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These finding along with the interest in vitamins combination triggered a study of the incompatibility of cyanocobalamin in light protected formulations to prove the overall effect of vitamin B 1 and B 6 on cyanocobalamin stability in commercialized parenteral concentrations and also to study the effect of some stabilizing agents in order to designate proper formulations and storage conditions

Because these patients symptoms skull asymmetry, infantile spasms, dwarfism, brain atrophy, sensory impairments, and glycosylation abnormalities resembled type II congenital disorder of glycosylation (CDG), this study established a link between Mn deficiency and hereditary CDG, showing that mutations in SLC39A8 can decrease the supply of Mn to the Golgi enzyme -1-galactosyltransferase, which is essential for glycoprotein biosynthesis

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