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Effects of L-carnitine supplementation in patients with mild-to-moderate COVID-19 disease: a pilot study.
Talebi, SS, Ghasemi, M, Etminani-Esfahani, M, Mohammadi, Y, Haddadi, R
Pharmacological reports : PR. 2022;74(6):1296-1305
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Coronavirus is an enveloped single-stranded-RNA positive-sense virus that includes four subgroups called alpha, beta, delta, and gamma, of which beta type is responsible for coronavirus disease 2019 (COVID-19). Due to the nature of COVID-19, L-carnitine may be considered a suitable therapeutic supplement as it has shown promising results in some viral infections related to the respiratory system. The aim of this study was to evaluate the extent of changes in inflammatory factors, such as c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), following L-carnitine supplementation. This study is a single-centre, prospective, randomised, double-blind, and pilot clinical trial. Seventy-six patients who were hospitalised with mild-to-moderate COVID-19 symptoms were enrolled for the study. They were randomly divided into intervention (n=33) and control (n=43) groups. Results show that L-carnitine supplementation can decrease inflammation caused by infection, increase oxygen saturation levels through improvements in oxygen delivery and decrease liver enzymes levels. Furthermore, the mean CRP and ESR levels in patients receiving L-carnitine were significantly reduced. Authors conclude that L-carnitine can be suggested as a pharmacological supplement in patients with COVID-19, but further research and clinical studies with larger sample sizes are needed to confirm and extend their findings.
Abstract
BACKGROUND The present single-center clinical trial was designed to evaluate the potential benefits of L-carnitine supplementation in patients with COVID-19 disease. METHODS AND PATIENTS The study was conducted on 75 patients with mild-to-moderate COVID-19 hospitalized in Shahid Beheshti Hospital-Hamadan, IRAN. The participants were randomly divided into intervention (n = 32) and control groups (n = 43). The control group received their standard hospital treatment only. In addition to standard medications, the intervention group received 3000 mg oral L-carnitine daily in three divided doses for five days. The blood samples were collected and para-clinical parameters were measured at the beginning and end of the treatment. Clinical outcomes were also recorded, and data were analyzed using χ2 and t-tests. RESULTS Higher means of O2 saturation were observed in the intervention rather than in the control group. Mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were significantly lower in the intervention group. Furthermore, mean alkaline phosphatase (ALP) activity and lactate dehydrogenase (LDH) were lower in the intervention group. Also, lower mean serum creatine phosphokinase (CPK) was observed in the intervention group. No significant differences were observed in terms of clinical symptoms; however, six patients (14%) in the control group died due to the complications of COVID-19, while all patients in the intervention group survived. CONCLUSION Taken together, L-carnitine can be considered as a drug supplement in patients with COVID-19.
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Changes in Gut Microbiota-Related Metabolites and Long-term Successful Weight Loss in Response to Weight-Loss Diets: The POUNDS Lost Trial.
Heianza, Y, Sun, D, Smith, SR, Bray, GA, Sacks, FM, Qi, L
Diabetes care. 2018;41(3):413-419
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Evidence has demonstrated that weight loss contributes to lowering the risk of developing type 2 diabetes among obese patients. The aim of this study was to examine whether diet-induced metabolites were associated with improvements in adiposity and metabolism during a weight-loss diet intervention in 510 overweight and obese individuals. Participants were randomly assigned to one of four diets with varying macronutrient composition to adhere to for six months. Blood samples and anthropometric data were taken at baseline and 6 months to monitor changes. This study found that overweight and obese individuals with reduced choline or L-carnitine levels achieved greater improvements of adiposity and energy metabolism. Based on these results, the authors conclude that metabolites are predictive of patient responsiveness to dietary interventions, and suggest further studies evaluate these effects in the pre-diabetic obese population.
Abstract
OBJECTIVE Adiposity and the gut microbiota are both related to the risk of type 2 diabetes. We aimed to comprehensively examine how changes induced by a weight-loss diet intervention in gut microbiota-related metabolites, such as trimethylamine N-oxide (TMAO) and its precursors (choline and l-carnitine), were associated with improvements in adiposity and regional fat deposition. RESEARCH DESIGN AND METHODS This study included 510 overweight and obese individuals who were randomly assigned one of four diets varying in macronutrient intake. We examined associations of 6-month changes in blood metabolites (TMAO, choline, and l-carnitine) with improvements in body weight (BW), waist circumference (WC), body fat composition, fat distribution, and resting energy expenditure (REE). RESULTS Individuals with a greater reduction of choline (P < 0.0001) and l-carnitine (P < 0.01) rather than TMAO showed significant losses of BW and WC at 6 months. The reduction of choline was significantly predictive of decreases in body fat composition, fat distribution, and REE. Results of sensitivity analysis showed that the baseline diabetes risk status, such as the presence of hyperglycemia (31% of the total participants) and fasting glucose levels, did not modify the associations. Early changes in choline and l-carnitine were significantly predictive of weight loss over 2 years (P < 0.05 for all). Individuals with increases in choline or l-carnitine were 2.35-times (95% CI 1.38, 4.00) or 1.77-times (1.06, 2.95) more likely to fail to lose weight (-5% or more loss) at 2 years. CONCLUSIONS Overweight and obese individuals who showed decreases in circulating choline or l-carnitine levels achieved greater improvements of adiposity and energy metabolism by eating a low-calorie weight-loss diet, suggesting that such metabolites are predictive of individuals' response to the treatment. Further investigations are necessary to confirm our findings, particularly in a population with prediabetes that is more representative of the U.S. population with obesity.
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Current experience in testing mitochondrial nutrients in disorders featuring oxidative stress and mitochondrial dysfunction: rational design of chemoprevention trials.
Pagano, G, Aiello Talamanca, A, Castello, G, Cordero, MD, d'Ischia, M, Gadaleta, MN, Pallardó, FV, Petrović, S, Tiano, L, Zatterale, A
International journal of molecular sciences. 2014;15(11):20169-208
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Many conditions are associated with mitochondrial dysfunction (MDF) and oxidative stress (OS). For example; some genetic diseases, aging and age-associated disorders, neurologic and psychiatric diseases, malignancies and autoimmune diseases. This review looks at the clinical trials focused on the use of mitochondrial cofactors (mitochondrial nutrients - MN) such as alpha-lipoic acid (ALA), Coenzyme Q 10 (CoQ10) and L-carnitine (CARN) which are essential in the functioning of mitochondria. Of the trials that were used in the review, 81 tested ALA, 107 tested CoQ10, 74 reports tested CARN, only 7 reports were retrieved testing double MN associations, while no report was found testing a triple MN combination. A total of 28 reports tested MN associations with “classical” antioxidants, such as antioxidant nutrients or drugs. Combinations of MN showed better outcomes than individual MN. Further studies are therefore needed.
Abstract
An extensive number of pathologies are associated with mitochondrial dysfunction (MDF) and oxidative stress (OS). Thus, mitochondrial cofactors termed "mitochondrial nutrients" (MN), such as α-lipoic acid (ALA), Coenzyme Q10 (CoQ10), and l-carnitine (CARN) (or its derivatives) have been tested in a number of clinical trials, and this review is focused on the use of MN-based clinical trials. The papers reporting on MN-based clinical trials were retrieved in MedLine up to July 2014, and evaluated for the following endpoints: (a) treated diseases; (b) dosages, number of enrolled patients and duration of treatment; (c) trial success for each MN or MN combinations as reported by authors. The reports satisfying the above endpoints included total numbers of trials and frequencies of randomized, controlled studies, i.e., 81 trials testing ALA, 107 reports testing CoQ10, and 74 reports testing CARN, while only 7 reports were retrieved testing double MN associations, while no report was found testing a triple MN combination. A total of 28 reports tested MN associations with "classical" antioxidants, such as antioxidant nutrients or drugs. Combinations of MN showed better outcomes than individual MN, suggesting forthcoming clinical studies. The criteria in study design and monitoring MN-based clinical trials are discussed.