Coenzyme Q10 (CoQ10)

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    Coenzyme Q10 (CoQ10), a lipophilic substituted benzoquinone, is a naturally occurring nutrient found within every cell of both animal and plant cells. It is endogenously synthesized and plays a critical role in a variety of cellular processes. CoQ10 is an obligatory component of the respiratory chain in the inner mitochondrial membrane and is also the only endogenous lipid antioxidant, highlighting its singular importance in cellular health and function. Its presence is not limited to the mitochondria but extends to all cellular membranes and is detectable in the blood.

    Dietary Sources

    Vegetable oils are the richest sources of dietary CoQ10; Meat and fish also are quite rich in CoQ10 levels over 50 mg/kg may be found in beef, pork, and chicken heart and liver. Dairy products are much poorer sources of CoQ10 than animal tissues. Among vegetables, parsley and perilla are the richest CoQ10 sources, but significant differences in their CoQ10 levels may be found in the literature. Broccoli, grapes, and cauliflower are modest sources of CoQ10. Most fruit and berries represent a poor to very poor source of CoQ10, with the exception of avocados, which have a relatively high CoQ10

    CoQ10 levels in selected foods[1]
    Food CoQ10 concentration (mg/kg)
    Oils soybean 54–280
    olive 40–160
    grapeseed 64–73
    sunflower 4–15
    canola 64–73
    Beef heart 113
    liver 39–50
    muscle 26–40
    Pork heart 12–128
    liver 23–54
    muscle 14–45
    Chicken breast 8–17
    thigh 24–25
    wing 11
    Fish sardine 5–64
    mackerel (red flesh) 43–67
    mackerel (white flesh) 11–16
    salmon 4–8

    Intake

    In the developed world, the estimated daily intake of CoQ10 has been determined at 3–6 mg per day, derived primarily from meat.[1]

    South Koreans have an estimated average daily CoQ (Q9 + Q10) intake of 11.6 mg/d, derived primarily from kimchi.[2]

    Effect of heat and processing

    Cooking by frying reduces CoQ10 content by 14–32%.[3]

    Legal

    United States (US)

    CoQ10 is not approved by the U.S. Food and Drug Administration (FDA) for the treatment of any medical condition.[4][5] However, it is sold as a dietary supplement in the name of UbiQ 300 & UbiQ 100, not subject to the same regulations as medicinal drugs, and is an ingredient in some cosmetics.[6][7] The manufacture of CoQ10 is not regulated, and different batches and brands may vary significantly:[4] a 2004 laboratory analysis of CoQ10 supplements on sale in the US found that some did not contain the quantity identified on the product label. Amounts ranged from "no detectable CoQ10", through 75% of stated dose, up to a 75% excess.[8]

    Biochemical Function

    CoQ10 is integral to the electron transport chain on the inner membrane of mitochondria, facilitating the conversion of electrons from food into ATP. Its roles, however, extend beyond energy production. It is essential for uncoupling proteins and controls the permeability transition pore in mitochondria. Additionally, CoQ10 is involved in extramitochondrial electron transport and affects membrane physicochemical properties. It impacts gene expression, which can alter overall metabolism. The primary alterations in energetic and antioxidant functions are believed to underpin its therapeutic effects [9].

    Potential Longevity Benefits

    Lifespan

    Cellular and Molecular Roles

    As the only endogenous lipid antioxidant, CoQ10 is critical in neutralizing free radicals, thus protecting against DNA damage and cellular dysfunction that are symptomatic of aging. By preserving cellular integrity, CoQ10's antioxidant action is proposed to impede aging and potentially extend cellular lifespan.

    It also contributes to the regulation of mitochondrial function, such as influencing uncoupling proteins and the mitochondrial permeability transition pore, which are crucial for cell survival and apoptosis, respectively. Such regulation is particularly important as mitochondrial dysfunction is a noted characteristic of aging [9].

    Potential Therapeutic Role

    CoQ10 has been widely researched for its potential in various health applications, including physical fitness, fertility, antiaging, diabetes management, and heart failure treatment. The therapeutic effects of CoQ10 are attributed to its enhancement of oxidative phosphorylation and its ability to mitigate oxidative stress.

    Neurological Diseases

    Clinical and experimental studies indicate that CoQ10 supplementation may exert beneficial effects on neurological diseases such as migraine, Parkinson's disease, Huntington's disease, Alzheimer's disease, amyotrophic lateral sclerosis, Friedreich’s ataxia, and multiple sclerosis.[9]

    Hypertension

    It is also of interest in the context of central mechanisms controlling blood pressure due to its effects on the brainstem rostral ventrolateral medulla and the hypothalamic paraventricular nucleus, which are related to cardiovascular hypertension.[9]

    Diabetic Retinopathy

    A particular area of interest is how CoQ10 might help with a condition called diabetic retinopathy, which is a leading cause of blindness in adults. High blood sugar in diabetes can harm tiny blood vessels in the eye, leading to this condition. The damage causes stress to the eye and can lead to the growth of unhealthy blood vessels, worsening the problem [Citations 55-57]. Since CoQ10 can help the mitochondria work better and has antioxidant properties, it might be useful in treating this eye condition. [10]

    Phase II clinical trials have been looking at CoQ10 for an early diabetic retinopathy, also called non-proliferative diabetic retinopathy (NPDR). Patients who took 400 mg of CoQ10 every day for 12 weeks to 6 months (different trials) showed improvements in blood flow and energy production in their cells compared to those who didn’t take it. These findings suggest that CoQ10 could help slow down the worsening of this eye disease by improving blood supply and energy use in the eye, which could help prevent the eye damage from getting worse. More studies are needed to see if CoQ10 can help stop diabetic retinopathy from progressing to more severe stages.[10]

    Safety and Dosage

    Dosage

    While there is no established ideal dosage of CoQ10, a typical daily dose is 100–200 milligrams. Different formulations have varying declared amounts of CoQ10 and other ingredients.

    Safety

    The safety profile of CoQ10 is notably benign, with it being well-tolerated even at high doses.[9]

    Side Effects

    It does not induce serious adverse effects in either humans or experimental animals. Minor side effects may include stomach upset, loss of appetite, nausea, and headaches.[9]

    Interactions

    CoQ10's interaction with various medications necessitates a consultation with a healthcare professional before beginning supplementation:

    • Theophylline: CoQ10 potential to inhibit the effects of theophylline
    • Blood thinner warfarin: CoQ10 may interfere with warfarin's actions by interacting with cytochrome p450 enzymes thereby reducing the INR, a measure of blood clotting.[11] The structure of coenzyme Q10 is very similar to that of vitamin K, which competes with and counteracts warfarin's anticoagulation effects. Coenzyme Q10 should be avoided in patients currently taking warfarin due to the increased risk of clotting.[12]
    • Chemotherapy drugs[9]

    See Also

    References

    1. 1.0 1.1 Pravst I et al.: Coenzyme Q10 contents in foods and fortification strategies. Crit Rev Food Sci Nutr 2010. (PMID 20301015) [PubMed] [DOI] Coenzyme Q10 (CoQ(10)) is an effective natural antioxidant with a fundamental role in cellular bioenergetics and numerous known health benefits. Reports of its natural occurrence in various food items are comprehensively reviewed and critically evaluated. Meat, fish, nuts, and some oils are the richest nutritional sources of CoQ(10), while much lower levels can be found in most dairy products, vegetables, fruits, and cereals. Large variations of CoQ(10) content in some foods and food products of different geographical origin have been found. The average dietary intake of CoQ(10) is only 3-6 mg, with about half of it being in the reduced form. The intake can be significantly increased by the fortification of food products but, due to its lipophilicity, until recently this goal was not easily achievable particularly with low-fat, water-based products. Forms of CoQ(10) with increased water-solubility or dispersibility have been developed for this purpose, allowing the fortification of aqueous products, and exhibiting improved bioavailability; progress in this area is described briefly. Three main fortification strategies are presented and illustrated with examples, namely the addition of CoQ(10) to food during processing, the addition of this compound to the environment in which primary food products are being formed (i.e. animal feed), or with the genetic modification of plants (i.e. cereal crops).
    2. Y.H. Pyo, H.J. Oh: Ubiquinone contents in Korean fermented foods and average daily intakes, 2011 [DOI]
    3. Weber C et al.: The coenzyme Q10 content of the average Danish diet. Int J Vitam Nutr Res 1997. (PMID 9129255) [PubMed] The average dietary intake of coenzyme Q10 and coenzyme Q9 of the Danish population was determined, based on food consumption data from a national dietary survey. Selected food items in edible form were analyzed for the coenzyme Q content by HPCL with UV-detection, and their contribution to the total intake calculated. The effect of cooking was a 14-32% destruction of coenzyme Q10 by frying, and no detectable destruction by boiling. The average coenzyme Q10 intake of the Danish population was estimated to 3-5 mg/day, primarily derived from meat and poultry (64% of the daily intake), while cereals, fruit, edible fats, and vegetables only make minor contributions. The intake of coenzyme Q10 is approximately 1 mg/day, primarily derived from vegetable fats and cereals. The alpha-tocopherol content of the selected food samples was analyzed by HPLC with fluorescence detection, and the calculated average intake of alpha-tocopherol was comparable to the estimate from the dietary survey (7-8 vs. 7.4 mg alpha-tocopherol/day, respectively). The commercially available dietary supplements (capsules) provide 10-30 mg CoQ10/day, thus the average diet. The optimal dietary intake of coenzyme Q10 is unknown.
    4. 4.0 4.1 PDQ® Coenzyme Q10, http://www.cancer.gov/cancertopics/pdq/cam/coenzymeQ10/HealthProfessional
    5. Mitochondrial disorders in children: Co-enzyme Q10, https://www.nice.org.uk/advice/es11/resources/mitochondrial-disorders-in-children-coenzyme-q10-pdf-1158110303173
    6. Hojerová et al.; "[Coenzyme Q10--its importance, properties and use in nutrition and cosmetics]."
    7. What is coenzyme Q10 (CoQ10) and why is it in skin care products?, https://www.webmd.com/beauty/qa/what-is-coenzyme-q10-coq10-and-why-is-it-in-skin-care-products
    8. ConsumerLab.com finds discrepancies in strength of CoQ10 supplements, https://www.consumerlab.com/news/coq10-coenzyme-q10-tests/01-13-2004/
    9. 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Rauchová H: Coenzyme Q10 effects in neurological diseases. Physiol Res 2021. (PMID 35199552) [PubMed] [DOI] [Full text] Coenzyme Q10 (CoQ10), a lipophilic substituted benzoquinone, is present in animal and plant cells. It is endogenously synthetized in every cell and involved in a variety of cellular processes. CoQ10 is an obligatory component of the respiratory chain in inner mitochondrial membrane. In addition, the presence of CoQ10 in all cellular membranes and in blood. It is the only endogenous lipid antioxidant. Moreover, it is an essential factor for uncoupling protein and controls the permeability transition pore in mitochondria. It also participates in extramitochondrial electron transport and controls membrane physicochemical properties. CoQ10 effects on gene expression might affect the overall metabolism. Primary changes in the energetic and antioxidant functions can explain its remedial effects. CoQ10 supplementation is safe and well-tolerated, even at high doses. CoQ10 does not cause any serious adverse effects in humans or experimental animals. New preparations of CoQ10 that are less hydrophobic and structural derivatives, like idebenone and MitoQ, are being developed to increase absorption and tissue distribution. The review aims to summarize clinical and experimental effects of CoQ10 supplementations in some neurological diseases such as migraine, Parkinson´s disease, Huntington´s disease, Alzheimer´s disease, amyotrophic lateral sclerosis, Friedreich´s ataxia or multiple sclerosis. Cardiovascular hypertension was included because of its central mechanisms controlling blood pressure in the brainstem rostral ventrolateral medulla and hypothalamic paraventricular nucleus. In conclusion, it seems reasonable to recommend CoQ10 as adjunct to conventional therapy in some cases. However, sometimes CoQ10 supplementations are more efficient in animal models of diseases than in human patients (e.g. Parkinson´s disease) or rather vague (e.g. Friedreich´s ataxia or amyotrophic lateral sclerosis).
    10. 10.0 10.1 Hill D et al.: Investigational neuroprotective compounds in clinical trials for retinal disease. Expert Opin Investig Drugs 2021. (PMID 33641585) [PubMed] [DOI] INTRODUCTION: Retinal neurodegeneration causes irreversible vision loss, impairing quality of life. By targeting neurotoxic conditions, such as oxidative stress and ischemia, neuroprotectants can slow or stop sight loss resulting from eye disease. Despite limimted clinical use of neuroprotectants, there are several promising compounds in early clinical trials (pre-phase III) which may fulfil new therapeutic roles. Search terms relating to neuroprotection and eye disease were used on ClinicalTrials.gov to identify neuroprotective candidates. AREAS COVERED: Research supporting neuroprotection in eye diseases is focused on, ranging from preclinical to phase II, according to the ClinicalTrials.gov database. The compounds discussed are explored in terms of future clinical applications. EXPERT OPINION: The major challenge in neuroprotection research is translation from basic research to the clinic. A number of potential neuroprotectants have progressed to ophthalmology clinical trials in recent years, with defined mechanisms of action - saffron and CoQ10 - targeting mitochondria, and both CNTF and NGF showing anti-apoptotic effects. Enhancements in trial design and patient cohorts in proof-of-concept trials with enriched patient populations and surrogate endpoints should accelerate drug development. A further important consideration is optimising drug delivery to improve individualised management and patient compliance. Progress in these areas means that neuroprotective strategies have a much improved chance of translational success.
    11. Sharma A et al.: Coenzyme Q10 and Heart Failure: A State-of-the-Art Review. Circ Heart Fail 2016. (PMID 27012265) [PubMed] [DOI] Heart failure (HF) with either preserved or reduced ejection fraction is associated with increased morbidity and mortality. Evidence-based therapies are often limited by tolerability, hypotension, electrolyte disturbances, and renal dysfunction. Coenzyme Q10 (CoQ10) may represent a safe therapeutic option for patients with HF. CoQ10 is a highly lipophilic molecule with a chemical structure similar to vitamin K. Although being a common component of cellular membranes, CoQ10's most prominent role is to facilitate the production of adenosine triphosphate in the mitochondria by participating in redox reactions within the electron transport chain. Numerous trials during the past 30 years examining CoQ10 in patients with HF have been limited by small numbers and lack of contemporary HF therapies. The recent publication of the Q-SYMBIO randomized controlled trial demonstrated a reduction in major adverse cardiovascular events with CoQ10 supplementation in a contemporary HF population. Although having limitations, this study has renewed interest in evaluating CoQ10 supplementation in patients with HF. Current literature suggests that CoQ10 is relatively safe with few drug interactions and side effects. Furthermore, it is already widely available as an over-the-counter supplement. These findings warrant future adequately powered randomized controlled trials of CoQ10 supplementation in patients with HF. This state-of-the-art review summarizes the literature about the mechanisms, clinical data, and safety profile of CoQ10 supplementation in patients with HF.
    12. Wyman M et al.: Coenzyme Q10: a therapy for hypertension and statin-induced myalgia?. Cleve Clin J Med 2010. (PMID 20601617) [PubMed] [DOI] Some small clinical trials seem to show that coenzyme Q10 supplements can be used to lower blood pressure and to treat or prevent myalgia caused by hydroxymethylglutaryl coenzyme A reductase inhibitors (statins). However, larger trials are needed to determine if they are truly effective for these purposes. The authors examine the evidence and also discuss issues such as bioavailability, elimination, safety, and cost.