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This happens because total B12 includes cobalamin attached to binding proteins, not just B12 available inside cells

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Trx effectively prevents the progression of COPD by regulating redox status and protease/anti-protease balance, blocking the NF-B and MAPK signalling pathways, suppressing the activation and migration of inflammatory cells and the production of cytokines, inhibiting the synthesis and the activation of adhesion factors and growth factors, and controlling the cAMP-PKA and PI3K/Akt signalling pathways

However, while B12 injections or oral supplements are typically considered safe, there are significant risks when administered without proper preliminary testing