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Only two forms of B12 are active as a coenzyme in the body: Methylcobalamin and adenosylcobalamin are the active coenzyme forms of B12

Activated p53 translocate to the nucleus, where it upregulates pro-apoptotic genes such as Bax, PUMA, and NOXA, while suppressing anti-apoptotic Bcl-2 expression (77)

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Other mechanisms include increased insulin resistance induced by high-dose glucocorticoids that increases intra-portal insulin, decreases IGFBP-1 that increases free IGF-I, and direct glucocorticoid effects in increasing hepatic IGF-I synthesis and decreasing hepatic insulin clearance (105)