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Despite correcting his severe B12 and iron deficiency with supplementation, this child remained delayed 7 months after treatment and upon MRI, still showed signs of inadequate myelination, suggesting that he may never achieve full neurological function

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This gradual progression allows the body to adapt comfortably to NAD supplementation

The authors would like to gratefully acknowledge the training and use of mass spectrometry instrumentation provided by Professor Perdita Barrans group at the Michael Barber centre for collaborative mass spectrometry (MBCCMS) based at the University of Manchester