ACEs, SIRT1, and Premature Vascular Aging in Humans

Nathaniel Jenkins

Status: Enrolling

Conditions: Endothelial Dysfunction; Adverse Childhood Experiences

Treatments: Dietary Supplement: Nicotinamide Riboside; Dietary Supplement: Placebo

Study type: Interventional

Funder types: Other

Identifiers

NCT07073352

202407275

Details and patient eligibility

About

Adverse childhood experiences (ACEs) are directly related to cardiovascular morbidity and mortality, and impaired vascular endothelial function (VEF) is an independent predictor of future cardiovascular disease (CVD) risk [1, 2]. Previous work from our lab (IRB 202010095) and others [3] demonstrates impaired VEF in young adults with prior exposure to ACEs even in the absence of clinical CVD risk factors. Sirtuin 1 (SIRT1) is a class III histone deacetylase (HDAC) that plays a role in regulating vascular homeostasis and reductions in SIRT1 are associated with age-related endothelial dysfunction [4]. We have shown that ACEs-related impairments in VEF are accompanied by reductions in SIRT1 [5]. However, the mechanisms by which ACE exposure promotes VEF remain unknown. The goal of this project is to establish proof of concept that alterations in vascular SIRT1 expression and activity mediate premature vascular aging in individuals with >=4 ACEs compared to those with 0 ACEs and that, because NAD+ is an essential substrate for SIRT1, increasing NAD+ bioavailability will restore VEF in those with >=4 ACEs.

Thus, we will use a robust translational approach coupling in vivo and in vitro measures of endothelial function, inflammation, oxidative stress, and SIRT1 expression and activity in young adults with (n=30-35) versus without (n=30-35) ACE exposure in a cross-sectional study, and during a randomized controlled trial employing a novel 4-week nicotinamide riboside (NR) supplementation approach to increase SIRT1 activity by increasing cellular NAD+ in ACE+ (n=15/group) to accomplish the following specific aims:

1. Determine the mechanisms by which ACE exposure alters the regulation of VEF by SIRT1. We hypothesize that compared to those without ACEs (ACE-), ACE+ will have (H1a) elevated endothelial oxidative stress and inflammation, (H1b) accompanied by reduced endothelial SIRT1 expression and increased p66SHC expression and acetylation of p65 and p53, (H1c) in association with lower VEF.
2. Determine how targeting SIRT1 by increasing NAD+ bioavailability affects VEF in young adults with ACEs. We hypothesize that systemic NR supplementation will (H2a) augment cellular SIRT1 activity and (H2b) improve VEF in ACE+.

[1] Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ace) study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8. [2] Jenkins, N.D.M., & Robinson, A.T. (2022). How do adverse childhood experiences get under the skin to promote cardiovascular disease? A focus on vascular health. Function (Oxf), 3(4), zqac032. PMC9279110. 10.1093/function/zqac032. [3] Rodriguez-Miguelez, P., Looney, J., Blackburn, M., Thomas, J., Pollock, J.S., & Harris, R.A. (2022). The link between childhood adversity and cardiovascular disease risk: Role of cerebral and systemic vasculature. Function. 10.1093/function/zqac029. [4] Thompson, A. M., Wagner, R., & Rzucidlo, E. M. (2014). Age-related loss of SirT1 expression results in dysregulated human vascular smooth muscle cell function. American Journal of Physiology-Heart and Circulatory Physiology, 307(4), H533-H541. [5] Jenkins, N.D.M., Rogers, E.M., Banks, N.F., Tomko, P.M., Sciarrillo, C.M., Emerson, S.R., Taylor, A., & Teague, T.K. (2021). Childhood psychosocial stress is linked with impaired vascular endothelial function, lower sirt1, and oxidative stress in young adulthood. Am J Physiol Heart Circ Physiol, 321(3), H532-H541. PMC8461842. 10.1152/ajpheart.00123.2021

Enrollment: 30 estimated patients

Sex: All

Ages: 18 to 30 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 18 - 30 years
• ACE score of 0 OR ≥4 (Aim 1); ACE score ≥4 (Aim 2)

Exclusion criteria

• Resting arterial blood pressure >140/90 mmHg
• BMI ≥30 kg/m2 and/or weight unstable (>2.27 kg change) last 6 month
• Cardiovascular, metabolic, or pulmonary disease
• Cardiovascular or metabolic prescription drug use
• Vasoactive antidepressant drug use (SSRIs and clonidine)
• Currently pregnant or breastfeeding
• Heavy alcohol consumption (AUDIT screening)
• Use of illicit drugs
• Current tobacco use
• Regular vigorous (>6 MET s) aerobic exercise (>4 bouts/week, >30 min/bout)
• Dietary supplementation with antioxidants or habitual use of NSAIDs

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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30 participants in 2 patient groups, including a placebo group

Nicotinamide Riboside

Experimental group

Description:

4-weeks of twice daily, oral supplementation (2,000 mg/day) of NR (NIAGEN® , ChromaDEX, Irvine, CA).

Treatment:

Dietary Supplement: Nicotinamide Riboside

Placebo

Placebo Comparator group

Description:

Participants randomized to the control group will consume matched placebo capsules containing microcrystalline cellulose.

Treatment:

Dietary Supplement: Placebo