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There is clinical heterogeneity among SCA3 patients, which resulted in the definition of at least 4 disease subtypes, according to their phenotypic presentation [6, 7]

pylori) or small intestine (such as SIBO)

High levels of HO inactivate protective peptides like ACTH and -MSH, while decreasing enzyme activities like methionine sulfoxide reductase, consequently intensifying oxidative damage and accelerating melanocyte death 46

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