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1,2,6 Neurologic manifestations are caused by progressive demyelination and can include peripheral neuropathy, areflexia, and the loss of proprioception and vibratory sense

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In the intact hormone these adipose actions travel together with systemic effects, including changes in insulin sensitivity and stimulation of IGF-1, which complicate the use of full-length hGH as a clean tool for studying lipid regulation in isolation

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A translational review on NNMT inhibitor clinical development ( Emerging opportunities for NNMT inhibitor clinical translation , ScienceDirect, 2026) points out that alternative routes like polyamine biosynthesis could compensate for the raised SAM, and that partial rather than total inhibition might even be preferable specifically to avoid triggering those compensatory mechanisms from a chronically imbalanced SAM/SAH ratio