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As can be seen in Figure 2, NAD + relies on the CD38/CD203a tandem and CD73 ectonucleotidase to activate a discontinuous multicellular pathway for ADO production, as detected in plasma aspirates from myeloma BM ( The cyclic nucleotide cAMP signaling pathway is a third alternative route to the production of extracellular ADO (Figure 1)

From there, our experienced providers will work with you to personalize a plan based on your health goals and how your body responds

Acknowledgments We thank our patient and his family for allowing us to share this case