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RhlI and RhlR are primarily responsible for the synthesis and detection of N-butanoyl-L-homoserine lactone (C4-HSL), which also promotes the transcription of RhlI, which in turn promotes the expression of virulence factors [79]
A copy of a separate letter from Carol's private consultant sent to her GP in March, however, advises giving her two injections a week, alongside folic acid and vitamin D, with a review in June following blood tests
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