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DNA methyltransferase 1-mediated modifications exhibit bidirectional effects: hypermethylation of promoter regions in protective genes, such as ACTN4 (encoding -actinin-4), suppresses their expression, while hypomethylation of pro-pathogenic genes, including matrix metalloproteinase-9, enhances their transcription (67, 68)

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Meanwhile, human clinical data are generally characterized by small sample sizes and short follow-up periods, with inadequate adjustment for confounding factors such as diet and concurrent medications, making it difficult to confirm the long-term efficacy and safety of Clostridium interventions

[43] Abed AF, Jarrar YB, Al-Ameer HJ, Al-Awaida W, Lee SJ