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Furthermore, a meta-analysis of multiple studies confirmed that ALA, when combined with other therapies, such as epalrestat, exhibited superior efficacy in improving nerve conduction velocities and reducing neuropathic pain (Zhao et al., 2018)

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Based on further evidence found in HEK cells, it appears that a mechanism that depends on Gq might trigger the activation of protein kinase C (PKC) and ERK 1/2