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. 2022 Jun 30;59(6):2101733. doi: 10.1183/13993003.01733-2021

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Biochemical pathways underlying severe asthma observed in the current study. a) Metabolism associated with oral corticosteroid (OCS) use. b) Carnitine metabolism. Green: OCS-associated alteration in severe asthma; pink: OCS-independent alteration in asthma; blue: OCS-associated, disease-independent alteration; orange: no change observed; grey: metabolites not detected in the current study; black: notes on metabolic reactions; yellow boxes: known pathogenic mechanisms of asthma. Arrows indicate direction of change. SAM: S-adenosylmethionine; AMD1: adenosylmethionine decarboxylase; dcSAM: decarboxylated SAM; ASM: airway smooth muscle; NMDA: N-methyl-D-aspartate; OCTN: organic cation transporter novel; CoA: conenzyme A; CPT: carnitine palmitoyltransferase; CAC: carnitine-acylcarnitine carrier. ^#: shift observed via multivariate analysis only.