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Kynurenine is a metabolite of the pentose phosphate pathway which serves as a metabolic checkpoint in the pathogenesis of SLE in double negative T cells which are a source of interleukin 4, interleukin 17 and necrotic debris

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After a single hydroxocobalamin injection, therapeutic levels can be maintained for approximately 8 to 12 weeks in most patients, which aligns with the standard maintenance schedule of injections every 2-3 months recommended in the British National Formulary (BNF)