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Stereoselective reduction by an imine reductase yields the amino acid (2S, 6S)-6-methyl-pipecolic acid ( 290 ) that is incorporated by the citrinadin NRPS into the natural product as the methylpiperidine moiety

Its vasodilatory actions have been shown to help those with hypertension and may increase the chances of fibrinolysis

A less than optimal production of red blood cells may lead to a lowered oxygen carrying capacity of the blood, resulting in poor performance and premature fatigue

Tiekou Lorinczova H, Begum G, Temouri L, Renshaw D, Zariwala MG

Results typically last six months to a year, so patients usually schedule annual refreshers to maintain optimal results