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Antibody to -enolase has been identified in some patients (79) but this antibody is also frequently found in other autoimmune diseases

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doi: 10.3390/antiox10101511 53 RanX.LiuR.XuS.BaiF.XuJ.YangY.et al

However, when GHB is consumed for recreational or health promotion purposes, its concentration in the body is much higher than normal, which changes the enzyme kinetics so that these pathways operate to metabolise GHB rather than producing it

The enzyme that is produced from a gene with this mutation is even more misshapen and even less efficient that one produced by a gene with a single mutation