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Epigenetic and Cellular Reprogramming: By blocking NNMT-mediated methylation of nicotinamide, preserves NAD salvage pathway activity, increases SIRT-1 signaling, reduces histone deacetylation, and promotes metabolic reprogramming toward oxidative phosphorylation and glycolysis balance, supporting tissue repair and energy homeostasis 1-4

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Given the mixed findings, it is therefore reasonable that all patients treated with a TNF alpha inhibitor undergo skin cancer surveillance for both melanoma and nonmelanoma skin cancer, use broad-spectrum sunscreens, and practice sun avoidance and skin self-examination