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Microglia are also directly involved in MS by producing cytokines such as tumor necrosis factor- (TNF-) and interferon- (IFN-), superoxide (O 2- ) or nitric oxide (NO), and release of proteolytic and lipolytic enzymes, which can destroy the myelin sheath [15,18]

446 However, pathological effects emerge when immune clearance fails, leading to senescent cell accumulation and SASP-driven fibrosis in the tissue microenvironment

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Some studies associate piperine with liver damage, while others emphasize its protective effects ( Genotoxicity studies present conflicting results between in vitro assays and in vivo rodent studies