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Additionally, P9 induces interleukin-6 (IL-6) secretion from the intestine, which subsequently stimulates GLP-1 secretion by intestinal L-cells and pancreatic -cells, and also affects Icam2 mRNA expression, which suggests the normal expression of Icam-2 and the effects of P9 in glucose homeostasis may require IL-6 [160] (Fig

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However, if excessive irritation occurs, it may be necessary to reduce the frequency of use or discontinue use altogether