1. In a healthy neuron, the enzyme NMNAT2 keeps the ratio of NAD > NMN above the threshold that activates the neurodegenerative pathway, SARM1.
2. In an unhealthy neuron, the enzyme NMNAT2 becomes deficient and is unable to maintain the ratio of NAD > NMN above the threshold for SARM1 activation. This triggers SARM1 driven axon degeneration.
3. Oral supplementation of NMN, into a system with healthy levels of NMNAT2, will lead to the conversion of NMN to NAD and help to maintain a healthy neuron (inhibits SARM1 activation).
4. However, in a compromised neuron, oral supplementation of NMN will quickly saturate the depleted NMNAT2 enzyme, causing alteration of the ratio of NMN to NAD to exceed the threshold for SARM1 activation. Triggering axon degeneration.
5. Supplementation with NR, that is converted to NMN, presumably “gates” the levels of NMN and maintains the ratio of NMN to NAD below the threshold of SARM1 activation.