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A combined potential biomarker model with Pyroglutamic acid and Kyn/Trp ratio for TTR V30M risk prognosis Peripheral plasma pyroglutamate (PGA) is a well-established biomarker of disrupted glutathione (GSH) homeostasis [65], whereas increased indoleamine 2,3-dioxygenase 1 (IDO1 ) activity, reflected by the kynurenine/tryptophan ratio, is a recognized marker of chronic inflammatory activation [61]