Figure 2 The potential effects of nicotinamide adenine

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Figure 2 The potential effects of nicotinamide adenine dinucleotide (NAD+) therapy on cardiac and renal pathophysiology Figure 2 | The potential effects of nicotinamide adenine dinucleotide (NAD+) therapy on cardiac and renal pathophysiology. Chronic cardiac (part a) and renal (part b) stresses such as ageing and left ventricular hypertrophy result in depleted cellular NAD+ levels. Mitochondrial protein hyperacylation accompanies general mitochondrial dysfunction and might contribute to impaired reduction–oxidation (redox) reactions and ATP depletion. Cellular stress causes overactivation of ADP-ribosyltransferases (ARTDs) and adenine diphosphate ribose (ADPR) cyclases, potentially contributing to overall NAD+ depletion. Acute stresses including ischaemia and acute kidney injury (AKI) deplete cellular NAD+ levels by lowering NAD+ synthesis (primarily through the amidated route). Supplementation with NAD+ or NAD+ precursors might boost cellular NAD+ levels and improve cardiac (part c) and renal (part d) function in disease states. The primary mechanism might be activation of mitochondrial sirtuins (SIRTs), which activate protein lysine deacylation and improve mitochondrial function, leading to improved cellular health. Other NAD+ boosting therapies include inhibiting ARTDs and ADPR cyclases to maintain nuclear and cytoplasmic NAD+ levels. In the heart, ARTD inhibition has beneficial effects but the mechanism is unclear. Inhibition of ADPR cyclases substantially increases NAD+ levels in the heart, but only minimally increases NAD+ levels in the kidney. Such inhibition might improve cardiac and renal function in disease states by normalizing calcium signalling. NA, nicotinic acid; NADH, reduced NAD; NAM, nicotinamide; NMN, nicotinamide mononucleotide; NR, nicotinamide riboside. Hershberger, K. A. et al. (2017) Role of NAD+ and mitochondrial sirtuins in cardiac and renal diseases Nat. Rev. Nephrol. doi:10.1038/nrneph.2017.5