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50 Adequate cellular NAD+ is critical for normal mitochondrial function both directly through its role in oxidative phosphorylation and indirectly through activation of SIRT1 and SIRT3, which are involved in the biogenesis and degradation of damaged mitochondria

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Energy stress-mediated AMPK activation and the activation of the Nrf2 antioxidant pathway also play important roles in regulating ferroptosis, through which metformin could alleviate ferroptosis and vascular calcification in high-lipid model mice