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E1 is a thiamin pyrophosphate (TPP)-dependent -ketoacid dehydrogenase, R -lipoic acid functions as a prosthetic group essential for E2 transacetylase activity, and E3 is a flavin adenine dinucleotide (FAD)-dependent dihydrolipoamide dehydrogenase ( Figure 4 )

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These agents may be appropriate for individuals with lipedema who also meet FDA criteria for obesity treatment (BMI 30 kg/m or 27 kg/m with weight-related comorbidities) or have concurrent type 2 diabetes