Antimyopathic effects of carnitine and nicotine.
OBJECTIVE
The clinical course of most chronic diseases is associated with declined energy intake and nutrient-resistant progressive myopathy, characterized by accelerated proteolysis and impaired function. This anorexia/cachexia syndrome leads to deterioration of quality of life, and increased morbidity and mortality. The clinical efficacy of currently available therapeutic strategies is limited and more effective treatments are needed.


RESULTS
Chronic systemic inflammation, triggered and sustained by cytokines, and increased oxidative stress contribute to the pathogenesis of the anorexia/cachexia syndrome. Carnitine and nicotine have recently been tested as immunomodulating and antioxidant agents. In particular, carnitine supplementation has been shown to reduce chronic inflammation and oxidative stress in hemodialysis patients and, in cancer patients, yielding to reduced fatigue and improved outcome. Nicotine is able to induce the anti-inflammatory activity of the vagus nerve. In animal models of sepsis and cancer, the nicotine-induced supplementation resulted in better protection of nutritional status and improved survival.


CONCLUSIONS
In the continuous effort to develop more efficacious strategies against the anorexia/cachexia syndrome, carnitine and nicotine may represent a further therapeutic tool. More clinical studies are needed, however, before their use can be routinely suggested.
Laviano
Alessandro
A
Department of Clinical Medicine, University La Sapienza, Rome, Italy. alessandro.laviano@uniroma1.it
Meguid
Michael M
MM
Guijarro
Ana
A
Muscaritoli
Maurizio
M
Cascino
Antonia
A
Preziosa
Isabella
I
Molfino
Alessio
A
Rossi Fanelli
Filippo
F
D000818:Animals; D000855:Anorexia / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy; D002100:Cachexia / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy; D002331:Carnitine / Q000627:therapeutic use*; D002149:Energy Intake / Q000187:drug effects / Q000502:physiology; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy; D009017:Morbidity; D009369:Neoplasms / Q000150:complications / Q000378:metabolism / Q000628:therapy; D009538:Nicotine / Q000627:therapeutic use*; D011788:Quality of Life; D014803:Vitamin B Complex / Q000627:therapeutic use*
D014803:Vitamin B Complex; D009538:Nicotine; D002331:Carnitine