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genotoxins released by bacteria, such as reactive oxygen species (ROS), reactive nitrogen species (RNS), and hydrogen sulfide (H2S), may have a direct cytotoxic effect ( 4.6 Bacterial microbiome affecting lower GI tract dynamics may indirectly trigger GERD The microbiome may induce reflux by affecting the lower GI tract dynamics, which in turn affects emptying

This finding suggests that p16INK4A could be involved in regulating melanocyte function in non-segmental vitiligo, possibly as a response to oxidative or inflammatory stressors in the skin microenvironment.32 Trained immunity and immune tolerance A long-term increase in innate memory function, described as trained immunity after vaccination and in other inflammatory diseases, could play a role as an enhancer and continuous trigger in the pathogenesis of vitiligo

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