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But a quieter, more dangerous conversation is emerging in the background: Why are so many patients developing peripheral neuropathy after starting these drugs

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The ecto-enzymes CD39 and CD73, expressed on Tregs, catalyze the metabolism of ATP (Adenosine triphosphate) into AMP (Adenosine monophosphate) and in turn, produce the immunoregulatory purine, adenosine ( in vivo ( 3) Induction of apoptosis

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Having both conditions in the chart without a documented clinical link doesn't justify D63.1

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N Engl J Med 387(3):205216 Jastreboff AM, le Roux CW, Stefanski A, Aronne LJ, Halpern B, Wharton S, Wilding JPH, Perreault L, Zhang S, Battula R, Bunck MC, Ahmad NN, Jouravskaya I (2025) SURMOUNT-1 investigators

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