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Patients with Leber's hereditary optic neuropathy should avoid cyanocobalamin (hydroxocobalamin is preferred in the UK)

doi: 10.7759/cureus.60545

There are carboxyl functional groups on the side chain of acidic amino acids

It is associated in published preclinical literature with collagen and decorin regulation and broad gene-expression shifts in ECM-related markers

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What key lessons can be learned from these patients