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Agitation-induced aggregation has been seen in numerous protein products, including recombinant factor XIII, human growth hormone, hemoglobin, and insulin (2)

2 These include: A ME/CFS-like phenotype with post-exertional malaise and impaired bioenergetics A dysautonomia/POTS-dominant presentation A mast celldriven inflammatory phenotype Persistent cardiopulmonary injury This heterogeneity explains why a single treatment approach fails