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Under normal circumstances, insulin maintains the NAD(+)/NADH ratio by activating the phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) pathway and inhibiting the forkhead box protein O1/heme oxygenase 1 (Foxo1/Hmox1) pathway, thereby mediating the activation of the sirtuin 1/peroxisome proliferator-activated receptor-gamma coactivator 1-alpha (SIRT1/PGC-1) pathway and regulating mitochondrial physiological functions ( 3.2 PD and mitochondrial dysfunction Mitochondria are the most common organelles in eukaryotic cells, generating energy through cellular oxidative phosphorylation, converting adenosine diphosphate (ADP) to adenosine triphosphate (ATP), and providing energy for neurons

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