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It is endogenously biosynthesised in the liver and kidneys from lysine and methionine through a four-step pathway proceeding via trimethyllysine and gamma-butyrobetaine, the final hydroxylation being catalysed by gamma-butyrobetaine dioxygenase

Efficacy of MEK inhibition in a recurrent malignant peripheral nerve sheath tumor

Vollenweider et al., 2010)

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Switching from a compounded vial to an FDA-approved medication is a clinical decision