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It is reported that in ATC, lactate accumulation promotes globally protein lactylation, especially the histone lysine lactylation, activating the expression of multiple essential genes involved in ATC including CTGF, CCNE1, CDK1, KLF2, IL1B, and AURKB [85]
Select metabolic phenotypes (for example, persistent hyperglycemia despite leanness and clean diet) may be considered case-by-case, with careful monitoring and a low threshold to stop if mood or GI issues emerge
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