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A key consideration of exosomes is that the challenges in extracting biological fluid-derived exosomes, for example, in plasma, where enrichment of biological molecules and various exosome species exists, thereby an issue like the corona effect occurs (Voke et al., 2025)

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The British National Formulary (BNF), for example, differentiates the prescription of hydroxocobalamin according to presenting symptoms, eg, For neurological involvement, it is advised to administer hydroxocobalamin by intramuscular injection, initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months. In the Netherlands, pharmacotherapeutic guidelines 51 recommend (for the same neurological symptoms or abnormalities) administration of 1000 mcg once or twice weekly for up to two years