CoQ 10 is found in the membranes of many organelles. Since its primary function in cells is in generating energy, the highest concentration is found on the inner membrane of the mitochondrion. Some other organelles that contain CoQ 10 include endoplasmic reticulum , peroxisomes , lysosomes , and vesicles. CoQ 10 is fat-soluble and is therefore mobile in cellular membranes; it plays a unique role in the electron transport chain ETC. This is crucial in the process, since no other molecule can perform this function Note: recent research now establishes that Vitamin K 2 co-performs this role with CoQ 10 [10].
The further question is whether it is defensible to give half of the patients in a future clinical trial placebo capsules when it is known that Coenzyme Q10 supplementation benefits heart failure patients. Already in , the heart failure treatment guidelines promulgated by the American College of Cardiology and the American Heart Association acknowledged that supplementation with Coenzyme Q10 might have a positive effect, but the guidelines stopped short of recommending Coenzyme Q10 supplementation until more data were available [1].
Now, the positive data from the Q-Symbio trial and from the meta-analyses done by Dr. Soja [87], Dr. Sander [79], and Dr. Fotino [26] provide the necessary documentation for recommending Coenzyme Q10 as an adjunctive treatment in heart failure. One of the best aspects of Coenzyme Q10 supplementation is that it works with the cells to restore a deficiency state — low blood and tissue Coenzyme Q10 levels are associated with heart failure — and it improves the bio-energetic processes and antioxidant processes in the heart muscle tissue.
They summarized the literature about the mechanisms, the clinical data, and the safety profile of Coenzyme Q10 supplementation in patients with heart failure. They concluded that supplementation with Coenzyme Q10 may represent a safe therapeutic option for patients with heart failure.
Numerous small trials with CoQ10 supplementation in heart failure populations extending back over 30 years have shown adjuvant therapy with Coenzyme Q10 to have beneficial heart health effects such as improvement in NYHA functional class, in the 6-minute walk, in stroke index, in cardiac index score, and in ejection fraction. One large randomized controlled trial, Morisco , showed decreased hospital admissions, decreased episodes of pulmonary edema, and decreased episodes of cardiac asthma.
The second large randomized controlled trial, Dr. The current literature suggests that supplementation with Coenzyme Q10 is relatively safe with very few drug interactions and side effects. Moreover, it is already widely available as an over-the-counter supplement. The legacy of Dr. Karl Folkers: extensive clinical research into the safety and the effects of Coenzyme Q Folkers set the standard for clinical research into the safety and the effects of Coenzyme Q10 supplementation.
He assisted and collaborated with Dr. Svend Aage Mortensen, Dr. Langsjoen, Dr. Judy, Mr. Sven Moesgaard and numerous other researchers in getting Coenzyme Q10 clinical trials designed and carried out. Thanks to the efforts of Dr. Folkers and his followers, we now have results from two large randomized controlled trials — Morisco and Mortensen — that show significantly improved symptoms and survival and significantly fewer hospitalizations in heart failure patients with Coenzyme Q10 added on to conventional treatment and compared to placebo treatment.
In addition, we have the results of many smaller studies that confirm a positive health effect of Coenzyme Q10 supplementation for heart failure patients, e. We have three meta-analyses — Soja , Sander , and Fotino — and two systematic literature reviews — Rosenfeldt and DiNicolantonio — that show improvements in various parameters such as NYHA functional class, ejection fraction, stroke volume, and cardiac output without side effects.
American and Australian studies have shown that supplementation with Coenzyme Q10 prior to and following heart surgery reduce the number and severity of complications and can reduce the length of the hospital stay [39,55].
The meta-analyses and systematic literature reviews show that Coenzyme Q10 as an adjuvant treatment in chronic heart failure is exceptionally safe and well-tolerated. Last but not least, we have the results of the KiSel study results showing significantly reduced cardiovascular mortality in healthy elderly Swedish citizens after four years of combined selenium and Coenzyme Q10 supplementation.
Thanks to the clinical research initiated by Dr. Folkers, we now understand much more about the mechanisms by which Coenzyme Q10 improves the working of the failing heart. Coenzyme Q10 supplementation improves the cardiac ATP production, serves as a powerful antioxidant, and helps to correct endothelial dysfunction.
Journal of The American College of Cardiology , 62 16 , ee Adarsh, K. Biofactors Oxford, England , 32 , Alehagen, U.
Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: a 5-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens.
International Journal of Cardiology , 5 , Plos One , 10 12 , e Selenium and coenzyme Q10 interrelationship in cardiovascular diseases--A clinician's point of view. Journal of Trace Elements in Medicine and Biology, Levels of sP-selectin and hs-CRP decrease with dietary intervention with selenium and Coenzyme Q10 combined: A Secondary analysis of a randomized clinical trial. Plos ONE, 10 9 , Less increase of copeptin and MR-proADM due to intervention with selenium and coenzyme Q10 combined: Results from a 4-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens.
Biofactors Oxford, England , 41 6 , Baggio, E. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure interim analysis. Balercia, G. Coenzyme Q10 supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Fertility and Sterility , 81 1 , Berman, M. Aravot, D. Coenzyme Q10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized, placebo-controlled study.
Clinical Cardiology , 27 5 , Bogsrud, M. No effect of combined coenzyme Q10 and selenium supplementation on atorvastatin-induced myopathy. Brauner, H. Markers of innate immune activity in patients with type 1 and type 2 diabetes mellitus and the effect of the anti-oxidant coenzyme Q10 on inflammatory activity.
Clinical and Experimental Immunology , 2 , Deichmann, R. Impact of coenzyme Q on parameters of cardiorespiratory fitness and muscle performance in older athletes taking statins. The Physician and Sports Medicine, 40 4 , Del Pozo-Cruz, J. Relationship between functional capacity and body mass index with plasma coenzyme Q10 and oxidative damage in community-dwelling elderly-people. Experimental Gerontology , Antioxidant and anti-inflammatory effects of Coenzyme Q a preliminary study.
Journal of Dental Research , 78, Coenzyme Q10 for the treatment of heart failure: a review of the literature. Open Heart , 19;2 1 :e Engelsen, J. Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients. A randomised, double blind, placebo-crossover trial. Thrombosis And Haemostasis, 87 6 , Ernster L. In: Folkers K. Biomedical and Clinical Aspects of Coenzyme Q.
Amsterdam: Elsevier, Eriksson, J. The effect of coenzyme Q10 administration on metabolic control in patients with type 2 diabetes mellitus. Biofactors Oxford, England , 9 , Fedacko, J. Coenzyme Q10 and selenium in statin-associated myopathy treatment. Canadian Journal of Physiology and Pharmacology , 91 2 , Evidence for a deficiency of coenzyme Q10 in human heart disease.
International Journal of Vitamin Research 40 3 Biochemical rationale and myocardial tissue data on the effective therapy of cardiomyopathy with Coenzyme Q Folkers, K. Lovastatin decreases coenzyme Q levels in humans. Activities of vitamin Q10 in animal models and a serious deficiency in patients with cancer.
Biochem Biophys Res Commun. A one year bioavailability study of coenzyme Q10 with 3 months withdrawal period. Molecular Aspects of Medicine , 15 Supplss Fotino, A. The American Journal of Clinical Nutrition, 97 2 , Golomb, B. Coenzyme Q10 benefits symptoms in Gulf War veterans: results of a randomized double-blind study. Neural Computation, 26 11 , Hathcock JN, Shao A. Risk assessment for coenzyme Q10 Ubiquinone.
Regul Toxicol Pharmacol. Henriksen, J. Impact of ubiquinone Coenzyme Q10 treatment on glycemic control, insulin requirement and well-being in patients with Type 1 diabetes mellitus.
Hidaka, T. Safety assessment of Coenzyme Q10 CoQ Hodges, S. CoQ could it have a role in cancer management? Huntington Study Group. A randomized, placebo-controlled trial of coenzyme Q10 and remacemide in Huntington's disease. Ikematsu, H. Safety assessment of coenzyme Q10 Kaneka Q10 in healthy subjects: a double-blind, randomized, placebo-controlled trial. Regulatory Toxicology and Pharmacology , 44 3 , Johansson, P. Improved health-related quality of life, and more days out of hospital with supplementation with selenium and Coenzyme Q10 combined.
Results from a double blind, placebo-controlled prospective study. Folkers, G. Littarru and T. Yamagami, eds. Amsterdam: Elsevier. Improved long-term survival in coenzyme Q10 treated congestive heart failure patients compared to conventionally treated patients, in: Biomedical and Clinical Aspects of Coenzyme Q , Vol.
Folkers and Y. Yamamura, eds. Myocardial preservation by therapy with Coenzyme Q10 during heart surgery. Clinical Investigator, 71 8 Suppl :S Coenzyme Q10 reduction of Adriamycin cardiotoxicity. In: Folkers K, Yamamura Y, eds. Vol 4. Judy, W. Coenzyme Q Facts or Fabrications? Natural Products Insider. Age-related changes in the lipid compositions of rat and human tissues. Keogh, A. Khatta, M. The effect of coenzyme Q10 in patients with congestive heart failure.
Annals of Internal Medicine , 8 , Kocharian, A. Coenzyme Q10 improves diastolic function in children with idiopathic dilated cardiomyopathy. Cardiology in the Young , 19 5 , Kuklinski, B. Coenzyme Q10 and antioxidants in acute myocardial infarction. Molecular Aspects of Medicine, 15 Supplss Langsjoen, PH. Effective treatment with coenzyme Q10 of patients with chronic myocardial disease. Drugs Under Experimental and Clinical Research , 11 8 , Response of patients in classes III and IV of cardiomyopathy to therapy in a blind and crossover trial with coenzyme Q Langsjoen, P.
Effective and safe therapy with coenzyme Q10 for cardiomyopathy. Klinische Wochenschrift , 66 13 , A six-year clinical study of therapy of cardiomyopathy with coenzyme Q10 , International Journal of Tissue Reactions 12, — Treatment of statin adverse effects with supplemental Coenzyme Q10 and statin drug discontinuation. Biofactors Oxford, England , 25 , Langsjoen, H. Usefulness of coenzyme Q10 in clinical cardiology: a long-term study. Lee, B. Coenzyme Q10 supplementation reduces oxidative stress and increases antioxidant enzyme activity in patients with coronary artery disease.
Nutrition Journal , 12 1 , Leong, J. Perioperative metabolic therapy improves redox status and outcomes in cardiac surgery patients: a randomised trial.
Lewin, A. The Effect of Coenzyme Q10 on sperm motility and function. Molecular Aspects of Medicine, 18 Supplement , ss Littarru, G. Coenzyme Q10 and statins: biochemical and clinical implications.
Mitochondrion , 7 SupplSS Lockwood, K. Apparent partial remission of breast cancer in 'high risk' patients supplemented with nutritional antioxidants, essential fatty acids and coenzyme Q Molecular Aspects Of Medicine , 15 Suppl ss Progress on therapy of breast cancer with vitamin Q10 and the regression of metastases. Biochemical And Biophysical Research Communications , 1 , McMurray, J.
Coenzyme Q10, rosuvastatin, and clinical outcomes in heart failure: a pre-specified substudy of CORONA controlled rosuvastatin multinational study in heart failure. Journal of the American College Of Cardiology , 56 15 , Madmani, M.
Coenzyme Q10 for heart failure. Molyneux, S. Coenzyme Q an independent predictor of mortality in chronic heart failure. Mohr, D. Dietary supplementation with coenzyme Q10 results in increased levels of ubiquinol within circulating lipoproteins and increased resistance of human low-density lipoprotein to the initiation of lipid peroxidation.
Biochimica et Biophysica Acta , 3 , Morisco, C. Effect of coenzyme Q10 therapy in patients with congestive heart failure: a long-term multicenter randomized study. Mortensen, SA. Coenzyme Q clinical benefits with biochemical correlates suggesting a scientific breakthrough in the management of chronic heart failure. International Journal of Tissue Reactions , 12 3 , Long-term coenzyme Q10 therapy: a major advance in the management of resistant myocardial failure. Mortensen, S. Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure.
Rationale, design and end-points of "Q-Symbio"--a multinational trial. Biofactors Oxford, England , 18 , Journal of The American College of Cardiology, 57 14 , ; author reply Heart Failure , 2 6 , Coenzyme Q will this natural substance become a guideline-directed adjunctive therapy in heart failure? Heart Failure , 3 3 , The mitochondria in heart failure: a target for coenzyme Q10 therapy? Clinical Pharmacology and Therapeutics, 96 6 , Munkholm, H. Coenzyme Q10 treatment in serious heart failure.
Navas, P. Comparative bioavailability of seven Coenzyme Q10 preparations. In publication. Nylander, M. Okuyama, H. Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. Expert Review of Clinical Pharmacology, 8 2 , Olson, RE. Karl August Folkers — Journal of Nutrition 9 : — Pourmoghaddas, M. ARYA Atherosclerosis , 10 1 , Rosenfeldt, F. Systematic review of effect of coenzyme Q10 in physical exercise, hypertension and heart failure.
Sander, S. The impact of coenzyme Q10 on systolic function in patients with chronic heart failure. Journal of Cardiac Failure , 12 6 , Sharma, A. Heart Failure, 9 4 , e Shive, W. Karl August Folkers, September 1, — December 9, Biographical memoirs.
National Academy of Sciences U. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. Shults, C. Pilot trial of high dosages of coenzyme Q10 in patients with Parkinson's disease. Experimental Neurology, 2 , Sinatra, S. Coenzyme Q10 and Congestive Heart Failure. Annals of Internal Medicine, 9 , Singh, R. Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction.
Cardiovascular Drugs and Therapy, 12 4 , Effect on absorption and oxidative stress of different oral Coenzyme Q10 dosages and intake strategy in healthy men. Soja, A. Treatment of congestive heart failure with coenzyme Q10 illuminated by meta-analyses of clinical trials.
Weber, C. Antioxidative effect of dietary coenzyme Q10 in human blood plasma. International Journal for Vitamin and Nutrition Research 64 4 , Intestinal absorption of Coenzyme Q10 administered in a meal or as capsules to healthy subjects.
Nutrition Research , 17, 6, Weis, M. Bioavailability of four oral coenzyme Q10 formulations in healthy volunteers. Ylikoski, T. It is recommended that laboratory monitoring should be correlated with effects of treatment. In the open-label clinical trial known as Pre-2Care, Huntington disease patients and healthy controls were given CoQ10 daily for 20 weeks Effect on the course of the disease was not studied.
A multicenter randomized, double-blind, placebo-controlled trial has shown that use of high dose CoQ10 for 60 months did not slow functional decline in Huntington disease Other uses of coenzyme Q10 are considered investigational. Diseases affecting the retina and brain, such as age-related macular degeneration, glaucoma, Alzheimer disease, and Parkinson disease, have shown defects in cellular biochemical reactions attributed to reduced levels of CoQ10, which can be counteracted through early detection and supplementation, but further research is required Controlled clinical trials have been conducted in neurodegenerative disorders: Parkinson disease, amyotrophic lateral sclerosis, and Huntington disease.
Open clinical trials with some beneficial effects include:. The basis for this is that simvastatin and other HMG-CoA reductase inhibitors have been documented to lower serum concentrations of coenzyme Q10 by blocking the production of an intermediate in the mevalonate pathway that leads to the production of CoQ In a clinical study, decreased CoQ10 content in the skeletal muscles was accompanied by a decreased maximal oxidative phosphorylation capacity in the simvastatin-treated patients This finding may explain the muscle pain and exercise intolerance that many patients experience with their statin treatment and provide a new rationale for CoQ10 supplementation.
Results of metaanalysis of available randomized controlled trials do not suggest any significant benefit of coenzyme Q10 supplementation in improving statin-induced myopathy Efficacy of CoQ10 supplements in the prevention and treatment of statin-associated muscle symptoms remains controversial, and the effect of oral CoQ10 supplementation in increasing mitochondrial CoQ10 in human skeletal muscle is not well established However, a randomized controlled trial showed that CoQ10 does not alleviate the fatigue of the late-onset sequelae of poliomyelitis CoQ10 may have value as an adjunct in the treatment of glioblastoma, which should be investigated in a clinical study.
The results suggested that CoQ10 has a positive effect on clinical parameters as well as mitochondrial dysfunction when administered in the early phase of sepsis. The aim of coenzyme Q10 therapy is neuroprotection and slowing the progression of neurodegenerative disorders. For these indications, long-term therapy is anticipated. If the decision to use coenzyme Q10 is based on deficiency of the enzyme, this can be determined in both muscle and fibroblasts by biochemical methods Primary deficiency has been well described and results from mutations in genes involved in CoQ10 biosynthesis A case-control study in Japan has shown that serum coenzyme Q10 levels are inversely associated with risk of disabling dementia Therapeutic dosages of coenzyme Q10 for serious diseases range from to mg.
Preventive dose ranges from 10 to 30 mg daily as recommended by various manufacturers. The normal curve of plasma coenzyme Q10 levels rises during each trimester of pregnancy, and an association between low coenzyme Q10 level and spontaneous abortion has been observed. Maternal coenzyme Q10 plasma levels can be considered as a biomarker of pathological uterine contractile activity. There is a substantial increase in coenzyme Q10 fetal plasma levels in fetuses affected by hypoxic hypoxia and in those affected by nonimmune fetal hydrops.
No interaction has been reported between anesthetics and coenzyme Q Interactions of coenzyme Q10 with other drugs have not been reported. Interaction with warfarin is well known. No serious adverse events have been reported with coenzyme Q Gastrointestinal disturbances have been reported after oral intake of large doses of coenzyme Q Jain is a consultant in neurology and has no relevant financial relationships to disclose.
Every article is reviewed by our esteemed Editorial Board for accuracy and currency. General Neurology. Neurologic conditions may be associated with occupational or environmental exposures to heavy metals, such as lead and manganese. Conditions resulting from metal exposure may mimic routine neurologic disease, such as encephalopathy, movement disorders, neuropathy, or seizures.
Neurotoxic illness is often a diagnosis of exclusion after considering other more common presentations for a condition. Botulinum toxin has been approved for treatment of migraine headache, cervical dystonia, strabismus and blepharospasm, and upper and lower limb spasticity.
E-mail: ni. Coenzyme Q CoQ or Ubiquinone is a naturally occurring quinone that is found in most aerobic organisms from bacteria to mammals. It was first identified in , and isolated from the mitochondria of the beef heart, in The various types of Coenzyme Q can be distinguished by the number of isoprenoid side-chains they have. The most common Coenzyme Q in human mitochondria is CoQ The 10 refers to the number of isoprene repeats. CoQ10 is ubiquitous in human tissues, although its level is variable.
The level of CoQ10 is the highest in organs with high rates of metabolism such as the heart, kidney, and liver , The primary biochemical action of CoQ10 is as a cofactor in the electron-transport chain, in the series of redox reactions that are involved in the synthesis of adenosine triphosphate. As most cellular functions are dependent on an adequate supply of Adenosine triphosphate ATP , CoQ10 is essential for the health of virtually all human tissues and organs.
Coenzyme Q10 is one of the most significant lipid antioxidants, which prevents the generation of free radicals and modifications of proteins, lipids, and DNA.
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