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Pathophysiology In normal metabolism, the essential amino acids isoleucine, valine, methionine, and threonine as well as odd-chain fatty acids and cholesterol are degraded to propionyl-CoA at which point propionyl-CoA carboxylase would normally catalyze further conversion to methylmalonyl-CoA

According to a study by Mohamad et al., probiotic supplementation with Lactobacillus and Bifidobacterium species reduced intestinal permeability, thereby decreasing blood endotoxin levels and supporting MASLD treatment [241]

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