15 Similarly, increased generation of NAD + via the KP in resting, aged or immune-challenged macrophages restores OXPHOS and homeostatic immune responses, whereas inhibition of de novo NAD + synthesis induces an increased inflammation-associated TCA-cycle metabolite succinate and elevated mitochondria-generated ROS, resulting in rising innate immune dysfunction in aging and age-associated diseases
But they may explain why some patients heal completely while others cycle through flare after flare
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