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The second hit involves the induction of autoantibodies, which may be triggered by viral proteins such as NS1 [117,118,119,120,121,122,123], and arise alongside antiviral antibodies during the immune response to DENV infection

Intrinsic (mitochondrial) pathways are also activated, with pro-apoptotic Bcl-2 family members (Bid, Bak, Bax) promoting mitochondrial outer membrane permeabilization, cytochrome C release, and apoptosome formation (cytochrome C + APAF-1 + procaspase-9)

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The challenge is that there is a lot of misinformation around natural remedies when it comes to erectile dysfunction