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As shown in Figure 7E, compared with the DMSO group, ATT-I treatment obviously elevated the thermal stability of CA9 protein under gradient temperatures ranging from 42 C to 70 C, which experimentally confirmed the direct binding of ATT-I to CA9 protein

I suspect this is from the glucagon agonism of the drug as glucagon stimulates the formation of extra bile acids/bile salts in the liver which can be very irritating to the intestinal lining causing diarrhea