Effect of carni Q-gel (ubiquinol and carnitine) on cytokines in patients with heart failure in the Tishcon study

• Published in: Acta Cardiologica Vol. 62; no. 4; pp. 349 - 354
• Main Authors: Kumar, Adarsh, Singh, Ram B., Saxena, Manoj, Niaz, Mohammad A., Joshi, Shashank R., Chattopadhyay, Pronobesh, Mechirova, Viola, Pella, Daniel, Fedacko, Jan
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-08-2007
• Subjects: Adult; Analysis of Variance; antioxidants; bio-energetic; Biomarkers - blood; Carnitine - pharmacology; Cytokines - blood; Cytokines - drug effects; Double-Blind Method; Exercise Test; Female; Follow-Up Studies; free radical stress; heart failure; Heart Failure - blood; Heart Failure - metabolism; Heart Failure - physiopathology; Heart Rate - drug effects; Humans; Interleukin-10 - blood; interleukin-6; Interleukin-6 - blood; Male; Malondialdehyde - blood; Middle Aged; mitochondria; Oxidative Stress - drug effects; Quality of Life; Stroke Volume - drug effects; TNF-alpha; Tumor Necrosis Factor-alpha - drug effects; Ubiquinone - analogs & derivatives; Ubiquinone - drug effects; Ubiquinone - pharmacology; Vitamin B Complex - pharmacology; Walking
• ISSN: 0001-5385; 1784-973X; 0001-5385
• DOI: 10.2143/AC.62.4.2022278

Introduction -There is evidence that both carnitine and coenzyme Q10 (Co Q), which are important for the functioning of myocardial mitochondria, are deficient in patients with congestive heart failure, in association with increased pro-inflammatory cytokines. It is possible that supplementation with ubiquinol and L-carnitine may protect these patients by decreasing inflammation.
Subjects and methods - In a randomized, double-blind, placebo-controlled trial, the effects of carni Q-gel (2250 mg/d L-carnitine and 270 mg/d hydrosoluble ubiquinol) were examined for 12 weeks.Thirty-one patients with heart failure received intervention (group A) and another 31 patients served as controls (group B). Serum levels of interleukin (IL)-6, tumour necrosis factor (TNF)-alpha and IL-10 could be studied among 29 patients in each group. Statistical analysis was conducted by analysis of variance and chi square test.
Results - Echocardiography ejection fractions were lower at baseline (38.8 + 7.6 vs. 39.3 + 6.7% in the intervention and control groups, respectively) among both group of patients, indicating class II-IV heart failure. Serum concentration of interleukin-6 (IL-6), a pro-inflammatory cytokine, was high (18.7 ± 5.8 vs. 15.0 + 3.3 pg/ml, normal 0.0-3.9) and IL-10 (anti-inflammatory) was normal (3.4 ± 1.5 vs. 2.9 ± 1.0 pg/ml, the normal range is 1.5-3.1 pg/ml) in both groups at baseline.After 12 weeks, there was a marked reduction in IL-6 in the intervention group without such changes in the control group (7.6 ± 1.5 vs. 11.4 ± 2.5 pg/ml, P< 0.01. IL-10 showed only the non-significant decrease in both groups from the baseline levels (3.2 ± 1.0 vs. 2.8 ± 0.9 pg/ml).TNF-alpha, which was comparable at baseline (17.6 ± 4.3 vs. 20.0 ± 5.3 pg/ml), also showed a greater decline in the carni Q-gel group compared to the placebo group (12.5 ± 3.3 vs. 17.2 ± 3.2 pg/ml, P< 0.05). Baseline serum CoQ levels (0.21 ± 0.11 vs. 0.19 ± 0.10 μg/ml) were low; however, after 12 weeks, serum CoQ showed a significant increase in the carni Q-gel group as compared to the control group (2.7 ± 1.2 and 0.76 ± 0.14 μg/ml, respectively). After 12 weeks of treatment, the quality of life visual analogous scale revealed that dyspnoea, palpitation and fatigue, (NYHA class II-III-IV), which were present at rest in all patients at baseline, showed beneficial effects in the intervention group compared to the placebo group. The six-minute walk test showed that there was a significant greater benefit in walking, from the baseline distance in the intervention group (208 ± 15.8 vs. 281 ± 20.6 metres, P<0.02) compared to the placebo group (218.4 ± 17.6 vs. 260.7 ± 19.3 metres, P < 0.05). The symptom scale indicated that the majority of patients showed improvement in the intervention group compared to the control group (28 vs. 16 patients, respectively, P< 0.05).Three patients in the intervention group had nausea and vomiting, which were controlled with symptomatic treatment.
Conclusions - These findings indicate that treatment with ubiquinol + L-carnitine can cause a significant reduction in the pro-inflammatory cytokines that are neurohumoural precursors related to sympathetic and parasympathetic activity, which is impaired in patients with heart failure. There was no adverse effect on IL-10.There was a significant improvement in quality of life as well as decrease in NYHA-defined heart failure.