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This immunomodulatory function is especially relevant in our cohort, where 93% of patients received in vivo T-cell depletion, a factor often associated with increased risk of PRCA due to reduced immune regulation [27]

In a recent study of healthy participants, sourdough's effects on postprandial glycemic and insulin responses were evaluated

The vascular endothelial growth factor (VEGF) is a key inducer in stimulating the abnormal growth of new vessels in DR, while the pigment epithelium-derived factor (PEDF), as a protective factor, can inhibit angiogenesis (88)

Clinically, such insights may pave the way for combination strategies, for example pairing JAK inhibitors with modulators of innate immune activation, thereby improving long-term repigmentation stability

However, this acute oxidative stress serves as a hormetic stimulus that triggers adaptive responses, including upregulation of endogenous antioxidant systems including glutathione synthesis