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44, 77 Methymalonic acid, a metabolite of PPA, results in abnormal mitochondrial morphology, 78 tissue specific ETC dysfunction, 79 inhibition of the complex I and II function when interacting with complex III in the brain 80 and reductions in reduced glutathione, 78 similar to the patient cohort presented and the PPA animal model

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Combination therapy in PCOS has demonstrated additive benefits on weight and menstrual cyclicity, highlighting synergistic mechanisms rather than direct reproductive pharmacodynamics

Administration less frequent than twice weekly likely allows complete dissipation of synaptic changes between doses, preventing the cumulative structural modifications that constitute Dihexas therapeutic mechanism