throbber
Cell Metabolism
`
`Article
`
`The NAD+ Precursor Nicotinamide Riboside
`Enhances Oxidative Metabolism
`and Protects against High-Fat Diet-Induced Obesity
`
`Carles Canto´ ,1,6,7 Riekelt H. Houtkooper,1,6,8 Eija Pirinen,1,2 Dou Y. Youn,3 Maaike H. Oosterveer,1 Yana Cen,3
`Pablo J. Fernandez-Marcos,1 Hiroyasu Yamamoto,1 Pe´ ne´ lope A. Andreux,1 Philippe Cettour-Rose,1 Karl Gademann,4
`Chris Rinsch,5 Kristina Schoonjans,1 Anthony A. Sauve,3 and Johan Auwerx1,*
`1E´ cole Polytechnique Fe´ de´ rale de Lausanne, CH-1015 Lausanne, Switzerland
`2Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, Biocenter Kuopio, University of Eastern Finland,
`70210 Kuopio, Finland
`3Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065, USA
`4Department of Chemistry, University of Basel, CH-4056 Basel, Switzerland
`5Amazentis, Quartier de L’innovation EPFL, CH-1015 Lausanne, Switzerland
`6These authors contributed equally to this work
`7Present address: Nestle´ Institute of Health Sciences, CH-1015 Lausanne, Switzerland
`8Present address: Laboratory Genetic Metabolic Diseases, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
`*Correspondence: admin.auwerx@epfl.ch
`DOI 10.1016/j.cmet.2012.04.022
`
`SUMMARY
`
`As NAD+ is a rate-limiting cosubstrate for the sirtuin
`enzymes, its modulation is emerging as a valuable
`tool to regulate sirtuin function and, consequently,
`oxidative metabolism.
`In line with this premise,
`decreased activity of PARP-1 or CD38—both NAD+
`consumers—increases NAD+ bioavailability, result-
`ing in SIRT1 activation and protection against meta-
`bolic disease. Here we evaluated whether similar
`effects could be achieved by increasing the supply
`of nicotinamide riboside (NR), a recently described
`natural NAD+ precursor with the ability to increase
`NAD+ levels, Sir2-dependent gene silencing, and
`replicative life span in yeast. We show that NR
`supplementation in mammalian cells and mouse
`tissues increases NAD+ levels and activates SIRT1
`and SIRT3, culminating in enhanced oxidative
`metabolism and protection against high-fat diet-
`induced metabolic abnormalities. Consequently,
`our results indicate that the natural vitamin NR could
`be used as a nutritional supplement to ameliorate
`metabolic and age-related disorders characterized
`by defective mitochondrial function.
`
`INTRODUCTION
`
`The administration of NAD+ precursors, mostly in the form of
`nicotinic acid (NA), has long been known to promote beneficial
`effects on blood lipid and cholesterol profiles and even to induce
`short-term improvement of type 2 diabetes (Karpe and Frayn,
`2004). Unfortunately, NA treatment often leads to severe flush-
`ing, resulting in poor patient compliance (Bogan and Brenner,
`2008). These side effects are mediated by the binding of NA to
`
`838 Cell Metabolism 15, 838–847, June 6, 2012 ª2012 Elsevier Inc.
`
`the GPR109A receptor (Benyo et al., 2005). We hence became
`interested in the possible therapeutic use of alternative NAD+
`precursors that do not activate GPR109A.
`NR was recently identified as a NAD+ precursor, with
`conserved metabolism from yeast to mammals (Bieganowski
`and Brenner, 2004). Importantly, NR is found in milk (Bieganow-
`ski and Brenner, 2004), constituting a dietary source for NAD+
`production. Once it enters the cell, NR is metabolized into nico-
`tinamide mononucleotide (NMN) by a phosphorylation step cata-
`lyzed by the nicotinamide riboside kinases (NRKs) (Bieganowski
`and Brenner, 2004). In contrast to NR, NMN has not yet been
`found in dietary constituents, and its presence in serum is
`a matter of debate (Hara et al., 2011; Revollo et al., 2007). This
`highlights how NR might be an important vehicular form of
`a NAD+ precursor whose levels could be modulated through
`nutrition.
`The sirtuins are a family of enzymes that use NAD+ as
`a cosubstrate to catalyze the deacetylation and/or mono-ADP-
`ribosylation of target proteins. One of their major particularities
`is that their Km for NAD+ is relatively high, making NAD+ a rate-
`limiting substrate for their reaction (Canto and Auwerx, 2012).
`Initial work by yeast biologists indicated that the activity of Sir2
`(the yeast SIRT1 homolog) as a NAD+-coupled enzyme could
`provide a link between metabolism and gene silencing (Imai
`et al., 2000a; Imai et al., 2000b). In this way, Sir2 was proposed
`to mediate metabolic transcriptional adaptations linked to situa-
`tions of nutrient scarcity, which are generally coupled to
`increased NAD+ levels (for review, see Houtkooper et al.,
`2010). During the last decade, an overwhelming body of
`evidence indicates that
`the activity of mammalian sirtuins,
`most notably SIRT1 and SIRT3, have the ability to enhance fat
`oxidation and prevent metabolic disease (Hirschey et al., 2011;
`Lagouge et al., 2006; Pfluger et al., 2008). Therefore, strategies
`aimed to increase intracellular NAD+ levels have gained interest
`in order to activate sirtuins and battle metabolic damage. Valida-
`tion of this concept was achieved recently, by demonstrating
`that pharmacological and genetic approaches aimed to reduce
`
`Elysium Health Exhibit 1018
`Page 1 of 10
`
`

`

`Cell Metabolism
`NR Increases NAD+ and Prevents Metabolic Disorders
`
`A
`
`1,2
`
`0,9
`
`0,6
`
`0,3
`
`NAD
`
`+
`
` content
`
` (mmol / kg of prot)
`
`B
`
`GPR109A-induced
`
`calcium mobilization
`
`C
`
`NAD
`
`+
`
` content
`
` (mmol / kg of prot)
`
`D
`
`NAD
`
`+
`
` content
`
` (mmol / kg of prot)
`
`4000
`
`(RLU – increase over basal)
`
`1,5
`
`Veh NR
`
`0,75
`
`3000
`
`2000
`
`1000
`
`0
`
`C2C12
`
`Hepa1.6
`
`HEK293T
`
`NR
`
`NMN
`
`NA
`
`NMN NA
`
`1
`
`*
`*
`*
`
`*
`*
`*
`
`* * *
`
`0,5
`
`0
`
`0,5
`
`*
`
`*
`*
`
`0,25
`
`* *
`
`0
`
`-8
`
`-7
`
`-6
`
`-5
`
`-3
`
`C2C12 Hepa1.6 HEK293T
`
`0
`
`200 400 600 800 1000
`
`-9
`10
`
`10
`
`10
`
`10
`
`10
`
`10
`
`-4 10
`
`Liver Muscle
`
`Nicotinamide Riboside (µM)
`
`Concentration (M)
`
`PAR
`
`H
`
`1,5
`
`1
`
`0,5
`
`0
`
`(relative to Veh)
`
`Nampt mRNA levels
`
`Nampt
`
`Tubulin
`
`PARP-1
`
`Veh NR
`
`Veh NR
`
`E
`
`F
`
`G
`
`*
`
`2
`
`1,5
`
`1
`
`0,5
`
`0
`
`(mmol / kg prot)
`
`liver mitochondria
`
` content in
`
`+
`
`NAD
`
`*
`
`3
`
`2
`
`1
`
`0
`
`(mmol / kg prot)
`
` levels
`
`+
`
`NAD
`
`Mitochondrial
`
`Figure 1. Nicotinamide Riboside Supplementation Increases NAD+ Content and Sirtuin Activity in Cultured Mammalian Cells
`(A) C2C12 myotubes, Hepa1.6, and HEK293T cells were treated with nicotinamide riboside (NR) for 24 hr, and acidic extracts were obtained to measure total
`NAD+ intracellular content.
`(B) GPR109A-expressing Chem-4 cells were loaded with 3 mM Fura-2 acetoxymethyl ester derivative (Fura-2/AM) for 30 min at 37
`C. Then cells were washed
`three times with Hank’s balanced salt solution. Finally, calcium fluxes in response to increasing concentrations of nicotinic acid (NA; as positive control), NR, or
`nicotinamide mononucleotide (NMN) were determined as indicated in the Experimental Procedures.
`(C) C2C12 myotubes, Hepa1.6, and HEK293T cells were treated with either PBS (as vehicle) or 0.5 mM of NR, NMN, or NA for 24 hr. Then total NAD+ intracellular
`content was determined as in (A).
`(D) C57Bl/6J mice were fed with chow containing vehicle (water) or either NR, NMN,or NA at 400 mg/kg/day (n = 8 mice per group). After 1 week, NAD+ content
`was determined in liver and quadriceps muscle.
`(E) HEK293T cells were treated with NR (0.5 mM, black bars) or vehicle (white bars) for 4 hr. Then cells were harvested, and mitochondria were isolated for NAD+
`measurement.
`(F) C57Bl/6J mice were fed with chow containing vehicle (water) or NR at 400 mg/kg/day (n = 8 mice per group). After 1 week, mitochondria were isolated from
`their livers to measure NAD+ content.
`(G) HEK293T cells were treated with either PBS (as vehicle) or 0.5 mM of NR for 24 hr. Then mRNA and protein was extracted to measure Nampt levels by
`RT-qPCR and western blot, respectively.
`(H) HEK293T cells were treated with either PBS (as vehicle) or 0.5 mM of NR for 24 hr. Then protein homogenates were obtained to test global PARylation and
`PARP-1 levels. Throughout the figure, all values are presented as mean ±SD. Asterisk indicates statistical significant difference versus respective vehicle group at
`p < 0.05. Unless otherwise stated, the vehicle groups are represented by white bars, and NR groups are represented by black bars.
`
`
`
`the activity of major NAD+-consuming activities in the cell, such
`as PARP-1 (Bai et al., 2011b) and CD38 (Barbosa et al., 2007),
`prompted an increase in NAD+ bioavailability and enhanced
`SIRT1 activity, ultimately leading to effective protection against
`metabolic disease. In this work we aimed to test whether similar
`effects could be achieved through dietary supplementation with
`a natural NAD+ precursor, such as NR.
`
`RESULTS
`
`NR Increases Intracellular and Mitochondrial NAD+
`Content in Mammalian Cells and Tissues
`NR treatment dose-dependently increased intracellular NAD+
`levels in murine and human cell lines (Figure 1A), with maximal
`
`effects at concentrations between 0.5 and 1 mM. In C2C12 my-
`otubes, the Km for NR uptake was 172.3 ± 17.6 mM, with a Vmax of
`204.2 ± 20.5 pmol/mg of protein/min. Unlike NA, both NR and
`another well-described NAD+ precursor, NMN (Revollo et al.,
`2007), did not activate GPR109A (Figure 1B), hence constituting
`valuable candidates to increase NAD+ levels without activating
`GPR109A. Strikingly, the ability of NR to increase intracellular
`NAD+ in mammalian cells was, at least, similar to that of these
`other precursors (Figure 1C). We next evaluated the efficacy of
`NR, NMN, and NA to increase NAD+ in vivo by supplementing
`mouse chow with NR, NMN, or NA at 400 mg/kg/day for
`1 week. All compounds increased NAD+ levels in liver, but only
`NR and NA significantly enhanced muscle NAD+ content. (Fig-
`ure 1D). These results illustrate how NR administration is a valid
`
`Cell Metabolism 15, 838–847, June 6, 2012 ª2012 Elsevier Inc. 839
`
`Elysium Health Exhibit 1018
`Page 2 of 10
`
`

`

`Cell Metabolism
`NR Increases NAD+ and Prevents Metabolic Disorders
`
`tool to boost NAD+ levels in mammalian cells and tissues without
`activating GPR109A.
`Given the existence of different cellular NAD+ pools and the
`relevance of mitochondrial NAD+ content for mitochondrial and
`cellular function (Yang et al., 2007a), we also analyzed whether
`NR treatment would affect mitochondrial NAD+ levels.
`In
`contrast to what has been observed with other strategies aimed
`to increase NAD+ bioavailability, such as PARP inhibition (Bai
`et al., 2011a), we found that mitochondrial NAD+ levels were
`enhanced in cultured cells (Figure 1E) and mouse liver (Figure 1F)
`after NR supplementation.
`To further solidify our data, we also wondered whether the
`enhanced NAD+ levels upon NR treatment could derive from
`alterations in the NAD+ salvage pathway or PARP activity.
`However, we could not see any change in Nampt mRNA or
`protein content in response to NR treatment (Figure 1G). Simi-
`larly, PARP activity and PARP-1 content were not affected by
`NR (Figure 1H). Altogether,
`these results suggest
`that NR
`increases NAD+ by direct NAD+ biosynthesis rather than by indi-
`rectly affecting the major NAD+ salvage (Nampt) or consumption
`(PARPs) pathways. Importantly, this increase in NAD+ was not
`linked to changes in cellular glycolytic rates or ATP levels (data
`not shown), which would be expected if NAD+/NADH ratios
`had been altered to the point of compromising basic cellular
`functions.
`
`NR Treatment Enhances SIRT1 and SIRT3 Activity
`The ability of NR to increase intracellular NAD+ levels both in vivo
`and in vitro prompted us to test whether it could activate sirtuin
`enzymes. Confirming this hypothesis, NR dose-dependently
`decreased the acetylation of FOXO1 (Brunet et al., 2004) in
`a SIRT1-dependent manner (Figure 2A). This deacetylation of
`FOXO1 by SIRT1 upon NR treatment resulted in its transcrip-
`tional activation, leading to higher expression of target genes,
`such as Gadd45, Catalase, Sod1, and Sod2 (see Figure S1 on-
`line) (Calnan and Brunet, 2008). The lack of changes in SIRT1
`protein levels upon NR treatment (Figure 2A) suggests that NR
`increases SIRT1 activity by enhancing NAD+ bioavailability.
`The higher SIRT1 activity in NR-treated cells was supported by
`mRNA expression analysis. Consistent with SIRT1 being a nega-
`tive regulator of Ucp2 expression (Bordone et al., 2006), NR
`decreased Ucp2 mRNA levels (Figure 2B). Importantly, knocking
`down Sirt1 prevented the action of NR on Ucp2 expression (Fig-
`ure 2B). Similarly, the higher expression of a FOXO1 target gene,
`Sod2, upon NR treatment was also prevented by the knockdown
`of either Foxo1 or Sirt1 (Figure 2B). This suggested that NR leads
`to a higher Sod2 expression through the activation of SIRT1,
`which then deacetylates and activates FOXO1. Importantly, the
`knockdown of Sirt1 did not compromise the ability of NR to
`increase intracellular NAD+ content, indicating that NR uptake
`and metabolism into NAD+ are not affected by SIRT1 deficiency
`(Figure 2C).
`In line with the increase in mitochondrial NAD+ levels (Figures
`1E and 1F) and the potential consequent activation of mitochon-
`drial sirtuins, NR also reduced the acetylation status of Ndufa9
`immunoprecipitates and SOD2 (Figures 2D and 2E, respec-
`tively), both targets for SIRT3 (Ahn et al., 2008; Qiu et al.,
`2010). SOD2 deacetylation has been linked to a higher intrinsic
`activity. In line with these observations, NR treatment enhanced
`
`840 Cell Metabolism 15, 838–847, June 6, 2012 ª2012 Elsevier Inc.
`
`SOD2 activity (Figure 2E). To ensure that NR-induced SOD2 de-
`acetylation was consequent to SIRT3 activation, we used mouse
`embryonic fibroblasts (MEFs) established from SIRT3 KO mice.
`The absence of SIRT3 was reflected by the higher basal acetyla-
`tion of SOD2 (Figure 2F).
`Importantly, NR was unable to
`/
`MEFs (Fig-
`decrease the acetylation status of SOD2 in SIRT3
`ure 2F), even though NAD+ levels increased to similar levels as in
`SIRT3+/+ MEFs (Figure 2G). These results clearly indicate that NR
`triggers SIRT3 activity, probably by increasing mitochondrial
`NAD+ levels, inducing the concomitant deacetylation of its mito-
`chondrial targets. Strikingly, not all sirtuins were affected by NR,
`as the acetylation of tubulin, a target of the cytoplasmic SIRT2
`(North et al., 2003), was not altered (data not shown).
`
`NR Supplementation Enhances Energy Expenditure
`Given the promising role of sirtuins to protect against metabolic
`disease, we next evaluated the effects of long-term NR adminis-
`tration in vivo. We fed 10-week-old male C57Bl/6J mice with
`either chow diet (CD) or high-fat diet (HFD), supplemented or
`not with NR at 400 mg/kg/day. While NR had no effect on the
`body weight (BW) on CD, HFD-induced BW gain was signifi-
`cantly attenuated by NR (Figure 3A), due to reduced fat mass
`(Figure 3B). This was visibly translated into a significant lower
`weight of the epididymal depot in NR-fed mice (Figure S2A).
`Importantly, this was not due to redistribution of lipids to other
`tissues (Figure S2A), most notably to liver, which actually con-
`tained 40% less triglycerides (Figure S2B).
`The reduced BW gain of NR-fed mice upon HFD was not due
`to reduced food intake, as NR-fed mice actually had a tendency
`to eat more, especially on HFD conditions (Figure 3C). Similarly,
`NR did not affect the activity pattern of mice (Figure 3D), indi-
`cating that the lower BW on HFD was not consequent to different
`physical activity. Rather, the phenotype was due to enhanced
`energy expenditure (EE). Mice on CD had a marked tendency
`to display higher O2 consumption rates when fed with NR, and
`this tendency became clearly significant under HFD conditions
`(Figure 3E). Of note, NR-fed mice became more flexible in their
`use of energy substrates, as reflected in the higher amplitude
`of the changes in RER between feeding and fasting periods (Fig-
`ure S2C) in CD conditions. Altogether, these results indicate that
`NR lowers HFD-induced BW gain by enhancing EE.
`From a metabolic perspective, NR- and vehicle-fed mice had
`similar fasting blood glucose levels in either CD or HFD condi-
`tions (Figure 3F). However, fasting insulin levels were much lower
`in NR-supplemented mice (Figure 3G). This lower insulin/glucose
`ratio is indicative of insulin sensitization after NR administration.
`This speculation was further supported by glucose tolerance
`tests. NR promoted a slight, albeit not significant, improvement
`in glucose tolerance (Figure 3H) in mice fed a HFD, accompanied
`by a robust reduction in insulin secretion (Figure 3I). Therefore,
`NR-fed mice on HFD display a better glucose disposal with lower
`insulin levels. In order to conclusively establish whether NR
`fed mice were more insulin sensitive, we performed insulin toler-
`ance tests and hyperinsulinemic-euglycemic clamps on CD and
`CD-NR mice. We chose not to perform this analysis on the HFD
`groups in order to avoid the possible influence of differential BW.
`Glucose disposal upon insulin delivery was largely enhanced in
`NR-fed mice (Figure 3J). In agreement, mice supplemented
`with NR required an almost 2-fold higher glucose infusion rate
`
`Elysium Health Exhibit 1018
`Page 3 of 10
`
`

`

`Cell Metabolism
`NR Increases NAD+ and Prevents Metabolic Disorders
`
`Vehicle
`
`NR
`
`*
`
`*
`
`*
`
`C
`
`NAD+ content
`
`(mmol / kg prot)
`
`*
`
`*
`
`1
`
`0,5
`
`0
`
`3
`
`2
`
`1
`
`0
`
`(arbitrary units)
`
`mRNA levels
`
`A
`
`IP: FOXO1
`
`B
`
`IB: Ac-Lys
`
`IB: FOXO1
`
`IB (SN):SIRT1
`
`IB (SN): Tubulin
`
`NR (mM)
`
` 0 0.2 0.5 0 0.2 0.5
`
`Scramble
`
`SIRT1
`
`siRNA
`
`siRNA
`
`FOXO1 siRNA
`
`- - + + - - - - + + - - - - + + - - - - + + - -
`
`SIRT1 siRNA
`
`- - - - + + - - - - + + - - - - + + - - - - + +
`
`FOXO1
`
`SIRT1
`
`UCP2
`
`SOD2
`
`D
`
`E
`
`F
`
`G
`
`NAD+ content
`
`(mmol / kg prot)
`
`*
`
`*
`
`1
`
`0,5
`
`0
`
`IP: Ndufa9
`
`IB: Ac-Lys
`
`IB: Ac-Lys
`
`IP: SOD2
`
`IP: SOD2
`
`Veh NR
`
`Veh NR
`
`MEF SIRT3 +/+ MEF SIRT3 -/-
`
`IB: SOD2
`
`IB: SOD2
`
`Veh NR
`
`*
`
`SIRT3
`
`Porin
`
`1,5
`
`1
`
`0,5
`
`0
`
`(relative to Veh)
`
`SOD2 activity
`
`Veh NR
`
`IB: Ac-Lys
`
`IB: Ndufa9
`
`Figure 2. Nicotinamide Riboside Supplementation Increases Sirtuin Activity in Cultured Mammalian Cells
`(A) HEK293T cells were transfected with a pool of either scramble siRNAs or SIRT1 siRNAs. After 24 hr, cells were treated with vehicle (PBS) or NR at the
`concentrations indicated, and, after an additional 24 hr, total protein extracts were obtained. FOXO1 acetylation was tested after FOXO1 immunoprecipitation (IP)
`from 500 mg of protein, while tubulin and SIRT1 levels were evaluated in the supernatant of the IP.
`(B) HEK293T cells were transfected with a pool of either scramble siRNAs, FOXO1 siRNAs, or SIRT1 siRNAs. After 24 hr, cells were treated with NR (0.5 mM; black
`bars) or vehicle (PBS; white bars) for an additional 24 hr. Then total mRNA was extracted and the mRNA expression levels of the markers indicated were evaluated
`by qRT-PCR.
`(C) HEK293T cells were transfected with a pool of either scramble siRNAs, FOXO1 siRNAs, or SIRT1 siRNAs. After 24 hr, cells were treated with NR (0.5 mM; black
`bars) or vehicle (PBS; white bars) for an additional 24 hr. Then acidic extracts were obtained to measure intracellular NAD+ levels.
`(D and E) HEK293T cells were treated with NR (0.5 mM) or vehicle (PBS) for 24 hr and total protein extracts were obtained to measure (D) Ndufa9 or (E) SOD2
`acetylation after IP. The extracts were also used to measure SOD2 activity (E, bottom panel).
`/
`(F and G) SIRT3+/+ and SIRT3
`mouse embryonic fibroblasts (MEFs) were treated with NR (0.5 mM) or vehicle (PBS) for 24 hr, and either (F) total extracts to test
`SOD2 acetylation were obtained or (G) acidic extracts were used to measure intracellular NAD+ content. Throughout the figure, all values are presented as
`mean ±SD. Asterisk indicates statistical significant difference versus respective vehicle group at p < 0.05. Unless otherwise stated, the vehicle groups are
`represented by white bars, and NR groups are represented by black bars. This figure is complemented by Figure S1.
`
`to maintain euglycemia in hyperinsulinemic-euglycemic clamps
`(Figure 3K). Together, these observations unequivocally demon-
`strate that NR-fed mice are more insulin sensitive. Furthermore,
`NR partially prevented the increase in total (Figure 3K) and LDL
`cholesterol levels (Figure S2D) induced by HFD, even though
`HDL-cholesterol
`levels were unaffected (Figure S2E). The
`amelioration of cholesterol profiles is fully in line with previous
`observations from the use of other NAD+ precursors, such as
`NA (Houtkooper et al., 2010).
`
`NR Enhances the Oxidative Performance of Skeletal
`Muscle and Brown Adipose Tissue
`NR-fed mice had a clear tendency to display a better endurance
`performance than vehicle-fed mice (Figure S3A). This tendency
`
`was significantly accentuated upon HFD (Figure 4A), suggesting
`an enhanced muscle oxidative performance. Similarly, NR-fed
`mice, both on CD and HFD, showed enhanced thermogenic
`capacity, as manifested in the ability to maintain body tempera-
`ture during cold exposure (Figure S3B and Figure 4B). The latter
`observation hints toward an improvement in brown adipose
`tissue (BAT) oxidative performance. To gain further insight into
`the ability of BAT and muscle to enhance their oxidative perfor-
`mance, we performed some histological analysis. Gastrocne-
`mius muscles from NR mice displayed a more intense SDH
`staining than gastrocnemius muscles from their vehicle-fed
`littermates, indicating a higher oxidative profile (data not shown).
`Electron microscopy revealed that mitochondria in BAT of
`NR-fed mice, despite not being significantly larger, had more
`
`Cell Metabolism 15, 838–847, June 6, 2012 ª2012 Elsevier Inc. 841
`
`Elysium Health Exhibit 1018
`Page 4 of 10
`
`

`

`Cell Metabolism
`NR Increases NAD+ and Prevents Metabolic Disorders
`
`B
`
`C
`
`D
`
`F
`
`G
`
`H
`
`J
`
`K
`
`L
`
`A
`
`E
`
`I
`
`Figure 3. NR Supplementation Prevents Diet-Induced Obesity by Enhancing Energy Expenditure and Reduces Cholesterol Levels
`Ten-week-old C57Bl/6J mice were fed with either chow diet (CD) or high-fat diet (HFD) mixed with either water (as vehicle) or NR (400 mg/kg/day) (n = 10 mice
`per group).
`(A) Body weight evolution was monitored for 12 weeks.
`(B) Body composition was evaluated after 8 weeks of diet through Echo-MRI.
`(C–E) Food intake, activity, and VO2 were evaluated using indirect calorimetry.
`(F and G) Blood glucose and insulin levels were measured in animals fed with their respective diets for 16 weeks after a 6 hr fast.
`(H and I) After 10 weeks on their respective diets (CD, squares; HFD, circles), an intraperitoneal glucose tolerance test was performed in mice that were fasted
`overnight. At the indicated times, blood samples were obtained to evaluate either (H) glucose or (I) insulin levels. Areas under the curve are shown at the top right
`of the respective panels.
`(J) Insulin tolerance tests were performed on either CD or CD-NR mice (4 weeks of treatment). At the indicated times, blood samples were obtained to evaluate
`blood glucose levels. The area above the curve is shown at the top right of the panel.
`(K) Hyperinsulinemic-euglycemic clamps were performed on either CD or CD-NR mice (4 weeks of treatment). Glucose infusion rates (GIR) were calculated after
`the test.
`(L) Serum levels of total cholesterol were measured in animals fed with their respective diets for 16 weeks, after a 6 hr fast. Throughout the figure, white represents
`the vehicle group, and black represents the NR-supplemented mice. All values are presented as mean ±SD. Asterisk indicates statistical significant difference
`versus respective vehicle-treated group. This figure is complemented by Figure S2.
`
`abundant cristae (Figure 4C), which has been linked to
`increased respiratory capacity (Mannella, 2006). Altogether,
`the above results suggest that NR-supplemented mice display
`a higher oxidative capacity due to enhanced mitochondrial
`function.
`
`Chronic NR Feeding Increases NAD+ In Vivo in a Tissue-
`Specific Manner
`We next wondered how chronic NR feeding would affect NAD+
`metabolism in mice. Chronic NR supplementation increased
`NAD+ levels in both CD (Figure S4A) and HFD (Figure 5A) condi-
`tions in some tissues, including liver and muscle, but not in
`others, such as brain or white adipose tissue (WAT). Interest-
`
`842 Cell Metabolism 15, 838–847, June 6, 2012 ª2012 Elsevier Inc.
`
`ingly, NAD+ was also higher in the BAT of NR-fed mice, but
`only on HFD (Figure 5B and Figure S4A). These differences could
`be due to the differential expression of NRKs in tissues. NRKs
`initiate NR metabolism into NAD+ (Houtkooper et al., 2010).
`There are two mammalian NRKs: NRK1 and NRK2 (Bieganowski
`and Brenner, 2004). While we found Nrk1 expressed ubiquitously
`(Figure S4B), Nrk2 was mainly present in cardiac and skeletal
`muscle tissues, as previously described (Li et al., 1999), but
`also detectable in BAT and liver (Figure S4C), in line with the
`better ability of these tissues to respond to NR.
`We also tested whether the increase in NAD+ would be
`concomitant to changes in other NAD+ metabolites. Strikingly,
`NADH and nicotinamide (NAM) levels were largely diminished
`
`Elysium Health Exhibit 1018
`Page 5 of 10
`
`

`

`Cell Metabolism
`NR Increases NAD+ and Prevents Metabolic Disorders
`
`that NAD+ salvage pathways do not explain the differences in
`NAD+ levels. We furthermore could not detect differences in
`mRNA expression of the different NMN adenylyltransferase
`(NMNAT) enzymes (Figure 5D). Altogether, these results rein-
`force the notion that the higher NAD+ levels observed in tissues
`from NR-fed mice are consequent to an increase in direct NAD+
`synthesis from NR.
`
`*
`
`*
`
`20
`
`15
`
`10
`
`5
`
`0
`
`AOC (a.u.)
`
`*
`
`NR Enhances Sirtuin Activity In Vivo
`Higher NAD+ levels were also accompanied by higher sirtuin
`activity in vivo. A prominent deacetylation of SIRT1 and
`SIRT3 targets (FOXO1, Brunet et al., 2004; and SOD2 Qiu
`et al., 2010, respectively) was observed in the skeletal muscle,
`liver, and BAT, where NAD+ content was induced by NR, but
`not in brain and WAT, where NAD+ levels were unaffected by
`NR supplementation (Figure 6A and Figure S5A). We also eval-
`uated PGC-1a acetylation as a second readout of SIRT1
`activity (Rodgers et al., 2005). We were unable to detect
`PGC-1a in total
`lysates from WAT or brain (Figure S5B), but
`liver, and BAT, PGC-1a was deacetylated upon
`in muscle,
`NR treatment (Figure S5C). These observations highlight how
`NR can only induce sirtuin activity in tissues where NAD+ accu-
`mulates. Like in cultured cells, we could not detect changes in
`the acetylation status of the SIRT2 target tubulin (data not
`shown), suggesting either that increasing NAD+ might not affect
`the activity of all sirtuins equally, that the increase is only
`compartment specific, or that additional regulatory elements,
`like class I and II HDACs, also contribute to tubulin acetylation
`status.
`In line with the changes in acetylation levels of PGC-1a, a
`key transcriptional regulator of mitochondrial biogenesis, we
`could observe either an elevated expression or a strong
`tendency toward an increase (p < 0.1) of nuclear genes encoding
`transcriptional
`regulators of oxidative metabolism (Sirt1,
`Ppargc1a, mitochondrial transcription factor A [Tfam]) and mito-
`chondrial proteins (Mitofusin 2 [Mfn2], cytochrome c [Cycs],
`medium-chain acyl-coA dehydrogenase [Acadm], carnitine
`palmitoyltransferase-1b [Cpt1b], citrate synthase [Cs], or ATP
`synthase lipid binding protein [Atp5g1]) in quadriceps muscles
`from NR-fed mice (Figure 6B). Conversely,
`in brain, where
`NAD+ and sirtuin activity levels were not affected by NR feeding,
`the expression of these genes was not altered (Figure 6B).
`Consistently also with enhanced mitochondrial biogenesis,
`mitochondrial DNA content was increased in muscle, but not in
`brain from NR-fed mice (Figure 6C). Finally, mitochondrial
`protein content also confirmed that mitochondrial function was
`only enhanced in tissues in which NAD+ content was increased
`(Figure 6D and Figure S5D). This way, while muscle, liver, and
`BAT showed a prominent increase in mitochondrial proteins
`(complex V—ATP synthase subunit a and porin), such change
`was not observed in brain or WAT. Altogether, these results
`suggest that NR feeding increases mitochondrial biogenesis in
`a tissue-specific manner, consistent with the tissue-specific
`nature of the increases in NAD+ and sirtuin activity observed in
`NR-fed mice. The higher number of mitochondria, together
`with the different morphological mitochondrial profiles found in
`NR-fed mice (Figure 4C), would contribute to explain the higher
`oxidative profile, EE, and protection against metabolic damage
`observed upon NR feeding.
`
`Cell Metabolism 15, 838–847, June 6, 2012 ª2012 Elsevier Inc. 843
`
`0
`
`1
`
`2
`
`3
`
`4
`
`5
`
`Time at 4ºC (hours)
`
`*
`
`2
`
`1,5
`
`1
`
`0,5
`
`0
`
`7
`
`6
`
`5
`
`4
`
`3
`
`2
`
`1
`
`0
`
`(relative to vehicle group)
`
`(relative to vehicle group)
`
`Mitochondrial size
`
`Cristae content
`
`38
`
`37
`
`36
`
`35
`
`34
`
`33
`
`B
`
`Body temperature ºC
`
`*
`
`A
`
`1000
`
`800
`
`600
`
`400
`
`200
`
`0
`
`Distance run (m)
`
`C
`
`Veh
`
`NR
`
`Figure 4. NR Enhances Skeletal Muscle and BAT Oxidative Function
`Ten-week-old C57Bl/6J mice were fed a high-fat diet (HFD) mixed with either
`water (as vehicle; white bars and circles) or NR (400 mg/kg/day; black bars and
`circles) (n = 10 mice per group).
`(A) An endurance exercise test was performed using a treadmill in mice fed
`with either HFD or HFD-NR for 12 weeks.
`(B) A cold test was performed in mice fed with either HFD or HFD-NR for
`9 weeks. The area over the curve (AOC) is shown on the top right of the graph.
`(C) Electron microscopy of the BAT was used to analyze mitochondrial content
`and morphology. The size and cristae content of mitochondria were quantified
`as specified in the Experimental Procedures. Throughout the figure, all values
`are shown as mean ±SD. Asterisk indicates statistical significant difference
`versus vehicle-supplemented group at p < 0.05. This figure is complemented
`by Figure S3.
`
`in muscles from NR-fed mice (Figure 5B), indicating that NR
`specifically increases NAD+, but not necessarily other byprod-
`ucts of NAD+ metabolism. We analyzed in vivo whether the
`activity of major NAD+-degrading enzymes or the levels of
`Nampt could also contribute to the increase in NAD+ after
`chronic NR supplementation. As previously observed in
`HEK293T cells (Figures 1G and 1H), PARP-1 levels and global
`PARylation were similar in muscle (Figure 5C) and livers (Fig-
`ure S4D) from NR- and vehicle-fed mice, indicating that the
`enhanced NAD+ content cannot be explained by differential
`NAD+ consumption through PARP activity. Nampt mRNA (Fig-
`ure 5D) and protein (Figure 5C, Figure S4E, and data not shown)
`levels were also similar in NR- and vehicle-fed mice, suggesting
`
`Elysium Health Exhibit 1018
`Page 6 of 10
`
`

`

`Cell Metabolism
`NR Increases NAD+ and Prevents Metabolic Disorders
`
`Figure 5. Chronic NR Supplementation Increases
`Plasma and Intracellular NAD+ Content
`in
`a Tissue-Specific Manner
`Tissues from C57Bl/6J mice were collected after 16 weeks
`of HFD supplemented with either water (as vehicle; white
`bars) or NR (400 mg/kg/day; black bars).
`(A) NAD+ levels were measured in acidic extracts obtained
`from different tissues.
`(B) NADH and NAM levels were measured in gastrocne-
`mius muscle.
`(C) Quadriceps muscle protein homogenates were ob-
`tained to test global PARylation, PARP-1, and Nampt
`protein levels.
`(D) Total mRNA was isolated from quadriceps muscles,
`and the mRNA levels of the markers indicated were
`measured by RT-qPCR. Throughout the figure, all values
`are expressed as mean ±SD. Asterisk indicates statistical
`significant difference versus respective vehicle-treated
`group.
`
`*
`
`*
`
`0,3
`
`0,2
`
`0,1
`
`0
`
`(mmol / kg tissue)
`
`B
`
`*
`
`*
`
`*
`
`Brain
`
`Muscle
`
`Liver
`
`BAT
`
`WAT
`
`NADH
`
`NAM
`
`Nampt NMNAT-1 NMNAT-2 NMNAT-3
`
`D
`
`2
`
`1,5
`
`1
`
`0,5
`
`0
`
`(relative to Vehicle)
`
` mRNA levels
`
`0,5
`
`0,4
`
`0,3
`
`0,2
`
`0,1
`
`0
`
`(mmol / kg tissue)
`
`A
`
` content
`
`+
`
`NAD
`
`C
`
`PAR
`
`PARP-1
`
`Nampt
`
` Vehicle NR
`
`DISCUSSION
`
`While increased NAD+ levels in response to NR supplementation
`were already reported in yeast (Belenky et al., 2007; Bieganow-
`ski and Brenner, 2004) and cultured human cells (Yang et al.,
`2007b), we extend these observations to a wide range of
`mammalian cell lines and demonstrate that NR supplementation
`also enhances NAD+ bioavailability in mammalian tissues. Also,
`our work provides evidence that the increase in NAD+ after NR
`administration stimulates the activity of mammalian sirtuins.
`This further supports the role of sirtuins as a family of proteins
`whose basal activity can be largely modulated by NAD+ avail-
`ability (Houtkooper et al., 2010).
`The fact that the activity of both SIRT1 and SIRT3 is positively
`regulated by NR both in vitro and in vivo favors the hypothesis
`that the increase in NAD+ promote

This document is available on Docket Alarm but you must sign up to view it.


Or .

Accessing this document will incur an additional charge of $.

After purchase, you can access this document again without charge.

Accept $ Charge
throbber

Still Working On It

This document is taking longer than usual to download. This can happen if we need to contact the court directly to obtain the document and their servers are running slowly.

Give it another minute or two to complete, and then try the refresh button.

throbber

A few More Minutes ... Still Working

It can take up to 5 minutes for us to download a document if the court servers are running slowly.

Thank you for your continued patience.

This document could not be displayed.

We could not find this document within its docket. Please go back to the docket page and check the link. If that does not work, go back to the docket and refresh it to pull the newest information.

Your account does not support viewing this document.

You need a Paid Account to view this document. Click here to change your account type.

Your account does not support viewing this document.

Set your membership status to view this document.

With a Docket Alarm membership, you'll get a whole lot more, including:

  • Up-to-date information for this case.
  • Email alerts whenever there is an update.
  • Full text search for other cases.
  • Get email alerts whenever a new case matches your search.

Become a Member

One Moment Please

The filing “” is large (MB) and is being downloaded.

Please refresh this page in a few minutes to see if the filing has been downloaded. The filing will also be emailed to you when the download completes.

Your document is on its way!

If you do not receive the document in five minutes, contact support at support@docketalarm.com.

Sealed Document

We are unable to display this document, it may be under a court ordered seal.

If you have proper credentials to access the file, you may proceed directly to the court's system using your government issued username and password.


Access Government Site

We are redirecting you
to a mobile optimized page.





Document Unreadable or Corrupt

Refresh this Document
Go to the Docket

We are unable to display this document.

Refresh this Document
Go to the Docket