Chemical structures and descriptions

Carnitine and acylcarnitines

carn

What is measured?

Butyrobetaine (BB), carnitine (C0), total carnitine (tC0), acetylcarnitine (C2), propionylcarnitine (C3), malonylcarnitine (C3-DC), butyrylcarnitine (C4), hydroxybutyrylcarnitine (C4-OH), succinylcarnitine (C4-DC), isovalerylcarnitine (iC5), glutarylcarnitine (C5-DC), tiglylcarnitine (C5:1), hexanoylcarnitine (C6), octanoylcarnitine (C8), decanoylcarnitine (C10), dodecanoylcarnitine (C12), myristoylcarnitine (C14), hydroxytetradecanoylcarnitine (C14-OH), palmitoylcarnitine (C16), hydroxyhexadecanoylcarnitine (C16-OH), stearoylcarnitine (C18), hydroxyoctadecanoylcarnitine (C18-OH), oleoylcarnitine (C18:1), linoleylcarnitine (C18:2).
Methods: LC-MS/MS using mixed-mode (multi-modal) chromatography

Carnitine, acylcarnitines and related metabolites

Acylcarnitines (ACs) are esters formed by conjugation of L-carnitine (LC; L-3-hydroxy-4-aminobutyrobetaine) with coenzyme A-activated acyl groups (acyl-CoA), such as acetate, propionate, butyrate, medium-chain, long-chain, and very-long-chain fatty acyl-CoA, and these fatty acid metabolites are necessary for cellular energy homeostasis.

In humans, 75% of the LC requirement is obtained from dietary sources (eventually including supplementation), while the remaining 25% is supplied by de novo synthesis from trimethyllysine [1], which takes place in the liver and kidneys. The final step in the synthesis is catalyzed by the α-ketoglutarate-dependent enzyme, gamma-butyrobetaine dioxygenase (BBOX) that converts gamma-butyrobetaine into LC.

LC and its acyl esters are essential for the oxidative catabolism of fatty acids in mitochondria and peroxisomes, involved in the metabolism of branched-chain amino acids and related metabolic pathways, and serve as a detoxification pathway [2, 3].

The best-known biological function of LC is to enable the transport of medium- to long-chain fatty acids (>C10) and their CoA derivates from the cells’ cytosol into the mitochondrial matrix, where the beta-oxidation of fatty acids takes place, and various AC intermediates are formed in this process. Accordingly, the AC profile in blood has historically been used in the diagnosis of inborn errors of fatty acid oxidation.

A number of other physiological roles of the LC/AC system have been discovered more recently. This includes the removal of excess acyl groups, modulation of the intracellular level of CoA, and thus the regulation of the ratio between free CoA and acyl-CoA in the mitochondria [4]. This ratio regulates the activity of many mitochondrial enzymes involved in the TCA cycle, gluconeogenesis, urea cycle, and fatty acid oxidation [5, 6].

The intramitochondrial free CoA/acyl-CoA ratio is reflected in the ACs/LC ratio outside the mitochondria, which under normal conditions should be around 0.25. Ratios larger than 0.4 are considered abnormal and indicate disturbed mitochondrial (and/or peroxisomal) metabolism [4, 7]. Thus, the AC profile in blood and other tissues is used as a marker for various conditions associated with mitochondrial (and/or peroxisomal) dysfunction, including imbalances between glucose and fatty acid oxidation as well as disturbances in the metabolism of (branched-chain) amino acids.

Over the past 30 years, ACs have been identified as important biomarkers for a growing number of diseases and conditions, including cardiovascular diseases, insulin resistance, metabolic syndrome, diabetes, NAFLD/MAFLD, depression, neurologic disorders, certain cancers, inflammatory conditions, psoriasis, and chronic fatigue syndrome [2, 8]

Indication(s)

To investigate the metabolomic signature of human diseases.

Specimen, collection and processing

Matrix: EDTA plasma or serum.
Volume: Minimum volume is 60 µL, but 200 µL is optimal and allows reanalysis.
Preparation and stability: Samples should be put on ice immediately after collection and stored at -80 °C.

Transportation

Frozen, on dry ice. (for general instruction on transportation, click here)

Reported values, interpretation

Reported values (µmol/L):BB, 0.2–2; C0, 7–90; tC0, 30–90; C2:0, 1–35; C3:0, 0.1–1.5; C3:0-DC, 0–0.5; C4:0, 0.04–1.2; C4:0-OH, 0.01–0.5; C4:0-DC, 0.01–1.0; iC5:0, 0.04–0.5; C5:0-DC, 0.01–0.3; C5:1, 0.005–0.1; C6:0, 0.005–2.1; C8:0, 0.03–1.1; C10:0, 0.03–2.1; C12:0, 0.01–0.5; C14:0, 0.015–0.3; C14:0-OH, 0.005–0.08; C16:0, 0.04–1.3; C16:0-OH, 0–0.05; C18:0, 0.01–0.5; C18:1, 0.02–1.0; C18:2, 0.02–0.3.

Intraclass correlation coefficients (ICCs): C0, 0.69; C2:0, 0.63; C3:0, 0.62; iC5:0, 0.68; C8:0, 0.41; C14:0, 0.38; C16:0, 0.49; C18:0, 0.40; C18:1, 0.66.

Literature

1. Longo N, Frigeni M, Pasquali M. Carnitine transport and fatty acid oxidation. Biochim Biophys Acta 2016; 1863: 2422-35.
2. Dambrova M, Makrecka-Kuka M, Kuka J et al. Acylcarnitines: nomenclature, biomarkers, therapeutic potential, drug targets, and clinical trials. Pharmacol Rev 2022; 74: 506-51.
3. Schooneman MG, Vaz FM, Houten SM, Soeters MR. Acylcarnitines: reflecting or inflicting insulin resistance? Diabetes 2013; 62: 1-8.
4. Reuter SE, Evans AM. Carnitine and acylcarnitines: pharmacokinetic, pharmacological and clinical aspects. Clin Pharmacokinet 2012; 51: 553-72.
5. Steiber A, Kerner J, Hoppel CL. Carnitine: a nutritional, biosynthetic, and functional perspective. Mol Aspects Med 2004; 25: 455-73.
6. Calabrese V, Giuffrida Stella AM, Calvani M, Butterfield DA. Acetylcarnitine and cellular stress response: roles in nutritional redox homeostasis and regulation of longevity genes. J Nutr Biochem 2006; 17: 73-88.
7. Pons R, De Vivo DC. Primary and secondary carnitine deficiency syndromes. J Child Neurol 1995; 10: 2S8-2S24.
8. Bene J, Szabo A, Komlósi K, Melegh B. Mass spectrometric analysis of L-carnitine and its esters: potential biomarkers of disturbances in carnitine homeostasis. Curr Mol Med 2020; 20: 336-54.

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Per Christian Eriksen

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Per Magne Ueland has been Professor at the University of Bergen 1987-2018. He is one of the founders of Bevital AS and the scientific advisor in Bevital since 2023. His interests includes biomarkers related to nutrition, inflammation, ageing and life-style related chronic diseases. Per is committed to the development of precise, high-throughput mass spectrometry methods, tailored for metabolic profiling of biobank specimens from large cohorts.

Ove completed his education in Biomedical Science at the Western Norway University of Applied Sciences, supplemented by specialized training in Electrical Engineering and Electronics at the Royal Norwegian Naval Training Establishment and the National Institute of Technology. With many years of experience as a biomedical scientist in hospital laboratories—specializing primarily in microbiology—he brings a unique blend of clinical and technical expertise to his work. Ove focuses on the design and prototyping of electronics, as well as the service and maintenance of laboratory instrumentation, ensuring that technical equipment and workflows remain precise and reliable for research-focused activities.

Lena holds a master’s degree in biology from the University of Bergen, where her thesis focused on identifying whale skeletons using zooarchaeology by mass spectrometry (ZooMS). At Bevital, she works with LC‑MS/MS analyses and method development, focusing on accurate and reliable testing of biological samples. She is dedicated to ensuring precise and high‑quality results that contribute to reliable scientific outcomes and support ongoing research efforts.

Marit holds a degree in chemical engineering from Bergen Ingeniørhøyskole, which is now part of the Western Norway University of Applied Sciences. She works with quantitative analysis and method development on LC-MS/MS at the laboratory of Bevital AS.

Randi holds a Master of Science in Chemical Process Engineering from the Norwegian University of Science and Technology (NTNU). She has been part of Bevital since its very beginning, contributing her expertise primarily to the LC-MS/MS platforms, but also to the microbiological assays. In 2021, she stepped into the role of Manager/CEO, where she is dedicated to strengthening Bevital’s innovative profile and ensuring the company’s continued growth and success. She is especially motivated by advancing research that improves health insights and by fostering collaboration that drives scientific and technological progress.

Ove completed a bachelor’s degree in Biomedical Laboratory Sciences at the Western Norway University of Applied Sciences in Bergen. With extensive experience in method development and expertise in GC-MS/MS, he specializes in optimizing analytical techniques for research-focused studies. At Bevital, Ove is dedicated to advancing laboratory methods and workflows, contributing to innovative research through precise and reliable analytical solutions.

Lene holds a bachelor’s degree in Biomedical Laboratory Science from the Western Norway University of Applied Sciences, where she is also completing her master’s degree in Medical Laboratory Technology, expected to graduate in 2026. Her master’s thesis focuses on method validation in fatty acid analysis. At Bevital, she works with GC-MS/MS analyses, routinely performing SCFA measurements and emphasizing accurate and reliable testing of biological samples. With her strong laboratory background, Lene is committed to delivering high-quality results that support medical research.

Klaus earned his PhD in physics from the University of Münster in Germany. For more than thirty years he has specialized in Time‑of‑Flight mass spectrometry, contributing innovative approaches to SNP genotyping and protein quantification. Together with his colleague Lene Njåstad, he oversees Bevital’s Olink Proteomics service. He also leads Bevital’s website and media design efforts, ensuring a clear and informative public presence.

Adrian holds a PhD in diabetes research, along with bachelor’s and master’s degrees in biomedical science and public health, respectively. With over 20 years of experience in laboratory science, he leads high-precision metabolite analyses and method development at Bevital. His expertise centers on quantifying biomarkers, metabolite classes, and metabolic pathways related to nutrition, cardiovascular and neurodegenerative diseases, and cancer. Adrian is committed to advancing research quality and actively collaborates nationally and internationally, leveraging targeted metabolomics to support innovative, multidisciplinary research.

Statistical power is the probability that a statistical test will correctly reject a false null hypothesis (H0​) when a specific alternative hypothesis (H1​) is true. H0​ is the null hypothesis, which states there is no effect or no difference. H1​ is the alternative hypothesis, which states there is a real effect or difference. Alpha (α) is the probability of a Type I error (a false positive), which is the risk of incorrectly rejecting the H0​ when it is actually true. You set this value before the experiment, commonly at 0.05. Beta (β) is the probability of a Type II error (a false negative), which is the risk of failing to reject the H0​ when it is actually false.

Power is calculated as 1−β. Increasing power means you are decreasing the probability of making a Type II error.

Several factors can be adjusted to increase the power of a statistical test:

  • Effect Size: This is the magnitude of the difference you are trying to detect. A larger effect size is easier to detect, thus increasing power. 

  • Sample Size: The number of observations in a study. A larger sample size provides more information about the population, reducing the margin of error and increasing the power to detect a true effect.

  • Variation: Refers to the spread or standard deviation of the data within the population. Less variation makes it easier to distinguish a real effect from random noise, thereby increasing power.

  • Alpha (): Increasing the alpha level (e.g., from 0.05 to 0.10) also increases power, but at the cost of a higher risk of a Type I error. This trade-off is often undesirable.

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In: Circ Res, vol. 89, no. 2, pp. 187–192, 2001, ISSN: 1524-4571.

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Guttormsen, A B; Ueland, P M; Kruger, W D; Kim, C E; Ose, L; Følling, I; Refsum, H

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Dekou, V; Whincup, P; Papacosta, O; Ebrahim, S; Lennon, L; Ueland, P M; Refsum, H; Humphries, S E; Gudnason, V

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Chambers, J C; Ueland, P M; Obeid, O A; Wrigley, J; Refsum, H; Kooner, J S

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