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In the first step holocarboxylase synthetase generates a biotin-AMP intermediate and in the second step the activated biotin is transferred to the carboxylase enzyme with release of AMP

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Available from: Billingsley P, Binka F, Chaccour C, Foy BD, Gold S, Gonzalez-Silva M et al (2020) A Roadmap for the development of Ivermectin as a complementary malaria vector control tool

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This led to your bile flow being too sluggish, which then led to cholesterol-based gallstones