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Several possible explanations: The patent holder may not have found a pharmaceutical company willing to invest in the expensive process of clinical development

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Processes, 7 (3), 127

In mitochondria [edit] The metabolism of propionyl-CoA occurs in the mitochondria and requires Vitamin B 12 (as adenosylcobalamin) to make succinyl-CoA

Theres also limited data on who may be at higher risk for negative side effects