The standard treatment for arthritis aches and pains involves painkillers of all varieties, that may bring some temporary relief but not without long lasting side-effects. What if there is a molecule that is already inside all of us that could protect the body from arthritis inflammation? Yes, we are talking about NAD+, a co-enzyme present naturally in all living cells.
NAD+ therapy in Arthritis
Our immune system protects us against infections and disease causing pathogens. But in some people with auto-immune disorders, their immune system regards its own normal healthy cells and tissues as foreign and begins to attack them. Type 1 diabetes, lupus, rheumatoid arthritis and multiple sclerosis are all examples of auto-immune disorders. Conventional medicines don’t offer any cure except to manage conditions with a variety of long-term drugs.
Rheumatoid arthritis is an auto-immune disorder where the immune system attacks the joint tissues – causing inflammation. Chronic inflammation, in turn, causes severe damage to the cartilage over time leading to damaged joints with pain, stiffness and swelling.
NAD+, a ubiquitous co-enzyme playing quite an integral role in energy generation and metabolic pathways, can reverse autoimmune disease through various mechanisms, one being activation of Sirtuins.
Sirtuins support and regulate the immune system by reducing pro-inflammatory cytokines – helping the body to fight inflammation. As arthritis is an inflammatory disease, the NAD+/Sirtuin pathway may help in bringing down the inflammation. Something else deserves a mention here. Our understanding of the role of NAD+ dependent sirtuins in reducing inflammation revolves mainly around their deacetylation activities. But there are many other studied mechanisms through which Sirtuins may be playing a broader role in inflammatory pathways  .
In addition, Sirtuin proteins are known to contribute to increased lifespan and healthy tissues, including cartilage structures. Not surprisingly, many studies have investigated the role of NAD+ activated Sirtuins in the development of conditions such as osteoarthritis (OA) and rheumatoid arthritis (RA).
A 2016 review article suggests that SIRT1 has beneficial effects on cartilage health as these proteins promote the survival of chondrocyte – especially under stress conditions . Chondrocyte are the only cells found in a healthy cartilage tissue and these cells are involved in the production and maintenance of cartilage matrix.
The Brigham and Women’s Hospital Study
A 2014 study conducted by researchers at Brigham and Women’s Hospital in Boston also provided more evidence on how NAD+ therapy may be a useful strategy in treating autoimmune diseases.
The study reported that NAD+
- Transforms bad cells that attack the body’s healthy tissues into protective cells – changing how the immune system responds in people with autoimmunity.
- Even repairs the advanced tissue damage caused by auto-immune response – showing the restorative aspect and ramping down the disease progression.
This study was the first to show that the NAD+ molecule can regulate the immune response and reinstate damaged tissue health by “regulating CD4+ T-cell differentiation.”  CD4(+) T cells are immune cells that are implicated in the onset of autoimmunity. Could there be any side effects? Because NAD+ occurs naturally in the body, researchers are hopeful that this treatment would be tolerated well by patients.
This is what the lead study author Stefan G. had to say, “This is a universal molecule that can potentially treat not only autoimmune diseases but other acute or chronic conditions such as allergy, chronic obstructive pulmonary disease, sepsis and immunodeficiency.” 
The potential protective nature of NAD+ treatment is significant for patients, particularly those who have been living with inflammatory arthritis for years and have extensive tissue damage.
- Y. Tao, C. Huang, Y. Huang et al., “SIRT4 suppresses inflammatory responses in human umbilical vein endothelial cells,” Cardiovascular Toxicology, vol. 15, no. 3, pp. 217–223, 2015.
- J. Du, Y. Zhou, X. Su et al., “Sirt5 is a NAD-dependent protein lysine demalonylase and desuccinylase,” Science, vol. 334, no. 6057, pp. 806–809, 2011.
- Dvir-Ginzberg M, Mobasheri A, Kumar A. The Role of Sirtuins in Cartilage Homeostasis and Osteoarthritis. Curr Rheumatol Rep. 2016 Jul;18(7):43. doi: 10.1007/s11926-016-0591-y.
- Tullius et al. NAD+ protects against EAE by regulating CD4+ T-cell differentiation. Nat Commun. 2014 Oct 7;5:5101. doi: 10.1038/ncomms6101.
- New pathway discovered regulating autoimmune diseases. Science Daily. October 2014.