A study protocol to investigate if acipimox improves muscle function and sarcopenia: an open-label, uncontrolled, before-and-after experimental medicine feasibility study in community-dwelling older adults

• Published in: BMJ open 2024-02, Vol.14 (2), p.e076518-e076518
• Main Authors: McDonald, Claire, Alderson, Craig, Birkbeck, Matthew G, Brown, Laura, Del Din, Silvia, Gorman, Grainne G, Hollingsworth, Kieren, Massarella, Clare, Rehman, Rana, Rochester, Lynn, Sayer, Avan AP, Su, Huizhong, Tuppen, Helen, Warren, Charlotte, Witham, Miles D
• Format: Article
• Language: English
• Subjects: Aged; Aging; Aspirin; Biopsy; Clinical Trial; Contraindications; Feasibility Studies; Frailty; Geriatric Medicine; Hand Strength; Humans; Independent Living; Intervention; Medicine; Muscle function; Muscle strength; Muscle, Skeletal; Musculoskeletal system; NAD; Neuromuscular disease; Older people; Phosphorylation; Pyrazines; Sarcopenia; Sarcopenia - drug therapy
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-076518

IntroductionSarcopenia is the age-associated loss of muscle mass and strength. Nicotinamide adenine dinucleotide (NAD) plays a central role in both mitochondrial function and cellular ageing processes implicated in sarcopenia. NAD concentrations are low in older people with sarcopenia, and increasing skeletal muscle NAD concentrations may offer a novel therapy for this condition. Acipimox is a licensed lipid-lowering agent known to act as an NAD precursor. This open-label, uncontrolled, before-and-after proof-of-concept experimental medicine study will test whether daily supplementation with acipimox improves skeletal muscle NAD concentrations.Methods and analysisSixteen participants aged 65 and over with probable sarcopenia will receive acipimox 250 mg and aspirin 75 mg orally daily for 4 weeks, with the frequency of acipimox administration being dependent on renal function. Muscle biopsy of the vastus lateralis and MRI scanning of the lower leg will be performed at baseline before starting acipimox and after 3 weeks of treatment. Adverse events will be recorded for the duration of the trial. The primary outcome, analysed in a per-protocol population, is the change in skeletal muscle NAD concentration between baseline and follow-up. Secondary outcomes include changes in phosphocreatine recovery rate by 31P magnetic resonance spectroscopy, changes in physical performance and daily activity (handgrip strength, 4 m walk and 7-day accelerometry), changes in skeletal muscle mitochondrial respiratory function, changes in skeletal muscle mitochondrial DNA copy number and changes in NAD concentrations in whole blood as a putative biomarker for future participant selection.Ethics and disseminationThe trial is approved by the UK Medicines and Healthcare Products Regulatory Agency (EuDRACT 2021-000993-28) and UK Health Research Authority and Northeast – Tyne and Wear South Research Ethics Committee (IRAS 293565). Results will be made available to participants, their families, patients with sarcopenia, the public, regional and national clinical teams, and the international scientific community.ProtocolAcipimox feasibility study Clinical Trial Protocol V.2 2/11/21.Trial registration numberThe ISRCTN trial database (ISRCTN87404878).