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As a result of pro-oxidative conditions, a variety of transcription factors, including nuclear factor kappa-light-chain-enhancer of activated B cells (NF-B), AP-1, p53, hypoxia-inducible factor-1 (HIF-1), peroxisome proliferator-activated receptor gamma (PPAR), -catenin/Wnt, and Nrf2, are activated 83,84,85,86 (Fig

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10.1111/cote.12750 120 DodsonM.Castro-PortuguezR.ZhangD

The mechanisms behind B12 deficiency in metformin users are multifactorial but are probably related to intestinal absorption, so it seems sensible to assume that oral B12 replacement may be less effective, although there is little evidence in this area