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GDF15 also acts centrally via the glial cell-derived neurotrophic factor family receptor alpha-like (GFRAL), potentially contributing to symptoms like fatigue, nausea, and stress in FM 30,31,32,33,34

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In a secondary sulfur metabolic pathway, APS phosphorylation catalyzed by APS kinases (APK) forms phosphoadenosine 5-phosphosulfate (PAPS) (Takahashi et al., 2011)