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For the species-level analysis of Bifidobacterium , taxonomic assignments were conducted by aligning each 16S rRNA V3-V4 sequence to the RefSeq database of 16S rRNA gene sequences released by NCBI ( updated at 2023.4.15) using the qiime feature-classifier classify-consensus-blast command with the parameter --p-perc-identity 0.99

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Continuous translocation of bacteria and its products stimulate the immune cells after identification by pathogen-recognition receptors, typically TLRs, causing overwhelming inflammatory response via producing inflammatory cytokines (25)

Suspected adverse reactions to metformin or B12 therapy should be reported via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app)