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However, critical evaluation requires acknowledging limitations: many studies lack the sample sizes and rigorous controls standard for Western regulatory purposes, independent replication has been limited, and long-term safety data in large human cohorts is lacking

Furthermore, research indicates that CPS1, the key enzyme in the urea cycle, is predominantly expressed in hepatocytes and certain renal cells, with low or absent expression in most immune cells due to the urea cycles inactivity in these cells (134, 135)