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Intracellular SAM, the one carbon-derived methyl donor, is synthesized by methionine and ATP in the presence of methionine adenosine transferase (Figure 1)

Studies showed that SIRT1 can stimulate AMPK via the modulation of upstream AMPK kinase such as liver kinase B1(LKB1) [76, 77], suppressing the production of ROS and inflammation response in HUVECs, while AMPK influences SIRT1 deacetylation activity by increasing cellular NAD+ levels or directly phosphorylating SIRT1

Further studies are needed to confirm its safety and efficacy and determine a safe and effective dose for clinical use in SCI

Their targets of action include oxidative stress, inflammatory responses, and fibrosis-related signaling pathways