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Patients with NAFLD have high levels of insulin and circulating leptin, giving rise to the activation of renal mesangial cells and tubular inflammation through the COX-2 (Cyclooxygenase type 2) pathway [46]

Increased growth hormone and IGF-1 levels are among the most commonly cited benefits and may support cell repair, tissue regeneration, and fat regulation

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Since the valinomycin synthetase Vlm shows the same genetic architecture as Ces, it is tempting to speculate that the novel mechanism of non-ribosomal peptide assembly proposed in this study is not a specificity of the cereulide synthetase but a more common logic for biosynthesis of ester bond containing NRPS products, thereby contributing to biodiversity of natural depsipeptide products