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Since the formation of OAA from its precursor, malate, is thermodynamically unfavorable, the highly exergonic nature of the citrate synthase reaction is of central importance in keeping the entire cycle going in the forward direction, since it drives oxaloacetate formation by mass action principals

(Bures 2010) While the gold standard of diagnosis is intestinal aspiration, breath tests using glucose or lactulose may also be used to test for hydrogen-dominant SIBO (H-SIBO) or methane-dominant SIBO (M-SIBO), with widely varying sensitivities and specificities

Superoxide anion is an endotheliumderived contracting factor

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