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26 Furthermore, DUL ameliorated LPS-induced oxidative stress in H9c2 myocardial cells, 22 and attenuated TNF-α-induced oxidative stress in human fibroblast-like synoviocytes, 28 because incretin-based therapy was found to exert antioxidant effects through the upregulation of renal Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2), which augments the transcription of antioxidant enzymes that scavenge free radicals, indeed Nrf2 is a major regulator of oxidative state, enhancing cellular defenses against oxidative damage by upregulating the transcription of antioxidant enzymes