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E1 is a TPP-dependent -ketoacid dehydrogenase, E2 is a dihydrolipoamide transacetylase that binds one or two lipoyl groups via covalent amide linkages to lysine residues, and E3 is an FAD-containing dihydrolipoamide dehydrogenase that re-oxidizes dihydrolipoamide using NAD +
[1] Other rare side effects noted (mostly in older literature or high-dose use) include: polycythemia vera and peripheral vascular thrombosis in patients receiving repeated injections (though these associations are not well understood, they were listed in prior product literature as possible adverse events)
They also have specialized pharmaceutical approvals that are important for peptide API supply
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