Carnitine Supplementation for Arterial Stiffness

Overseen By Sandra Pena, CCRP

Age: < 65

Sex: Any

Trial Phase: Phase 2

Sponsor: Baylor College of Medicine

Disqualifiers: Seizure disorder, Renal failure, Diabetes, others

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

Duration: 6 months

90 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you have a known metabolic disorder that requires carnitine therapy, you cannot participate in the trial.

What data supports the effectiveness of the drug for arterial stiffness?

Research suggests that L-carnitine supplementation may improve walking performance in peripheral arterial disease, and low levels of L-carnitine are linked to increased arterial stiffness in patients who have had a kidney transplant. This indicates that L-carnitine might help reduce arterial stiffness. ^{1 2 3 4 5}

Is carnitine supplementation safe for humans?

Research on carnitine supplements, including L-carnitine and levocarnitine, has been conducted in various conditions like cardiovascular diseases and hemodialysis. These studies generally suggest that carnitine is safe for human use, although specific safety data for arterial stiffness is not detailed. ^{1 6 7 8 9}

How is the drug L-Carnitine unique in treating arterial stiffness?

L-Carnitine is unique because it is a natural compound that helps in fatty-acid metabolism and has been shown to improve endothelial function (the inner lining of blood vessels) and reduce inflammation, which are important factors in managing arterial stiffness. ^{1 2 6 7 10}

What is the purpose of this trial?

Hardening of the blood vessels, called arterial stiffness, is a risk factor for future heart disease and its causes are unclear. The proposed study will 1) randomly assign adolescents at high risk of stiffening blood vessels to take a protein supplement called carnitine and study its effects on arterial stiffening and 2) study carnitine related genes for their effect on arterial stiffening. The study will definitively establish a role for carnitine action as a cause of stiffening blood vessels and signal a way to treat or prevent stiffening.

Research Team

Justin P Zachariah, MD MPH

Principal Investigator

Study Principal Investigator

Eligibility Criteria

This trial is for boys and girls aged 11-21 with high triglyceride levels, but not too high cholesterol or any severe health issues like kidney failure, diabetes, heart disease, seizures, or pregnancy. They should be willing to follow the study rules.

Inclusion Criteria

My fasting triglyceride levels are between 130 and 500 mg/dL.

I am between 13 and 19 years old.

I am between 11 and 21 years old.

Exclusion Criteria

I have a heart condition from birth that needed surgery or a catheter procedure.

Nonadherence to study protocol during run-in phase defined as possessing 25% more than the expected remainder of placebo supplement pro-rated to the day of assessment

I need carnitine therapy for my metabolic disorder.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 6 months of oral carnitine supplementation or placebo to study its effects on arterial stiffness

6 months

Regular visits for monitoring and assessment

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• CS-
• CS+

Trial Overview The study tests if a protein supplement called carnitine can prevent hardening of blood vessels in at-risk teens. Participants are randomly chosen to receive carnitine or not and researchers will also look at their genes related to carnitine.

Participant Groups

Group I: Carnitine supplementation (CS+) Experimental Treatment 1 Intervention

Carnitine supplementation in liquid form, sugar free.

Group II: Placebo (CS-) Placebo Group 1 Intervention

Placebo comparator liquid similar in appearance and taste to CS+.

CS- is already approved in United States, European Union, Canada, Japan for the following indications:

Approved in United States as L-Carnitine for:

• Dietary supplement for heart health and energy production

Approved in European Union as Levocarnitine for:

• Treatment of carnitine deficiency, adjunctive therapy for the treatment of angina pectoris

Approved in Canada as L-Carnitine for:

• Dietary supplement for heart health and energy production

Approved in Japan as Levocarnitine for:

• Treatment of carnitine deficiency

Who Is Running the Clinical Trial?

Baylor College of Medicine

Lead Sponsor

Trials

1,044

Recruited

6,031,000+

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Findings from Research

In a study of 120 patients aged 54-67 with cardiovascular issues and moderate cognitive deficits, the addition of levocarnitine and acetylcarnitine to standard treatment significantly reduced cognitive deficits over a follow-up period of 70 days.

The treatment was well-tolerated and safe, suggesting that these compounds may help improve cognitive function by correcting endothelial dysfunction in patients with cardiovascular conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Possibilities of sequential levocarnitin and acetylcarnitin treatment in correcting cognitive deficiency in patients with cardiovascular diseases]. Statsenko, ME., Turkina, SV.[2021]

In a study of 65 kidney transplant patients, lower serum levels of l-carnitine were significantly associated with higher rates of peripheral arterial stiffness (PAS), indicating that l-carnitine may play a protective role in vascular health post-transplant.

The research found that l-carnitine levels can independently predict PAS, with a diagnostic power of 0.789, suggesting that monitoring l-carnitine could be important for managing cardiovascular risks in kidney transplant patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of Low Serum l-Carnitine Levels with Peripheral Arterial Stiffness in Patients Who Undergo Kidney Transplantation. Lai, YH., Lee, MC., Ho, GJ., et al.[2020]

In a 12-week study involving seven patients with peripheral arterial disease, supplementation with propionyl-L-carnitine (PLC) at 2 g per day showed a modest improvement in walking performance for some individuals, despite no significant increase in the overall group.

Muscle strength significantly increased from 695 N to 812 N after 4 weeks of PLC supplementation, indicating that PLC may enhance muscle strength in patients with peripheral arterial disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of propionyl-L-carnitine on exercise performance in peripheral arterial disease. Barker, GA., Green, S., Askew, CD., et al.[2019]

In a study involving 22 patients with peripheral arterial disease, L-carnitine supplementation significantly improved walking capacity in patients with low resting levels of acetylcarnitine, indicating its potential efficacy in enhancing exercise performance.

The results suggest that measuring plasma acetylcarnitine levels can help identify which patients are most likely to benefit from L-carnitine therapy, as those with elevated resting levels did not show improvement after treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carnitine-related alterations in patients with intermittent claudication: indication for a focused carnitine therapy. Brevetti, G., di Lisa, F., Perna, S., et al.[2019]

L-propionyl-carnitine (LPC) significantly improved arteriolar function during reperfusion in patients with intermittent claudication, as indicated by increased laser-Doppler power spectrum measurements after LPC infusion.

LPC also reduced tissue acidosis during ischaemia and reperfusion, suggesting it protects tissues from ischaemic injury without affecting overall blood flow, indicating its potential for broader use in peripheral arterial disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

L-propionyl-carnitine protects tissues from ischaemic injury in an 'in vivo' human ischaemia-reperfusion model. Andreozzi, GM., Martini, R., Cordova, RM., et al.[2021]

L-carnitine (LC) and taurine (TAU) work together to significantly inhibit the growth and osteoblastic differentiation of vascular smooth muscle cells (VSMCs), as shown by reduced DNA synthesis and alkaline phosphatase activity in laboratory tests.

The effectiveness of this combination is linked to LC enhancing the uptake of TAU and increasing the expression of the TAU transporter, indicating a specific mechanism of action that could be targeted for therapeutic purposes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

L-carnitine and taurine synergistically inhibit the proliferation and osteoblastic differentiation of vascular smooth muscle cells. Xie, H., Yang, B., Zhou, XM., et al.[2021]

Treatment with L-carnitine (LC) and propionyl-L-carnitine (PLC) improved endothelial function in small mesenteric arteries of spontaneously hypertensive rats without affecting blood pressure, indicating their potential as therapeutic agents for endothelial dysfunction.

Propionyl-L-carnitine specifically increased the expression of eNOS, enhancing nitric oxide availability, which is crucial for vascular relaxation, while both treatments reduced harmful superoxide production in hypertensive rats.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of L-carnitine and propionyl-L-carnitine on endothelial function of small mesenteric arteries from SHR. Alvarez de Sotomayor, M., Bueno, R., Pérez-Guerrero, C., et al.[2022]

A study involving 166 adolescents with dyslipidemia evaluated the effects of 6 months of 3 g daily oral l-carnitine supplementation on arterial stiffness and lipid levels, aiming to understand its potential role in preventing hypertension.

The research is designed to explore both genetic and supplemental influences of carnitine on cardiovascular health, which could lead to new therapies for young individuals at risk of atherosclerotic cardiovascular disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of exogenous l-carnitine on aortic stiffness in dyslipidemic adolescents: Design of a quadruple-blind, randomized, controlled interventional trial. Zachariah, JP., Pena, S., Lupo, PJ., et al.[2023]

In a randomized, double-blind, placebo-controlled trial involving 36 hemodialysis patients, l-carnitine supplementation significantly increased serum free carnitine levels by 150% and reduced serum amyloid A (SAA) by 32%, indicating its potential to lower systemic inflammation.

While l-carnitine effectively decreased SAA, a marker associated with cardiovascular risk, it did not significantly affect other vascular inflammation markers, suggesting a targeted mechanism of action in reducing inflammation specifically related to SAA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of l-carnitine supplement on serum amyloid A and vascular inflammation markers in hemodialysis patients: a randomized controlled trial. Tabibi, H., Hakeshzadeh, F., Hedayati, M., et al.[2015]

L-carnitine supplementation (1000 mg/d) for 12 weeks significantly reduced inflammation markers in patients with coronary artery disease (CAD), including C-reactive protein (CRP) and interleukin-6 (IL-6), compared to baseline and placebo groups.

The study involved 47 patients with CAD, and the results suggest that L-carnitine may help lower inflammation due to its antioxidant properties, indicating potential benefits for managing CAD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Antiinflammatory effects of L-carnitine supplementation (1000 mg/d) in coronary artery disease patients. Lee, BJ., Lin, JS., Lin, YC., et al.[2022]

References

1. Russia (Federation) pubmed.ncbi.nlm.nih.gov

[Possibilities of sequential levocarnitin and acetylcarnitin treatment in correcting cognitive deficiency in patients with cardiovascular diseases]. [2021]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Association of Low Serum l-Carnitine Levels with Peripheral Arterial Stiffness in Patients Who Undergo Kidney Transplantation. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

Effect of propionyl-L-carnitine on exercise performance in peripheral arterial disease. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Carnitine-related alterations in patients with intermittent claudication: indication for a focused carnitine therapy. [2019]

5. New Zealand pubmed.ncbi.nlm.nih.gov

L-propionyl-carnitine protects tissues from ischaemic injury in an 'in vivo' human ischaemia-reperfusion model. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

L-carnitine and taurine synergistically inhibit the proliferation and osteoblastic differentiation of vascular smooth muscle cells. [2021]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Effect of L-carnitine and propionyl-L-carnitine on endothelial function of small mesenteric arteries from SHR. [2022]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Effect of exogenous l-carnitine on aortic stiffness in dyslipidemic adolescents: Design of a quadruple-blind, randomized, controlled interventional trial. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Effects of l-carnitine supplement on serum amyloid A and vascular inflammation markers in hemodialysis patients: a randomized controlled trial. [2015]

10. United States pubmed.ncbi.nlm.nih.gov

Antiinflammatory effects of L-carnitine supplementation (1000 mg/d) in coronary artery disease patients. [2022]