It was found that the AMPK-SIRT1/3-PGC-1α axis is downregulated in CRS 3 and 4, and it is closely related to mitochondrial impairment; moreover, it seems that N-acetylcysteine (NAC) has protective effects against oxidative stress and inflammation thanks to its ability to increase AMPK, SIRT1, and SIRT3 expression. Here, PPARGC1A is linked to congenital rubella syndrome.