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A prominent player in cytokine-mediated tight junction regulation is myosin light chain kinase (MLCK) 56,65,66 , which disrupts the interaction between the tight junction proteins and the actin-myosin cytoskeleton, subsequently damaging the tight junction scaffold, which is crucial for the maintenance of barrier integrity 66,67,68

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It was not a major reason for discontinuation in the trial, but it represents a side effect category that tirzepatide users do not encounter