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The vast majority of patients present with ocular symptoms including double vision and ptosis, but may progress on to develop generalised fatiguable muscle weakness

Future investigations should integrate cutting-edge approaches (e.g., single-cell RNA sequencing, spatial transcriptomics) with dynamic molecular mechanism analyses to systematically unravel the molecular interaction networks and signaling pathways underlying ESCM efficacy

Key factors include the energy balance of the production process, the environmental consequences of discarding spent mushroom substrate (SMS) and the greenhouse gas (GHG) emissions in comparison to fossil fuels and other biofuel methods

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da Silva et al., 2025)