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In response to OS, different metabolites oxidize highly reactive cysteine residues in KEAP1, inducing a conformational change in the KEAP1-NEDD8-CUL3-RBX1-E3 ubiquitin ligase complex, with an improper orientation of Lys residues on NRF2 [122, 158]

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The FDAs current safety page continues to cite concerns about immunogenicity, peptide impurities and limited safety data, and the agency has stated that a substance may still pose significant safety risks

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