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This theory includes various factors, including lipid accumulation, IR, adipose tissue dysfunction, diet and nutrition, immune responses, changes in the gut microbiome, and genetic and epigenetic factors [21]

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In addition, in vitro studies have shown that recombinant TTR amyloid aggregates are internalized by human cardiac fibroblasts, which subsequently secrete IL-6 and IL-8, providing mechanistic evidence that TTR aggregates can trigger inflammatory responses in cardiac cells [77]

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