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Author contributions ZX: Conceptualization, Data curation, Formal Analysis, Writing original draft, Writing review and editing

subtilis ribDGEABHT operon together with the genes from Enterococci and Streptococci plasmids, where the non- rib operon sequence was identical to the plasmid pSM19035 (GenBank ID: AY357120), a low-copy-number theta-replicating plasmid of Streptococcus pyogenes , stably maintained in a broad range of Gram-positive bacteria

Recognizing the timing of onset helps patients and healthcare providers distinguish between temporary side effects and more persistent issues

Titrate Up to 1 mg or 2.4 mg Weekly Based on Individual Response After patients stabilize on 0.5 mg, the next stage involves titration to higher doses such as 1 mg or, in some cases, up to 2.4 mg weekly