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These findings confirm that while the GLP-1 RAs do not materially increase rare adverse events such as pancreatitis and severe hypoglycaemia, gastrointestinal side effects represent a predictable and clinically relevant class effect that often limits tolerability

Interestingly, the effect of AMG on translation was enhanced during selenium restriction, suggesting that under conditions of adequate selenium, the presence of cofactors involved in Sec incorporation may protect against AMG-induced misincorporation

197 For instance, increased blood urea concentrations can alter the microbiome, resulting in the increased generation of toxic metabolites from the gastrointestinal tract as well as an increased tendency for toxins to cross the gut barrier, which can promote further kidney injury