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Accumulating evidence argues for some intrinsic metabolic defects in vitiligo melanocytes that may lead to the acquisition of a senescence-associated secretory phenotype 1,2 and perhaps activate immune cells

Small research studies and anecdotal clinical reports suggest that some people tolerate DSIP without major side effects, but standardized long-term safety studies do not exist

Thus, patients taking the agents associated with the greatest weight loss, tirzepatide and semaglutide, have the highest incidence of developing both hypocalcemia and hypercalcemia

For example, a DNA repair protein, redox factor Ref-1, was reported to promote the DNA-binding activities of several transcription factors, including HIF-1 and p53, which confers cytoprotective function under hypoxia