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Elevated PKM2 expression activates the transcription of HIF-1 and promotes the release of high mobility group box 1 (HMGB1) from activated macrophages, thereby amplifying sterile inflammation, particularly in sepsis-associated AKI, and enhancing TEC susceptibility to OS (Yang et al., 2014)

This hormone-based mechanism affects multiple metabolic pathways simultaneously, which explains its more pronounced appetite suppression compared to older medications