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If the manufacturing refolding process is incomplete or poorly controlled, non-native disulfide isomers can form peptides with the same molecular weight and identical sequence but different disulfide connectivity

doi: 10.7759/cureus.13424

It is also worth holding in mind the general clinical principle I raised earlier: if the musculoskeletal presentation of a patient with a known or suspected endocrine disorder does not fully match the history or mechanism, consider whether the endocrine condition may be contributing to the symptom picture

That conversion depends on liver enzymes and methyl donors such as folate