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The peptide exists in a dehydrated crystalline state where molecular motion is minimal, preventing peptide bond hydrolysis that occurs in solution

This could be caused by d-carnitine itself, or indirectly by the lipotoxicity it induced, which is the result of excess fat deposition

2 in the journal JAMA Network Open

The glucose is oxidized in the transition metal-dependent reaction (TMDR) to the ene-diol anion, which is transformed into ketoaldehydes and superoxide anions