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Key mechanisms include systemic communication, brain-kidney interactions, gut-kidney interactions, and integrated gut-brain-kidney signals (Figure 1)

doi: 10.1016/j.coph.2007.04.005 96 LiQLiaoJChenWZhangKLiHMaFet al

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The development of quasispecies may be one mechanism by which the virus escapes the hosts immune response and establishes persistent infection

20 , 34 The loss of the nerve (in)growth suppressive factors from the ECM and the concomitant presence of pathologically high levels of inflammatory cytokines stimulating release of neurotrophins enhances nociceptive sensory neuron ingrowth into the disc

For tirzepatide, the approach is similar