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CNS Drugs

, Volume 21, Supplement 1, pp 13–23 | Cite as

Acetyl-L-Carnitine in Diabetic Polyneuropathy

Experimental and Clinical Data
Review Article

Abstract

Diabetic polyneuropathy (DPN) is the most common late complication of diabetes mellitus. The underlying pathogenesis is multifaceted, with partly interrelated mechanisms that display a dynamic course. The mechanisms underlying DPN in type 1 and type 2 diabetes mellitus show overlaps or may differ. The differences are mainly due to insulin deficiency in type 1 diabetes which exacerbates the abnormalities caused by hyperglycaemia.

Experimental DPN in rat models have identified early metabolic abnormalities with consequences for nerve conduction velocities and endoneurial blood flow. When corrected, the early functional deficits are usually normalised. On the other hand, if not corrected, they lead to abnormalities in lipid peroxidation and expression of neurotrophic factors which in turn result in axonal, nodal and paranodal degenerative changes with worsening of nerve function. As the structural changes progress, they become increasingly less amendable to metabolic interventions.

In the past several years, experimental drugs — such as aldose reductase inhibitors, antioxidants and protein kinase C inhibitors — have undergone clinical trials, with disappointing outcomes. These drugs, targeting a single underlying pathogenetic factor, have in most cases been initiated at the advanced stage of DPN. In contrast, substitution of acetyl-L-carnitine (ALC) or C-peptide in type 1 DPN target a multitude of underlying mechanisms and are therefore more likely to be effective on a broader spectrum of the underlying pathogenesis.

Clinical trials utilising ALC have shown beneficial effects on nerve conduction slowing, neuropathic pain, axonal degenerative changes and nerve fibre regeneration, despite relatively late initiation in the natural history of DPN. Owing to the good safety profile of ALC, early initiation of ALC therapy would be justified, with potentially greater benefits.

Keywords

Nerve Growth Factor Neuropathic Pain Nerve Conduction Velocity Dorsal Root Ganglion Cell Diabetic Polyneuropathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

Dr Anders Sima is a paid consultant to Sigma-Tau Research Inc., Gaithersburg, MD, USA. He has no financial interest in the company.

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© Adis Data Information BV 2007

Authors and Affiliations

  1. 1.Departments of Pathology and Neurology, School of MedicineWayne State University and Detroit Medical CenterDetroitUSA

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