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By contrast, during oxidative stress, Nrf2 dissociates from Keap1, translocates to the nucleus, forms a heterodimer with small musculoaponeurotic fibrosarcoma oncogene homolog proteins and binds to ARE, thereby enhancing the transcription of antioxidant genes (6365)

A 2023 review in The Lancet Diabetes & Endocrinology described these adaptations as "the biological basis for weight regain" and noted that pharmacotherapy must overcome these signals continuously to maintain weight loss 10

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