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Screening via serum B12, holotranscobalamin, and methylmalonic acid identifies actual deficiency versus subclinical insufficiency

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The resulting albumin-cagrilintide complex: Is too large (~70,000 Da total) for glomerular filtration Is partially shielded from proteolytic degradation by albumin's spatial occupancy Functions as a reversible depot, slowly releasing free cagrilintide as albumin binding equilibrium dynamics allow Only the unbound (free) fraction of cagrilintide is pharmacologically active -- it binds amylin and calcitonin receptors in the central nervous system and periphery -- while the albumin-bound fraction serves as a circulating reservoir

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