The Prospect of the NAD+ Precursors in Age-related Diseases

1. Introduction

2. The synthesis and metabolism of NAD+ in age-related pathologies

NAD+ is synthesized from NAD+ precursors and amino acids tryptophan via three main pathways: De novo, Preiss-Handler, and Salvage. Supplementation of NAD+ precursors can be advantageous in maintaining normal cellular metabolism regulated by NAD+ and NAD+-dependent enzymes such as Sirtuins, PARP, CD38, and SARM1. NAD+ intermediates require conversion into NA to elevate NAD+ level.



NAD+ and its metabolism-related enzymes have very important roles in biological processes such as cellular metabolic processes, gene expression, apoptosis and carcinogenesis. NAD+ repletion is drawing attention as an anti-aging intervention. NAD+ precursors, such as NA, NAM, NR, and NMN, provide beneficial effects in various preclinical disease models of age-induced deficits, including metabolic disorders, cardiovascular, neurodegenerative diseases, and musculoskeletal diseases.

3. Comparison on the efficacy of replenishing NAD precursors in pre-clinical studies and clinical studies in age-related pathologies

The downregulation of NAD+ level in cells and tissues is not a universal phenomenon for aging-related pathologies. NAD+ merely decreases with age in certain tissues. The efficacy of NAD+ precursors in clinical studies has been limited in comparison with that in the pre-clinical studies. Noteworthily, this issue can be addressed as long as much attention has been paid to the metabolism of NAD. With regards to the oral supplementation of NAD+ precursors, there is obvious link between NAD metabolism and gut microbes. Specifically, oral consumption of NMN is converted into NAMN through interaction with the gut microbiome. In addition, dietary NAM and NR are converted into NA through gut microbiota.

4. Future research directions regarding the NAD+ metabolism

It is fundamental to consider how the gut microbiome affects NAD+ metabolism, and changes in microbiome composition may affect the availability of NAD+ precursors. Future studies also require the comparative analysis of different precursors, and the role of gut microbiomes regarding various intermediaries needs to be investigated. Assessment of how NAD+ precursors affect microbiota and how their interaction with NAD+ metabolism benefits the physiological condition is essential for future preclinical and clinical studies.

 

5. Conclusion

Reference

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