Carnitine status in Thai adults

Pharmacokinetic Study of Praziquantel Enantiomers and Its Main Metabolite R-trans-4-OH-PZQ in Plasma, Blood and Dried Blood Spots in Opisthorchis viverrini-Infected Patients

BACKGROUND

Praziquantel (PZQ) is the treatment of choice for infections with the liver fluke Opisthorchis viverrini, a major health problem in Southeast Asia. However, pharmacokinetic (PK) studies investigating the disposition of PZQ enantiomers (R- and S-PZQ) and its main metabolite, R-trans-4-OH-PZQ, in diseased patients are lacking. The implementation of a dried blood spot (DBS) sampling technique would ease the performance of PK studies in remote areas without clinical facilities. The aim of the present study is to provide data on the disposition of PZQ enantiomers and R-trans-4-OH-PZQ in opisthorchiasis patients and to validate the use of DBS compared to plasma and blood sampling.

METHODOLOGY/PRINCIPAL FINDINGS

PZQ was administered to nine O. viverrini-infected patients at 3 oral doses of 25 mg/kg in 4 h intervals. Plasma, blood and DBS were simultaneously collected at selected time points from 0 to 24 h post-treatment. PK parameters were determined using non-compartmental analysis. Drug concentrations and areas under the curve (AUC0-24h) measured in the 3 matrices were compared using Bland-Altman analysis. We observed plasma AUC0-24hs of 1.1, 9.0 and 188.7 μg/ml*h and half-lives of 1.1, 3.3 and 6.4 h for R-PZQ, S-PZQ and R-trans-4-OH, respectively. Maximal plasma concentrations (Cmax) of 0.2, 0.9 and 13.9 μg/ml for R-PZQ, S-PQZ and R-trans-4-OH peaked at 7 h for PZQ enantiomers and at 8.7 h for the metabolite. Individual drug concentration measurements and patient AUC0-24hs displayed ratios of blood or DBS versus plasma between 79-94% for R- and S-PZQ, and between 108-122% for R-trans-4-OH.

CONCLUSIONS/SIGNIFICANCE

Pharmacodynamic (PD) in vitro studies on PZQ enantiomers and R-trans-4-OH-PZQ are necessary to be able to correlate PK parameters with efficacy. DBS appears to be a valid alternative to conventional venous sampling for PK studies in PZQ-treated patients.

The effects of acute L-carnitine supplementation on endurance performance of athletes

This study examined the effect of acute L-carnitine loading on the endurance performance of footballers. Measurements were performed on 26 candidate professional footballers who volunteered to take part in the study. Athletes were given a glass of fruit juice 1 hour before applying L-carnitine with the double-blind method. Then, 12 participants were given 3 g of L-carnitine (LK-3) and the remaining 14 were given 4 g (LK-4). Athletes began the exercise test at a running speed of 8 km·h and then continued at 10 km·h. The speed was increased 1 km·h every 3 minutes, and the test continued until the subject chose to quit. Heart rate was registered using a portable telemetric heart rate monitor during the test. Blood samples were taken from the earlobes of the footballers both before the test and before the speed increase (during the 1-minute interval), and the lactate (La) concentration was measured electroenzymatically. The test was repeated after 1 week as a group of placebos (P-3 and P-4). The result showed that the running speeds corresponding to specific La concentrations were increased, and La and heart rate responses to the running speeds were decreased in both supplemented groups compared with placebos (p ≤ 0.05). A significant reduction in heart rate was found in LK-4 and P-4 (p ≤ 0.05). When the Borg responses to the running speeds were analyzed, a significant difference was found in both supplemented groups (p ≤ 0.05). The results show that 3 or 4 g of L-carnitine taken before physical exercise prolonged exhaustion.

Failure of carnitine in improving hepatic nitrogen content in alcoholic and non-alcoholic malnourished rats

AIMS

To investigate the effect of carnitine supplementation on alcoholic malnourished rats' hepatic nitrogen content.

METHODS

Malnourished rats, on 50% protein-calorie restriction with free access to water (malnutrition group) and malnourished rats under the same conditions with free access to a 20% alcohol/water solution (alcohol group) were studied. After the undernourishment period (4 weeks with or without alcohol), both groups were randomly divided into two subgroups, one of them nutritionally recovered for 28 days with free access to a normal diet and water (recovery groups) and the other re-fed with free access to diet and water plus carnitine (0.1 g/g body weight/day by gavage) (carnitine groups). No alcohol intake was allowed during the recovery period.

RESULTS

The results showed: i) no difference between the alcohol/no alcohol groups, with or without carnitine, regarding body weight gain, diet consumption, urinary nitrogen excretion, plasma free fatty acids, lysine, methionine, and glycine. ii) Liver nitrogen content was highest in the carnitine recovery non-alcoholic group (from 1.7 to 3.3 g/100 g, P<0·05) and lowest in alcoholic animals (about 1.5 g/100g). iii) Hepatic fat content (~10 g/100 g, P>·05) was highest in the alcoholic animals.

CONCLUSION

Carnitine supplementation did not induce better nutritional recovery.

Plasma free and total carnitine measured in children by tandem mass spectrometry

Free and total carnitine quantification is important as a complementary test for the diagnosis of unusual metabolic diseases, including fatty acid degradation disorders. The present study reports a new method for the quantification of free and total carnitine in dried plasma specimens by isotope dilution electrospray tandem mass spectrometry with sample derivatization. Carnitine is determined by looking for the precursor of ions of m/z = 103 of N-butylester derivative, and the method is validated by comparison with radioenzymatic assay. We obtained an inter- and intra-day assay coefficient of variation of 4.3 and 2.3, respectively. Free and total carnitine was analyzed in 309 dried plasma spot samples from children ranging in age from newborn to 14 years using the new method, which was found to be suitable for calculating reference age-related values for free and total carnitine (less than one month: 19.3 +/- 2.4 and 23.5 +/- 2.9; one to twelve months: 28.8 +/- 10.2 and 35.9 +/- 11.4; one to seven years: 30.7 +/- 10.3 and 38.1 +/- 11.9; seven to 14 years: 33.7 +/- 11.6, and 43.1 +/- 13.8 micro M, respectively). No difference was found between males and females. A significant difference was observed between neonates and the other age groups. We compare our data with reference values in the literature, most of them obtained by radioenzymatic assay. However, this method is laborious and time consuming. The electrospray tandem mass spectrometry method presented here is a reliable, rapid and automated procedure for carnitine quantitation.

Necessity of carnitine supplementation in semistarved rats fed a high-fat diet

We investigated the effects of carnitine supplementation on lipid metabolism in semistarved rats. The semistarved rats were fed a high-fat diet and half the normal energy intake for 2 wk. Carnitine was supplied daily at a dose of 250 mg/kg of body weight. The results showed that the concentration of plasma free carnitine increased significantly in semistarved and carnitine-supplemented rats compared with normal and semistarved rats. The activities of muscle carnitine palmitoyltransferase I and preheparin plasma lipoprotein lipase also were significantly increased in semistarved and carnitine-supplemented rats. The plasma triacylglycerol secretion rate was restored to normal by carnitine supplementation in semistarved rats. Urinary excretion of ketone bodies was reduced significantly after carnitine supplementation. We concluded that supplementation of carnitine can significantly increase the concentration of plasma free carnitine and improve lipid metabolism in semistarved rats fed a high-fat diet.

Renal conservation of carnitine by infants and adults: no evidence of developmental regulation

To determine the efficiency of renal conservation of carnitine in infants, urinary carnitine excretion was measured at intervals in 10 infants while plasma carnitine concentration was manipulated by supplementing carnitine-free formula with 0 microM, 140 microM and 280 microM L-carnitine. As carnitine supplementation increased from 0 microM to 280 microM, fractional excretion of free carnitine increased tenfold from 0.6% to 6.0%; fractional excretion of acylcarnitine esters increased to a lesser degree (10.5-15.6%). At all supplementation levels fractional excretion of acylcarnitine esters was significantly greater than fractional excretion of free carnitine. We conclude that free and esterified carnitine are handled differently in the infant kidney. Results in infants were compared to previously reported data for adults. Mean fractional excretions of total, free and esterified carnitine by infants (7.2%, 5.4% and 12.7%, respectively) were similar to those by adults (6.5%, 5.0% and 15.0%). Thus, renal losses of carnitine apparently do not account for the low plasma carnitine concentrations observed in infants fed carnitine-free formulas.

Liver function in protein-energy malnutrition measured by cinnamic acid tolerance and benzoic acid tolerance: effect of carnitine supplementation

1. Rats fed on a protein-depleted diet for 8 weeks were repleted for 5 weeks on high-protein (HP), high-protein + 20 g DL-carnitine/kg (HP + C), or low-protein + 20 g DL-carnitine/kg (LP + C) diets. At 4 and 8 weeks of depletion, and 1 and 5 weeks of repletion, rats from each treatment group were given a benzoic acid tolerance test (BATT) or a cinnamic acid tolerance test (CATT) as a measure of liver function. 2. BATT and CATT measured the molar percentage of a test dose (1 mmol/kg body-weight) of benzoic acid or cinnamic acid excreted in the urine as hippuric acid within 24 h. Liver weight, liver lipid levels, and carnitine concentration in plasma and liver were also measured following liver-function testing. 3. BATT and CATT were severely impaired in protein-depleted rats, but returned rapidly to control levels following protein refeeding. Correlations of BATT and CATT with liver lipid concentration were high (r -0.49 and -0.62 respectively), and both tests show promise as clinical tests for liver function in protein-energy malnutrition. 4. Carnitine supplementation was required to return liver carnitine concentration of protein-depleted rats to control levels during repletion, but was not associated with accelerated reduction in liver fat concentration in protein-repleted rats.

Serum carnitine in children with kwashiorkor

Concentrations of free and acylcarnitine were measured in serum of children with kwashiorkor and compared with those obtained for well nourished children of similar age. The mean values (S.E.) for both free and acylcarnitine were significantly lower in the kwashiorkor group [32.6 (6.2) and 8.1 (2.2), respectively] than in the controls [53.2 (2.9) and 13.8 (3.1), respectively]. Serum albumin was also low in kwashiorkor patients, but there was no significant correlation with carnitine values.

Urinary carnitine excretion in surgical patients on total parenteral nutrition

Urinary free and total carnitine excretions were measured in 41 normal adults and seven surgical patients on fat-free total parenteral nutrition for 8 to 45 days. The means (+/-SEM) of urinary free and total carnitine excretion in normal adults were 162 +/- 19 and 328 +/- 28 micrometers/days, respectively. All of the patients exhibited protein-calorie malnutrition with a mean carnitine intake of 11.6 +/- 1.5 micrometers/day. Under this stringent carnitine economy with the adequate supply of lysine and methionine, urinary total carnitine excretion significantly reduced to 127 to 162 micrometers/day. This probably reflects the carnitine biosynthetic rate. However, during the periods of operation and/or infection, urinary total carnitine excretion significantly increased 2- to 7-fold that of normal levels. Significant positive correlation was found between the two forms of urinary carnitine and total nitrogen excretions. Serum free and total carnitine levels in patients were significantly higher than normal adults. Such findings can be explained by the endocrine responses to the stress phenomenon and indicate a catabolic response of skeletal muscle in which most of the body carnitine resides. This can impair their carnitine status.