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Yaku K, Nakagawa T. NAD + Precursors in Human Health and Disease: Current Status and Future Prospects. Antioxid Redox Signal 2023; 39:1133-1149. [PMID: 37335049 DOI: 10.1089/ars.2023.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Significance: Nicotinamide adenine dinucleotide (NAD+) acts as a cofactor in many important biological processes. The administration of NAD+ precursors increases the intracellular NAD+ pool and has beneficial effects on physiological changes and diseases associated with aging in various organisms, including rodents and humans. Recent Advances: Evidence from preclinical studies demonstrating the beneficial effects of NAD+ precursors has rapidly increased in the last decade. The results of these studies have prompted the development of clinical trials using NAD+ precursors, particularly nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). In addition, in vivo studies of NAD+ metabolism have rapidly progressed. Critical Issues: Several studies have demonstrated that the oral administration of NAD+ precursors, such as NR and NMN, is safe and significantly increases NAD+ levels in humans. However, the efficacy of these NAD+ precursors is lower than expected from the results of preclinical studies. In addition, the identification of the contribution of the host-gut microbiota interactions to NR and NMN metabolism has added to the complexity of NAD+ metabolism. Future Directions: Further studies are required to determine the efficacy of NAD+ precursors in humans. Further in vivo studies of NAD+ metabolism are required to optimize the effects of NAD+ supplementation. There is also a need for methods of delivering NAD+ precursors to target organs or tissues to increase the outcomes of clinical trials. Antioxid. Redox Signal. 39, 1133-1149.
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Affiliation(s)
- Keisuke Yaku
- Department of Molecular and Medical Pharmacology, Faculty of Medicine; Toyama, Japan
| | - Takashi Nakagawa
- Department of Molecular and Medical Pharmacology, Faculty of Medicine; Toyama, Japan
- Research Center for Pre-Disease Science; University of Toyama, Toyama, Japan
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Ketteler M, Wiecek A, Rosenkranz AR, Ose C, Rekowski J, Lorenz H, Hellmann B, Karus M, Ruhmann M, Ammer R. Modified-release nicotinamide for the treatment of hyperphosphataemia in haemodialysis patients: 52-week efficacy and safety results of the phase III randomised controlled NOPHOS trial. Nephrol Dial Transplant 2022; 38:982-991. [PMID: 35751625 PMCID: PMC10064978 DOI: 10.1093/ndt/gfac206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We previously reported that modified-release nicotinamide (NAMR) was superior to placebo in reducing serum phosphate concentrations over 12 weeks in a large cohort of haemodialysis patients with hyperphosphataemia. Here, we report outcomes after 52 weeks of treatment. METHODS NOPHOS was a phase III, international, randomised, controlled, double-blind trial in parallel group design. NAMR (250-1500 mg/d) was investigated in comparison to placebo as an add-on therapy to an individual therapy with approved phosphate binders. RESULTS In the intention-to-treat population (NAMR: N = 539, placebo: N = 183), serum phosphate was significantly lower in the NAMR group compared to the placebo group at W24 (5.40 ± 1.55 mg/dl vs. 5.79 ± 1.37 mg/dl, P < 0.001) with a mean difference of -0.39 mg/dl [95% CI -0.66, -0.13], but was comparable between the groups at W52 (mean difference -0.08 [95% CI -0.36, 0.20]). In the completer population (N = 358), statistical significance in favour of NAMR was reached at W24 and W52. The treatment effect was reduced in patients with high baseline serum intact parathyroid hormone (iPTH) compared to patients with low baseline serum iPTH. Compliant patients in the NAMR group had a more pronounced and sustained reduction in serum phosphate than non-compliant patients. NAMR treatment was associated with a significantly increased risk of thrombocytopenia, pruritus, anaemia, and diarrhoea. Herpes zoster occurred exclusively in patients randomised to NAMR. CONCLUSIONS NAMR combined with phosphate binders significantly reduced serum phosphate over the first 24 weeks of treatment, but the treatment effect was not maintained up to W52. Non-compliance may have contributed to reduced long-term efficacy. Several newly identified safety signals warrant further evaluation.
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Affiliation(s)
- Markus Ketteler
- Robert Bosch Hospital, Department of General Internal Medicine and Nephrology, Stuttgart,Germany.,University of Split, School of Medicine, Split, Croatia
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Poland
| | - Alexander R Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Claudia Ose
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Rekowski
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Horst Lorenz
- BBS-Büro für Biometrie und Statistik, Neuberg, Germany
| | - Burkhard Hellmann
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Michael Karus
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Michaela Ruhmann
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Richard Ammer
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany.,Department of Nephrology, University Hospital Münster, Münster, Germany
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Yan X, Wang S. The efficacy of niacin supplementation in type 2 diabetes patients: Study protocol of a randomized controlled trial. Medicine (Baltimore) 2021; 100:e22272. [PMID: 33761625 PMCID: PMC9282106 DOI: 10.1097/md.0000000000022272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Dyslipidemia is a main risk factor of cardiovascular disease in the diabetic patients. Niacin was found acutely to decrease the plasma concentration of free fatty acids by inhibiting their mobilization from adipose tissue. This present study is a double blinded, randomized, and prospective trial to determine the effect of niacin during dyslipidemia in type 2 diabetic patients. METHODS This randomized controlled, double-blinded, single center trial is carried out according to the principles of Declaration of Helsinki. This present study was approved in institutional review committee of the Second Affiliated Hospital of Dalian Medical University. All the patients received the informed consent. Diabetic patients were randomized (1:1) to receive 3-month treatment with extended-release niacin or matching placebo. The major outcome of our present study was the change in the level of HbA1c from the baseline to week 12. Secondary outcome measures contained the levels of fasting blood glucose, the concentrations of serum transaminase, the other laboratory variables, and self-reported adverse events. The P < .05 was regarded as statistically significant. RESULTS We assumed that adding the niacin to the medication in patients with type 2 diabetes would reduce dyslipidemia and achieve target lipid levels. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5925).
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Affiliation(s)
- Xiaoying Yan
- Department of General Practice, The Second Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Shunyu Wang
- Department of General Practice, The Second Affiliated Hospital of Dalian Medical University, Liaoning, China
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Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events. Cochrane Database Syst Rev 2017; 6:CD009744. [PMID: 28616955 PMCID: PMC6481694 DOI: 10.1002/14651858.cd009744.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Nicotinic acid (niacin) is known to decrease LDL-cholesterol, and triglycerides, and increase HDL-cholesterol levels. The evidence of benefits with niacin monotherapy or add-on to statin-based therapy is controversial. OBJECTIVES To assess the effectiveness of niacin therapy versus placebo, administered as monotherapy or add-on to statin-based therapy in people with or at risk of cardiovascular disease (CVD) in terms of mortality, CVD events, and side effects. SEARCH METHODS Two reviewers independently and in duplicate screened records and potentially eligible full texts identified through electronic searches of CENTRAL, MEDLINE, Embase, Web of Science, two trial registries, and reference lists of relevant articles (latest search in August 2016). SELECTION CRITERIA We included all randomised controlled trials (RCTs) that either compared niacin monotherapy to placebo/usual care or niacin in combination with other component versus other component alone. We considered RCTs that administered niacin for at least six months, reported a clinical outcome, and included adults with or without established CVD. DATA COLLECTION AND ANALYSIS Two reviewers used pre-piloted forms to independently and in duplicate extract trials characteristics, risk of bias items, and outcomes data. Disagreements were resolved by consensus or third party arbitration. We conducted random-effects meta-analyses, sensitivity analyses based on risk of bias and different assumptions for missing data, and used meta-regression analyses to investigate potential relationships between treatment effects and duration of treatment, proportion of participants with established coronary heart disease and proportion of participants receiving background statin therapy. We used GRADE to assess the quality of evidence. MAIN RESULTS We included 23 RCTs that were published between 1968 and 2015 and included 39,195 participants in total. The mean age ranged from 33 to 71 years. The median duration of treatment was 11.5 months, and the median dose of niacin was 2 g/day. The proportion of participants with prior myocardial infarction ranged from 0% (4 trials) to 100% (2 trials, median proportion 48%); the proportion of participants taking statin ranged from 0% (4 trials) to 100% (12 trials, median proportion 100%).Using available cases, niacin did not reduce overall mortality (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.97 to 1.12; participants = 35,543; studies = 12; I2 = 0%; high-quality evidence), cardiovascular mortality (RR 1.02, 95% CI 0.93 to 1.12; participants = 32,966; studies = 5; I2 = 0%; moderate-quality evidence), non-cardiovascular mortality (RR 1.12, 95% CI 0.98 to 1.28; participants = 32,966; studies = 5; I2 = 0%; high-quality evidence), the number of fatal or non-fatal myocardial infarctions (RR 0.93, 95% CI 0.87 to 1.00; participants = 34,829; studies = 9; I2 = 0%; moderate-quality evidence), nor the number of fatal or non-fatal strokes (RR 0.95, 95% CI 0.74 to 1.22; participants = 33,661; studies = 7; I2 = 42%; low-quality evidence). Participants randomised to niacin were more likely to discontinue treatment due to side effects than participants randomised to control group (RR 2.17, 95% CI 1.70 to 2.77; participants = 33,539; studies = 17; I2 = 77%; moderate-quality evidence). The results were robust to sensitivity analyses using different assumptions for missing data. AUTHORS' CONCLUSIONS Moderate- to high-quality evidence suggests that niacin does not reduce mortality, cardiovascular mortality, non-cardiovascular mortality, the number of fatal or non-fatal myocardial infarctions, nor the number of fatal or non-fatal strokes but is associated with side effects. Benefits from niacin therapy in the prevention of cardiovascular disease events are unlikely.
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Affiliation(s)
- Stefan Schandelmaier
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main Street WestHamiltonONCanadaL8S4L8
| | - Matthias Briel
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchBaselSwitzerland
| | - Ramon Saccilotto
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchBaselSwitzerland
| | - Kelechi K Olu
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchBaselSwitzerland
| | - Armon Arpagaus
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchBaselSwitzerland
| | - Lars G Hemkens
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchBaselSwitzerland
| | - Alain J Nordmann
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchBaselSwitzerland
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Silva de Paula E, Carneiro MFH, Grotto D, Hernandes LC, Antunes LMG, Barbosa F. Protective effects of niacin against methylmercury-induced genotoxicity and alterations in antioxidant status in rats. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2016; 79:174-183. [PMID: 26914397 DOI: 10.1080/15287394.2015.1137264] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study investigates the potential beneficial effects of niacin (NA; vitamin B3) supplementation in rats chronically exposed to methylmercury (MeHg). Animals were randomly assigned to one of 4 groups (n = 6): Group I, control, received distilled water by gavage; Group II, received MeHg (100 µg/kg/d) by gavage; Group III, received NA (50 mg/kg/d) in drinking water; Group IV, received MeHg (100 µg/kg/d) by gavage + NA (50 mg/kg/d) in drinking water. Biochemical parameters levels of glucose, triglycerides, total cholesterol and fractions, and enzyme activities aspartate transaminase (AST) and alanine transaminase (ALT) were determined. Further, oxidative stress markers activity of glutathione peroxidase (GPx) and catalase (CAT) activity, as well as levels of reduced glutathione (GSH), malondialdehyde (MDA), and nitric oxide, were examined, and the comet assay was performed, using blood/plasma. Hg levels were measured in blood, brain, and kidneys of animals. Our results demonstrated that NA reduced adverse effects produced by MeHg. The mechanism underlying these effects appears to be related to the intrinsic antioxidant potential of NA. Considering the beneficial effects attributed to NA following MeHg exposure and that fish are the main source of both NA and MeHg, future studies need to evaluate the potential counteractive effect of NA against the adverse consequences of MeHg exposure in fish-eating populations.
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Affiliation(s)
- Eloisa Silva de Paula
- a Laboratório de Toxicologia e Essencialidade de Metais , Faculdade de Ciências Farmacêuticas de Ribeirão Preto-USP, Monte Alegre , Ribeirão Preto , São Paulo , Brazil
| | - Maria Fernanda Hornos Carneiro
- a Laboratório de Toxicologia e Essencialidade de Metais , Faculdade de Ciências Farmacêuticas de Ribeirão Preto-USP, Monte Alegre , Ribeirão Preto , São Paulo , Brazil
| | - Denise Grotto
- b Programa de Pós-Graduação em Ciências Farmacêuticas , Universidade de Sorocaba , Sorocaba , São Paulo , Brazil
| | - Lívia Cristina Hernandes
- c Laboratório de Nutrigenômica , Faculdade de Ciências Farmacêuticas de Ribeirão Preto-USP, Monte Alegre , Ribeirão Preto , São Paulo , Brazil
| | - Lusânia Maria Greggi Antunes
- c Laboratório de Nutrigenômica , Faculdade de Ciências Farmacêuticas de Ribeirão Preto-USP, Monte Alegre , Ribeirão Preto , São Paulo , Brazil
| | - Fernando Barbosa
- a Laboratório de Toxicologia e Essencialidade de Metais , Faculdade de Ciências Farmacêuticas de Ribeirão Preto-USP, Monte Alegre , Ribeirão Preto , São Paulo , Brazil
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Yadav R, Liu Y, Kwok S, Hama S, France M, Eatough R, Pemberton P, Schofield J, Siahmansur TJ, Malik R, Ammori BA, Issa B, Younis N, Donn R, Stevens A, Durrington P, Soran H. Effect of Extended-Release Niacin on High-Density Lipoprotein (HDL) Functionality, Lipoprotein Metabolism, and Mediators of Vascular Inflammation in Statin-Treated Patients. J Am Heart Assoc 2015; 4:e001508. [PMID: 26374297 PMCID: PMC4599486 DOI: 10.1161/jaha.114.001508] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background The aim of this study was to explore the influence of extended-release niacin/laropiprant (ERN/LRP) versus placebo on high-density lipoprotein (HDL) antioxidant function, cholesterol efflux, apolipoprotein B100 (apoB)-containing lipoproteins, and mediators of vascular inflammation associated with 15% increase in high-density lipoprotein cholesterol (HDL-C). Study patients had persistent dyslipidemia despite receiving high-dose statin treatment. Methods and Results In a randomized double-blind, placebo-controlled, crossover trial, we compared the effect of ERN/LRP with placebo in 27 statin-treated dyslipidemic patients who had not achieved National Cholesterol Education Program-ATP III targets for low-density lipoprotein cholesterol (LDL-C). We measured fasting lipid profile, apolipoproteins, cholesteryl ester transfer protein (CETP) activity, paraoxonase 1 (PON1) activity, small dense LDL apoB (sdLDL-apoB), oxidized LDL (oxLDL), glycated apoB (glyc-apoB), lipoprotein phospholipase A2 (Lp-PLA2), lysophosphatidyl choline (lyso-PC), macrophage chemoattractant protein (MCP1), serum amyloid A (SAA) and myeloperoxidase (MPO). We also examined the capacity of HDL to protect LDL from in vitro oxidation and the percentage cholesterol efflux mediated by apoB depleted serum. ERN/LRP was associated with an 18% increase in HDL-C levels compared to placebo (1.55 versus 1.31 mmol/L, P<0.0001). There were significant reductions in total cholesterol, triglycerides, LDL cholesterol, total serum apoB, lipoprotein (a), CETP activity, oxLDL, Lp-PLA2, lyso-PC, MCP1, and SAA, but no significant changes in glyc-apoB or sdLDL-apoB concentration. There was a modest increase in cholesterol efflux function of HDL (19.5%, P=0.045), but no change in the antioxidant capacity of HDL in vitro or PON1 activity. Conclusions ERN/LRP reduces LDL-associated mediators of vascular inflammation, but has varied effects on HDL functionality and LDL quality, which may counter its HDL-C-raising effect. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01054508.
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Affiliation(s)
- Rahul Yadav
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.) Cardiovascular Trials Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom (R.Y., S.K., M.F., R.E., J.S., H.S.)
| | - Yifen Liu
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.)
| | - See Kwok
- Cardiovascular Trials Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom (R.Y., S.K., M.F., R.E., J.S., H.S.)
| | - Salam Hama
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.)
| | - Michael France
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.) Cardiovascular Trials Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom (R.Y., S.K., M.F., R.E., J.S., H.S.) The Institute of Inflammation & Repair at the University of Manchester, United Kingdom (M.F.)
| | - Ruth Eatough
- Cardiovascular Trials Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom (R.Y., S.K., M.F., R.E., J.S., H.S.)
| | - Phil Pemberton
- Department of Biochemistry, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom (P.P.)
| | - Jonathan Schofield
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.) Cardiovascular Trials Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom (R.Y., S.K., M.F., R.E., J.S., H.S.)
| | - Tarza J Siahmansur
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.)
| | - Rayaz Malik
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.)
| | - Basil A Ammori
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, United Kingdom (B.A.A.)
| | - Basil Issa
- Department of Diabetes and Endocrinology, University Hospital of South Manchester, United Kingdom (B.I., N.Y.)
| | - Naveed Younis
- Department of Diabetes and Endocrinology, University Hospital of South Manchester, United Kingdom (B.I., N.Y.)
| | - Rachelle Donn
- Complex Disease Genetics, Centre for Musculoskeletal Research, University of Manchester, United Kingdom (R.D.)
| | - Adam Stevens
- Royal Manchester Children's Hospital, Manchester, United Kingdom (A.S.)
| | - Paul Durrington
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.)
| | - Handrean Soran
- Cardiovascular Research Group, Core Technologies Facility, University of Manchester, United Kingdom (R.Y., Y.L., S.H., M.F., J.S., T.J.S., R.M., P.D., H.S.) Cardiovascular Trials Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom (R.Y., S.K., M.F., R.E., J.S., H.S.)
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Zhou H, Zhu Q, Gan Z, Dong G, Xu Y. Synthesis and biological evaluation of novel laropiprant derivatives as potential anti-allergic agents. Med Chem Res 2015. [DOI: 10.1007/s00044-015-1431-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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McKenney JM. Combination Treatment with Atorvastatin plus Niacin Provides Effective Control of Complex Dyslipidemias: A Literature Review. Postgrad Med 2015; 124:7-20. [DOI: 10.3810/pgm.2012.01.2513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ma L, Lee BH, Clifton H, Schaefer S, Zheng J. Nicotinic acid is a common regulator of heat-sensing TRPV1-4 ion channels. Sci Rep 2015; 5:8906. [PMID: 25752528 PMCID: PMC4894441 DOI: 10.1038/srep08906] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/05/2015] [Indexed: 01/08/2023] Open
Abstract
Nicotinic acid (NA, a.k.a. vitamin B3 or niacin) can reduce blood cholesterol and low-density lipoproteins whereas increase high-density lipoproteins. However, when NA is used to treat dyslipidemias, it causes a strong side effect of cutaneous vasodilation, commonly called flushing. A recent study showed that NA may cause flushing by lowering activation threshold temperature of the heat-sensitive capsaicin receptor TRPV1 ion channel, leading to its activation at body temperature. The finding calls into question whether NA might also interact with the homologous heat-sensitive TRPV2–4 channels, particularly given that TRPV3 and TRPV4 are abundantly expressed in keratinocytes of the skin where much of the flushing response occurs. We found that NA indeed potentiated TRPV3 while inhibited TRPV2 and TRPV4. Consistent with these gating effects, NA lowered the heat-activation threshold of TRPV3 but elevated that of TRPV4. We further found that activity of TRPV1 was substantially prolonged by extracellular NA, which may further enhance the direct activation effect. Consistent with the broad gating effect on TRPV1–4 channels, evidence from the present study hints that NA may share the same activation pathway as 2-aminoethoxydiphenyl borate (2-APB), a common agonist for these TRPV channels. These findings shed new light on the molecular mechanism underlying NA regulation of TRPV channels.
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Affiliation(s)
- Linlin Ma
- 1] Department of Physiology and Membrane Biology, University of California School of Medicine, Davis, California, USA [2] Institute for Molecular Bioscience, University of Queensland, St Lucia, QLD 4072, Australia
| | - Bo Hyun Lee
- Department of Physiology and Membrane Biology, University of California School of Medicine, Davis, California, USA
| | - Heather Clifton
- Division of Cardiovascular Medicine, University of California School of Medicine, Davis, California, USA
| | - Saul Schaefer
- Division of Cardiovascular Medicine, University of California School of Medicine, Davis, California, USA
| | - Jie Zheng
- Department of Physiology and Membrane Biology, University of California School of Medicine, Davis, California, USA
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McKenney J, Bays H, Gleim G, Mitchel Y, Kuznetsova O, Sapre A, Sirah W, Maccubbin D. Safety and tolerability of extended-release niacin-laropiprant: Pooled analyses for 11,310 patients in 12 controlled clinical trials. J Clin Lipidol 2015; 9:313-25. [PMID: 26073389 DOI: 10.1016/j.jacl.2015.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/29/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE) showed that adding extended-release niacin-laropiprant (ERN-LRPT) to statin provided no incremental cardiovascular benefit vs placebo (PBO). ERN-LRPT was also associated with an excess of serious adverse experiences (AEs), some of which were unexpected (infections and bleeding). These findings led to the withdrawal of ERN-LRPT from all markets. OBJECTIVE We examined the safety profile of ERN-LRPT vs the comparators ERN alone and statins in the ERN-LRPT development program to assess whether similar safety signals were observed to those seen in HPS-THRIVE and whether these might be attributed to ERN or LRPT. METHODS Postrandomization safety data from 12 clinical studies, 12 to 52 weeks in duration and involving 11,310 patients, were analyzed across 3 treatments: (1) ERN-LRPT; (2) ERN-NSP (ERN, Merck & Co, Inc or Niaspan [NSP], Abbott Laboratories); and (3) statin-PBO (statin or PBO). RESULTS The safety profiles of ERN-LRPT and ERN-NSP were similar, except for less flushing with ERN-LRPT. Nonflushing AEs reported more frequently with ERN-LRPT or ERN-NSP than with statin-PBO were mostly nonserious and typical of niacin (nausea, diarrhea, and increased blood glucose). There was no evidence for an increased risk of serious AEs related to diabetes, muscle, infection, or bleeding. CONCLUSIONS Pooled data from 11,310 patients revealed that, except for reduced flushing, the safety profile of ERN-LRPT was similar to that of ERN-NSP; LRPT did not appear to adversely affect the side-effect profile of ERN. The inability to replicate the unexpected AE findings in HPS2-THRIVE could be because of the smaller sample size and substantially shorter duration of these studies.
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Affiliation(s)
- James McKenney
- Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Harold Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | - Gilbert Gleim
- Clinical Research, Merck & Co, Inc, Kenilworth, NJ, USA
| | - Yale Mitchel
- Clinical Research, Merck & Co, Inc, Kenilworth, NJ, USA.
| | - Olga Kuznetsova
- Late Development Statistics, Merck & Co, Inc, Kenilworth, NJ, USA
| | - Aditi Sapre
- Late Development Statistics, Merck & Co, Inc, Kenilworth, NJ, USA
| | - Waheeda Sirah
- Clinical Research, Merck & Co, Inc, Kenilworth, NJ, USA
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Ma L, Lee BH, Mao R, Cai A, Jia Y, Clifton H, Schaefer S, Xu L, Zheng J. Nicotinic acid activates the capsaicin receptor TRPV1: Potential mechanism for cutaneous flushing. Arterioscler Thromb Vasc Biol 2014; 34:1272-80. [PMID: 24675661 DOI: 10.1161/atvbaha.113.303346] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Nicotinic acid (also known as niacin or vitamin B3), widely used to treat dyslipidemias, represents an effective and safe means to reduce the risk of mortality from cardiovascular disease. Nonetheless, a substantial fraction of patients discontinue treatment because of a strong side effect of cutaneous vasodilation, commonly termed flushing. In the present study, we tested the hypothesis that nicotinic acid causes flushing partially by activating the capsaicin receptor TRPV1, a polymodal cellular sensor that mediates the flushing response on consumption of spicy food. APPROACH AND RESULTS We observed that the nicotinic acid-induced increase in blood flow was substantially reduced in Trpv1(-/-) knockout mice, indicating involvement of the channel in flushing response. Using exogenously expressed TRPV1, we confirmed that nicotinic acid at submillimolar to millimolar concentrations directly and potently activates TRPV1 from the intracellular side. Binding of nicotinic acid to TRPV1 lowers its activation threshold for heat, causing channel opening at physiological temperatures. The activation of TRPV1 by voltage or ligands (capsaicin and 2-aminoethoxydiphenyl borate) is also potentiated by nicotinic acid. We further demonstrated that nicotinic acid does not compete directly with capsaicin but may activate TRPV1 through the 2-aminoethoxydiphenyl borate activation pathway. Using live-cell fluorescence imaging, we observed that nicotinic acid can quickly enter the cell through a transporter-mediated pathway to activate TRPV1. CONCLUSIONS Direct activation of TRPV1 by nicotinic acid may lead to cutaneous vasodilation that contributes to flushing, suggesting a potential novel pathway to inhibit flushing and to improve compliance.
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Affiliation(s)
- Linlin Ma
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.)
| | - Bo Hyun Lee
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.)
| | - Rongrong Mao
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.)
| | - Anping Cai
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.)
| | - Yunfang Jia
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.)
| | - Heather Clifton
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.)
| | - Saul Schaefer
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.)
| | - Lin Xu
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.)
| | - Jie Zheng
- From the Department of Physiology and Membrane Biology (L.M., B.H.L., J.Z.) and Division of Cardiovascular Medicine (H.C., S.S.), University of California School of Medicine, Davis; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan Province, China (R.M, A.C., Y.J., L.X.); and Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia (L.M.).
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He YM, Feng L, Huo DM, Yang ZH, Liao YH. Benefits and harm of niacin and its analog for renal dialysis patients: a systematic review and meta-analysis. Int Urol Nephrol 2013; 46:433-42. [PMID: 24114284 DOI: 10.1007/s11255-013-0559-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/04/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Clinical trials have shown that niacin and its analog, niacinamide, significantly reduce serum phosphate in patients undergoing dialysis. This review aimed to assess the benefits and harm of niacin and niacinamide in renal dialysis patients. METHODS PubMed, EMBASE, and Cochrane Library were searched, without language limitation, randomized controlled trials (RCTs). Standard methods, consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were used. Reviewer Manager software, version 5.2, was used for meta-analysis. RESULTS Five RCTs with a sample size of 230 patients were included. The meta-analysis showed that niacin and niacinamide significantly decreased serum phosphorus levels [weight mean difference (WMD) -0.88; 95 % confidence interval (CI) -1.19 to -0.57] as well as the calcium × phosphorus product (Ca × P) (WMD -9.15; 95 % CI -13.23 to -5.08), and increased high-density lipoprotein (HDL) levels (WMD 9.30; 95 % CI 5.86-12.74) in renal dialysis patients. Niacin significantly increased the risk of flushing [relative risk (RR) 33; 95 % CI 4.71-232.12] in these patients, while the risk of thrombocytopenia was significantly increased in the niacinamide group (RR 2.82; 95 % CI 1.14-6.94). However, sensitivity analysis showed that our finding regarding thrombocytopenia should be regarded with a low degree of certainty. CONCLUSION Niacin and its analog effectively improved phosphorus metabolism in renal dialysis patients. However, niacin can cause flushing and niacinamide probably cause thrombocytopenia. Further larger sample size and well-designed RCTs are needed.
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Affiliation(s)
- Yuan-Mei He
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
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DiDonato JA, Huang Y, Aulak KS, Even-Or O, Gerstenecker G, Gogonea V, Wu Y, Fox PL, Tang WHW, Plow EF, Smith JD, Fisher EA, Hazen SL. Function and distribution of apolipoprotein A1 in the artery wall are markedly distinct from those in plasma. Circulation 2013; 128:1644-55. [PMID: 23969698 DOI: 10.1161/circulationaha.113.002624] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior studies show that apolipoprotein A1 (apoA1) recovered from human atherosclerotic lesions is highly oxidized. Ex vivo oxidation of apoA1 or high-density lipoprotein (HDL) cross-links apoA1 and impairs lipid binding, cholesterol efflux, and lecithin-cholesterol acyltransferase activities of the lipoprotein. Remarkably, no studies to date directly quantify either the function or HDL particle distribution of apoA1 recovered from the human artery wall. METHODS AND RESULTS A monoclonal antibody (10G1.5) was developed that equally recognizes lipid-free and HDL-associated apoA1 in both native and oxidized forms. Examination of homogenates of atherosclerotic plaque-laden aorta showed >100-fold enrichment of apoA1 compared with normal aorta (P<0.001). Surprisingly, buoyant density fractionation revealed that only a minority (<3% of total) of apoA1 recovered from either lesions or normal aorta resides within an HDL-like particle (1.063≤d≤1.21). In contrast, the majority (>90%) of apoA1 within aortic tissue (normal and lesions) was recovered within the lipoprotein-depleted fraction (d>1.21). Moreover, both lesion and normal artery wall apoA1 are highly cross-linked (50% to 70% of total), and functional characterization of apoA1 quantitatively recovered from aorta with the use of monoclonal antibody 10G1.5 showed ≈80% lower cholesterol efflux activity and ≈90% lower lecithin-cholesterol acyltransferase activity relative to circulating apoA1. CONCLUSIONS The function and distribution of apoA1 in human aorta are quite distinct from those found in plasma. The lipoprotein is markedly enriched within atherosclerotic plaque, predominantly lipid-poor, not associated with HDL, extensively oxidatively cross-linked, and functionally impaired.
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Affiliation(s)
- Joseph A DiDonato
- Departments of Cellular and Molecular Medicine, Lerner Research Institute (J.A.D., Y.H., K.A., G.G., V.G., P.L.F., W.H.W.T., J.D.S., S.L.H.), Cardiovascular Medicine, Heart, and Vascular Institute (W.H.W.T., J.D.S., S.L.H.), and Molecular Cardiology, Lerner Research Institute (E.F.P.), Cleveland Clinic, Cleveland, OH; Department of Medicine, New York University, New York, NY (O.E.-O., E.A.F.); and Departments of Chemistry (G.G., V.G., S.L.H.) and Mathematics (Y.W.), Cleveland State University, Cleveland, OH
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Franceschini G, Favari E, Calabresi L, Simonelli S, Bondioli A, Adorni MP, Zimetti F, Gomaraschi M, Coutant K, Rossomanno S, Niesor EJ, Bernini F, Benghozi R. Differential effects of fenofibrate and extended-release niacin on high-density lipoprotein particle size distribution and cholesterol efflux capacity in dyslipidemic patients. J Clin Lipidol 2013; 7:414-22. [PMID: 24079282 DOI: 10.1016/j.jacl.2013.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/12/2013] [Accepted: 06/19/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effectiveness of therapies that raise high-density lipoprotein cholesterol (HDL-C) to lower cardiovascular disease risk is currently under debate, and further research into the relationship between HDL-C and function is required. OBJECTIVE o investigate whether 2 established HDL-C-raising therapies had differential effects on parameters of high-density lipoprotein (HDL) quality and function, such as HDL particle profile and cholesterol efflux capacity (CEC), in patients with dyslipidemia. METHODS AND RESULTS Sixty-six patients with dyslipidemia, 24 with low HDL-C levels (<40 mg/dL) and 42 with normal HDL-C levels (40-59 mg/dL), were treated for 6 weeks with fenofibrate (160 mg/d) or extended-release (ER) niacin (0.5 g/d for 3 weeks, then 1 g/d) with 4 weeks of washout between treatments. Lipoprotein particle size distribution was determined using nuclear magnetic resonance, and pathway-specific serum CECs were assessed in J774 macrophages, hepatoma, and Chinese hamster ovary-human adenosine triphosphate-binding cassette transporter G1 cells. Comparable increases in HDL-C and apolipoprotein A-I levels were seen with fenofibrate and ER niacin. There was a shift toward larger HDL, predominantly to medium-size HDL particles for fenofibrate (+209%) and to large HDL particles for ER niacin (+221%). Minor changes in serum CECs were observed with fenofibrate and ER niacin for all the efflux pathways measured. Small increases in plasma cholesteryl ester transfer protein and lecithin: cholesterol acyltransferase concentrations, and decreases in cholesteryl ester transfer protein activity were seen with both drugs. CONCLUSIONS Fenofibrate and ER niacin increased plasma HDL-C level similarly, but modulated HDL particle size distribution differently; however, these changes did not result in differential effects on serum CECs.
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Affiliation(s)
- Guido Franceschini
- Center E. Grossi Paoletti, Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy.
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Niacin Reduces Atherosclerosis Development in APOE*3Leiden.CETP Mice Mainly by Reducing NonHDL-Cholesterol. PLoS One 2013; 8:e66467. [PMID: 23840481 PMCID: PMC3686722 DOI: 10.1371/journal.pone.0066467] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/06/2013] [Indexed: 12/29/2022] Open
Abstract
Objective Niacin potently lowers triglycerides, mildly decreases LDL-cholesterol, and largely increases HDL-cholesterol. Despite evidence for an atheroprotective effect of niacin from previous small clinical studies, the large outcome trials, AIM-HIGH and HPS2-THRIVE did not reveal additional beneficial effects of niacin (alone or in combination with laropiprant) on top of statin treatment. We aimed to address this apparent discrepancy by investigating the effects of niacin without and with simvastatin on atherosclerosis development and determine the underlying mechanisms, in APOE*3Leiden.CETP mice, a model for familial dysbetalipoproteinemia (FD). Approach and Results Mice were fed a western-type diet containing cholesterol without or with niacin (120 mg/kg/day), simvastatin (36 mg/kg/day) or their combination for 18 weeks. Similarly as in FD patients, niacin reduced total cholesterol by -39% and triglycerides by −50%, (both P<0.001). Simvastatin and the combination reduced total cholesterol (−30%; −55%, P<0.001) where the combination revealed a greater reduction compared to simvastatin (−36%, P<0.001). Niacin decreased total cholesterol and triglycerides primarily by increasing VLDL clearance. Niacin increased HDL-cholesterol (+28%, P<0.01) and mildly increased reverse cholesterol transport. All treatments reduced monocyte adhesion to the endothelium (−46%; −47%, P<0.01; −53%, P<0.001), atherosclerotic lesion area (−78%; −49%, P<0.01; −87%, P<0.001) and severity. Compared to simvastatin, the combination increased plaque stability index [(SMC+collagen)/macrophages] (3-fold, P<0.01). Niacin and the combination reduced T cells in the aortic root (−71%, P<0.01; −81%, P<0.001). Lesion area was strongly predicted by nonHDL-cholesterol (R2 = 0.69, P<0.001) and to a much lesser extent by HDL-cholesterol (R2 = 0.20, P<0.001). Conclusion Niacin decreases atherosclerosis development mainly by reducing nonHDL-cholesterol with modest HDL-cholesterol-raising and additional anti-inflammatory effects. The additive effect of niacin on top of simvastatin is mostly dependent on its nonHDL-cholesterol-lowering capacities. These data suggest that clinical beneficial effects of niacin are largely dependent on its ability to lower LDL-cholesterol on top of concomitant lipid-lowering therapy.
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Philipose S, Konya V, Lazarevic M, Pasterk LM, Marsche G, Frank S, Peskar BA, Heinemann A, Schuligoi R. Laropiprant attenuates EP3 and TP prostanoid receptor-mediated thrombus formation. PLoS One 2012; 7:e40222. [PMID: 22870195 PMCID: PMC3411562 DOI: 10.1371/journal.pone.0040222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/02/2012] [Indexed: 11/24/2022] Open
Abstract
The use of the lipid lowering agent niacin is hampered by a frequent flush response which is largely mediated by prostaglandin (PG) D2. Therefore, concomitant administration of the D-type prostanoid (DP) receptor antagonist laropiprant has been proposed to be a useful approach in preventing niacin-induced flush. However, antagonizing PGD2, which is a potent inhibitor of platelet aggregation, might pose the risk of atherothrombotic events in cardiovascular disease. In fact, we found that in vitro treatment of platelets with laropiprant prevented the inhibitory effects of PGD2 on platelet function, i.e. platelet aggregation, Ca2+ flux, P-selectin expression, activation of glycoprotein IIb/IIIa and thrombus formation. In contrast, laropiprant did not prevent the inhibitory effects of acetylsalicylic acid or niacin on thrombus formation. At higher concentrations, laropiprant by itself attenuated platelet activation induced by thromboxane (TP) and E-type prostanoid (EP)-3 receptor stimulation, as demonstrated in assays of platelet aggregation, Ca2+ flux, P-selectin expression, and activation of glycoprotein IIb/IIIa. Inhibition of platelet function exerted by EP4 or I-type prostanoid (IP) receptors was not affected by laropiprant. These in vitro data suggest that niacin/laropiprant for the treatment of dyslipidemias might have a beneficial profile with respect to platelet function and thrombotic events in vascular disease.
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Affiliation(s)
- Sonia Philipose
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Viktoria Konya
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Mirjana Lazarevic
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Lisa M. Pasterk
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Gunther Marsche
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Sasa Frank
- Institute of Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - Bernhard A. Peskar
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Akos Heinemann
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Rufina Schuligoi
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
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Villines TC, Kim AS, Gore RS, Taylor AJ. Niacin: the evidence, clinical use, and future directions. Curr Atheroscler Rep 2012; 14:49-59. [PMID: 22037771 DOI: 10.1007/s11883-011-0212-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of FDA-approved niacin (nicotinic acid or vitamin B3) formulations at therapeutic doses, alone or in combination with statins or other lipid therapies, is safe, improves multiple lipid parameters, and reduces atherosclerosis progression. Niacin is unique as the most potent available lipid therapy to increase high-density lipoprotein (HDL) cholesterol and it significantly reduces lipoprotein(a). Through its action on the GPR109A receptor, niacin may also exert beneficial pleiotropic effects independent of changes in lipid levels, such as improving endothelial function and attenuating vascular inflammation. Studies evaluating the impact of niacin in statin-naïve patients on cardiovascular outcomes, or alone and in combination with statins or other lipid therapies on atherosclerosis progression, have been universally favorable. However, the widespread use of niacin to treat residual lipid abnormalities such as low HDL cholesterol, when used in combination with statins among patients achieving very low (<75 mg/dL) low-density lipoprotein cholesterol levels, is currently not supported by clinical outcome trials.
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Affiliation(s)
- Todd C Villines
- Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA.
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Ho CKM, Walker SW. Statins and their interactions with other lipid-modifying medications: safety issues in the elderly. Ther Adv Drug Saf 2012; 3:35-46. [PMID: 25083224 PMCID: PMC4110829 DOI: 10.1177/2042098611428486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Inhibitors of the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, commonly known as statins, are widely used in both primary and secondary prevention of occlusive cardiovascular disease. Statins are effective not only in improving total and low-density lipoprotein cholesterol concentrations in blood but also in decreasing morbidity and mortality associated with cardiovascular diseases resulting from underlying atheroma. There is, however, evidence that statins are underutilized in elderly patients, possibly due to concerns about safety/tolerability issues or potential drug interactions, including interactions with other lipid-modifying medications, or both. In this review, we summarize the major adverse events associated with statin use, with particular reference to the elderly patient, including factors which might increase the risk of adverse effects. Potential drug interactions between statins and other lipid-modifying medications including fibrates, ezetimibe, nicotinic acid, bile acid sequestrants and omega-3-acid ethyl esters (fish oils) are specifically discussed. Clinical management strategies to avoid these drug interactions are outlined.
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Yadav R, Kwok S, Ammori BJ, Issa B, Soran H. Safety and tolerability of extended-release niacin with laropiprant. Expert Opin Drug Saf 2011; 11:151-9. [DOI: 10.1517/14740338.2011.638281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Elmallah W, Krasuski RA. Therapy and clinical trials. Curr Opin Lipidol 2011; 22:512-3. [PMID: 22101564 DOI: 10.1097/mol.0b013e32834d208d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bostom AG, Maclean AA, Maccubbin D, Tipping D, Giezek H, Hanlon WA. Extended-release niacin/laropiprant lowers serum phosphorus concentrations in patients with type 2 diabetes. J Clin Lipidol 2011; 5:281-7. [PMID: 21784373 DOI: 10.1016/j.jacl.2011.03.455] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/26/2011] [Accepted: 03/09/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Niacin compounds lower serum phosphorus concentrations in patients with end-stage renal disease. METHODOLOGY We evaluated the impact of extended release niacin, given in fixed-dose combination with laropiprant, a specific inhibitor of prostaglandin-mediated, niacin-induced flushing, versus placebo, on serum phosphorus concentrations measured serially (at weeks 0, 4, 8, 12, 18, 24, 30, and 36) during a 36-week randomized, controlled trial. All subjects had a confirmed diagnosis of type 2 diabetes (n = 446 niacin/laropiprant; n = 339 placebo). Estimated glomerular filtration rate ranged from 36 to 184 mL/min/1.73 m(2), with n = 111 (14.1%) having a value <60 mL/min/1.73 m(2). Subjects received one tablet daily of extended-release niacin/laropiprant (1g niacin/ 20 mg laropiprant) for the first 4 weeks, and 2 tablets once daily, thereafter, or matched placebo. Niacin lowered serum phosphorus concentrations by 0.36 mg/dL (95% CI: -0.40, -0.31; P < .001), relative to placebo, from baseline values of 3.57 and 3.56 mg/dL in the niacin and placebo groups, respectively. Subgroup analyses revealed no evidence for phosphorus-lowering effect modification by these baseline variables: glomerular filtration rate <60 (n = 111;14.1%) vs ≥60 mL/min/m(2) (n = 674; 85.9%); phosphorus ≤3.5 mg/dL (n = 392; 49.9%) vs >3.5 mg/dL (n = 393; 50.1%); or prior statin use (n = 618; 78.7%) vs nonuse (n = 167; 21.3%). CONCLUSIONS AND IMPLICATIONS These data confirm that niacin's phosphorus-lowering effects-which may have therapeutic implications for the management of hyperphosphatemia and possible prevention of cardiorenal outcomes in renal disease-extend across a broad spectrum of renal function in type 2 diabetics without stage 4 or 5 chronic kidney disease (a glomerular filtration rate ≥30 mL/min/1.73 m(2)).
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Affiliation(s)
- Andrew G Bostom
- Rhode Island Hospital, Division of Kidney Diseases and Hypertension, 593 Eddy Street, Providence, RI 02903, USA.
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Offermanns S, Colletti SL, Lovenberg TW, Semple G, Wise A, IJzerman AP. International Union of Basic and Clinical Pharmacology. LXXXII: Nomenclature and Classification of Hydroxy-carboxylic Acid Receptors (GPR81, GPR109A, and GPR109B). Pharmacol Rev 2011; 63:269-90. [PMID: 21454438 DOI: 10.1124/pr.110.003301] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The G-protein-coupled receptors GPR81, GPR109A, and GPR109B share significant sequence homology and form a small group of receptors, each of which is encoded by clustered genes. In recent years, endogenous ligands for all three receptors have been described. These endogenous ligands have in common that they are hydroxy-carboxylic acid metabolites, and we therefore have proposed that this receptor family be named hydroxy-carboxylic acid (HCA) receptors. The HCA(1) receptor (GPR81) is activated by 2-hydroxy-propanoic acid (lactate), the HCA(2) receptor (GPR109A) is a receptor for the ketone body 3-hydroxy-butyric acid, and the HCA(3) receptor (GPR109B) is activated by the β-oxidation intermediate 3-hydroxy-octanoic acid. HCA(1) and HCA(2) receptors are found in most mammalian species, whereas the HCA(3) receptor is present only in higher primates. The three receptors have in common that they are expressed in adipocytes and are coupled to G(i)-type G-proteins mediating antilipolytic effects in fat cells. HCA(2) and HCA(3) receptors are also expressed in a variety of immune cells. HCA(2) is a receptor for the antidyslipidemic drug nicotinic acid (niacin) and related compounds, and there is an increasing number of synthetic ligands mainly targeted at HCA(2) and HCA(3) receptors. The aim of this article is to give an overview on the discovery and pharmacological characterization of HCAs, and to introduce an International Union of Basic and Clinical Pharmacology (IUPHAR)-recommended nomenclature. We will also discuss open questions regarding this receptor family as well as their physiological role and therapeutic potential.
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Affiliation(s)
- Stefan Offermanns
- Department of Pharmacology, Max-Planck-Institute for Heart and Lung Research, Ludwigstrasse 43, 61231 Bad Nauheim, Germany.
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Ahmed K. Biological roles and therapeutic potential of hydroxy-carboxylic Acid receptors. Front Endocrinol (Lausanne) 2011; 2:51. [PMID: 22654812 PMCID: PMC3356039 DOI: 10.3389/fendo.2011.00051] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 09/23/2011] [Indexed: 11/13/2022] Open
Abstract
In the recent past, deorphanization studies have described intermediates of energy metabolism to activate G protein-coupled receptors and to thereby regulate metabolic functions. GPR81, GPR109A, and GPR109B, formerly known as the nicotinic acid receptor family, are encoded by clustered genes and share a high degree of sequence homology. Recently, hydroxy-carboxylic acids were identified as endogenous ligands of GPR81, GPR109A, and GPR109B, and therefore these receptors have been placed into a novel receptor family of hydroxy-carboxylic acid (HCA) receptors. The HCA(1) receptor (GPR81) is activated by the glycolytic metabolite 2-hydroxy-propionic acid (lactate), the HCA(2) receptor is activated by the ketone body 3-hydroxy-butyric acid, and the HCA(3) receptor (GPR109B) is a receptor for the β-oxidation intermediate 3-hydroxy-octanoic acid. While HCA(1) and HCA(2) receptors are present in most mammalian species, the HCA(3) receptor is exclusively found in humans and higher primates. HCA receptors are expressed in adipose tissue and mediate anti-lipolytic effects in adipocytes through G(i)-type G protein-dependent inhibition of adenylyl cyclase. HCA(2) and HCA(3) inhibit lipolysis during conditions of increased β-oxidation such as prolonged fasting, whereas HCA(1) mediates the anti-lipolytic effects of insulin in the fed state. As HCA(2) is a receptor for the established anti-dyslipidemic drug nicotinic acid, HCA(1) and HCA(3) also represent promising drug targets and several synthetic ligands for HCA receptors have been developed. In this article, we will summarize the deorphanization and pharmacological characterization of HCA receptors. Moreover, we will discuss recent progress in elucidating the physiological and pathophysiological role to further evaluate the therapeutic potential of the HCA receptor family for the treatment of metabolic disease.
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Affiliation(s)
- Kashan Ahmed
- Institute of Molecular Systems Biology, Swiss Federal Institute of TechnologyZurich, Switzerland
- Competence Center of Systems Physiology and Metabolic Disease, Swiss Federal Institute of TechnologyZurich, Switzerland
- *Correspondence: Kashan Ahmed, Institute of Molecular Systems Biology, Swiss Federal Institute of Technology Zurich, Wolfgang-Pauli-Strasse 16, CH-8093 Zurich, Switzerland. e-mail:
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Blad CC, Ahmed K, IJzerman AP, Offermanns S. Biological and pharmacological roles of HCA receptors. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2011; 62:219-250. [PMID: 21907911 DOI: 10.1016/b978-0-12-385952-5.00005-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The hydroxy-carboxylic acid (HCA) receptors HCA(1), HCA(2), and HCA(3) were previously known as GPR81, GPR109A, and GPR109B, respectively, or as the nicotinic acid receptor family. They form a cluster of G protein-coupled receptors with high sequence homology. Recently, intermediates of energy metabolism, all HCAs, have been reported as endogenous ligands for each of these receptors. The HCA receptors are predominantly expressed on adipocytes and mediate the inhibition of lipolysis by coupling to G(i)-type proteins. HCA(1) is activated by lactate, HCA(2) by the ketone body 3-hydroxy-butyrate, and HCA(3) by hydroxylated β-oxidation intermediates, especially 3-hydroxy-octanoic acid. Both HCA(2) and HCA(3) are part of a negative feedback loop which keeps the release of fat stores in check under starvation conditions, whereas HCA(1) plays a role in the antilipolytic (fat-conserving) effect of insulin. HCA(2) was first discovered as the molecular target of the antidyslipidemic drug nicotinic acid (or niacin). Many synthetic agonists have since been designed for HCA(2) and HCA(3), but the development of a new, improved HCA-targeted drug has not been successful so far, despite a number of clinical studies. Recently, it has been shown that the major side effect of nicotinic acid, skin flushing, is mediated by HCA(2) receptors on keratinocytes, as well as on Langerhans cells in the skin. In this chapter, we summarize the latest developments in the field of HCA receptor research, with emphasis on (patho)physiology, receptor pharmacology, major ligand classes, and the therapeutic potential of HCA ligands.
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Affiliation(s)
- Clara C Blad
- Division of Medicinal Chemistry, Leiden/Amsterdam Center for Drug Research, Leiden University, Leiden, The Netherlands
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