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methylmalonyl CoA mutase converts methylmalonyl CoA to succinyl CoA, with 5-deoxy adenosyl cobalamin required as a cofactor

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Malabsorption of vitamin B12, resulting from structural or functional damage to the stomach, where intrinsic factor is secreted or to the ileum, where intrinsic factor facilitates vitamin B12 absorption

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That substitution is thought to shift the peptide's affinity more specifically toward hair follicle cells, rather than toward the broader tissue-repair profile of GHK-Cu