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In 90% of hereditary cases of ALS, patients have mutations in the superoxide dismutase 1 (SOD1) enzyme which converts O 2 •− to H 2 O 2 and O 2 to protect cells from ROS, and is directly associated with oxidative stress and inflammation [180]

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Once symptoms clear, reintroduce 5-amino-1MQ at half the original dose (e.g., 25mg instead of 50mg daily) and titrate upward slowly over 2–3 weeks to assess tolerance