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Oral L-Carnitine Supplementation Increases Trimethylamine-N-oxide but Reduces Markers of Vascular Injury in Hemodialysis Patients
Abstract
OBJECTIVES: Food or supplement-derived L-carnitine is changed to trimethylamine (TMA) by interstinal microbiota, which is further metabolized to trimethylamine-N-oxide (TMAO), being involved in the promotion of atherosclerosis in animal models. Meanwhile, carnitine deficiency has played a role in accelerated atherosclerosis in hemodialysis (HD) patients. However, effects of oral L-carnitine supplementation on circulating levels of TMAO and markers of vascular injury and oxidative stress in patients on HD remain unclear. In this study, we addressed the issue. METHODS: Thirty-one HD patients with carnitine deficiency were treated with oral L-carnitine (900 mg/d) for 6 months. At baseline and after treatment, clinical variables including circulating levels of carnitine fractions, TMA, TMAO, advanced glycation end products (AGE), soluble forms of intracellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), and malondialdehyde (MDA) were measured. RESULTS: Oral L-carnitine supplementation significantly increased total, free, acyl carnitine, and plasma TMA and TMAO levels, whereas it decreased markers of vascular injury and oxidative stress such as sICAM-1, sVCAM-1, and MDA levels. TMA and TMAO levels at baseline were correlated with each other, and free carnitine was independently associated with TMAO levels. Furthermore, change in AGE values from baseline ([INCREMENT]AGE) was positively correlated with [INCREMENT]sICAM-1 (P = 0.043) and was a sole independent determinant of [INCREMENT]sICAM-1 (R = 0.133, P = 0.043). CONCLUSIONS: This study demonstrated that although oral L-carnitine supplementation was associated with increased TMAO levels, it might be beneficial on vascular injury in patients on HD. Vasculoprotective properties of L-carnitine supplementation in HD patients might be ascribed partly to its inhibitory actions on AGE.
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“Supplementation with L-carnitine seems to improve some features of CVD [68] although it raises plasma TMAO and TMA levels [69]”
From Implication of Trimethylamine N-Oxide (TMAO) in Disease: Potential Biomarker or New Therapeutic Target (2018) · cites this paper as [69]
In the citing paper
“Although oral supplementation of L-carnitine was associated with increased plasma TMAO concentrations, it decreased vascular injury markers and oxidative stress markers in hemodialysis patients (43).”
From Trimethylamine N -Oxide, the Microbiome, and Heart and Kidney Disease (2017) · cites this paper as [43]
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Metadata
- Authors
- Fukami, K., Yamagishi, S.-I., Sakai, K., Kaida, Y., Yokoro, M., Ueda, S., Wada, Y., Takeuchi, M., Shimizu, M., Yamazaki, H., & Okuda, S.
- Affiliations
- Kurume University (JP)
- Kanazawa Medical University (JP)
- Showa Pharmaceutical University (JP)
- Corresponding author
- Fukami, Kei
- Sakai, Kazuko
- Kaida, Yusuke
- Yokoro, Miyuki
- Ueda, Seiji
- Okuda, Seiya
- ORCID
- Venue
- Journal of Cardiovascular Pharmacology
- Published
- 2015-03
- Volume
- 65
- Issue
- 3
- Pages
- 289-295
- ISSN
- 0160-2446 (ISSN-L)
- OpenAlex
- W2328568033
- Cited by
- 84
- References
- 33
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 6 · 2022: 3 · 2021: 10 · 2020: 14 · 2019: 11 · 2018: 7 · 2017: 8 · 2016: 8 · 2015: 3
- FWCI
- 7.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Pharmacology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (26860487)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
- Keywords
- carnitine supplementation, trimethylamine N-oxide, trimethylamine, hemodialysis, carnitine deficiency, vascular injury, advanced glycation end products, oxidative stress, soluble ICAM-1, soluble VCAM-1, malondialdehyde, gut microbiota, atherosclerosis, vascular protection
- MeSH terms
- Administration, Oral, Aged, Carnitine, Deficiency Diseases, Female, Renal Dialysis, Humans, Japan, Kidney Diseases, Male, Malondialdehyde, Methylamines, Middle Aged, Time Factors, Biomarkers, Case-Control Studies, Treatment Outcome, Glycation End Products, Advanced, Oxidative Stress, Intercellular Adhesion Molecule-1, Vascular Cell Adhesion Molecule-1, Dietary Supplements, Vascular System Injuries
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