Abstract
IntroductionWe previously found decreased levels of Coenzyme Q10 (CoQ10) in patients with septic shock. The objective of the current study was to assess whether the provision of exogenous ubiquinol (the reduced form of CoQ10) could increase plasma CoQ10 levels and improve mitochondrial function.MethodsWe performed a randomized, double-blind, pilot trial at a single, tertiary care hospital. Adults (age ≥18 years) with severe sepsis or septic shock between November 2012 and January 2014 were included. Patients received 200 mg enteral ubiquinol or placebo twice a day for up to seven days. Blood draws were obtained at baseline (0 h), 12, 24, 48, and 72 h. The primary outcome of the study was change in plasma CoQ10 parameters (total CoQ10 levels, CoQ10 levels relative to cholesterol levels, and levels of oxidized and reduced CoQ10). Secondary outcomes included assessment of: 1) vascular endothelial biomarkers, 2) inflammatory biomarkers, 3) biomarkers related to mitochondrial injury including cytochrome c levels, and 4) clinical outcomes. CoQ10 levels and biomarkers were compared between groups using repeated measures models.ResultsWe enrolled 38 patients: 19 in the CoQ10 group and 19 in the placebo group. The mean patient age was 62 ± 16 years and 47 % were female. Baseline characteristics and CoQ10 levels were similar for both groups. There was a significant increase in total CoQ10 levels, CoQ10 levels relative to cholesterol levels, and levels of oxidized and reduced CoQ10 in the ubiquinol group compared to the placebo group. We found no difference between the two groups in any of the secondary outcomes.ConclusionsIn this pilot trial we showed that plasma CoQ10 levels could be increased in patients with severe sepsis or septic shock, with the administration of oral ubiquinol. Further research is needed to address whether ubiquinol administration can result in improved clinical outcomes in this patient population.Trial registrationClinicaltrials.gov identifier NCT01948063. Registered on 18 February 2013.
Highlights
We previously found decreased levels of Coenzyme Q10 (CoQ10) in patients with septic shock
We found that levels of CoQ10 were inversely associated with levels of vascular cell adhesion molecule 1 (VCAM-1) and the antiinflammatory cytokine interleukin-10 (IL-10), suggesting that CoQ10 may play a role in vascular endothelial dysfunction and the inflammatory response seen in severe sepsis and septic shock [10]
We have shown that ubiquinol is absorbed in patients with severe sepsis and septic shock
Summary
We previously found decreased levels of Coenzyme Q10 (CoQ10) in patients with septic shock. Severe sepsis and septic shock continue to be leading causes of morbidity and mortality despite widespread implementation of strategies focused on early antibiotic administration and aggressive resuscitation [1]. CoQ10 plays an essential role in the electron transport chain as the carrier of electrons from complex I and II to complex III. Disruption of this mechanism can compromise oxidative phosphorylation, thereby leading to decreased levels of cellular energy (adenosine triphosphate (ATP)) production [9]
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