| Rank |
Pathway / Axis |
Cancer / Tumor Context |
Normal Tissue Context |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
NAD+ salvage pathway (NAMPT → NMN → NAD+) |
NAD+ pool ↑ supports glycolysis, DNA repair, PARP activity; NAMPT often upregulated |
Maintains metabolic homeostasis |
R, G |
Metabolic support node |
Many tumors depend on NAMPT-driven NAD+ salvage; NAMPT inhibitors (e.g., FK866) deplete NAD+ and induce energetic collapse. |
| 2 |
Glycolysis support (LDH-dependent NAD+ recycling) |
NAD+ regeneration sustains Warburg flux |
Normal glycolytic tissues also require NAD+ |
P, R |
Warburg sustainment |
LDH converts NADH → NAD+ to maintain glycolytic flux; NAD+ availability is a rate-limiting factor in high glycolysis tumors. |
| 3 |
PARP-mediated DNA repair (NAD+ consumption) |
DNA damage repair ↑; therapy resistance ↑ (context) |
Genome stability maintenance |
R, G |
DNA repair capacity |
PARPs consume NAD+ during DNA repair. PARP inhibitors exploit tumors with HR defects (e.g., BRCA). |
| 4 |
Sirtuin signaling (SIRT1–7; NAD+-dependent deacetylases) |
Context-dependent tumor survival or suppression |
Metabolic regulation, longevity pathways |
R, G |
Epigenetic/metabolic modulation |
Sirtuins require NAD+; effects vary by tumor type (pro-survival in some, suppressive in others). |
| 5 |
Redox balance (NAD+/NADH ratio) |
High NAD+/NADH ratio supports anabolic growth |
Redox homeostasis |
P, R |
Redox control |
Altered NAD+/NADH ratios influence ROS, mitochondrial function, and metabolic flexibility. |
| 6 |
CD38/CD157 NAD+ degradation |
NAD+ depletion influences immune and tumor metabolism |
Immune modulation, aging |
R, G |
Immune-metabolic interface |
CD38 overexpression can lower NAD+ pools; relevant in immune microenvironment contexts. |
| 7 |
OXPHOS support (mitochondrial NADH supply) |
NADH fuels ETC; supports mitochondrial ATP production |
Normal energy metabolism |
P, R |
Mitochondrial respiration support |
NADH oxidation via Complex I regenerates NAD+; OXPHOS-dependent tumors rely on this axis. |
| 8 |
Therapy resistance modulation |
NAD+ restoration may reduce oxidative therapy efficacy |
May protect normal tissue from oxidative injury |
G |
Context-dependent |
NAD+ boosting (e.g., NR, NMN) may theoretically support tumor repair pathways; data mixed and context-specific. |
| 9 |
NAMPT inhibition (therapeutic strategy) |
NAD+ depletion → ATP ↓ → apoptosis ↑ |
Toxicity risk in high-turnover tissues |
R, G |
Metabolic collapse |
NAMPT inhibitors are being explored as anti-cancer metabolic therapies. |
| 10 |
Bioavailability / supplementation constraint |
Systemic NAD+ boosting may not selectively target tumor NAD pools |
Systemic NAD+ supports normal tissue repair |
— |
Translation constraint |
Oral precursors (NR, NMN, niacin) increase systemic NAD+ but tumor-specific impact remains unclear. |