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Finally, the in vivo tracking of EVs remains a challenge, and the lack of clarity on the pharmacokinetics makes it hard to eliminate concerns about potential adverse effects

Studies have found that KA induces ERS through G protein inwardly rectifying K + receptor, activates ATF6, glucose-regulated protein 78 and IRE1, and stimulates the expression of pyrin domain-containing protein 3 (NLRP3) and NF-B [111]

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Patients experience this as post-exertional malaise (PEM) or "crashes," where even minor physical or cognitive exertion leads to a disproportionate exacerbation of symptoms