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Although horses can synthesize some choline endogenously, requirements may increase under metabolic stress, high performance demands, or when diets are low in methyl donors such as methionine or folate

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When endothelial NOS function is abnormal caused by pathological stimulating factors such as insulin resistance, impaired glucose tolerance and obesity, its catalytic process becomes "uncoupled," leading to the production of superoxide anion (O) instead of NO