L-carnitine Group Research Articles

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 +/- 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 +/- 16 and 36 +/- 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 +/- 14 vs 14 +/- 5 cmH2O, and 87 +/- 30 vs 34 +/- 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 +/- 0.7 vs 2.3 +/- 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

Results of a single blind, randomized, placebo-controlled clinical trial to study the effect of intravenous L-carnitine supplementation on health-related quality of life in Indian patients on maintenance hemodialysis

Carnitine insufficiency is responsible for various co-morbid conditions in maintenance hemodialysis (MHD) patients. L-carnitine supplementation is expected to improve the quality of life (QoL) of patients on MHD. To study the effect of L-carnitine supplementation on QoL of Indian patients on MHD. This was a single (patient) blind, randomized, placebo-controlled clinical trial conducted on patients on MHD attending hemodialysis unit of the study center. Twenty patients on MHD suffering from hemodialysis-related symptoms were randomly assigned to receive intravenous L-carnitine 20 mg/kg or placebo after every dialysis session for 8 weeks. SF36 (Short Form with 36 questions) score for QoL, laboratory investigations and dialysis related symptoms were recorded at baseline and after 8 weeks. Improvement in QoL, laboratory parameters and dialysis related symptoms in the two groups after 8 weeks was compared. Depending on normality of data, unpaired T test or Mann Whitney U test was used for comparison of change (8 weeks-baseline) in SF36 scores and laboratory parameters observed in the two groups. L-carnitine supplementation increased total SF36 score by 18.29 +/- 12.71 (95% CI: 10.41 to 26) while placebo resulted in reduction in total SF36 score by 6.4 +/- 16.39 (95% CI: -16.59 to 3.73). L-carnitine also resulted in significant increase in hemoglobin and serum albumin and decrease in serum creatinine as compared to placebo. More patients were relieved of dialysis related symptoms in L-carnitine group. Intravenous L-carnitine supplementation improves QoL in patients on MHD.

Effects ofL-carnitine on neutrophil-mediated ischemia–reperfusion injury in rat stomach

Reactive oxygen metabolites play an important role in ischemia-reperfusion related gastric injury. Primary sources of reactive oxygen metabolites seem to be the xanthine/xanthine oxidase system and neutrophils accumulating within the reperfused tissue. Tissue myeloperoxidase activity is an important index of neutrophil accumulation. The purpose of the present study was to clarify the effect of L-carnitine on the accumulation of neutrophils and neutrophil-induced gastric mucosal damage in rats exposed to ischemia-reperfusion. Rats were randomly divided into three groups: sham-operated, ischemia-reperfusion and ischemia-reperfusion plus L-carnitine groups. Ischemia was induced by clamping the celiac artery for 30 min and then reperfusion was established for 60 min. Gastric injury was assessed by measuring myeloperoxidase activity in gastric tissue. The neutrophil accumulation and hemorrhagic lesions due to ischemia-reperfusion in gastric mucosa were ascertained in a histological study. L-Carnitine (100 mg kg(-1)) administrated intravenously 5 min before ischemia significantly reduced both the gastric injury and myeloperoxidase activity compared with the ischemia-reperfusion group. The results suggest that L-carnitine provides marked protection against ischemia-reperfusion-related gastric injury which could be due to its ability to reduce neutrophil accumulation in ischemic tissue.

A Randomised, Controlled Clinical Trial Evaluating Changes in Therapeutic Efficacy and Oxidative Parameters after Treatment with Propionyl L-Carnitine in Patients with Peripheral Arterial Disease Requiring Haemodialysis

We explored the efficacy of intravenous therapy with propionyl L-carnitine in patients with both peripheral arterial disease (PAD) and chronic renal insufficiency requiring haemodialysis. The trial was a randomised, double-blind, placebo-controlled trial. Sixty-four patients on haemodialysis (32 per treatment arm) with chronic renal insufficiency and PAD were assigned to receive either intravenous propionyl L-carnitine 600 mg or placebo 3 times weekly for 12 months. The main outcome measures were the ankle/brachial index (ABI), plasma malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE) concentrations, and the plasma nitrite/nitrate ratio (NO(2)/NO(3)); these were measured at baseline and at 6 and 12 months. Significant increases in ABI were observed in the propionyl L-carnitine group, whereas in the placebo group the reverse trend was seen. In patients treated with propionyl L-carnitine, significant progressive decreases were seen in plasma MDA, 4-HNE and the NO(2)/NO(3) ratio from baseline. In the placebo-treated group, only weakly significant or no differences were seen. Intravenous administration of propionyl L-carnitine to haemodialysis patients with PAD improves both haemodynamic flow and the oxidative profile.

The role of L-carnitine in nutritional status and echocardiographic parameters in idiopathic dilated cardiomyopathy in children

Malnutrition is an independent predictor of death in idiopathic dilated cardiomyopathy. An analysis was performed of the impact of L-carnitine supplementation on the nutritional status and echocardiogram parameters of children with idiopathic dilated cardiomyopathy. This was an open label cohort of 11 patients who received L-carnitine (100 mg/kg/day) plus the conventional medical treatment, compared with 40 controls, matched for gender and age. The L-carnitine group was weighed 118 times and the controls 264 times. Additionally, the L-carnitine group underwent 65 two-dimensional echocardiograms and the controls 144. Chi-square, Student's t test, Person correlation and ANOVA were calculated with alpha = 0.05. For the L-carnitine group: age at presentation = 3.82 years old, 72.7% (p = 0.033) were females younger than 2 years and 90.9% (p = 0.0001) were in functional classes III and IV. There were no deaths during this period. At presentation, no differences were observed in weight percentile (31.2+/-8.74 vs. 19.6+/-21.2) (p = 0.29) or z score (-0.68+/-1.05 vs. -1.16+/-0.89) (p = 0.24). Increases were observed in both the percentile (p = 0.026) and z score (p = 0.033) after the introduction of L-carnitine. At presentation, there were no differences in ejection fraction (54.9%+/-3.8 vs. 49.3%+/-6.6) (p = 0.19), but LV mass/BSA were greater in the L-carnitine group (169.12 g/m2+/-26.24 vs. 110.67 g/m2+/-15.62) (p = 0.0005). After the introduction of L-carnitine an increase in ejection fraction (48.3+/-7 to 67.2+/-7) (p = 0.044) was observed. LV mass/BSA decreased (164.29 g/m2+/-28.14 to 110.88 g/m2+/-28.88), but without significance (p = 0.089) In children with idiopathic dilated cardiomyopathy, supplementation of L-carnitine may be helpful for nutritional and echocardiographic improvement.

O papel da L-carnitina no estado nutricional e na evolução ecocardiográfica da cardiomiopatia dilatada idiopática da infância

OBJECTIVES: Malnutrition is an independent predictor of death in idiopathic dilated cardiomyopathy. An analysis was performed of the impact of L-carnitine supplementation on the nutritional status and echocardiogram parameters of children with idiopathic dilated cardiomyopathy. METHODS: This was an open label cohort of 11 patients who received L-carnitine (100 mg/kg/day) plus the conventional medical treatment, compared with 40 controls, matched for gender and age. The L-carnitine group was weighed 118 times and the controls 264 times. Additionally, the L-carnitine group underwent 65 two-dimensional echocardiograms and the controls 144. Chi-square, Student's t test, Pearson correlation and ANOVA were calculated with alpha = 0.05. RESULTS: For the L-carnitine group: age at presentation = 3.82 years old, 72.7% (p = 0.033) were females younger than 2 years and 90.9% (p = 0.0001) were in functional classes III and IV. There were no deaths during this period. At presentation, no differences were observed in weight percentile (31.2±8.74 vs. 19.6±21.2) (p = 0.29) or z score (-0.68±1.05 vs. -1.16±0.89) (p = 0.24). Increases were observed in both the percentile (p = 0.026) and z score (p = 0.033) after the introduction of L-carnitine. At presentation, there were no differences in ejection fraction (54.9%±3.8 vs. 49.3%±6.6) (p = 0.19), but LV mass/BSA were greater in the L-carnitine group (169.12 g/m2±26.24 vs. 110.67 g/m2±15.62) (p = 0.0005). After the introduction of L-carnitine an increase in ejection fraction (48.3±7 to 67.2±7) (p = 0.044) was observed. LV mass/BSA decreased (164.29g/m2±28.14 to 110.88g/m2±28.88), but without significance (p = 0.089) CONCLUSION: In children with idiopathic dilated cardiomyopathy, supplementation of L-carnitine may be helpful for nutritional and echocardiographic improvement.

Effect of L-carnitine on cardiomyocyte apoptosis and cardiac function in patients undergoing heart valve replacement operation

The effects of L-carnitine, as an ingredient of cardioplegia solution, on cardiac function and cardiomyocyte apoptosis in patients undergoing heart valve replacement operation were investigated. Twenty-three cases undergoing heart valve replacement with cardiopulmonary bypass (CPB) were randomly allocated into two groups: L-carnitine group (n = 12, 12 g/L L-carnitine was put in the ST. Thomas cardioplegia) and control group (n = 11, identical to the L-carnitine group except that normal saline was administered instead of L-carnitine). Serum cardial troponin I (cTnI) levels, the left ventricular ejection fraction (LVEF), and cardiac index (CI) were measured perioperatively. A bit of myocardial tissue obtained from right atria was taken before CPB and by the end of intracardiac procedure to undergo electron microscopy examination and estimate apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL). From the end of CPB to 3 days after operation, the serum levels of cTnI in the L-carnitine group was significantly lower than that in the control group (P < 0.05). Heart color ultrasonogram showed that the CI index and LVEF at 7th day postoperatively in the L-carnitine group were significantly higher than in the control group (P < 0.05). Compared to the control group, L-carnitine significantly alleviated the morphologic changes of cardiac muscle cells (electron microscopy examination) and decreased the amounts of apoptotic cardiac muscle cells (TUNEL). Furthermore, the dosage of vasoactive drugs used after operation was significantly less in the L-carnitine group (P < 0.01). It was concluded that L-carnitine cardioplegia solution could improve cardiac function in patients undergoing heart valve replacement operation and alleviate CPB-mediated apoptosis of cardiac muscle cells.

Effect of L-carnitine on plasma glycemic and lipidemic profile in patients with type II diabetes mellitus

We designed this study to investigate the effects of oral L-carnitine administration on fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and lipid parameters in patients with diabetes mellitus type II. The effect of L-carnitine on FPG and lipid parameters was investigated in 22 male and 13 female type II diabetic patients; the mean age +/- s.d. was 51.3 +/- 3.7 y. The patients were randomly allocated to two groups (L-carnitine and placebo group) and 1 g of L-carnitine or of placebo was given orally three times a day for a period of 12 weeks. FPG in the L-carnitine group decreased significantly from 143 +/- 35 to 130 +/- 33 mg/dl (P = 0.03), and we observed a significant increase of triglycerides (TG) from 196+/-61 to 233+/-12 mg/dl (P = 0.05), of Apo A1 from 94 +/- 20 to 103 +/- 23 mg/dl (P = 0.02), and of Apo B100 from 98 +/- 18 to 108 +/- 22 mg/dl (P = 0.02) after 12 weeks of treatment. There was no significant change in LDL-C, HDL-C, HbA1C, LP(a) or total cholesterol. L-Carnitine significantly lowers FPG but increases fasting triglyceride in type II diabetic patients.

The effect of l-carnitine on plasma lipoprotein(a) levels in hypercholesterolemic patients with type 2 diabetes mellitus

Background: A previous study has demonstrated that l-carnitine reduces plasma lipoprotein(a) (Lp[a]) levels in patients with hypercholesterolemia. Objective: To test a tolerable Lp(a)-reducing agent in diabetic patients, we assessed the effect of a dietary supplementation of l-carnitine on plasma lipid levels, particularly Lp(a), of patients with type 2 diabetes mellitus (DM) and hypercholesterolemia. Methods: In this 6-month, randomized, double-masked, placebo-controlled clinical trial, patients were enrolled, assessed, and followed up at the Diabetic and Metabolic Diseases Center of the Department of Internal Medicine and Therapeutics at the University of Pavia, Pavia, Italy. All study patients had newly diagnosed type 2 DM that was managed through dietary restriction alone throughout the study, as well as hypercholesterolemia. Patients were randomized to 1 of 2 groups. One group received l-carnitine, one 1-g tablet BID. The other group received a corresponding placebo. We assessed body mass index, fasting plasma glucose, postprandial plasma glucose, glycosylated hemoglobin, fasting plasma insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein (apo) A-I, apo B, and Lp(a) at baseline and at 1, 3, and 6 months of treatment. Results: This study included 94 patients. The treatment group included 24 men and 22 women (mean [SD] age, 52 [6] years). The placebo group included 23 men and 25 women (mean [SD] age, 50 [7] years). The baseline characteristics of the groups did not differ significantly. The mean (SD) body weight, height, and body mass index were 78.2 (5.8) kg, 1.70 (0.04) m, and 27.3 (2.5) kg/m 2, respectively, in the l-carnitine group and 77.6 (6.4) kg, 1.71 (0.05) m, and 26.8 (2.2) kg/m 2, respectively, in the placebo group. In the treatment group, Lp(a) was significantly reduced at 3 and 6 months compared with baseline ( P < 0.05) and P < 0.01, respectively). We observed a significant improvement after 6 months ( P < 0.05) in the Lp(a) value in patients taking l-carnitine compared with those taking placebo. Between-group differences in other variables did not reach a level of significance at months 3 and 6. No drug-related adverse events were reported or observed. Conclusion: In this preliminary study, after 3 and 6 months, l-carnitine significantly lowered the plasma Lp(a) level compared with placebo in selected hypercholesterolemic patients with newly diagnosed type 2 DM.

Protection of the Retina from Ischemia-Reperfusion Injury by L-Carnitine in Guinea Pigs

To investigate the efficacy of L-carnitine in preventing retinal injury followed by ischemia-reperfusion. The eyes of 34 guinea pigs were used in this experiment. The guinea pigs were divided into two groups: the first group (n=17) was given L-carnitine intraperitoneally (500 mg/kg) and second group (n=17) received the same dose of saline solution. Under general anesthesia, peritomy was performed. Retro-orbital tissues were ligated for 90 minutes and ischemia was induced, followed by 4 hours of reperfusion. One of the enucleated eye was stained with hematoxylin and eosin (H&E) and retinal thicknesses were evaluated. Thiobarbituric acid reactive substances (TBARS) levels were determined in the retina of the other eye. Mean TBARS levels in retinal tissue were found lower in L-carnitine group (2.77 +/- 0.55 microM) than in the control group (6.57 +/- 1.19 microM), (p<0.01). On the other hand, mean retinal thickness was found to be increased in the control group (47.47 +/- 5.62 microm) when compared to the L-carnitine group (26.52 +/- 4.65 microm), (p<0.01). In correlation analysis, significantly positive relationships were found between retinal TBARS level and retinal thickness both in the control and L-carnitine groups (r=0.981, p<0.01 and r= 0.967, p<0.01 respectively). L-carnitine is effective in preventing retinal injury followed by ischemia-reperfusion.

Protective Effect of Dietary Supplementation with L-Arginine and L-Carnitine on Hypoxia/Reoxygenation-Induced Necrotizing Enterocolitis in Young Mice

Oxygen-derived free radicals are important components of gastrointestinal injury in necrotizing enterocolitis (NEC). In the present investigation, we examined the protective actions of L-arginine, a nitric oxide synthase substrate, and L-carnitine against hypoxia-reoxygenation (H/R) induced NEC in young mice. Young mice were divided into four groups: group 1 mice were subjected to H/R only; group 2 H/R mice were supplemented with L-arginine in the drinking water (2 g/l) for 7 days; group 3 H/R mice were given L-carnitine solution in water (50 mg/kg p.o.) for 7 days, and group 4 mice served as controls.Hypoxia was induced by placing the mice in a 100% CO₂ chamber for 5 min. After hypoxia, the mice were reoxygenated for 10 min with 100% oxygen. We examined the intestinal lesions by light microscopy and measured the intestinal generation of thiobarbituric acid reactive substances (TBARS) and the activities of superoxide dismutase and catalase in the H/R-induced model of NEC. In both L-arginine and L-carnitine groups, the NEC-induced intestinal tissue damage was greatly attenuated, with necrosis limited partially to the mucosa. The tissue TBARS level was significantly higher in group 1 than in any of the other groups (p < 0.001). However, those treated with L-arginine and L-carnitine had TBARS levels similar to those in the control animals. An increased tissue concentration of nitrate, a stable metabolite of nitric oxide, was found in the L-arginine-supplemented group as compared with the control group (p < 0.05). Both superoxide dismutase and catalase activities in the intestine were similar in H/R groups when compared with the intestine of control animals. The present study suggests that oxygen-derived free radicals are involved in the pathogenesis of H/R-induced NEC. This study also shows that dietary supplementation with L-arginine and L-carnitine ameliorates the histological evidence of H/R-induced intestinal injury and significantly decreases lipid peroxidation in H/R-induced bowel injury. Based on these findings, the beneficial effects of L-arginine and L-carnitine in this model may be mediated via mechanisms preventing free radical damage.

Efficacy of L-Carnitine in Reducing Hyperammonaemia and Improving Neuropsychological Test Performance in Patients with Hepatic Cirrhosis

To determine the efficacy of L-carnitine in reducing hyperammonaemia and improving neuropsychological performance in patients with hepatic cirrhosis and subclinical hepatic encephalopathy (SHE). Randomised, parallel group, controlled trial. The study enrolled 31 patients with hepatic cirrhosis resulting from hepatitis C and/or hepatitis B, alcohol abuse and other causes. Patients randomised to active treatment, received oral L-carnitine 6 g/day in two divided doses for 4 weeks. Diagnosis of SHE was based on psychometric tests (subtests of the Wechsler Adult Intelligence Scale-Revised and the Halstead-Reitan Neuropsychological Test Battery) carried out at beginning and end of study. Serum ammonia levels were measured before treatment and weekly thereafter. A total of 27 patients completed the study. Sixteen patients received L-carnitine and 11 served as controls (no treatment). L-carnitine caused rapid and significant reductions in ammonia levels, sustained over the 4-week treatment period (mean reductions 60.1 and 1.4 (μmol/L in the treated and control groups, respectively). Normal ammonia levels were attained in 14 of 16 patients receiving L-carnitine. Based on psychometric test results, seven patients (43.7%) in the L-carnitine group and five (45.5%) in the control group had SHE at baseline. L-carnitine treatment for 4 weeks caused a net overall improvement in psychometric test results compared with controls. No clinically significant adverse events were reported and all patients receiving L-carnitine reported subjective improvements in their condition. RESULTS of this preliminary study indicate that L-carnitine reduces hyperammonaemia and improves the clinical symptoms of SHE in patients with hepatic cirrhosis.

Influence of dietary carnitine in growing sheep fed diets containing non-protein nitrogen

The influence of supplemental l-carnitine was investigated in growing sheep fed rations containing non-protein nitrogen (NPN). The experiment was conducted as a randomized block design with a 2×2 factorial arrangement of treatments. Lambs (77.4 kg BW, n=24) were fed a total mixed ration (12.1–13.6% CP) with two levels of l-carnitine (0 or 250 ppm) and two levels of NPN (urea contributing 0 or 50% of total dietary N) for a 50-day period. Jugular blood samples were collected at 0, 1, and 3 h post-feeding, and ruminal fluid samples were collected at 1 h post-feeding, during days 1, 8, 29, and 50 of the experiment. Average daily gain (121 versus 214 g) was lower ( P<0.0001) in lambs fed the NPN diets. Lambs consuming diets containing NPN had higher ( P<0.0001) ruminal fluid pH (6.6 versus 5.9), ruminal ammonia N (4.8 versus 2.8 mmol/l), and plasma ammonia N (177.1 versus 49.5 μmol/l) than lambs not fed NPN. Additionally, lambs fed the NPN diets had lower plasma urea N (14.5 versus 17.5 mmol/l; P<0.003) and thyroxine (T 4) concentrations (65.8 versus 78.4 ng/ml; P<0.02), and lower T 4:triiodothyronine (T 3) ratio (37.9 versus 43.9; P<0.02). Plasma glucose concentrations were higher ( P<0.05) in lambs fed l-carnitine (3.83 versus 3.70 mmol/l). Two oral urea load tests (OULT 1 and OULT 2) were conducted during the 50-day trial. Urea solutions (0.835 g/kg 0.75 BW) were administered as oral drenches. During the OULT 1 (day 10), plasma ammonia N and glucose concentrations were highest ( P<0.0001) in the lambs fed NPN with l-carnitine compared with lambs fed control, l-carnitine, and NPN diets. During the OULT 2 (day 50), plasma ammonia N was highest ( P<0.0001) in the NPN and NPN with l-carnitine groups compared with the control and l-carnitine groups. Plasma glucose was lowest ( P<0.04) in the NPN with l-carnitine group compared with the NPN and l-carnitine groups, but did not differ ( P>0.10) from the control group. Plasma urea N levels in both OULT 1 and OULT 2 were lower ( P<0.0001) in the NPN and NPN with l-carnitine groups compared with the control and l-carnitine groups. In the present experiment, production and plasma criteria were affected by NPN incorporation in the diets. Production criteria were not affected by inclusion of l-carnitine in the diet, however, l-carnitine reduced experimentally induced hyperammonemia by day 50 of the trial.

Three-year survival of patients with heart failure caused by dilated cardiomyopathy and L-carnitine administration

We examined the efficacy of long-term L-carnitine administration for the treatment of heart failure caused by dilated cardiomyopathy in adult patients. To accomplish this, we studied 80 patients with moderate to severe heart failure (New York Heart Association classification III to IV) caused by dilated cardiomyopathy. This article reports on the nearly 3 years of follow-up data on patient mortality. Primary results will be published in the future. After a period of stable cardiac function up to 3 months, patients were randomly assigned to receive either L-carnitine (2 g/d orally) or placebo. There were no statistical differences between the 2 groups at baseline examination in clinical and hemodynamic parameters, such as ejection fraction, Weber classification, maximal time of cardiopulmonary exercise test, peak VO 2 consumption, arterial and pulmonary blood pressure, and cardiac output. After a mean of 33.7 ± 11.8 months of follow-up (range 10 to 54 months), 70 patients were in the study: 33 in the placebo group and 37 in the L–carnitine group. At the time of analysis, 63 patients were alive. There were 6 deaths in the placebo group and 1 death in the L-carnitine group. Survival analysis with the Kaplan-Meier method showed that patients’ survival was statistically significant ( P < .04) in favor of the L-carnitine group. L-carnitine appears to possess considerable potential for the long-term treatment of patients with heart failure attributable to dilated cardiomyopathy. (Am Heart J 2000;139:S120-S123.)

L-carnitine supplementation in patients with cystic acne on isotretinoin therapy

Background Patients with cystic acne (CA) on Isotretinoin (Iso) therapy might present muscular symptoms as side effect of the drug. Myalgia, weakness, hypotension are also some of the main characteristics of carnitine (car) deficiency.Methods Two hundred and thirty (N=230) patients with CA were treated with Isotretinoin (0.5 mg/kg per 24 h). All the patients were requested to visit our out-patient department at the onset of muscular symptoms. Laboratory tests including car (total, free, acylcarnitine) were determined in blood and urine before treatment, at the onset of muscular symptoms and after the end of a 45 day study. Fifty percent of the patients with muscular involvement received L-carnitine (100 mg/kg per 24 h per os) (group C) and 50% placebo (group P).Results Their laboratory tests showed the well known increases of their liver enzymes and lipids, whereas car blood levels were remarkably decreased at the onset of their muscular symptoms and or at the end of the study. Their supplementation with L-car, in patients of group C (N=20) without Iso discontinuation or reduction, resulted in the disappearance of their muscular symptoms within 5–6 days and normalisation not only of the increased levels of their liver enzymes but also those of car, at the 45 day of their therapy. Additionally, the patients who received placebo (group P, N=20) continued complaining for mualgias. The rest of the patients (group A, N=190) did not experience any muscular symptoms, their laboratory tests showed elevation of liver enzymes and lipids and a decrease in car levels in the blood whereas a remarkable increase of car excretion was determined in their urine.Conclusions Iso therapy decreases car blood levels in patients with CA. l-car supplementation might treat liver and muscular side effects of the drug. These hopeful preliminary results need further investigation.

L‐carnitine supplementation in patients with cystic acne on isotretinoin therapy★

Patients with cystic acne (CA) on Isotretinoin (Iso) therapy might present muscular symptoms as side effect of the drug. Myalgia, weakness, hypotension are also some of the main characteristics of carnitine (car) deficiency. Two hundred and thirty (N = 230) patients with CA were treated with Isotretinoin (0.5 mg/kg per 24 h). All the patients were requested to visit our out-patient department at the onset of muscular symptoms. Laboratory tests including car (total, free, acylcarnitine) were determined in blood and urine before treatment, at the onset of muscular symptoms and after the end of a 45 day study. Fifty percent of the patients with muscular involvement received L-carnitine (100 mg/kg per 24 h per os) (group C) and 50% placebo (group P). Their laboratory tests showed the well known increases of their liver enzymes and lipids, whereas car blood levels were remarkably decreased at the onset of their muscular symptoms and or at the end of the study. Their supplementation with L-car, in patients of group C (N = 20) without Iso discontinuation or reduction, resulted in the disappearance of their muscular symptoms within 5-6 days and normalisation not only of the increased levels of their liver enzymes but also those of car, at the 45 day of their therapy. Additionally, the patients who received placebo (group P, N = 20) continued complaining for mualgias. The rest of the patients (group A, N = 190) did not experience any muscular symptoms, their laboratory tests showed elevation of liver enzymes and lipids and a decrease in car levels in the blood whereas a remarkable increase of car excretion was determined in their urine. Iso therapy decreases car blood levels in patients with CA. L-car supplementation might treat liver and muscular side effects of the drug. These hopeful preliminary results need further investigation.

Randomised controlled trial of L-carnitine as a nutritional supplement in preterm infants

AIMSTo evaluate the effect of L-carnitine supplementation (25 mg/kg/d) on the growth and incidence of hypoglycaemia in preterm infants.METHODSA double blind, placebo controlled randomised trial, stratified for gestational age, was...

Effects of l-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the l-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial

Objectives. This study was performed to evaluate the effects of l-carnitine administration on long-term left ventricular dilation in patients with acute anterior myocardial infarction.Background. Carnitine is a physiologic compound that performs an essential role in myocardial energy production at the mitochondrial level. Myocardial carnitine deprivation occurs during ischemia, acute myocardial infarction and cardiac failure. Experimental studies have suggested that exogenous carnitine administration during these events has a beneficial effect on function.Methods. The l-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial was a randomized, double-blind, placebo-controlled, multicenter trial in which 472 patients with a first acute myocardial infarction and high quality two-dimensional echocardiograms received either placebo (239 patients) or l-carnitine (233 patients) within 24 h of onset of chest pain. Placebo or l-carnitine was given at a dose of 9 g/day intravenously for the first 5 days and then 6 g/day orally for the next 12 months. Left ventricular volumes and ejection fraction were evaluated on admission, at discharge from hospital and at 3, 6 and 12 months after acute myocardial infarction.Results. A significant attenuation of left ventricular dilation in the first year after acute myocardial infarction was observed in patients treated with l-carnitine compared with those receiving placebo. The percent increase in both end-diastolic and endsystolic volumes from admission to 3-, 6- and 12-mouth evaluation was significantly reduced in the l-carnitine group. No significant differences were observed in left ventricular ejection fraction changes over time in the two groups. Although not designed to demonstrate differences in clinical end points, the combined incidence of death and congestive heart failure after discharge was 14 (6%) in the l-carnitine treatment group versus 23 (9.6%) in the placebo group (p = NS). Incidence of ischemic events during follow-up was similar in the two groups of patients.Conclusions. l-Carnitine treatment initiated early after acute myocardial infarction and continued for 12 months can attenuate left ventricular dilation during the first year after an acute myocardial infarction, resulting in smaller left ventricular volumes at 3, 6 and 12 months after the emergent event.

The Effects of L-Carnitine Supplementation on Performance During Interval Swimming

To examine the effects of L-carnitine supplementation on short high-intensity exercise, twenty male collegiate swimmers completed two trials separated by seven days. Each trial consisted of five 91.4 m (100 yd) swims with a two minute rest interval between each bout. Following the first trial subjects were evenly and randomly assigned to either an L-carnitine (LC) group or a placebo (PL) group. The LC group ingested 2 grams L-carnitine in a citrus drink twice daily for 7 days, while the PL group received only the citrus drink during the same time period. Performance times were recorded for each repeat during both trials. Blood samples (5 ml) were obtained from an antecubital vein 1 minute following the interval set. Blood pH, base excess (BE), lactate (LA), carnitine and carnitine fractions were measured. Total serum carnitine was significantly (p < 0.05) elevated (75.9 +/- 2.0 vs. 106.4 +/- 3.5 mumol.l-1) in the LC group following treatment, while the PL group was unchanged (79.5 +/- 2.8 vs. 77.6 +/- 5.3 mumol.l-1). Free and short-chain serum carnitine fractions were also increased (p < 0.05) in the LC group, but were not altered in the PL group. No differences in performance times were observed between trials or between groups. Blood pH, LA and BE revealed a similar response in both groups during each trial. Despite the elevation in serum L-carnitine and carnitine fractions, these results indicate that L-carnitine supplementation does not provide an ergogenic benefit during repeated bouts of high-intensity anaerobic exercise in highly trained swimmers.

Pulmonary surfactant in bronchoalveolar lavage after canine lung transplantation: Effect of l-carnitine application

Pulmonary surfactant during lung transplantation was investigated in the control group of a canine single lung transplantation model by measuring dipalmitoyl-phosphatidylcholine, the main phosphocholine fraction of surfactant in bronchoalveolar lavage. In a second group of dogs, L-carnitine, an essential cofactor for transfer of long-chain fatty acids into the mitochondria, was applied. Organ function after pulmonary artery flushing with modified Euro-Collins solution and hypothermic storage for 4 hours was adequate in both groups, with significantly higher arterial oxygen pressure levels in the L-carnitine group after 12 (p less than 0.05) and 24 (p less than 0.025) hours, respectively. In the control group, a reduction of the dipalmitoyl-phosphotidylcholine portion on total phosphotidylcholines was observed 4 and 12 hours after transplantation of the left lung (p less than 0.005 and p less than 0.01, respectively, both specified by Student's t test for dependent data, not significant by Bonferroni correction). In the simultaneously stored right lungs, a constant fall of the dipalmitoyl-phosphotidylcholine portion was demonstrated. In the L-carnitine group, significantly higher dipalmitoyl-phosphotidylcholine levels were observed in the transplanted left lungs after 4 hours (p less than 0.01) and in the continuously stored right lungs after 24 hours (p less than 0.005), when compared with the control group. These results suggest that dipalmitoyl-phosphotidylcholine portion on total phosphotidylcholine decreases parallel to the extent of the ischemic damage. Furthermore, the application of L-carnitine improved pulmonary function after transplantation, possibly by reducing the impairing effect of ischemia on alveolar type II cell metabolism and thereby on pulmonary surfactant system.