title: Effect of L-carnitine on oxidative stress and platelet activation after major surgery.
abstract: BACKGROUND
  The surgical/anesthesia trauma is associated with an increased production of reactive oxygen species (ROS). This enhanced oxidative stress leads to cell damage resulting in various complications such as sepsis, myocardial injury and increased mortality. The aim of this study was to investigate the role of antioxidant treatment with l-carnitine in oxidative stress and platelet activation in patients undergoing major abdominal surgery.
  
  
  METHODS
  Forty patients scheduled for abdominal surgery were randomly allocated to l-carnitine, administered with a rapid infusion (0.05 g/kg) diluted in 250 ml of saline solution, vs. placebo treatment just before the surgical intervention. At baseline and after treatment, oxidative stress was evaluated by detection of circulating levels of soluble NOX2-derived peptide (sNOX2-dp), a marker of NADPH oxidase activation, and by analyzing platelet ROS formation. Platelet activation was studied by dosing sCD40L.
  
  
  RESULTS
  We observed an increase of soluble sNOX2-dp, sCD40L and ROS production in the placebo group compared with the baseline after the surgical intervention. Conversely, in the l-carnitine-treated group, sNOX2-dp, sCD40L and ROS production did not significantly differ from the baseline. A linear correlation analysis showed that Δ of ROS correlated with Δ of sNOX2 (R(s) =0.817; P<0.001) and Δ of sCD40L (R(s) =0.780; P<0.001). Multiple linear regression analysis showed that the only independent predictive variable associated with Δ of ROS was Δ of serum NOX2 levels (SE=0.05; standardized coefficient β=1.075; P<0.001).
  
  
  CONCLUSIONS
  Our findings suggest that l-carnitine could be helpful in modulating oxidative stress and platelet activation during major abdominal surgery-dependent oxidative damage.
authors.affiliation: Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Italy. pasquale.pignatelli@uniroma1.it
authors.forename: P
authors.initials: P
authors.lastname: Pignatelli
authors.forename: G
authors.initials: G
authors.lastname: Tellan
authors.forename: M
authors.initials: M
authors.lastname: Marandola
authors.forename: R
authors.initials: R
authors.lastname: Carnevale
authors.forename: L
authors.initials: L
authors.lastname: Loffredo
authors.forename: M
authors.initials: M
authors.lastname: Schillizzi
authors.forename: M
authors.initials: M
authors.lastname: Proietti
authors.forename: F
authors.initials: F
authors.lastname: Violi
authors.forename: P
authors.initials: P
authors.lastname: Chirletti
authors.forename: G
authors.initials: G
authors.lastname: Delogu
mesh_terms: D000368:Aged; D000758:Anesthesia; D001792:Blood Platelets / Q000187:drug effects / Q000201:enzymology; D023201:CD40 Ligand / Q000097:blood; D002331:Carnitine / Q000494:pharmacology*; D004789:Enzyme Activation / Q000187:drug effects; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016014:Linear Models; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism; D008875:Middle Aged; D000074662:NADPH Oxidase 2; D019255:NADPH Oxidases / Q000097:blood / Q000378:metabolism; D018384:Oxidative Stress / Q000187:drug effects*; D015539:Platelet Activation / Q000187:drug effects*; D011184:Postoperative Period; D017382:Reactive Oxygen Species / Q000378:metabolism; D018401:Sample Size; D013514:Surgical Procedures, Operative
chemical_list: D008562:Membrane Glycoproteins; D017382:Reactive Oxygen Species; D023201:CD40 Ligand; C056558:CYBB protein, human; D000074662:NADPH Oxidase 2; D019255:NADPH Oxidases; D002331:Carnitine