Accumulating evidence indicates that NAD+ — a coenzyme for several enzymes, with a critical role in mitochondrial energy production — confers protection against ageing and numerous diseases. Using Caenorhabditis elegans and cell lines, Katsyuba et al. identify α-amino-β-carboxymuconate-ɛ-semialdehyde decarboxylase (ACMSD) as a key regulator of the de novo NAD+ synthesis pathway. Knockdown of ACMSD boosted NAD+ levels, increased sirtuin 1 activity and enhanced mitochondrial function. In mice, the ACMSD inhibitors TES-991 and TES-1025 increased tissue NAD+ levels and protected hepatic and renal function in models of nonalcoholic fatty liver disease and acute kidney injury, respectively.