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However, there is one case report of life-threatening eosinophilic pleuropericardial effusion in an elderly woman who took a combination of 10 mg/day of biotin and 300 mg/day of pantothenic acid for two months (44)

This process involves includes many mechanisms at nanoscale (gene expression), mesoscale (changes in enzymes, ion channels, cytoskeletal proteins, receptors and secreted molecules) to macroscale (neuropathy) levels with the final common consequence of the lost retinal output to the brain (Figure 1)

Findings from preclinical studies, for example, antinociceptive activity to some extent corroborated with data from self-report studies of which among the reasons for kratom use is to manage pain, further supported by the recent randomized controlled study in humans ( FIGURE 1 Here, we highlight physiological interactions of kratom alkaloids focusing on interactions with enzymes, receptors, and cellular barriers

Funding This work was supported by the National Natural Science Foundation of China (82172656, 81902550, 81802476), and the Natural Science Foundation of Hunan Province (2021JJ40882)

Liu AX, He WH, Yin LJ, Lv PP, Zhang Y, Sheng JZ, Leung PC, Huang HF: Sustained endoplasmic reticulum stress as a cofactor of oxidative stress in decidual cells from patients with early pregnancy loss