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Its mechanism of action is primarily mediated by its role as a substrate for NAD + -dependent enzymes such as the sirtuin family (SIRT1-7), poly(ADP-ribose) polymerases (PARPs), and certain ectoenzymes like CD38 and CD157

Cystine transporter slc7a11/xCT in cancer: Ferroptosis, nutrient dependency, and cancer therapy

With topical use, rash and blistering have been reported with 5% alpha-lipoic acid creams, including a case in an 86-year-old woman who applied a 5% alpha-lipoic acid cream to her lower leg and thigh for chronic venous insufficiency [32], and cases of severe facial skin irritation from skin-aging creams containing 5% alpha-lipoic acid [33][34]

It's important to treat vitamin B12 deficiency to ensure both maternal and fetal health