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Initially, the mechanisms of action of this enzyme were considered paradoxical because CD38 is predominantly localized on the cell surface, yet its final products are utilized within cytoplasmic compartments

Bock-Marquette et al., 2004 Accelerated healing of tendons, ligaments, and muscle fibers

Mol Gen Genet 172:1724 Mahon G, Green M, Middleton B et al (1989) Analysis of data from microbial colony assays

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(And even if they were approved, pharmaceutical companies would shy away from them for fear of being undercut by compounding pharmacies.) If companies can sell them and make lots of money without having to prove that they do what theyre claimed to do, why wouldnt they? Zettler points out

Polymyxin induced nephrotoxicity is a common adverse effect