b12 injection for muscle pain Benefits of Vitamin Shots The effects of intracerebroventricular (ICV)

[PMC free article: PMC3436618] [PubMed: 22958753] 255

Bacteria-derived hydroxocobalamin (OHCbl) and CNCbl are converted in humans to useful coenzyme forms to support metabolic processes such as mitochondrial methylmalonylcoenzyme A mutase conversion of methylmalonic acid (MMA) to succinate to link lipid and carbohydrate metabolism, and activation of methionine synthase, the rate limiting step in the synthesis of methionine

In Noonans syndrome genetic defects in the PTPN11 gene may affect this pathway and has been implicated in poor growth and poor response to GH therapy, although reports are conflicting (99, 100)

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Patients may also have low levels of vitamin B12 if they have had bariatric surgery, are strict vegetarians, or have used antacids or proton pump inhibitors for a prolonged period