Levocarnitine

L‑carnitine transports long‑chain fatty acids into mitochondria for β‑oxidation; its acetylated derivative acetyl‑L‑carnitine (ALCAR) can provide acetyl groups for energy, acetylcholine synthesis, and incorporation into glutamate, GABA, and lipids. Preclinical studies show that both compounds improve energy status, reduce oxidative stress, and prevent cell death in models of adult, neonatal, and pediatric brain injury. In rat pups, ALCAR given after brain injury improved long‑term functional outcomes including memory. The authors call for more research to explore their potential for protecting the developing brain, where therapies are urgently needed.

Fig. 1 L-Carnitine biosynthesis in humans. (Ferreira GC, McKenna MC, 2017)

In a 12‑month randomized controlled trial, maintenance hemodialysis patients receiving levocarnitine 1000 mg thrice weekly after dialysis maintained target hemoglobin and hematocrit levels while gradually reducing erythropoiesis‑stimulating agent (ESA) doses. At 6 and 12 months, the ESA dose and erythropoietin responsiveness index were significantly lower in the levocarnitine group than at baseline and, at 12 months, lower than in the control group. Levocarnitine improves ESA responsiveness, potentially reducing the required dose in renal anemia.

Fig. 2 Changes in Hb values from baseline to 6 and 12 months in the treatment and control groups with a comparison between the 2 groups. (Maruyama T, et al., 2017)