Recent regulatory guidance documents, such as the 2025 Australian Therapeutic Goods Administration (TGA) guidance on the quality of listed probiotic medicines and broader discussions on LBPs from 2020, underscore the necessity for strain-level identification, validated enumeration techniques, and explicit labeling of potency and storage conditions (570, 571)
Introduction Endometriosis, the presence of endometrial-like tissue (glands and stroma) outside the uterine cavity, is a chronic estrogen-dependent inflammatory disease affecting approximately 10-15% of reproductive-age women and 3550% of women with pelvic pain and/or infertility worldwide ( A complex network of molecular, cellular, and hormonal factors could help unravel the underlying pathogenic mechanism for declined reproductive outcomes of endometriosis patients ( The assisted reproductive technique (ART) is the main treatment option for endometriosis-induced infertility ( Astaxanthin (dihydroxy-4,4-dione- ,-carotene: AST), called the king of antioxidants, is a red-orange, lipid-soluble xanthophyll photo-pigmented ketocarotenoid isolated from the alga Haematococcus pluvialis with an antioxidant activity 10 times stronger than that of other natural carotenoids ( AST targets several molecules and pathways, including phosphoinositide 3-kinases (PI3K)/Akt and Janus kinase-2/signal transducer and activator of transcription-3 (JAK2/STAT3) signaling pathways, NF-B family, mitogen-activated protein kinases (MAPKs), nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1), and peroxisome proliferator-activated receptor gamma (PPAR) to efficiently modulate the dynamic oxidant: antioxidant equilibrium ( via the Nrf2/HO-1 antioxidant signaling pathway, and increases the expression of its antioxidant target genes, including the phase II biotransformation enzyme ( Furthermore, AST suppresses the expression of scavenger receptors, controlled by NFB, the main mediator of the inflammatory response through inhibiting IB- degeneration and the NF-B nuclear translocation ( via inhibition of the MAPK signaling pathway by reducing the induction and expression of extracellular-signal-regulated kinase (ERK1/2), c-Jun N-terminal kinases (JNK), and p38 MAP Kinase ( Fertility-enhancing properties of AST have been established in various in vitro and in vivo studies
Mechanistic insights explaining the overall health effects of the ketogenic state, will lead to precision nutrition for the latter diseases
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