Cited by 790Sirtuins and Resveratrol in MedicineNuclear Receptors and SignalingBiochemical and Molecular Research

The DOI matches its Crossref record; 228 of the 233 references it cites were found in a registry or an index; none of the 273 sources its claims cite is checked for support yet.

NAD+ in Brain Aging and Neurodegenerative Disorders

Open access

Abstract

NAD+ is a pivotal metabolite involved in cellular bioenergetics, genomic stability, mitochondrial homeostasis, adaptive stress responses, and cell survival. Multiple NAD+-dependent enzymes are involved in synaptic plasticity and neuronal stress resistance. Here, we review emerging findings that reveal key roles for NAD+ and related metabolites in the adaptation of neurons to a wide range of physiological stressors and in counteracting processes in neurodegenerative diseases, such as those occurring in Alzheimer's, Parkinson's, and Huntington diseases, and amyotrophic lateral sclerosis. Advances in understanding the molecular and cellular mechanisms of NAD+-based neuronal resilience will lead to novel approaches for facilitating healthy brain aging and for the treatment of a range of neurological disorders.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that NAD+ availability declines with brain aging and in Alzheimer’s, Parkinson’s, Huntington’s, and ALS, while NAD+-boosting strategies improve pathology and function in many preclinical models. It also surveys human trial evidence and cautions that causal human data, optimal precursors, and long-term safety remain unresolved.

Key findings

  • NAD+ depletion is reported across species and tissues: human brain NAD+ and NAD+/NADH decline with age by non-invasive 31P MR assay; mouse hippocampus shows nearly 40% lower NAD+ at 10–12 months versus 1 month; aged worms also show lower organismal NAD+.
  • The review links NAD+ loss to the 10 hallmarks of brain aging, including mitochondrial dysfunction, oxidative damage, impaired autophagy/proteasome function, disturbed calcium handling, weakened adaptive stress responses, reduced network plasticity, defective DNA repair, inflammation, impaired neurogenesis, and senescence/telomere changes.
  • In neurodegenerative disease models, NAD+ augmentation with precursors such as NR, NMN, NAM, or NA, or by PARP inhibition/SIRT activation, reduces pathology and improves behavior. Examples include a 30% NAD+ reduction in LRRK2 G2019S dopaminergic neurons, 69% lower NAD+ in PINK1 mutant flies, 78% lower NAD+ in parkin mutant flies, and about 50% lower total NAD+ in Fbxo7-deficient cells or patient fibroblasts.
  • Human trials show bioavailability and some safety signals: oral NR at 1,000 mg/day for 7 days raised blood NAD+ up to 2.7-fold and NAAD 45-fold; NRPT raised whole-blood NAD+ by 90%; however, a phase II NAM trial in 15 mild-to-moderate AD patients showed no significant benefit, and NAD+ precursors may carry cancer-related concerns in some contexts.

Methods

  • Narrative review synthesizing mechanistic, preclinical, and clinical literature on NAD+ synthesis, metabolism, subcellular balance, brain aging, and neurodegenerative disorders.
  • Evidence discussed includes animal models (mice, C. elegans, Drosophila, rhesus monkeys), human postmortem tissue, patient-derived cells/iPSCs, and clinical trials; no new primary data are generated.
  • Main analysis is conceptual synthesis, including a proposed model connecting NAD+ depletion to the hallmarks of brain aging and disease-specific pathologies, with tables summarizing preclinical and clinical findings.

Limitations

  • The paper states that human data on NAD+ changes during normal aging are sparse and require large, well-controlled population studies; a direct causal role for impaired NAD+-dependent processes in human neurodegenerative disease remains to be established.
  • The paper notes unresolved questions about mechanisms upstream/downstream of NAD+ depletion, whether NAD+ precursors increase cancer risk in the general population, and the lack of direct human comparisons among NR, NMN, NA, and NAM.
  • Evident from the text: as a review, it does not perform a systematic search or meta-analysis, and many cited clinical trials are small or short (for example, 15 AD patients in the NAM phase II trial and 20 ALS patients in the EH301 pilot), with mixed outcomes.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.cmet.2019.09.001

Cites

228 of 228 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 273 cited sources checked · 0 supported · 0 flagged

Show all 82 claims

  • It may state two separate claims as one. 123
  • Probably not a substantial claim. 25
  • The quote only partly states this claim. 1
132 of 132
  • The paper relies on this without support.

    Mechanisms of NAD+ depletion and benefits of NAD+ augmentation observed in animal models apply to human brain aging and neurodegenerative disorders.

    “While mounting evidence in animals shows age-dependent NAD+ depletion, similar data on NAD+ changes through normal aging in humans are sparse, and data from large, well-controlled population studies will be required.”
  • The paper relies on this without support.

    Understanding NAD+-based neuronal resilience mechanisms will lead to novel approaches for healthy brain aging and treatment of neurological disorders.

    “Advances in understanding the molecular and cellular mechanisms of NAD+-based neuronal resilience will lead to novel approaches for facilitating healthy brain aging and for the treatment of a range of neurological disorders.”
  • The paper relies on this without support.

    Cancer cells and post-mitotic cells have fundamentally different metabolism despite both having high energy demand.

    “Despite both being nutrition demanding, cancer cells and post-mitotic cells exhibit a completely different metabolism”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Opposite effects of lysosome activation on neural stem-cell activation

    Minor

    The review says enhancing lysosome activity inhibited activation of quiescent neural stem cells, but the cited reference's title says lysosome activation enhanced it.

1 of 1

Citations

Cites

2 retracted

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Show all 233 references

5 of the 233 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Birkmayer, 1995, Nicotinamide adenine dinucleotide (NADH)- a new therapeutic approach: preliminary results with cancer patients and patients with dementia of the Alzheimer type, J. Tumor Marker Oncol., 10, 1

Cited by

Sorted by citations

Items 501–600 of 790

Metadata

Authors
Lautrup, S., Sinclair, D. A., Mattson, M. P., & Fang, E. F.
Affiliations
  • University of Oslo (NO)
  • Harvard University (US)
  • Johns Hopkins University (US)
Corresponding author
Fang, Evandro F.
Venue
Cell Metabolism
Publisher
Elsevier BV
Published
2019-10
Volume
30
Issue
4
Pages
630-655
ISSN
1550-4131 (ISSN-L)
OpenAlex
W2977367243
Cited by
790
References
233
Citations by year
2026: 140 · 2025: 130 · 2024: 126 · 2023: 115 · 2022: 123 · 2021: 100 · 2020: 52 · 2019: 4
FWCI
8.51
Type
journal article
Language
en
Open access
Locations
  • Cell Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Funders
  • Mayo Clinic
  • Glenn Foundation for Medical Research
  • Harvard Medical School
  • National Natural Science Foundation of China (207819, 269901, 81971327)
  • Akershus Universitetssykehus
  • Zhengzhou University
  • Norges Forskningsråd (262175, 277813)
  • Norges Idrettshøgskole (R01 AG019719, R01 DK100263, R37 AG028730)
  • Sun Yat-sen University
  • Jinan University
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Sirtuins and Resveratrol in Medicine
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nuclear Receptors and Signaling
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Biochemical and Molecular Research
Keywords
NAD+, brain aging, neurodegenerative diseases, neuronal resilience, NAD+ metabolism, neurological disease treatment
MeSH terms
Aging, Animals, Brain, Cell Line, Humans, NAD, Neurons, Neurodegenerative Diseases, Mice, Rats

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