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Zepbound does have a black box warning due to findings in rodent studies concerning thyroid tumors, Bruno says

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In both pathways, cysteine-dependent proteases known as caspases execute apoptotic cell death by cleaving key structural and regulatory proteins, primarily through the action of caspase-3 (CASP3) and caspase-7 (CASP7), with caspase-6 (CASP6) contributing to downstream substrate cleavage and apoptotic progression

Analytical verification requires reverse-phase HPLC with UV detection at 214-220 nm to confirm retention time consistency and peak purity above 95%, while mass spectrometry (MALDI-TOF or ESI-MS) can confirm the expected molecular ion at 1419.53 Da and identify any truncation or oxidation products

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They work on pathways like PI3K/AKT, MAPK/ERK, and JAK/STAT to promote cell survival, proliferation, and migration, all of which are required for regenerating lining and parenchyma