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The 14 viral ORFs interact with a few thousands of human metabolites in a specific manner for its intra-cellular invasion, replication, and transmission, which results in HMRD in favor of the viral pathogen

Patients clinically present with lactic acidosis and neurodegeneration from inefficient oxidative metabolism, as well as increased BCAA concentrations and -keto acids in the urine, with many of the same symptoms as MSUD, but with a more severe phenotype (71)

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Collectively, quercetin acts as a potent mitochondrial biogenesis enhancer and metabolic modulator through the activation of the PGC-1 axis