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The impurity caused by the interaction between B12 and compounded tirzepatide is concerning because nothing is known about its short- or long-term effects in humans, the potential impact on the drugs interaction with the GLP-1 and GIP receptors, toxicity, immune reactions, or how it is absorbed, distributed, metabolized and eliminated

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This effect was likely due to decreased expression of transcription factors that regulate fatty acid and triglyceride synthesis, such as PPAR and SREBP-1c , as well as lipid absorption genes CD36 and FABP6

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