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The precise regulation of ALS pathogenetic mechanisms is still elusive, despite the abundance of identified mechanisms mediating MN degeneration and death, including neuroinflammation, glutamate excitotoxicity, altered RNA metabolism, mitochondrial dysfunction, impaired cytoskeletal integrity, altered axonal transport dynamics, OS [71, 84, 85]

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Independent laboratory testing of gray-market products has documented bacterial endotoxin contamination sufficient to trigger septic reactions, heavy metal and solvent residues from manufacturing, and in some products less than half the labeled peptide dose