| Rank |
Pathway / Axis |
Cancer Cells (↑ / ↓ / ↔) |
Normal Cells (↑ / ↓ / ↔) |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
NAD+ pool / Redox capacity (NADH/NADPH) |
↑ (often pro-survival; context-dependent) |
↑ (cytoprotection; metabolic support) |
R→G |
Metabolic resilience |
Raising NAD+ can support tumor metabolism and stress tolerance; also supports normal-cell repair/mitochondria. Directional “benefit” is context- and tumor-genotype dependent. |
| 2 |
PARP-mediated DNA repair (NAD+-consuming) |
↑ capacity if NAD+↑; ↓ (high NAM only; model-dependent) |
↑ repair capacity if NAD+↑; ↓ (high NAM only) |
R→G |
DNA damage response tuning |
Mechanistic bifurcation: NAD+ replenishment may enhance repair; high NAM (mM) can functionally inhibit NAD+-consuming enzymes in vitro/adjunct contexts. |
| 3 |
Sirtuins (Class III “HDAC”) / stress-response programs |
↔ (context-dependent); ↓ (high NAM only) |
↔; ↓ (high NAM only) |
R→G |
Epigenetic + mitochondrial signaling modulation |
NAM is a known sirtuin reaction product and can inhibit sirtuin activity at sufficiently high concentrations; many “HDAC-like” effects in cell culture are high-dose NAM-driven. |
| 4 |
GPR109A (HCAR2) signaling (nicotinic acid >> nicotinamide) |
↑ anti-inflammatory / anti-tumor signaling (colon models; context-dependent) |
↑ anti-inflammatory signaling; metabolic effects (adipose) |
P→R |
Immune–epithelial signaling shift |
GPR109A activation can suppress colonic inflammation and inflammation-associated carcinogenesis in preclinical models; translational relevance is tissue-context specific. |
| 5 |
ROS |
↔ (secondary; model-dependent) |
↔ (secondary) |
R |
Redox buffering vs stress |
NADPH availability and mitochondrial function can shift ROS handling indirectly; not typically a “direct ROS drug” mechanism unless dosing/model forces oxidative stress. |
| 6 |
Ca2+ signaling (notably flushing pathway; immune skin cells) |
↔ (not core) |
↑ (GPR109A-linked Ca2+ signaling in specific immune/skin contexts) |
P |
Trigger-proximal signaling |
Ca2+ signaling is mechanistically prominent for nicotinic-acid flushing biology; less central as a generalized anticancer axis. |
| 7 |
Ferroptosis |
↔ (indirect, context-dependent) |
↔ |
R |
Lipid-peroxidation sensitivity (indirect) |
No canonical “niacin → ferroptosis” axis; any effect would likely be via NADPH/redox network shifts. |
| 8 |
HIF-1α / Warburg metabolism |
↔ (indirect) |
↔ |
G |
Hypoxia/metabolic phenotype (indirect) |
NAD+ availability can influence glycolytic flux and mitochondrial balance, but direction is strongly model/tumor dependent. |
| 9 |
Clinical Translation Constraint |
Dose-limited by tolerability/toxicity (NA flushing; hepatotoxicity risk with some regimens; metabolic side effects); many in-vitro concentrations exceed routine systemic exposure. |
— |
PK / Safety |
Anticancer claims are mostly preclinical/contextual; routine supplementation is unlikely to reproduce common in-vitro mM exposures. |
| Rank |
Pathway / Axis |
Cells (↑ / ↓ / ↔) |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
NAD+ pool / mitochondrial support |
↑ |
R→G |
Bioenergetic resilience |
High-dose oral NAM can markedly raise plasma NAM (and related metabolites) in clinical settings; intended to support cellular redox/mitochondrial function. |
| 2 |
Tau phosphorylation / proteostasis (hypothesized) |
↓ (hypothesized; not confirmed clinically) |
G |
Biomarker-targeting rationale |
Phase 2a early-AD trial of high-dose NAM (48 weeks) was safe/tolerable but did not significantly reduce the primary CSF p-tau biomarker endpoint. |
| 3 |
Sirtuins / Class III “HDAC” modulation (NAM as inhibitor at high exposure) |
↓ (high concentration only) |
R→G |
Epigenetic/stress-response reprogramming |
Mechanistic rationale includes NAM effects on sirtuin-mediated signaling; clinical translation depends on achieving relevant CNS exposure. |
| 4 |
Neuroinflammation |
↔ (context-dependent) |
R→G |
Inflammatory tone shift (indirect) |
Potential secondary benefit via metabolic support and immune signaling; not established as a consistent clinical effect in AD. |
| 5 |
ROS / Redox stress |
↓ (secondary, indirect) |
R |
Oxidative stress buffering |
Likely mediated by improved NAD(P)H-linked buffering/mitochondrial function rather than direct antioxidant chemistry. |
| 6 |
Clinical Translation Constraint |
— |
— |
Trial outcome limits |
High-dose NAM can raise plasma levels substantially; CNS penetration/target engagement may be variable; Phase 2a biomarker outcome negative. |