Preclinical Characterization of Pharmacologic NAD+Boosting as a Promising Therapeutic Approach inRheumatoid Arthritis
Autor
Pérez Sánchez, Carlos
Escudero Contreras, Alejandro
Cerdó, Tomás
Sánchez-Mendoza, Luz Marina
Llamas Urbano, Adrián
Arias de la Rosa, Iván
Pérez Rodríguez, Miguel
Muñoz-Barrera, Laura
Ábalos-Aguilera, María del Carmen
Barbarroja, Nuria
Calvo Gutiérrez, Jerusalém
Ortega Castro, María Rafaela
Ruiz-Vilchez, Desirée
Moreno, Juan Antonio
Burón, Isabel
González Reyes, José Antonio
López-Pedrera, Ch.
Villalba, José Manuel
Editor
WileyFecha
2023Materia
Rheumatoid arthritisInflammation
Anti-TNF-a therapy
Inflammatory diseases
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Objective:
We analyzed NAD+ metabolism in patients with rheumatoid arthritis (RA), its association with disease activity and clinical outcomes of RA, and the therapeutic potential of pharmacologic NAD+ boosting.
Methods:
Our study included 253 participants. In the first cohort, comprising 153 RA patients and 56 healthy donors, we assessed NAD+ levels and NAD+-related gene pathways. We analyzed 92 inflammatory molecules by proximity extension assay. In the second cohort, comprising 44 RA patients starting anti–tumor necrosis factor (anti-TNF) drugs, we evaluated changes in NAD+ levels and their association with clinical response after 3 months. Mechanistic studies were performed ex vivo on peripheral blood mononuclear cells (PBMCs) from patients with RA to test the beneficial effects of NAD+ boosters, such as nicotinamide and nicotinamide riboside.
Results:
Reduced NAD+ levels were found in RA samples, in line with altered activity and expression of genes involved in NAD+ consumption (sirtuins, poly[ADP-ribose] polymerase, CD38), transport (connexin 43), and biosynthesis (NAMPT, NMNATs). Unsupervised clustering analysis identified a group of RA patients with the highest inflammatory profile, the lowest NAD+ levels, and the highest disease activity (as shown by the Disease Activity Score in 28 joints). NAD+ levels were modulated by anti-TNF therapy in parallel with the clinical response. In vitro studies using PBMCs from RA patients showed that nicotinamide riboside and nicotinamide increased NAD+ levels via NAMPT and NMNAT and reduced their prooxidative, proapoptotic, and proinflammatory status.
Conclusión:
RA patients display altered NAD+ metabolism, directly linked to their inflammatory and disease activity status, which was reverted by anti-TNF therapy. The preclinical beneficial effects of NAD+ boosters, as shown in leukocytes from RA patients, along with their proven clinical safety, might pave the way for the development of clinical trials using these compounds.