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1,4 Hyperglycemia, dyslipidemia, and insulin resistance activate various metabolic pathways, resulting in oxidative stress, mitochondrial dysfunction, inflammation, and microvascular damage, culminating in neuronal injury, Schwann cell damage, and myelin sheath degeneration

It does this by taking a methyl group from 5-methyltetrahydrofolate (the active form of folate), transferring it back to the cobalamin, and releasing free tetrahydrofolate

For this reason, identifying strategies that reduce metabolic efficiency has long been of interest in experimental research

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