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BPC-157 is the best characterized at the molecular level with respect to VEGFR2-Akt-eNOS activation and Caveolin-1-mediated endothelial modulation, making it the preferred tool for endothelial cell research [3](#ref-3)

Vitamin B12 deficiency Long-term metformin use can lower B12 levels, leading to fatigue, numbness, tingling in the hands and feet, pale/yellowish skin, and memory loss

Nitric oxide and T helper cell immunity

Elevated serum B12 levels may sometimes indicate underlying medical conditions rather than true overdose, warranting clinical investigation to exclude haematological disorders, liver disease, or renal impairment