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The gut microbiota also plays a significant role in late-phase oral NR metabolism (3 h post-administration), which is converted to NAM by the enzyme BST1, and then deamidated into NA by microbes, allowing PreissHandler synthesis by capable tissues 127

Dipeptidase deficiency has been described in one patient

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50 For symptomatic deficiency (box 1) caused by insufficient dietary intake, intramuscular B 12 therapy is usually initiated with the aim of progressing to oral supplements once symptoms have resolved

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