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Finally, in the course of hepatic lipidosis, liver dysfunction can lead to reduced synthesis of all transport proteins, including transcobalamin II, although it has been observed in vitro that transcobalamin II is not produced exclusively by the liver but also by other cell lines [79]

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A BBL surgery might have more dramatic and permanent results, but the downsides can be extreme, including a high risk of surgery complications and 6+ weeks of downtime