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N 1 -acetylspermine and N 1 -acetylspermidine are converted to spermidine and putrescine, respectively, by polyamine oxidase (encoded by the PAOX gene) along with the production of H 2 O 2 and 3-acetylaminopropanal (3Ac-AP or 3-AAP)

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This review synthesizes mechanistic insights from redox biology and immunometabolism to clinical trial data, proposing a framework for optimizing VC-based combination therapies while addressing critical gaps in biomarker development and dose scheduling