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It is becoming clear that astrocytes in neurodegenerative diseases, including ALS, are subjected to a shift from a supportive to a neurotoxic phenotype, causing the metabolic alteration, loss of trophic function, secretion of toxic factors, and development of a chronic inflammatory response [60]
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When liver function deteriorates significantly, the combination of released stored B12, increased circulating haptocorrin, and reduced hepatic clearance can result in markedly elevated total serum B12 levels
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