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The adult onset presentations at 20 and 44 years included exercise intolerance and progressive muscle weakness, with gait difficulties, bilateral foot drop, and arm weakness in the older patient

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These findings indicate that lipid peroxidation products like 4-HNE contribute to high-fatinduced cardiomyocyte damage and that activation of the AMPK signaling pathway may serve as a protective mechanism against such oxidative stress (Yun et al., 2025)

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This activates a signaling pathway within the cell that promotes the expression and synthesis of collagen genes