The rise… and rise of co-Q10

Consumers can't seem to get enough of anti-ageing and energy-boosting ingredients. Despite bio-availability issues and price wars emanating from Chinese manufacturing, co-Q10 continues to come on strong. Mark J Tallon, PhD, examines the latest and most intriguing research on this exciting natural product

Co-Q10 is used by the body as an endogenous antioxidant and an essential component in energy production (ATP). Because of ubiquitous presence in nature it can be found in almost every cell (including those in the skin). As such, its growth as a dietary supplement in the US represented more than $350 million in 2005, with kg sales expected to double current numbers by 2012 despite low-price Chinese imports.1 Numerous disease processes and drugs can be linked to low levels of co-Q10. Additionally, co-Q10 supplementation is being studied in application to cardiovascular disease, muscular dystrophy, diabetes mellitus and male infertility.

Co-Q10 cotherapy with statins
Statins are used by nearly two million people in the UK to prevent heart attacks and stroke by lowering harmful blood cholesterol. In January 2007, the BBC ran a news story highlighting a study from Chinese researchers linking statin use and Parkinson's disease.2 With the likes of Pfizer's statin, Lipitor, making $12.2 billion in sales in 2005, this research could be big news. A recent review study suggests co-Q10 could be instrumental as a possible adjunct therapy for statin users because some statins work by inhibiting the synthesis of mevalonic acid (decreasing the plasma cholesterol), and mevalonic acid is also required for ubiquinone synthesis.3 These authors highlight the many studies confirming the relationship between statin therapy and lower plasma ubiquinone levels. As such, the recommended use of supplemental co-Q10 cotherapy during statin use may be warranted.

However, this is not an open-and-closed case, as two other studies have not shown statins to be linked with Parkinson's disease.4,5 Further work is clearly needed in this area, and at present the leading research from the Chinese study conducted by Dr Huang is examining the statin link with 16,000 patients for whom 20 years of baseline fasting cholesterol measurements are available. Underway at Harvard is another large-scale trial investigating a cholesterol link with Parkinson's risk.

Antitoxin and cancer benefits
New studies are highlighting the beneficial influence of co-Q10 in overcoming the many issues related to both cancer as a disease and its treatment through conventional medicine. A recent study from German researchers at the University of Witten-Herdecke investigated the influence of chemotherapy on plasma co-Q10 concentrations in 27 subjects with acute lymphoblastic leukaemia (ALL).6 Given the redox stress during chemotherapy it was suggested that co-Q10 concentrations may change during therapy. The starting values were compared to the co-Q10 concentrations in 92 healthy children.

While the co-Q10 concentration in the plasma of children with ALL was within a normal range at the time of diagnosis, a drastic increase was observed during induction treatment. The increase in co-Q10 (in a reduced form) concentration during induction treatment could have been attributed to many factors such as steroid treatments, but in my opinion the most likely reason is its release from damaged cells to the plasma. This potential loss from tissues could be a clear rationale for co-Q10 use during chemotherapy to maintain optimum energy and antioxidant status, vital for recovery.

So is there any new evidence for co-Q10 use in cancer treatment? One of the most common forms of cancer is skin melanoma, which is treated primarily with early surgical intervention. Despite good results from surgical interventions, the results of pharmacological therapies are still disappointing. Most often, chemically synthesized interferons (produced by cells in the body to help fight infections and tumours) are used.

Studies have demonstrated that low concentrations of coenzyme Q10 have been demonstrated in melanoma cell lines of melanoma patients. In a recent three-year trial, uninterrupted treatment with low-dose recombinant interferon alpha-2b administered twice daily and coenzyme Q10 (400mg/day) was conducted in patients with stages I and II melanoma and surgically removed lesions.7 Treatment efficacy was evaluated at incidence of recurrences at five years.

The results demonstrated that long-term administration of recombinant interferon alpha-2b in combination with coenzyme Q10 seemed to induce significantly decreased rates of recurrence beyond that of interferon alone.7

Heart healthy
For some time scientists have been aware of the potential benefits of supporting energy production and redox status (oxidant and antioxidant balance) in heart cells (myocardial tissue) following a heart attack (myocardial infarction). When infarction occurs, blood supply is halted, and upon its return cardiac cells can be damaged by a process known as ischemia-reperfusion injury (IRI) from excessive oxidative stress.

In a bid to overcome IRI, effective pharmaceutical and natural-product treatments have been investigated. Some natural products — including N-acetylcysteine, beta-glucan and co-Q10 — have been shown to have effective antioxidant and anti-inflammatory effects against reperfusion injury. The aim of a recent animal study was to determine and evaluate the effects of these agents on myocardial ischemia-reperfusion injury.8

Forty-four New Zealand white rabbits, all female, were used in the study. Four study groups of 11 animals were arranged by randomization. The groups were the control group (group C), a group premedicated with co-Q10 (group Q), a group premedicated with beta-glucan (group betaT), and a group premedicated with N-acetylcysteine (group N). Following an experimental procedure to mimic the damage caused by IRI, blood and muscle was taken and analyzed for a selection of chemical and histological markers of cell damage.

Baseline and reperfusion levels of antioxidant enzymes (glutathione peroxidase, superoxide dismutase) and cell-membrane damage (malonyldialdehyde) changed significantly. While malonyldialdehyde levels increased in group C, they decreased in the other study groups. The increases in glutathione peroxidase and superoxide dismutase levels were significant in all groups except group C.

The take home from this experiment is that antioxidant medication may help in lowering the risk of myocardial ischemia-reperfusion injury. All the interventions were shown to have effective roles in preventing the heart from ischemia-reperfusion injury to a large extent, through their antioxidant properties. Further studies in humans using dose response trials are necessary to assess which of these antioxidants are the most effective.

Gets you heard
An estimated 50 million people have experienced tinnitus in the US, according to the American Tinnitis Association. A further 12 million people have tinnitus severe enough to warrant medical attention in the US. In an attempt to address the symptoms of chronic tinnitus aurium, and the plasma co-Q10 and antioxidant status in known sufferers,9 a 16-week prospective nonrandomized clinical trial (n = 20) was undertaken. Tinnitus and Short Form-36 Questionnaires (TQ/SF-36) were evaluated together with the plasma concentrations of co-Q10, malondialdehyde and the total antioxidant status. The mean plasma co-Q10 concentration increased following supplemental co-Q10 intake, and remained elevated after medication stopped, without overall effects on the tinnitus score. However, in a subgroup of seven patients with low initial plasma co-Q10 concentration and significant increase in the plasma co-Q10 level, a clear decrease in the TQ score was observed.

In the first study to examine the effect of co-Q10 in chronic tinnitus aurium, the data show a clear association in patients with a low plasma co-Q10 concentration. Co-Q10 supply may decrease the tinnitus expression.

The future
Given the rapid expansion of research trials highlighting co-Q10's benefits, expect significant market growth to continue. One of the biggest issues is still cost. On average the consumer is looking at a monthly bill of $40 to $350, depending on dose and brand. But recent development of synthetic co-Q10 has highlighted the cost/demand issues, and more recent novel microbial applications may drive down production costs even further, making co-Q10 available to a wider market.10

Positive safety studies11,12 are outnumbering negative ones, and co-Q10's effect on all facets of human health are being explored. Novel areas of application likely to influence the future market include eyesight, photo-ageing, gum disease and migraines. These developments are opening a world of potential in the ever-expanding self-medication and wellness categories. The input from pharma, and cell-specific co-Q10 forms such as 'mitQ,' can only strengthen the relationships between big pharma and natural products.13

Mark J Tallon,PhD, is chief science officer of NutriSciences, a London-based consultancy firm specializing in health claim substantiation, product development and technical writing (

Coenzyme Q10 Retail Value RSP - $ in millions













?2007 Euromonitor International

1. No Author. Raw material and ingredient supply report. 2006. Nutrition Business Journal. Penton Media, Inc. USA
2. Huang X, Chen H, et al.Lower low-density lipoprotein cholesterol levels are associated with Parkinson's disease. Mov Disord. 2007 15;22(3):377-81.
3. Rák?czi K, Párdutz A, et al. Statin drugs decrease the plasma level of coenzyme Q10 (ubiquinone) in the organism. Ideggyogy Sz. 2007 30; 60(7-8):295-300.
4. Wolozin B, Wang SW, et al. Simvastatin is associated with a reduced incidence of dementia and Parkinson's disease. BMC Med. 2007 19; 5:20.
5. Lieberman A, Lyons K, et al. Statins, cholesterol, Co-enzyme Q10, and Parkinson's disease. Parkinsonism Relat Disord. 2005;11(2):81-4.
6. Niklowitz P, Wiesel T, et al. Coenzyme Q10 concentration in the plasma of children suffering from acute lymphoblastic leukaemia before and during induction treatment. Biofactors. 2007;29(2-3):
7. Rusciani L, Proietti I, et al. Recombinant interferon alpha-2b and coenzyme Q10 as a postsurgical adjuvant therapy for melanoma: a 3-year trial with recombinant interferon-alpha and 5-year follow-up. Melanoma Res. 2007;17(3):177-83.
8. Bolcal C, Yildirim V, et al. Do N-acetylcystein, beta-glucan, and coenzyme Q10 mollify myocardial ischemia-reperfusion injury? Heart Surg Forum. 2007;10(3):E222-7.
9. Khan M, Gross J, et al. A pilot clinical trial of the effects of coenzyme Q10 on chronic tinnitus aurium. Otolaryngol Head Neck Surg. 2007;136(1):72-7.
10. Cluis CP, Burja AM, et al. Current prospects for the production of coenzyme Q10 in microbes. Trends Biotechnol. 2007 Oct 10; [Epub ahead of print]
11. Nuku K, Matsuoka Y, et al. Safety assessment of PureSorb-Q40 in healthy subjects and serum coenzyme Q10 level in excessive dosing. J Nutr Sci Vitaminol (Tokyo). 2007;53(3):198-206.
12. Shah SA, Sander S, et al. Electrocardiographic and hemodynamic effects of coenzyme Q10 in healthy individuals: a double-blind, randomized controlled trial. Ann Pharmacother. 2007; 41(3):420-5.
13. Tauskela JS. MitoQ--a mitochondria-targeted antioxidant. IDrugs. 2007 ;10(6):399-412.

For more on co-Q10 in the personal-care market, see 'Business Strategies.'

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