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The Medical Ethical Committee of the AMC provided a letter of no objection to perform the study as formal consent of patients is not required in the Netherlands for retrospective studies

For all other participants, Table 2 and Figure 2a shows the level of urinary excretion of toxic metals (normalized per gram creatinine) at baseline (beginning of Phase 1, before taking any DMSA), and after the first and 9 th doses of DMSA in the Phase 1 challenge round

FIGURE 2 TIRAP (toll/interleukin-1 receptor domain-containing adapter protein) recruits MyD88 (myeloid differentiation factor 88) directly to the TLR4 cytoplasmic domain

By adjusting the dosage based on individual needs, doctors can help patients with vitamin B12 deficiency get the best results

doi: 10.3389/fphar.2025.1632588 Received 21 May 2025 Accepted 28 July 2025 Published 29 August 2025 Volume 16 - 2025 Edited by Yurong Lai, Gilead, United States Reviewed by Daniel Crona, University of North Carolina at Chapel Hill, United States John Prybylski, Pfizer, United States Updates Copyright 2025 Cao, Qian, Wang, Zheng, Huang, Wei, Jiang, Yu, Jiang, Yu, Mao and Zhai