Acetyl-
L-carnitine, ALCAR or ALC, is an
acetylated
:
In organic chemistry, acetylation is an organic esterification reaction with acetic acid. It introduces an acetyl group into a chemical compound. Such compounds are termed ''acetate esters'' or simply ''acetates''. Deacetylation is the opposit ...
form of
L-
carnitine
Carnitine is a quaternary ammonium compound involved in metabolism in most mammals, plants, and some bacteria. In support of energy metabolism, carnitine transports long-chain fatty acids into mitochondria to be oxidized for energy production, an ...
. It is naturally produced by the human body, and it is available as a dietary supplement. Acetylcarnitine is broken down in the blood by
plasma
Plasma or plasm may refer to:
Science
* Plasma (physics), one of the four fundamental states of matter
* Plasma (mineral), a green translucent silica mineral
* Quark–gluon plasma, a state of matter in quantum chromodynamics
Biology
* Blood pla ...
esterase
An esterase is a hydrolase enzyme that splits esters into an acid and an alcohol in a chemical reaction with water called hydrolysis.
A wide range of different esterases exist that differ in their substrate specificity, their protein structure, ...
s to carnitine which is used by the body to transport fatty acids into the
mitochondria
A mitochondrion (; ) is an organelle found in the Cell (biology), cells of most Eukaryotes, such as animals, plants and Fungus, fungi. Mitochondria have a double lipid bilayer, membrane structure and use aerobic respiration to generate adenosi ...
for breakdown.
Biochemical production and action
Carnitine
Carnitine is a quaternary ammonium compound involved in metabolism in most mammals, plants, and some bacteria. In support of energy metabolism, carnitine transports long-chain fatty acids into mitochondria to be oxidized for energy production, an ...
is both a
nutrient
A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excret ...
and made by the body as needed; it serves as a substrate for important reactions in which it accepts and gives up an
acyl group
In chemistry, an acyl group is a moiety derived by the removal of one or more hydroxyl groups from an oxoacid, including inorganic acids. It contains a double-bonded oxygen atom and an alkyl group (). In organic chemistry, the acyl group (IUPAC ...
. Acetylcarnitine is the most abundant naturally occurring derivative and is formed in the reaction:
:
acetyl-CoA
Acetyl-CoA (acetyl coenzyme A) is a molecule that participates in many biochemical reactions in protein, carbohydrate and lipid metabolism. Its main function is to deliver the acetyl group to the citric acid cycle (Krebs cycle) to be oxidized for ...
+ carnitine
CoA + acetylcarnitine
where the acetyl group displaces the hydrogen atom in the central hydroxyl group of carnitine.
Coenzyme A (CoA) plays a key role in the
Krebs cycle
The citric acid cycle (CAC)—also known as the Krebs cycle or the TCA cycle (tricarboxylic acid cycle)—is a series of chemical reactions to release stored energy through the oxidation of acetyl-CoA derived from carbohydrates, fats, and protein ...
in
mitochondria
A mitochondrion (; ) is an organelle found in the Cell (biology), cells of most Eukaryotes, such as animals, plants and Fungus, fungi. Mitochondria have a double lipid bilayer, membrane structure and use aerobic respiration to generate adenosi ...
, which is essential for the production of
ATP, which powers many reactions in cells; acetyl-CoA is the primary substrate for the Krebs cycle, once it is de-acetylated, it must be re-charged with an acetyl-group in order for the Krebs cycle to keep working.
[
Most cell types appear to have transporters to import carnitine and export acyl-carnitines, which seems to be a mechanism to dispose of longer-chain moieties; however many cell types can also import ALCAR.][
Within cells, carnitine plays a key role in importing acyl-CoA into mitochondria; the acyl-group of the acyl-CoA is transferred to carnitine, and the acyl-carnitine is imported through both mitochondrial membranes before being transferred to a CoA molecule, which is then beta oxidized to acetyl-CoA. A separate set of enzymes and transporters also plays a buffering role by eliminating acetyl-CoA from inside mitochondria created by the ]pyruvate dehydrogenase complex
Pyruvate dehydrogenase complex (PDC) is a complex of three enzymes that converts pyruvate into acetyl-CoA by a process called pyruvate decarboxylation. Acetyl-CoA may then be used in the citric acid cycle to carry out cellular respiration, and t ...
that is in excess of its utilization by the Krebs cycle; carnitine accepts the acetyl moiety and becomes ALCAR, which is then transported out of the mitochondria and into the cytosol, leaving free CoA inside the mitochondria ready to accept new import of fatty acid chains.[ ALCAR in the cytosol can also form a pool of acetyl-groups for CoA, should the cell need it.][
Excess acetyl-CoA causes more carbohydrates to be used for energy at the expense of fatty acids. This occurs by different mechanisms inside and outside the mitochondria. ALCAR transport decreases acetyl-CoA inside the mitochondria, but increases it outside.
]
Health effects
Carnitine and ALCAR supplements carry warnings of a risk that they promote seizures in people with epilepsy, but a 2016 review found this risk to be based only on animal trials.
Research
Reviews
*Peripheral neuropathy
Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or or ...
: Meta-analyses from 2015 and 2017 both conclude that the current evidence suggests ALC reduces pain from peripheral neuropathy with few adverse effects. The 2017 review also suggested ALC improved electromyographic
Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an medical instrument, instrument called an electromyograph to produce a record called an electromyog ...
parameters. Both called for more randomized controlled trials. An updated Cochrane review in 2019 of four studies with 907 participants was very uncertain as to if ALC caused a pain reduction after 6 to 12 months of treatment.
*Chemotherapy-induced peripheral neuropathy
Chemotherapy-induced peripheral neuropathy (CIPN) is a nerve-damaging side effect of antineoplastic agents in the common cancer treatment, chemotherapy. CIPN afflicts between 30% and 40% of patients undergoing chemotherapy. Antineoplastic agents ...
(CIPN): A review of two studies concluded that ALC may be a treatment option for paclitaxel
Paclitaxel (PTX), sold under the brand name Taxol among others, is a chemotherapy medication used to treat a number of types of cancer. This includes ovarian cancer, esophageal cancer, breast cancer, lung cancer, Kaposi's sarcoma, cervical cancer ...
- and cisplatin
Cisplatin is a chemotherapy medication used to treat a number of cancers. These include testicular cancer, ovarian cancer, cervical cancer, breast cancer, bladder cancer, head and neck cancer, esophageal cancer, lung cancer, mesothelioma, br ...
-induced CIPN, while a clinical trial showed it did not prevent CIPN and appeared to worsen the conditions in taxane
Taxanes are a class of diterpenes. They were originally identified from plants of the genus ''Taxus'' (yews), and feature a taxadiene core. Paclitaxel (Taxol) and docetaxel (Taxotere) are widely used as chemotherapy agents. Cabazitaxel was FDA ap ...
therapy.
*Male infertility: Scientific reviews from 2016 and 2014 showed mixed results, with some studies showing a positive relationship between ALC and sperm motility, and others showing no relationship.
*Dementia: A 2003 Cochrane Cochrane may refer to:
Places Australia
*Cochrane railway station, Sydney, a railway station on the closed Ropes Creek railway line
Canada
* Cochrane, Alberta
* Cochrane Lake, Alberta
* Cochrane District, Ontario
** Cochrane, Ontario, a town wit ...
review sought to determine the safety and efficacy of ALCAR in dementia but the reviewers found only clinical trials studies on Alzheimer's disease; the review found that the pharmacology of ALCAR was poorly understood and that based on the lack of efficacy, ALCAR was unlikely to be an important treatment for AD.
*Depression: One 2014 review assessed the use of ALCAR in fourteen clinical trials for various conditions with depressive symptoms; the trials were small (ranging from 20 to 193 subjects) and their design was so different that results could not be generalized; most studies showed positive results and a lack of adverse effects. The mechanism of action by which ALCAR could treat depression is not known. A meta-analysis from 2014 concluded that ALCAR could only be recommended for the treatment of persistent depressive disorder if publication bias
In published academic research, publication bias occurs when the outcome of an experiment or research study biases the decision to publish or otherwise distribute it. Publishing only results that show a significant finding disturbs the balance o ...
was deemed improbable. A 2018 systematic review and meta-analysis of 12 randomized controlled trials found "supplementation significantly decreases depressive symptoms compared with placebo/no intervention, while offering a comparable effect with that of established antidepressant agents with fewer adverse effects." The review also indicates that "the effect of ALC in younger subjects was not more effective than placebo in improving these symptoms." indicating a need for more research explaining the age/effect relation.
*Fragile X syndrome
Fragile X syndrome (FXS) is a genetic disorder characterized by mild-to-moderate intellectual disability. The average IQ in males with FXS is under 55, while about two thirds of affected females are intellectually disabled. Physical features may ...
: A 2015 Cochrane review of ALCAR in fragile X syndrome found only two placebo-controlled trials, each of low quality, and concluded that ALCAR is unlikely to improve intellectual functioning or hyperactive behavior in children with this condition.
*Hepatic encephalopathy
Hepatic encephalopathy (HE) is an altered level of consciousness as a result of liver failure. Its onset may be gradual or sudden. Other symptoms may include movement problems, changes in mood, or changes in personality. In the advanced stages ...
: ALCAR has been studied in hepatic encephalopathy, a complication of cirrhosis
Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue repai ...
involving neuropsychiatric impairment; ALCAR improves blood ammonia levels and generates a modest improvement in psychometric scores but does not resolve the condition – it may play a minor role in managing the condition.
Studies
*In a small clinical study, when ALCAR was administered intravenously and insulin levels were held steady and a meal low in carnitine but high in carbohydrates was taken by healthy young men, ALCAR appeared to decrease glucose consumption in favor of fat oxidation.
*Mitochondrial
A mitochondrion (; ) is an organelle found in the cells of most Eukaryotes, such as animals, plants and fungi. Mitochondria have a double membrane structure and use aerobic respiration to generate adenosine triphosphate (ATP), which is use ...
decay and oxidative damage
Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage. Disturbances in the normal r ...
to RNA/DNA increases with age in the rat hippocampus
The hippocampus (via Latin from Greek , 'seahorse') is a major component of the brain of humans and other vertebrates. Humans and other mammals have two hippocampi, one in each side of the brain. The hippocampus is part of the limbic system, a ...
, a region of the brain associated with memory
Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered, ...
.[Liu J, Head E, Gharib AM, Yuan W, Ingersoll RT, Hagen TM, Cotman CW, Ames BN. Memory loss in old rats is associated with brain mitochondrial decay and RNA/DNA oxidation: partial reversal by feeding acetyl-L-carnitine and/or R-alpha -lipoic acid. Proc Natl Acad Sci U S A. 2002 Feb] Memory performance declines with age. These increases in decay and damage, and memory loss itself, can be partially reversed in old rats by feeding acetyl-L-carnitine.[
]
References
Other reviews
*
Carnitine (L-carnitine)
''University of Maryland Medical Center''
{{Cholinergics
Acetate esters
Amino acid derivatives
Anti-aging substances
Salts of carboxylic acids
Dietary supplements
Quaternary ammonium compounds