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The medication may look, smell, and feel normal while delivering significantly reduced efficacy

[21] Within cells, cyanocobalamin is converted to methylcobalamin and 5- deoxyadenosylcobalamin, coenzymes that participate respectively in homocysteine remethylation to methionine and in the isomerization of methylmalonyl-CoA to succinyl CoA, reactions essential for DNA synthesis, erythropoiesis, and myelin maintenance

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The research, published in the Journal of Endocrinology and Metabolism, found that the peptide had no effect on serum IGF-1 levels, no negative effect on carbohydrate metabolism, and no anti-AOD-9604 antibodies were detected in any patients

doi: 10.1016/0304-4165(82)90033-2

Gene-level modulation: Pickart & Margolina 2018 documented activity across ~4,000 human genes, with fibroblast expression patterns shifting closer to younger cells