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In the shuttle, glutamate is converted to glutamine in astrocytes, and then exported to neuronal system A transporters, where it is converted to glutamate intracellularly by phosphate activated glutaminase (21)

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Adjunctive approaches involving topical calcineurin inhibitors or corticosteroids in conjunction with phototherapy have yielded improved regimentation outcomes [209, 210], while emerging combinations with antioxidants and laser therapies offer additional therapeutic potential, albeit with limited clinical data to date [211]