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Review
. 2025 Nov 10;14(22):7954.
doi: 10.3390/jcm14227954.

Nicotinamide and Pyruvate as Potential Therapeutic Interventions for Metabolic Dysfunction in Primary Open-Angle Glaucoma-A Narrative Review

Nathan Schanzer  1 , Alon Harris  1 , Kunal Kanwar  2 , Rick Mortensen  1 , Alice Verticchio Vercellin  1 , Francesco Oddone  3 , Carmela Carnevale  3 , Keren Wood  1 , Brent Siesky  1
Affiliations
Review

Nicotinamide and Pyruvate as Potential Therapeutic Interventions for Metabolic Dysfunction in Primary Open-Angle Glaucoma-A Narrative Review

Nathan Schanzer et al. J Clin Med. .

Abstract

Mitochondrial dysfunction and oxidative stress have been suggested as potential contributors to the initiation and progression of primary open-angle glaucoma (POAG). Nicotinamide and pyruvate are important in the human body for maintaining metabolic function and preserving cytoskeletal structures. Both substances show an age-dependent decline in humans which may contribute to metabolic dysfunction and POAG vulnerability. Pilot works suggest their consumption may help prevent retinal ganglion cell deterioration under elevated intraocular pressure (IOP) and oxidative stress. Currently, there are no approved POAG treatments to mitigate risks from non-IOP drivers of disease, including oxidative stress. The purpose of this review is to summarize and critically evaluate interventional studies that have investigated nicotinamide and pyruvate supplementation in attempts to treat metabolic dysfunction in POAG patients. A review of the relevant literature from October 1979 to November 2025 was performed using related search terminologies through PubMed, ClinicalTrials.gov, and Google Scholar, and by reference cross-matching of all related articles. Current pilot data suggests that supplementation with nicotinamide and pyruvate demonstrates certain aspects of retinal neuroprotection and produces short-term improvements in visual function. However, much of the existing work has been conducted in animal models, and human study data are severely limited in scope and duration. Several clinical trials are registered as being in progress that aim to determine the chronic effects of nicotinamide and pyruvate in humans. Long-term longitudinal investigations with significantly larger and diverse sample sizes tied to functional and structural outcomes are needed for the safety and potential clinical utility of nicotinamide and pyruvate for POAG.

Keywords: glaucoma; metabolism; mitochondria; nicotinamide; pyruvate.

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Conflict of interest statement

The authors declare no conflicts of interest. Professor Alon Harris would like to disclose that he received remuneration from AdOM, Qlaris, and Cipla for serving as a consultant, and he serves on the boards of AdOM, Qlaris, and SlitLed. Professor Alon Harris holds an ownership interest in AdOM, Oxymap, Qlaris, SlitLed, and AEYE Health. Alice Verticchio Vercellin is an external collaborator of the IRCCS Fondazione Bietti, Rome. If you have questions regarding paid relationships that your physician/researcher may have with the industry, you are encouraged to talk with your physician/researcher or check for industry relationships posted on individual faculty pages on our website at http://icahn.mssm.edu/.

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