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The depletion of amino acids at baseline in ME/CFS, coupled with their impaired glucose metabolism, could limit the availability of alternative energy sources during exertion, potentially contributing to PEM

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Using a targeted CRISPR knockout library consisting of 64 KGDDs, we discovered that Trimethyllysine Hydroxylase Epsilon (TMLHE), the first and rate-limiting enzyme in de novo carnitine synthesis, is necessary for proliferation of HR-proficient cells in the presence of DNA damaging agents

H.PuppoC.GonteroB.et al (2012a)