USMLE Step 1 · Question of the Day

USMLE Step 1 Question of the Day

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Wednesday, October 28, 2026

An experiment is designed to study the coupling of the citric acid cycle and electron transport. Isolated mitochondria are provided with pyruvate and oxygen. It is observed that a high intramitochondrial NADH/NAD+ ratio, which can be caused by an ETC defect, strongly inhibits the citric acid cycle.

An elevated NADH/NAD+ ratio directly causes allosteric inhibition of which of the following key regulatory enzymes?

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An experiment is designed to study the coupling of the citric acid cycle and electron transport. Isolated mitochondria are provided with pyruvate and oxygen. It is observed that a high intramitochondrial NADH/NAD+ ratio, which can be caused by an ETC defect, strongly inhibits the citric acid cycle.

An elevated NADH/NAD+ ratio directly causes allosteric inhibition of which of the following key regulatory enzymes?

  1. Isocitrate dehydrogenase (correct answer)
  2. Succinate thiokinase
  3. Fumarase
  4. Aconitase

Explanation: The citric acid cycle is tightly regulated by the energy state of the cell, reflected by ratios like ATP/ADP and NADH/NAD+. High levels of NADH, indicating a state of high energy or a block in the ETC, directly inhibit several key dehydrogenases. The most important regulated steps inhibited by NADH are pyruvate dehydrogenase, isocitrate dehydrogenase, and the α-ketoglutarate dehydrogenase complex. Of the options provided, isocitrate dehydrogenase is a major regulatory point that is allosterically inhibited by NADH.