Abstract 12508: Nicotinamide Restores Tissue NAD + and Improves Mouse Survival After Cardiac Arrest

Abstract

Introduction: Metabolic suppression in the ischemic heart is characterized by NAD + depletion. How nicotinamide (NAM) supplementation affects NAD + repletion and cardiac arrest outcomes is unknown. Hypothesis: We hypothesized that NAM supplementation restores tissue NAD + and promotes glucose oxidation and sorbitol clearance, resulting in improved cardiac function and survival in a mouse model of cardiac arrest. Methods: Adult C57BL6 mice were subjected to an established KCL-induced 8 min cardiac arrest, randomly assigned to receive saline (NS) or 100 mg/kg NAM during cardiopulmonary resuscitation (CPR). Survival, MAP, ETCO 2, and ECG were monitored for 4 h after the return of spontaneous circulation (ROSC). Direct cardiac effects were assessed using a cardiomyocyte stunning model and an isolated rat heart Langendroff model to measure the contraction recovery and cardiac function, respectively. NAD + , lactate and ATP were measured by assay kits and AMPK phosphorylation was measured by Western blot. Results: Cardiomyocyte NAD + content decreased from 4.51 ± 0.03 nMol/g pre-ischemia to 2.69 ± 0.42 nMol/g at the end of ischemia. Treatment with 0.01 mM NAM completely restored the cellular level of NAD + and improved contractile recovery by 10 min reperfusion (58.1 ± 7.3% of baseline contractile velocity vs.18.5 ± 3.7% in control cells). NAM administered immediately after ROSC significantly improved mouse survival, with 10/10 survival at 4 h as compared to 5/10 in the NS group. NAM-treated mice displayed improved NAD + content in hearts obtained at 4 h post-ROSC compared to saline treated hearts (4.5 ± 0.1 nMol/g vs. 2.4 ± 0.1 nMol/g). NAM significantly reduced sorbitol accumulation in heart from saline control of 20.4 ± 2.7 μMol/g to 7.2 ± 1.5 μMol/g at 30 min post-ROSC, indicating less glucose shunting to polyol pathway. Cardiac contractile function was completely recovered with 1 mM NAM treatment in the isolated perfused rat heart. Compared with buffer control, NAM treatment increased heart content of NAD + , lactate, ATP and phosphorylated AMPK. Conclusion: NAM is efficacious for restoring cardiac NAD + and promotes metabolic and contractile recovery, with improved survival of cardiac arrest.