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Such microglial transitions likely involve epigenetic reprogramming induced by MIA, coupled with metabolic adaptations in response to subsequent stress

chronic liver disease and hepatitis may present with elevated levels Renal impairment : Reduced clearance can contribute to accumulation, though this is rarely clinically significant Solid tumours : Certain malignancies, particularly hepatocellular carcinoma and metastatic disease, may elevate B12 levels [3] Evidence suggests that unexplained markedly elevated B12 levels without supplementation may sometimes be associated with underlying disease

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For instance, TEPP-46 and microbial metabolite-based therapies (e.g., butyrate, itaconate) exhibit robust efficacy in animal models but have yet to be systematically evaluated in human autoimmune populations