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Malonyl-CoA also plays a vital role in PUFA synthesis, where dietary linoleic acid undergoes sequential desaturation and elongation reactions catalyzed by fatty acid desaturase (FADS)2, ELOVL5 and FADS1, leading to the formation of AA (C20:4, -6), which can be further elongated by ELOVL2/4 to generate AdA (C22:4, -6) (76)

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However, this is a somewhat subjective diagnosis and other factors such as emotional or physical stress may contribute to the development of ME/CFS

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It can be coordinated by transcription factors (such as Nrf2) and amino acid transport systems