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Gomes et al 3 showed that, compared to nonmetastatic breast cancer cells, metastatic breast cancer cells downregulate an enzyme of the propionate metabolism pathway, methylmalonyl-CoA epimerase, which leads to an intracellular accumulation of MMA and fuels metastasis

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and c) irregular dietary patterns), reduced bioavailability (impairment of the intrinsic factor-mediated absorption pathway, often due to the widespread and prolonged use of proton pump inhibitors), and malabsorption syndromes