NDUFS4 and Encephalopathy: For example, LS has been linked to mutations in >50 different genes encoding mitochondrial respiratory complexes I, III, IV, and V, etc. Conversely, the mutation in one gene (e.g., Ndufs4) can manifest with different clinical syndromes in patients: encephalopathy, myopathy, and/or cardiomyopathy, with or without lactic acidosis, indicating a wide range of the clinical spectrum.