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In early sepsis, excessive ROS produced by the ETC and NADPH oxidases overwhelms antioxidant defences such as glutathione 50 , damaging mitochondrial lipids, proteins and nucleic acids

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It is essential for the initial transport of activated long-chain fatty acids across the mitochondrial membrane via the CPT system, thus governing the substrate flux available for both -oxidation and subsequent ketogenesis

Summary Integrating emerging mechanistic and clinical observations, this review synthesizes current evidence from a metabolic flux perspective

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