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The methodological quality of the included studies, as assessed through the Jadad and NewcastleOttawa scales, varied from moderate to high, while the GRADE assessment indicated moderate certainty of evidence for serum vitamin B12 increase and low certainty for homocysteine reduction

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The D-Retro-Inverso modification (using D-amino acids in reverse sequence) provides resistance to proteolytic degradation while maintaining the ability to interfere with the target protein interaction