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Beyond redox chemistry, NAD+ serves as a substrate for enzymes that cleave the molecule and transfer its ADP-ribose moiety or remove acetyl groups. Sirtuins consume NAD+ during deacetylation, poly(ADP-ribose) polymerases use it in DNA damage responses, and CD38 enzymes hydrolyze it to signaling metabolites. These consumption pathways mean that NAD+ availability can influence gene regulation, DNA repair, and calcium signaling. Cellular NAD+ concentrations decline in some tissues with age in animal models, but whether this decline is a cause or consequence of aging in humans remains an active open question.
Nicotinamide adenine dinucleotide, commonly abbreviated NAD+, is a dinucleotide coenzyme built from an adenine nucleotide and a nicotinamide nucleotide joined by a pyrophosphate linkage. Its oxidized form carries a positive charge on the nicotinamide ring, while the reduced form, NADH, carries a hydride equivalent. The molecule participates in hundreds of oxidoreductase reactions, where it accepts or donates electrons and protons. Because it can cycle between oxidized and reduced states without net consumption, NAD+ functions as a reusable electron carrier rather than a fuel molecule.
In cells, NAD+ functions primarily as an electron carrier. Dehydrogenase enzymes in glycolysis and the citric acid cycle transfer hydride from substrates to NAD+, producing NADH. NADH then delivers electrons to the mitochondrial respiratory chain, supporting ATP synthesis. In fermentation, NADH is reoxidized to NAD+ so that glycolysis can continue. The balance between NAD+ and NADH helps set metabolic flux. Beyond redox, NAD+ serves as a substrate for enzymes that cleave it, including sirtuins, poly(ADP-ribose) polymerases, and CD38. These reactions consume NAD+ and release nicotinamide and ADP-ribose products.
Biosynthesis occurs through salvage, Preiss-Handler, and de novo pathways. In mammals, the salvage pathway from nicotinamide predominates, and NAMPT is often described as rate-limiting. Nicotinamide riboside and nicotinic acid enter related routes that converge on NAD+ production. Tissue NAD+ concentrations vary widely and are maintained by a balance of synthesis and consumption. Some studies report age-related declines in certain tissues, but whether these changes cause disease or can be reversed to improve human health remains an open question.
| Property | Value | Notes |
|---|---|---|
| Common synonyms | β-NAD+, coenzyme I, DPN | DPN stands for diphosphopyridine nucleotide; older literature uses this term. |
| CAS Registry Number | 53-84-9 | Free acid form of β-nicotinamide adenine dinucleotide. |
| Molecular formula | C21H27N7O14P2 | Anhydrous free acid; molar mass 663.43 g/mol. |
| Appearance | White to off-white powder | Crystalline solid; may absorb moisture from air. |
| Solubility | Freely soluble in water | Insoluble in most nonpolar organic solvents. |
Measuring NAD+ in biological samples requires care because the molecule is chemically reactive and present at low concentrations in some tissues. Common approaches include enzymatic cycling assays, high-performance liquid chromatography, and liquid chromatography coupled to mass spectrometry. Each method has different sensitivity and specificity, and sample preparation can affect results. Acidic or alkaline extraction steps are used in some protocols, but the choice depends on the analyte and matrix. No single method is universally optimal for every tissue or fluid.
Solid NAD+ is relatively stable when kept dry, cold, and protected from light. Aqueous solutions are more vulnerable to hydrolysis and can lose activity during repeated freeze-thaw cycles or prolonged storage at ambient temperature. Stability depends on pH, ionic strength, and the presence of degrading enzymes or metal ions. For many laboratory uses, aliquots are stored frozen and thawed only once. Exact degradation rates vary by matrix, so stability should be checked for each application rather than assumed.
Solid NAD+ is usually supplied as a white to off-white powder or lyophilized preparation. It is hygroscopic and should be kept desiccated at low temperature, commonly -20 °C or below for long-term storage. Aqueous solutions are less stable than dry material and are often prepared fresh or stored frozen in aliquots. Light exposure and repeated freeze-thaw cycles can promote degradation, so amber containers and single-use aliquots are preferred. Buffered solutions near neutral pH are generally less stable than acidic or frozen preparations.
Quantification of NAD+ in biological samples typically uses liquid chromatography coupled to mass spectrometry. Enzymatic cycling assays offer higher throughput and rely on NAD+ dependent dehydrogenases to amplify signal. Both approaches require careful sample quenching because NAD+ can be rapidly consumed or converted after collection. Acidic extraction is common for NAD+, while alkaline conditions favor NADH in some protocols. Isotopically labeled internal standards help correct for losses during extraction and ionization.
Commercial NAD+ is available at research grade, often with purity specifications determined by high-performance liquid chromatography. Certificates of analysis may report water content, residual solvents, and counterion identity. Identity can be confirmed by ultraviolet absorbance near 260 nm, mass spectrometry, or enzymatic activity. Because different salt forms and hydration states exist, researchers should verify that the product matches the intended molecular form. Lot-to-lot variation in purity can affect quantitative assays and should be documented.
Laboratory measurement of NAD+ often begins with rapid quenching of cell or tissue samples to prevent enzymatic conversion. Acidic or alkaline extraction can precipitate proteins, but the chosen method affects recovery of oxidized and reduced forms. Enzymatic cycling assays provide high sensitivity by amplifying a NAD+-dependent reaction. High-performance liquid chromatography and mass spectrometry offer separation and structural confirmation. Each method has trade-offs in throughput, specificity, and the ability to distinguish NAD+ from close analogues.
Purified NAD+ is typically supplied as a white to off-white powder and stored desiccated at low temperature. Airtight containers limit moisture uptake, while protection from light reduces degradation of the nicotinamide ring. Aqueous stock solutions are less stable than solid material and are often aliquoted before freezing. Repeated freeze-thaw cycles can lower integrity, so working portions are kept separate. Purity is commonly checked by ultraviolet absorbance near 260 nm, high-performance liquid chromatography, or mass spectrometry.
Nicotinamide adenine dinucleotide, commonly abbreviated NAD+, is a coenzyme present in all living cells. The molecule consists of two nucleotides linked by phosphate groups, with adenine and a nicotinamide ring as its principal features. In its oxidized form, the nicotinamide ring can accept a hydride ion, becoming NADH. This reversible conversion places NAD+ at the center of many electron-transfer reactions. Its role as a redox carrier is well established across bacteria, plants, fungi, and animals.
Beyond redox chemistry, NAD+ acts as a substrate for several enzyme families. ADP-ribosyltransferases, sirtuins, and CD38 ectoenzymes cleave the molecule into nicotinamide and ADP-ribose or related products. These reactions connect NAD+ availability to processes such as DNA repair, chromatin modification, and calcium signaling. Because the coenzyme is used in both electron transfer and signaling, cells maintain separate pools in compartments including the cytosol, mitochondria, and nucleus. The relative sizes and regulation of those pools remain active areas of study.
Trading relations were established with Malacca in the 15th century, with cloth, ambergris and porcelain being the main commodities of the trade. Giraffes, zebras and incense were exported to the Ming Empire of China, which established Somali merchants as leaders in the commerce between East Asia and the Horn. Hindu merchants from Surat and Southeast African merchants from Pate, seeking to bypass both the Portuguese India blockade (and later the Omani interference), used the Somali ports of Merca and Barawa (which were out of the two powers' direct jurisdiction) to conduct their trade in safety and without interference.
The redox reactions catalyzed by oxidoreductases are vital in all parts of metabolism, but one particularly important area where these reactions occur is in the release of energy from nutrients. Here, reduced compounds such as glucose and fatty acids are oxidized, thereby releasing energy. This energy is transferred to NAD+ by reduction to NADH, as part of beta oxidation, glycolysis, and the citric acid cycle. In eukaryotes the electrons carried by the NADH that is produced in the cytoplasm are transferred into the mitochondrion (to reduce mitochondrial NAD+) by mitochondrial shuttles, such as the malate-aspartate shuttle. The mitochondrial NADH is then oxidized in turn by the electron transport chain, which pumps protons across a membrane and generates ATP through oxidative phosphorylation. These shuttle systems also have the same transport function in chloroplasts. Since both the oxidized and reduced forms of nicotinamide adenine dinucleotide are used in these linked sets of reactions, the cell maintains significant concentrations of both NAD+ and NADH, with the high NAD+/NADH ratio allowing this coenzyme to act as both an oxidizing and a reducing agent. In contrast, the main function of NADPH is as a reducing agent in anabolism, with this coenzyme being involved in pathways such as fatty acid synthesis and photosynthesis. Since NADPH is needed to drive redox reactions as a strong reducing agent, the NADP+/NADPH ratio is kept very low. Although it is important in catabolism, NADH is also used in anabolic reactions, such as gluconeogenesis.
=== Non-medical === Modafinil has been used non-medically as a "smart drug" by various groups, including students, office workers, and transhumanists. The reported effect ranges from a significant increase in cognitive abilities to a mild or absent improvement. In some cases, it has been associated with impairments in certain cognitive functions. It has been shown that a positive impact on cognitive abilities is more noticeable on sleep-deprived individuals. Therefore, in people who are not sleep-deprived, the potential of modafinil as a cognitive enhancer may be limited.
=== Specialized reactions === As with all carbonyl compounds, the protons on the α-carbon are labile due to keto–enol tautomerization. Thus, the α-carbon is easily halogenated in the Hell–Volhard–Zelinsky halogenation. The Schmidt reaction converts carboxylic acids to amines. Carboxylic acids are decarboxylated in the Hunsdiecker reaction. The Dakin–West reaction converts an amino acid to the corresponding amino ketone. In the Barbier–Wieland degradation, a carboxylic acid on an aliphatic chain having a simple methylene bridge at the alpha position can have the chain shortened by one carbon. The inverse procedure is the Arndt–Eistert synthesis, where an acid is converted into acyl halide, which is then reacted with diazomethane to give one additional methylene in the aliphatic chain. Many acids undergo oxidative decarboxylation. Enzymes that catalyze these reactions are known as carboxylases (EC 6.4.1) and decarboxylases (EC 4.1.1). Carboxylic acids are reduced to aldehydes via the ester and DIBAL, via the acid chloride in the Rosenmund reduction and via the thioester in the Fukuyama reduction. In ketonic decarboxylation carboxylic acids are converted to ketones. Organolithium reagents (>2 equiv) react with carboxylic acids to give a dilithium 1,1-diolate, a stable tetrahedral intermediate which decomposes to give a ketone upon acidic workup. The Kolbe electrolysis is an electrolytic, decarboxylative dimerization reaction. It gets rid of the carboxyl groups of two acid molecules, and joins the remaining fragments together.
Sources: en.wikipedia.org
=== Subclinical === Subclinical hypothyroidism is a biochemical diagnosis characterized by an elevated serum TSH level, but with a normal serum free thyroxine level. The incidence of subclinical hypothyroidism is estimated to be 3-15% and a higher incidence is seen in elderly people, females and those with lower iodine levels. Subclinical hypothyroidism is most commonly caused by autoimmune thyroid diseases, especially Hashimoto's thyroiditis. The presentation of subclinical hypothyroidism is variable and classic signs and symptoms of hypothyroidism may not be observed. Of people with subclinical hypothyroidism, a proportion will develop overt hypothyroidism each year. In those with detectable antibodies against thyroid peroxidase (TPO), this occurs in 4.3%, while in those with no detectable antibodies, this occurs in 2.6%. In addition to detectable anti-TPO antibodies, other risk factors for conversion from subclinical hypothyroidism to overt hypothyroidism include female sex or in those with higher TSH levels or lower level of normal free T4 levels. Those with subclinical hypothyroidism and detectable anti-TPO antibodies who do not require treatment should have repeat thyroid function tested more frequently (e.g. every 6 months) compared with those who do not have antibodies.
== Locations == In addition to the main hospital in Raleigh, Rex Health Care has locations throughout Wake County. These include an outpatient rehabilitation and fitness center in Garner, outpatient facilities in Cary, Holly Springs (Holly Springs facility), and Wake Forest (Wakefield facility), and outpatient diagnostics in Cary, Wakefield, and Knightdale. Apex also has a rehabilitation and nursing care center that is run by Rex. In December 2021, Rex opened a new facility in Holly Springs offering multiple services.
The histological and ultrastructural features of Ledderhose and Dupuytren's disease are the same, which supports the hypothesis that they have a common cause and pathogenesis. As with Dupuytren's disease, the root cause(s) of Ledderhose's disease are not yet understood. It has been noted that it is an inherited disease and of variable occurrence within families, i.e. the genes necessary for it may remain dormant for a generation or more and then surface in an individual, or be present in multiple individuals in the same generation with varying degree. There are certain identified risk factors. The disease is more commonly associated with:
Sources: en.wikipedia.org
== Neurodegeneration == Inhibition of Hsp90 leads to Hsp70 and Hsp40 upregulation, which can channel misfolded protein for proteasome degradation, which can potentially inhibit the progression of neurodegenerative diseases. For example, Hsp70 overexpression in human neuroglioma cells transfected with mutant alpha-synuclein led to 50% less oligomeric alpha-synuclein species, pointing towards the possibility that increasing its expression could diminish the spread of Parkinson's disease. Similarly, Hsp70 overexpression suppressed poly-Q dependent aggregation and neurodegeneration in cell cultures, yeast, fly, and mouse models, and deletion of hsp70 increased the size of polyQ inclusion bodies, suggesting that increasing its expression could help to prevent Huntington's disease. Similarly, reductions in Hsp70 have been shown in transgenic mouse models of ALS and patients with sporadic ALS. Lastly, increased expression or activity of Hsp70 has been proposed as a method to prevent the progression of Alzheimer's disease, because knock down of Hsp70 promoted A-beta toxicity, and Hsp70 was shown to promote tau stability, while Hsp70 levels are decreased in tauopathies like Alzheimer's disease. Given the complex interplay between the different chaperone proteins, therapeutic development in this field is aimed at investigating how the chaperone network as a whole can be manipulated and the effect of this manipulation on the progression of neurodegenerative disease, but the balance of Hsp70 and Hsp90 levels appears to be central in this pathophysiology.
Pellucid marginal degeneration (PMD) is a degenerative corneal condition, often confused with keratoconus. It typically presents with painless vision loss affecting both eyes. Rarely, it may cause acute vision loss with severe pain due to perforation of the cornea. It is typically characterized by a clear, bilateral thinning (ectasia) in the inferior and peripheral region of the cornea, although some cases affect only one eye. The cause of the disease remains unclear. Pellucid marginal degeneration is diagnosed by corneal topography. Corneal pachymetry may be useful in confirming the diagnosis. Treatment usually consists of vision correction with eyeglasses or contact lenses. Intacs implants, corneal collagen cross-linking, and corneal transplant surgery are additional options. Surgery is reserved for individuals who do not tolerate contact lenses. The term pellucid marginal degeneration was coined in 1957 by the ophthalmologist Schalaeppi. The word "pellucid" means clear, indicating that the corneas retain clarity in pellucid marginal degeneration. The condition is rare, though the exact prevalence and incidence are unknown.
== Treatment == Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. In some cases the fistula is temporarily covered, using a fibrin glue or plug. Catheters may be required to drain a fistula. Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess). Various surgical procedures are used, most commonly fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). Management involves treating any underlying causative condition. For example, surgical treatment of fistulae in Crohn's disease can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of the fistula is very high (well above 50%).
Sources: en.wikipedia.org
NAD+ is an oxidized dinucleotide coenzyme that carries electrons in metabolic reactions. It is also consumed by signaling enzymes, including sirtuins and PARPs. Its reduced form is NADH.
NAD+ is the oxidized form and can accept a hydride equivalent. NADH is the reduced form and donates electrons to the electron transport chain. The two forms cycle between each other during cellular respiration.
In mammals, NAD+ is synthesized mainly through salvage pathways using nicotinamide, nicotinamide riboside, or nicotinic acid. Tryptophan can also contribute through a de novo route. The salvage pathway is often considered the primary source in many tissues.
Nicotinamide adenine dinucleotide, with the plus sign indicating the oxidized form. It is a coenzyme present in all living cells. The reduced form is NADH.