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Although generally safe, injections should be used with caution in people with a history of allergic reactions to cobalamin or in people with Leber's disease (hereditary optic neuropathy), as B12 may worsen the condition

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Where the injectable route has an advantage on paper systemic reach that same property is also its main safety liability, as the copper-handling discussion below explains

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Postsynaptic TrkB signaling has distinct roles in spine maintenance in adult visual cortex and hippocampus