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Data indicate that H-FIRE induces both reversible and irreversible cell damage in a dose-dependent manner, and the existence of dose-dependent recovery mechanisms allows tumor cell proliferation (75)

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45 The second step is an irreversible rate-limiting reaction catalyzed by branched-chain α-keto acid dehydrogenase (BCKDH), which is phosphorylated and inactivated by the specific kinase BCKDH kinase (BCKDK) and dephosphorylated and activated by Protein phosphatase 1 K (PPM1K)