Influence of ?-carnitine and its derivatives on myocardial metabolism and function in ischemic heart disease and during cardiopulmonary bypass

Abstract

Carnitine and its derivatives have recently been shown to protect cardiac metabolism and function in ischemic heart disease and other clinical conditions of myocardial ischemia. Potential mechanisms of this effect include an increase in glucose metabolism, a reduction of toxic effects of long-chain acyl-CoA and acyl-carnitine in myocytes, an increase in coronary blood flow and anti-arrhythmic effect. It has also been shown that propionyl-L-carnitine which penetrates faster than carnitine into myocytes is effective in inhibiting production of free radicals. Beneficial effects of carnitine supplementation have been demonstrated under a variety of clinical conditions such as acute cardiac ischemia, during extracorporeal circulation, in carnitine-dependent cardiomyopathy as well as in patients with chronic circulatory failure and in cardiogenic shock. However, further studies are required before carnitine administration could be recommended as a routine procedure in ischemic heart disease or before cardiopulmonary bypass.

Preventive cytoprotection in social diseases

“…Механизм действия карнитина связан с усилением метаболизма глюкозы, ограничением токсического влия-ния недоокисленных СЖК, длинноцепочечных ацетил-коэнзима А и ацетил-карнитина на кардиомиоциты, а также с интенсификацией кровотока в венечных сосудах [14]. Комбинированный метаболический препарат, со-держащий в себе L-карнитин и пропионат, в условиях клеточной и тканевой гипоксии, вызванной ишемией ми-окарда, помогает осуществлению энергетических процес-сов цикла трикарбоновых кислот (цикла Кребса) за счет легко метаболизируемого пропионата, который быстро трансформируется в сукцинат, не требуя дополнительно-го энергообеспечения [15].…”

Metabolic Modulators to Treat Cardiac Arrhythmias Induced by Ischemia and Reperfusion

“…It participates in metabolism of branched chain amino acids (Lango et al, 2001). Supplementation of the myocardium with L-Car results in an increased tissue carnitine content which restores carnitine losses and lessens the severity of ischemic injury.…”

“…Increased glucose oxidation is beneficial for cardiac cells because of a lower conversion of pyruvate into lactate, a metabolic step contributing to acidification of the intracellular compartment. Finally, L-Car have been proposed to mitigate the noxious effects of oxygen free radicals in the reperfused hearts and to render cardiac cells more resistant to I/R damage by stabilizing cellular membranes (Lango et al, 2001, Calvani et al, 2000.…”

Role and Location of L-Carnitine in Cytoprotection and Correction of Metabolic Processes in Patients With Metabolic Syndrome

“…К настоящему времени накоплен опре-деленный опыт применения L-карнитина у пациентов с различными формами ИБС и кардиомиопатиями [36][37][38][39][40].…”

“…Большое значение имеет предупреждение под влия-нием L-карнитина фатальных аритмий, спровоцирован-ных ишемией миокарда и дисметаболическими наруше-ниями [37,38,47].…”