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Slowly titrating the dose over months allows the body to clear the toxic burden without triggering a massive immune flare or severe Herxheimer reaction
The carboxylate group of carnitine forms a salt bridge with the guanidinium group of R471 (TM11), as well as a hydrogen bonding interaction with the hydroxyl of Y447 (TM10), both residues from the C-terminal bundle
Change in HbA1c shown for clinically relevant dose
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