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Although ERT offers mutation-independent metabolic control, injectable agents such as pegtibatinase face lifetime adherence and immunogenicity hurdles, and oral agents such as SYNT-202 still require durable efficacy and safety data

(29) also demonstrated low serum 25-hydroxyvitamin D levels in patients with alopecia areata, but did not find a clear correlation between serum 25-hydroxyvitamin D levels and the degree of hair loss

Alpha-lipoic acid (ALA), vitamin E, and acetyl-L-carnitine have all been studied in patients with DPN over the past ten years with variable results pertaining to their different antioxidant and anti-inflammatory effects on DPN [8, 12,13,14] Additionally, in preclinical models of diabetic neuropathy, natural supplements including curcumin, resveratrol, and melatonin as well as other antioxidants (Vitamins A, C, E and ALA) that target mitochondrial dysfunction have showed promising results [15,16,17,18] N-acetylcysteine (NAC) was previously shown to impact multiple pathogenetic pathways in DPN, making it a potential candidate for treatment