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By kinetic analysis of single, double, and triple mutants, as well as from studies of reaction products, it was established that the enzyme A216H catalyzes the hydrolysis of the thiol-ester substrate by a mechanism that includes an acyl intermediate at the side chain of Y9

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Theories include: Rapid weight loss releasing stored toxins into the bloodstream Nutrient deficiencies from reduced appetite Key Fact: Neuropathy from diabetes itself remains far more common than drug-induced cases

JACC Basic Transl Sci 4:575591 Tochiya M, Makino H, Tamanaha T, Matsuo M, Hishida A, Koezuka R, Ohata Y, Tomita T, Son C, Miyamoto Y, Yasuda S, Hosoda K (2020) Effect of tofogliflozin on cardiac and vascular endothelial function in patients with type 2 diabetes and heart diseases: A pilot study