Energy Booster
CreatineMay Be Shot in the Arm for Dying Cells

A North American study is investigating whether a supplement used by athletes to boost energy and build muscle can slow progression of Parkinson's disease.

Creatine, under study for neurological and neuromuscular diseases such as Lou Gehrig's and muscular dystrophy, may give an energy boost to the dying cells of Parkinson's patients, said Dr. Kapil D. Sethi, neurologist and director of the MCG Movement Disorders Program.

"We think it may help cells that are damaged or overworked," said Dr. Sethi, a site principal investigator on the National Institute of Neurological Disorders and Stroke study. MCG hopes to recruit 45 patients for the study that will enroll 1,720 patients at 51 sites in the United States and Canada.

Mitochondria, the powerhouse for cells, become dysfunctional in the brain, muscle and platelet cells of many patients with Parkinson's disease. "By giving more energy to the cells, you are giving them a safety margin," Dr. Sethi said. "If a cell is dying, it takes another route [to survive]."

The goal is to slow progression of the disease that affects about 1 million people in North America. Symptoms include tremors, rigidity, slowed movement and, late in the disease, dementia and behavior disorders.

Treatments-including the gold standard, a synthetic dopamine called levodopa and MAO-B inhibitors that forestall breakdown of dopamine- target those symptoms. Dopamine, a neurotransmitter critical to movement, is depleted in Parkinson's. Researchers hope newer therapies, including creatine, can be added to the mix to help slow the disease.

The study will enroll patients who have been on standard therapies from 90 days to two years and follow them for five years. Half the enrollees will get creatine and half placebo. Researchers hope for at least a 20 percent reduction in disease progression so that in five years, patients on creatine will look like placebo patients at four years, said Buff Dill, MCG study coordinator.

The disease is assessed by following its progression long term and measuring endpoints such as falls, nursing home placement, dementia and death. The study may be extended five years, based on preliminary results and funding.

Those treated with creatine may also build muscle-a significant benefit since Parkinson's patients often experience muscle atrophy and weight loss.

Creatine is available over the counter, but "patients realize that we don't know if it works [for Parkinson's]," Dr. Sethi said. "They are willing to take the risk of being on placebo for the cause of science and to learn more about the disease. They want to beat this disease and if they can't, they want to help somebody else beat it."

Avicena Group, Inc., will provide creatine and placebo for this first large study in a series of National Institutes of Health-sponsored exploratory trials in Parkinson's.

MCG will soon participate in a similar study of coenzyme Q10, another natural supplement that boosts energy production. Dr. Sethi, project director of the Parkinson Research Alliance of India, which is working to bring more clinical trials to his homeland, plans to incorporate these supplements into innovative treatment cocktails