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The carnitine shuttle becomes effectively useless if the downstream electron transport chain lacks the oxygen required to finalize ATP production, creating a compounding energy crisis that leaves patients feeling physically paralyzed by exhaustion

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A 2021 study reported motor-function recovery after focal stroke in rats (PMID 34500605), and 2018 work on phosphorylated DSIP reported restored spatial memory and improved sleep architecture in a high-altitude model (PMID 30107169)

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