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1A Schematic illustration of pathways regulated by NNMT, including the NAD+ biosynthesis salvage pathway starting from NA as a precursor that feeds into energy metabolism, methionine cycle that regulates intracellular SAM concentrations and thus cellular epigenetic modifications and polyamine flux, and clearance of NA by conversion to 1-MNA and excretory products

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Gene regulation NAD activates sirtuin proteins, which influence metabolism, stress resistance, and cellular longevity

"The Effect of Gastric Bypass on the Pharmacokinetics of Serotonin Reuptake Inhibitors." Am Journ Psychiatry 169.3 (2012): 256263

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Regular monitoring includes: annual B12 levels, semi-annual kidney function tests (for B6 clearance), and periodic neurological assessments