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By inhibiting NNMT, 5-Amino-1MQ reduces 1-MNA formation and alleviates the methyl sink, increasing SAM availability for other methylation reactions, while freeing nicotinamide for recycling through NAMPT toward NAD

Initial clinical assessment should include a thorough neurological examination documenting: Sensory testing for vibration sense (using a 128 Hz tuning fork) and proprioception Assessment of gait and coordination (Romberg's test) Evaluation of reflexes and muscle tone Cognitive screening if indicated Fundoscopy if visual symptoms are present History of nitrous oxide exposure (recreational or occupational) Laboratory investigations recommended in UK practice include: Serum B12 level whilst the standard first-line test, interpretation requires caution

This quinolinium cation structure enables selective recognition by the NNMT active site, where it acts as a competitive inhibitor with respect to nicotinamide substrate

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