Pharmacological augmentation of nicotinamide phosphoribosyltransferase (NAMPT) protects against paclitaxel-induced peripheral neuropathy

Elife. 2017 Nov 10:6:e29626. doi: 10.7554/eLife.29626.


Chemotherapy-induced peripheral neuropathy (CIPN) arises from collateral damage to peripheral afferent sensory neurons by anticancer pharmacotherapy, leading to debilitating neuropathic pain. No effective treatment for CIPN exists, short of dose-reduction which worsens cancer prognosis. Here, we report that stimulation of nicotinamide phosphoribosyltransferase (NAMPT) produced robust neuroprotection in an aggressive CIPN model utilizing the frontline anticancer drug, paclitaxel (PTX). Daily treatment of rats with the first-in-class NAMPT stimulator, P7C3-A20, prevented behavioral and histologic indicators of peripheral neuropathy, stimulated tissue NAD recovery, improved general health, and abolished attrition produced by a near maximum-tolerated dose of PTX. Inhibition of NAMPT blocked P7C3-A20-mediated neuroprotection, whereas supplementation with the NAMPT substrate, nicotinamide, potentiated a subthreshold dose of P7C3-A20 to full efficacy. Importantly, P7C3-A20 blocked PTX-induced allodynia in tumored mice without reducing antitumoral efficacy. These findings identify enhancement of NAMPT activity as a promising new therapeutic strategy to protect against anticancer drug-induced peripheral neurotoxicity.

Keywords: NAD; NAMPT; cancer biology; chemotherapy; mouse; neuropathy; neuroprotection; neuroscience; neurotoxicity; pain; rat.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Antineoplastic Agents, Phytogenic / adverse effects*
  • Behavior, Animal
  • Carbazoles / administration & dosage*
  • Disease Models, Animal
  • Enzyme Activators / administration & dosage*
  • Histocytochemistry
  • Neuroprotective Agents / administration & dosage*
  • Nicotinamide Phosphoribosyltransferase / metabolism*
  • Paclitaxel / adverse effects*
  • Peripheral Nervous System Diseases / prevention & control*
  • Rats
  • Treatment Outcome


  • Antineoplastic Agents, Phytogenic
  • Carbazoles
  • Enzyme Activators
  • Neuroprotective Agents
  • P7C3 compound
  • Nicotinamide Phosphoribosyltransferase
  • Paclitaxel