title: Potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease.
abstract: Creatine is of paramount importance for maintaining and managing cellular ATP stores in both physiological and pathological states. Besides these "ergogenic" actions, it has a number of additional "pleiotropic" effects, e.g., antioxidant activity, neurotransmitter-like behavior, prevention of opening of mitochondrial permeability pore and others. Creatine supplementation has been proposed for a number of conditions, including neurodegenerative diseases. However, it is likely that creatine's largest therapeutic potential is in those diseases caused by energy shortage or by increased energy demand; for example, ischemic stroke and other cerebrovascular diseases. Surprisingly, despite a large preclinical body of evidence, little or no clinical research has been carried out in these fields. However, recent work showed that high-dose creatine supplementation causes an 8-9 % increase in cerebral creatine content, and that this is capable of improving, in humans, neuropsychological performances that are hampered by hypoxia. In addition, animal work suggests that creatine supplementation may be protective in stroke by increasing not only the neuronal but also the endothelial creatine content. Creatine should be administered before brain ischemia occurs, and thus should be given for prevention purposes to patients at high risk of stroke. In myocardial ischemia, phosphocreatine has been used clinically with positive results, e.g., showing prevention of arrhythmia and improvement in cardiac parameters. Nevertheless, large clinical trials are needed to confirm these results in the context of modern reperfusion interventions. So far, the most compelling evidence for creatine and/or phosphocreatine use in cardiology is as an addition to cardioplegic solutions, where positive effects have been repeatedly reported.
authors.affiliation: Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy. mbalestrino@neurologia.unige.it.
authors.forename: Maurizio
authors.identifier: 0000-0002-5971-2200
authors.initials: M
authors.lastname: Balestrino
authors.affiliation: Department of Internal Medicine and Cardionephrology, University of Genova, Genoa, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Sarocchi
authors.affiliation: Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Adriano
authors.affiliation: Department of Internal Medicine and Cardionephrology, University of Genova, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Spallarossa
mesh_terms: D000818:Animals; D019587:Dietary Supplements; D006801:Humans; D002534:Hypoxia, Brain / Q000378:metabolism / Q000517:prevention & control*; D017202:Myocardial Ischemia / Q000378:metabolism / Q000517:prevention & control*; D010725:Phosphocreatine / Q000493:pharmacokinetics / Q000627:therapeutic use*; D020521:Stroke / Q000378:metabolism / Q000517:prevention & control*
chemical_list: D010725:Phosphocreatine
keywords: Creatine; Creatine kinase; Myocardial infarction; Phosphocreatine; Prevention; Stroke; Treatment