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Meanwhile, hypoxia activates the HIF-1/PDK4 axis, which inhibits PDH activity and elevates mitochondrial membrane potential(MMP), suppressing the TCA cycle while enhancing glycolysis and lactate production, ultimately driving VSMC cell cycle progression and proliferation [86]

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However, the transfusion of stored red blood cells plays a negative role in the regenerative process through increased Mhem activation following PHx