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While age was associated with clinical symptoms, there was very little association between MMA levels and other biochemical parameters or clinical symptoms, including neurological symptoms

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The combination allows a maximized release of GH because they each have a different mechanism of action, working on different receptors

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Furthermore, dihydrobiopterin plays a role in maintaining the reduced state of tetrahydrofolate, so the clinical phenotype of dihydrobiopterin deficiency is similar to that of dihydrofolate reductase deficiency