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Lipoylation, a critical post-translational modification for TCA cycle enzymes, including pyruvate dehydrogenase, -ketoglutarate dehydrogenase, branched-chain -ketoacid dehydrogenase and the glycine decarboxylase complex, enhances their catalytic activity under normal conditions (159)

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Int J (2015) 3(10):21126

suggested that measurement of fatigue level should be considered and a fatigue scale (such as FACIT-F) should be applied, especially because a validated treatment for L-C19 fatigue is not known and exercise therapy is generally not beneficial (37)