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I believe that the difference between whether or not the molecule or element is side by side or opposite each other is how they enable bonding between other molecules. The different positions would allow the molecule to bind to, say proteins, differently if they are orientated differently, and their general reactivity with other molecules/elements would determine their biological significance. Please correct me if I am wrong.
You're totally correct but just to add to that, if the compound is cis- then the same elements on the same side can bind in two places to the Lewis Acid versus only one being able to form a coordinate covalent bound if the molecule was trans-.
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