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this, in turn, leads to accentuated elevations in blood concentrations of tHcy and MMA, and exacerbation of neurological sequelae due to vitamin B-12 deficiency in the brain and peripheral nervous system To test these and other predictions, in addition to human studies, it will be important to develop better animal models with closer similarity to the physiologic and clinical features of vitamin B-12 deficiency than rodent models currently provide

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Gastrointestinal side effects are the primary clinical concern: nausea (44%), diarrhea (30%), vomiting (24%), and constipation (24%) are common, particularly during dose escalation

However, the aftereffects can linger, often causing soreness and tenderness in the affected area