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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
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The formulation was created for clinical settings in which oral supplementation is impractical or where rapid, predictable plasma amino-acid levels are required, such as peri-operative cardiovascular optimization, growth-hormone stimulation testing, or specialized sports-medicine protocols
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