title: Propionyl-L-carnitine improves endothelial function, microcirculation and pain management in critical limb ischemia.
abstract: BACKGROUND
  Chronic critical limb ischemia (CLI) is a severe condition of hypo-perfusion of lower limbs, which is associated with inflammation and a pro-coagulative state. It is a disease at high risk of amputation and cardiovascular death. Propionyl-L-carnitine (PLC) is efficacious in improving pain free walking distance in peripheral arterial disease with claudication; it also exerts favorable effects on the arterial wall and on endothelial function. The purpose of this study was to evaluate the effects of PLC on microcirculation, endothelial function and pain relief in patients affected by CLI not suitable for surgical intervention.
  
  
  METHODS
  We enrolled 48 patients with CLI. Patients were randomized into two groups: the first group was treated with PLC, the second was treated with saline solution. All of them underwent the following tests: laser Doppler flowmetry at the forefoot at rest and after ischemia, trans cutaneous oxygen partial pressure and carbon dioxide partial pressure at the forefoot at rest and after ischemia, endothelium dependent dilation of the brachial artery. All tests were repeated after treatments. Pain was assessed by visual analog pain scale.
  
  
  RESULTS
  Endothelium dependent dilation increased after PLC (9.5 ± 3.2 vs 4.9 ± 1.4 %; p < 0.05). Post-ischemic peak flow with laser-Doppler flow increased after PLC. TcPO2 increased, while TcPCO2 decreased after PLC; CO2 production decreased after PLC. VAS showed a significant reduction in pain perception after active treatment.
  
  
  CONCLUSIONS
  In CLI patients, PLC can improve microcirculation (post ischemic hyperemia, TcPO2 and TcPCO2 production). PLC also enhances endothelium dependent dilation and reduces analgesic consumption and pain perception.
authors.affiliation: Division of Vascular Rehabilitation, Department of Medicine, University of Verona, Verona, Italy. sergio.demarchi@univr.it
authors.forename: S
authors.initials: S
authors.lastname: De Marchi
authors.forename: S
authors.initials: S
authors.lastname: Zecchetto
authors.forename: A
authors.initials: A
authors.lastname: Rigoni
authors.forename: M
authors.initials: M
authors.lastname: Prior
authors.forename: L
authors.initials: L
authors.lastname: Fondrieschi
authors.forename: A
authors.initials: A
authors.lastname: Scuro
authors.forename: F
authors.initials: F
authors.lastname: Rulfo
authors.forename: E
authors.initials: E
authors.lastname: Arosio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology / Q000627:therapeutic use*; D001785:Blood Gas Monitoring, Transcutaneous; D001916:Brachial Artery / Q000502:physiology; D002331:Carnitine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry; D007866:Leg / Q000098:blood supply; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D059408:Pain Management; D058729:Peripheral Arterial Disease / Q000188:drug therapy* / Q000503:physiopathology; D012039:Regional Blood Flow / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; C003223:propionylcarnitine; D002331:Carnitine