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Nat Rev Rheumatol 16 , 645660 (2020)

Stage 4 is the most severe stage of B12 deficiency

In the pivotal 2018 animal study by Neelakantan et al., systemic treat Mechanism of Action 5-Amino-1MQ inhibits NNMT (nicotinamide N-methyltransferase), an enzyme that catalyzes the N-methylation of nicotinamide using S-adenosylmethionine (SAM) as the methyl donor, producing 1-methylnicotinamide (MNA) and S-adenosylhomocysteine (SAH) as products

doi: 10.1038/s41598-019-43704-7 30 EguchiKNagaiR

B12 is naturally found in animal products like meat, dairy, and eggs, making vegetarians and vegans more susceptible to deficiencies

The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi individuals with type 2 diabetes mellitus