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Acknowledgements Support for VA and Centers for Medicare and Medicaid Services data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center (Project Number/Data Use Agreement ID Al-Aly-01-A-1)

However, growing evidence indicates that alternative metabolic routes such as malic enzyme 1 (ME1), isocitrate dehydrogenases (IDH1 and IDH2), and the folate cycle also significantly contribute to NADPH production, particularly under stress conditions or during metabolic reprogramming [43]

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