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Refrigeration may be required, depending on the exact formulation

In humans, cyanocobalamin must undergo intracellular enzymatic conversion to the active coenzyme formsmethylcobalamin and adenosylcobalaminwhich, depending on the pH environment, can interconvert with hydroxocobalamin ( Despite extensive biochemical knowledge of cobalamin metabolism and its physiological importance, the optimal supplementation route for maintaining or restoring adequate vitamin B12 levels remains debated

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Abstract B26: immunomodulatory activity of isatuximab