Background: Nicotinamide adenine dinucleotide - a coenzyme found in every cell in the human body - is involved in hundreds of critical metabolic processes. As humans age, intracellular NAD+ levels decrease - this depletion is exacerbated during complicated SARS-COV-2 infections - impairing our antiviral defense systems and our ability to control inflammation.
Methods: Ten consecutive acutely-ill presumed SARS-CoV-2 infected patients older than 50 years were treated with nicotinamide mononucleotide (NMN), betaine, sodium chloride and zinc sulfate (NMN cocktail). Eight patients had positive nasopharyngeal SARS-CoV-2 NAA test results, one patient was clinically diagnosed with COVID-19 based on classic symptoms; one patient was excluded (COVID-19 was ruled out). The COVID-19 patients were monitored with clinical evaluations, body temperatures and room air oxygen saturation levels. Serial inflammatory cytokine measurements and chest X-rays were done.
Results: Cases #1, 4, 7 and 10 were critically-ill with worsening O2 sats, pulmonary infiltrates and inflammation prior to administration of the NMN cocktail. Post-treatment, prompt clinical improvement was seen including fever resolution in 2-3 days, rapid CXR improvement, dramatic drops in CRP and IL-6 within 72 hours and hospital discharge in ≤ 5 days (3/3 cases). No patient required ICU care or intubation post treatment. Cases 5 and 8 (bilateral pneumonias but no prior CXRs) and cases 2 and 3 (symptomatic outpatients with failed trials of hydroxychloroquine, azithromycin and zinc with no CXRs performed) had a strong temporal relationship between NMN cocktail use and rapid clinical improvement. Patient #6 improved with prompt fever and symptom resolution but after premature NMN cocktail discontinuation he relapsed.
Summary: The NMN cocktail resulted in rapid improvement in older persons with complicated SARS-CoV-2 infections. NMN with and without boosters deserves further study. This treatment has a strong molecular rationale for success and can be safely administered orally at home and in hospitalized patients.