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Lint: mitochondrial-encephalomyopathy-with-lactic-acidosis-and-stroke-like-episodes-melas

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"To establish the diagnosis of MELAS, identification of the most common pathogenic mtDNA variant (m.3243A>G) can be made from peripheral blood samples in 80% of patients. To identify non-m.3243A>G mutations, additional testing or muscle biopsy may be required 5."

Line 6:102 · Check the number format against the style guide: '.3243'.

"To establish the diagnosis of MELAS, identification of the most common pathogenic mtDNA variant (m.3243A>G) can be made from peripheral blood samples in 80% of patients. To identify non-m.3243A>G mutations, additional testing or muscle biopsy may be required 5."

Line 6:191 · Check the number format against the style guide: '.3243'.

"The defect involves the respiratory chain, which is responsible for energy production 7. A point mutation at mtDNA nucleotide 3243 (A-to-G transition, i.e., A3243G or m.3243A>G), which encodes transfer RNA (tRNA) for leucine, is the most common cause (~80%) of the condition 7. It is therefore thought that this abnormality results in abnormal protein production throughout the mitochondria and affects multiple parts of the respiratory chain. The exact mechanism notwithstanding, the net result is a shift in the NAD+/NADH ratio, with relative depletion of NAD+ and accumulation of NADH. This, in turn, results in a shift to anaerobic metabolism, accounting for the buildup of lactic acid. This is believed to result in several changes that contribute to the imaging features, including rendering the cortex susceptible to neuronal death and vessel dysfunction, resulting in vasogenic oedema 1,9,10."

Line 22:183 · Check the number format against the style guide: '.3243'.
Acronyms
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"The defect involves the respiratory chain, which is responsible for energy production 7. A point mutation at mtDNA nucleotide 3243 (A-to-G transition, i.e., A3243G or m.3243A>G), which encodes transfer RNA (tRNA) for leucine, is the most common cause (~80%) of the condition 7. It is therefore thought that this abnormality results in abnormal protein production throughout the mitochondria and affects multiple parts of the respiratory chain. The exact mechanism notwithstanding, the net result is a shift in the NAD+/NADH ratio, with relative depletion of NAD+ and accumulation of NADH. This, in turn, results in a shift to anaerobic metabolism, accounting for the buildup of lactic acid. This is believed to result in several changes that contribute to the imaging features, including rendering the cortex susceptible to neuronal death and vessel dysfunction, resulting in vasogenic oedema 1,9,10."

Line 22:217 · 'RNA' has no definition. Spell it out if it's unfamiliar to the audience.

"The defect involves the respiratory chain, which is responsible for energy production 7. A point mutation at mtDNA nucleotide 3243 (A-to-G transition, i.e., A3243G or m.3243A>G), which encodes transfer RNA (tRNA) for leucine, is the most common cause (~80%) of the condition 7. It is therefore thought that this abnormality results in abnormal protein production throughout the mitochondria and affects multiple parts of the respiratory chain. The exact mechanism notwithstanding, the net result is a shift in the NAD+/NADH ratio, with relative depletion of NAD+ and accumulation of NADH. This, in turn, results in a shift to anaerobic metabolism, accounting for the buildup of lactic acid. This is believed to result in several changes that contribute to the imaging features, including rendering the cortex susceptible to neuronal death and vessel dysfunction, resulting in vasogenic oedema 1,9,10."

Line 22:540 · 'NAD' has no definition. Spell it out if it's unfamiliar to the audience.

"The defect involves the respiratory chain, which is responsible for energy production 7. A point mutation at mtDNA nucleotide 3243 (A-to-G transition, i.e., A3243G or m.3243A>G), which encodes transfer RNA (tRNA) for leucine, is the most common cause (~80%) of the condition 7. It is therefore thought that this abnormality results in abnormal protein production throughout the mitochondria and affects multiple parts of the respiratory chain. The exact mechanism notwithstanding, the net result is a shift in the NAD+/NADH ratio, with relative depletion of NAD+ and accumulation of NADH. This, in turn, results in a shift to anaerobic metabolism, accounting for the buildup of lactic acid. This is believed to result in several changes that contribute to the imaging features, including rendering the cortex susceptible to neuronal death and vessel dysfunction, resulting in vasogenic oedema 1,9,10."

Line 22:545 · 'NADH' has no definition. Spell it out if it's unfamiliar to the audience.

"The defect involves the respiratory chain, which is responsible for energy production 7. A point mutation at mtDNA nucleotide 3243 (A-to-G transition, i.e., A3243G or m.3243A>G), which encodes transfer RNA (tRNA) for leucine, is the most common cause (~80%) of the condition 7. It is therefore thought that this abnormality results in abnormal protein production throughout the mitochondria and affects multiple parts of the respiratory chain. The exact mechanism notwithstanding, the net result is a shift in the NAD+/NADH ratio, with relative depletion of NAD+ and accumulation of NADH. This, in turn, results in a shift to anaerobic metabolism, accounting for the buildup of lactic acid. This is believed to result in several changes that contribute to the imaging features, including rendering the cortex susceptible to neuronal death and vessel dysfunction, resulting in vasogenic oedema 1,9,10."

Line 22:584 · 'NAD' has no definition. Spell it out if it's unfamiliar to the audience.

"The defect involves the respiratory chain, which is responsible for energy production 7. A point mutation at mtDNA nucleotide 3243 (A-to-G transition, i.e., A3243G or m.3243A>G), which encodes transfer RNA (tRNA) for leucine, is the most common cause (~80%) of the condition 7. It is therefore thought that this abnormality results in abnormal protein production throughout the mitochondria and affects multiple parts of the respiratory chain. The exact mechanism notwithstanding, the net result is a shift in the NAD+/NADH ratio, with relative depletion of NAD+ and accumulation of NADH. This, in turn, results in a shift to anaerobic metabolism, accounting for the buildup of lactic acid. This is believed to result in several changes that contribute to the imaging features, including rendering the cortex susceptible to neuronal death and vessel dysfunction, resulting in vasogenic oedema 1,9,10."

Line 22:609 · 'NADH' has no definition. Spell it out if it's unfamiliar to the audience.
Oxford Comma
suggestion

"MELAS usually has a relapsing-remitting course, with or without superimposed accretion of permanent deficits. Clinical presentation is highly variable between patients (even from the same affected family), with potential clinical features including 1,6,7:"

Line 8:44 · Use the Oxford comma in 'course, with or without'.
Inline EG
suggestion

"stroke-like episodes (e.g. hemiparesis, hemianopia)"

Line 10:36 · Consider replacing a bracketed e.g. with an inline e.g. after a comma.
There Is
suggestion

"There is no disease-modifying treatment. Substances such as L-arginine, carnitine, and coenzyme Q10 may slow/reduce the effects of the disease 13."

Line 76:4 · Don't start a sentence with 'There is'.