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Studies suggest azelaic acid's dicarboxylic structure enables multiple bioactive sites for cellular interaction, though transdermal bioavailability has historically been limited by poor water solubility

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The cause for hepatic fat accumulation in MAFLD includes increased fat accumulation in the liver from high caloric intake with persistent adipocyte derived FFA delivery and uptake by the liver, increased de novo hepatic lipogenesis, and decreased VLDL export from hepatocytes [27,152,153]