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This immune activation can attack normal tissues, causing autoimmune reactions

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Moussa et al., 2008[86])

Despite this complexity, numerous studies have reached conclusions on the intricate process of ASM remodeling, which includes ASM cell proliferation and apoptosis (255, 256), dysregulation Ca2+ homeostasis (257259), excessive production of ECM components like fibronectin and collagen type I that play a role in stimulating the proliferation of human ASM cells (260264), and factors associated with immune cells, airway cells, growth factors, cytokine and inflammatory mediators (263, 265268)

There are two consecutive reactions: from ATP and pantoate to form an enzyme-bound intermediate (pantoyl adenylate), and then the intermediate is nucleophilically attacked by -alanine to produce pantothenate and AMP [183, 184]