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Fig. 5 | Journal of Translational Medicine

Fig. 5

From: Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and d-lactic acidosis: a systematic review

Fig. 5

Proposed mechanisms of gut–brain interaction leading to neurological symptoms observed in d-lactic acidosis. Supporting and opposing evidence for proposed central nervous system (CNS) mechanisms are categorised according to direct effects of d-lactate, indirect effects of d-lactate and other possible mechanisms unrelated to d-lactate. Abbreviations: enteric nervous system (ENS); d-2-hydroxy acid dehydrogenase (d-2-HDH); adenosine triphosphate (ATP); short chain fatty acids (SCFA)

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