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Acetate is reported in high concentrations in systemic circulation and functions as a versatile metabolite in a myriad of cellular pathways, including, but not limited to, mitochondrial energy metabolism, reactive oxygen species (ROS) metabolism, lipogenesis and histone-and lysine acetylation (Peng et al., 2013

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The GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide) and the GIP/GLP-1 dual agonist tirzepatide sit behind the STEP (NEJM, 2021), SURMOUNT (NEJM, 2022), and SURMOUNT-OSA (NEJM, 2024) evidence, and the clinical picture does not change with the price tag

Elevates NAD+ and S-adenosylmethionine (SAM) levels, shifting metabolic flux toward energy expenditure and away from fat storage 1-4