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One possible explanation is that low serum vitamin B12 levels would trap folate as 5-methyltetrahydrofolate, prevent the generation of methionine from homocysteine, and therefore reduce protein synthesis and lean tissue deposition

studied 69 patients with IC/PBS (diagnosed based on the 1987 NIH criteria and including both ESSIC types 2 and 3) and 37 controls (with and without non-IC/BPS chronic cystitis) and demonstrated that the presence of mast cells correlated with the level of background lymphoplasmacytic infiltrate, but not with the diagnosis of IC

Hesdorffer CS, Longo DL

Microbiota characterization of atmospheric cold plasma treated blueberries

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Hence, it seems likely to us that other causes of classical EDS exist and involve genes encoding proteins other than the fibrillar collagens or collagen-modifying enzymes