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5.2 Therapeutic strategies that indirectly affect SUA-related pathological processes through metabolic regulation In addition to directly reducing uric acid levels, metabolic abnormalities may indirectly influence the onset and progression of gout by altering uric acid production, excretion, and susceptibility to inflammation

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L-citrulline supplementation Rationale Oral L-arginine undergoes first-pass metabolism [38% in humans (Castillo et al., 1993)], whereas L-citrulline is converted into L-arginine via the argininosuccinate pathway, in which argininosuccinate synthase (ASS) catalyzes the formation of argininosuccinate from citrulline and aspartate

However, from week six onward, the differences between groups narrowed, with both treatments producing similar long-term results

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That regulatory status is important for patients to understand, but it should be separated from the biological research