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Likewise, many putative mechanisms have been implicated in the pathogenesis of LC, including viral persistence, endothelial dysfunction, coagulation disorders and microthrombotic manifestations, the disruption of gut microbiota, neuroinflammation, autoimmunity and mast cell activation, the reactivation of dormant viral pathogens and perturbations of the brainstem and autonomic nervous signaling, among others [11,21,22,23]

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Mammalian PK has four isoforms with distinct tissue distributions, PKM1 is predominantly expressed in normal adult cells favoring oxidative phosphorylation, while PKM2 is highly expressed in rapidly proliferating tumor and non-malignant cells, favoring glycolysis (36)