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As a secondary messenger of free radicals and growth regulators, 4-HNE participates in various pathophysiological processes and act as a bioactive marker, especially in oxidative stress related to diseases (111)

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Using this compound as a marker of cobalamin deficiency, we have been able to demonstrate that cats and dogs with very low serum cobalamin do indeed have a significant tissue-level cobalamin deficiency (Figure 2)