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Nicotinamide Riboside on Mitochondrial Function in Li-Fraumeni Syndrome

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ClinicalTrials.gov Identifier: NCT03789175
Recruitment Status : Recruiting
First Posted : December 28, 2018
Last Update Posted : March 13, 2019
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Heart, Lung, and Blood Institute (NHLBI) )

Brief Summary:

Background:

Nicotinamide riboside (NR) is a vitamin B3 dietary supplement. It may help improve muscle function, that may in turn may improve a person s exercise capacity. Researchers want to study how skeletal muscle responds to NR in an individual who has Li-Fraumeni Syndrome and slow muscle energy recovery after exercise.

Objective:

To study how nicotinamide riboside affects skeletal muscle after exercise.

Eligibility:

One person at least 18 years old with Li-Fraumeni syndrome and a certain gene mutation

Design:

The participant will be screened with a medical history, physical exam, and blood and urine tests.

The participant may also have a heart test.

The participant will maintain their regular diet and supplements during the study.

The participant will take the study drug as 1-4 tablets twice a day for 12 weeks. The participant may be contacted with reminders and questions about side effects.

The participant will have 4-5 visits over 18-30 weeks. At visits, the participant will repeat screening tests. At some visits they will also have:

  • Ultrasound of the heart with a wand placed on the chest.
  • Test of oxygen used at rest and exercise, while wearing a face mask.
  • Exercise test on a treadmill or bicycle with electrodes on the skin.
  • Magnetic resonance spectroscopy. The participant will have no caffeine for 12 hours. Then they will lie in a machine for about 2 hours. Sometimes they will lie still. Sometimes they will be asked to move.

Health questionnaire

The participant may have a skin sample taken by needle.

The participant will be withdrawn from the study if they become pregnant.


Condition or disease Intervention/treatment Phase
Cancer Skin Fibroblasts Muscle Weakness Dietary Supplement: Niagen Phase 1 Phase 2

Detailed Description:

We have previously reported that inherited mutations of TP53, which causes the premature cancer disorder Li-Fraumeni syndrome (LFS), can promote mitochondrial function both in patients and mouse models. In the course of our follow up studies, we encountered a LFS patient with a long-standing history of fatigue and muscle weakness of unclear etiology. Notably, we observed in vivo evidence of markedly decreased mitochondrial function in her leg skeletal muscle during exercise using noninvasive phosphorus-31 magnetic resonance spectroscopy (31P-MRS), a technique that has previously been used to study patients with primary mitochondrial disorders. The decrease in mitochondrial function was also confirmed by the patient s skin fibroblasts in vitro using standard biochemical measurements.

There is growing evidence that nicotinamide adenine dinucleotide (NAD+) homeostasis plays a significant role in maintaining the mitochondria through various mechanisms and that it is possible to improve mitochondrial function by dietary supplementation with the vitamin B3 analogue nicotinamide riboside (NR), an intermediate in the NAD+ salvage pathway. Remarkably, we observed that culturing the LFS patient s fibroblasts in medium containing NR rescued the severe deficit in mitochondrial respiration. While continuing our investigations into the molecular mechanism(s) underlying the mitochondrial dysfunction observed in this patient, the in vitro rescue of the respiratory deficiency by NR presents a unique opportunity to investigate whether it can also be observed in vivo using skeletal muscle 31P-MRS. We propose to explore the effect of NR, currently available as a dietary supplement, on in vivo mitochondrial function in this LFS patient.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 1 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Exploratory Study of Nicotinamide Riboside on Mitochondrial Function in Li-Fraumeni Syndrome
Actual Study Start Date : January 25, 2019
Estimated Primary Completion Date : June 3, 2019
Estimated Study Completion Date : July 12, 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Subjects receiving supplement
Subjects with Li-Fraumeni syndrome with TP53 mutations will receive NR
Dietary Supplement: Niagen
Niacin is a form of vitamin B3 and has been used to treat hypercholesterolemia for many years. There is growing evidence that nicotinamide adenine dinucleotide (NAD+ can maintain mitochondria through various mechanisms and that it is possible to improve mitochondrial function by dietary supplementation with the vitamin B3 analogue nicotinamide riboside (NR), an intermediate in the NAD+ salvage pathway. We have observed that culturing the fibroblasts of a LFS patient with mitochondrial deficiency in medium containing NR rescues the defect in mitochondrial respiration.




Primary Outcome Measures :
  1. intra-subject comparison of baseline to 12 wk NR supplementation PCr recovery Tc measurements using the 31P-MRS skeletal muscle submaximal exercise. [ Time Frame: 12 weeks ]
    The effect of NR supplementation on the PCr recovery Tc of skeletal muscle after exercise as a marker of mitochondrial oxidative phosphorylation capacity.


Secondary Outcome Measures :
  1. Examine whether NR supplementation affects the respiratory capacity of blood mononuclear cells, CPET, self-reported symptoms of fatigue. [ Time Frame: 7 months ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • At least 18-years of age and able to give informed consent
  • Have delayed PCr recovery time constant >45 sec by 31P-MRS testing and a history of fatigue symptoms
  • Ability to undergo study procedures, including scheduled visits, blood draws and skeletal muscle exercise NMR spectroscopy
  • Have Li-Fraumeni syndrome and confirmed TP53 mutation by genetic testing
  • Committed to using reliable contraception which may include abstinence during study participation
  • Female participants of child-bearing ability and potential willing to commit to reliable contraception while participating in the study

EXCLUSION CRITERIA:

  • Current systemic treatment for cancer
  • Unable to perform required study visits or procedures
  • MRI incompatible hardware
  • Pregnant or breastfeeding women
  • History of intolerance to NR precursor compounds, including niacin or nicotinamide

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03789175


Contacts
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Contact: Rebecca D Huffstutler, C.R.N.P. (301) 594-1281 rebecca.huffstutler@nih.gov

Locations
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United States, Maryland
National Institutes of Health Clinical Center Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR)    800-411-1222 ext TTY8664111010    prpl@cc.nih.gov   
Sponsors and Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
Investigators
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Principal Investigator: Paul M Hwang, M.D. National Heart, Lung, and Blood Institute (NHLBI)

Additional Information:
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Responsible Party: National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier: NCT03789175     History of Changes
Other Study ID Numbers: 190034
19-H-0034
First Posted: December 28, 2018    Key Record Dates
Last Update Posted: March 13, 2019
Last Verified: January 17, 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Heart, Lung, and Blood Institute (NHLBI) ):
Oxidative Phosphorylation Capacity
Increased Oxidative Metabolism
Regeneration of Phosphocreatine( PCr)
Inherited Mutation of TP53 Tumor Supressor Gene

Additional relevant MeSH terms:
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Niacinamide
Niacin
Nicotinic Acids
Muscle Weakness
Paresis
Li-Fraumeni Syndrome
Muscular Diseases
Musculoskeletal Diseases
Neuromuscular Manifestations
Neurologic Manifestations
Nervous System Diseases
Pathologic Processes
Signs and Symptoms
Neoplastic Syndromes, Hereditary
Neoplasms
Genetic Diseases, Inborn
DNA Repair-Deficiency Disorders
Metabolic Diseases
Vitamin B Complex
Vitamins
Micronutrients
Nutrients
Growth Substances
Physiological Effects of Drugs
Hypolipidemic Agents
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Lipid Regulating Agents
Vasodilator Agents