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In the Krebs cycle, NAD+ functions as a coenzyme for the rate-limiting enzymes alpha ketoglutarate dehydrogenase, isocitrate dehydrogenase, and malate dehydrogenase

Current availability is confined to the research-chemical market, without regulatory oversight or established human safety data

Inflammation increases the bioactive molecules in the tumor microenvironment, such as cytokines, chemokines, growth factors, and matrix-modifying enzymes (e.g., MMPs), which in turn raises the risk of cancer development [80]

Such risk factors include early treatment phase, persistent gastrointestinal symptoms such as nausea or vomiting, and comorbid conditions such as diabetic gastroparesis or Parkinsons disease

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