Novel therapeutic strategies to improve deranged metabolism in chronic diseases: The potential role of carnitine and nicotine

Reduced appetite, decreased energy intake, and progressive myopathy leading to impaired functioning characterize the clinical course of chronic diseases. These symptoms are frequently observed and clinically relevant because they decrease patients' quality of life while increasing their morbidity and mortality. As the currently available therapeutic strategies are only partially effective, novel treatments are being investigated. Moderate, chronic systemic inflammation also leading to increased oxidative stress is involved in the pathogenesis of the reduction of appetite and muscle mass secondary to chronic diseases. Therefore, antiinflammatory and antioxidant agents may modulate the immune response and protect the patient against reactive oxygen species. In the past few years, experimental and clinical studies have tested the potential role of carnitine and nicotine as immunomodulating and antioxidant agents. Carnitine supplementation reduces chronic inflammation and oxidative stress in patients on hemodialysis and patients with cancer. These results are associated with reduced fatigue and improved outcome. Nicotine is more selective than acetylcholine in activating the antiinflammatory properties mediated by the vagus nerve. In animal models of sepsis and cancer, nicotine-induced activation of the nicotinic antiinflammatory pathway resulted in protection of nutritional status and improved survival. In the continuous effort to improve the metabolic alterations induced by acute and chronic diseases, the use of carnitine and nicotine may represent an interesting therapeutic approach, which needs to be supported by more clinical studies involving larger samples. © SINPE-GASAPE.