“…Evidence supporting the MNLS model includes: (1) the concentration of serum lactic acid is higher in persons with ALS (2.77 Ϯ 0.79 mmol/L) and chronic denervated non-ALS patients (2.79 Ϯ 1.29 mmol/L) compared with controls (1.48 Ϯ 0.49 mmol/L) (Siciliano et al, 2001); (2) lactic acid can induce death in neurons (Nedergaard et al, 1991); (3) increased lactate concentrations have been reported in other neurodegenerative conditions such as Huntington disease (Bowling and Beal, 1995) as well as in models of severe and mild brain injury (Ramonet et al, 2004); (4) neuroprotective drugs like nizofenone that block lactate accumulation are used to treat other neurodegenerative diseases ; (5) lactate metabolism in ALS is associated with glutamate excitotoxicity related to neuronal degeneration (Shobha et al, 2007); (6) mitochondrial oxidative phosphorylation is dysfunctional in SOD1 G93A transgenic mice (Jung et al, 2002;Mattiazzi et al, 2002;Vijayvergiya et al, 2005); (7) the malate-aspartate shuttle is inhibited in hSOD1 G93A expressing cells (Mali and Zisapels, 2008) and this may explain the elevated levels of lactate and the damage to neurons (Mali and Zisapels, 2008); (8) hSOD1 G93A -expressing cells showed increased concentrations of cytoplasmic malate dehydrogenase messenger ribonucleic acid (mRNA), malate, and lactate compared with noninduced or wild-type-hSOD1-expressing cells (Mali and Zisapels, 2008); (9) the mitochondrial NADH/NADϩ ratio is elevated in hSOD1 G93A -expressing cells indicating an increased conversion of oxaloacetate to malate in the mitochondria by NADH-dependent mitochondrial malate dehydrogenase MDH (Mali and Zisapels, 2008); (10) impairments in the malate-aspartate shuttle which controls the brain mitochondrial NADH/NAD ϩ balance is known to drive anaerobic metabolism (particularly damaging to neurons) as well as vulnerability to impairments of glycolytic pathways (Mali and Zisapels, 2008); (11) impaired oxidative metabolism and accumulation of lactate was reported in exercising ALS patients (Siciliano et al, 2001);and (12) functional motor unit failure precedes neuromuscular degeneration in motoneuron disease (Balice- Gordon et al, 2000;Fischer et al, 2004).…”