Evidence for a Direct Effect of the NAD+ Precursor Acipimox on Muscle Mitochondrial Function in Humans

Recent preclinical studies showed the potential of nicotinamide adenine dinucleotide : NAD+ : precursors to increase oxidative phosphorylation and improve metabolic health, but human data is lacking. Here, we hypothesized that the nicotinic acid derivative Acipimox, a NAD+ precursor, would directly affect mitochondrial function, independent of reductions in non-esterified fatty acid (NEFA) concentrations. In a multi-center randomized cross-over trial, 21 patients with type 2 diabetes (age 57.7+/-1.1 years, BMI, 33.4+/-0.8 kg/m2) received either placebo or 250 mg Acipimox thrice daily for 2 weeks. Acipimox treatment increased plasma NEFA (759+/-44 vs. 1135+/-97 micromol/L, p<0.01 for placebo vs. Acipimox), due to a previously described rebound effect. As a result, skeletal muscle lipid content increased and insulin sensitivity decreased. Despite the elevated plasma NEFA levels, ex vivo mitochondrial respiration in skeletal muscle increased. Subsequently, we showed that Acipimox treatment resulted in a robust elevation in expression of nuclear-encoded mitochondrial gene-sets and by presence of a mitonuclear protein imbalance, which may indicate activation of the mitochondrial unfolded protein response (UPRmt). Further studies in C2C12 myotubes confirmed a direct effect of Acipimox on NAD+ levels, mitonuclear protein imbalance and mitochondrial oxidative capacity. To the best of our knowledge, this is the first demonstration that NAD+ boosters can also directly impact skeletal muscle mitochondrial function in humans