Natural boost may repair damaged lungs

Millions of people live with chronic obstructive pulmonary disease (COPD), which makes breathing more difficult and often worsens with age. Researchers think that part of the problem is that important repair mechanisms decline over time – especially the concentrations of NAD⁺, which helps to repair cells and control inflammation. When NAD⁺ concentrations drop, the lung tissue becomes more sensitive to irritation, which accelerates the development of COPD.

But could boosting NAD⁺ concentrations slow this progression? To investigate this, researchers tested a dietary supplement called nicotinamide riboside on people with COPD. By measuring inflammatory markers in the lungs and the function of the cells, they hoped to find a safer and more effective way to help people with COPD.

“After only a few weeks, the evidence indicated that supplementing with nicotinamide riboside reduced irritation in the lungs and strengthened the cells’ defences. This discovery opens new possibilities for treating people with COPD and other age-related diseases by helping cells to protect and potentially repair themselves. The increased NAD⁺ concentrations appear to give the body more energy to defend and rebuild itself,” explains Morten Scheibye-Knudsen, Associate Professor, Department of Cellular and Molecular Medicine, University of Copenhagen, Denmark.

Why breathing becomes more difficult with age

COPD is the third leading cause of death worldwide and affects about 200 million people globally. Each year about 3.3 million people die from it. COPD gradually damages the lungs, leading to shortness of breath and frequent coughing that impairs the quality of life. Researchers suspect that biological stresses caused by ageing – such as DNA damage and inflammation – may accelerate the development of COPD.

“We thought that COPD would be a good focus because part of the disease mechanism is strongly associated with smoking and smoking can damage DNA. An important factor in this process is NAD⁺, a molecule cells need for producing energy and repairing DNA,” says Morten Scheibye-Knudsen.

As NAD⁺ concentrations decline with age, cells become weaker and heal more slowly and are more likely to overreact with harmful inflammation. This has led researchers to consider whether boosting NAD⁺ might slow the progression of COPD and improve lung health.

“I became interested in the NAD molecule when I discovered its role in many important processes in the body. Our previous research has shown that this B₃-like vitamin can help to counteract some of the harmful effects of diseases with increased DNA damage,” adds Morten Scheibye-Knudsen.

In addition to giving the cells energy, NAD⁺ also helps to protect them from the daily wear and tear that accumulates over time.

“Since COPD worsens with age, suspecting that declining NAD⁺ concentrations contribute to this seems reasonable. Increasing the concentration of this key molecule may be able to help the body repair itself more effectively,” he explains.

Might stop the ageing clock

Researchers previously observed that people with chronic lung diseases often show signs of accelerated ageing in the respiratory tract. Inflammation becomes a persistent condition that breaks down the lung tissue and makes breathing more difficult.

“This attracts cells that break down the elastic tissue of the lungs, which contributes to progression. From a pragmatic perspective, achieving positive effects by reducing inflammation therefore makes sense,” says Morten Scheibye-Knudsen.

Current treatments primarily aim to relieve symptoms and prevent exacerbation but do not address the underlying causes.

“Recent research on ageing suggests that restoring normal NAD⁺ concentrations may help to repair damage and may slow disease progression,” he adds.

Researchers have therefore turned their attention to nicotinamide riboside, a precursor that the body converts into NAD⁺. Early laboratory tests suggest this may help cells to stay healthier by reducing harmful inflammation and improving DNA repair.

“The idea that NAD⁺ might be able to stop the ageing clock for lung cells is really fascinating. There is probably no quick fix, but if nicotinamide riboside can strengthen the body’s natural defences, it could really help people with COPD,” explains Morten Scheibye-Knudsen.

Broader sense of the effects

The researchers hoped that increasing NAD⁺ would address the fundamental processes that accelerate lung disease, such as chronic inflammation and cellular breakdown.

“The goal was not to cure COPD but to improve treatment. Any small improvement that eases breathing and increases energy is worth investigating. We analysed not only the lungs but also blood and cell samples to get a broader sense of how nicotinamide riboside affects the body – such as examining everything simultaneously from multiple angles to discover important details,” says Morten Scheibye-Knudsen.

The participants visited the clinic three times: before the trial, after six weeks and again 12 weeks later. At each visit, their lung function was measured and samples of blood and saliva were analysed for signs of inflammation and changes in NAD⁺ concentrations.

“After just six weeks, the inflammation marker interleukin-8 in lung mucus declined about 50% among those who took nicotinamide riboside versus the placebo group, a great improvement,” he says.

This improvement persisted even after treatment ended, suggesting a long-lasting effect on airway inflammation. In addition, tests showed that nicotinamide riboside more than doubled blood concentrations of NAD⁺ – associated with healthier cells and better DNA repair.

“Blood tests showed no changes in other inflammatory markers, which suggests that nicotinamide riboside worked primarily in the lungs. There were no serious side-effects either, so the treatment seems safe so far,” notes Morten Scheibye-Knudsen.

No miracle cure

Clear decline in a marker that is so central to lung inflammation is rare. Even more intriguing, these changes followed increased NAD⁺ concentrations – as if the cells were receiving the energy they needed to heal themselves more effectively.

“Biology is rarely simple and predictable. Nevertheless, this evidence strongly indicates that nicotinamide riboside can affect important processes that typically accelerate with age, although the long-term significance remains uncertain. My immediate thought is that it may well slow down progression a little,” explains Morten Scheibye-Knudsen.

Reducing inflammation also means that fewer neutrophils (immune cells) are attracted to the area. Additional tests suggest that nicotinamide riboside can make cells more resistant to daily stress.

“The genetic analysis indicated that the body’s ability to repair DNA was activated, which could mean fewer damaged cells in the long term. Early results also suggest fewer ‘old’ cells, which can otherwise contribute to harmful inflammation,” he adds.

Although these findings do not confirm long-term cure for lung diseases, they indicate biological changes that may slow the progression of COPD and support overall lung health.

“The most important thing is signs of stronger and more resistant cells,” says Morten Scheibye-Knudsen, adding: “We have not discovered a miracle cure, but higher NAD⁺ concentrations may slow some of the degenerative processes that accompany ageing. Even small improvements in inflammation and cell function can make a big difference. We hope that these promising results may one day lead to real help for those who have lived with COPD for many years.”

Promising first step

These findings are not a cure-all for COPD, but they identify NAD⁺ as a key factor in slowing some damaging processes.

“The mechanism leading to loss of lung function in COPD may be similar to natural ageing processes, but this is still uncertain. The sustained positive effects after treatment suggest that nicotinamide riboside may have long-term benefits,” explains Morten Scheibye-Knudsen.

This was a relatively short study with a limited number of participants, so larger and longer studies are needed to determine whether a wider population can achieve the same benefits.

“Another important factor is whether nicotinamide riboside combined with existing treatments can protect better against pneumonia. Inflammation increases with age – inflammageing – and can contribute to the changes in disease patterns among older people,” adds Morten Scheibye-Knudsen.

The researchers hope that this approach may lead to a more effective way of managing COPD.

“These results are a promising first step but not a final conclusion. COPD is a complex disease, and many studies with more participants are required to determine whether the effects last. Nevertheless, remarkably, inflammation in the lungs continued to decline following treatment,” says Morten Scheibye-Knudsen.

Treating the cause

This trial raises the question of whether nicotinamide riboside supplementation can complement existing medications to boost lung health.

“There is still much we do not know: how the supplement affects the immune system, which people benefit most from it and how long it is effective after you stop taking it,” explains Morten Scheibye-Knudsen.

In addition to COPD, these findings may also inspire new research into whether increasing NAD⁺ concentrations can help in other diseases with chronic inflammation and cellular stress, such as certain heart or brain diseases.

“Although different diseases require different treatments, the body always needs stronger repair and defence. Future studies may examine longer treatments, different doses or combining nicotinamide riboside with other protective compounds,” he adds.

Each new piece of the puzzle may bring researchers closer to safer and more targeted ways to use NAD⁺ to improve health.

“What motivates me most is that we are not only treating symptoms but also the cause itself," concludes Morten Scheibye-Knudsen, adding: “If we can strengthen the body’s ability to repair DNA and suppress inflammation, this may change our approach to age-related diseases. I hope that larger studies can confirm our promising signs and perhaps pave the way for new treatments for COPD and other chronic diseases.”