Carnitine bij etalagebenen (claudicatio)

[bert]

Bij mensen met etalagebenen is de l-carnitine stofwisseling veranderd: ….een indicatie voor een gerichte behandeling met l-carnitine.
Een placebo deed niets, maar carnitine verbeterde de wandelcapaciteit significant bij de mensen die tijdens/na wandelen een daling van acetylcarnitine in het bloed vertoonden (ipv een stijging)..

Carnitine-related alterations in patients with intermittent claudication: indication for a focused carnitine therapy.

Brevetti G, di Lisa F, Perna S, Menabó R, Barbato R, Martone VD, Siliprandi N.

Department of Medicine, University Federico II, Naples, Italy.
Abstract

BACKGROUND: Carnitine metabolism is altered in peripheral arterial disease. (= etalagebenen/claudicatio intermittens)

L-carnitine supplementation may correct these alterations and improve walking performance.

METHODS AND RESULTS:
Plasma levels of carnitine and its esters were measured at rest and after maximally tolerated exercise in 22 claudicant patients and 8 normal subjects.
One week later, this protocol was repeated in patients after random administration of placebo or L-carnitine (500 mg IV as a single bolus).

Two groups of patients emerged.
In 10 patients (group IC1), the plasma level of acetylcarnitine at rest was 3.7 +/- 0.2 micromol/L and increased significantly (P<.01) at maximally tolerated exercise. In 12 patients (group IC2), the resting level of plasma acetylcarnitine was elevated (7.9 +/- 0.7 micromol/L, P<.01) and decreased with exercise. Furthermore, group IC2 patients had a significantly lower walking capacity than group IC1 patients. In both groups, placebo did not affect the metabolic profile, nor did it improve exercise performance. Conversely, after L-carnitine administration, all but one patient in group IC2 (n=7) showed an increase in plasma acetylcarnitine concentration during exercise versus the decrease observed without L-carnitine. This metabolic effect was accompanied by a significant increase (P<.01) in walking capacity. Interestingly, in group IC1 patients (n=5), L-carnitine neither improved walking capacity nor modified the metabolic profile. Statistical analysis showed that changes in walking capacity with L-carnitine treatment were influenced exclusively by exercise-induced changes in plasma acetylcarnitine. CONCLUSIONS: In patients with intermittent claudication, assessment of plasma acetylcarnitine at rest and after exercise may be a means to select a target population for L-carnitine therapy. PMID: 8653874 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/8653874
Free Article

Carnitine is te meten in het bloed.
Bepaal: Totaal carnitine, vrij carnitine en acetyl carnitine.
Streef (ook bij suppletie) naar hoognormale waarden, die zijn optimaal gebleken).

Carnitine is een aminozuur en zit in vlees. Het is belangrijk voor de vetstofwisseling en produktie van energie.

Carnitine is als supplement vrij te koop.
Carnitine van Sigma Tau is bij de apotheek verkrijgbaar en - mits op recept van een arts - vergoedbaar.

[Lisa]

Carnitine and peripheral arterial disease (PAD, perifere vaatziekten, claudicatio intermittens, etalagebenen).

Hiatt WR. 2004

University of Colorado Health Sciences Center, Colorado Prevention Center, Denver, CO 80203, USA. will.hiatt@uchsc.edu

Patients with peripheral arterial disease (PAD) who become symptomatic with claudication (approximately one-third of the population) have a marked impairment in exercise performance and overall functional capacity.

Patients with claudication have a peak oxygen consumption measured during graded treadmill exercise testing that is 50% of that in age-matched normal subjects, and also report great difficulty in walking relatively short distances, even at a slow walking speed.

The reduced walking capacity is associated with impairment in activities of daily living and quality of life.
Thus, claudication is highly limiting to the physical functioning of daily activities.

Improving mobility and improving the reduced quality of life are therefore major goals of treatment.

Patients with PAD develop metabolic abnormalities in the skeletal muscles of the lower extremity. These abnormalities include impairment in ischemic muscle mitochondrial electron transport chain activity and accumulation of intermediates of oxidative metabolism (acylcarnitines).

Patients with the greatest accumulation of muscle acylcarnitines have the most impaired exercise performance.
Thus, claudication is not simply the result of reduced blood flow, and alterations in skeletal muscle metabolism are part of the pathophysiology of the disease.

L-carnitine and propionyl-L-carnitine may improve the metabolism and exercise performance of ischemic muscles.

L-carnitine in a dose of 2 grams twice daily improved treadmill performance, but propionyl-L-carnitine (an acyl form of carnitine) was more effective than L-carnitine in improving treadmill walking distance.

In two multicenter trials of a total of 730 patients, initial and maximal treadmill walking distance improved more with propionyl-L-carnitine than placebo.
The drug also improved quality of life and had minimal side effects as compared with placebo.

PMID: 15591006 [PubMed – indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/15591006

[Lisa]

J Am Coll Cardiol. 1999 Nov 1;34(5):1618-24.
European multicenter study on propionyl-L-carnitine in intermittent claudication.

Brevetti G, Diehm C, Lambert D.

Department of Medicine, University Federico II, Napoli, Italy. brevetti@unina.it
Abstract

OBJECTIVES: This study was performed to identify a target population of claudicants for propionyl-L-carnitine treatment.

BACKGROUND: Previous studies suggest that the efficacy of propionyl-L-carnitine in intermittent claudication is greater in patients with severe functional impairment than in those with mild walking disability.

METHODS: After run-in, 485 claudicant patients were randomized to placebo or propionyl-L-carnitine (1 g bid, p.o.) and then stratified on the basis of maximal walking distance (cutoff point 250 m) and maximal walking distance variability (cutoff point 25%).

Treatment lasted 12 months. Walking capacity was assessed by treadmill and quality of life by a questionnaire exploring various aspects of daily life.

RESULTS: In the target population, that is, patients who at baseline walked < or = 250 m and showed a maximal walking distance variability < or = 25%, per-protocol analysis showed that the effect of propinyl-L-carnitine was significantly greater than that with placebo for both maximal walking distance and initial claudication distance (ICD). In the intention-to-treat population, maximal walking distance increased by 62 +/- 14% on propionyl-L-carnitine and by 46 +/- 9% (p < 0.05) on placebo, while no difference between treatments was observed for ICD. The beneficial effect of propionyl-L-carnitine was confirmed when data of the target population were pooled with those of patients who at baseline walked < or = 250 m and showed a > 25% maximal walking distance < 50% variability. Actually, maximal walking distance increased by 98 +/- 16% in the propionyl-L-carnitine group and by only 54 +/- 10% in the placebo group (p < 0.01). The corresponding values for ICD were 99 +/- 21% and 51 +/- 8% (p < 0.05). For patients with baseline maximal walking distance > 250 m, no difference between treatments was observed.

CONCLUSIONS: Claudicants with maximal walking distance < or = 250 m benefited from the use of propionyl-L-carnitine, with improvement in walking distance and quality of life. However, patients with mild functional impairment (i.e., walking distance > 250 m) showed no response to propionyl-L-carnitine.

PMID: 10551714 [PubMed – indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/10551714

[Lisa]

Nog een studie met propionyl -l carnitine bij claudicatio patienten.

http://www.ncbi.nlm.nih.gov/pubmed/11382369

Am J Med. 2001 Jun 1;110(8):616-22.
Propionyl-L-carnitine improves exercise performance and functional status in patients with claudication.

CONCLUSIONS: Propionyl-L-carnitine safely improved treadmill exercise performance and enhanced functional status in patients with claudication.
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en nog eentje:

http://www.ncbi.nlm.nih.gov/pubmed/11528327

Med Sci Sports Exerc. 2001 Sep;33(9):1415-22.
Effect of propionyl-L-carnitine on exercise performance in peripheral arterial disease.

CONCLUSIONS: These preliminary data suggest that, in addition to walking performance, muscle strength can be increased in PAD patients after 4 wk of supplementation with propionyl-L-carnitine.
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en nog eentje:
http://www.ncbi.nlm.nih.gov/pubmed/7594063

J Am Coll Cardiol. 1995 Nov 15;26(6):1411-6.
Propionyl-L-carnitine in intermittent claudication: double-blind, placebo-controlled, dose titration, multicenter study.

CONCLUSIONS: Although the precise mode of therapeutic action requires clarification, propionyl-L-carnitine, at a dose of 1 to 2 g/day, appears to be effective and well tolerated, with minimal adverse effects.

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