Nicotinamide/nicotinate mononucleotide (NMN/ NaMN)adenylyltransferase (NMNAT) is an indispensable enzyme in the biosynthesis of NAD؉ and NADP ؉ . Human NMNAT displays unique dual substrate specificity toward both NMN and NaMN, thus flexible in participating in both de novo and salvage pathways of NAD synthesis. Human NMNAT also catalyzes the ratelimiting step of the metabolic conversion of the anticancer agent tiazofurin to its active form tiazofurin adenine dinucleotide (TAD). The tiazofurin resistance is mainly associated with the low NMNAT activity in the cell. We have solved the crystal structures of human NMNAT in complex with NAD, deamido-NAD, and a non-hydrolyzable TAD analogue -CH 2 -TAD. These complex structures delineate the broad substrate specificity of the enzyme toward both NMN and NaMN and reveal the structural mechanism for adenylation of tiazofurin nucleotide. The crystal structure of human NMNAT also shows that it forms a barrel-like hexamer with the predicted nuclear localization signal sequence located on the outside surface of the barrel, supporting its functional role of interacting with the nuclear transporting proteins. The results from the analytical ultracentrifugation studies are consistent with the formation of a hexamer in solution under certain conditions. Nicotinamide/nicotinic acid mononucleotide (NMN/NaMN) 1 adenylyltransferase (NMNAT) is an indispensable enzyme in both de novo and salvage pathways of NAD biosynthesis (1, 2) (Fig. 1a). In human, the de novo NAD biosynthesis proceeds via several enzymatic steps to transform tryptophan into NaMN, which is then converted into deamido-NAD (NaAD) via the action of the ubiquitous enzyme NMNAT, and into NAD by means of NAD synthetase (2). Alternatively, the nicotinamide or nicotinamide ribose from degradation of NAD or from the extracellular medium can be re-used and adenylated by NMNAT to form NAD directly, potentially bypassing the last amidation step catalyzed by NAD synthetase (Fig. 1a). Human NMNAT displays unique dual substrate specificity toward both NMN and NaMN (3, 4) and is thus capable of participating in both de novo and salvage pathways of NAD generation.In addition to the fundamental role as coenzyme in hundreds of oxidation-reduction reactions throughout the cell, NAD can also be used as a substrate for the modification of a variety of nuclear proteins by ADP-ribosyltransferases (5, 6) and for the repair of DNA by DNA ligase in bacteria (7,8). The formation of protein-coupled poly(ADP-ribose) relaxes the chromatin structure and facilitates DNA regulatory and repair events under conditions of DNA damage. Recently, several NAD derivatives such as cyclic ADP-ribose and nicotinic acid adenine dinucleotide phosphate have been reported to be potent intracellular calcium-mobilizing agents participating in calcium-dependent signaling pathways (5, 9). In some situations these processes may significantly deplete the cellular NAD pool which, coupled with a decrease in ATP production, could potentially lead to a cellular energy cris...