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Ongoing challenges to trial conduct include the substances short half-life, the availability of unregulated commercial products, and ensuring protocol compliance

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Instead, research suggests it works by inhibiting Hepatocyte Growth Factor Activator Inhibitor (HAI-1), an enzyme that normally limits HGF activity

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However, as a precautionary measure, patients with severe kidney disease or those with known cyanide metabolism disorders are sometimes advised to use alternative B12 forms