Overview
Background
Psoriasis causes chronic inflammation in the body. Researchers want to see if a kind of vitamin B3 dietary supplement can help. This might lead to more treatment options.
ObjectiveTo test if the dietary supplement nicotinamide riboside can improve immune system function in the blood and skin of people with mild to moderate psoriasis.
EligibilityPeople ages 18-70 with mild to moderate active psoriasis not currently treated with biological therapy
DesignParticipations will be screened with:
- Medical and medication history
- Physical exam
- Measure of body mass index
- Skin exam
- Blood and urine tests
Participants will have visit 1. They will have repeats of the screening tests. They will also have 2 skin biopsies. These will be from both lesions and unaffected areas. The areas will be injected with a numbing medicine. A round cutting device will remove small pieces of skin from each area.
Participants will take the study supplement or a placebo starting at the first visit. Neither participants nor the study team will know which they receive. Participants will take capsules twice daily for a total of 4 weeks.
Participants will then have visit 2. This will include the tests performed at visit 1.
Participants may by contacted by phone or email between visits to see how they are doing.
If participants develop any side effects in the 7 days after they stop taking the capsules, they may have another visit.
Description
Study Description:
Psoriasis is a Th17 linked inflammatory disease and we find that the vitamin B3 analogue nicotinamide riboside (NR) blunts Th1 and Th17 activation in ex-vivo na(SqrRoot) ve and differentiated T cells from control and psoriasis subjects. These findings supported the proposal of the following hypothesis. Supplementation with NR will blunt systemic immune activation in mild/moderate psoriasis.
Objectives- Evaluate the effect of NR on Th17 biology
- Explore the effect of NR on neutrophils, specifically lowdensity granulocytes
- Evaluate whether NR modulates keratinocyte activation in skin lesions in psoriatic subjects
- Evaluate the effect of NR on HDL regulated reverse cholesterol transport and lipid composition
The primary outcome will be the change in the TH17 cell cytokine IL-17 secretion in response to T-cell differentiation comparing the baseline versus NR or placebo. The comparisons will be performed using paired two-tailed Student t-tests. Significance will be tested at
the 0.05 alpha level in this pilot study.
Secondary outcomes are:
- Evaluate the effect of NR on the T cell transcriptome
- Explore the effect of NR on low-density granulocytes and neutrophils
- Evaluate whether NR modulates keratinocyte activation in skin lesions in psoriatic subjects
- Evaluate the effect of NR on HDL regulated reverse cholesterol transport and lipid composition by NMR spectroscopy
Study Population:
Up to 40 male and female subjects of all races between the ages of 18-70 years with mild-moderate psoriasis who live locally will be screened.
PhaseN/A
Description of Sites/Facilities:
Enrollment and study visits will take place at the NIH Clinical Center.
Enrolling Participants:
Psoriatic Subjects
Description of Study Intervention:
Nicotinamide Riboside Chloride 500mg or placebo twice daily by mouth for 28 days.
Study Duration:
3 years
Participant Duration:
5-7 weeks
Eligibility
- INCLUSION CRITERIA:
Individuals must meet all inclusion criteria listed below in order to be eligible to participate in the study.
- Males and females between the ages of 18 and 70 with mild to moderate active psoriasis.
- Female subjects of child-bearing ability willing to commit to reliable contraception while participating in the study.
- Ability to provide informed consent
- Willingness and ability to participate in required study procedures
EXCLUSION CRITERIA:
- Severe psoriasis by PASI (Psoriasis Area and Severity Index) score > 12
- Currently being treated with biologic immune modifying agents.
- Currently on treatment for allergies or other inflammatory diseases.
- Has taken Vitamin B or tryptophan supplementation within 2 weeks of participation.
- Unwillingness/inability to provide informed consent
- ALT > x3 upper limit of normal, hepatic insufficiency or active liver disease
- Recent history of acute gout
- Chronic renal insufficiency with creatinine > 2.5mg/dl
- Pregnant (or attempting to become pregnant) women
- Current participation in another drug study
- History of intolerance to NR precursor compounds, including niacin or nicotinamide
- Study adherence concerns
- Individuals with diabetes type 1 and 2 who use insulin
- Women of child-bearing potential unwilling to use contraception or unwilling to practice abstinence
- Breastfeeding women unwilling to stop breastfeeding