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5 Challenges and future directions Despite compelling mechanistic insights and promising early-phase interventions, there are several challenges in translating perioperative mitochondrial immunomodulation into standard clinical care: 5.1 Timing and deliverability Many mitochondrial-protective strategies are highly time-sensitive

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Growth of the mdh mutant on L-malate was still possible due to the presence of an L-malate dehydrogenase as part of the TCA cycle