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Many different factors are at play

Mayatepek E, Nezu J, Tamai I, Oku A, Katsura M, Shimane M, Tsuji A: Two novel missense mutations of the OCTN2 gene (W283R and V446F) in a patient with primary systemic carnitine deficiency

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Mitochondrial iron accumulation further disrupts redox homeostasis, amplifying oxidative stress and contributing to persistent cellular injury (92)

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