Nicotinamide Riboside (NR) for Stage IV Cancer
Also known as: NR, Niagen, TruNiagen
NAD+ metabolism is altered in cancer, and NR's effects on tumor biology require careful consideration of pro- vs anti-tumor potential.
Mechanism of Action
Elevated NAD+ activates sirtuins which may suppress tumor growth through metabolic regulation. However, cancer cells also require NAD+ for proliferation (NAMPT overexpression). NR may benefit by enhancing anti-tumor immune cell metabolism and protecting normal tissue from treatment toxicity.
General mechanism: NAD+ precursor via NR kinase pathway. SIRT1/3 activator, mitochondrial biogenesis enhancer, PARP1 substrate, DNA repair support.
Current Evidence
Preclinical data mixed — NAD+ augmentation may benefit or harm depending on tumor type and context. Protective effects on chemotherapy-induced toxicity better established.
Clinical Status: Context-dependent effects. More useful for treatment toxicity reduction than direct anti-tumor therapy.
Safety Profile
Very safe at 300-1000mg/day. Mild GI effects. Well-tolerated in clinical trials. No significant drug interactions.
Key Research Questions
- In which cancer contexts does NAD+ augmentation help vs harm?
- Can NR protect normal tissue during chemotherapy without feeding tumor growth?