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So the mechanistic picture is a chain with a weak link at every joint: an unidentified proximal target, a downstream marker whose biology is species-divergent, and a functional readout in tissue preparations that does not by itself establish how the signal was initiated
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Those with chronic kidney disease or impaired detox function may also need medical guidance, especially if using cyanocobalamin, which contains a methyl group bound to a small amount of cyanide
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