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The lack of B12 halts the methylation cycle, which leads to a buildup of toxic homocysteine

Li et al., 2025

Tissue-local accumulation at injury sites is plausible but not extensively characterised

As described above, there is compelling evidence that significant tissue-level cobalamin deficiency is present in some companion animal patients with gastrointestinal disease

Until the PCAC has issued its recommendations and the FDA has updated its bulk drug substances list, US compounding pharmacies will remain unable to use these peptides routinely in compounded preparations.

The following databases were searched: Ovid MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, Wiley Cochrane, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and Centre for Reviews and Dissemination/International Agency for Health Technology Assessment