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Methylcobalamin requires no conversion to become biologically active

In hypoxic HUVECs, eNOS Ser1177 phosphorylation was shown to be reduced, whereas Thr495 phosphorylation was increased, resulting in altered eNOS activity and reduced NO production [148]

Nakamura, K., Nonaka, H., Saito, H., Tanaka, M

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This is typically reversible with dose reduction or discontinuation