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The most common are nausea, vomiting, diarrhea, and constipation, affecting between 20 and 40 percent of patients in the STEP and SURMOUNT trials

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Regarding histone lactylation, hypoxia stimulates broad hyper-lactylation, specifically at H3K18 and H4K5 residues, in PASMCs and lung tissues of hypoxic PH rats

A mechanism in a cell culture or a rat tendon injection is not proof of the same effect in an oral human dose