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Meanwhile, they may have a direct effect on the efficacy of the drug

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ME2 activity is extremely abundant in synaptic mitochondria in the brain, indicating that it plays a role in the pyruvate recycling pathway and in the maintenance of intramitochondrial reduced glutathione in synaptic terminals 27

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Additionally, the activation of microglia and astrocytes in ALS leads to the production of ROS and pro-inflammatory cytokines, further exacerbating oxidative damage and motor neuron degeneration [170]