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These undergo four sequential reactions with long-chain acyl-CoA dehydrogenase, enoyl-CoA hydratase, 3-hydroxyl-acyl-CoA dehydrogenase, and 3-ketoacyl-CoA thiolase, resulting in the shortening of the fatty acyl-CoA by respiration and synthetic cellular pathways (Figure 2) [20]

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This deficiency can be caused by poor dietary consumption, a breakdown in the digestive process, or from taking certain medications that make it difficult to absorb B12 (such as antacids)