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Arginine, a conditionally essential amino acid in periods of stress and a precursor of NO, improves the proliferation response of T cells and increases phagocytosis in critically ill patients.12 In MELAS, the energy deficit that stimulates mitochondrial proliferation in the smooth muscle and endothelial cells leads to angiopathy with impaired blood perfusion in the microvasculature of several organs, in addition to a deficiency of NO.3 Oral administration of arginine in patients with MELAS prevents the development of cerebrovascular accidents and reduces the degree of severity of the disease,8,13 while intravenous administration helps to eliminate its main symptoms, such as headache, nausea, vomiting, loss of consciousness and visual impairment

7 It may be a treatment option for the future

Mediation analysis revealed that MASLD significantly mediated the effects of several metabolites on GDM risk (Table 2)