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Diketopiperazine (DKP) formation is a particularly important impurity in tirzepatide and other N-terminally unprotected peptides

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In the cardiovascular system, succinate released by macrophages stimulated the production of inflammatory cytokine IL-1 by activating HIF-1, thus inducing endothelial inflammation and then promoting atherosclerosis

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However, both berberine and semaglutide have been shown in clinical trials to help cells respond better to insulin