Inflammation and perturbation of the l-carnitine system in heart failure.
BACKGROUND
Heart failure (HF) is accompanied by elevated levels of pro-inflammatory cytokines. Skeletal muscle myopathy with atrophy of fibres, decreased oxidative metabolism and preferential synthesis of fast myosin heavy chains (MHCs) occurs, which contributes to the worsening of symptoms. l-Carnitine has been shown to be protective against the apoptosis-induced atrophy of fibres and fast MHCs shift.


OBJECTIVE
To investigate the interrelationship between TNFalpha and sphingosine (SPH), which induce muscle wastage, and plasma levels of l-carnitine.


METHODS
We studied 18 heart failure patients and correlated NYHA class and ventricular function with the plasma concentration of these molecules.


RESULTS
TNFalpha and SPH levels were raised and correlated with the severity of HF. l-Carnitine levels were increased in HF patients, but decreased according to the severity of cardiac decompensation.


CONCLUSIONS
The increased levels of l-carnitine are likely due to release from the damaged muscle, reduced urinary excretion, decreased dietary intake and liver synthesis (malnutrition). It is possible that the cytokine-induced muscle wastage is not counterbalanced by the beneficial metabolic effects of l-carnitine, the metabolism of which is profoundly perturbed in CHF. l-Carnitine supplementation may produce positive effects on the skeletal muscle, as has been shown in animal models of HF.
Vescovo
Giorgio
G
Internal Medicine 1, S. Bortolo Hospital Vicenza, Italy. ldl@bio.unipd.it
Ravara
Barbara
B
Gobbo
Valerio
V
Dalla Libera
Luciano
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002331:Carnitine / Q000032:analysis / Q000378:metabolism*; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013110:Sphingosine / Q000032:analysis / Q000378:metabolism*; D013318:Stroke Volume / Q000502:physiology*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000378:metabolism*
D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha; D013110:Sphingosine; D002331:Carnitine