Mechanisms of Ischemic Neuroprotection by Acetyl-l-carnitine

Department of Anesthesiology, University of Maryland, Baltimore, Baltimore, Maryland, United States
Annals of the New York Academy of Sciences (Impact Factor: 4.38). 09/2005; 1053(1):153-61. DOI: 10.1196/annals.1344.013
Source: PubMed


Acetyl-L-carnitine is a naturally occurring substance that, when administered at supraphysiologic concentrations, is neuroprotective in several animal models of global and focal cerebral ischemia. Three primary mechanisms of action are supported by neurochemical outcome measures performed with these models and with in vitro models of acute neuronal cell death. The metabolic hypothesis is based on the oxidative metabolism of the acetyl component of acetyl-L-carnitine and is a simple explanation for the reduction in postischemic brain lactate levels and elevation of ATP seen with drug administration. The antioxidant mechanism is supported by reduction of oxidative stress markers, for example, protein oxidation, in both brain tissue and cerebrospinal fluid. The relatively uncharacterized mechanism of inhibiting excitotoxicity could be extremely important in both acute brain injury and chronic neurodegenerative disorders. New experiments performed with primary cultures of rat cortical neurons indicate that the presence of acetyl-L-carnitine significantly inhibits both acute and delayed cell death following exposure to NMDA, an excitotoxic glutamate antagonist. Finally, several other mechanisms of action are possible, including a neurotrophic effect of acetyl-L-carnitine and inhibition of mitochondrial permeability transition. While the multiple potential mechanisms of neuroprotection by acetyl-L-carnitine limit an accurate designation of the most important mode of action, they are compatible with the concept that several brain injury pathways must be inhibited to optimize therapeutic efficacy.

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    • "L-carnitine, an antioxidant dietary supplement, plays an integral role in attenuating brain injury associated with mitochondrial neurodegenerative disorders (Liu et al., 2013; Zou et al., 2008). It has been reported that L-carnitine provides neuroprotective benefits in neurodegenerative and aging situations (Abdul and Butterfield, 2007; Abdul et al., 2006; Ishii et al., 2000; Zanelli et al., 2005). In this study, acetyl-L-carnitine (L-Ca; a more active agent in biological systems than carnitine itself) was utilized to evaluate the potential protective ability of antioxidants, associated with propofol administration. "
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    ABSTRACT: Propofol is a widely used general anesthetic. A growing body of data suggests that perinatal exposure to general anesthetics can result in long-term deleterious effects on brain function. In the developing brain there is evidence that general anesthetics can cause cell death, synaptic remodeling, and altered brain cell morphology. Acetyl-L-carnitine (L-Ca), an anti-oxidant dietary supplement, has been reported to prevent neuronal damage from a variety of causes. To evaluate the ability of L-Ca to protect against propofol-induced neuronal toxicity, neural stem cells were isolated from gestational day 14 rat fetuses and on the eighth day in culture were exposed for 24 hr to propofol at 10, 50, 100, 300 and 600μM, with or without L-Ca (10μM). Markers of cellular proliferation, mitochondrial health, cell death/damage and oxidative damage were monitored to determine: 1) the effects of propofol on neural stem cell proliferation; 2) the nature of propofol-induced neurotoxicity; 3) the degree of protection afforded by L-Ca; and 4) to provide information regarding possible mechanisms underlying protection. After propofol exposure at a clinically-relevant concentration (50μM), the number of dividing cells was significantly decreased, oxidative DNA damage was increased and a significant dose-dependent reduction in mitochondrial function/health was observed. No significant effect on lactase dehydrogenase (LDH) release was observed at propofol concentrations up to 100μM. The oxidative damage at 50μM propofol was blocked by L-Ca. Thus, clinically-relevant concentrations of propofol induce dose-dependent adverse effects on rat embryonic neural stem cells by slowing or stopping cell division/proliferation and causing cellular damage. Elevated levels of 8-oxoguanine suggest enhanced oxidative damage [reactive oxygen species (ROS) generation] and L-Ca effectively blocks at least some of the toxicity of propofol, presumably by scavenging oxidative species and/or reducing their production.
    NeuroToxicology 04/2014; 42. DOI:10.1016/j.neuro.2014.03.011 · 3.38 Impact Factor
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    • "Moreover, NAC has been found to reduce expression of ED1 in activated microglial cells and macrophages [71]. ALC could also reduce inflammatory reactions in the brain by lowering circulating levels of TNF-alpha and interleukins [72]. Recently, a new role of mitochondria in inflammatory response has been identified [73]. "
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    ABSTRACT: Following the initial acute stage of spinal cord injury, a cascade of cellular and inflammatory responses will lead to progressive secondary damage of the nerve tissue surrounding the primary injury site. The degeneration is manifested by loss of neurons and glial cells, demyelination and cyst formation. Injury to the mammalian spinal cord results in nearly complete failure of the severed axons to regenerate. We have previously demonstrated that the antioxidants N-acetyl-cysteine (NAC) and acetyl-L-carnitine (ALC) can attenuate retrograde neuronal degeneration after peripheral nerve and ventral root injury. The present study evaluates the effects of NAC and ALC on neuronal survival, axonal sprouting and glial cell reactions after spinal cord injury in adult rats. Tibial motoneurons in the spinal cord were pre-labeled with fluorescent tracer Fast Blue one week before lumbar L5 hemisection. Continuous intrathecal infusion of NAC (2.4 mg/day) or ALC (0.9 mg/day) was initiated immediately after spinal injury using Alzet 2002 osmotic minipumps. Neuroprotective effects of treatment were assessed by counting surviving motoneurons and by using quantitative immunohistochemistry and Western blotting for neuronal and glial cell markers 4 weeks after hemisection. Spinal cord injury induced significant loss of tibial motoneurons in L4-L6 segments. Neuronal degeneration was associated with decreased immunostaining for microtubular-associated protein-2 (MAP2) in dendritic branches, synaptophysin in presynaptic boutons and neurofilaments in nerve fibers. Immunostaining for the astroglial marker GFAP and microglial marker OX42 was increased. Treatment with NAC and ALC rescued approximately half of the motoneurons destined to die. In addition, antioxidants restored MAP2 and synaptophysin immunoreactivity. However, the perineuronal synaptophysin labeling was not recovered. Although both treatments promoted axonal sprouting, there was no effect on reactive astrocytes. In contrast, the microglial reaction was significantly attenuated. The results indicate a therapeutic potential for NAC and ALC in the early treatment of traumatic spinal cord injury.
    PLoS ONE 07/2012; 7(7):e41086. DOI:10.1371/journal.pone.0041086 · 3.23 Impact Factor
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    • "Increasing mitochondrial antioxidant activities by elevating mitochondrial reducing power is considered as an important mechanism of neuroprotection by several naturally occurring compounds, including ketone bodies, pyruvate, and acyl-carnitines (Ryu et al, 2004; Zanelli et al, 2005; Gasior et al, 2006; Zhao et al, 2006b; Jarrett et al, 2008; Rosca et al, 2009; Alves et al, 2009; Jones et al, 2010; Zhang et al, 2010). This mechanism of action might be particularly important during reperfusion after cerebral ischemia, when the mitochondrial redox state is hyperoxidized, ROS production is elevated, and there are increased markers of oxidative molecular modification (Perez-Pinzon et al, 1999; Fiskum et al, 2004). "
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    ABSTRACT: Mitochondrial dysfunction contributes to the pathophysiology of acute neurologic disorders and neurodegenerative diseases. Bioenergetic failure is the primary cause of acute neuronal necrosis, and involves excitotoxicity-associated mitochondrial Ca(2+) overload, resulting in opening of the inner membrane permeability transition pore and inhibition of oxidative phosphorylation. Mitochondrial energy metabolism is also very sensitive to inhibition by reactive O(2) and nitrogen species, which modify many mitochondrial proteins, lipids, and DNA/RNA, thus impairing energy transduction and exacerbating free radical production. Oxidative stress and Ca(2+)-activated calpain protease activities also promote apoptosis and other forms of programmed cell death, primarily through modification of proteins and lipids present at the outer membrane, causing release of proapoptotic mitochondrial proteins, which initiate caspase-dependent and caspase-independent forms of cell death. This review focuses on three classifications of mitochondrial targets for neuroprotection. The first is mitochondrial quality control, maintained by the dynamic processes of mitochondrial fission and fusion and autophagy of abnormal mitochondria. The second includes targets amenable to ischemic preconditioning, e.g., electron transport chain components, ion channels, uncoupling proteins, and mitochondrial biogenesis. The third includes mitochondrial proteins and other molecules that defend against oxidative stress. Each class of targets exhibits excellent potential for translation to clinical neuroprotection.
    Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism 03/2012; 32(7):1362-76. DOI:10.1038/jcbfm.2012.32 · 5.41 Impact Factor
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