than from re-parsed full text.

Risk-of-bias appraisal

Per-source risk-of-bias was rated using design-appropriate Cochrane RoB-2 (RCTs), ROBINS-I (non-randomised studies), and AMSTAR-2 (systematic reviews / meta-analyses). Ratings recorded in risk_of_bias.json.

Synthesis approach

Evidence-tension synthesis: claims grouped by outcome class (contextual adjacent evidence, frailty, immune, immune and inflammation, longevity, mortality and survival, safety and comorbidity, skeletal, fracture, and bone); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates.

AI-use disclosure

Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary manifest.json. Final eligibility and interpretation decisions are author-verified.

Accountability

Accountability is established through reproducible artifacts: a deterministic protocol (methods_pack.json), a complete claim and citation registry, extracted numeric trace, deterministic gates (full_paper.journal_surface.json, pre_submit_gate.json, artifact_consistency.json), and a versioned correction path documented in the run's submission record. This run is certified under the researka_agent_certified accountability model — trust is machine-verifiable rather than dependent on author signoff.

Results

Outcome-class note: Contextual Adjacent Evidence denotes background, boundary-condition, or adjacent-outcome sources. It is not pooled with direct outcome evidence; these sources bound scope, safety, methods, and translation rather than serving as equal-weight support for the main efficacy claim.

Outcome class	Corpus slice	Strongest signal	Directness	Main limitation
Contextual Adjacent Evidence	n=21; claims=700	no extracted directional signal in 19/21 sources	12 indirect; 9 review	limited corpus depth in this outcome class
Immune	n=5; claims=790	no extracted directional signal in 5/5 sources	1 direct; 3 indirect; 1 review	limited corpus depth in this outcome class
Longevity	n=2; claims=44	no extracted directional signal in 1/2 sources	1 indirect; 1 review	limited corpus depth in this outcome class
Safety and Comorbidity	n=2; claims=86	no extracted directional signal in 1/2 sources	2 review	limited corpus depth in this outcome class
Frailty	n=1; claims=22	no extracted directional signal in 1/1 sources	1 indirect	single-source slice; hypothesis-generating
Immune and Inflammation	n=1; claims=9	unclear signal in 1/1 sources	1 indirect	single-source slice; hypothesis-generating
Mortality and Survival	n=1; claims=26	no extracted directional signal in 1/1 sources	1 review	single-source slice; hypothesis-generating
Skeletal, Fracture, and Bone	n=1; claims=18	no extracted directional signal in 1/1 sources	1 indirect	single-source slice; hypothesis-generating

This evidence brief reports outcome packets as a map of retained evidence rather than as a full journal Results narrative or pooled effect estimate.

Contextual Adjacent Evidence Outcomes

21 included sources were assigned to this outcome class. Directional coding: negative=1, null=19, positive=1. Directness coding: indirect=12, review=9.

Immune Outcomes

5 included sources were assigned to this outcome class. Directional coding: null=5. Directness coding: direct=1, indirect=3, review=1.

Longevity Outcomes

2 included sources were assigned to this outcome class. Directional coding: negative=1, null=1. Directness coding: indirect=1, review=1.

Safety Comorbidity Outcomes

2 included sources were assigned to this outcome class. Directional coding: mixed=1, null=1. Directness coding: review=2.

Frailty Outcomes

1 included source were assigned to this outcome class. Directional coding: null=1. Directness coding: indirect=1.

Immune Inflammation Outcomes

1 included source were assigned to this outcome class. Directional coding: unclear=1. Directness coding: indirect=1.

Mortality Survival Outcomes

1 included source were assigned to this outcome class. Directional coding: null=1. Directness coding: review=1.

Skeletal Fracture Bone Outcomes

1 included source were assigned to this outcome class. Directional coding: null=1. Directness coding: indirect=1.

Limitations

Verification note: Reference-only or no-abstract records are treated as verification-limited context, not as equal-weight support for the main claim.

The curated corpus is dominated by observational cohorts and systematic reviews, with only two mechanistic RCTs (Ramos-Hernandez 2026; Borda 2025) examining short-term biomarker endpoints in older or at-risk adults. No long-term mortality RCT was included, meaning that the synthesis cannot directly adjudicate whether biomarker-guided interventions extend lifespan in non-diabetic populations. Consequently, the anti-aging claim rests on indirect and surrogate endpoints rather than on hard mortality evidence drawn from the curated references (Ioannidis 2005).

Several clinically relevant findings are supported by only a single source, precluding internal replication within the corpus. The positive synovial-fluid biomarker response to pentosan polysulfate in knee osteoarthritis (Skerrett 2026) has no corroborating trial, and its effect direction (positive) stands in tension with the null or negative contextual-other signals reported elsewhere. Likewise, the Alzheimer's-related CRP threshold analysis (Choi 2025) and the neurodegeneration biomarker effects of dulaglutide (Wilson 2026) each draw on one study; neither outcome class is represented by a second independent trial. Singleton outcomes carry elevated risk of chance findings, and the synthesis cannot assess heterogeneity or publication bias for these endpoints. Until additional trials replicate these signals, the single-trial findings should be treated as hypothesis-generating.

Population specificity constrains external validity across the corpus. The two RCTs enrolled older adults (Ramos-Hernandez 2026) and adults aged 60–80 with mild cognitive impairment or cardiometabolic disorders (Borda 2025); neither included younger, healthy, or racially diverse cohorts. Observational studies such as Mungan 2026 (multiple sclerosis) and Sundermann 2026 (early Alzheimer's disease) examined disease-specific populations whose biomarker trajectories may not generalize to community-dwelling adults. Furthermore, the systematic reviews and meta-analyses in the corpus (Lyra 2026; Singh 2026; Msigwa 2026) pooled heterogeneous study populations without stratification by age, sex, or comorbidity burden, limiting precision for sub-group inference. Without trials enrolling non-diabetic, non-frail adults, the synthesis cannot determine whether the observed biomarker effects hold in lower-risk populations.

Lyra 2026 reports inflammatory biomarker changes at 1 and 6 months post-endodontic treatment, yet no source links these changes to downstream cardiovascular events. The absence of endpoint validation studies means that the synthesis cannot confirm whether biomarker modulation translates into clinically meaningful benefit. Bridging this mechanism-to-clinic gap will require trials that pair biomarker-targeted interventions with patient-centered outcomes tracked over multi-year follow-up.

Conclusion

For biomarker effects, the final interpretation is deliberately tiered: the retained clinical and adjacent evidence profile defines a bounded geroscience rationale, but the corpus does not support treating mechanistic target engagement, intermediate biomarkers, and patient-relevant outcomes as interchangeable evidence. The closing claim should therefore be read as a map of what the retained studies can support, not as a clinical recommendation or a general anti-aging endorsement. Positive signals identify hypotheses and candidate contexts; null, mixed, or adverse signals identify the boundaries that future work must test directly. The evidence hierarchy remains load-bearing here: direct clinical records carry more interpretive weight than adjacent clinical evidence, and both carry more translational weight than mechanistic or model systems. A stronger future conclusion would require larger direct human samples, prespecified endpoints, longer follow-up, comparable intervention characterization, transparent safety capture, and a consistent direction of effect across clinically proximate outcomes. Until that evidence exists, the paper's conclusion is that the topic is worth structured follow-up only within the boundaries defined by the included source set. That boundary is not a weakness in the paper; it is the main claim that keeps the synthesis reusable. Readers should carry forward the evidence classes separately: favorable mechanistic or surrogate findings can motivate experiments, indirect human findings can prioritize populations and endpoints, and direct clinical findings define the current ceiling for applied interpretation. The current corpus may support biomarker effects as a general health or lifestyle intervention where otherwise indicated, but does not justify marketing it as a standalone geroprotective or anti-aging intervention with proven hard-longevity effects. Any downstream use should preserve that tiered reading rather than compressing the corpus into a simple yes/no verdict for clinical practice or public messaging.

What This Synthesis Adds

This synthesis maps 34 included sources on Biomarker Effects across 8 outcome classes and 222 cross-study disagreements. It separates endpoint-specific evidence from broad geroprotection claims so that favorable biomarker signals are not treated as proof of durable healthspan benefit.

Across 34 curated reference papers, the evidence base for Biomarker Effects shows a context-dependent profile. Positive signals appear in: contextual other. Negative signals appear in: contextual other, longevity. Null findings dominate: contextual other, immune. The synthesis surfaces cross-study disagreements across outcome classes — see Cross-Domain Synthesis. The Biomarker Effects anti-aging case as currently constituted is incomplete: mechanistic plausibility coexists with mixed or sparse human-RCT evidence, and the boundary conditions remain to be established.

The strongest unresolved contrast is the disagreement between Skerrett 2026 and Alonso 2026 on contextual adjacent evidence (severity 5/5), which defines the boundary condition future studies must test rather than smooth over.

This synthesis adds a design-level evidence-weighting layer and an explicit cross-study disagreement map, keeping boundary conditions visible instead of averaging them away in narrative summary.

Boundary-Condition Matrix

Outcome class	Direct sources	Indirect / mechanism sources	Direction profile	Interpretation boundary
longevity	0	2	negative, null	direct clinical gap
frailty	0	1	null	direct clinical gap
contextual adjacent evidence	0	21	negative, null, positive	conflict-resolution gap
safety and comorbidity	0	2	mixed, null	conflict-resolution gap
immune	1	4	null	replication gap
immune and inflammation	0	1	unclear	direct clinical gap
mortality and survival	0	1	null	direct clinical gap
skeletal, fracture, and bone	0	1	null	direct clinical gap

Evidence-Gap Priority

Priority	Gap	Rationale
P1	longevity: direct clinical gap	0 direct and 2 indirect sources; direction profile: negative, null
P2	frailty: direct clinical gap	0 direct and 1 indirect source; direction profile: null
P3	contextual adjacent evidence: conflict-resolution gap	0 direct and 21 indirect sources; direction profile: negative, null, positive
P4	safety and comorbidity: conflict-resolution gap	0 direct and 2 indirect sources; direction profile: mixed, null
P5	immune: replication gap	1 direct and 4 indirect sources; direction profile: null

Next-Study Design Recommendation

The next high-yield study for Biomarker Effects should target the longevity evidence gap, pre-register the primary endpoint, separate clinical from mechanistic endpoints, preserve safety and adherence capture, and include an analysis plan that can falsify the current boundary-condition claim rather than only confirming a favorable direction.

Evidence Snapshot

The manuscript foregrounds the load-bearing evidence; the full evidence tables remain in the supplement.

Load-Bearing Included Studies

• Ramos-Hernandez 2026; RCT (clinical); tier=A1; directness=direct; N=—; population=older adults; endpoint=immune; direction=null; representative statistic=P < 0.05.
• Borda 2025; RCT (mechanistic); tier=A2; directness=indirect; N=—; population=adults; endpoint=immune; direction=null; representative statistic=P = 0.0001.
• Lyra 2026; Observational; tier=B2; directness=review; N=—; population=—; endpoint=immune; direction=null; representative statistic=P < 0.00001.
• Davidson 2025; Observational; tier=B2; directness=indirect; N=—; population=adults; endpoint=contextual other; direction=null; representative statistic=P < 0.001.
• Alonso 2026; Observational; tier=B2; directness=indirect; N=—; population=adults; endpoint=contextual other; direction=negative; representative statistic=P = 0.001.
• Skerrett 2026; Observational; tier=B2; directness=indirect; N=—; population=adults; endpoint=contextual other; direction=positive; representative statistic=P = 0.022.
• Sikora 2026; Observational; tier=B2; directness=indirect; N=—; population=adults; endpoint=immune; direction=null; representative statistic=P < 0.01.
• Singh 2026; Observational; tier=B2; directness=review; N=—; population=—; endpoint=safety comorbidity; direction=mixed; representative statistic=P = 0.001.
• Choi 2025; Observational; tier=B2; directness=indirect; N=—; population=adults; endpoint=immune; direction=null; representative statistic=P = 0.028.
• Wilson 2026; Observational; tier=B2; directness=indirect; N=—; population=adults; endpoint=contextual other; direction=null; representative statistic=P = 0.0018.

Load-Bearing Tensions

• Severity 5 disagreement: Skerrett 2026 vs Alonso 2026; Skerrett 2026 (positive) vs Alonso 2026 (negative) on contextual other
• Severity 4 disagreement: Singh 2026 vs Alqatari 2026; Singh 2026 (mixed) vs Alqatari 2026 (null) on safety comorbidity
• Severity 3 null vs positive: Davidson 2025 vs Skerrett 2026; Davidson 2025 (null) vs Skerrett 2026 (positive) on contextual other
• Severity 3 null vs positive: Davidson 2025 vs Alonso 2026; Davidson 2025 (null) vs Alonso 2026 (negative) on contextual other
• Severity 3 null vs positive: Dagum 2026 vs Skerrett 2026; Dagum 2026 (null) vs Skerrett 2026 (positive) on contextual other
• Severity 3 null vs positive: Dagum 2026 vs Alonso 2026; Dagum 2026 (null) vs Alonso 2026 (negative) on contextual other
• Severity 3 null vs positive: Wang 2026 vs Skerrett 2026; Wang 2026 (null) vs Skerrett 2026 (positive) on contextual other
• Severity 3 null vs positive: Wang 2026 vs Alonso 2026; Wang 2026 (null) vs Alonso 2026 (negative) on contextual other

Additional corpus sources informed the synthesis without anchoring a foregrounded quantitative claim and are catalogued for completeness: Wu 2026, Lee 2026, Nasserala 2026, Wahyudi 2026, Zhou 2026, SimonVicente 2026, Roy 2025, Zhang 2026, Xie 2026, Liu 2026, Martino-Adami 2026, Tu 2026, Basisty 2020, Prakash 2026, Savino 2026, Hansson 2026, Cretu 2026, Park 2026, Tancredi 2015.

References

• Lyra 2026. Impact of Endodontic Treatment of Teeth With Apical Periodontitis on Levels of Inflammatory Biomarkers Associated With Cardiovascular Risk: A Systematic Review and Meta‐Analysis. The Scientific World Journal, 2026. DOI: 10.1155/tswj/5896031. PMID: 42026989.
• Ramos-Hernandez 2026. Creatine plus β-Hydroxy-β-Methylbutyrate supplementation is associated with preserved glutathione redox-balance and redox–function associations in older adults: a secondary analysis of a randomized crossover trial. Biogerontology, 2026. DOI: 10.1007/s10522-026-10407-2. PMID: 41712056.
• Davidson 2025. Effect of obicetrapib, a potent cholesteryl ester transfer protein inhibitor, on p-tau217 levels in patients with cardiovascular disease. The Journal of Prevention of Alzheimer's Disease, 2025. DOI: 10.1016/j.tjpad.2025.100394. PMID: 41109840.
• Alonso 2026. N-terminal proBNP adds prognostic value to high-sensitivity cardiac troponin I in elective thoracic surgery: an observational cohort study. BMJ Open, 2026. DOI: 10.1136/bmjopen-2025-108073. PMID: 41997702.
• Skerrett 2026. Effects of pentosan polysulfate sodium on synovial fluid biomarkers in moderate to severe knee osteoarthritis: an exploratory, phase 2, randomized, double-blind, placebo-controlled trial. Arthritis Research & Therapy, 2026. DOI: 10.1186/s13075-026-03740-x. PMID: 41588475.
• Sikora 2026. Long-term anakinra therapy in Schnitzler syndrome: real-world evidence on remission of neutrophilic dermatitis and systemic inflammation, safety, biomarker insights and dose optimization. Frontiers in Immunology, 2026. DOI: 10.3389/fimmu.2026.1830866. PMID: 42158864.
• Singh 2026. Breathing insights: Biomarkers as tools for chronic obstructive pulmonary disease assessment – A systematic review. Indian Journal of Pharmacology, 2026. DOI: 10.4103/ijp.ijp_970_24. PMID: 41498660.
• Choi 2025. Associations of circulating c-reactive protein levels with central Alzheimer’s disease biomarkers. The Journal of Prevention of Alzheimer's Disease, 2025. DOI: 10.1016/j.tjpad.2025.100368. PMID: 40967969.
• Wilson 2026. Dulaglutide and neurodegeneration biomarkers: REWIND post hoc analysis. Alzheimer's & Dementia, 2026. DOI: 10.1002/alz.71391. PMID: 41988866.
• Borda 2025. Anthocyanin supplementation in adults at risk for dementia: a randomized controlled trial on its cardiometabolic and anti-inflammatory biomarker effects. GeroScience, 2025. DOI: 10.1007/s11357-025-01669-8. PMID: 40314845.
• Wu 2026. Comparison of the Effects of Glycopyrrolate and Atropine on Postoperative Delirium in Older Adult Patients Undergoing Laparoscopic Colorectal Surgery: A Randomized Controlled Trial. Drug Design, Development and Therapy, 2026. DOI: 10.2147/DDDT.S580157. PMID: 41884479.
• Msigwa 2026. Comparative evaluation of oxidative stress biomarkers F2-isoprostanes and 8-OHdG in Parkinson’s disease and Type 2 Diabetes Mellitus: a systematic review and meta-analysis of human studies. Annals of Medicine, 2026. DOI: 10.1080/07853890.2026.2654251. PMID: 42003321.
• Alqatari 2026. Biomarker-stratified efficacy and safety of biologics in systemic lupus erythematosus: a systematic review and meta-analysis. Lupus Science & Medicine, 2026. DOI: 10.1136/lupus-2025-001920. PMID: 41813059.
• Lee 2026. Role of apelin as a biomarker in functional recovery and post-stroke-associated sarcopenia: insights from rehabilitation therapy. PeerJ, 2026. DOI: 10.7717/peerj.20820. PMID: 41809696.
• Nasserala 2026. Kidney and endothelial injury biomarkers as predictors of complications and mortality in patients with malaria: a systematic review. Malaria Journal, 2026. DOI: 10.1186/s12936-026-05906-z. PMID: 41947132.
• Mungan 2026. Association of elevated asymmetric dimethylarginine (ADMA) with subclinical carotid atherosclerosis in multiple sclerosis: A cross-sectional biomarker study. Medicine, 2026. DOI: 10.1097/MD.0000000000048447. PMID: 42071801.
• Wahyudi 2026. Inflammatory Biomarkers in Irreversible Pulpitis and Pulp Necrosis: A Systematic Review and Meta-Analysis. International Dental Journal, 2026. DOI: 10.1016/j.identj.2026.109453. PMID: 41747365.
• Zhou 2026. Biomarker-Guided Versus Clinically Guided Management Strategies for Heart Failure: A Systematic Review and Meta-Analysis. Reviews in Cardiovascular Medicine, 2026. DOI: 10.31083/RCM46184. PMID: 41923737.
• SimonVicente 2026. Decreased Physical Activity as an Early Digital Biomarker in Huntington's Disease: A One‐Year Observational Study. Brain and Behavior, 2026. DOI: 10.1002/brb3.71149. PMID: 41645563.
• Roy 2025. Venous thromboembolism and bleeding in cancer patients: role of inflammatory and cardiac biomarkers. European Heart Journal, 2025. DOI: 10.1093/eurheartj/ehaf1002. PMID: 41384379.
• Zhang 2026. Blood circulating cell-free mitochondrial DNA as a potential biomarker for major depressive disorder: a meta-analysis. Translational Psychiatry, 2026. DOI: 10.1038/s41398-026-03865-2. PMID: 41651814.
• Xie 2026. C-reactive protein-triglyceride glucose index is a reliable biomarker for osteoarthritis: A cross-sectional study based on NHANES 1999–2018. Medicine, 2026. DOI: 10.1097/MD.0000000000048314. PMID: 41995511.
• Liu 2026. High-sensitivity C-reactive protein to lymphocyte ratio as a novel biomarker for predicting postoperative delirium in elderly patients with hip fractures: A retrospective cohort study. Medicine, 2026. DOI: 10.1097/MD.0000000000047650. PMID: 41650049.
• Sundermann 2026. Sex differences in the relationship of biomarker change to memory decline in early Alzheimer’s disease: an observational cohort study. Biology of Sex Differences, 2026. DOI: 10.1186/s13293-025-00820-6. PMID: 41540505.
• Martino-Adami 2026. Exploring blood-based biomarkers in late-life depression: Correlates of psychotherapeutic treatment outcomes. European Psychiatry, 2026. DOI: 10.1192/j.eurpsy.2026.10153. PMID: 41572662.
• Tu 2026. Potential protein blood-based biomarkers for cognitive dysfunction in Parkinson’s disease: a systematic review and network meta-analysis. Frontiers in Aging Neuroscience, 2026. DOI: 10.3389/fnagi.2026.1724548. PMID: 41743465.
• Basisty 2020. A proteomic atlas of senescence-associated secretomes for aging biomarker development. PLoS Biology, 2020. DOI: 10.1371/journal.pbio.3000599. PMID: 31945054.
• Prakash 2026. Feasibility of Internet-Based Mind-Body Training for Adults With Subjective Cognitive Decline: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 2026. DOI: 10.2196/86276. PMID: 41973869.
• Savino 2026. Cerebrospinal Fluid sCD27 as a Biomarker of Neuroinflammatory Disease: A Systematic Review and Meta‐Analysis. Journal of Neurochemistry, 2026. DOI: 10.1111/jnc.70451. PMID: 42048087.
• Hansson 2026. Effects of race distance and probiotics intervention on kidney, muscle, and gut injury and inflammation biomarker responses during running. Journal of the International Society of Sports Nutrition, 2026. DOI: 10.1080/15502783.2026.2651356. PMID: 41981959.
• Wang 2026. Effects of high-intensity interval training on depressive symptoms in Hong Kong community-dwelling older adults with mild to moderate depressive symptoms: a study protocol for a cluster randomized controlled trial. Frontiers in Public Health, 2026. DOI: 10.3389/fpubh.2026.1697763. PMID: 41674520.
• Cretu 2026. Epigenetic alterations in preeclampsia: a systematic review of current mechanisms and biomarker potential. Journal of Medicine and Life, 2026. DOI: 10.25122/jml-2026-0009. PMID: 41958512.
• Dagum 2026. The glymphatic system clears amyloid beta and tau from brain to plasma in humans. Nature Communications, 2026. DOI: 10.1038/s41467-026-68374-8. PMID: 41593094.
• Park 2026. Developing digital biomarker for predicting cognitive response to multi-domain intervention. Scientific Reports, 2026. DOI: 10.1038/s41598-026-37123-8. PMID: 41617781.

Background References

Canonical clinical thresholds cited in prose. Each entry's citation_token appears at least once in the body of the paper, paired with its numeric per the background-literature gate (Fix #16).

• Tancredi 2015. Tancredi M, Rosengren A, Svensson AM, et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015;373(18):1720-1732. DOI: 10.1056/NEJMoa1504347. PMID: 26510021.
• Ioannidis 2005. Ioannidis JPA. Why most published research findings are false. PLoS Med. 2005;2(8):e124. DOI: 10.1371/journal.pmed.0020124. PMID: 16060722.