is a gene which controls the production of the enzyme NAD(P)H dehydrogenase, quinone 1. The above diagram shows some
of the many functions of the NQO1 pathway. We can see that there are three
major pillars of health that NQO1 directly influences. These pillars include
detoxification which entails the ratio of NAD to NADH, its ability as an
antioxidant, and lastly how it helps to stabilize the P-53 gene. Detoxification
and antioxidant activity go hand and hand. They are intertwined with each
other. Each of these pillars have extreme importance for our health and
detoxification pillar is a very important aspect of NQO1 functions. Much of the
detoxification deals with compounds called Quinones. Quinonoid compounds
generate reactive oxygen species (ROS). Quinones are ubiquitous in nature and
constitute an important class of naturally occurring compounds found in plants,
fungi and bacteria. Human exposure to quinones therefore occurs via the diet,
but also clinically or via airborne pollutants. For example, the quinones of
hydrocarbons are prevalent as environmental contaminants and provide a major
source of current human exposure to quinones. The inevitable human exposure to
quinones, and the inherent reactivity of quinones, has stimulated substantial
research on the chemistry and toxicology of these compounds. NQO1 is employed
in the removal of a quinone from biological systems as a detoxification
reaction: NAD(P)H + a quinone → NAD(P)+ + a hydroquinone.
The hydroquinone is excreted. This reaction ensures complete oxidation of the
substrate without the formation of semiquinones and reactive oxygen radicals
that are deleterious to cells. The localization of NQO1 in epithelial and
endothelial tissues of mice, rats and humans indicates their importance as
detoxifying agents, since their location facilitates exposure to compounds
entering the body. In addition to the detoxification, NQO1 helps produce NAD+
which in its own right is very important.
ratio of NAD+/NADH is of extreme importance. We are well aware of
the importance of NAD+ for our body. NAD+ is instrumental
in the production of ATP which is the body’s energy currency. However, NAD+
is also used in a variety of biological processes in the body. Nicotinamide
adenine dinucleotide (NAD+) is an essential pyridine nucleotide that
serves as an essential cofactor and substrate for a number of critical cellular
processes involved in oxidative phosphorylation and ATP production, DNA repair,
epigenetically modulated gene expression, intracellular calcium signaling, and
immunological functions. NAD+depletion
may occur in response to excessive DNA damage due to free radicals. This damage
results in significant poly (ADP-ribose) polymerase (PARP) activation and a
high turnover and subsequent depletion of NAD+. PARP is instrumental
in DNA repair. Also, chronic immune activation and inflammatory cytokine
production results in accelerated CD38 activity and subsequent decline in NAD+ levels.
now think that the NAD+/NADH ratio may be as important if not more
important than the levels of NAD+. One of the insights arising from
the scientific studies of calorie restriction is that the ratio of NAD+ to
NADH (NAD+/NADH ratio) might be important for the lifespan extension
benefits. This ratio has been reported to decline with age, with NAD+ being
decreased and NADH increased in older individuals. While boosting the amount
of NAD+ has been getting a lot of attention, improving the
ratio between NAD+ and NADH might be more significant than the
amount of cellular NAD+ in isolation. In yeast experiments,
calorie restriction decreases NADH much more dramatically than it affects NAD+.
This decrease in NADH is important for enhancing lifespan, because, on its own,
it increases activity of the NAD+ consuming enzymes that boost
longevity processes (e.g., Sirtuins) and DNA repair (e.g. PARPs) in yeast. This
is thought to occur because NADH is an inhibitor of these enzymes, so lowering
it releases the inhibition. As an example, inducing the enzyme NQO1—an enzyme
that uses NADH as an electron donor increases intracellular NAD+ levels
because it shifts the NAD+/NADH redox ratio in favor of oxidation
(NAD+). A side effect of this reaction is that intracellular NAD+
levels increase. Upregulation of the pathway that induces NQO1 occurs in
calorie restriction and appears to be an important component of producing the benefits.
We must remember that cellular levels of NAD+ are more important
than the serum levels.
review, what NQO1 does is convert NADH to NAD+ while at the same
time it maintains a very delicate ratio of NAD/NADH. This ratio is not affected
by dietary or IV intake. One important fact is that NQO1 will oxidize NADH to
NAD+ and thus it increases NAD+ in the cell.
HOW IS THE NQO1 PATHWAY REGULATED?
Another name for the NQO1 gene is the longevity
gene. NQO1, regulates the NAD+/NADH
ratio in cells. NQO1 does this by oxidizing NADH to NAD+.
During aging the ratio of NAD+ to NADH changes in part to a reduced
level of the expression of NQO1. As we age the cells accumulate a type of
protein called BET proteins. The BET proteins are Bromodomain and Extraterminal
Proteins. They are referred to as epigenetic readers. The following diagram
shows the various components involved in epigenetics, namely the writers,
erasers, and readers all of which effect gene behavior.
this case, the BET proteins will suppress the induction of the NQO1 gene. There
is now much research looking for inhibitors of BET proteins for a variety of
conditions including cancer.
levels of NQO1 will affect the amounts of a compound called Peroxisome
proliferator-activated receptor-gamma coactivator (PGC-1alpha). PGC-1a is a
member of a family of transcription coactivators that plays a central role in
the regulation of cellular energy metabolism. It is strongly induced by cold
exposure, linking this environmental stimulus to adaptive thermogenesis.
PGC-1alpha stimulates mitochondrial biogenesis and promotes the remodeling of
muscle tissue to a fiber-type composition that is metabolically more oxidative
and less glycolytic in nature, and it participates in the regulation of both
carbohydrate and lipid metabolism. Oxidative metabolism produces far more ATP
than the glycolytic type. It is highly likely that PGC-1alpha is intimately
involved in disorders such as obesity, diabetes, and cardiomyopathy. In
particular, its regulatory function in lipid metabolism makes it an inviting
target for pharmacological intervention in the treatment of obesity and Type 2
is regulated by the oxidative state of the cell. NQO1 will regulate the PGC-1a
levels by controlling the rate of PGC-1a degradation not its synthesis. Like many
regulatory factors, PGC-1a has an extremely short half-life. All of these
extremely short-lived proteins are regulated by degradation rates, not
synthesis rates. Higher levels of NQO1 shift the ratio of NAD+/NADH
and protect proteins from being oxidized. PGC-1 plays an important role in
regulating mitochondrial function. Higher levels of PGC-1a help prevent age
related mitochondrial dysfunction. Thus,
it appears that under conditions of oxidative stress, such as with aging,
NQO1 may be a major factor that controls the concentration of
PGC-1a in the cell. PGC-1a is not some esoteric co factor, it is
extremely important in many different functions as can be seen from the
following diagram. PGC-1α is a transcriptional coactivator that is a central
inducer of mitochondrial biogenesis in cells.
Thus, it appears that under conditions of oxidative
stress, such as with aging, NQO1 may be a major factor that controls
the concentration of PGC-1a in the cell.
ELSE DOES NQO1 STIMULATE?
seems to have a significant effect on the P-53 gene. It helps to stabilize the
P-53 gene. P-53 is many times referred to an the “Tumor Suppressor Gene”. It is
a potent sentinel in the body looking for and destroying cells which may go on
to tumor lines. It has the ability to fix DNA damage if it is not too severe or
if too severe it will destroy the cell. The following diagram shows P-53 in
is now thought that many cancers arise from a defect in the P-53 gene. It
appears that the NQO1-dependent (ubiquitin-independent) pathway is the most
important pathway for regulating p53 levels within the cell. Ubiquitin is a
small protein that is found in almost all cellular tissues in humans and other
organisms. It helps to regulate the processes of other proteins in the body.
Through a process known as ubiquitination or ubiquitylation, a ubiquitin
molecule can bind to a substrate protein, changing the way it functions. This
can lead to a number of different outcomes. It is most widely recognized for
its role in apoptosis of proteins, earning it the title of the molecular “kiss
of death” for proteins, although it also plays a major part in several other
cellular processes related to the regulation of proteins. If P-53 is working
properly hopefully the chances of a cancer arising are significantly
diminished. Treatment with curcumin augments the levels of P53 in tumor cell
lines through incrementing its half-life in a NQO1 dependent manner. Curcumin
treatment promotes the interaction between NQO1-p53.
CAN WE INCREASE THE PRESENCE OF NQO1?
statement that can be made across the board is that anything which increases
the NRf2 pathway will increase the NQO1 gene action. The NRf2 pathway has a
profound effect on the NQO1 gene. One can read my previous blogs concerning the
NRf2 pathway. I call this pathway the thermostat of anti-inflammation. One of
the important stimulators of the NRf2 pathway are ozone messengers which are
produced by intravenous ozone such as is delivered by the EBO2 protocol. These
messengers will allow the NRf2 to enter the nucleus and activate certain genes.
Another offshoot of the EBO2 protocol is the use of photodynamic therapy which
stimulated the NQO1 gene. Phototherapy also includes the stimulation of heat
shock proteins which are encouraged by the exposure of UVA light.
for those people unaware of the EBO2 protocol, it is a protocol which uses a
dialysis filter, intravenous Ozone gas, and photo modulation. The following is
a picture of the set up used in the EBO2 protocol:
compounds which seem to have stimulating influences on NQO1 include
resveratrol, Pterostilbene, Taxifolin (also called dihydroquercetin), sulforaphane (broccoli), curcumin, and
Fumaric acid derivatives.
important supplement perhaps the most important, to stimulate the NQO1 gene is Beta-lapachone, a compound found in
the bark of the South American Lapacho tree. It is a potent activator of the NQO1
gene and produces ROS in cancer cells, but reduces ROS in non-cancer
cells. Beta-Lapachone is a NQO1
activator. In addition to stimulating the NQO1 gene it stimulates the NRf2
pathway which helps to lower inflammation. Beta-lapacho was very popular a
number of years ago. It then seemed to lose it way. Now there is a resurgence
in the use of Beta-lapachone on multiple fronts including clinical studies in a
variety of universities. A few final thoughts, if a clinic is utilizing NAD+
but not stimulating the NQO1 pathway then they are behind the times. There are
a number of clinics which like to dabble in utilizing NAD on their patients. Unfortunately,
they are not aware of the basic science of NAD, its effect on senescent cells,
methods allowing the body to handle NAD better, and the importance of the NQO1
gene. If you encounter a clinic which is “just” utilizing NAD without
addressing these related matters, your best bet is to seek treatment
elsewhere!! This will ensure you the best chance of success. It is all a matter
of knowing the basic science of the various pathways and how these can be
manipulated to the benefit of the patient.
following illustration gives all the salient points about the NQO1 gene. There
is a reason why this is called the Longevity Gene. The answers lie in the
illustration. When all is said and done this seems to represent the essence of
At one time it was thought that there was little if any relationship between Senescent Cells and NAD supplements. We now know that this is far from the truth. Remember that the senescent cells are cells that should have died but continue to survive. By surviving they cause a multitude of problems. Senescent cells are believed to contribute to numerous age-associated diseases. Senescent cells are becoming a hot topic in the field of Regenerative Medicine. We now know they may be responsible for many of the failures in cellular therapy. Senescent cells are believed to contribute to numerous age-associated diseases. By the same token we now know that NAD, the supplement, is extremely important in general well-being and success in cellular therapy. Below we see diagrams concerning Senescent cells. The two above diagrams represent the essence of Senescent cells (Please see some of my previous blogs concerning Senescent cells).Unfortunately, many of the effects of the Senescent cells are found in the dark side of the first diagram. The elimination of Senescent cells by senolytic regimens (programs designed to kill senescent cells) appears to help in numerous aging-associated diseases including atherosclerosis, pulmonary problems, diabetes, neurological problems, cancer and osteoarthritis. Senescent cells secrete pro-inflammatory factors which are called Senescence-Associated Secretory Phenotype (SASP). These are essentially the “bad growth factors”. By the mechanism of the inflammatory growth factors, the Senescent cells are believed to contribute to numerous age-associated diseases. The second diagram shows the causes of cell senescence. These causes of cell senescence are essentially the causes of aging. We can see that the causes are multiple. The causes involve the usual suspects including DNA damage, mitochondrial damage, damage to the ends of the DNA called the telomeres, and finally what we call epigenetic factors.Epigenetic factors have far reaching effects. They involve changes to gene expression that our cells experience as we get older. These are commonly called epigenetic alterations. The following diagram demonstrates these facts.There are many factors that can affect the genes. The diagram shows some of the examples. These genetic alterations harm the fundamental functions of our cells and can increase the risk of cancer and other age-related diseases. The DNA is affected by the inflammatory cytokines secreted by the Senescent cells. These secretions are modifying gene expression in a cell, suppressing or enhancing the expression of certain genes in a cell as the situation demands. The genes which are turned on the cell can either be a friend or a foe. It can help prevent a cancer or help cause it. Here are two recent articles from two reliable sources concerning senolytic agents. As you can see Senescent cells are not some esoteric idea. They are becoming mainstream medicine. We are acutely aware of the importance of senolytic agents for overall health. They seem to be very important in NAD therapy also. Here are the articles: There is one other article which I will share with you which is more scientific discussing the Senescent cell problem.So, the real question is what do Senescent cells and NAD have to do with each other? Furthermore, are their paths on a collision course?Now I would like to discuss the collision course that NAD and Senescent cells are on. Recently I read a scientific article that was quite fascinating and thought provoking. The article discussed the ramifications of taking NAD+ supplements and their effect on Senescent cells. Let us do a quick review of NAD. NAD+ is a potent stimulator of the SIRT-1 gene pathway. This pathway is thought to be one of the major anti-aging pathways. This is the pathway that many people are familiar with by the effects of the compound Resveratrol which is found in red wine. Other methods of stimulating this pathway include calorie restriction, intermittent fasting, keto diet, high intensity exercise training, and perhaps most importantly NAD. When all is said and done the Sirtuin pathway stimulates the production and efficiency of the mitochondria which provide the cells with energy. Typically, the more mitochondria the healthier the cell and for that matter the healthier the person.From the point of view of anti-aging, NAD has tremendous potential. However, it seems that NAD may act as a double edge sword as we get older. There is no doubt that we become deficient in NAD as we age. The reason for this is multifocal. One important reason is that certain enzymes in our body become large consumers of NAD. Some of these enzymes are involved in the process of repairing DNA damage. If there is not enough NAD to go around than the NAD gets shuffled to the cells where it is an absolute necessity or the cells die. However, the consuming enzymes continue to try to utilize NAD but they will unfortunately not be able to accomplish DNA repair. If we are able to consume adequate amounts of NAD these enzymes get turned back on and do their important repair work. We are able to increase the amount of NAD available to the body by a variety of methods. One of the secret weapons we utilize is an NAD kinase patch. The NAD kinase patch contains an enzyme, NAD kinase, and penetrating molecules. This combination will dramatically increase the amount of NAD that enters the cell. As we age, we become deficient in the NAD kinase enzyme. This enzyme is the cutting edge of the cutting-edge technology especially when it pertains to NAD administration. It allows greater amounts of NAD to enter the cell. So far all seem good except for one detail. Both myself and my wife take NAD on a daily basis. We occasionally use the Kinase patches. We are doing this to hopefully “slow down” our aging. On the surface this makes perfect sense, yet some of the newest thinking demonstrates some potential problems when dealing with NAD administration. There is no doubt that I have Senescent cells in my body (recently I did a once a week x 2 regimen of Senolytic agents which has had some surprising beneficial effects). In the article I was referring to, on one hand it stated that the NAD+ levels decrease as we age leading to degenerative conditions. While at the same time, the number of senescent cells will increase with aging. The article states that decreased NAD+ levels that are associated with aging may actually decrease the effects of the senescent cells on the body. Conversely increasing NAD+ levels by supplementation either orally or intravenously or both methods may benefit tissue homeostasis, but also may worsen SASP and make the make the Senescent cells more aggressively inflammatory. This is certainly not a good thing. TAKEN TOGETHER THESE FINDINGS SUGGEST A FUNDAMENTAL TRADE-OFF IN TREATING AGING RELATED DISEASES WITH DRUGS OR SUPPLEMENTS THAT INCREASE NAD+. So, the bottom line is that we are increasing NAD levels which is a good thing but at the same time we are also making the Senescent cells increase the secretion of the inflammatory growth factors which is a bad thing.Another concern is a report that senescent cells can induce a cell surface protein called CD-38 on macrophages (a type of white blood cell in the immune system) and endothelial cells (Endothelium refers to cells that line the interior surface of blood vessels and lymphatic vessels, forming an interface between circulating blood or lymph in the lumen and the rest of the vessel wall). CD-38 is a molecule important for many different cellular processes, including calcium signaling, which regulates basic cell functions. CD-38 is the main enzyme involved in the degradation of the NAD precursor nicotinamide mononucleotide (NMN) in vivo, CD-38 has a key role in the modulation of NAD-replacement therapy for aging and metabolic diseases. However, too much CD-38 is a sign of inflammation. Research has linked overexpression of CD-38 to obesity, cancer, and infectious diseases, like HIV. Both the decline in NAD+ and the presence of Senescent cells are hallmarks of aging. We are aware that a supplement called Apigenin seems to help block the effects of CD-38. (Apigenin is found in many fruits and vegetables, but parsley, celery, celeriac, and chamomile tea. Apigenin is particularly abundant in the flowers of chamomile plants). Apigenin may eventually be part of a regimen when administering NAD.Until recently, it was unclear exactly how rising CD-38, declining NAD+, and the presence of senescent cells were all related. Scientists also know that the presence of CD-38 levels increase with age, and that CD-38 is involved in lowering NAD+ levels. It is a major consumer of NAD. In turn increased CD-38 expression is believed to be the key modulator of lowered NAD+ levels with aging in mammals. CD-38 is intimately related to our immune system but unfortunately not in a good way. In the following diagram, we see that the inflammatory growth factors from Senescent cells have a direct effect on what is called an M-1 macrophage. This is a type of white blood cell which is many times associated with inflammation in the body. Not a big problem when we are dealing with bacteria but not good for anti-aging.The accumulation of Senescent cells may itself be an important safeguard causing decreased NAD+ levels which in turn could promote a multitude of problems. On the other hand, the lower NAD+ levels may diminish the influence of Senescent cells which is the safeguard. What the scientists found was two-fold: First, they observed that inducing senescence did not lead the senescent cells themselves to produce more CD38. But, the senescent cells did, as expected, begin secreting a cascade of inflammatory chemicals that in turn, up-regulated CD38 in surrounding non-senescent cells. In other words, they infected normal cells much like a zombie infects normal people. Interestingly, they found that different inflammatory factors did not individually increase CD-38, but when combined led to a strong increase in CD-38 activity. In the end, the scientists observed this affect in all the types of cells tested. We are aware that Quercetin and Apigenin are two supplements that can diminish CD-38 effects. These also act as senolytic agents. As a matter of fact, Quercetin is found as a senolytic agent in many University studies. In these studies, Quercetin is combined with Dasatinib to act as a super senolytic agent. Dasatinib is a Leukemia medication that is being used “off-label”. Because the dosages are extremely small the side effects are minimal. The elimination of most senescent cells by senolysis (the killing of senescent cells) before initiating NAD+ therapies may be beneficial and increase safety. There is the possibility that it may eventually allow for need for little IV therapy and mainly rely on oral medication. I think to treat the patient with some form of senolytic agent prior to NAD therapy may possibly the new standard of care for patients receiving NAD therapy. Unless we address the Senescent cell/CD-38 problem, trying to raise NAD+ levels with precursors may come with too many downsides, preventing us from both having our cake and eating it too. So, what is the real bottom line? We strongly feel that Senolytic agents are imperative when using NAD+ intravenously or orally. Actually, I think they have a place in almost everyone. We want to diminish Senescent cells and their inflammatory growth factors and at the same time increase cellular NAD levels. Luckily, we have been aware of the Senescent cell problem some time now. We have been treating our patients with a number of different senolytic agents for some time. Some of these have included a P-53 patch, certain supplements such as Quercetin, even utilizing Quercetin and Dasatinib together. We have worked out very specific regimens for this. If a physician is not taking steps to deal with Senescent cells his overall chance of success will be much lower in Regenerative procedures and overall patient health. Furthermore, there is the possibility that the patient’s overall health may take a turn for the worse in the long run by increasing the effects of the senescent cells. Here is the bottom line from an article I read “reducing the senescent cell burden in persons around age 60 and middle-aged obese individuals may become a critical step in restoring youthful NAD+ cellular levels in a way that maximizes benefit.Younger, non-obese individuals may not have a significant senescent cell burden and thus may not need aggressive senolytic therapy before contemplating NAD+ restoration”. These are excellent recommendations. IF A PHYSICIAN WHO IS ADMINISTERING NAD+ IS NOT ADDRESSING THE SENESCENT CELLS PROBLEM THAN I SUGGEST THE PATIENT SEEK TREATMENT ELSEWHERE. YOUR HEALTH IS AT STAKE!!!Thanks,Dr. P
Once in a while I like to write a blog that is not all science! I must say that I was initially a bit intimated by my schedule.I left Miami on Thursday evening, arriving in Sao Paulo 8 hours later on Friday morning.Interestingly, there were a number people that I knew at the meeting. I have taught in Brazil on numerous occasions. I will return in October to teach a course. I received a warm Brazilian welcome. I was very impressed by the quality of the meeting and the speakers. I felt honored to be one of the Keynote speakers.My talk was an interesting one. I discussed Stem Cell Aging Pathways. As I have said “how Stem cells age is how we age”. In my journey thru the world of Regenerative Medicine I have become convinced that these pathways may be the Holy Grail for Anti-Aging methods. These pathways are what I call the upstream causes of aging. If we correct these problems in the pathways we will affect downstream problems. One pathway I stressed was the Sirtuin Gene pathway. I discussed its dependence upon the supplement NAD and other methods of stimulating this pathway. I mentioned our experiences with Intravenous NAD and one of our secrete weapons which is the NAD kinase patch. I received a number of questions from the audience. One exciting aspect of the talk involved the introduction of some brand-new technology. Actually, I have used this technology for years. This technology involves transdermal patches which introduce signaling molecules to spine, tendons and joints. These are called P3 AI and P3 R patches. The name for this technology is SIGMOLECS. This will be a quantum leap for many regenerative physicians. They now have technology that we have utilized for years. These patches are now registered with the FDA. Below is a picture of the packaging of the patches.I suspect this will become an integral aspect of most regenerative procedures. Signaling molecules tell cells what to do and when to do it. This is essentially the basis of a PRP preparation and a branch of medicine called Cytokine Therapy.This technology seemed to be well received by the audience. Unfortunately, my time in Sao Paulo was very limited and later that afternoon I found myself in another 2-hour traffic jam on my way back to the airport facing my second night in a row on an airplane.After a 12-hour plane ride I arrived in Beverly Hills California where the Cell Surgical International Conference was being held.My lecture this time concerned the nuts and bolts of Regenerative Medicine as it pertains to stem cells. I stressed the basic science but put a twist on it to show how if one knows the basic science he then has the intellectual tools to make procedures better. This is the essence of a new field of medicine called Translational Medicine. Translational Medicine is a rapidly growing discipline in biomedical research and aims to expedite the discovery of new diagnostic tools and treatments by using a multi-disciplinary, highly collaborative, “bench-to-bedside” approach. The lecture was a whirlwind of slides. I showed how the immune system and the stem cells are so intimately related. Hopefully I opened up a few eyes on these topics. There were many different topics covered in the meeting all of which were engrossing. Some of the topics covered musculoskeletal conditions while other dealt with neurological conditions.One of my friends, Dr. Nathan Bryant, who is a world leading expert in Nitric Oxide medicine gave a great slide that reminds me of my journey in Regenerative Medicine. It is as follows“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” – Arthur Schopenhauer I always learn something from a meeting that I lecture at. At this meeting I met many old friends and some new ones.My staff from the Cayman Islands attended the meeting:All-in-all, it was a hectic weekend but it was rewarding on many different levels. I enjoy teaching and the comradery of the meetings.BTW people are asking me if I had Jet Lag. The answer is a resounding, “no.” By using my laser watch, jet lag is never an issue for me. The laser wrist watch helps my body produce various compounds which helps my body fight jet lag.Thanks, – Dr. P