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The melanocortin 4 receptor (MC4R) is expressed in the hypothalamus, brainstem and other brain regions and plays a pivotal role in the regulation of hunger, satiety and food preference 6

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Although studies suggested that tryptophan and its derivatives could influence the gut microbiome and interact with the gut mucosal immune system, recent clinical investigations proposed that changes in immunity and kynurenine metabolism may trigger fatigue in ME/CFS but do not sustain it over time [61, 67, 68]

H., Hung, Y

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