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In the second step, the thiol group of a cytosolic coenzyme A attacks the acyl-adenylate, displacing AMP to form thioester fatty acyl-CoA

J Food Nutr Metabol

However, this approach was reconsidered due to several factors: the patient lacked classical manifestations of neurosyphilis (e.g., cognitive decline, sensory ataxia, ArgyllRobertson pupils)