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Its mechanism of action has been attributed to the suppression of proteolytic bacteria, by favoring an increase in acidophilic bacteria (e.g., Lactobacillus) and ammonia ion uptake, thanks to the acidification of the content of the colon (the increase in bowel movement rhythm and osmotic effect due to reduced pH) and bacterial nitrogen metabolism alteration, stimulating the use of ammonia by those bacteria for protein synthesis.47 All those mechanisms explain its efficacy.48,49 A series of randomized clinical trials (RCTs),50–53 as well as observational studies, have shown the benefit of lactulose compared with the absence of therapy, albeit there are no truly double-blind studies, given that it is extremely difficult to blind the laxative effect and the typical sweet taste of lactulose

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Reprogramming of lipid metabolism in the treatment of COPD Reprogramming of lipid metabolism is involved in the pathogenesis of COPD through immune cells Immune cells are distributed throughout immune organs and various parts of the body, playing roles in maintaining tissue and organ homeostasis, as well as resisting pathogen invasion