Vitamin B₃ modulates mitochondrial vulnerability and prevents glaucoma in aged mice

Glaucomas are neurodegenerative diseases that cause vision loss, especially in the elderly. The mechanisms initiating glaucoma and driving neuronal vulnerability during normal aging are unknown. Studying glaucoma-prone mice, we show that mitochondrial abnormalities are an early driver of neuronal dysfunction, occurring before detectable degeneration. Retinal levels of nicotinamide adenine dinucleotide (NAD⁺, a key molecule in energy and redox metabolism) decrease with age and render aging neurons vulnerable to disease-related insults. Oral administration of the NAD⁺ precursor nicotinamide (vitamin B₃), and/or gene therapy (driving expression of Nmnat1, a key NAD⁺-producing enzyme), was protective both prophylactically and as an intervention. At the highest dose tested, 93% of eyes did not develop glaucoma. This supports therapeutic use of vitamin B₃ in glaucoma and potentially other age-related neurodegenerations.