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Metabolic disturbances also play a key role, including SIRT1/NAD + pathway dysfunction causing mitochondrial impairment, ceramide accumulation leading to lipotoxic injury, and ferroptosis exacerbating cellular damage

94 However, high concentrations of UA can promote oxidative stress and mitochondrial dysfunction

Berman E, Arlin Z, Daghestani A, Gee T, Kempin S, Mertelsmann R, Andreeff M , Hancock R, Baratz R, Williams L, Clarkson B, Young C

Stemmler, T

Source: [4] Deficiency of Carnitine Deficiency of carnitine has been classified in two types - primary carnitine deficiency and secondary carnitine deficiency