Carnitine and FIV
L-Lysine seems to be the best known amino acid to most people with FIV+ cats, even though it has no
special activity against FIV and is not the all-purpose immune booster that many imagine. (Its activity, by a very specific route, is against feline herpesvirus.) In the body,
however, lysine and methionine synthesize an amino acid that might arguably have the most
significant action against FIV: carnitine. (Cats synthesize carnitine in the kidneys, dogs in the
liver.) Carnitine is essential for fat transport and metabolism in mitochondria, the cellular energy
engines. It is available as a supplement as both L-Carnitine and, in its acetylated form, as Acetyl-L-Carnitine. There is a long-running debate over which is better for what purpose, but either one
is probably acceptable as a potential FIV therapy. Both are pricey, but Acetyl-L-Carnitine is
pricier.
Carnitine, which has a variety of cardiovascular and neural protective roles, is generally depleted
in people with HIV, possibly because of leaky gut syndrome, possibly for other reasons. What
has particularly caught the attention of HIV researchers, however is the benefit of carnitine
supplementation for CD4+ lymphocytes, the Helper T cells whose depletion is the primary cause
of immunosuppression in HIV+ people and FIV+ cats. In a groundbreaking 1998 study, four
months of intravenous treatment of HIV+ patients who had refused antiretroviral drugs "resulted
in statistically significant increases in the CD4+ counts [and] decreased numbers of CD4+ and
CD8+ cells undergoing apoptosis" [1]. "Apoptosis" is spontaneous cellular self-destruction
owing to skewed immune response and is now believed to be a more important factor in CD4+
depletion than actual viral infection. A 2002 study likewise found inhibition of apoptosis of both
CD4+ and CD8+ cells. CD8+ lymphocytes are the actual effector arm of the T cell population,
their function being destruction of infected cells: "The addition of L-carnitine is safe and allows
apoptosis and oxidant stress to be greatly reduced in lymphocytes from subjects treated with AZT
and DDI" [2]. Concludes a 2004 study, "[A]dministration of large doses of LC and/or ALC to
HIV positive subjects untreated/treated with HAART was shown to . . . increase the number of
CD4 cells and reduce lymphocyte apoptosis"[3]. (This study pointedly validated oral dosing, as
well as IV and IM). A 2003 study implies that some of the anti-apoptotic action may stem from a
steroidal-like suppression of tumor necrosis factor alpha (TNF-α), a protein central to several
apoptotic pathways, although it also curiously found a suppressive effect on Interleuken-12 (IL-12), an important co-stimulant of CD8+ cell maturation [8].
Another study found that carnitine, when combined with two other micronutrients, alpha lipoic
acid (ALA) and n-acetylcysteine (NAC), increased the number of CD4+ lymphocytes by 26%, a
surprising and unexpected finding for the researchers, who had been testing the combination's
ability to lessen the effects of mitochondrial toxicity, a significant cause of neuropathy in HIV
patients taking some antiretroviral drugs [4]. Like NAC and ALA, Carnitine is a major
antioxidant with anti-inflammatory properties that include reduction of tumor necrosis factor-alpha (TNF-α), a proinflammatory immune factor strongly implicated in various secondary
inflammatory diseases and in encouraging viral infectivity.
No studies in people have found any toxicities associated with intake of even large quantitites of
carnitine. One source describes carnitine as one of the 8 key supplements for people with HIV.
Multi-vitamins, L-glutamine, alpha lipoic acid, and milk thistle are among the others mentioned
[5]. Might Carnitine have the same benefit for FIV+ cats?
The principal established uses for carnitine supplementation in cats are for treatment of
idiopathic hepatic lipidosis and obesity. "In humans, carnitine deficiency . . . causes hepatic lipid
accumulation and liver dysfunction. A similar connection is being investigated in cats with IHL,
with current evidence suggesting that use of supplemental carnitine hastens recovery and
improves survival in affected cats. Carnitine also increases lean muscle mass and enhances
weight loss in obese cats"[6]. Since 250 to 500 mg daily are recommended for these purposes,
this is clearly a tolerable dosage range for extended periods of use.
This dosage range is roughly borne out by Dr. Wilfried Kraft, a German veterinarian and
researcher, who has authored and coauthored many books on small animals. This information
(here translated) appears on one FIV website: "Administration is recommended three times
daily. Cats get emphatic 'dosage suggestions' from Wilfried Kraft, 50 to 100 mg/kg. With FIV
the maximum dosage should always be given and may even be exceeded"[7]. Three times daily
seems a bit rigorous, but twice daily is certainly not unusual with antioxidants and amino acids.
If a 4-5 kilo cat is about average, the "exceeded" would imply that in excess of 500mg is fine for
an FIV+ of that size.
_____________________________________________________________________
References
[1] Carnitine may boost T cell counts.[Article in English, French] [No authors listed]. Treatment
Update. 1998 Jul;10(5):4-6.
http://www.ncbi.nlm.nih.gov/pubmed/11365627?
[2] L-carnitine reduces lymphocyte apoptosis and oxidant stress in HIV-1-infected subjects treated
with zidovudine and didanosine.Moretti S, Famularo G, Marcellini S, Boschini A, Santini G,
Trinchieri V, Lucci L, Alesse E, De Simone C. Antioxid Redox Signal. 2002 Jun;4(3):391-403.
http://www.ncbi.nlm.nih.gov/pubmed/12215207?
[3] L-Carnitine and acetyl-L-carnitine in the treatment of complications associated with HIV
infection and antiretroviral therapy.Ilias I, Manoli I, Blackman MR, Gold PW, Alesci S.
Mitochondrion. 2004 Jul;4(2-3):163-8.
http://www.ncbi.nlm.nih.gov/pubmed/16120381?
[4] Broad-spectrum Micronutrient Supplementation in HIV-infected Patients with
Dideoxynucleoside-related Peripheral Neuropathy: A Prospective, Double Blind, Placebo-controlled Trial. Kaiser J, Ondercin J, Santos G, Leoung G, Brown S, Mass M, Baum M.
11th Conf Retrovir Opportunistic Infect. Feb 8 11 2004 San Franc CA Conf Retrovir
Opportunistic Infect 11th 2004 San Franc Calif. 2004 Feb 8-11; 11: abstract no. 494.
http://gateway.nlm.nih.gov/MeetingAbstracts/102271457.html
[5] The 8 most important supplements for people on HAART.[No authors listed]. STEP Perspect.
1999 Summer;99(2):18.
http://www.ncbi.nlm.nih.gov/pubmed/11366747?
[6] The carnivore connection to nutrition in cats. Debra L. Zoran. JAVMA, Vol 221, No. 11,
December 1, 2002. http://www.catinfo.org/zorans_article.pdf
[7] www.poose.de. Likeliest sources of Kraft's recommendations are Cat Diseases: Hospital and
Therapy [coauthored with Hartmann & Durr] or Dosage Suggestions for Medications for Cats
and Dogs.
[8] L-Carnitine: a nutritional modulator of glucocorticoid receptor functions. Alesci S, De
Martino MU, Mirani M, Benvenga S, Trimarchi F, Kino T, Chrousos G. The FASEB Journal.
Vol. 17, August 2003, pp. 1553-1555. http://www.fasebj.org/cgi/reprint/17/11/1553.pdf
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