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Oral Dis (2015) 21(2):15662

Furthermore, the proximal promoters are embedded in a CpG island and thereby regulated by methylation and chromatin remodeling, further contributing to differential GR expression regulation (35)

If there is a lack of cobalamin in the body, methylmalonyl CoA accumulates, which presumably leads to the neurological manifestations of B12 deficiency.[4][7][9][12] The replenishment with parenteral cyanocobalamin causes a rapid and complete improvement of megaloblastic anemia and gastrointestinal symptoms caused by vitamin B12 deficiency

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Your clinician evaluates this step on a case-by-case basis