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This was likely related to decreased levels of glutathione (GSH) and Trx2, and the resulting more oxidizing environment correlated with impaired excitation-contraction coupling

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Vitamin B12, Fact Sheet for Health Professionals

The mechanisms contributing to development of VIPN include disruption of calcium homeostasis, activation of the immune system and subsequent neuroinflammation, membrane remodeling of peripheral neurons and loss of large myelinated fibers (Figure 3) (Devor, 2006