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This process, mediated by a pyridoxal-5-phosphate-dependent enzyme and a glutamate/GABA antiporter, involves the decarboxylation of L-glutamate to GABA by the enzyme glutamate decarboxylase (GAD), typically expressed under acidic stress conditions [92,95,96,97]

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After injection, it is slowly broken down into water and carbon dioxide within the skin over one to two years