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Recently, both the FDA and the United States National Heart, Lung and Blood Institutes (NHLBI) have underscored the limitations of these measurements 7

This leads to the inability to absorb B12 and thus deficiency

At the clinical strategy level, the establishment of quantifiable metabolic readouts, such as the Kyn/Trp ratio, the expression of key metabolic enzymes or transporters, and the proportions of signaling metabolites, combined with stratified interventions based on disease stage and tissue involvement, may help further promote tissue repair and restoration of immune homeostasis while suppressing inflammatory responses, thereby enabling treatment strategies for autoimmune diseases with greater long-term benefit (139)

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