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Age-related NAD+ decline impairs this critical DNA repair pathway CD38 balance: The ectoenzyme CD38 consumes NAD+ and increases with age, creating a vicious cycle of NAD+ depletion and immune dysregulation By restoring NAD+ levels, supplementation recalibrates multiple aging pathways simultaneously: improved DNA repair, enhanced mitochondrial biogenesis, restored epigenetic regulation, activated autophagy, and improved nutrient sensing

Figure 63 The fraction of clinically used drugs metabolized by the major phase 1 and phase 2 enzymes

doi: 10.1084/jem.20041257 29 McGeachyMJChenYTatoCMLaurenceAJoyce-ShaikhBBlumenscheinWMet al