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This process involves includes many mechanisms at nanoscale (gene expression), mesoscale (changes in enzymes, ion channels, cytoskeletal proteins, receptors and secreted molecules) to macroscale (neuropathy) levels with the final common consequence of the lost retinal output to the brain (Figure 1)

This has led researchers to explore alternative delivery routes that maximize cellular uptake, stability, and systemic reach, while minimizing degradation

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Epidemiological and clinical factors associated with post-exertional malaise severity in patients with myalgic encephalomyelitis/chronic fatigue syndrome