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It should be noted that an NADH-bound Mt DHDPR structure showed a partially closed conformation, with the authors speculating that this unexpected closed structure might represent a snapshot of the equilibrium state between open and closed forms awaiting further substrate binding, and that subsequent substrate binding might induce the fully closed conformation 21

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Whilst this route is essential for treating pernicious anaemia and other malabsorption conditions, it can produce serum B12 levels far exceeding physiological requirements

The dose needed depends on how severe the deficiency is and the persons health

However, it is not approved for use in children or adolescents