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Patients who have experienced at least two relapses are described as suffering from relapsing-remitting multiple sclerosis (RRMS), while approximately 15% of patients enter the progressive phase upon the onset of the disease, which is termed primary progressive multiple sclerosis (PPMS) (10)

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[15] Inside the lysosome, transcobalamin is degraded and free cobalamin is exported to the cytosol, where a trafficking and processing protein encoded by MMACHC (with a partner encoded by MMADHC ) strips off whatever upper-axial ligand the incoming cobalamin carried cyanide, hydroxyl, methyl, or adenosyl and reduces the cobalt center

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