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Under the influence of a leaky epithelial barrier, the immune system is locally activated and inflammation develops, which can be transmitted via immune cells and the cytokines they secrete to other systems and organs

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Deficiency can lead to peripheral neuropathy, cognitive impairment, and in severe cases, subacute combined degeneration of the spinal cord

Even when performed in compounding pharmacies, the risk of contamination exceeds that of FDA-approved pre-filled pens manufactured under current Good Manufacturing Practice (cGMP) standards