Nicotinamide adenine dinucleotide (NADNicotinamide adenine dinucleotide (NAD ϩ ) is an essential redox molecule and a key player in several signaling pathways that govern fundamental biological processes (1, 2). In the redox reactions, a hydride equivalent is reversibly transferred at the nicotinamide moiety, resulting in a switch between oxidized (NAD ϩ ) and reduced (NADH) forms of the nucleotide. Although the redox reactions are critical for efficient mitochondrial metabolism, they are not accompanied by any net consumption of the nucleotide. On the contrary, NAD ϩ -dependent signaling processes lead to its degradation.Three distinct families of enzymes consume NAD ϩ as substrate: poly(ADP-ribose) polymerases (PARPs), 2 ADP-ribosyl cyclases (CD38 and CD157), and sirtuins (SIRT1-7) (3-5). PARPs hydrolyze NAD ϩ and transfer the ADP-ribose moiety of NAD ϩ to a receptor amino acid, building poly(ADP-ribose) polymers. PARPs regulate DNA damage repair, tumorigenesis, cell differentiation, and metabolism (3, 6, 7). CD38 is a ubiquitously expressed multifunctional enzyme that catalyzes the production of second messengers (like cyclic ADP-ribose) (8), which act as potent intracellular calcium-mobilizing agents to control cell cycle, insulin signaling, and microglial activation (8 -10). Sirtuins are a highly conserved family of proteins capable of catalyzing NAD ϩ -dependent deacylation and mono-(ADP-ribosyl)ation reactions (11). Sirtuin activation has been shown to modulate mitochondrial biogenesis and all major mitochondrial processes, including the tricarboxylic acid cycle, fatty acid metabolism, oxidative phosphorylation, and antioxidant response (4,(12)(13)(14)(15). Because all of the above NAD ϩ -consuming enzymes generate nicotinamide (NAM) as a byproduct, mammalian cells have evolved an NAD ϩ salvage pathway capable of resynthesizing NAD ϩ from NAM (16). Although NAD ϩ synthesis can occur from L-tryptophan (kynurenine pathway), nicotinic acid (Preiss-Handler pathway), or nicotinamide riboside (NR) (17-19), the salvage pathway appears to account for the majority of NAD ϩ synthesis in mammalian cells. The enzyme nicotinamide phosphoribosyltransferase (NAMPT) catalyzes the conversion of NAM and 5Ј-phosphoribosyl 1-pyrophosphate to nicotinamide mononucleotide (NMN); subsequently nicotinamide mononucleotide * This study was supported by National Institutes of Health Grants NS089640 and GM103542. The authors declare that they have no conflict of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. 20,21). NAMPT is the rate-limiting enzyme in this pathway. Accordingly, overexpression of NAMPT, but not NMNATs, increases NAD levels (22-24).adenylyltransferases (NMNATs) transfer adenine from ATP to NMN to generate NAD ϩ (All the different types of NAD ϩ -consuming reactions have been described in the mitochondria, but in general NAMPT appears to be absent from the mitochondrial compartment (22, 24 -26), and the ori...