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In areas of more advanced damage, moderate muscle necrosis was present, characterized by small, dark pyknotic nuclei, marked hypereosinophilia, and evidence of sarcoplasmic coagulation and clamping

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The study revealed reduced markers of membrane damage, such as malondialdehyde, despite reduced hemoglobin saturation

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Others using MS to investigate ME/CFS serum suggested that a deficiency in pyruvate dehydrogenase (PDH) function may instead form a bottleneck for the provision of TCA cycle substrate downstream of glycolysis, PDH being the enzyme that converts pyruvate into the TCA cycle intermediate acetyl-CoA [110]