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Renal carnitine loss may also affect the morphology and function of red blood cells and reduce the oxygen carrying and releasing capacity of red blood cells, thereby reducing tissue oxygen supply (including the kidney), and tissue hypoxia activates hypoxia-inducible factor 1 (HIF-1), which in turn reduces OCTN2 expression through the HIF-1-PPAR signaling pathway

Those expansion projects were driven by a multi-year commercial GLP-1 agreement requiring substantial capital investment over three years