The current increase in cardiovascular and cerebrovascular morbidity is a growing burden for society. Consideration must therefore be given to compounds capable of slowing down these pathological processes without significant adverse effects. The natural vitamins pantetheine/pantothenic acid are major precursors of coenzyme A and acyl carrier protein, which are essential for fatty acid oxidation and participate in the metabolism of cholesterol and carbohydrates and in at least 70 other enzymatic processes. Following a number of theoretical considerations and clinical observations, various clinical studies have revealed that they possess significant beneficial effects. In particular, they demonstrate useful moderating effects on vascular pathological processes, lowering lipid levels, and inhibiting platelet functions and lipid peroxidation. Although they are natural, well-tolerated therapeutic agents, few controlled clinical trials have been conducted. The available data suggest the need for larger clinical trials and possible use of pantetheine/pantothenic acid as adjuvant therapy.
BiosynthesisPantetheine/pantothenic acid (also called vitamin B 5 ) belong to the vitamin B group. The names originate from the Greek word pantothen (Pantoyen), meaning ''from everywhere,'' because small quantities of pantetheine are found in nearly every form of food, with high amounts in whole-grain cereals, legumes, eggs, and meat. Pantetheine was described first as Lactobacillus bulgaricus growth factor.1 It was later proven that it is essential for eukaryotic cells and also as a precursor of coenzyme A. 2,3 Pantethine is the stable dimeric form of pantetheine; the 2 monomers are linked by a disulfide bond. After the oral or parenteral intake of pantethine, this disulfide bond is cleaved by glutathione reductase in the membranes of the small intestine or the blood. Within most foods, pantetheine is present in the form of coenzyme A or acyl carrier protein. For this vitamin to be absorbed, it must be converted into free pantothenic acid. Within the lumen of the intestine, coenzyme A and acyl carrier protein are first hydrolyzed to 4 0 -phosphopantetheine, which is then dephosphorylated to pantetheine. Pantetheinase, an intestinal enzyme, next hydrolyzes pantetheine to give free pantothenic acid. 4 Free pantothenic acid is absorbed in the intestinal cells via a sodium-dependent active transport system or via passive diffusion. After absorption, 4 0 -phosphopantetheine is reformed by the action of pantothenate kinase, after which ribose and adenine molecules link to it in the mitochondria to create coenzyme A or bind to acyl carrier protein 5 (see Figures 1-4).The enzymatic catabolism of pantethine takes place in the lysosomes of the hepatocytes, where its enzymatic cleavage produces cysteamine (and later taurine) and pantothenic acid.Coenzyme A and acyl carrier protein function as acyl or acetyl carriers. Coenzyme A facilitates the transfer of acetyl groups from pyruvate to oxaloacetate, thereby initiating the Szent-Györgyi...