Recent studies have found that koumine improves the composition of the GM, primarily by increasing the abundance of Lactobacillus johnsonii and Muribaculaceae, thereby upregulating heme oxygenase-1 (HO-1), B-cell lymphoma-2, and Nrf2 while downregulating Bax, NF-B, and TLR4, and consequently mitigating Concanavalin A-induced autoimmune hepatitis via the gut-liver axis [133]
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Fine-tuning doses to balance efficacy against adverse effects optimizes long-term outcomes
It suggests that many patients may be escalated to higher doses by default, and that structured support, dose personalisation, and behavioural coaching could offer a more sustainable model
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