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Additionally, environmental factors such as iodine excess or deficiency, smoking, stress, exposure to chemicals, medications (e.g., amiodarone, interferon-), and some viral/bacterial infections can alter gene expression patterns through epigenetic mechanisms and trigger autoimmune processes

The levels of telomeric DNA in samples were quantified using qPCR, the reference gene used was the single-copy gene 36B4, with primers for both telomeric and 36B4 sequences outlined in Table 1