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The keloid tissues for organ culture were firstly incubated in a DMEM containing 10% FBS at 37 C for 24 h, and the medium was replaced by the DMEM containing 2% FBS, the final concentration of 25 M FOXO4-DRI was added in the medium immediately

Phase 1: Establish tirzepatide baseline (weeks 1-4) Start tirzepatide alone at 2.5mg weekly

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Laboratory models examine how activation of noradrenergic pathways through reuptake inhibition influences basal metabolism, sympathetic nervous system activity, and adaptive thermogenesis mechanisms