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The lack of central carbon and nitrogen catabolism not only leads to energy deficiency but also reduces the supply of the main metabolite anabolic precursors such as pyruvate, acetyl-CoA, glucose-6-phosphate, and erythrose 4-phosphate used for biomass biosynthesis 21

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4 - 6 Although glutamine is synthesized endogenously under normal conditions, its levels can deplete during hypermetabolic states such as sepsis, trauma, and severe illness, which leads to its classification as a conditionally essential amino acid