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The major function of Mhem macrophages is the safe elimination of cell free Hb from the plaque, therefore they highly express CD163, the receptor for uptake of Hb:Hp complex and HO-1, the rate limiting enzyme of heme catabolism (Boyle et al., 2012)

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Although the progression of neurologic complications is generally gradual, such symptoms may not be reversed with treatment of vitamin B 12 deficiency, especially if they have been present for a long time