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The 2025 narrative review noted that despite the volume of preclinical work, well-controlled human trial data are scarce, and the regenerative findings should be interpreted accordingly (PMID 40789979)

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[91] Since only bacteria and some archea possess the genes and enzymes necessary to synthesize vitamin B 12 , plant and algae sources all obtain the vitamin secondarily from symbiosis with various species of bacteria, [5] or in the case of fermented plant foods, from bacterial fermentation