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Its activity intersects two major metabolic pathways simultaneously: the NAD+ biosynthesis pathway (by consuming nicotinamide, an NAD+ precursor, NNMT competes with the NAD+ salvage pathway) and the methyl-donor pathway (by consuming SAM, NNMT reduces the availability of methyl groups for epigenetic and metabolic methylation reactions)

This specific enzyme acts as a biochemical bridge, driving what scientists call the "remethylation pathway" within the broader methylation cycle

Several groups require higher vitamin B12 doses due to increased needs, impaired absorption, or specific health conditions