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In addition to the complexity of the PDHc at the level of the total number of protein subunits (30 subunits of E1, 60 subunits of E2, and 12 subunits of E3), the full activity of the PDHc requires five different vitamin-derived coenzymes: CoASH, NAD + , FAD, lipoic acid, and thiamine pyrophosphate (TPP)

This phenomenon seems to be promoted by supplementation with high doses of vitamin B12 or its long-term use [106]

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doi: 10.3389/fendo.2022.970439 67 AbolhassaniNWinterfeldUKaplanYCJaquesCMinder WyssmannBDel GiovaneCet al

If increased homocysteine or methylmalonic acid levels and a normalization of these metabolites in response to replacement therapy are used as diagnostic criteria for vitamin B 12 deficiency, approximately 50 percent of these patients have serum vitamin B 12 levels above 200 pg per mL