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Elevated serum zonulin levels, as well as bacterial dysbiosis and a leaky gut barrier, have been observed in patients with rheumatoid arthritis, while subclinical intestinal inflammation has been observed in patients with ankylosing spondylitis [74, 75]

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Considerations for Clinical Adoption: Evidence, Safety, and Regulatory Landscape Despite encouraging preclinical findings and increasing patient enthusiasm, the integration of peptide-based therapies in mainstream orthopaedic practice remains cautious