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As a cofactor, cobalamins are essential for two cellular reactions: the mitochondrial methylmalonyl-CoA mutase conversion of methylmalonic acid (MMA) to succinate, which links lipid and carbohydrate metabolism, and the activation of methionine synthase, which is the rate-limiting step in the synthesis of methionine from homocysteine and 5-methyltetrahydrofolate

When the early signal also happened to favor a lower dose over a higher one an inverted dose-response that is a classic warning sign of noise rather than a true pharmacological effect the case for genuine efficacy was already fragile before the pivotal trial delivered its verdict

Apr 20 2021;10(4)doi:10.3390/cells10040951 Ridker PM, Everett BM, Thuren T, et al

simply preserving what hair remains)