Journal Article

Carnitine-mediated improved response to erythropoietin involves induction of haem oxygenase-1: studies in humans and in an animal model

Lorenzo A Calò, Paul A Davis, Elisa Pagnin, Lara Bertipaglia, Agostino Naso, Antonio Piccoli, Robert Corradini, Michela Spinello, Vincenzo Savica and Luciano Dalla Libera

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 3, pages 890-895
Published in print March 2008 | ISSN: 0931-0509
Published online October 2007 | e-ISSN: 1460-2385 | DOI:
Carnitine-mediated improved response to erythropoietin involves induction of haem oxygenase-1: studies in humans and in an animal model

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Background. Carnitine improves erythropoetin (EPO) response and anaemia in haemodialysis patients (HD); however, the mechanism(s) responsible remain unidentified. We have reported that carnitine induces haem oxygenase (HO)-1, which is an antioxidant and antiapoptotic that acts via pathways shared with EPO. Therefore carnitine's effect on these pathways may account for the improved EPO response. This study evaluates carnitine's effect on protein expression of HO-1 in unexplained EPO resistant HD. Carnitine's effect was assessed by HO-1 expression in patients and compared to its antiapoptotic effect via HO-1 induction in a rat model of carnitine-treated heart failure.

Methods. Unexplained EPO resistant HD mononuclear cell HO-1 and rat gastrocnemious muscle HO-1 and Bcl-2 protein expression were evaluated by western blot.

Results. HD's haemoglobin (Hb) and haematocrit (Ht) were not different before carnitine treatment: 8.8 ± 0.4 mg/dl versus 8.98 ± 0.13 and 30.20% ± 0.84 versus 30.72 ± 1.14, respectively. Carnitine increased HO-1, Hb and Ht compared with patients not treated with carnitine: 2.40 ± 0.58 versus 1.49 ± 0.41, P = 0.02; 11.22 ± 0.54 versus 8.90 ± 0.15, P < 0.0001; 32.72 ± 1.77 versus 30.66 ± 0.43, P = 0.035, respectively. Carnitine-treated HD's HO-1 significantly correlated with haemoglobin. HO-1 and Bcl-2 protein levels in untreated heart failure rat's gastrocnemious muscle were reduced when compared with controls: 3.41 ± 0.49 versus 5.32 ± 0.38 and 0.69 ± 0.11 versus 1.65 ± 0.37, respectively, but were higher in carnitine-treated heart failure rats: 4.8 ± 0.32 versus 3.41 ± 0.49, P < 0.0002 and 1.09 ± 0.08 versus 0.69 ± 0.11, P = 0.0007, respectively.

Conclusions. These results are consistent with an involvement of HO-1 in carnitine's effect on erythropoiesis. The initial signals or effectors responsible for carnitine's effect remain to be identified.

Keywords: anaemia; apoptosis; carnitine; dialysis; erythropoietin; haem oxygenase-1

Journal Article.  3567 words.  Illustrated.

Subjects: Nephrology

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