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A translational review on NNMT inhibitor clinical development ( Emerging opportunities for NNMT inhibitor clinical translation , ScienceDirect, 2026) points out that alternative routes like polyamine biosynthesis could compensate for the raised SAM, and that partial rather than total inhibition might even be preferable specifically to avoid triggering those compensatory mechanisms from a chronically imbalanced SAM/SAH ratio

After administration, pyridoxine is converted in the body to its active metabolite, pyridoxal 5-phosphate (PLP), by the enzyme pyridoxal kinase

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particularly meat, fish, eggs and dairy

This is why B12 deficiency is taken seriously