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The Use of Colon-Release Propionyl-L-Carnitine in Patients with Ulcerative Colitis
By Alan Gaby, MD Note from Dr. Jen: This study focuses on using propionyl-Lcarnitine to treat UC specifically, but it is also likely that this nutrient is beneficial for other inflammatory conditions in the gastrointestinal tract. One very small trial hints that propionyl-L-carnitine improved the disease activity score in Crohn's Disease, which affects the gastrointestinal tract above the colon. Ulcerative colitis (UC) is a chronic autoimmune disease characterized by inflammation of the colon and rectum. Symptoms include abdominal pain, diarrhea, and rectal bleeding. The musculoskeletal system, skin, eyes, or hepatobiliary system are also involved in many cases. Patients with UC are at increased risk of developing colon cancer. Conventional treatment may include anti-inflammatory drugs, antibiotics, glucocorticoids, immunosupressive agents, and biological response modifiers. Colectomy may be performed in severe cases. One of the biochemical abnormalities associated with UC is impaired oxidation of fatty acids, which could lead to decreased mitochondrial energy production. L-Carnitine enhances fatty acid oxidation by facilitating the transport of fatty acids into mitochondria and might therefore be beneficial for people with ulcerative colitis. However, because 70% of the energy used by colon cells is derived directly from the colonic lumen, providing L-carnitine directly to the colon (by administering a colon-release oral preparation) might be more effective than standard oral administration. Propionyl-L-carnitine is a derivative of L-carnitine that has been used successfully in the treatment of various L-carnitine-responsive disorders, such as intermittent claudication and angina pectoris. Colon-release propionyl-L-carnitine has now been investigated as a treatment for UC and the results are encouraging. One hundred twenty-one patients (ages 18- 75 years) with mild-to-moderate UC (disease activity index of 3 to 10, with lower numbers indicating less severe disease) were randomly assigned to receive, in double-blind fashion, a colon-release preparation of propionyl- L-carnitine or placebo for four weeks. The dosage was 500 or 1,000 mg twice a day orally, one hour before breakfast and one hour before dinner. All patients had been receiving stable aminosalicylate or thiopurine therapy, and continued to receive this therapy during the trial. The primary endpoint was clinical/endoscopic response (defined as a decrease of at least 3 points in the disease activity score) or remission (defined as a disease activity index score of 2 or less, with no individual sub-score greater than 1). After four weeks, the proportion of patients who experienced a clinical/endoscopic response was significantly greater in the combined propionyl-L-carnitine groups, with no trend suggesting the higher dose was more effective. The remission rate was also higher in the propionyl-L-carnintine group than in the placebo group (52% vs 35%), but the difference was not statistically significant. No serious side effects were reported, and the side effect of propionyl-L-carnitine was similar to that of placebo. The most common side effects were gastrointestinal. The results of this study suggest that colonrelease propionyl-L-carnitine at a dosage of 500 mg twice a day is safe and effective as adjunctive therapy in adults with mild-tomoderate ulcerative colitis. At the time of this writing, there are no well-known interactions between propionyl-L-carnitine and medications used to treat Ulcerative Colitis. Reference: Aliment Pharmacol Ther 2011;34:1088-97. World J Gastroenterol. 2012 Sep 28;18(36):5065-71. |
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