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At the cellular level, B12 acts as a cofactor for two critical enzymatic reactions: Methionine synthase converts homocysteine to methionine, essential for DNA methylation and synthesis Methylmalonyl-CoA mutase involved in fatty acid metabolism and myelin production By restoring adequate B12 levels, injections enable normal red blood cell maturation in the bone marrow, correcting the megaloblastic anaemia

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However, a review of recent studies indicates that this is soon to change as more clinicians become aware of the unique advantages of nasal delivery of peptides and other therapeutics