(52) Thr →→→ acetyl-CoA; acetyl-CoA + OAA → citrate, catalyzed by CS; citrate exits the mitochondria through the dicarboxylate carrier; citrate + ATP + CoASH → acetyl-CoA + ADP + Pi + OAA by ACLY; OAA → PEP by PCK1; PEP enters the mitochondria; PEP → OAA by PCK2; OAA → Mal by MDH2; Mal exits the mitochondria; Mal → pyruvate by ME1 (for considerations related to cancer, see pathway no. 14). The gene discussed is ME1; the disease is cancer.