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Proteomic analysis of extracellular vesicles containing damaged mtDNA has revealed that the TLR4 activator ribosomal protein S3 is a key protein involved in recognizing damaged mtDNA [263]

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[DOI] [PubMed] [Google Scholar] 43.Gatt JM, et al

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While these studies were open-label and lacked a placebo control groupa notable clinical limitationthe sheer magnitude of the symptomatic improvement strongly supports the hypothesis that D-Ribose addresses a core bioenergetic deficit in these patient populations