1
|
Cao B, Chen Y, McIntyre RS, Yan L. Acyl-Carnitine plasma levels and their association with metabolic syndrome in individuals with schizophrenia. Psychiatry Res 2020; 293:113458. [PMID: 32977055 DOI: 10.1016/j.psychres.2020.113458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/13/2020] [Indexed: 02/06/2023]
Abstract
The metabolic syndrome (MetS) affects individuals with schizophrenia at a higher rate when compared to individuals in the general population. Accumulating evidence indicated that subjects with MetS generally manifest elevated levels of acyl-carnitines, which are important carriers for transporting fatty acyl group. Abnormalities of acyl-carnitines in individuals with schizophrenia with or without MetS had not been sufficiently characterized. We conducted this post-hoc analysis with our published data to further evaluate the differences of 29 acyl-carnitines in 46 individuals with schizophrenia with MetS and 123 without MetS. The rate of MetS was 27.2% (46/169) in the individuals with schizophrenia. After FDR correction, the individuals with schizophrenia and MetS showed significantly higher levels of 17 plasma acyl-carnitines, compared to individuals without MetS. Eight acyl-carnitines (i.e., C3, C4, C5, C6: 1, C10: 1, C10: 2, C14: 2-OH, C16: 2-OH) were significantly different between two groups after adjusting for age and sex. The correlation analysis reported that acyl-carnitine concentrations have potential correlations with certain metabolic parameters. Our findings provide valuable new clues for exploring the roles of acyl-carnitines in the diagnosis and treatment of schizophrenia. More data and molecular biology evidences are needed to replicate our findings and elucidate relevant mechanisms.
Collapse
Affiliation(s)
- Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China; National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing 400715, China.
| | - Yan Chen
- Dalla Lana School of Public Health, University of Toronto. 155 College St., Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Lailai Yan
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, P. R. China; Medical and Health Analysis Center, Peking University, Beijing 100191, P. R. China; Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, P. R. China.
| |
Collapse
|
2
|
Cao B, Wang D, Pan Z, McIntyre RS, Brietzke E, Subramanieapillai M, Nozari Y, Wang J. Metabolic profiling for water-soluble metabolites in patients with schizophrenia and healthy controls in a Chinese population: A case-control study. World J Biol Psychiatry 2020; 21:357-367. [PMID: 31161852 DOI: 10.1080/15622975.2019.1615639] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: Objective measures integrated with clinical symptoms may improve early prevention and detection of schizophrenia. Herein we aim to evaluate potential water-soluble metabolic biomarkers in schizophrenia.Methods: We recruited adults with schizophrenia (n = 113) who had not received pharmacological treatment for at least 1 month prior to enrollment and 111 age- and sex-matched healthy subjects from Weifang, Shandong province, China. All serum samples were analysed using liquid chromatography-tandem mass spectrometry coupled with a hydrophilic interaction liquid chromatography column.Results: Eleven metabolites, namely carnitines (oleoylcarnitine, l-palmitoylcarnitine, 9-decenoylcarnitine and 2-trans,4-cis-decadienoylcarnitine), polar lipids (lysophosphatidylcholine (LPC)(P-16:0), LPC (16:0), LPC (15:0) and LPC(14:0)), amino acids (taurine and l-arginine), and organic acid (2,5-dichloro-4-oxohex-2-enedioate), separated the patients and healthy controls. Compared with healthy controls, taurine, l-palmitoylcarnitine and oleoylcarnitine levels were higher, whereas the remaining eight metabolites were lower in patients with schizophrenia. A combination of four metabolites, i.e., oleoylcarnitine, 9-decenoylcarnitine, LPC (15:0) and LPC (14:0), provided the most robust between-group separation.Conclusions: This study appears to distinguish between groups of patients and controls, which should be considered as a contribution to putative potential biomarkers. The water-soluble metabolites were determined to be significantly different between the groups in the current study, and were primarily related to cellular bioenergetics, notably oxidative stress.
Collapse
Affiliation(s)
- Bing Cao
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, P. R. China
| | | | - Zihang Pan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Elisa Brietzke
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Mehala Subramanieapillai
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Yasaman Nozari
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Jingyu Wang
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, P. R. China.,Beijing Key Laboratory of Toxicological Research, Risk Assessment for Food Safety, Beijing, P. R. China.,Peking University Medical and Health Analysis Center, Peking University, Beijing, P. R. China
| |
Collapse
|
3
|
Characterizing acyl-carnitine biosignatures for schizophrenia: a longitudinal pre- and post-treatment study. Transl Psychiatry 2019; 9:19. [PMID: 30655505 PMCID: PMC6336814 DOI: 10.1038/s41398-018-0353-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/18/2018] [Accepted: 11/08/2018] [Indexed: 12/21/2022] Open
Abstract
Subjects with schizophrenia have high risks of metabolic abnormalities and bioenergetic dysfunction. Acyl-carnitines involved in bioenergetic pathways provide potential biomarker targets for identifying early changes and onset characteristics in subjects with schizophrenia. We measured 29 acyl-carnitine levels within well-characterized plasma samples of adults with schizophrenia and healthy controls using liquid chromatography-mass spectrometry (LC-MS). Subjects with schizophrenia were measured at baseline and after 8 weeks of treatment. A total of 225 subjects with schizophrenia and 175 age- and gender-matched healthy controls were enrolled and 156 subjects completed the 8-week follow-up. With respect to plasma acyl-carnitines, the individuals with schizophrenia at baseline showed significantly higher levels of C4-OH (C3-DC) and C16:1, but lower concentrations of C3, C8, C10, C10:1, C10:2, C12, C14:1-OH, C14:2, and C14:2-OH when compared with healthy controls after controlling for age, sex, body mass index (BMI), smoking, and drinking. For the comparison between pretreatment and posttreatment subjects, all detected acyl-carnitines were significantly different between the two groups. Only the concentration of C3 and C4 were increased after selection by variable importance in projection (VIP) value >1.0 and false discovery rate (FDR) q value <0.05. A panel of acyl-carnitines were selected for the ability to differentiate subjects of schizophrenia at baseline from controls, pre- from post-treatment, and posttreatment from controls. Our data implicated acyl-carnitines with abnormalities in cellular bioenergetics of schizophrenia. Therefore, acyl-carnitines can be potential targets for future investigations into their roles in the pathoetiology of schizophrenia.
Collapse
|
4
|
El Mously S, Abdel Ghaffar H, Magdy R, Hamza S, Mansour M. Carnitine deficiency in epileptic children treated with a diversity of anti-epileptic regimens. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:37. [PMID: 30546248 PMCID: PMC6267633 DOI: 10.1186/s41983-018-0033-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 10/19/2018] [Indexed: 12/30/2022] Open
Abstract
Background Carnitine deficiency is relatively common in epileptic patients. The risk factors reported include the combination of valproic acid with other antiepileptic drugs (AEDs), young age, multiple neurologic disabilities, non-ambulatory status, and being underweight. Objectives To study the level of carnitine deficiency and its associated risk factors among a group of children with idiopathic epilepsy treated with different AEDs. Patients and methods Fifty children with idiopathic epilepsy and 40 age-matched controls were enrolled. For all, serum carnitine level was measured by enzyme-linked immune sorbent assay (ELISA). Results The mean carnitine level was lower in cases compared to controls (p = 0.04). Patients receiving monotherapy treatment had a high percentage of carnitine deficiency compared to controls (p = 0.04). Patients receiving valproate with other AEDs had a lower level of carnitine compared to controls (p = 0.03). The age of the patients, the duration of treatment, and the doses of different AEDs were not risk factors for carnitine deficiency. Conclusions Carnitine deficiency is common in our population, and the use of valproate with other AEDs is considered the most important risk factor for it in epileptic children.
Collapse
Affiliation(s)
| | | | - Remon Magdy
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
| | - Somaia Hamza
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
| | - Mohamed Mansour
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
| |
Collapse
|
5
|
Brown LM, Cupples N, Moore TA. Levocarnitine for valproate-induced hyperammonemia in the psychiatric setting: A case series and literature review. Ment Health Clin 2018; 8:148-154. [PMID: 29955560 PMCID: PMC6007637 DOI: 10.9740/mhc.2018.05.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction Hyperammonemia is a potential adverse effect of valproic acid (VPA) therapy, which is often asymptomatic but can lead to severe, life-threatening encephalopathy. Carnitine deficiency due to VPA is the proposed mechanism for hyperammonemia and the development of VPA-induced hyperammonemic encephalopathy (VHE). Levocarnitine, the active form of carnitine, has been suggested for treatment and prevention of VHE. Methods Data was collected by chart review of 3 patients who received oral levocarnitine supplementation in the psychiatric setting for VPA-induced hyperammonemia. Review of the literature was performed through June 2017 using the following PubMed search terms: valproate, valproic acid, hyperammonemia, altered mental status, encephalopathy, and levocarnitine. Articles were included if they described use of levocarnitine in VPA-treated patients with psychiatric disorders. Results One patient developed encephalopathy with resolution of symptoms after VPA discontinuation. Valproic acid was restarted with the addition of levocarnitine to prevent VHE reoccurrence. In the other 2 cases, levocarnitine was started prophylactically in patients who developed hyperammonemia without emergence of any clinical symptoms. Ammonia levels were reduced to normal in all cases, and no symptoms consistent with encephalopathy were reported. The literature search identified 6 additional cases with 5 of 6 reports supporting use of levocarnitine for decreased ammonia levels as well as an observational trial. Discussion This literature review and case series illustrates successful use of levocarnitine supplementation for reduction of ammonia levels in the setting of VPA-induced hyperammonemia among patients with psychiatric disorders. However, clinical significance of ammonia reduction in asymptomatic patients is difficult to determine.
Collapse
Affiliation(s)
- Lauren M Brown
- Clinical Pharmacy Specialist, Psychiatry, South Texas Health Care System, San Antonio, Texas; UT Health San Antonio, College of Medicine, San Antonio, Texas; University of Texas at Austin, College of Pharmacy, Austin, Texas,
| | - Nicole Cupples
- Clinical Pharmacy Specialist, South Texas Health Care System, San Antonio, Texas; UT Health San Antonio, College of Medicine, San Antonio, Texas; University of Texas at Austin, College of Pharmacy, Austin, Texas
| | - Troy A Moore
- Clinical Pharmacy Specialist, South Texas Health Care System, San Antonio, Texas; UT Health San Antonio, Department of Psychiatry, Division of Community Recovery, Research and Training, San Antonio, Texas; UT Health San Antonio, College of Medicine, San Antonio, Texas; University of Texas at Austin, College of Pharmacy, Austin, Texas
| |
Collapse
|
6
|
Lee H, Kim HK, Kwon JT, Park S, Park HJ, Kim SK, Park JK, Kang WS, Kim YJ, Chung JH, Kim JW, Kim HJ. BBOX1 is down-regulated in maternal immune-activated mice and implicated in genetic susceptibility to human schizophrenia. Psychiatry Res 2018; 259:197-202. [PMID: 29065368 DOI: 10.1016/j.psychres.2017.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/12/2017] [Accepted: 10/01/2017] [Indexed: 01/09/2023]
Abstract
Prenatal exposure to infectious or inflammatory insults can increase the risk of developing neuropsychiatric disorders such as bipolar disorder, autism, and schizophrenia in later life. Gamma-butyrobetaine hydroxylase (BBOX 1) is an enzyme responsible for the biosynthesis of l-carnitine, a key molecule in fatty acid metabolism. This cytosolic dimeric protein belongs to the dioxygenase family. In this study, we investigated whether BBOX 1 expression was related to psychiatric disorder in an animal model. We also conducted a case-control study using 284 schizophrenia patients and 409 controls with single-nucleotide polymorphisms (SNPs) in the 5'-near region of BBOX 1. BBOX 1 expression was increased in the medial frontal cortex of a mouse model of schizophrenia induced by maternal immune activation. Furthermore, the genotype and allele frequencies of two SNPs (rs7939644 and rs10767592) were significantly associated with schizophrenia susceptibility. Our results suggest that BBOX 1 might be associated with maternal immune activation and schizophrenia susceptibility. Therefore, it might be involved in the pathophysiology of schizophrenia.
Collapse
Affiliation(s)
- Hwayoung Lee
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Hyung-Ki Kim
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Jun-Tack Kwon
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Shohyun Park
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Hae Jeong Park
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Su Kang Kim
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Jin Kyung Park
- Department of Neuropsychiatry, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Won Sub Kang
- Department of Neuropsychiatry, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Young Jong Kim
- Department of Neuropsychiatry, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Joo-Ho Chung
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Jong Woo Kim
- Department of Neuropsychiatry, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Hak-Jae Kim
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea; Soonchunhyang Medical Research Institute, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea.
| |
Collapse
|
7
|
Cuturic M, Abramson RK, Breen RJ, Edwards AC, Levy EE. Comparison of serum carnitine levels and clinical correlates between outpatients and acutely hospitalised individuals with bipolar disorder and schizophrenia: A cross-sectional study. World J Biol Psychiatry 2016; 17:475-9. [PMID: 27088656 DOI: 10.1080/15622975.2016.1178803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We sought to compare serum carnitine levels and clinical correlates between stable outpatients and acutely hospitalised individuals with diagnoses of bipolar disorder and schizophrenia. METHODS We obtained clinical information as well as serum levels for total and free carnitine, high-density lipoprotein (HDL) and triglycerides in 60 consenting individuals. RESULTS We found higher total serum carnitine levels in our outpatient group in comparison to acutely hospitalised psychiatric patients, with a statistically significant P value of 0.045. Metabolic syndrome was more prevalent in the outpatient (37.9%) versus inpatient group (16.1%). We identified significantly higher carnitine levels in patients who met the criteria for metabolic syndrome in comparison to the patients without metabolic syndrome, with respective P values for total and free carnitine of 0.0048 and 0.0029. CONCLUSIONS This study revealed a complex relationship among carnitine metabolism, metabolic syndrome and behavioural outcomes. Future studies of carnitine metabolism in the context of mental illness as well as metabolic syndrome are warranted.
Collapse
Affiliation(s)
- Miroslav Cuturic
- a Departments of Mental Health and Neurology , University of South Carolina School of Medicine , Columbia , SC , USA
| | - Ruth K Abramson
- b Department of Neuropsychiatry and Behavioral Science , University of South Carolina School of Medicine , Columbia , SC , USA
| | - Robert J Breen
- c Departments of Mental Health and Neuropsychiatry and Behavioral Science , University of South Carolina School of Medicine , Columbia , SC , USA
| | | | - Elliott E Levy
- e Departments of Mental Health and Psychiatry & Behavioral Science , Medical University of South Carolina , Charleston , SC , USA
| |
Collapse
|
8
|
Al-sharefi A, Bilous R. Reversible weakness and encephalopathy while on long-term valproate treatment due to carnitine deficiency. BMJ Case Rep 2015; 2015:bcr-2015-210727. [PMID: 26336183 DOI: 10.1136/bcr-2015-210727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We describe a case of a 35-year-old woman who presented with bilateral leg weakness and encephalopathy while on long-term valproate therapy. She was diagnosed with valproate-induced encephalopathy due to carnitine deficiency. Clinical improvement occurred with oral carnitine supplementation. Our case report highlights the importance of considering carnitine deficiency in patients presenting with unexplained neurological signs while on long-term valproate treatment.
Collapse
Affiliation(s)
| | - Rudy Bilous
- Department of Endocrinology and Diabetes, James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
9
|
Jia YY, Lu CT, Feng J, Song Y, Zhao JY, Wang S, Sun Y, Wen AD, Yang ZF, Hang TJ. Impact on L-carnitine Homeostasis of Short-term Treatment with the Pivalate Prodrug Tenofovir Dipivoxil. Basic Clin Pharmacol Toxicol 2013; 113:431-5. [PMID: 23855818 DOI: 10.1111/bcpt.12112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/10/2013] [Indexed: 02/02/2023]
Abstract
Pivalate-generating prodrugs have been suggested to cause clinically significant hypocarnitinaemia. Tenofovir dipivoxil, a novel ester prodrug of tenofovir, can be used for treatment for hepatitis B and HIV infection and it was necessary to evaluate the effect of its treatment on carnitine homeostasis. We sought to investigate the effect of Class 1 drug tenofovir dipivoxil on endogenous L-carnitine level during a 72-hr test in healthy Chinese volunteers and to establish a suitable dose of L-carnitine nutritional supplement for patients who were administered short-term tenofovir dipivoxil tablets for treatment for hepatitis B and herpes simplex virus infection. Tenofovir dipivoxil was administered in one of eight dosing regimens (single dose 150, 300 and 600 mg, multiple dose 300, 450, and 600 mg, multiple dose 450 (600) mg tenofovir dipivoxil and 0.5 g L-carnitine) to gender-balanced groups of 84 healthy Chinese volunteers. Plasma concentrations of L-carnitine were quantified before, during and after treatment. Plasma L-carnitine concentrations fell during tenofovir dipivoxil dosing. The nadir in L-carnitine concentration was dependent on the dose of tenofovir dipivoxil and it decreased from 6.1 ± 0.6 to 4.4 ± 0.8 μg/ml, 6.1 ± 1.8 to 3.3 ± 1.2 μg/ml, 6.2 ± 0.6 to 2.5 ± 0.5 μg/ml for single doses of 150, 300, 600 mg tenofovir dipivoxil tablets and from 6.0 ± 1.4 to 2.1 ± 1.5 μg/ml, 6.2 ± 0.4 to 0.9 ± 0.5 μg/ml for multiple doses of 450, 600 mg tenofovir dipivoxil tablets, respectively. Short-term administration of tenofovir dipivoxil results in hypocarnitinaemia and increased losses of carnitine in resulting of minor adverse events of decreased food appetite, nausea, abdominal distention and muscle weakness.
Collapse
Affiliation(s)
- Yan-Yan Jia
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Tao Lu
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Juan Feng
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ying Song
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jin-Yi Zhao
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shan Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuan Sun
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ai-Dong Wen
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhi-Fu Yang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Tai-Jun Hang
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| |
Collapse
|
10
|
Serum carnitine levels and levocarnitine supplementation in institutionalized Huntington's disease patients. Neurol Sci 2013; 34:93-8. [PMID: 22294053 DOI: 10.1007/s10072-012-0952-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 01/13/2012] [Indexed: 12/17/2022]
Abstract
Along with antioxidant properties, carnitine is an important regulator of lipid metabolism in humans. While beneficial effects of carnitine have been demonstrated in animal models of Huntington's disease (HD), metabolism of carnitine has not been studied in humans with this illness. In this retrospective database review from 23 patients admitted to a HD-specialized nursing home unit, we found a relatively high prevalence of hypocarnitinemia (6 cases, 26%). Our review suggests that catabolism and chronic valproate use predisposed our patients to develop hypocarnitinemia. The patients with low serum carnitine levels who received levocarnitine supplementation, during a mean period of 7.3 months, showed improvement in motor, cognitive and behavioral measures. We hypothesize that observed improvement related to the resolution of reversible metabolic encephalopathy and myopathy associated with secondary carnitine deficiency. In conclusion, notwithstanding its limitations, this is the first study to report measurements of carnitine levels in HD patients, revealing relatively high prevalence of hypocarnitinemia in our population. Our findings suggest that HD patients with hypocarnitinemia may benefit from low-dose levocarnitine supplementation. Further studies of carnitine metabolism and supplementation in HD patients are warranted.
Collapse
|