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All three are actively transported into proximal tubular cells via organic anion transporters (OAT1/3), where they trigger oxidative stress through NADPH oxidase activation and reactive oxygen species (ROS) generation (115, 124)

doi:10.1111/dom.15211 189

These results remain heterogeneous depending on cellular models and concentrations used, which probably reflects the peptide's pleiotropic complexity rather than a single linear mechanism