• mitochondrial myopathy;
  • NAD+;
  • nicotinamide riboside;
  • treatment;
  • unfolded protein response


Nutrient availability is the major regulator of life and reproduction, and a complex cellular signaling network has evolved to adapt organisms to fasting. These sensor pathways monitor cellular energy metabolism, especially mitochondrial ATP production and NAD+/NADH ratio, as major signals for nutritional state. We hypothesized that these signals would be modified by mitochondrial respiratory chain disease, because of inefficient NADH utilization and ATP production. Oral administration of nicotinamide riboside (NR), a vitamin B3 and NAD+ precursor, was previously shown to boost NAD+ levels in mice and to induce mitochondrial biogenesis. Here, we treated mitochondrial myopathy mice with NR. This vitamin effectively delayed early- and late-stage disease progression, by robustly inducing mitochondrial biogenesis in skeletal muscle and brown adipose tissue, preventing mitochondrial ultrastructure abnormalities and mtDNA deletion formation. NR further stimulated mitochondrial unfolded protein response, suggesting its protective role in mitochondrial disease. These results indicate that NR and strategies boosting NAD+ levels are a promising treatment strategy for mitochondrial myopathy.


Thumbnail image of graphical abstract

Nicotinamide riboside (vitamin B3) delays the progression of mitochondrial myopathy by preventing pathology-associated mitochondrial ultrastructure, improving mitochondrial DNA stability and further stimulating mitochondrial unfolded protein response.

  • Nicotinamide riboside, vitamin B3, delays the progression of mitochondrial myopathy.
  • Nicotinamide riboside cures pathology-associated mitochondrial ultrastructure.
  • Nicotinamide riboside improves mitochondrial DNA stability.
  • Mitochondrial disease induces mitochondrial unfolded protein response, further enhanced by nicotinamide riboside.
  • Nicotinamide riboside is a promising treatment for adult-onset mitochondrial myopathy.