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Furthermore, NADPH is replenished by the isocitrate dehydrogenase (IDH1/IDH2) branch of the citric acid cycle (TCA cycle), malic enzyme (ME1), and one-carbon metabolism (such as the folate cycle) depending on cell type or nutritional status

People with heart conditions , kidney disease , diabetes , thyroid disorders , or seizure disorders should avoid L-carnitine injections unless approved by a healthcare provider