PIGR and endothelial dysfunction: Oxidative stress is another critical factor in endothelial dysfunction, as high levels of reactive oxygen species (ROS) inhibit nitric oxide (NO) production, which is essential for vascular dilation (Salisbury and Bronas, 2015) By mitigating inflammatory responses, particularly through NF-κB pathway modulation, PIGR may reduce ROS levels (Sheng et al., 2021).