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Gut microbe-derived metabolites such as ROS and lipopolysaccharides can leak into the body circulation via a bidirectional microbe-gut-brain axis communication system, and these neurotoxin releases from the gut microbiota can elicit an inflammatory response and cross the bloodbrain barrier to modulate neuronal activity, and neuroinflammation has been implicated in the pathogenesis of diabetes mellitus and its associated cognitive dysfunction (124)

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Taken together, these results do not support major alterations in somatotropic axis function as the primary mechanism underlying Sema's growth-inhibitory effects in stunted juveniles