Is Oral l-Acyl-Carnitine an Effective Therapy for Hepatic Encephalopathy? Review of the Literature

Abstract

Hepatic encephalopathy (HE) is a significant cause of morbidity and mortality in patients with advanced chronic liver disease. Current therapies are associated with inconvenient side-effects, high cost, and incomplete efficacy. The quanternary ammonium compound L-acyl-carnitine has been suggested as a potent, low-cost, and safe alternative therapy for patients with cirrhosis and HE. A systematic review of the literature assessing the use of carnitine in the treatment of HE identified three high-quality human trials for review. Analysis of the selected carnitine trials compared to currently accepted therapies suggests that L-acyl-carnitine is promising as a safe and effective treatment for HE, and further trials of this drug are warranted.

Role of carnitine in disease

“…L-acyl-carnitine has been suggested as a potent, low-cost, and safe alternative therapy for patients with cirrhosis [58]. Minimal hepatic encephalopathy (MHE) is a serious and common complication that occurs in the majority of cirrhotic patients [59].…”

“…Hepatic encephalopathy (HE) is a significant cause of morbidity and mortality in advanced cirrhotic patients [58]. Although the mechanisms by which carnitine provides neurological protection are unknown, a systematic review of the literature confirmed that L-acyl-carnitine is promising as a safe and effective treatment for HE [58].…”

“…Although the mechanisms by which carnitine provides neurological protection are unknown, a systematic review of the literature confirmed that L-acyl-carnitine is promising as a safe and effective treatment for HE [58]. One suggested mechanism of carnitine action is its reduction of serum ammonia levels leading to improved psychometric measures [63-65].…”

Hepatic encephalopathy in dogs and cats

“…These include prevention of glutamate‐mediated neurotoxicity in N‐methyl‐D‐aspartate type glutamine receptors. A systematic review identified three high quality clinical trials assessing the efficacy of L‐carnitine in treating HE . These studies reported positive effects such as decreased serum ammonia concentrations and improved neuropsychological test scores in comparison to accepted therapies.…”

Reevaluation of Serum Carnitine Status in Patients with Liver Cirrhosis

“…10,11,15 Additionally, since ALC acts as a direct antioxidant, ALC supplementation has been shown to be effective in inhibiting oxidative stress and death in rat models of dementia and chronic ischemia. [16][17][18][19] However, in the clinical studies in LC patients with MHE or OHE-except for a report by Saito et al…”