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Pooled Effect-Size Between-studies heterogeneity was not significant for VR ( I 2 = 12.8%, Cochran's Q = 24.14, p = 0.19) and CVR ( I 2 = 0%, Cochran's Q = 14.33, p = 0.76) estimates, but as expected, for SMDH there was a significant between-studies heterogeneity ( I 2 = 47.4%, Cochran's Q = 37.15, p = 0.008)

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Metabolic by-products can be chemically reactive, binding to proteins, DNA, and enzymes, leading to functional changes or triggering immune responses by forming immunogenic haptens

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This combination will improve results and reduce oxidative stress, lowering the chance of immune-related side effects