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Once inside the matrix, a complex series of reactions unfold as summarized below. These reactions are catalyzed by a large multienzyme complex referred to in general as pyruvate dehydrogenase.

One carbon and two oxygens are removed from the pyruvate. These atoms leave the mitochondria as carbon dioxide. The 2-carbon molecule that is left over is basically acetic acid.

Electrons and hydrogen are transferred from the acetic acid to NAD+ as the NAD+ is reduced to NADH. NADH carries those electrons and hydrogen to the electron transport chain.

Coenzyme A attaches to the acetic acid to form a molecule called acetyl CoA. Coenzyme A then carries the acetyl group over to the entry point of the next phase called the Kreb's Cycle.

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