Use of 1-MNA to Improve Exercise Tolerance and Fatigue in Patients after COVID-19

Abstract

COVID-19 is not only a short-term infection, as patients (pts) recovering from SARS-CoV-2 infection complain of persisting symptoms, which may lead to chronic fatigue syndrome. There is currently no evidence that nutritional supplements can assist in the recovery of pts with chronic fatigue syndrome. 1-Methylnicotinamide (1-MNA) is an endogenic substance that is produced in the liver when nicotinic acid is metabolized. 1-MNA demonstrates anti-inflammatory and anti-thrombotic properties. Therefore, we investigated whether 1-MNA supplements could improve exercise tolerance and decrease fatigue among patients recovering from SARS-CoV-2. Methods: The study population was composed of 50 pts who had recovered from symptomatic COVID-19. The selected pts were randomized into two groups: Gr 1 (NO-1-MNA)—without supplementation; Gr 2 (1-MNA) with 1-MNA supplementation. At the beginning of the study (Phase 0), in both groups, a 6-minute walk test (6MWT) was carried out and fatigue assessment was performed using the Fatigue Severity Scale (FSS). Both FSS and 6MWT were repeated after 1 month. Results: A significant improvement in the mean distance covered in the 6MWT was noted at follow-up in Gr 1-MNA, compared with Gr NO-1-MNA. We also noted that in Gr 1-MNA, the 6MWT distance was significantly higher after 1 month of supplementation with 1-MNA, compared with the beginning of the study (515.18 m in Phase 0 vs. 557.8 m in Phase 1; p = 0.000034). In Gr 1-MNA, significantly more pts improved their distance in the 6MWT (23 out of 25 pts, equal to 92%), by a mean of 47 m, compared with Gr NO-1-MNA (15 of 25 pts, equal to 60%) (p = 0.0061). After one month, significantly more patients in the group without 1-MNA had severe fatigue (FSS ≥ 4) compared with the group with supplementation (Gr 1-MNA = 5 pts (20%) vs. Gr NO-1-MNA = 14pts (56%); p = 0.008). Conclusions: 1-MNA supplementation significantly improved physical performance in a 6-min walk test and reduced the percentage of patients with severe fatigue after COVID-19. The comprehensive action of 1-MNA, including anti-inflammatory and anticoagulant effects, may be beneficial for the recovery of patients with persistent symptoms of fatigue and low tolerance to exercise after COVID-19.

Chronic Fatigue Associated with Post-COVID Syndrome versus Transient Fatigue Caused by High-Intensity Exercise: Are They Comparable in Terms of Vascular Effects?

“…They can also be used to identify potential treatments to improve exercise tolerance and fatigue in patients after COVID-19, as is being demonstrated by one of the co-authors. 28 …”

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

“…As mentioned above, vitamin C [ 994 ] is to be recommended only if one is sure that free or poorly liganded iron is absent. Niacin (vitamin B 3 ) may also be of value in a tapered-up strategy, since NAD+ levels are known to be lowered in COVID-19 [ 995 ] and other viral infections [ 996 ]; its metabolite 1-methylnicotinamide has also shown promise in Long COVID [ 997 ].…”

Fatigue outcomes following COVID-19: a systematic review and meta-analysis

“…69 70 Exercise impairments are a common feature of post-COVID-19 sequelae. [71][72][73][74][75][76][77] Poorer performance on the 6 min walk test (6MWT) was associated with fatigue and lower vitality at 6 months despite no concomitant impairments in pulmonary functions. 78 Indeed, impairments in lung functions have not thus far fully explained worse fatigue in COVID-19.…”

“…Being over 50 years was associated with fatigue severity in some studies,52 67 68 but not in others 69 70. Exercise impairments are a common feature of post-COVID-19 sequelae 71–77. Poorer performance on the 6 min walk test (6MWT) was associated with fatigue and lower vitality at 6 months despite no concomitant impairments in pulmonary functions 78.…”