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Sassi S, Bianchi E, Diamanti L, Tornabene D, Sette E, Medici D, Matà S, Leccese D, Sperti M, Martinelli I, Ghezzi A, Mandrioli J, Iuzzolino VV, Dubbioso R, Trojsi F, Passaniti C, D'Alvano G, Filosto M, Padovani A, Mazzini L, De Marchi F, Zinno L, Nuredini A, Bongioanni P, Dolciotti C, Canali E, Toschi G, Petrucci A, Perna A, Riso V, Inghilleri M, Libonati L, Cambieri C, Pupillo E. Retrospective observational study on the use of acetyl-L-carnitine in ALS. J Neurol 2023; 270:5344-5357. [PMID: 37378756 PMCID: PMC10576701 DOI: 10.1007/s00415-023-11844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
ALCAR (Acetyl-L-carnitine) is a donor of acetyl groups and increases the intracellular levels of carnitine, the primary transporter of fatty acids across the mitochondrial membranes. In vivo studies showed that ALCAR decrease oxidative stress markers and pro-inflammatory cytokines. In a previous double-blind placebo-controlled phase II trial showed positive effects on self-sufficiency (defined as a score of 3+ on the ALSFRS-R items for swallowing, cutting food and handling utensils, and walking) ALSFRS-R total score and FVC. We conducted an observational, retrospective, multicentre, case-control study to provide additional data on the effects of ALCAR in subjects with ALS in Italy. Subjects treated with ALCAR 1.5 g/day or 3 g/day were included and matched with not treated subjects by sex, age at diagnosis, site of onset, and time from diagnosis to baseline, (45 subjects per group). ALCAR 3 g/day vs not treated: 22 not treated subjects (48.9%) were still alive at 24 months after baseline, compared to 23 (51.1%) treated subjects (adj. OR 1.18, 95% CI 0.46-3.02). No statistically significant differences were detected in ALSFRS nor FVC nor self-sufficiency. ALCAR 1.5 g/day vs not treated: 22 not treated subjects (48.9%) were still alive at 24 months after baseline, compared to 32 (71.1%) treated subjects (adj. OR 0.27, 95% CI 0.10-0.71). For ALSFRS-R, a mean slope of - 1.0 was observed in treated subjects compared to - 1.4 in those not treated (p = 0.0575). No statistically significant difference was detected in the FVC nor self-sufficiency. Additional evidence should be provided to confirm the efficacy of the drug and provide a rationale for the dosage.
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Affiliation(s)
- Serena Sassi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luca Diamanti
- Neuro-Oncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Danilo Tornabene
- Neuro-Oncology Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elisabetta Sette
- UO di Neurologia Dipartimento Neuroscienze e Riabilitazione, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | | | - Sabrina Matà
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Deborah Leccese
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Martina Sperti
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Ghezzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, Centre for Neuroscience and Nanotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Virginia Iuzzolino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesca Trojsi
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Carla Passaniti
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Giulia D'Alvano
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, NeMO-Brescia Clinical Center for Neuromuscular Diseases, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Unit of Neurology ASST Spedali Civili Di Brescia, University of Brescia, Brescia, Italy
| | - Letizia Mazzini
- ALS Center Azienda Ospedaliero Universitaria "Maggiore della Carità" e Università del Piemonte Orientale, Novara, Italy
| | - Fabiola De Marchi
- ALS Center Azienda Ospedaliero Universitaria "Maggiore della Carità" e Università del Piemonte Orientale, Novara, Italy
| | - Lucia Zinno
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andi Nuredini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Bongioanni
- Dpt. Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Dolciotti
- Dpt. Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Elena Canali
- U.O di Neurologia, Presidio Ospedaliero S.Maria Nuova Azienda USL, IRCCS di Reggio Emilia, Florence, Italy
| | - Giulia Toschi
- U.O di Neurologia, Presidio Ospedaliero S.Maria Nuova Azienda USL, IRCCS di Reggio Emilia, Florence, Italy
| | - Antonio Petrucci
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Alessia Perna
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Vittorio Riso
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Maurizio Inghilleri
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy
| | - Laura Libonati
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy.
| | - Chiara Cambieri
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy
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Wilson ADH, Hart A, Wiberg M, Terenghi G. Acetyl-l-carnitine increases nerve regeneration and target organ reinnervation - a morphological study. J Plast Reconstr Aesthet Surg 2009; 63:1186-95. [PMID: 19664977 DOI: 10.1016/j.bjps.2009.05.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/04/2009] [Accepted: 05/21/2009] [Indexed: 11/19/2022]
Abstract
Peripheral nerve injury frequently results in functional morbidity since standard management fails to adequately address many of the neurobiological hurdles to optimal regeneration. Neuronal survival and regeneration are neurotrophin dependent and require increased aerobic capacity. Acetyl-l-carnitine (ALCAR) facilitates this need and prevents neuronal loss. ALCAR is clinically safe and is shown here to significantly improve nerve regeneration and target organ reinnervation. Two groups of five rats underwent sciatic nerve division followed by immediate repair. One group received parenteral ALCAR (50mg/kg/day) from time of operation until termination at 12 weeks. A 'sham treatment' group received normal saline. A third group was left unoperated and did not receive any treatment. A segment of nerve was harvested between 5mm proximal and 10mm distal to the repair in operated groups, and at the corresponding level in the unoperated group. Mean axonal count in normal, non-axotomised nerve was 14,720 (SD 2378). That of the saline group (17,217 SD 1808) was not significantly different from normal nerve (P=0.0985). Mean number of myelinated axons in the ALCAR group (24,460 SD 3750) was significantly greater than both sham group (P<0.01) and normal nerve (P=0.0012). Mean myelin thickness in the saline treated group (0.408 microm SD 0.067 microm) was less than normal nerve (0.770 microm SD 0.143 microm) (P<0.001). Mean myelin thickness in the ALCAR group (0.627 microm SD 0.052 microm) was greater than the sham (saline) group (P<0.01) and not statistically different from normal nerve (P=0.07). ALCAR increased dermal PGP9.5 staining by 210% compared to sham treatment (P<0.0001) and significantly reduced the mean percentage weight loss in gastrocnemius muscle (ALCAR group 0.203% vs. 0.312% in sham group P=0.015). ALCAR not only increases the number of regenerating nerve fibres but also morphologically improves the quality of regeneration and target organ reinnervation. Adjuvant ALCAR treatment may improve both sensory and motor outcomes and merits further investigation.
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Affiliation(s)
- Andrew D H Wilson
- Blond McIndoe Research Laboratories, Tissue Injury and Repair Group, University of Manchester, Room 3.106 Stopford Building, Oxford Road, Manchester M13 9PT, UK.
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