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Carbon monoxide Carbon monoxide is a potent vasodilator and promotes NO release.59 Endogenously, the production of CO results from the breakdown of senescent erythrocytes through the heme oxidase pathway (a process known as iron scavenging).60 In vitro, not only does V-B12 bind CO, but reduced V-B12 also catalyzes an oxidation of CO to carbon dioxide using ascorbate as a cofactor.7,8 Ascorbic acid can rapidly reduce/supply electrons to V-B12 to generate the reduced or Co 2+ state and super-reduced or Co 1+ forms

2012 Comprehensive review establishing thymosin 4 as regenerative, promoting cell migration, reducing inflammation/apoptosis, and decreasing scar formation

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This dual-pathway activation generates greater local cytokine release and nociceptor stimulation, intensifying injection site burning