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The abnormal signal pathways will lead to excessive production of FFAs and ROS in adipocytes and hepatocytes, which is a milestone of the first step to develop MASH (Portincasa et al., 2024)

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A key enzyme in the anabolic utilization of ketone bodies is cytosolic acetoacetyl-CoA synthetase, which catalyses the coupling of acetoacetate to CoA in a reaction dependent on ATP with acetoacetyl-CoA as the product