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254 Moreover, H3K18la in astrocytes contributes to bilirubin encephalopathy by upregulating nucleotide-binding oligomerization domain 2 (NOD2) expression, which boosts downstream MAPK and NF-B signaling pathway activation, exacerbating astrocytic neuroinflammation and pyroptosis

Increasing levels of 5MTHF in the cerebral spinal fluid can take months if not years, so improvement is usually very slow and steady once you start treatment