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Following the generation of acetyl-CoA by pyruvate dehydrogenase (PDH), acetyl-CoA condenses with oxaloacetate to form citrate

Tnf-mediated restriction of arginase 1 expression in myeloid cells triggers type 2 NO synthase activity at the site of infection

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Therefore, the effectiveness is reduced

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This pathological process, called insulitis, gradually destroys these vital cells, leading to lifelong use of exogenous insulin