What are the best scientific explanations out there for PEM?

I feel like PEM is the worst symptom of LC. I've learned how to manage or live with everything else, but PEM is the thing that I will never be able to live with. I'm constantly setting myself off on accident due to overdoing it, and even when I'm not, I have to pretend I'm 95 years old constantly and live in permanent fear that anything I do might set me off. I know that most of the time I probably could do more but I have to okay it safe.

Playing it safe is the healthy choice, but I am also getting weak, unfit, and generally frail due to the complete lack of exercise.

I want to understand the cutting edge research on PEM and compare all the best theories out there for what is happening. Is there anything yet we know with certainty about what is going on biologically?

The stuff I saw that I felt had the greatest promise was the Nature article from over a year ago about endothelial necroptosis and RNC hemolysis. A year later, I expected to see more breakthroughs but haven't kept up well.