Research Article

Carnitine deficiency and its possible risk factors in TB patients: first report

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Enghelab Avenue, 1417614411, PO Box 14155/6451, Tehran, Iran

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Hossein Khalili

* Author for correspondence

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Enghelab Avenue, 1417614411, PO Box 14155/6451, Tehran, Iran.

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Email the corresponding author at khalilih@tums.ac.ir

Iman Karimzadeh

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Enghelab Avenue, 1417614411, PO Box 14155/6451, Tehran, Iran

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Alireza Abdollahi

Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

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Sirous Jafari

Department of Infectious Diseases, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

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Zahra Khazaeipour

Brain & Spinal Cord Injury Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

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Published Online:2 Sep 2013https://doi.org/10.2217/imt.13.90

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Abstract

Aim: To assess carnitine serum levels and possible risk factors of its deficiency in patients with TB. Patients & methods: All newly diagnosed TB patients admitted to an infectious diseases ward were recruited. Demographic, clinical and paraclinical characteristics of the patients were collected. Total carnitine serum concentrations were measured. To investigate factors that can predict carnitine deficiency, logistic regression analysis with odds ratio and 95% CI was performed. Results: The mean ± standard deviation of carnitine serum levels of patients was 43.77 ± 32.92 µmol/l. Carnitine deficiency was detected in 47.7% of the study population. According to the final model of multivariate logistic regression analysis, increased serum triglyceride levels and hypoalbuminemia were identified as predictive factors of carnitine deficiency in TB patients aged over 35 years old. Conclusion: Nearly half of Iranian patients with TB were carnitine-deficient. Increased serum triglyceride levels and hypoalbuminemia were identified as independent risk factors of carnitine deficiency in patients aged over 35 years. Considering malnutrition as a major risk factor of TB and the safety of carnitine supplementation, use of carnitine as an adjunctive modality instead of other standard interventions may show beneficial effects in patients with TB.

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Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

References

1 Narasimhan P, Wood J, MacIntyre CR, Mathai D. Risk factors for tuberculosis. Pulm. Med.2013,828939 (2013).Crossref, Medline, Google Scholar
2 Flanagan JL, Simmons PA, Vehige J, Willcox MD, Garrett Q. Role of carnitine in disease. Nutr. Metab. (Lond.)7,30 (2010).Crossref, Google Scholar
3 Cegielski J, McMurray D. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int. J. Tuberc. Lung. Dis.8(3),286–298 (2004).▪ Evaluation of association between TB and malnutrition.Medline, CAS, Google Scholar
4 Cegielski JP, Arab L, Cornoni-Huntley J. Nutritional risk factors for tuberculosis among adults in the United States, 1971–1992. Am. J. Epidemiol.176(5),409–422 (2012).Crossref, Medline, Google Scholar
5 Rigault C, Le Borgne F, Demarquoy J. Genomic structure, alternative maturation and tissue expression of the human BBOX1 gene. Biochim. Biophys. Acta1761(12),1469–1481 (2006).Crossref, Medline, CAS, Google Scholar
6 Eaton S, Pierro A. Carnitine and fatty acid oxidation in sepsis. Monatshefte für Chemie – Chemical Monthly136(8),1483–1492 (2005).Crossref, CAS, Google Scholar
7 Cederbaum SD, Auestad N, Bernar J. Four-year treatment of systemic carnitine deficiency. N. Engl. J. Med.310(21),1395–1396 (1984).Crossref, Medline, CAS, Google Scholar
8 Hurot JM, Cucherat M, Haugh M, Fouque D. Effects of L-carnitine supplementation in maintenance hemodialysis patients: a systematic review. J. Am. Soc. Nephrol.13(3),708–714 (2002).Crossref, Medline, CAS, Google Scholar
9 Vinci E, Rampello E, Zanoli L, Oreste G, Pistone G, Malaguarnera M. Serum carnitine levels in patients with tumoral cachexia. Eur. J. Intern. Med.16(6),419–423 (2005).Crossref, Medline, CAS, Google Scholar
10 Pistone G, Marino AD, Leotta C, Dell’Arte S, Finocchiaro G, Malaguarnera M. Levocarnitine administration in elderly subjects with rapid muscle fatigue. Drugs Aging20(10),761–767 (2003).Crossref, Medline, CAS, Google Scholar
11 Malaguarnera M, Cammalleri L, Gargante MP, Vacante M, Colonna V, Motta M. L-carnitine treatment reduces severity of physical and mental fatigue and increases cognitive functions in centenarians: a randomized and controlled clinical trial. Am. J. Clin. Nutr.86(6),1738–1744 (2007).Crossref, Medline, CAS, Google Scholar
12 Malaguarnera M, Gargante MP, Cristaldi E et al. Acetyl L-carnitine (ALC) treatment in elderly patients with fatigue. Arch. Gerontol. Geriatr.46(2),181–190 (2008).Crossref, Medline, CAS, Google Scholar
13 Galvano F, Li Volti G, Malaguarnera M, Avitabile T, Antic T, Vacante M. Effects of simvastatin and carnitine versus simvastatin on lipoprotein(a) and apoprotein(a) in Type 2 diabetes mellitus. Expert Opin. Pharmacother.10(12),1875–1882 (2009).Crossref, Medline, CAS, Google Scholar
14 Warner MH, Anderson GD, McCarty JP, Farwell JR. Effect of carnitine on measures of energy levels, mood, cognition, and sleep in adolescents with epilepsy treated with valproate. J. Epilepsy10(3),126–130 (1997).Crossref, Google Scholar
15 Malaguarnera M. Carnitine derivatives: clinical usefulness. Curr. Opin. Gastroenterol.28(2),166–176 (2012).▪ Review of carnitine use.Crossref, Medline, CAS, Google Scholar
16 Jerusalem F. [Carnitine deficiency myopathy (author’s transl)]. Nervenarzt51(5),266–271 (1980).Medline, CAS, Google Scholar
17 Ferrari R, Merli E, Cicchitelli G, Mele D, Fucili A, Ceconi C. Therapeutic effects of L-carnitine and propionyl-L-carnitine on cardiovascular diseases: a review. Ann. N.Y. Acad. Sci.1033(1),79–91 (2006).Crossref, Google Scholar
18 Rezaee H, Khalili H, Salamzadeh J, Jafari S, Abdollahi A. Potential benefits of carnitine in HIV-positive patients. Future Virol.7(1),73–83 (2012).Link, CAS, Google Scholar
19 Malaguarnera M, Restuccia S, Di Fazio I, Zoccolo AM, Ferlito L, Bentivegna P. Serum carnitine levels in chronic hepatitis C patients before and after lymphoblastoid interferon-alpha treatment. BioDrugs12(1),65–69 (1999).Crossref, Medline, CAS, Google Scholar
20 Malaguarnera M, Vacante M, Giordano M et al.L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-α 2b plus ribavirin. World J. Gastroenterol.17(39),4414–4420 (2011).Crossref, Medline, CAS, Google Scholar
21 Neri S, Pistone G, Saraceno B, Pennisi G, Luca S, Malaguarnera M. L-carnitine decreases severity and type of fatigue induced by interferon-alpha in the treatment of patients with hepatitis C. Neuropsychobiology47(2),94–97 (2003).Crossref, Medline, CAS, Google Scholar
22 Romano M, Vacante M, Cristaldi E et al.L-carnitine treatment reduces steatosis in patients with chronic hepatitis C treated with alpha-interferon and ribavirin. Dig. Dis. Sci.53(4),1114–1121 (2008).Crossref, Medline, CAS, Google Scholar
23 Jirillo E, Altamura M, Munno I et al. Effects of acetyl-L-carnitine oral administration on lymphocyte antibacterial activity and TNF-alpha levels in patients with active pulmonary tuberculosis. A randomized double blind versus placebo study. Immunopharmacol. Immunotoxicol.13(1–2),135–146 (1991).Crossref, Medline, CAS, Google Scholar
24 Thangasamy T, Subathra M, Sittadjody S et al. Role of L-carnitine in the modulation of immune response in aged rats. Clin. Chim. Acta389(1–2),19–24 (2008).Crossref, Medline, CAS, Google Scholar
25 Foresta P, Albertoni C, Ramacci MT, Angelucci L, De Simone C, Martelli E. Immunological parameters in aged rats: effects of acetyl – L-carnitine. In: Stress, Immunity, and Ageing: a Role for Acetyl-L-Carnitine : Proceedings of the Porkshop Held in Pomezia, Rome, Italy (Volume 844). De Simone C, Martelli EA, Sigma-Tau (Eds). Excerpta Medica, Amsterdam, The Netherlands, 97 (1989).Google Scholar
26 Karlic H, Lohninger A. Supplementation of L-carnitine in athletes: does it make sense? Nutrition20(7–8),709–715 (2004).▪▪ Evaluation of carnitine effects on the immune system.Crossref, Medline, CAS, Google Scholar
27 Alesci S. Carnitine: the science behind a conditionally essential nutrient. N.Y. Acad. Sci.1033,1–197 (2004).Crossref, Medline, Google Scholar
28 Oncology Nutrition Dieteic Practice Group. The Clinical Guide to Oncology Nutrition. (2nd Edition). Elliott L, Molseed LL, McCallum PD (Eds). American Dietetic Association, IL, USA (2006).Google Scholar
29 Whaley-Connell A, Sowers J, McCullough P et al. KDOQI clinical practice guideline for nutrition in children with CKD: 2008 update. Executive summary. Am. J. Kidney Dis.53(3 Suppl. 2),S11–S104 (2009).Crossref, Medline, CAS, Google Scholar
30 De Simone C, Tzantzoglou S, Jirillo E, Marzo A, Vullo V, Martelli EA. L-carnitine deficiency in AIDS patients. AIDS6(2),203–205 (1992).Crossref, Medline, CAS, Google Scholar
31 Salamzadeh J, Rezaee H, Khalili H, Jafari S, Abdollahi A. Evaluation of serum level of carnitine in HIV-positive individuals and its possible explanatory factors. Future Virol.7(10),1021–1028 (2012).▪ Evaluation of carnitine status in HIV-positive patients.Link, CAS, Google Scholar
32 Mikhail MM, Mansour MM. The relationship between serum carnitine levels and the nutritional status of patients with schistosomiasis. Clin. Chim. Acta71(2),207–214 (1976).Crossref, Medline, CAS, Google Scholar
33 Krahenbuhl S. Carnitine metabolism in chronic liver disease. Life Sci.59(19),1579–1599 (1996).Crossref, Medline, CAS, Google Scholar
34 Selimoglu MA, Yagci RV. Plasma and liver carnitine levels of children with chronic hepatitis B. J. Clin. Gastroenterol.38(2),130–133 (2004).Crossref, Medline, CAS, Google Scholar
35 Anty R, Marjoux S, Bekri S et al. Plasma carnitine is associated with fatigue in chronic hepatitis C but not in the irritable bowel syndrome. Aliment. Pharmacol. Ther.33(8),961–968 (2011).Crossref, Medline, CAS, Google Scholar
36 Eskandari GH, Kandemir O, Polat G, Tamer L, Ersoz G, Atik U. Serum L-Carnitine levels and lipoprotein compositions in chronic viral hepatitis patients. Clin. Biochem.34(5),431–433 (2001).Crossref, Medline, CAS, Google Scholar
37 Demarquoy J, Georges B, Rigault C et al. Radioisotopic determination of L-carnitine content in foods commonly eaten in western countries. Food Chem.86(1),137–142 (2004).Crossref, CAS, Google Scholar
38 Lheureux PE, Hantson P. Carnitine in the treatment of valproic acid-induced toxicity. Clin. Toxicol. (Phila.)47(2),101–111 (2009).Crossref, Medline, CAS, Google Scholar
39 Lennon DL, Shrago ER, Madden M, Nagle FJ, Hanson P. Dietary carnitine intake related to skeletal muscle and plasma carnitine concentrations in adult men and women. Am. J. Clin. Nutr.43(2),234–238 (1986).Crossref, Medline, CAS, Google Scholar
40 Swaminathan S, Padmapriyadarsini C, Sukumar B et al. Nutritional status of persons with HIV infection, persons with HIV infection and tuberculosis, and HIV-negative individuals from southern India. Clin. Infect. Dis.46(6),946–949 (2008).Crossref, Medline, Google Scholar
41 Kim HJ, Lee CH, Shin S et al. The impact of nutritional deficit on mortality of in-patients with pulmonary tuberculosis. Int. J. Tuberc. Lung. Dis.14(1),79–85 (2010).▪ Evaluation of the role of nutrition in TB mortality.Medline, Google Scholar
42 Gupta KB, Gupta R, Atreja A, Verma M, Vishvkarma S. Tuberculosis and nutrition. Lung. India26(1),9–16 (2009).Crossref, Medline, Google Scholar
43 Loignon M, Toma E. L-carnitine for the treatment of highly active antiretroviral therapy-related hypertriglyceridemia in HIV-infected adults. AIDS15(9),1194–1195 (2001).Crossref, Medline, CAS, Google Scholar
44 De Simone C, Famularo G, Tzantzoglou S, Trinchieri V, Moretti S, Sorice F. Carnitine depletion in peripheral blood mononuclear cells from patients with AIDS: effect of oral L-Carnitine. AIDS8(5),655–660 (1994).Crossref, Medline, CAS, Google Scholar
45 De Simone C, Tzantzoglou S, Famularo G et al. High dose L-carnitine improves immunologic and metabolic parameters in AIDS patients. Immunopharmacol. Immunotoxicol.15(1),1–12 (1993).Crossref, Medline, CAS, Google Scholar
46 Clark RM, Balakrishnan A, Waters D, Aggarwal D, Owen KQ, Koo SI. L-carnitine increases liver alpha-tocopherol and lowers liver and plasma triglycerides in aging ovariectomized rats. J. Nutr. Biochem.18(9),623–628 (2007).Crossref, Medline, CAS, Google Scholar
47 Ahn EM, Cho SC, Lee M, Cha YS. Serum carnitine, triglyceride and cholesterol profiles in Korean neonates. Br. J. Nutr.98(2),373–379 (2007).Crossref, Medline, CAS, Google Scholar
48 Hatamkhani S, Karimzadeh I, Elyasi S, Farsaie S, Khalili H. Carnitine and sepsis: a review of an old clinical dilemma. J. Pharm. Pharm. Sci.16(3),414–423 (2013).▪ Review of the role of carnitine in sepsis.Crossref, Medline, Google Scholar
101 WHO (2012). Global tuberculosis report 2012. www.who.int/tb/publications/global_report/gtbr12_main.pdf (Accessed 24 July 2013)▪ Reliable reference for the world TB status.Google Scholar
102 WHO (2012). Global Database on BMI: BMI classification. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html (Accessed 24 July 2013)Google Scholar

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Published online 2 September 2013

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Acknowledgments

The authors appreciate the nursing staff of Infectious Diseases Wards and Valiasr Laboratory of Imam Khomeini Hospital Complex for their kind support.

Financial & competing interests disclosure

This study was supported by a grant from Office of Vice-Chancellor for Research of Tehran University of Medical Sciences. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The Institutional Review Board and the Medical Ethics Committee of the hospital approved the study (authorization code: 89-03-33-11299). The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

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