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Poor CYP2D6 metabolizers already have reduced clearance capacity adding another compound that requires hepatic processing can amplify side effects of both the drug and the peptide

Across different organs, protein-bound lysine is methylated to form -N-trimethyllysine in a reaction catalyzed by specific lysine methyltransferases that use S-adenosyl-methionine (derived from methionine) as a methyl donor

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