Deep Insight on NADH: a Potential Medical Arsenal

Deep Insight on NADH: a Potential Medical Arsenal



NADH (reduced form of NAD+) serves as a carrier of biological hydrogen and an electron donor, which participates in diverse physiological processes such as protein synthesis, DNA repair, insulin synthesis and secretion, immune response and cell division, playing a critical role in promoting health span and mitigating various disease states.

Major enzymatic reactions in substrate metabolism that are dependent upon NAD+/NADH ratio

The equilibrium of the NAD+/NADH ratio is vital for maintaining cellular reduction–oxidation (redox) homeostasis and modulating energy metabolism. Several enzymatic reactions in substrate metabolism are carried out in a NAD+/NADH ratio-dependent way. For instance, ketones suppress the increased mitochondrial production of ROS associated with excitotoxic injury by enhancing NADH oxidation (i.e. elevated NAD+/NADH ratio) in the electron transport chain, directly affecting NADH level .


NADH in Krebs cycle and glycolysis

NADH is produced in glycolysis and the Krebs cycle (also known as citric acid cycle or tricarboxylic acid cycle), which can transfer energy to supply ATP synthesis through the process of oxidative phosphorylation in the inner membrane of the mitochondria. Krebs cycle supplies NADH as an electron carrier to the electron transport chain in mitochondria, while glycolysis-produced NADH can be used by L-lactate dehydrogenase (LDH) or transported to the mitochondria for redox homeostasis. The effects of NADH on the mitochondria are accomplished by specialized shuttle systems (e.g., malate-aspartate or glycerol-3-phosphate).


The possible strategies to modulate NADH level

The main NAD/NADH biosynthetic pathways include de novo synthesis from tryptophan (TRP), synthesis from either form of vitamin B3, nicotinamide (NAM) or nicotinic acid (NA), or conversion of nicotinamide riboside (NR). Correspondingly, NADH level can be regulated by replenishing NADH precursors (eg. NR and NMN), applying NADH dehydrogenase inhibitors, having diets rich in certain nutrients (eg. vitamin B3), administrating mitochondrial targeting agents and supplementing exogenous NADH.



NADH may be a versatile therapeutic candidate by leverage of its ability to affect redox homeostasis, mitochondrial functions, and enzymatic reactions.


Schiuma G, Lara D, Clement J, Narducci M, Rizzo R. NADH: the redox sensor in aging-related disorders. Antioxid Redox Signal. Published online February 17, 2024. doi:10.1089/ars.2023.0375


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