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Alternatively, acetylcarnitine, produced in excess in mitochondria by CrAT, is transported into cytosol by CACT and enters the nucleus, where a nuclear CrAT converts the acetylcarnitine to acetyl-CoA 67 , and it becomes a source of acetyl groups for histone acetylation

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Elevated serine/threonine phosphorylation of IRS-1 and IRS-2 inhibits their binding to the juxtamembrane region of the insulin receptor and impairs their ability to undergo insulin-induced tyrosine phosphorylation