In a recent

study, Schiavi et al. [33] found that uremic NaPi2b knockout mice had significantly lower serum phosphate levels and a significant attenuation of elevation of FGF23 levels (relative to uremic wild-type mice). Treating the NaPi2b knockout mice with the phosphate binder sevelamer carbonate further reduced serum phosphate levels. These data suggest that in addition to using dietary phosphorus binders, targeting NaPi2b could also be of value in the modulation of serum phosphate in CKD [33]. Fig. 1 Nicotinamide’s mechanism of action at the brush border membrane of the enterocyte in the intestine. ADP adenosine diphosphate, ATP adenosine triphosphate Thus, NAM click here decreases circulating phosphate levels in a different way to currently marketed orally administered compounds, which bind phosphate in the gastrointestinal tract by forming an insoluble complex or by binding the ion into a resin. Hence, less phosphate is available for absorption by the gastrointestinal tract and more is excreted in the feces. The NAM-mediated modulation of renal and/or intestinal phosphate transport processes constitutes a new LBH589 mw approach for controlling serum phosphate levels. 1.3 Pharmacokinetic Properties In a clinical study, twice-daily oral administration of NAM (total daily dose 25 mg/kg) was associated with a plasma half-life of 3.5 h and a mean peak plasma concentration of 42.1 μg/mL

(0.3 mM) [34]. In pharmacokinetic studies in healthy volunteers, orally ingested NAM doses of 1–6 g were associated with dose-dependent peak plasma concentrations and showed a relative lack of toxicity [35, 36]. 1.3.1 Administration Dietary NAM is readily absorbed

by the stomach and small intestine. The serum NAM concentration peaks 1 h after oral ingestion of a standard preparation [34]. The administration route determines how NAM is metabolized. When NAM is taken orally, it is metabolized Progesterone by the small intestine and liver before being diluted in the systemic circulation. 1.3.2 Metabolism As the main precursor for the formation and maintenance of a cellular pool of NAD, NAM is metabolized in the liver by cytochrome P450 to form nicotinamide-N-oxide (via an oxidative reaction), 6-hydroxy-nicotinamide (via a hydroxylation reaction), and N-methyl-nicotinamide (MNA, through catalysis by nicotinamide-N-methyltransferase). In mammals, MNA is further metabolized to N-methyl-2-pyridone-5-carboxamide (2PY) or N-methyl-4-pyridone-5-carboxamide (4PY) by aldehyde oxidase (Fig. 2). The 2PY/4PY ratio differs as a function of species and gender. In the context of uremia, studies in mice have evidenced the accumulation of plasma 4PY [37]. Although 4PY can be detected in the plasma in humans, the main metabolic product of MNA is 2PY [38]. Rutkowski et al. [37] have shown that the blood 2PY concentration increases as renal function deteriorates.