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perinatal stress, infection, injury, surgery with endogenous protein breakdown) or when excessive protein is ingested, there is an increase in the offending amino acids (isoleucine, valine, methionine and threonine) as well as in propionic acid, leading to an accumulation of methylmalonic acid with the central emergency biochemical features of profound metabolic acidosis (due to ketone body production and organic acid accumulation), hypoglycemia, and hyperammonemia (see figure above)

Evaluation of a high concentrate omega-3 for correcting the omega-3 fatty acid nutritional deficiency in non-alcoholic fatty liver disease and effects on hepatic steatosis (condin)

PubMed Central PMCID: PMC3650111

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For example, substrate availability (the concentration of acyl-CoA molecules) directly affects the enzyme's activity