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Folic acid (Vitamin B9), in its reduced form as tetrahydrofolate, functions as an important cofactor in methylation reactions and as a carrier of carbon units in the synthesis of purines and pyrimidines (36, 37)

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A viable solution would be to implement a multimodal framework that combines NFE2L2 / KEAP1 genotyping to identify genetic drivers of NRF2 activation, immunohistochemistry for p62/SQSTM1 to detect post-translational stabilization of NRF2, and transcriptomic profiling of NRF2 downstream targets such as NQO1 , SLC7A11 , and GPX4 to capture pathway activation at the functional level [57, 58]