Abstract TP345: NAD/NADP Dynamics After Stroke: Preliminary Evidence Linking Metabolism to Recovery

Background: Nicotinamide adenine dinucleotide (NAD) and its phosphorylated form NADP are essential coenzymes in redox metabolism and cellular repair. Their depletion has been implicated in aging, mitochondrial dysfunction, and poor neurovascular recovery post-stroke. However, little is known about NAD/NADP levels during early stroke recovery or their relationship to functional outcomes. Methods: Acute stroke patients were enrolled at OU Medical Center and underwent serial assessments at <48 hours (V1-acute), 30 days (V2 subacute), 90 days (V3-late subacute) and 180 days (chronic). Functional assessments included the Montreal Cognitive Assessment (MoCA) and Fugl-Meyer motor scale. Whole blood was collected and processed into aliquots for NAD/NADP quantification via LC-MS. Reference levels were drawn from the literature (33 µM). Results: This result reflects preliminary data analysis of acute and subacute data points (n= 18). Average NAD levels were higher in the subacute group (32.4 ± 8.2 µM; n=7)) compared to the acute group (23.7 ± 8.1 µM; n=11), nearing levels reported in healthy controls (~33 µM). NADP levels followed a similar trend (subacute: 24.3 ± 8.8 µM vs acute: 17.6 ± 3.0 µM). Subacute patients also showed better functional outcomes (MoCA: 27.0 ± 2.0 vs 21.6 ± 3.9; FMA: 26.0 ± 5.7 vs 54.2 ± 18.6), though differences in FMA reflect inclusion of severely impaired acute cases. Despite this group-level trend, we observed substantial inter-individual variability, with several subacute participants showing persistently low NAD levels Conclusion: These preliminary findings support the relevance of NAD metabolism in stroke and recovery. As we expand our sample size and include longitudinal follow-up, our dataset will help clarify whether NAD levels serve as a meaningful biomarker of recovery potential or persistent dysfunction after stroke.