Dataset Information

Biological Efficacy and Safety of Niacinamide in Patients With ADPKD.

ABSTRACT:

Introduction

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive cyst enlargement, leading to kidney failure. Sirtuin-1 is upregulated in ADPKD and accelerates disease progression by deacetylating p53. Niacinamide is a dietary supplement that inhibits sirtuins at high doses.

Methods

We conducted an open-label, single-arm intervention trial (study 1, N = 10), and a randomized, double blinded, placebo-controlled trial (study 2, N = 36) to assess the biological activity and safety of niacinamide. Patients with ADPKD were given 30 mg/kg oral niacinamide or placebo, for 12 months. The primary endpoint was the ratio of acetylated p53 to total p53 protein in peripheral blood mononuclear cells (PBMCs).

Results

There was no sustained effect of niacinamide on acetylated/total p53 in either study and no difference between placebo and niacinamide arms. There was no difference in the change in height-adjusted total kidney volume over 12 months between niacinamide and placebo. Niacinamide was generally well tolerated. The most common adverse effects were nausea, diarrhea, gastroesophageal reflux, headache, and acneiform rash but there was no difference in their incidence between niacinamide and placebo.

Conclusions

In conclusion, niacinamide is safe and well-tolerated in patients with ADPKD. However, we were unable to detect a sustained inhibition of sirtuin activity over 12 months of treatment, and there was no signal to suggest a beneficial effect on any efficacy measure.

SUBMITTER: El Ters M

PROVIDER: S-EPMC7403550 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Biological Efficacy and Safety of Niacinamide in Patients With ADPKD.

El Ters Mireille M Zhou Xia X Lepping Rebecca J RJ Lu Pengcheng P Karcher Rainer T RT Mahnken Jonathan D JD Brooks William M WM Winklhofer Franz T FT Li Xiaogang X Yu Alan S L ASL

Kidney international reports 20200610 8

<h4>Introduction</h4>Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive cyst enlargement, leading to kidney failure. Sirtuin-1 is upregulated in ADPKD and accelerates disease progression by deacetylating p53. Niacinamide is a dietary supplement that inhibits sirtuins at high doses.<h4>Methods</h4>We conducted an open-label, single-arm intervention trial (study 1, <i>N</i> = 10), and a randomized, double blinded, placebo-controlled trial (study 2, <i>N</i> = 36) ...[more]

PMID: 32775826

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Project description:BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is a genetic ciliopathy disease characterized by progressive formation and enlargement of cysts in multiple organs. The kidneys are particularly affected and patients may eventually develop end-stage renal disease (ESRD). We hypothesize that bone marrow mesenchymal stromal cells (BMMSCs) are renotropic and may improve kidney function via anti-apoptotic, anti-fibrotic, and anti-inflammatory effects. In this study, we aim to assess the safety and tolerability of a BMMSC infusion in ADPKD patients.MethodsWe performed a single-arm phase I clinical trial with a 12-month follow-up. This study enrolled six eligible ADPKD patients with an estimated glomerular filtration rate (eGFR) of 25-60 ml/min/1.73 m2. Patients received autologous cultured BMMSCs (2 × 106 cells/kg) through the cubital vein according to our infusion protocol. We investigated safety issues and kidney function during the follow-up visits, and compared the findings to baseline and 1 year prior to the intervention.ResultsThere were no patients lost to follow-up. We observed no cell-related adverse events (AE) and serious adverse events (SAE) after 12 months of follow-up. The mean eGFR value of 33.8 ± 5.3 ml/min/1.73 m2 1 year before cell infusion declined to 26.7 ± 3.1 ml/min/1.73 m2 at baseline (P = 0.03) and 25.8 ± 6.2 ml/min/1.73 m2 at the 12-month follow-up visit (P = 0.62). The mean serum creatinine (SCr) level of 2 ± 0.3 mg/dl 1 year before the infusion increased to 2.5 ± 0.4 mg/dl at baseline (P = 0.04) and 2.5 ± 0.6 mg/dl at the 12-month follow-up (P = 0.96). This indicated significant changes between the differences of these two periods (12 months before infusion to baseline, and 12 months after infusion to baseline) in SCr (P = 0.05), but not eGFR (P = 0.09).ConclusionsThis trial demonstrated the safety and tolerability of an intravenous transplantation of autologous BMMSCs. BMMSC efficacy in ADPKD patients should be investigated in a randomized placebo-controlled trial with a larger population, which we intend to perform.Trial registrationClinicalTrials.gov, NCT02166489 . Registered on June 14, 2014.

Project description:The objective of this work was to use transcriptional profiling to assess the biological activity of structurally related chemicals to define their biological similarity and with that, substantiate the validity of a read-across approach usable in risk assessment. Two case studies are presented, one with 4 short alkyl chain parabens: methyl (MP), ethyl (EP), butyl (BP), and propyl paraben (PP), as well as their main metabolite, p-Hydroxybenzoic acid (pHBA) with the assumption that PP was the target chemical; and a second one with caffeine (CA) and its main metabolites theophylline (TP), theobromine (TB) and paraxanthine (PX), where caffeine was the target chemical. The comprehensive transcriptional response of MCF7, HepG2, A549 and ICell cardyomiocytes was evaluated (TempO-Seq) after exposure to vehicle-control, each paraben or pHBA, caffeine or its metabolites, at 3 non-cytotoxic concentrations, for 6h. Differentially expressed genes (FDR ≥ 0.05, and fold change ±1.2≥) were identified for each chemical, at each dose of exposure, and used to determine similarities between them. Each of the chemicals is able to elicit changes in the expression of a number of genes, as compared to controls, particularly at the highest dose tested. Importantly, the transcriptional profile elicited by each of the parabens shares a high degree of similarities across the category members. The highest number of genes commonly affected by the parabens was found between BP and PP. The transcriptional profile of the parabens is similar to the one elicited by some estrogen receptor agonist, among other actives. Pathway enrichment analysis (MSigDB v7.0) of the transcriptional profile for each paraben indicated a significant overlap in the up- and down-regulated pathways across the four parabens.The highest similarity in biological activity was found between BP and PP. This was indicative of their biological similarity, and thus the validity of the read across among the group, with BT being the closest structural and biological analogue for PP. In the caffeine case and its main metabolites, the transcriptional profile elicited of all four compounds had a high degree of similarity across the cell types, with CA and TP being the most active. The most robust response was obtained in the cardiomyocytes with the highest transcriptional profile similarity between CA and TP. The transcriptional profile of the methylxantines is similar to the one elicited by inhibitors of phosphatidylinositol 3-kinase as well as other actives. Pathway enrichment analysis (MSigDB v7.0) of the transcriptional profile for each compound indicated a significant overlap in the up- and down-regulated pathways across the four methylxanthines. The highest similarity in biological activity was found between CA and TP, supporting the conclusion that from the group of methylxantines evaluated TP is the most appropriate analogue to read-across for CA. Overall, our results support the approach of incorporating transcriptional profiling in well-designed in vitro tests to support biological similarity driven read-across procedures and strengthening the traditional structure-based approaches useful in risk assessment.

Dataset Information

Biological Efficacy and Safety of Niacinamide in Patients With ADPKD.

Introduction

Methods

Results

Conclusions

Publications

Biological Efficacy and Safety of Niacinamide in Patients With ADPKD.

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