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Mechanistically, gut microbiota modulates drug metabolism through two primary pathways: direct participation via microbial enzyme synthesis and metabolite production, and indirect regulation by altering drug-metabolizing enzymes [e.g., cytochrome P450 (CYP450)] and drug transporters, thereby modifying drug bioavailability, bioactivity, or toxicity (Qiu et al., 2024)

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Whilst their primary indications relate to glycaemic control and weight management, emerging evidence suggests potential cardiovascular benefits that extend beyond these core therapeutic areas