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In contrast, ALA exerts its principal effects on mitochondrial metabolism through its established role as an essential cofactor for mitochondrial -ketoacid dehydrogenase complexes, including pyruvate dehydrogenase and -ketoglutarate dehydrogenase, thereby facilitating efficient entry of glycolytic substrates into the tricarboxylic acid cycle and sustaining electron transport chain activity under oxidative stress conditions

doi: 10.1016/j.neuroscience.2008.06.010

The use of CO for diagnostic purposes, such as total haemoglobin mass measurements or the determination of pulmonary diffusion capacity, is not prohibited

Two independent controlled studies using the same dose concluded the effect was of little clinical significance and not likely to be of major therapeutic benefit. Because the negative studies matched the positive studies dose, the failure cannot be explained by underdosing