Using coenzyme Q10 in clinical practice

Using coenzyme Q10 in clinical practice By Emily A. Brandmeyer, BSN, RN; Qiuhua Shen, PhD, APRN, RN; Amanda R. Thimmesch, BA; and Janet D. Pierce, PhD, APRN, CCRN, FAAN COENZYME Q10 (CoQ10), a tion drugs such as statins may lipid-soluble, vitamin-like sub- lower CoQ10 levels. This article stance present in nearly all human will review the cellular function of tissues, is essential for the basic CoQ10 and how it’s used in clinical functioning of cells. Mainly pro- practice. duced in the mitochondria, it’s re- quired for the production of ad- Mitochondrial function enosine triphosphate (ATP), which To understand the effects of CoQ10, stores energy used to support cell it’s important to review the anatomy growth and maintenance.1 CoQ10 and physiology of the mitochon- is also an antioxidant that protects drion, where CoQ10 is synthesized the body from damage caused by and used by cells. Mitochondria are free radicals, which are highly reac- known as “cellular power plants” tive chemicals that can harm cells.2 because they generate most of the As people age, their CoQ10 pro- cell’s ATP. (See Inside the cellular duction decreases.1 power plant.) Rich sources of dietary CoQ10 CoQ10 is found in the mito- include meat, poultry, and fish. It chondria in two forms: fully can also be found in soybean and oxidized ubiquinone and reduced canola oil, nuts, eggs, and dairy ubiquinol. Ubiquinone is convert- products. However, a person defi- ed to ubiquinol in a reduction cient in CoQ10 would have to con- reaction, during which the mol- sume an enormous amount of these ecule gains two electrons. In or- foods to supplement CoQ10 needs der for the body to use CoQ10, adequately.3 it must undergo this reaction. In patients with cardiovascular Efficient reduction of CoQ10 disease, diabetes, neurodegenerative to ubiquinol occurs rapidly after disorders, and cancer, CoQ10 levels CoQ10 appears in the blood, are insufficient to prevent free radi- carried by lipoproteins. As hu- cal damage to protein, DNA, and mans age, CoQ10 production de- lipids in the cells.4 Certain prescrip- creases, and the ability to reduce www.Nursing2014.com March l Nursing2014 l 63 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. ubiquinone to ubiquinol in the dant in both the mitochondria and supplement and has been used as a mitochondria is impaired.5 lipid membranes. As an antioxidant, supplemental treatment for multiple Found in the inner membrane CoQ10 is capable of recycling and diseases. Research has found that of the mitochondria, CoQ10 is in- regenerating other antioxidants, such CoQ10 is an effective antioxidant volved in essential cellular processes as tocopherol and alpha-ascorbate. that reduces damage to cellular of energy production. It acts as both In contrast to other antioxidants, mechanisms and can be useful in an electron carrier and proton trans- CoQ10 inhibits both the initiation the treatment of the following locator during cellular respiration and propagation of lipid and protein conditions. and ATP production.6 CoQ10 func- oxidation. This is very important to tions as an electron carrier from prevent oxidative damage caused by Cardiovascular disorders each enzyme complex down the free radicals.7 Heart failure (HF) is a major health- electron transport chain (ETC). This care issue in the United States, with action is crucial to ATP production.1 Implications for practice over 5 million people diagnosed and In its reduced form (ubiquinol), The reduced form of CoQ10 300,000 deaths from HF each year.8 CoQ10 acts as a lipophilic antioxi- (ubiquinol) is available as a dietary The leading causes of HF are coronary Inside the cellular power plant I LLUSTRATION BY THE KIDDRC I MAGING C ORE The mitochondria transform organic compounds into energy that’s easily accessible to the cell. They contain the enzymes need- ed for converting energy from food into cellular energy. Mitochondria are composed of two membranes: an outer membrane that encloses the periphery of the mitochondrion and an inner membrane that forms cristae, which expand the surface area of the inner membrane. Many chemical reactions that take place in the mitochondria occur in the inner membrane, which contains the ETC complexes I–V needed for the synthesis of ATP. These complexes help move electrons down the ETC. In between complexes I and II, two electrons are removed from the nicotinamide adenine dinucleotide structure and transferred to CoQ10, which become ubiquinol (reduced form). Ubiquinol is a lipid-soluble carrier for these electrons that facilitates the production of ATP.16 64 l Nursing2014 l March www.Nursing2014.com Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. artery disease, hypertension, and mitted to hospitals with complica- doses of orally ingested CoQ10 diabetes. tions such as coronary artery for long periods is well estab- Depletion of energy in the myo- disease, cerebrovascular disease, lished.3 It has an acceptable safety cardium is a dominant feature of HF. diabetic ketoacidosis, hyperglyce- profile as a dietary supplement Reduced amounts of CoQ10 in myo- mic crises, and peripheral neu- with multiple daily doses. Only cardial tissues have been identified ropathy, one of the most common mild gastrointestinal symptoms in patients with HF. Some clinicians complications. CoQ10 can reduce have been reported in a small use CoQ10 as a supplement to an peripheral neuropathy through its number of subjects; these HF medication regimen because it action as an antioxidant.14 It can weren’t dose- related and can help stabilize myocardial me- also improve glycemic control in occurred in both CoQ10 and tabolism and maintain mitochondrial patients when given a daily oral placebo groups. 21 However, function.9 dose in addition to their pre- CoQ10 may interact with some CoQ10 levels in the myocardial scribed antihyperglycemic medica- medications such as warfarin, so tissue are directly correlated to the tions.15 Research has shown a advise patients to consult their severity of HF. Current studies have significant improvement in A1C healthcare provider before taking focused on CoQ10 treatment in and glycemic control with the CoQ10. HF to improve ejection fraction. use of CoQ10.10 Better glycemic Some studies have shown that management may lead to a lower Supplement wisely oral CoQ10 might be helpful in risk of diabetic complications and CoQ10 is a safe, accessible treat- improving functional capacity, hospitalization. ment that may help reduce the endothelial function, and left signs and symptoms of many ventricular contractility in patients Neurodegenerative disorders chronic conditions at a reasonable with HF when taken in combina- CoQ10 has been used to reduce cost. Educate patients regarding tion with other HF medications the symptoms of Parkinson, Hun- CoQ10, its benefits when used for and treatment.9,10 tington, and Alzheimer diseases.16,17 different conditions, and possible A recent study showed that exer- These conditions are partially minor adverse reactions based on cise, along with CoQ10 supplemen- caused by impairment of the ETC their medical history. For example, tation, resulted in higher plasma in the mitochondria and increased patients with HF or diabetes could CoQ10 levels and improved ejection generation of reactive oxygen take oral CoQ10 as an antioxidant fraction with fewer HF symptoms. It species.18,19 and a new source of energy for the also found that CoQ10 supplementa- In Parkinson disease, CoQ10 has mitochondria. Assist patients with tion over a 2-year period may reduce been shown to protect the nigros- accurately monitoring CoQ10 unplanned cardiovascular hospital- triatal dopaminergic system, which doses based on their report of ization due to worsening HF and is the major dopamine pathway condition and improvement, and mortality.11 connecting the stiatum and sub- schedule follow-up visits to mea- Patients with high cholesterol stantia nigra and contributing to sure improvements in their health levels who are taking statins usually movement function.20 Researchers status. ■ have lower levels of CoQ10 in tis- found that daily oral CoQ10 supple- sues because statins interfere with mentation for 16 months resulted REFERENCES the synthesis pathway of CoQ10. in reported higher energy levels 1. Bentinger M, Tekle M, Dallner G. Coenzyme There’s some evidence that CoQ10 and increased CoQ10 levels in tis- Q—biosynthesis and functions. 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