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Megaloblastic anemia, resulting from vitamin B12 deficiency, can cause symptoms such as fatigue, weakness, and shortness of breath

Substitution of three aromatic residues with threonine (W385T), tyrosine (F417Y), and alanine (W525A), present at the corresponding positions in EcGGT, resulted in enhanced transpeptidase activity for all three mutants, while a 514% decrease in hydrolytic activity was observed

However, the structured dose titration protocols used in trials are absent in self-administration scenarios, significantly increasing the likelihood and severity of these reactions

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