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This paper reviews the regulatory effects of metformin on the gut microbiota, such as increasing the abundance of genus Akkermansia , enriching short-chain fatty acids (SCFAs)-producing bacterial genus, and regulating gene expression of certain genera

Physiologically, OAT4 facilitates uric acid excretion in the proximal tubule by orchestrating ion exchange processes such as PAH/Cl-, PAH/ES, and potentially PAH/UA interactions

It's a hormonal signal driven by insulin resistance, leptin dysfunction, and disrupted satiety pathways