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Nicotinamide Riboside in LVAD Recipients (PilotNR-LVAD)

Primary Purpose

Heart Failure,Congestive, Heart Failure New York Heart Association Class IV, Mitochondrial Alteration

Status
Completed
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Nicotinamide riboside
Sponsored by
University of Washington
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Heart Failure,Congestive

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosis of advanced heart failure.
  • Planned elective LVAD implantation surgery with patient agreements for candidacy in place as required by UWMC.
  • Hospital inpatient at time of enrollment.
  • Ability to undergo Study procedures.
  • Willingness/ability to provide informed consent.

Exclusion Criteria:

  • Current smoking
  • Receiving certain concurrent supplements (to be determined at discretion of the PI). Note that UWMC Nutrition Care standards call for a general multivitamin (1 tab PO daily) as part of the advanced heart failure therapy (AHFT) work-up.
  • Known allergies to niacin or nicotinamide.
  • Hepatic, renal, endocrine, or neurological disease that disqualify them from consideration for LVAD implantation.
  • Inability to perform Study visits or procedures.
  • Unwillingness/inability to provide informed consent.
  • Women who are currently pregnant or who wish to become pregnant over the course of the study follow-up are not allowed to join this study. This exclusion is built into the LVAD candidate selection process.

Sites / Locations

  • University of Washington

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Open-label nicotinamide riboside

Baseline controls

Arm Description

Participants scheduled to receive an LVAD will be prescribed nicotinamide riboside (NR) according to the following administration schedule: Dose Escalation Day 1: 250 mg (1 capsule) twice daily (total daily intake = 500 mg) Day 2: 500 mg (2 capsules) twice daily (total daily intake = 1000 mg) Day 3: 1000 mg (4 capsules) twice daily (total daily intake = 2000 mg) Dose Maintenance Day 4: 1000 mg (4 capsules) twice daily Day 5-14 as applicable thru Day Before Surgery: 1000 mg (4 capsules) twice daily Washout Day of LVAD Surgery and/or Day 15: None

Patients previously receiving LVADs, in whom blood and myocardial tissue assays for NAD+ levels and mitochondrial function were performed.

Outcomes

Primary Outcome Measures

Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Adverse Events

Secondary Outcome Measures

Effect of NR on whole blood NAD+ levels
Change in whole blood NAD+ levels from Baseline to Day of Surgery in NR-treated participants
Effect of NR on mitochondrial respiration (Seahorse assay) in isolated peripheral blood mononuclear cells (PBMCs)
Change in mitochondrial respiration from Baseline to Day of Surgery in NR-treated participants
Between-group comparison of whole blood NAD+ levels
Comparison of whole blood NAD+ levels on the Day of LVAD Surgery in NR-treated vs. historical control patients
Between-group comparison of mitochondrial respiration in PBMCs
Comparison of mitochondrial respiration in PBMCs on the Day of LVAD Surgery in NR-treated vs. historical control patients

Full Information

First Posted
October 16, 2018
Last Updated
August 28, 2020
Sponsor
University of Washington
Collaborators
American Heart Association
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1. Study Identification

Unique Protocol Identification Number
NCT03727646
Brief Title
Nicotinamide Riboside in LVAD Recipients
Acronym
PilotNR-LVAD
Official Title
Pilot Study of Preoperative Nicotinamide Riboside (Vitamin B3) Supplementation in Patients Undergoing Elective Left Ventricular Assist Device (LVAD) Implantation
Study Type
Interventional

2. Study Status

Record Verification Date
August 2020
Overall Recruitment Status
Completed
Study Start Date
September 26, 2018 (Actual)
Primary Completion Date
November 26, 2018 (Actual)
Study Completion Date
November 26, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Washington
Collaborators
American Heart Association

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
While preliminary data show that oral nicotinamide riboside (NR) supplementation increases myocardial levels of oxidized nicotine-adenine dinucleotide (NAD+) levels in mice, there has been no direct evidence that suggests oral NR increases NAD+ levels or improves mitochondrial function in human hearts. This Pilot Study is designed to obtain feasibility data for a planned, larger study testing the hypothesis that oral NR supplementation will increase myocardial NAD+ levels and improve cardiomyocyte mitochondrial function in participants with advanced heart failure planned for elective left ventricular assist device (LVAD) implantation. To demonstrate safety and feasibility of NR in this patient population, the investigators propose to enroll 5 participants planned for LVAD implantation in a Pilot Study of NR in which participants will receive NR, up-titrated over 3 days to a final NR dose of 1000mg twice daily. Blood and myocardial tissue analyses collected previously from age- and gender-matched LVAD recipients will serve as controls.
Detailed Description
This Pilot Study will examine the following Aims: Aim 1: Enroll 5 participants scheduled for elective left ventricular assist device (LVAD) placement into an open-label study of nicotinamide riboside (NR). a. Participants will have labs (including safety panels) drawn at baseline (Day 1), then receive escalating doses of NR to a maximum dose of 1000mg twice daily by Day 3. Participants will be continued on NR at 1000mg twice daily until LVAD implantation surgery. On the morning of LVAD implantation Surgery (Day 5 or later), participants will have final labs drawn. Samples of fresh cardiac tissue removed from the left ventricular apex during LVAD implantation surgery will be collected in the operating room. The primary analyses will be performed on NR-treated participants who were on the maximum NR dose of 1000mg twice daily for at least 2 days prior to LVAD implantation surgery. The maximum duration of NR administration will be capped at 14 days. If the surgery doesn't happen by then, the participant will be withdrawn from the study. Aim 2: Determine the effect of NR (as compared to historical controls) on levels of the oxidized and reduced forms of nicotine-adenine dinucleotide (NAD+ and NADH, respectively), mitochondrial function and its regulation through modifications of the epigenome in the failing myocardium. Measure NAD+ and NADH levels in the blood and myocardium of the participants. Assess mitochondrial morphology and function in cardiac tissue using, respectively, electron microscopy (EM) and isolated mitochondria. Determine protein acetylation in the mitochondrial and non-mitochondrial compartments and changes in nuclear gene regulation. Aim 3: Test the hypothesis that NR improves mitochondrial function and reduces inflammatory response in heart failure (HF) patients receiving NR (as compared to historical controls). Measure mitochondrial function in peripheral blood mononucleated cells (PBMC). Determine the inflammatory response in PBMC. Compare effects on the circulating inflammasome vs. myocardial inflammation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure,Congestive, Heart Failure New York Heart Association Class IV, Mitochondrial Alteration

7. Study Design

Primary Purpose
Treatment
Study Phase
Early Phase 1
Interventional Study Model
Sequential Assignment
Model Description
This single-center, open-label study will compare blood and myocardial NAD+ levels and other mitochondrial endpoints in participants with end-stage heart failure treated with open-label nicotinamide riboside prior to LVAD implantation to similar endpoints from untreated patients previously undergoing LVAD implantation.
Masking
Outcomes Assessor
Masking Description
Study biostatistician will be blinded to group (NR vs. untreated controls)
Allocation
Non-Randomized
Enrollment
5 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Open-label nicotinamide riboside
Arm Type
Experimental
Arm Description
Participants scheduled to receive an LVAD will be prescribed nicotinamide riboside (NR) according to the following administration schedule: Dose Escalation Day 1: 250 mg (1 capsule) twice daily (total daily intake = 500 mg) Day 2: 500 mg (2 capsules) twice daily (total daily intake = 1000 mg) Day 3: 1000 mg (4 capsules) twice daily (total daily intake = 2000 mg) Dose Maintenance Day 4: 1000 mg (4 capsules) twice daily Day 5-14 as applicable thru Day Before Surgery: 1000 mg (4 capsules) twice daily Washout Day of LVAD Surgery and/or Day 15: None
Arm Title
Baseline controls
Arm Type
No Intervention
Arm Description
Patients previously receiving LVADs, in whom blood and myocardial tissue assays for NAD+ levels and mitochondrial function were performed.
Intervention Type
Dietary Supplement
Intervention Name(s)
Nicotinamide riboside
Intervention Description
nicotinamide riboside supplied as 250mg capsules
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Description
Adverse Events
Time Frame
Up to 14 days
Secondary Outcome Measure Information:
Title
Effect of NR on whole blood NAD+ levels
Description
Change in whole blood NAD+ levels from Baseline to Day of Surgery in NR-treated participants
Time Frame
Duration of NR treatment
Title
Effect of NR on mitochondrial respiration (Seahorse assay) in isolated peripheral blood mononuclear cells (PBMCs)
Description
Change in mitochondrial respiration from Baseline to Day of Surgery in NR-treated participants
Time Frame
Up to 14 days
Title
Between-group comparison of whole blood NAD+ levels
Description
Comparison of whole blood NAD+ levels on the Day of LVAD Surgery in NR-treated vs. historical control patients
Time Frame
Up to 14 days
Title
Between-group comparison of mitochondrial respiration in PBMCs
Description
Comparison of mitochondrial respiration in PBMCs on the Day of LVAD Surgery in NR-treated vs. historical control patients
Time Frame
Up to 14 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of advanced heart failure. Planned elective LVAD implantation surgery with patient agreements for candidacy in place as required by UWMC. Hospital inpatient at time of enrollment. Ability to undergo Study procedures. Willingness/ability to provide informed consent. Exclusion Criteria: Current smoking Receiving certain concurrent supplements (to be determined at discretion of the PI). Note that UWMC Nutrition Care standards call for a general multivitamin (1 tab PO daily) as part of the advanced heart failure therapy (AHFT) work-up. Known allergies to niacin or nicotinamide. Hepatic, renal, endocrine, or neurological disease that disqualify them from consideration for LVAD implantation. Inability to perform Study visits or procedures. Unwillingness/inability to provide informed consent. Women who are currently pregnant or who wish to become pregnant over the course of the study follow-up are not allowed to join this study. This exclusion is built into the LVAD candidate selection process.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kevin O'Brien, MD
Organizational Affiliation
University of Washington
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Washington
City
Seattle
State/Province
Washington
ZIP/Postal Code
98195
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
32790648
Citation
Zhou B, Wang DD, Qiu Y, Airhart S, Liu Y, Stempien-Otero A, O'Brien KD, Tian R. Boosting NAD level suppresses inflammatory activation of PBMCs in heart failure. J Clin Invest. 2020 Nov 2;130(11):6054-6063. doi: 10.1172/JCI138538.
Results Reference
result

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Nicotinamide Riboside in LVAD Recipients

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