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Not only does this bottleneck starve the cell of ATP, but the accumulating MMA is highly neurotoxic

Macromolecular derivatives of NAD and their application [PMID: 6998512] Laboratory literature summary: Macromolecular derivatives of NAD and their application

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On the downside, your endogenous MOTS-C levels naturally decline with age in both humans and mice, which is one reason why biological processes such as metabolic flexibility, insulin sensitivity, and mitochondrial function tend to deteriorate as you get older

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