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Underlying health conditions: Some health conditions, such as gastrointestinal disorders or liver disease, can affect B12 absorption and metabolism, potentially leading to shorter-lasting benefits from B12 injections

First, cysteine and glutamate are combined by gamma-glutamyl cysteinyl synthetase

10.1016/j.jbc.2021.100842 55 MayleK

However, in patients with PEM, due to underlying pathological factors, such as persistent viral infections, mitochondrial autophagy and repair mechanisms are impaired, hindering the effective resolution of mitochondrial stress and initiating a potential pathological feedback loop ( 2.2 Decline in ATP synthesis and insufficient energy supply The traditional view asserts that the marked decline in ATP synthesis resulting from mitochondrial dysfunction is a potential primary contributor to the muscle weakness and fatigue observed in PEM (68, 69)

Synthetic peptides can be altered to persist longer in blood or to target specific tissues by attaching small chemical moieties or cyclizing the chain to prevent degradation

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