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This hypothesized VEGF/VEGFR interaction may activate a complex intracellular signaling cascade, which may involve multiple proteins such as phospholipase C, protein kinase C, and the mitogen-activated protein kinases

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Dosing information Usual Adult Dose for Pernicious Anemia: Initial dose: 100 mcg intramuscularly or deep subcutaneous once a day for 6 to 7 days If clinical improvement and reticulocyte response is seen from the above dosing: 100 mcg every other day for 7 doses, then: 100 mcg every 3 to 4 days for 2 to 3 weeks, then: Maintenance dose: 100 to 1000 mcg monthly Duration of therapy: Life Comments: Administer concomitant folic acid if needed

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This conservative approach minimizes copper toxicity risk but may require 16+ weeks to produce observable density changes