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Among patients who do fill their first script, an additional 36% discontinue after just one fill, a phenomenon known as "one & done" or non-persistent patient behavior

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A similar phenomenon has been observed in experimental models succinate accumulation activates HIF-1, further enhancing glycolysis and pro-inflammatory factor release to accelerate alveolar destruction ( 4.2.2 Key cytokines and metabolic substrate abnormalities Matrix metalloproteinases (MMP-9, MMP-12) are secreted by macrophages and neutrophils to directly degrade elastic fibers of alveolar walls

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