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Costantini TW, Deree J, Peterson CY, et al

Additionally, PKM2 activation promotes the activity of eukaryotic translation initiation factor 2 alpha kinase 2 (EIF2AK2), also known as PKR (protein kinase R), leading to enhanced inflammatory vesicle activity [27, 28]

This complexity underscores the need for stage-specific interventions: acute mitochondrial injury may respond to antioxidants or metabolic substrates, while advanced disease may require reprogramming of cellular bioenergetics