Efficacy of L-carnitine administration on fatigue, nutritional status, oxidative stress, and related quality of life in 12 advanced cancer patients undergoing anticancer therapy

Department of Medical Oncology, University of Cagliari, Monserrato, Italy.
Nutrition (Impact Factor: 2.93). 03/2006; 22(2):136-45. DOI: 10.1016/j.nut.2005.06.003
Source: PubMed


Fatigue is a multidimensional symptom that is described in terms of perceived energy, mental capacity, and psychological status: it can impair daily functioning and lead to negative effects on quality of life. It is one of the most common side effects of chemotherapy and radiotherapy. In recent studies, l-carnitine (LC) supplementation has been demonstrated to be able to improve fatigue symptoms in patients with cancer.
In the present study we tested the efficacy and safety of LC supplementation in a population of patients who had advanced cancer and developed fatigue, high blood levels of reactive oxygen species, or both. As outcome measures we evaluated fatigue and quality of life in relation to oxidative stress, nutritional status, and laboratory variables, mainly levels of reactive oxygen species, glutathione peroxidase, and proinflammatory cytokines. From March to July 2004, 12 patients who had advanced tumors (50% at stage IV) at different sites were enrolled (male-to-female ratio 2:10, mean age 60 y, range 42-73). Patients were only slightly anemic (hemoglobin 10.9 g/dL) and hemoglobin levels did not change after treatment. LC was administered orally at 6 g/d for 4 wk. All patients underwent antineoplastic treatment during LC supplementation.
Fatigue, as measured by the Multidimensional Fatigue Symptom Inventory-Short Form, decreased significantly, particularly for the General and Physical scales, and for quality of life in each subscale of quality of life in relation to oxidative stress. Nutritional variables (lean body mass and appetite) increased significantly after LC supplementation. Levels of reactive oxygen species decreased and glutathione peroxidase increased but not significantly. Proinflammatory cytokines did not change significantly.
Improvement of symptoms with respect to fatigue and quality of life in relation to oxidative stress may be explained mainly by an increase in lean body mass, which may be considered the most important nutritional or functional parameter in assessing the cachectic state of patients. In this view, fatigue with related symptoms can well be considered an important constituent of cancer-related anorexia cachexia syndrome.

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Available from: Giovanni Mantovani, Oct 02, 2015
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    • "For instance, studies suggest that cancer cachexia, which includes anorexia, weight loss, muscle loss, skeletal muscle atrophy, anemia, and alterations in carbohydrate, lipid, and protein metabolism [135], is associated with a decrease in intracellular glutathione concentration in the muscle [136–138], and L-carnitine supplementation increases the tumor-induced decrease in muscular glutamate and glutathione levels at least in animal models [136]. Gramignano et al. [139], studying the efficacy of L-carnitine supplementation (6 g/day for 4 weeks) in a population of advanced cancer patients, found a decreased ROS and increased glutathione peroxidase levels. Promising antioxidant activities have been also found following supplementation in patients with nonalcoholic steatohepatitis [140], renal disease [141], and phenylketonuria [142], as well as in several experimental models of oxidative stress [143–146]. "
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    ABSTRACT: Myopathies are chronic degenerative pathologies that induce the deterioration of the structure and function of skeletal muscle. So far a definitive therapy has not yet been developed and the main aim of myopathy treatment is to slow the progression of the disease. Current nonpharmacological therapies include rehabilitation, ventilator assistance, and nutritional supplements, all of which aim to delay the onset of the disease and relieve its symptoms. Besides an adequate diet, nutritional supplements could play an important role in the treatment of myopathic patients. Here we review the most recent in vitro and in vivo studies investigating the role supplementation with creatine, L-carnitine, and ω3 PUFAs plays in myopathy treatment. Our results suggest that these dietary supplements could have beneficial effects; nevertheless continued studies are required before they could be recommended as a routine treatment in muscle diseases.
    BioMed Research International 08/2014; 2014:613890. DOI:10.1155/2014/613890 · 2.71 Impact Factor
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    • "Rationale for treatment plan The agents included in our combined treatment approach have been selected on the basis of our previously published studies carried out in patients with cancer cachexia [11] [12] with the following rationale. L-Carnitine plays a pivotal role in modulating cell energy metabolism [13]. The cyclooxygenase-2 inhibitor celecoxib is able to inhibit the inflammatory process and has an effect on weight loss [14]. "
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    ABSTRACT: Objectives Myelofibrosis (MF) is characterized by shortened survival and a greatly compromised quality of life. Weight loss and cachexia seem to be the most important factors influencing survival in myelofibrosis patients. We aimed to assess the efficacy of an integrated supportive therapy in improving cachexia and MF-related symptoms. Methods We report a case of a single MF patient who presented weight loss and cachexia associated with severe anemia, fatigue, fever and bone pain. The circulating levels of inflammatory, oxidative stress parameters, hepcidin and erythropoietin were evaluated and were above normal ranges. The patient was treated with a multitargeted approach specifically developed for cachexia including oral L-carnitine, celecoxib, curcumin, lactoferrin and subcutaneous recombinant human erythropoietin (EPO)-α. Results Surprisingly, after 1 year, the protocol obtained in addition to improving cachexia features, the remission of all MF symptoms, associated with a reduction of inflammatory, oxidative stress parameters, hepcidin and EPO. Conclusions Since our protocol was targeted to inflammation and the metabolic state, its effectiveness may emphasize the role of inflammation in the pathogenesis of MF symptoms and gives a hint for the study of new integrated therapeutic strategies.
    Nutrition 08/2014; 31(1). DOI:10.1016/j.nut.2014.07.016 · 2.93 Impact Factor
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    • "Amino acid supplementation has been shown to stimulate the immune system [9,10], enhance recovery of the critically ill [11] and maintain gut function [12] as well as alleviate symptoms of CFS [5] and CRF [13]. During exercise, supplementation with branched chain amino acids (BCAAs) has been shown to improve performance, possibly through a reduction in fatigue [14]. "
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    ABSTRACT: A new dietary supplement, Fatigue RevivaTM, has been recently developed to address issues related to amino acid depletion following illness or in conditions of sub-health where altered amino acid homeostasis has been associated with fatigue. Complex formulations of amino acids present significant challenges due to solubility and taste constraints. This initial study sets out to provide an initial appraisal of product palatability and to gather pilot evidence for efficacy. Males reporting symptoms of sub-health were recruited on the basis of being free from any significant medical or psychological condition. Each participant took an amino acid based dietary supplement (Fatigue RevivaTM) daily for 30 days. Comparisons were then made between pre- and post-supplement general health symptoms and urinary amino acid profiles. Seventeen men took part in the study. Following amino acid supplementation the total Chalder fatigue score improved significantly (mean +/- SEM, 12.5 +/- 0.9 versus 10.0 +/- 1.0, P<0.03). When asked whether they thought that the supplement had improved their health, 65% of participants responded positively. A subgroup of participants reported gastrointestinal symptoms which were attributed to the supplement and which were believed to result from the component fructooligosaccharide. Analysis of urinary amino acids revealed significant alterations in the relative abundances of a number of amino acids after supplementation including an increase in valine, isoleucine and glutamic acid and reduced levels of glutamine and ornithine. Discriminant function analysis of the urinary amino acid data revealed significant differences between the pre- and post-supplement urine excretion profiles. The results indicated that Fatigue RevivaTM was palatable and that 65% of the study group reported that they felt the product had improved their health. The product could provide an effective tool for the management of unexplained fatigue and symptoms of sub-health. Further product development may yield additional options for those patients susceptible to fructooligosaccharide.
    Nutrition Journal 08/2013; 12(1):115. DOI:10.1186/1475-2891-12-115 · 2.60 Impact Factor
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