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Last, although we demonstrate that diminishing TCA cycle activity improves ER structure, diminishes UPR signaling, and alters secretory protein maturation, neither how protein folding and processing is altered nor how changes to cytosolic glutathione redox are transmitted to the ER is clear yet

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These skin changes seen with APD are notably tied to the menstrual cycle, typically worsening in the five to seven days leading up to menstruation when progesterone levels are high