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While the mechanism was scientifically sound, the safety profile of ACC inhibition presented complex challenges that became apparent during the trial phases. The 2021 data highlighted a critical hurdle for the ACC inhibitor class: the phenomenon of hypertriglyceridemia. Paradoxically, while inhibiting ACC reduces de novo lipogenesis in the liver, it can lead to an accumulation of substrates that are shunted into other pathways, resulting in elevated serum triglycerides in some patients.
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