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Next, the thiolate of homocysteine nucleophilically attacks this aminoacrylate, leading to cystathionine formation (Figure 3) (Yadav et al., 2012

Appetite Effects The question about appetite is interesting because the proposed mechanism could reasonably go either direction: Reduced lipogenesis and improved metabolic flexibility could produce secondary effects on appetite regulation NAD+ restoration has complex effects on hypothalamic appetite signaling Preclinical data do not consistently describe dramatic appetite changes In human use were it to become clinically available patient-reported appetite effects would be a relevant monitoring parameter, but the data do not currently support a strong a priori expectation