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Through neural, immune, endocrine, and metabolic signaling pathways, the gut microbiome can influence brain physiology, while the brain can in turn modulate gut microbial composition via stress hormones and autonomic innervation [11, 12]

Progressive axonal loss in the lesions, an inability of demyelinated axons to interact with myelinating cells [33], or the presence of myelination inhibiting factors in the extracellular space [204] may additionally impair the capacity of remyelination

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