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Under hypoxic conditions, HIF-1 regulates aldehyde dehydrogenase 1 family member A3 (ALDH1A3) upregulation in HGSC cells, leading to increased H3K27ac modification levels in the PITX1 promoter region, which directly reduces cell sensitivity to cisplatin [136]

If these are elevated at baseline, MIC B12 injections may help normalize them over time, though a provider should monitor progress with serial blood work every 812 weeks during treatment initiation

Importantly, functional B12 deficiency can sometimes coexist with high total B12 levels, especially in kidney disease, and may require additional testing with methylmalonic acid (MMA) or holotranscobalamin if deficiency is suspected clinically

These include injections of: Corticosteroids to relieve pain and inflammation