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In typical ERK1/2 pathways, ligand-induced activation of receptor tyrosine kinases (RTKs) at the plasma membrane activates and recruits the small GTPase RAS in its GTP-bound form, which then triggers dimerization and activation of MAP3K RAF to initiate a downstream phosphorylation cascade for sequential activation of MAP2K MEK and MAPK ERK (Lavoie and Therrien 2015)

Advanced liver disease may further complicate B12 status through altered binding proteins and reduced storage capacity

In CFS/ME, disruptions in this axis are believed to play a central role in the manifestation of fatigue, cognitive dysfunction, and mood disturbances (Knig et al., 2021)

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