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However in our opinion, the low probability of MS coincidence with another rare disease, together with the animal studies where MS is never a consideration, makes it more likely that these human examples align with an inside-out model (Figure 2), where a primary biochemical derangement of myelin, coupled with an immune predisposition, culminated in a MS-like phenotype

References Gerstein HC, Sattar N, Rosenstock J et al (2021) Cardiovascular and renal outcomes with Efpeglenatide in Type 2 Diabetes

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