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The subsequent increase in cAMP leads to the activation of cAMP-regulated guanine nucleotide exchange factor 2 (cAMP-GEFII or Epac2) and protein kinase A (PKA)

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Goldbecker, A

MMA rises when there is not enough B12 in the mitochondria (the cells energy factories) to process fats and proteins so that they can be burnt as fuel for energy