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In mice fed with a KD, pyruvate was oxidatively decarboxylated to acetyl-CoA, catalyzed by pyruvate dehydrogenase (67), and the KD led to increased levels of pyruvate in skeletal muscles (68)

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This may render patients particularly susceptible to viral reactivation, as seen with pathogens such as Epstein-Barr virus (EBV) and cytomegalovirus [59, 60]

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