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Caution is advised in patients with Leber optic atrophy, a genetic disorder caused by chronic cyanide intoxication (such as from smoking, alcohol or some plants), against the use of cyano-B12 due to its cyanide moiety, whilst hydroxo-B12 is a cyanide antagonist and can therefore be used in these patients

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For instance, pharmacological agents that activate mitochondrial biogenesis pathways, such as peroxisome PGC-1, have shown potential in preclinical studies to improve mitochondrial function and protect against both cardiovascular and neurological disorders