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Kumar Sarker S, Islam MT, Sarower Bhuyan G, Sultana N, Begum MN, Al Mahmud-Un-Nabi M, Al Noman Howladar MA, Farhana Dipta T, Muraduzzaman AKM, Kashfi Qadri S, Shirin T, Sadiya S, Hussain M, Ahmed Khan W, Akhteruzzaman S, Saleheen Qadri S, Qadri F, Mannoor K. Impaired acylcarnitine profile in transfusion-dependent beta-thalassemia major patients in Bangladesh. J Adv Res 2018; 12:55-66. [PMID: 30046479 PMCID: PMC6057484 DOI: 10.1016/j.jare.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/04/2018] [Accepted: 04/24/2018] [Indexed: 10/25/2022] Open
Abstract
Patients with beta-thalassemia major (BTM) suffer from fatigue, poor physical fitness, muscle weakness, lethargy, and cardiac complications which are related to an energy crisis. Carnitine and acylcarnitine derivatives play important roles in fatty acid oxidation, and deregulation of carnitine and acylcarnitine metabolism may lead to an energy crisis. The present study aimed to investigate carnitine and acylcarnitine metabolites to gain an insight into the pathophysiology of BTM. Dried blood spots of 45 patients with BTM and 96 age-matched healthy controls were analyzed for free carnitine and 24 acylcarnitines by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Although medium chain acylcarnitine levels were similar in the patients with BTM and healthy controls, free carnitine, short chain acylcarnitines, long chain acylcarnitines, and total acylcarnitine levels were significantly lower in patients with BTM than in the healthy controls (P < 0.05). Moreover, an impaired fatty acid oxidation rate was observed in the patients with BTM, as manifested by decreased fatty acid oxidation indicator ratios, namely C2/C0 and (C2 + C3)/C0. Furthermore, an increase in the C0/(C16 + C18) ratio indicated reduced carnitine palmitoyltransferase-1 (CPT-1) activity in the patients with BTM compared with that in the healthy controls. Thus, a low level of free carnitine and acylcarnitines together with impaired CPT-1 activity contribute to energy crisis-related complications in the patients with BTM.
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Affiliation(s)
- Suprovath Kumar Sarker
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh.,Department of Genetic Engineering & Biotechnology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Md Tarikul Islam
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh
| | - Golam Sarower Bhuyan
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh
| | - Nusrat Sultana
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh
| | - Mst Noorjahan Begum
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh
| | - Mohammad Al Mahmud-Un-Nabi
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh
| | - Md Abdulla Al Noman Howladar
- Research and Development, Incepta Chemicals Ltd., Barabaria, Saturia, Dhankora, Manikganj, Dhaka 1810, Bangladesh
| | - Tashmim Farhana Dipta
- Transfusion Medicine and Clinical Haematology, BIRDEM General Hospital and Ibrahim Medical College, Shahbag, Dhaka 1000, Bangladesh
| | - A K M Muraduzzaman
- Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka 1212, Bangladesh
| | - Syeda Kashfi Qadri
- Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Tahmina Shirin
- Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka 1212, Bangladesh
| | - Salma Sadiya
- Department of Biochemistry and Molecular Biology, Dhaka Shishu Hospital, Dhaka 1207, Bangladesh
| | - Manzoor Hussain
- Department of Pediatric Medicine and Cardiology, Dhaka Shishu Hospital, Dhaka 1207, Bangladesh
| | - Waqar Ahmed Khan
- Department of Biochemistry and Molecular Biology, Dhaka Shishu Hospital, Dhaka 1207, Bangladesh
| | - Sharif Akhteruzzaman
- Department of Genetic Engineering & Biotechnology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Syed Saleheen Qadri
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh
| | - Firdausi Qadri
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh.,Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka 1212, Bangladesh
| | - Kaiissar Mannoor
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka 1212, Bangladesh
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Tabei SMB, Mazloom M, Shahriari M, Zareifar S, Azimi A, Hadaegh A, Karimi M. Determining and surveying the role of carnitine and folic acid to decrease fatigue in β-thalassemia minor subjects. Pediatr Hematol Oncol 2013; 30:742-7. [PMID: 23458634 DOI: 10.3109/08880018.2013.771388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Beta-thalassemia minor (BTM) patients usually experience fatigue, bone pain complaint, and muscle weakness. Carnitine is an essential protein for transportation of long-chain fatty acids to the matrix for beta-oxidation. BTM patients have abnormally low plasma carnitine concentrations, which results in deficient ATP production. Carnitine and folic acid together may have a role in preventing bone pain complaint and fatigue in these patients. The aim of this study is to determine the effect of carnitine and folic acid supplementation in subjects with BTM. Seventy three BTM (mean age 11.06 ± 5.46 years) and 23 healthy controls (mean age 8.48 ± 3.78 years) were enrolled in the study. Fasting blood was drawn to determine baseline free and total carnitine levels, red blood cell folate concentration, and hemoglobin level. BTM were divided into three groups and received different types of supplementation for 3 months: Group 1, 50 mg/kg/day carnitine; Group 2, 50 mg/kg/day carnitine plus 1 mg/day folic acid; and Group 3, 1 mg/day folic acid. Controls did not receive supplementation. Laboratory parameters were again evaluated after 3 months' supplementation. A detailed quality of life questionnaire was designed to investigate muscle symptoms before and after supplementation. Free and total plasma carnitine concentration and hemoglobin levels in BTM subjects increased significantly after carnitine supplementation (P < .0001). Bone pain complaint and muscle weakness decreased with carnitine. Red blood cell folate level increased after folic acid supplementation. Carnitine and folic acid supplementation resulted in a decrease in bone pain complaint and muscle weakness in cases with β-thalassemia minor.
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