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Injections are indicated when there's confirmed severe deficiency, pernicious anemia (an autoimmune condition where intrinsic factor is absent), or documented malabsorption that prevents oral B12 from reaching adequate levels

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Secondary effects include NF-B-dependent anti-inflammatory signaling and angiogenic outgrowth driven by endothelial migration into the wound bed

This timing requirement adds a layer of complexity to the protocol that newer compounds simply do not have