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[4] Regulation by phosphorylation/dephosphorylation Unlike prokaryotes, in mammals the activity of the pyruvate dehydrogenase complex is also regulated by covalent modifications , namely, the phosphorylation and dephosphorylation of three specific serine residues on the α-subunit of pyruvate dehydrogenase, the enzyme that catalyzes the first and irreversible step of the overall reaction sequence

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These factors are especially true for the association between hyperhomocysteinemia and stroke