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While safety monitoring was comprehensive, the trials were not specifically designed to detect rare adverse effects that might occur at rates lower than 1-2%, which would require much larger participant numbers

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the minimum concentration of a substance needed to reduce the activity of an enzyme by at least 50%)

Its mechanism NNMT inhibition leading to AMPK activation directly improves insulin sensitivity, as demonstrated in the 2021 Nature Metabolism study where treated mice showed reduced hepatic steatosis and improved glucose tolerance