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In apoptosis, -sitosterol upregulates pro-apoptotic factors such as p53 and Bax, while downregulating anti-apoptotic proteins such as Bcl-2, leading to an increase in mitochondrial outer membrane permeability and the activation of key apoptotic enzyme cascades such as caspase-9 and 3, which induces programmed cell death (83)

In a subgroup of 98 people with non-alcoholic fatty liver disease (NAFLD) in the latter trial, liver fat content normalized in 90% at the highest dose of retatrutide