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Direct and Indirect Biochemical Markers of Mitochondrial Dysfunction There are direct markers of mitochondrial dysfunction: lactate, pyruvate, lactate/pyruvate ratio, ubiquinone, alanine, alanine/lysine ratio, and acylcarnitine profiles, and indirect markers of mitochondrial function, such as creatine kinase (CK), free L-carnitine and total L-carnitine (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and ammonia [15,38]

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