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Cysteine is derived normally from the diet, protein breakdown and in the liver, from methionine via transsulfuration (conversion of homocysteine to cysteine)

Regarding the form of vitamin B12 used, cyanocobalamin was the most common (n = 14), followed by methylcobalamin (n = 6), hydroxocobalamin (n = 4), and combinations including adenosylcobalamin in isolated cases

however, food processing and digestion often disrupt these structures, leaving linear epitopes more likely to reach the immune system in a reactive state