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In patients with PAH, chemokines secreted locally by pulmonary vessels recruit B cells, which recognize self-antigens via B cell receptors and receive co-stimulatory signals from follicular helper T cells (Tfh) (IL-21), Th2 cells (IL-4/IL-6/IL-13), and mast cell cytokines

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It also improves lipid profiles, lowers insulin levels, and enhances glucose metabolism and insulin sensitivity

NAD+ therapy restores the cellular fuel supply that powers DNA repair (via PARP enzymes), sirtuin activation (the longevity gene pathway), and mitochondrial energy production

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