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In PBC livers, Kupffer cells polarize to the pro-inflammatory M1 phenotype, which is positively correlated with hepatic inflammation severity (220)

Ethics declarations Competing interests SJW is the founder of Ridgeline Therapeutics, HN is a paid employee of Ridgeline Therapeutics and, since manuscript submission, ADW has also become a paid employee of Ridgeline Therapeutics

Ideal candidates for leading with NAD+: Patients over 40 experiencing persistent fatigue that does not resolve with sleep or lifestyle changes Individuals with metabolic syndrome, insulin resistance, or difficulty managing weight despite dietary effort Patients recovering from substance use, where NAD+ IV therapy has shown measurable benefit in reducing withdrawal symptoms and cravings High-performance athletes or executives seeking cognitive edge and faster physical recovery Patients with early neurodegenerative concerns who want evidence-supported mitochondrial support GHK-Cu Dosage and NAD+ Dosage: What Clinical Protocols Actually Use Dosing varies based on delivery route, patient body weight, and clinical goal

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