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Activation of polyamine flux causes an increase in energy expenditure by catalyzing polyamine acetylation to produce acetylpolyamines using acetyl-coA as a substrate [48]

NICE guidance recommends 1 mg hydroxocobalamin three times weekly for 2 weeks for patients without neurological symptoms, with lifelong maintenance therapy for irreversible causes

Treatments are customized , and weekly or monthly doses may be recommended based on individual needs