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That situation normal or high serum B12 with elevated MMA is what researchers now call functional B12 deficiency, and it is far more common than most clinicians recognize
The inhibition of SIRT3 leads to the downregulation of superoxide dismutase 2 (SOD2) expression, resulting in increased levels of ROS and subsequent mitochondrial dysfunction
Even in severe VHT, the prognosis seems to be improved if VPA therapy is promptly discontinued [62]
However, the exact mechanisms and clinical significance of these effects are still being explored
