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Meanwhile, the gut microbiota metabolite trimethylamine N-Oxide (TMAO) can alter the pyruvate metabolism of renal cells, leading to increased lactic acid accumulation, and then through the lactylation modification of histone H4, promote macrophage M2 polarization by directly binding to the promoters of IL-10 and TGF-β, resulting renal fibrosis (Tang et al., 2025)
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