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In the mitochondria the acetyl-CoA is diverted into the ketone synthesis pathway producing acetoacetate which, due to the elevated NADH levels, is preferentially converted to -hydroxybutyrate

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While ETC activity drives pro-ferroptotic ROS generation via electron leakage, it is also essential for anti-ferroptotic enzymes (e.g., DHODH and GPD2) that reduce mitochondrial coenzyme Q (CoQ) to ubiquinol (CoQH 2 ) (113115)