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2.5 Quality assessment and risk of bias In line with PRISMA guidelines, the assessment of methodological quality was conducted to evaluate the strength of evidence, recognising that methodological limitations may introduce bias

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showed that upregulation of surface CD38 leads to intracellular NAD + depletion, which induces mitochondrial alterations and increases oxidative stress ( + precursors appears to improve NAD+ levels, acting as adjuvants to boost T lymphocyte responses ( CD38 primarily functions as a NAD+-glycohydrolase ( 2.3.3 CD38 as an immune checkpoint in therapy Based on this understanding, it is speculated that CD38 serves as an immune checkpoint regulating NAD + and ADO homeostasis