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While the etiology of NTD is multifactorial, some studies have found that blood concentrations of homocysteine or holo-transcobalamin to be lower in NTD-affected infants and mothers compared to non-affected controls (reviewed in 59)

doi: 10.1038/sj.clpt.6100272

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The compounds quinolinium scaffold mimics nicotinamides structure, allowing it to compete for the NNMT active site while avoiding interactions with other enzymes

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