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In fact, CD38 knockout mice exhibit significant increases in both extra- and intracellular NAD + levels ( Because of its ability to use NAD + as a substrate, CD38 has been hypothesized to act as a metabolic sensor, limiting the duration of NAD + half-life and signaling in the extracellular compartment

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Mechanisms of primary and/or acquired resistance include tumor-related factors, such as reduced cell surface expression levels of the target antigen and high levels of complement inhibitors (CD55 and CD59)