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Endothelial cells are known to be particularly vulnerable to hyperhomocysteinemia, since they do not express CBS, the first enzyme of the hepatic reverse transsulfuration pathway, or betaine-homocysteine methyltransferase (BHMT), which catalyzes the alternate remethylation pathway in the liver using betaine as a substrate [51]

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Early detection and proactive B12 supplementation are crucial to prevent irreversible neurological damage