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Conducting well-powered clinical trials that utilize NAD + precursors and enzyme modulators, employing standardized endpoints such as MRI-proton density fat fraction and histological scoring, is imperative

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This finding indicates that in the minimal in vitro reconstitution system the two sites act cooperatively rather than independently: loss of one site compromises the ability of the other to promote activation

Recent developments, including the use of exosomes and gene-editing technologies, have expanded therapeutic options for OA, demonstrating efficacy across cellular, animal, and clinical models