Therapeutics

Acetyl-l-carnitine HCI

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Overview

Name: Acetyl-l-carnitine HCI
Synonyms: ALCAR
Therapy Type: Dietary Supplement
Target Type: Other
Condition(s): Alzheimer's Disease
U.S. FDA Status: Alzheimer's Disease (Discontinued)
Company: Sigma-Tau Pharmaceuticals
Approved for:

Background

ALCAR is a naturally occurring substance. It can be metabolized to acetyl-COA by the carnitine transferase reaction and may serve as an alternative source of fuel for the citric-acid cycle, thus promoting aerobic energy metabolism, reducing tissue acidosis. ALCAR is thought to have several properties that may be beneficial in dementia. It may protect against oxidative stress indirectly by promoting oxidative metabolism and inhibiting tissue lactic acidosis, a condition that favors reactive oxygen species production. In addition, continued oxidative metabolism provides NADPH, the reducing power needed to convert oxidized glutathione to the reduced form capable of detoxifying H202 and other organic peroxides. Acetly-CoA is also important to the biosynthesis of acetylcholine. 

Findings

ALCAR has been found to be cardioprotective as well as neuroprotective in a number of disease models (hypoxia/ischmia, traumatic brain injury) (Zanelli et al., 2005). Beneficial effects of ALCAR on memory have been observed in aging rats (Liu et al., 2002) as well as in human studies of MCI and AD (Montgomery et al., 2003; Sano et al., 1992) although a meta-analysis failed to confirm the beneficial effects (Hudson and Tabet, 2003).

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References

Paper Citations

  1. . Mechanisms of ischemic neuroprotection by acetyl-L-carnitine. Ann N Y Acad Sci. 2005 Aug;1053:153-61. PubMed.
  2. . Age-associated mitochondrial oxidative decay: improvement of carnitine acetyltransferase substrate-binding affinity and activity in brain by feeding old rats acetyl-L- carnitine and/or R-alpha -lipoic acid. Proc Natl Acad Sci U S A. 2002 Feb 19;99(4):1876-81. PubMed.
  3. . Meta-analysis of double blind randomized controlled clinical trials of acetyl-L-carnitine versus placebo in the treatment of mild cognitive impairment and mild Alzheimer's disease. Int Clin Psychopharmacol. 2003 Mar;18(2):61-71. PubMed.
  4. . Double-blind parallel design pilot study of acetyl levocarnitine in patients with Alzheimer's disease. Arch Neurol. 1992 Nov;49(11):1137-41. PubMed.
  5. . Acetyl-L-carnitine for dementia. Cochrane Database Syst Rev. 2003;(2):CD003158. PubMed.

Further Reading

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