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This occurs because TGF- disrupts mitochondrial quality control: it inhibits critical mitophagy pathways via Aldose Reductase and suppresses antioxidant enzymes (e.g., the SIRT3/SOD2 pathway)

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Figure 5.4: Psychopathological and psychosocial assessment Table 5.2: Indications for specific diagnostic tests for ED and the specific diagnostic tests 5.5.6