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This multi-step process involves -N-methyltransferasemediated methylation of lysine to form trimethyllysine (TML), followed by sequential oxidation, hydroxylation, and cleavage to generate -butyrobetaine, which is finally hydroxylated by -butyrobetaine hydroxylase (BBOX) to yield free carnitine

The NAD + -salvage-pathway connection has positioned NNMT inhibition within the broader cellular-aging and sirtuin-pathway research framework, alongside NAD + precursors such as nicotinamide riboside and nicotinamide mononucleotide

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