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The D-amino acid substitution preserves the spatial orientation of amino acid side chains needed for competitive binding to the FOXO4-p53 interaction surface, maintaining biological activity despite the non-natural backbone (PMID: 28340339)

Regulations vary by country and state

The most common experiences include slight nausea (particularly with first doses), minor fatigue or drowsiness, temporary dizziness, injection site reactions like mild redness or itching, and sleep disturbances (usually with evening dosing)

Additionally, vitamin B12 injections can be used in conjunction with oral supplements and fortified foods to maintain adequate vitamin B12 levels