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NNMT enzyme inhibition occurs within 24 hours of subcutaneous dosing based on pharmacokinetic modelling, but downstream metabolic effects NAD+ elevation, changes in fat oxidation markers typically require 24 weeks of consistent dosing to manifest in measurable endpoints

For oral cobalamin supplementation: Protocol: Daily administration for a total of 12 weeks and re-check the serum cobalamin concentration 4 weeks after stopping supplementation

Nadjsombati MS, McGinty JW, Lyons-Cohen MR et al (2018) Detection of succinate by intestinal tuft cells triggers a type 2 innate immune circuit

Centers for Medicare & Medicaid Services (CMS) decisions will reveal whether these changes amount to a recalibration of waiver policy or a broader retreat from state-led Medicaid innovation