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The ability to deliver high local IGF-1 concentrations without systemic exposure could be advantageous in rehabilitation medicine, though clinical validation requires further research

86 Overall, the evidence is overwhelmingly in favour of the use of methyl-B12, alone or alongside other treatments, in diabetic neuropathy, with oral and injectable B12 showing benefits

Neurovasc Res

Alcohol- and other substance-use disorders may well benefit from the effects of GLP-1RAs on dopamine and opioid pathways that are dysregulated in addiction 243 , as seen in some of the studies we identified, and the same could also apply to other under-investigated disorders with similar underlying dysfunctions (for example, gambling disorder)

The barrier breakdown also allows the intestinal microbiota and its derivatives (e.g., lipopolysaccharides (LPS)) to penetrate the epithelial barrier, which triggers innate and adaptive immune signaling pathways 68