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chronic liver disease and hepatitis may present with elevated levels Renal impairment : Reduced clearance can contribute to accumulation, though this is rarely clinically significant Solid tumours : Certain malignancies, particularly hepatocellular carcinoma and metastatic disease, may elevate B12 levels [3] Evidence suggests that unexplained markedly elevated B12 levels without supplementation may sometimes be associated with underlying disease

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The proposed mechanism involves controlling glutamate release in the synaptic cleft, modulating NMDA receptor stimulation, affecting excitatory amino acid transporter (EAAT)-mediated reuptake, and maintaining the glutamate/glutamine cycle within astrocytes