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The mechanisms leading to these severe brain lesions are still not well understood, but recent studies show that ammonium exposure alters several amino acid pathways and neurotransmitter systems, cerebral energy metabolism, nitric oxide synthesis, oxidative stress and signal transduction pathways

The implications of NNMT inhibition extend far beyond simple cofactor availability, influencing fundamental cellular processes including mitochondrial biogenesis, oxidative stress management, and epigenetic regulation

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In human hypertension, an increase in the production of superoxide anions and hydrogen peroxide, a decrease in NO synthesis and a reduction in antioxidant bioavailability have been observed