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In the elderly, hypothyroidism is associated with accelerated cognitive decline and an increased risk of Alzheimer's disease, raising the possibility that impaired thyroid signaling may act as a modifiable risk factor for dementia (83)

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Taken together, Akkermansia muciniphila may exert a double-edged sword effect on the homeostasis of the gut-joint axis through changes in its abundance: at moderate levels, it enhances intestinal barrier function and inhibits inflammation, while dysbiosis (either excessive or insufficient abundance) exacerbates the pathological progression of OA by disrupting mucus layer integrity and promoting toxin translocation