Propionyll-carnitine: intermittent claudication and peripheral arterial disease

Abstract

Peripheral arterial disease (PAD) is a clinical manifestation of underlying aorto-iliac and leg atherosclerosis that is characterized by different stages of stenosis and obstruction. It affects approximately 12% of the adult population and about 20% of people over the age of 70 years, and is associated with increased cardiovascular (CV) and cerebrovascular morbidity. Intermittent claudication (IC) is the major symptom of PAD; it is defined as cramping leg pain (in the buttock, thigh, or calf) while/after clim bing one or two flights of stairs, or during walking. The goals of IC management are to: slow the progression of local and systemic atherosclerosis, prevent major fatal and nonfatal CV events (myocardial infarction and stroke), improve walking capacity, prevent and reduce resting pain and cutaneous lesions. Propionyl L-carnitine is an acyl derivative of levocarnitine (L-carnitine) and is indicated for patients with peripheral arterial occlusive disease. It corrects secondary muscle carnitine deficiency in patients with PAD, significantly improving the walking capacity; it is a free radical that produces positive effects on endothelial function; it protects from oxidative stress; and it enhances most measures of quality of life. The recent Trans-Atlantic Inter-Society Consensus II update recommends the use of propionyl L-carnitine in combination with physical training to improve the symptoms associated with PAD.

The pretransplant systemic metabolic profile reflects a risk of acute graft versus host disease after allogeneic stem cell transplantation

“…Propionylcarnitine have effects on endothelial cells and may thereby influence the trafficking of immunocompetent cells (Andreozzi 2009; Malaguarnera 2012). …”

“…Oral propyonyl-L-carnitine has been tried in the treatment of human diseases (Andreozzi 2009; Malaguarnera 2012), mainly cardiovascular disease, but it has also shown beneficial effects in a randomized, double-blind, placebo-controlled study of patients with ulcerative colitis, i.e. an autoimmune disease (Mikhailova et al 2011).…”

<i>L</i>-Carnitine Treatment in Patients with Mild Diastolic Heart Failure Is Associated with Improvement in Diastolic Function and Symptoms

“…The clinical effect of L -carnitine treatment has been documented in patients with peripheral vascular disease. It has been shown to correct secondary muscle L -carnitine deficiency in patients with peripheral vascular disease, significantly improving walking capacity [25]. There have been several studies evaluating L -carnitine treatment in cardiovascular diseases and heart failure [26].…”

Critical update for the clinical use of L-carnitine analogs in cardiometabolic disorders

“…In contrast, the effects of ALC on PAD have been poorly evaluated. Some reviews focused on these effects are the main sources considered in the present analysis 26,27,29…”

“…Wiseman and Brogden concluded that PLC had no direct vasoactive effects in patients with IC 29. However, other scholars mentioned the capacity of PLC to improve endothelial function,26,42 and some years later, Andreozzi gathered clinical evidence demonstrating the beneficial effects of PLC treatment on the vasculature of patients with PAD 27. More precisely, this recent review concluded that PLC has an ability to enhance flow mediated dilatation (FMD) in the brachial artery,43 even when impaired post-exercise 44.…”