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The direct protection includes preventing the generation of oxidants, scavenging free radicals or inhibiting oxidant reactivity, and elevating cofactors of defective mitochondrial enzymes with increased MichaelisMenten constant to stimulate enzyme activity, and also protect enzymes from further oxidation, and the indirect protection includes repairing oxidative damage by enhancing antioxidant defense systems either through activation of phase 2 enzymes or through increase in mitochondrial biogenesis

Clinical studies in patients with MM have explored metabolic interventions such as dichloroacetate, L-carnitine, niacin, Coenzyme Q10 (CoQ10), and oligomycin derivatives (96100)

In the presence of publication bias, trim and fill analysis was used to simulate a model without publication bias presenting a new effect size by inserting new fictitious studies

A.FathereeN.MansourR.HashmiS