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The systemic inflammation and immune dysregulation inherent to these conditions appear to impair the transport mechanisms that carry B12 from the bloodstream into the brain and spinal cord

focus on precursor strategies, modern clinical practice has also begun exploring direct delivery methods

No absorption is required, so plasma levels are independent of such factors as gastrointestinal (GI) absorption and adequate skin or muscle perfusion

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doi: 10.1038/nature21363 365 CahillGFJr