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High doses of Put (2.5 mM) can induce mild metabolic stress, e.g., by increasing the production of HO as a byproduct of amine oxidation and shifting metabolic pathways towards proline synthesis 66

Subsequent processes convert D to calcitriol, the active form of the vitamin

Extracellular vesicles as an emerging treatment option for intervertebral disc degeneration: therapeutic potential, translational pathways, and regulatory considerations