L-Carnitine in the treatment of fatigue in adult celiac disease patients: a pilot study.
BACKGROUND
Fatigue is common in celiac disease. L-Carnitine blood levels are low in untreated celiac disease. L-Carnitine therapy was shown to improve muscular fatigue in several diseases.


OBJECTIVE
To evaluate the effect of L-carnitine treatment in fatigue in adult celiac patients.


METHODS
Randomised double-blind versus placebo parallel study. Thirty celiac disease patients received 2 g daily, 180 days (L-carnitine group) and 30 were assigned to the placebo group (P group). The patients underwent clinical investigation and questionnaires (Scott-Huskisson Visual Analogue Scale for Asthenia, Verbal Scale for Asthenia, Zung Depression Scale, SF-36 Health Status Survey, EuroQoL). OCTN2 levels, the specific carnitine transporter, were detected in intestinal tissue.


RESULTS
Fatigue measured by Scott-Huskisson Visual Analogue Scale for Asthenia was significantly reduced in the L-carnitine group compared with the placebo group (p=0.0021). OCTN2 was decreased in celiac patients when compared to normal subjects (-134.67% in jejunum), and increased after diet in both celiac disease treatments. The other scales used did not show any significant difference between the two celiac disease treatment groups.


CONCLUSIONS
L-Carnitine therapy is safe and effective in ameliorating fatigue in celiac disease. Since L-carnitine is involved in muscle energy production its decreased absorption due to OCTN2 reduction might explain muscular symptoms in celiac disease patients. The diet-induced OCTN2 increase, improving carnitine absorption, might explain the L-carnitine treatment efficacy.
Ciacci
C
C
Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy. ciacci@unina.it
Peluso
G
G
Iannoni
E
E
Siniscalchi
M
M
Iovino
P
P
Rispo
A
A
Tortora
R
R
Bucci
C
C
Zingone
F
F
Margarucci
S
S
Calvani
M
M
D000284:Administration, Oral; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D002331:Carnitine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D002851:Chromatography, High Pressure Liquid; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004591:Electrophoresis, Polyacrylamide Gel; D005221:Fatigue / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000378:metabolism / Q000473:pathology; D008297:Male; D027701:Organic Cation Transport Proteins / Q000378:metabolism; D010865:Pilot Projects; D011788:Quality of Life; D000074058:Solute Carrier Family 22 Member 5; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*
D015415:Biomarkers; D027701:Organic Cation Transport Proteins; C492020:SLC22A5 protein, human; D000074058:Solute Carrier Family 22 Member 5; D014803:Vitamin B Complex; D002331:Carnitine