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However, notably, TMAO also exerts protective effects by activating the Nrf2 pathway, promoting Nrf2 dissociation from Keap1 and nuclear translocation, thereby inducing antioxidant genes (HO-1, NQO1, CAT) to reduce ROS accumulation and restore antioxidant enzyme activityunderscoring Nrf2s dual regulatory role in oxidative stress (Zou et al., 2024)

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The details that made this case notable: the user was not on an aggressive protocol

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