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While slower than at 37 C, metabolism at 4 C favors the intracellular acidification, in turn inhibiting pH-sensitive enzymes at rate-limiting steps of glycolysis, the Rapoport-Luebering shunt, and the pentose phosphate pathway (PPP) 11,12

A 2021 paper in Cephalalgia (Schievink et al.) described the same mechanism in spontaneous CSF leaks, where low CSF volume makes patients headache-free lying down but symptomatic upright

Epidemiological evidence demonstrates a strong association between obesity and KOA, highlighting shared pathogenic mechanisms

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The development of peptide synthesis changed the field dramatically because it allowed scientists to build peptides in the lab with greater precision