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The PDI-substrate mixed disulfide can then be resolved by nucleophilic attack from another substrate cysteine, forming a new substrate disulfide and releasing PDI again in the reduced state

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She was therefore placed on dietary restrictions, and told to decrease intake of larger fish, along with alpha lipoic acid 600 mg PO BID, and low-dose hydrocortisone in the morning and at noon (5 mg PO BID) with adaptogenic herbs (B vitamins, ashwagandha, rhodiola)