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Protein aggregates can potentially trigger immune responses, since the immune system may recognize aggregated forms of a peptide as foreign even when it tolerates the properly folded monomer

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Additionally, when PEN2 is specifically knocked out in the gut, the ability of metformin to promote insulin and GLP-1 secretion is impaired (Ma et al., 2022)

Cross-threading or debris on threads can prevent proper sealing

Some peptides can adhere to the plastic of the syringe over time, which can alter the actual dose administered