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pylori, the formed glutamate can be taken up and converted to 2-ketoglutarate by the bacteria and channeled into the TCA cycle 21,29 , an important metabolic pathway that provides precursors for a variety of cell components, as well as for supplying energy to the bacterium 31

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Additional causes of melasma can be related to pregnancy, oral contraceptives, sunlight, heat, stress, and tanning beds