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This phenotype was manifested in the accumulation of lactic acid, pyruvate, and carnitine, increased alanine aminotransferase and aspartate aminotransferase levels in plasma [72], suppressed ETC activity, and reduced mitochondrial membrane potential ( m ) [79]

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Neuroimaging studies demonstrate substantial brain alterations in patients, including reduced gray matter in the medial temporal and prefrontal regions, pronounced ventricular enlargement, extensive cortical thinning and white matter abnormalities (3,4)

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The hypothalamic-pituitary-adrenal axis, oxidative stress, and inflammatory pathways are among the several possible explanations

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