Acetyl-L-carnitine for the treatment of diabetic peripheral neuropathy

Abstract

Background Diabetic peripheral neuropathy (DPN) is a common and severe complication that a ects 50% of people with diabetes. Painful DPN is reported to occur in 16% to 24% of people with diabetes. A complete and comprehensive management strategy for the prevention and treatment of DPN, whether painful or not, has not yet been defined. Research into treatment for DPN has been characterised by a series of failed clinical trials, with few noteworthy advances. Strategies that support peripheral nerve regeneration and restore neurological function in people with painful or painless DPN are needed. The amino acid acetyl-L-carnitine (ALC) plays a role in the transfer of long-chain fatty acids into mitochondria for β-oxidation. ALC supplementation also induces neuroprotective and neurotrophic e ects in the peripheral nervous system. Therefore, ALC supplementation targets several mechanisms relevant to potential nerve repair and regeneration, and could have clinical therapeutic potential. There is a need for a systematic review of the evidence from clinical trials. Objectives To assess the e ects of ALC for the treatment of DPN. Search methods On 2 July 2018, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. We checked references, searched citations, and contacted study authors to identify additional studies. Selection criteria We included randomised controlled trials (RCTs) and quasi-RCTs of ALC compared with placebo, other therapy, or no intervention in the treatment of DPN. Participants could be of any sex and age, and have type 1 or type 2 diabetes mellitus, of any severity, with painful or painless DPN. We accepted any definition of minimum criteria for DPN, in accordance with the Toronto Consensus. We imposed no language restriction. Pain was the primary outcome, measured as the proportion of participants with at least 30% (moderate) or 50% (substantial) decrease in pain over baseline, or as the score on a visual analogue scale (VAS) or Likert scale for pain. Acetyl-L-carnitine for the treatment of diabetic peripheral neuropathy (Review)

Carnitine and Depression

“…The decreased concentrations of BDNF ( 89 ), glial cell line-derived neurotrophic factor (GDNF), Artemin (ARTN) ( 90 ), nerve growth factor (NGF) ( 91 ), and vascular endothelial growth factor (VEGF) ( 92 ) are a good repetitive finding in depression. Supplementation of LAC can induce neuroprotective and neurotrophic effects of the peripheral nervous system by increasing the level of brain-derived neurotrophic factor (BDNF), especially in the hippocampus and prefrontal cortex ( 93 – 95 ). Meanwhile, it could promote the growth of dendrites and increase the number of intersections in the medial amygdala ( 82 ).…”

A UPLC–MS/MS method for determination of endogenous l‐carnitine and acetyl‐l‐carnitine in serum of patients with depression

“…ALC exhibits a variety of physiological activities, including nutritional effects, neuroprotective effects, analgesic effects of the peripheral nervous system, antioxidant effects, and plays important roles in the functioning of male reproductive system. Commercially, ALC‐based drugs are mainly used to improve male fertility, treat Alzheimer’s disease, hepatic encephalopathy, depression, and diabetic peripheral neuropathy (Anikin, Makhova, & Shikh, 2019; Di Stefano, Di Lionardo, Galosi, Truini, & Cruccu, 2019; Gamidov, Ovchinnikov, & Popova, 2019; Jeong et al, 2017; Ponomareva, 2017; Rolim, da Silva, Flumignan, Abreu, & Dib, 2019).…”

Oltipraz Prevents High Glucose-Induced Oxidative Stress and Apoptosis in RSC96 Cells through the Nrf2/NQO1 Signalling Pathway

“…Peripheral neuropathy is the most common complication of diabetes, with a prevalence of up to 50% in diabetic patients [2][3][4][5]. Several drugs have been reported to be less effective, such as oxcarbazepine and acetyl L-carnitine [33][34][35]. Therefore, we still need to find more effective treatments.…”