Tier 2 — strong

Oral MIB-626 (β Nicotinamide Mononucleotide) Safely Raises Blood Nicotinamide Adenine Dinucleotide Levels in Hospitalized Patients With COVID-19 and Acute Kidney Injury: A Randomized Controlled Trial

Karol M Pencina, David E Leaf, Rodrigo J Valderrabano, Sushrut S Waikar, Tapan S Mehta, Yili Valentine Shang, Nancy K Latham, Tejossy John, Elena Volpi, Dahlene Fusco, Yusnie Memish-Beleva, Shobana Krishnamurthy, Siva Lavu, Salma Karmi, David J Livingston, Shalender Bhasin
FASEB BioAdvances 2025 7(8):e70011

Bibliography

PubMed
PMID 40746868
PubMed Central
PMC12312518
DOI
10.1096/fba.2025-00014
Funding
The study was supported by Metro International Biotech with academic aging-research infrastructure contributing to conduct and analysis.
Competing interests
Several authors had employment, research or financial relationships with Metro International Biotech, the developer of MIB-626.

Study snapshot

DesignRandomized, placebo-controlled parallel-group clinical trial with 3:2 allocation.
ModelHospitalized adults with COVID-19 and acute kidney injury.
Samplen=42; 25 MIB-626 and 17 placebo.
InterventionMIB-626 1000 mg twice daily (2000 mg/day) versus placebo.
Duration14 days.
EndpointsBlood NAD+ and NAD metabolome; Serum creatinine and cystatin-C; AKI biomarkers; CRP, IL-6 and TNFα; COVID-19 disease-severity indices; Safety

What the study showed, in plain terms

This trial tested whether high-dose MIB-626 could safely raise NAD+ in 42 hospitalized adults with COVID-19 and acute kidney injury. Participants received 2,000 mg/day or placebo for 14 days.

MIB-626 substantially raised blood NAD+ and related metabolites, but markers of kidney injury, inflammation and disease severity did not significantly differ between groups. The trial therefore supports pharmacodynamic activity in acute illness, not clinical efficacy for COVID-19 or AKI.

Key findings

  • Blood NAD+ rose substantially with MIB-626 over the treatment period.
  • Plasma NAD-related metabolites increased rapidly.
  • Creatinine, cystatin-C and other AKI markers did not significantly differ between groups.
  • CRP, IL-6, TNFα and disease-severity measures did not significantly differ.
  • The study reported acceptable short-term tolerability.

What this study can and cannot tell us

The study enrolled only 42 acutely ill patients and was not powered for meaningful clinical efficacy outcomes. NAD+ increased gradually, and the authors considered that kinetics may have limited the ability to influence acute disease. Industry involvement was substantial.

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MIB-626, an oral formulation of a microcrystalline unique polymorph of β-nicotinamide mononucleotide, increases circulating nicotinamide adenine dinucleotide and its metabolome in middle-aged and older adults
Pencina KM et al. · The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences · 2023
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Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study
Karol Mateusz Pencina et al. · The Journal of Clinical Endocrinology & Metabolism · 2023

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Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology