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Clinical indications include deficiency due to inadequate diet or malabsorption, drug-induced deficiency (for example, from long-term isoniazid or oral contraceptives), and certain inborn errors of metabolism (such as pyridoxine-dependent seizures or sideroblastic anemia)

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In research models with elevated NNMT activity, this methylation reaction has been reported to deplete cellular SAM pools and reduce NAD+ availability