Multi-targeted Effect of Nicotinamide Mononucleotide on Brain Bioenergetic Metabolism.

Dysfunctions in NAD metabolism are associated with neurodegenerative diseases, acute brain injury, diabetes, and aging. Loss of NAD levels results in impairment of mitochondria function, which leads to failure of essential metabolic processes. Strategies to replenish depleted NAD pools can offer significant improvements of pathologic states. NAD levels are maintained by two opposing enzymatic reactions, one is the consumption of NAD while the other is the re-synthesis of NAD. Inhibition of NAD degrading enzymes, poly-ADP-ribose polymerase 1 (PARP1) and ectoenzyme CD38, following brain ischemic insult can provide neuroprotection. Preservation of NAD pools by administration of NAD precursors, such as nicotinamide (Nam) or nicotinamide mononucleotide (NMN), also offers neuroprotection. However, NMN treatment demonstrates to be a promising candidate as a therapeutic approach due to its multi-targeted effect acting as PARP1 and CD38 inhibitor, sirtuins activator, mitochondrial fission inhibitor, and NAD supplement. Many neurodegenerative diseases or acute brain injury activate several cellular death pathways requiring a treatment strategy that will target these mechanisms. Since NMN demonstrated the ability to exert its effect on several cellular metabolic pathways involved in brain pathophysiology it seems to be one of the most promising candidates to be used for successful neuroprotection.