Sarcopenia and satellite cell homeostasis disruption: the dual function of NAD+ metabolism

Sarcopenia is an age-related syndrome characterized by progressive loss of skeletal muscle mass and function, which is closely associated with impaired regenerative capacity of muscle satellite cells (MuSCs). During aging, the MuSC niche undergoes severe deterioration, including mitochondrial dysfunction, chronic inflammation, and neuromuscular junction (NMJ) degeneration, all of which compromise MuSC quiescence, proliferation, and differentiation. Nicotinamide adenine dinucleotide (NAD+) serves as a critical coenzyme and signaling molecule that governs MuSC homeostasis in a context-dependent, dual-function manner. Moderate NAD+ repletion via precursors such as nicotinamide mononucleotide (NMN) or nicotinamide riboside (NR) activates SIRT1 and SIRT3, enhances mitochondrial bioenergetics, reduces oxidative stress, and promotes MuSC proliferation and myogenic differentiation. In contrast, under pathological or aging conditions, excessive or dysregulated NAD+ signaling activates SIRT2 to deacetylate PAX7 and repress Myogenic Differentiation 1 (MyoD), leading to cell-cycle arrest and MuSC exhaustion. This review adopts a hypothesis-driven framework to systematically summarize the molecular crosstalk between NAD+ metabolism, sirtuin family deacetylases (SIRTs), and MuSC fate regulation. We integrate evidence from nearly 60 representative preclinical and clinical studies, clarify the dual-function role of NAD+, and address current inconsistencies in the field. We also highlight key limitations and propose future directions for developing NAD+-targeted therapies for sarcopenia.