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Revision as of 16:07, 22 May 2016 editNjain1091 (talk | contribs)Extended confirmed users1,581 edits CoQ10 and electron transport chain: Wikilinked Vitamin K2 for easy referenceTag: Visual edit← Previous edit Latest revision as of 14:44, 7 January 2025 edit undoPekpeklover (talk | contribs)54 edits no mention of adverse effects on the elderly in the cited link. Also, many clinical studies show benefits for people with renal disease. 
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{{Short description|Biochemical cofactor and antioxidant}}
{{DISPLAYTITLE:Coenzyme Q<sub>10</sub>}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Use American English|date=April 2024}}
{{Use dmy dates|date=October 2022}}
{{chembox {{chembox
| Name = Coenzyme Q<sub>10</sub> | Name = Coenzyme Q<sub>10</sub>
| Watchedfields = changed | Watchedfields = changed
| verifiedrevid = 477001960 | verifiedrevid = 477001960
| ImageFile = Unibuinone.svg | ImageFile = Coenzyme_Q10.svg
| IUPACName = 2--5,6-dimethoxy-3-methylcyclohexa-2,5-diene-1,4-dione | PIN = 2--5,6-dimethoxy-3-methylcyclohexa-2,5-diene-1,4-dione
| OtherNames =
{{plainlist|1=
* In general: Ubiquinone, coenzyme Q, CoQ, vitamin Q
* This form: ubidecarenone,
Q<sub>10</sub>, CoQ<sub>10</sub> {{IPAc-en|ˌ|k|oʊ|ˌ|k|juː|ˈ|t|ɛ|n}}}}
|Section1={{Chembox Identifiers |Section1={{Chembox Identifiers
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
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| CASNo = 303-98-0 | CASNo = 303-98-0
| PubChem = 5281915 | PubChem = 5281915
| KEGG = C11378
| ChEBI_Ref = {{ebicite|correct|EBI}} | ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 46245 | ChEBI = 46245
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}} }}
|Section8={{Chembox Related |Section8={{Chembox Related
| OtherFunction = ]<br>]<br>] | OtherFunction = ]<br />]<br />]
| OtherFunction_label = ]s | OtherFunction_label = ]s
}} }}
}} }}


'''Coenzyme Q<sub>10</sub> (CoQ<sub>10</sub>''' {{IPAc-en|ˌ|k|oʊ|k|j|uː|ˈ|t|ɛ|n}}''')''', also known as ubiquinone, is a naturally occurring ] (coenzyme) and an ] produced by the human body.<ref name="lpi">{{cite web |title=Coenzyme Q10 |url=https://lpi.oregonstate.edu/mic/dietary-factors/coenzyme-Q10 |publisher=Micronutrient Information Center, Linus Pauling Institute, Oregon State University |access-date=13 April 2024 |date=2018 |archive-date=15 March 2024 |archive-url=https://web.archive.org/web/20240315190507/https://lpi.oregonstate.edu/mic/dietary-factors/coenzyme-Q10 |url-status=live }}</ref><ref name="sood">{{cite web |vauthors=Sood B, Preeti Patel P, Keenaghan M |title=Coenzyme Q10 |url=https://www.ncbi.nlm.nih.gov/books/NBK531491/ |publisher=StatPearls, US National Library of Medicine |access-date=17 April 2024 |date=30 January 2024 |pmid=30285386 |archive-date=2 October 2023 |archive-url=https://web.archive.org/web/20231002122139/https://ncbi.nlm.nih.gov/books/NBK531491/ |url-status=live }}</ref><ref name="nccih">{{cite web |title=Coenzyme Q10 |url=https://www.nccih.nih.gov/health/coenzyme-q10 |publisher=National Center for Complementary and Integrative Health, US National Institutes of Health |access-date=13 April 2024 |date=January 2019 |archive-date=4 April 2024 |archive-url=https://web.archive.org/web/20240404222534/https://www.nccih.nih.gov/health/coenzyme-q10 |url-status=live }}</ref> It can also be obtained from dietary sources, such as meat, fish, seed oils, vegetables, and ]s.<ref name=lpi/><ref name=sood/> CoQ<sub>10</sub> is found in many organisms, including animals and bacteria.
'''Coenzyme Q<sub>10</sub>''', also known as '''ubiquinone''', '''ubidecarenone''', '''coenzyme Q''', and abbreviated at times to '''CoQ<sub>10</sub>''' {{IPAc-en|ˌ|k|oʊ|_|ˌ|k|juː|_|ˈ|t|ɛ|n}}, '''CoQ''', or '''Q<sub>10</sub>''' is a ] that is ] in the bodies of most ]s. It is a ], where '''Q''' refers to the ] chemical group and '''10''' refers to the number of ] chemical subunits in its tail.


CoQ<sub>10</sub> plays a role in ]l ], aiding in the production of ] (ATP), which is involved in energy transfer within cells.<ref name=lpi/> The structure of CoQ<sub>10</sub> consists of a benzoquinone moiety and an isoprenoid side chain, with the "10" referring to the number of ] chemical subunits in its tail.<ref name="pmid36768907">{{cite journal | vauthors = Mantle D, Lopez-Lluch G, Hargreaves IP | title = Coenzyme Q10 Metabolism: A Review of Unresolved Issues | journal = International Journal of Molecular Sciences | volume = 24 | issue = 3 | page = 2585 | date = January 2023 | pmid = 36768907 | pmc = 9916783 | doi = 10.3390/ijms24032585 | doi-access = free }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref><ref name="Kadian-2022">{{cite journal|doi=10.1007/s40495-021-00273-6 |title=The Impact of Coenzyme Q10 on Neurodegeneration: A Comprehensive Review |date=2022 |journal=Current Pharmacology Reports |volume=8 |pages=1–19 | vauthors = Kadian M, Sharma G, Pandita S, Sharma K, Shrivasatava K, Saini N, Kumar A }}</ref><ref name="pmid34064686">{{cite journal | vauthors = Mantle D, Heaton RA, Hargreaves IP | title = Coenzyme Q10 and Immune Function: An Overview | journal = Antioxidants | volume = 10 | issue = 5 | page = 759 | date = May 2021 | pmid = 34064686 | pmc = 8150987 | doi = 10.3390/antiox10050759 | doi-access = free }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref>
This fat-soluble substance, which resembles a vitamin, is present in most ] cells, primarily in the ]. It is a component of the ] and participates in ], which generates energy in the form of ]. Ninety-five percent of the ]’s energy is generated this way.<ref>{{cite journal |last1=Ernster |first1=L |last2=Dallner |first2=G |title=Biochemical, physiological and medical aspects of ubiquinone function |journal=Biochimica et Biophysica Acta |volume=1271 |issue=1 |pages=195–204 |year=1995 |pmid=7599208 |doi=10.1016/0925-4439(95)00028-3}}</ref><ref>{{cite book |last1=Dutton |first1=PL |last2=Ohnishi |first2=T |last3=Darrouzet |first3=E |last4=Leonard |first4=MA |last5=Sharp |first5=RE |last6=Cibney |first6=BR |last7=Daldal |first7=F |last8=Moser |first8=CC |chapter=4 Coenzyme Q oxidation reduction reactions in mitochondrial electron transport |pages=65–82 |title=Coenzyme Q: Molecular mechanisms in health and disease |editor1-last=Kagan |editor1-first=VE |editor2-last=Quinn |editor2-first=PJ |publisher=CRC Press |year=2000 |location=Boca Raton}}</ref> Therefore, those organs with the highest energy requirements—such as the heart, liver, and kidney—have the highest CoQ<sub>10</sub> concentrations.<ref>{{cite journal |last1=Okamoto |first1=T |last2=Matsuya |first2=T |last3=Fukunaga |first3=Y |last4=Kishi |first4=T |last5=Yamagami |first5=T |title=Human serum ubiquinol-10 levels and relationship to serum lipids |journal=International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition |volume=59 |issue=3 |pages=288–92 |year=1989 |pmid=2599795}}</ref><ref>{{cite journal |doi=10.1016/0003-9861(92)90511-T |last1=Aberg |first1=F |last2=Appelkvist |first2=EL |last3=Dallner |first3=G |last4=Ernster |first4=L |title=Distribution and redox state of ubiquinones in rat and human tissues |journal=Archives of Biochemistry and Biophysics |volume=295 |issue=2 |pages=230–4 |year=1992 |pmid=1586151}}</ref><ref>{{cite journal |doi=10.1111/1523-1747.ep12371744 |last1=Shindo |first1=Y |last2=Witt |first2=E |last3=Han |first3=D |last4=Epstein |first4=W |last5=Packer |first5=L |title=Enzymic and non-enzymic antioxidants in epidermis and dermis of human skin |journal=The Journal of Investigative Dermatology |volume=102 |issue=1 |pages=122–4 |year=1994 |pmid=8288904}}</ref>


Although a ubiquitous molecule in human tissues, CoQ<sub>10</sub> is not a dietary ] and does not have a ], and its use as a supplement is not ] in the United States for any health or anti-disease effect.<ref name=lpi/><ref name=sood/>
There are three ] states of CoQ<sub>10</sub>: fully oxidized ('''ubi'''quinone), '''semi'''quinone ('''ubisemi'''quinone), and fully ] (]). The capacity of this molecule to act as a 2 electron carrier (moving between the quinone and quinol form) and 1 electron carrier (moving between the semiquinone and one of these other forms) is central to its role in the electron transport chain, and as radical-scavenging antioxidant.
{{TOC limit|3}}


==Biological functions==
==Deficiency and toxicity==
{{See also|Q cycle}}
There are two major factors that lead to deficiency of CoQ<sub>10</sub> in humans: reduced biosynthesis, and increased use by the body. Biosynthesis is the major source of CoQ<sub>10</sub>. Biosynthesis requires at least 12 genes, and mutations in many of them cause CoQ deficiency. CoQ<sub>10</sub> levels also may be affected by other genetic defects (such as mutations of mitochondrial DNA, ETFDH, APTX, FXN, and BRAF, genes that are not directly related to the CoQ<sub>10</sub> biosynthetic process). The role of statins in deficiencies is controversial.<ref name=Trevisson11>{{cite journal |author=Trevisson E, Dimauro S, Navas P, Salviati L |title=Coenzyme Q deficiency in muscle |journal=Curr. Opin. Neurol. |volume=24 |issue=5 |pages=449–56 |date=October 2011 |pmid=21844807 |doi=10.1097/WCO.0b013e32834ab528 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1350-7540&volume=24&issue=5&spage=449}}</ref> Some chronic disease conditions (cancer, heart disease, etc.) also are thought to reduce the biosynthesis of and increase the demand for CoQ<sub>10</sub> in the body, but there are no definite data to support these claims.
CoQ<sub>10</sub> is a component of the mitochondrial ] (ETC), where it plays a role in oxidative phosphorylation, a process required for the biosynthesis of adenosine triphosphate, the primary energy source of cells.<ref name=lpi/><ref name="pmid34064686"/><ref name="pmid34596729">{{cite journal |vauthors=Pradhan N, Singh C, Singh A |title=Coenzyme Q10 a mitochondrial restorer for various brain disorders |journal=Naunyn Schmiedebergs Arch Pharmacol |volume=394 |issue=11 |pages=2197–2222 |date=November 2021 |pmid=34596729 |doi=10.1007/s00210-021-02161-8}}</ref>


CoQ<sub>10</sub> is a ] molecule that is located in all biological membranes of human body and serves as a component for the synthesis of ATP and is a life-sustaining cofactor for the three complexes (], ], and ]) of the ETC in the mitochondria.<ref name=lpi/><ref name="Kadian-2022"/> CoQ<sub>10</sub> has a role in the transport of ]s across ] membranes to regulate pH in lysosome functions.<ref name=lpi/>
Usually, toxicity is not observed with high doses of CoQ<sub>10</sub>. A daily dosage up to 3600&nbsp;mg was found to be tolerated by healthy as well as unhealthy persons.<ref>{{cite journal |author=Hyson HC, Kieburtz K, Shoulson I |title=Safety and tolerability of high-dosage coenzyme Q<sub>10</sub> in Huntington's disease and healthy subjects |journal=Mov. Disord. |volume=25 |issue=12 |pages=1924–8 |date=September 2010 |pmid=20669312 |doi=10.1002/mds.22408 |display-authors=etal}}</ref> Some adverse effects, however, largely gastrointestinal, are reported with very high intakes. The observed safe level (OSL) risk assessment method indicated that the evidence of safety is strong at intakes up to 1200&nbsp;mg/day, and this level is identified as the OSL.<ref>{{cite journal |author=Hathcock JN, Shao A |title=Risk assessment for coenzyme Q<sub>10</sub> (Ubiquinone) |journal=Regul. Toxicol. Pharmacol. |volume=45 |issue=3 |pages=282–8 |date=August 2006 |pmid=16814438 |doi=10.1016/j.yrtph.2006.05.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0273-2300(06)00090-0}}</ref>


The mitochondrial oxidative phosphorylation process takes place in the inner mitochondrial membrane of eukaryotic cells.<ref name=lpi/> This membrane is highly folded into structures called cristae, which increase the surface area available for oxidative phosphorylation. CoQ<sub>10</sub> plays a role in this process as an essential cofactor of the ETC located in the inner mitochondrial membrane and serves the following functions:<ref name=lpi/><ref name="pmid34596729"/>
=== Clinical assessment ===
* electron transport in the mitochondrial ETC, by shuttling electrons from mitochondrial complexes like ] (NADH), ] (complex I), and succinate ubiquinone reductase (complex II), the fatty acids and branched-chain amino acids oxidation (through flavin-linked dehydrogenases) to ] (complex III) of the ETC:<ref name=lpi/><ref name="pmid34596729"/> CoQ<sub>10</sub> participates in fatty acid and glucose metabolism by transferring electrons generated from the reduction of fatty acids and glucose to electron acceptors;<ref name="pmid33291255">{{cite journal |vauthors=Manzar H, Abdulhussein D, Yap TE, Cordeiro MF |title=Cellular Consequences of Coenzyme Q10 Deficiency in Neurodegeneration of the Retina and Brain |journal=Int J Mol Sci |volume=21 |issue=23 |date=December 2020 |page=9299 |pmid=33291255 |pmc=7730520 |doi=10.3390/ijms21239299 |doi-access=free}}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref>
Although CoQ<sub>10</sub> may be measured in plasma, these measurements reflect dietary intake rather than tissue status. Currently, most clinical centers measure CoQ<sub>10</sub> levels in cultured skin ]s, muscle biopsies, and blood mononuclear cells.<ref name=Trevisson11/>
* antioxidant activity as a lipid-soluble antioxidant together with ], scavenging ] and protecting cells against oxidative stress,<ref name=lpi/><ref name="pmid34064686"/> inhibiting the oxidation of proteins, DNA, and use of vitamin E.<ref name=lpi/><ref name="pmid32349341">{{cite journal |vauthors=Di Lorenzo A, Iannuzzo G, Parlato A, Cuomo G, Testa C, Coppola M, D'Ambrosio G, Oliviero DA, Sarullo S, Vitale G, Nugara C, Sarullo FM, Giallauria F |title=Clinical Evidence for Q10 Coenzyme Supplementation in Heart Failure: From Energetics to Functional Improvement |journal=J Clin Med |volume=9 |issue=5 |date=April 2020 |page=1266 |pmid=32349341 |pmc=7287951 |doi=10.3390/jcm9051266 | doi-access=free}}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref>
Culture fibroblasts can be used also to evaluate the rate of endogenous CoQ<sub>10</sub> biosynthesis, by measuring the uptake of 14C-labelled p-hydroxybenzoate.<ref>{{cite journal |author=Montero R, Sánchez-Alcázar JA, Briones P |title=Analysis of coenzyme Q<sub>10</sub> in muscle and fibroblasts for the diagnosis of CoQ<sub>10</sub> deficiency syndromes |journal=Clin. Biochem. |volume=41 |issue=9 |pages=697–700 |date=June 2008 |pmid=18387363 |doi=10.1016/j.clinbiochem.2008.03.007 |url=http://linkinghub.elsevier.com/retrieve/pii/S0009-9120(08)00128-8|display-authors=etal}}</ref>


==Biochemistry==
=== Inhibition by statins and beta blockers ===
{{Expert needed|biochemistry|talk=Biological function|date=April 2024}}
CoQ<sub>10</sub> shares a biosynthetic pathway with ]. The synthesis of an intermediary precursor of CoQ<sub>10</sub>, ], is inhibited by some ]s, blood pressure-lowering medication,<ref>{{Cite journal |last1=Kishi |first1=T |last2=Watanabe |first2=T |last3=Folkers |first3=K |title=Bioenergetics in clinical medicine XV. Inhibition of coenzyme Q<sub>10</sub>-enzymes by clinically used adrenergic blockers of beta-receptors |journal=Research communications in chemical pathology and pharmacology |volume=17 |issue=1 |pages=157–64 |year=1977 |pmid=17892}}</ref> and ], a class of cholesterol-lowering drugs.<ref>{{cite journal |last1=Mortensen |first1=SA |last2=Leth |first2=A |last3=Agner |first3=E |last4=Rohde |first4=M |title=Dose-related decrease of serum coenzyme Q<sub>10</sub> during treatment with HMG-CoA reductase inhibitors |journal=Molecular aspects of medicine |volume=18 |issue=Suppl |pages=S137–44 |year=1997 |pmid=9266515 |doi=10.1016/S0098-2997(97)00014-9}}</ref> Statins can reduce serum levels of CoQ<sub>10</sub> by up to 40%.<ref>{{cite journal |last1=Ghirlanda |first1=G |last2=Oradei |first2=A |last3=Manto |first3=A |last4=Lippa |first4=S |last5=Uccioli |first5=L |last6=Caputo |first6=S |last7=Greco |first7=AV |last8=Littarru |first8=GP |title=Evidence of plasma CoQ<sub>10</sub>-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study |journal=] |volume=33 |issue=3 |pages=226–9 |year=1993 |pmid=8463436 |doi=10.1002/j.1552-4604.1993.tb03948.x}}</ref>
Coenzymes Q is a ] family that is ] in animals and many ],<ref name="pmid20599680">{{cite journal | vauthors = Nowicka B, Kruk J | title = Occurrence, biosynthesis and function of isoprenoid quinones | journal = Biochimica et Biophysica Acta (BBA) - Bioenergetics | volume = 1797 | issue = 9 | pages = 1587–1605 | date = September 2010 | pmid = 20599680 | doi = 10.1016/j.bbabio.2010.06.007 | doi-access = free }}</ref> a group of gram-negative bacteria. The fact that the coenzyme is ubiquitous gives the origin of its other name, ubiquinone.<ref name=lpi/><ref name=sood/><ref name="pubchem-Ubidecarenone">{{Include-USGov|agency=]|title=Ubidecarenone |url=https://pubchem.ncbi.nlm.nih.gov/compound/5281915 | work = PubChem | publisher = US National Library of Medicine |access-date=4 April 2024 |date=30 March 2024}}</ref> In humans, the most common form of coenzymes Q is coenzyme Q<sub>10</sub>, also called CoQ<sub>10</sub> ({{IPAc-en|ˌ|k|oʊ|k|j|uː|ˈ|t|ɛ|n}}) or ubiquinone-10.<ref name=lpi/>


Coenzyme Q<sub>10</sub> is a ], in which "Q" refers to the ] chemical group and "10" refers to the number of ] chemical subunits (shown enclosed in brackets in the diagram) in its tail.<ref name=lpi/> In natural ubiquinones, there are from six to ten subunits in the tail, with humans having a tail of 10 isoprene units (50 carbon atoms) connected to its benzoquinone "head".<ref name=lpi/>
==Supplementation==
CoQ<sub>10</sub> is not approved by the U.S. ] (FDA) for the treatment of any medical condition.<ref name= NCI>{{cite web |author1= White, J. (lead reviewer) |author2= ] (NCI) |date= 14 May 2014 |title= PDQ® Coenzyme Q10 |url= http://www.cancer.gov/cancertopics/pdq/cam/coenzymeQ10/HealthProfessional |publisher= NCI, ], ] |accessdate= 29 June 2014}}</ref> It is sold as a dietary supplement. In the U.S., supplements are not regulated as drugs, but as foods. How CoQ<sub>10</sub> is manufactured is not regulated and different batches and brands may vary significantly.<ref name= NCI/>


This family of fat-soluble substances is present in all respiring ] cells, primarily in the mitochondria.<ref name=lpi/> Ninety-five percent of the human body's energy is generated this way.<ref name="pmid7599208">{{cite journal | vauthors = Ernster L, Dallner G | title = Biochemical, physiological and medical aspects of ubiquinone function | journal = Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease | volume = 1271 | issue = 1 | pages = 195–204 | date = May 1995 | pmid = 7599208 | doi = 10.1016/0925-4439(95)00028-3 | doi-access = free }}</ref> Organs with the highest energy requirements—such as the ], ], and ]—have the highest CoQ<sub>10</sub> concentrations.<ref name="pmid2599795">{{cite journal | vauthors = Okamoto T, Matsuya T, Fukunaga Y, Kishi T, Yamagami T | title = Human serum ubiquinol-10 levels and relationship to serum lipids | journal = International Journal for Vitamin and Nutrition Research. Internationale Zeitschrift Fur Vitamin- und Ernahrungsforschung. Journal International de Vitaminologie et de Nutrition | volume = 59 | issue = 3 | pages = 288–292 | year = 1989 | pmid = 2599795 }}</ref><ref name="pmid1586151">{{cite journal | vauthors = Aberg F, Appelkvist EL, Dallner G, Ernster L | title = Distribution and redox state of ubiquinones in rat and human tissues | journal = Archives of Biochemistry and Biophysics | volume = 295 | issue = 2 | pages = 230–234 | date = June 1992 | pmid = 1586151 | doi = 10.1016/0003-9861(92)90511-T }}</ref><ref name="pmid8288904">{{cite journal | vauthors = Shindo Y, Witt E, Han D, Epstein W, Packer L | title = Enzymic and non-enzymic antioxidants in epidermis and dermis of human skin | journal = The Journal of Investigative Dermatology | volume = 102 | issue = 1 | pages = 122–124 | date = January 1994 | pmid = 8288904 | doi = 10.1111/1523-1747.ep12371744 | doi-access = }}</ref><ref name="Žmitek-2008">{{cite journal|vauthors=Žmitek J, ŽMitek K, Pravs I|title=Improving the bioavailability of coenzyme q10 from theory to practice|year=2008|journal=Agro Food Industry Hi-Tech|url=https://www.scopus.com/inward/record.uri?eid=2-s2.0-53849139131&partnerID=40&md5=25ac2ff16eec9fc4a8b52430316bfbd8|access-date=5 April 2024|archive-date=23 April 2024|archive-url=https://web.archive.org/web/20240423075336/https://www.scopus.com/record/display.uri?eid=2-s2.0-53849139131&origin=inward&txGid=4f4a035686dfee6b6fbde3099b06b518|url-status=live}}</ref>
A 2004 laboratory analysis by ] of CoQ<sub>10</sub> supplements on the market found that some did not contain the quantity identified on the product label. Amounts varied from "no detectable CoQ<sub>10</sub>", to 75% of stated dose, and up to a 75% excess.<ref>{{cite news |date= August–September 2004 |title= ConsumerLab.com finds discrepancies in strength of CoQ10 supplements |periodical= ] |page= 19}}</ref>


There are three ] states of CoQ: fully oxidized (''ubi''quinone), ] (''ubisemi''quinone), and fully ] (]).<ref name=lpi/> The capacity of this molecule to act as a two-electron carrier (moving between the quinone and quinol form) and a one-electron carrier (moving between the semiquinone and one of these other forms) is central to its role in the electron transport chain due to the ]s that can only accept one electron at a time, and as a free radical–scavenging antioxidant.<ref name=lpi/><ref name="pubchem-Ubidecarenone"/>
Generally, CoQ<sub>10</sub> is well tolerated. The most common side effects are gastrointestinal symptoms (nausea, vomiting, appetite suppression, and stomachache), rash, and headache.<ref name=wyman>{{cite journal |author=Wyman M, Leonard M, Morledge T |title=Coenzyme Q10: a therapy for hypertension and statin-induced myalgia? |journal=Cleve Clin J Med |volume=77 |issue=7 |pages=435–42 |date=July 2010 |pmid=20601617 |doi=10.3949/ccjm.77a.09078 |url=}}</ref>


===Heart disease=== ==Deficiency==
There are two major pathways of deficiency of CoQ<sub>10</sub> in humans: reduced ], and increased use by the body.<ref name="pmid25091424">{{cite journal |vauthors=Desbats MA, Lunardi G, Doimo M, Trevisson E, Salviati L |title=Genetic bases and clinical manifestations of coenzyme Q10 (CoQ 10) deficiency |journal=J Inherit Metab Dis |volume=38 |issue=1 |pages=145–56 |date=January 2015 |pmid=25091424 |doi=10.1007/s10545-014-9749-9 |url=}}</ref> Biosynthesis is the major source of CoQ<sub>10</sub>. Biosynthesis requires at least 15 ]s, and mutations in any of them can cause CoQ deficiency.<ref name="pmid25091424"/> CoQ<sub>10</sub> levels also may be affected by other genetic defects (such as mutations of ], '']'', '']'', '']'', and '']'', genes that are not directly related to the CoQ<sub>10</sub> biosynthetic process).<ref name="pmid25091424"/> Some of these, such as mutations in '']'', can lead to serious diseases such as steroid-resistant ] with sensorineural ].<ref>{{cite journal|doi=10.1172/JCI45693 |title=COQ6 mutations in human patients produce nephrotic syndrome with sensorineural deafness |date=2011 |journal=Journal of Clinical Investigation |volume=121 |issue=5 |pages=2013–2024 |pmid=21540551 |pmc=3083770 |vauthors = Heeringa SF, Chernin G, Chaki M, Zhou W, Sloan AJ, Ji Z, Xie LX, Salviati L, Hurd TW, Vega-Warner V, Killen PD, Raphael Y, Ashraf S, Ovunc B, Schoeb DS, McLaughlin HM, Airik R, Vlangos CN, Gbadegesin R, Hinkes B, Saisawat P, Trevisson E, Doimo M, Casarin A, Pertegato V, Giorgi G, Prokisch H, Rötig A, Nürnberg G, Becker C }}</ref><ref>{{cite journal|doi=10.1002/jmd2.12068 |title=''COQ6'' mutation in patients with nephrotic syndrome, sensorineural deafness, and optic atrophy |date=2020 |journal=Jimd Reports |volume=54 |issue=1 |pages=37–44 |pmid=32685349 |pmc=7358665 | vauthors = Justine Perrin R, Rousset-Rouvière C, Garaix F, Cano A, Conrath J, Boyer O, Tsimaratos M }}</ref><ref>{{cite web | url=https://www.ncbi.nlm.nih.gov/medgen/886260 | title=Nephrotic Syndrome - COQ6 Associated (Concept Id: C4054393) - MedGen - NCBI | access-date=6 April 2024 | archive-date=6 April 2024 | archive-url=https://web.archive.org/web/20240406102811/https://www.ncbi.nlm.nih.gov/medgen/886260 | url-status=live }}</ref>


===Assessment===
A 2014 ] ] found "no convincing evidence to support or refute" the use of CoQ10 for the treatment of heart failure.<ref>{{cite journal |title= Coenzyme Q10 for heart failure |url= http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008684.pub2/full |journal= ] |issue= 6 |page= Art. no. CD008684 |nopp= yes |last1= Madmani |first1= M.E. |last2= Yusuf Solaiman |first2= A. |last3= Tamr Agha |first3= K. |last4= Madmani |first4= Y. |last5= Shahrour |first5= Y. |last6= Essali |first6= A. |last7= Kadro |first7= W. |displayauthors= 4 |department= Heart Group |publisher= ] |date= 2 June 2014 |subscription= yes |via= ] |doi=10.1002/14651858.CD008684.pub2}}</ref> Evidence with respect to preventing heart disease in those who are otherwise healthy is also poor.<ref>{{cite journal| last1=Flowers |first1=N| last2=Hartley |first2=L| last3=Todkill |first3=D |last4=Stranges |first4=S|last5=Rees|first5=K|title=Co-enzyme Q10 supplementation for the primary prevention of cardiovascular disease.|journal=The Cochrane database of systematic reviews|date=4 December 2014|volume=12|pages=CD010405|pmid=25474484|doi=10.1002/14651858.CD010405.pub2}}</ref>
Although CoQ<sub>10</sub> may be measured in ], these measurements reflect dietary intake rather than tissue status. Currently, most clinical centers measure CoQ<sub>10</sub> levels in cultured skin ]s, muscle ], and blood mononuclear cells.<ref name="pmid21844807">{{cite journal | vauthors = Trevisson E, DiMauro S, Navas P, Salviati L | title = Coenzyme Q deficiency in muscle | journal = Current Opinion in Neurology | volume = 24 | issue = 5 | pages = 449–456 | date = October 2011 | pmid = 21844807 | doi = 10.1097/WCO.0b013e32834ab528 | hdl-access = free | hdl = 10261/129020 }}</ref> Culture fibroblasts can be used also to evaluate the rate of endogenous CoQ<sub>10</sub> biosynthesis, by measuring the uptake of ]-] ].<ref name="pmid18387363">{{cite journal | vauthors = Montero R, Sánchez-Alcázar JA, Briones P, Hernández AR, Cordero MD, Trevisson E, Salviati L, Pineda M, García-Cazorla A, Navas P, Artuch R | title = Analysis of coenzyme Q10 in muscle and fibroblasts for the diagnosis of CoQ<sub>10</sub> deficiency syndromes | journal = Clinical Biochemistry | volume = 41 | issue = 9 | pages = 697–700 | date = June 2008 | pmid = 18387363 | doi = 10.1016/j.clinbiochem.2008.03.007 | hdl-access = free | hdl = 11577/2447079 }}</ref>


A 2009 ] concluded that studies looking at the effects of CoQ<sub>10</sub> on blood pressure were unreliable, and therefore no conclusions could be made regarding its effectiveness in lowering blood pressure.<ref>{{cite journal|last=Ho|first=MJ|author2=Bellusci, A |author3=Wright, JM |title=Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension.|journal=The Cochrane database of systematic reviews|date=Oct 7, 2009|issue=4|pages=CD007435|pmid=19821418|doi=10.1002/14651858.CD007435.pub2}}</ref>
CoQ<sub>10</sub> is studied as an adjunctive therapy to reduce inflammation in ].<ref name="pmid37592831">{{cite journal |vauthors=Fawzy El-Sayed KM, Cosgarea R, Sculean A, Doerfer C |title=Can vitamins improve periodontal wound healing/regeneration? |journal=Periodontol 2000 |volume=94 |issue=1 |pages=539–602 |date=February 2024 |pmid=37592831 |doi=10.1111/prd.12513 |url=}}</ref>


===Huntington's disease=== ===Statins===
Although statins may reduce CoQ<sub>10</sub> in the blood it is unclear if they reduce CoQ<sub>10</sub> in muscle.<ref name="pmid28546301"/> Evidence does not support that supplementation improves side effects from statins.<ref name="pmid28546301">{{cite journal | vauthors = Tan JT, Barry AR | title = Coenzyme Q10 supplementation in the management of statin-associated myalgia | journal = American Journal of Health-System Pharmacy | volume = 74 | issue = 11 | pages = 786–793 | date = June 2017 | pmid = 28546301 | doi = 10.2146/ajhp160714 | s2cid = 3825396 | doi-access = free }}</ref><ref>{{Cite journal |last1=Kennedy |first1=Cormac |last2=Köller |first2=Yasmin |last3=Surkova |first3=Elena |date=2020-04-01 |title=Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis |journal=Atherosclerosis |language=en |volume=299 |pages=1–8 |doi=10.1016/j.atherosclerosis.2020.03.006 |pmid=32179207 |doi-access=free }}</ref>


==Chemical properties==
Available evidence suggests that "CoQ<sub>10</sub> is likely ineffective in moderately improving" the chorea associated with ].<ref>{{cite journal|last1=Armstrong|first1=MJ|last2=Miyasaki|first2=JM|publisher=American Academy of Neurology|title=Evidence-based guideline: pharmacologic treatment of chorea in Huntington disease: report of the guideline development subcommittee of the American Academy of Neurology.|journal=]|date=Aug 7, 2012| volume=79| issue=6| pages=597–603 |pmid=22815556| doi=10.1212/wnl.0b013e318263c443 |pmc=3413759}}</ref>
The oxidized structure of CoQ<sub>10</sub> is shown below. The various kinds of coenzyme Q may be distinguished by the number of ] subunits in their ]. The most common coenzyme Q in human mitochondria is CoQ<sub>10</sub>.<ref name=lpi/> Q refers to the quinone head and "10" refers to the number of isoprene repeats in the tail. The molecule below has three isoprenoid units and would be called Q<sub>3</sub>.
:]


In its pure state, it is an orange-colored lipophile powder, and has no taste nor odor.<ref name="pubchem-Ubidecarenone"/>
===Male infertility===


==Biosynthesis==
While CoQ<sub>10</sub> can improve some measurements regarding sperm quality, there is no evidence that CoQ<sub>10</sub> increases live births or pregnancy rates.<ref>{{cite journal|last=Lafuente|first=R|author2=González-Comadrán, M |author3=Solà, I |author4=López, G|author5=Brassesco, M |author6=Carreras, R |author7= Checa, MA |title=Coenzyme Q10 and male infertility: a meta-analysis.|journal=Journal of assisted reproduction and genetics|date=Sep 2013|volume=30|issue=9|pages=1147–56|pmid=23912751|doi=10.1007/s10815-013-0047-5}}</ref>
Biosynthesis occurs in most human tissue. There are three major steps:
# Creation of the ] structure (using ] or ], via ])
# Creation of the ] side chain (using ])
# The joining or ] of the above two structures


The initial two reactions occur in ], the ], and ]s, indicating multiple sites of synthesis in animal cells.<ref name="pmid20494114">{{cite journal | vauthors = Bentinger M, Tekle M, Dallner G | title = Coenzyme Q--biosynthesis and functions | journal = Biochemical and Biophysical Research Communications | volume = 396 | issue = 1 | pages = 74–79 | date = May 2010 | pmid = 20494114 | doi = 10.1016/j.bbrc.2010.02.147 }}</ref>
===Migraine headaches===


An important enzyme in this pathway is ], usually a target for intervention in cardiovascular complications. The "statin" family of cholesterol-reducing medications inhibits HMG-CoA reductase. One possible side effect of statins is decreased production of CoQ<sub>10</sub>, which may be connected to the development of ] and ]. However, the role statins play in CoQ deficiency is controversial. Although statins reduce blood levels of CoQ, studies on the effects of muscle levels of CoQ are yet to come. CoQ supplementation also does not reduce side effects of statin medications.<ref name="pmid21844807"/><ref name="pmid28546301"/>
Supplementation of CoQ<sub>10</sub> has been found to have a beneficial effect on the condition of some sufferers of ]. This is based on the theory that migraines are a mitochondrial disorder,<ref>{{cite journal |author=Markley HG |title=CoEnzyme Q10 and riboflavin: the mitochondrial connection |journal=Headache |volume=52 Suppl 2 |issue= |pages=81–7 |date=October 2012 |pmid=23030537 |doi=10.1111/j.1526-4610.2012.02233.x |type=Review}}</ref> and that mitochondrial dysfunction can be improved with CoQ<sub>10</sub>.<ref>{{cite journal |author=Yorns WR, Hardison HH |title=Mitochondrial dysfunction in migraine |journal=Semin Pediatr Neurol |volume=20 |issue=3 |pages=188–93 |date=September 2013 |pmid=24331360 |doi=10.1016/j.spen.2013.09.002 |url=}}</ref> The Canadian Headache Society guideline for migraine prophylaxis recommends, based on low-quality evidence, that 300&nbsp;mg of CoQ<sub>10</sub> be offered as a choice for prophylaxis.<ref>{{cite journal |author=Pringsheim T, Davenport W, Mackie G |title=Canadian Headache Society guideline for migraine prophylaxis |journal=Can J Neurol Sci |volume=39 |issue=2 Suppl 2 |pages=S1–59 |date=March 2012 |pmid=22683887 |doi= |url=|display-authors=etal}}</ref>


Genes involved include '']'', '']'', '']'', and '']'' (''COQ8'', ''CABC1'').<ref name="Espinós-2009">{{Cite book | vauthors = Espinós C, Felipo V, Palau F |url=https://books.google.com/books?id=uxQ_pjKNhE8C&pg=PA122 |title=Inherited Neuromuscular Diseases: Translation from Pathomechanisms to Therapies |date=2009 |publisher=Springer |isbn=978-90-481-2812-9 |pages=122ff |access-date=4 January 2011}}</ref>
===Statin myopathy===
CoQ<sub>10</sub> has been routinely used to treat muscle breakdown associated as a side effect of use of statin medications. However, evidence from randomized controlled trials does not appear to support the idea that CoQ<sub>10</sub> is an effective treatment for statin myopathy.<ref name="Banach2015">{{cite journal|author=Banach M, Serban C, Sahebkar A, Ursoniu S, Rysz J, Muntner P, Toth PP, Jones SR, Rizzo M, Glasser SP, Lip GY, Dragan S, Mikhailidis DP; Lipid and Blood Pressure Meta-analysis Collaboration Group|title=Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials|journal=Mayo Clin Proc|volume=90|issue=1|pages=24–34|date=January 2015|pmid=25440725|doi=10.1016/j.mayocp.2014.08.021 |type=Systematic Review and Meta-Analysis}}</ref>


Organisms other than humans produce the benzoquinone and isoprene structures from somewhat different source chemicals. For example, the bacteria '']'' produces the former from ] and the latter from a non-] source. The common yeast '']'', however, derives the former from either chorismate or tyrosine and the latter from ]. Most organisms share the common 4-hydroxybenzoate intermediate, yet again uses different steps to arrive at the "Q" structure.<ref name="pmid11583838">{{cite journal | vauthors = Meganathan R | title = Ubiquinone biosynthesis in microorganisms | journal = FEMS Microbiology Letters | volume = 203 | issue = 2 | pages = 131–139 | date = September 2001 | pmid = 11583838 | doi = 10.1111/j.1574-6968.2001.tb10831.x | doi-access = free }}</ref>
===Cancer===


==Dietary supplement==
No large well-designed clinical trials of CoQ<sub>10</sub> in cancer treatment have been done.<ref name= NCI/> The ] identified issues with the few, small studies that have been done stating, "the way the studies were done and the amount of information reported made it unclear if benefits were caused by the CoQ<sub>10</sub> or by something else".<ref name= NCI/> The ] has concluded, "CoQ<sub>10</sub> may reduce the effectiveness of chemo and radiation therapy, so most oncologists would recommend avoiding it during cancer treatment."<ref>{{cite web|title=Coenzyme Q10|url=http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/pharmacologicalandbiologicaltreatment/coenzyme-q10|publisher=American Cancer Society|accessdate=20 February 2014}}</ref>
Although neither a ] nor an ], CoQ<sub>10</sub> is commonly used as a dietary supplement with the intent to prevent or improve disease conditions, such as cardiovascular disorders.<ref name=sood/><ref name="arenas">{{cite journal | vauthors = Arenas-Jal M, Suñé-Negre JM, García-Montoya E | title = Coenzyme Q10 supplementation: Efficacy, safety, and formulation challenges | journal = Comprehensive Reviews in Food Science and Food Safety | volume = 19 | issue = 2 | pages = 574–594 | date = March 2020 | pmid = 33325173 | doi = 10.1111/1541-4337.12539 | hdl-access = free | hdl = 2445/181270 }}</ref> CoQ<sub>10</sub> is naturally produced by the body and plays a crucial role in cell growth and protection.<ref name="pmid34064686"/> Despite its significant role in the body, it is not used as a drug for the treatment of any specific disease.<ref name=lpi/><ref name=sood/><ref name=nccih/>


Nevertheless, CoQ<sub>10</sub> is widely available as an over-the-counter dietary supplement and is recommended by some healthcare professionals, despite a lack of definitive scientific evidence supporting these recommendations,<ref name=lpi/><ref name=nccih/> especially when it comes to cardiovascular diseases.<ref name="pmid36852817">{{cite journal |vauthors=Bjørklund G, Semenova Y, Gasmi A, Indika NR, Hrynovets I, Lysiuk R, Lenchyk L, Uryr T, Yeromina H, Peana M |title=Coenzyme Q10 for Enhancing Physical Activity and Extending the Human Life Cycle |journal=Curr Med Chem |volume=31 |issue=14 |pages=1804–1817 |date=2024 |pmid=36852817 |doi=10.2174/0929867330666230228103913}}</ref>
===Dental disease===


==Regulation and composition==
A review study has shown that there is no clinical benefit to the use of CoQ<sub>10</sub> in the treatment of ].<ref>{{cite journal |author=T.L.P. Watts, BDS, MDS, PhD, FDS, Department of Periodontology and Preventive Dentistry, UMDS, Guy's Hospital London |title=Coënzyme Q10 and periodontal treatment: is there any beneficial effect? |journal=British Dental Journal |year=1995 |volume=178 |pages=209–213 |doi=10.1038/sj.bdj.4808715 |pmid=7718355 |issue=6 }}</ref> Most of the studies suggesting otherwise were outdated, focused on in-vitro tests,<ref>{{cite journal |last1=Folkers |first1=K |last2=Hanioka |first2=T |last3=Xia |first3=L |last4=McRee Jr |first4=J |last5=Langsjoen |first5=P |title=Coenzyme Q<sub>10</sub> increases T4/T8 ratios of lymphocytes in ordinary subjects and relevance to patients having the aids related complex |journal=Biochemical and Biophysical Research Communications |volume=176 |issue=2 |pages=786–91 |year=1991 |pmid=1673841 |doi=10.1016/S0006-291X(05)80254-2}}</ref><ref>{{cite journal |author=Littarru GP, Nakamura R, Ho L, Folkers K, Kuzell WC |title=Deficiency of Coenzyme Q<sub>10</sub> in Gingival Tissue from Patients with Periodontal Disease |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=68 |issue=10 |pages=2332–5 |date=October 1971 |pmid=5289867 |pmc=389415 |doi=10.1073/pnas.68.10.2332 }}</ref><ref>{{cite journal |author=Nakamura R, Littarru GP, Folkers K, Wilkinson EG |title=Study of CoQ<sub>10</sub>-Enzymes in Gingiva from Patients with Periodontal Disease and Evidence for a Deficiency of Coenzyme Q<sub>10</sub> |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=71 |issue=4 |pages=1456–60 |date=April 1974 |pmid=4151519 |pmc=388248 |doi=10.1073/pnas.71.4.1456 }}</ref> had too few test subjects and/or erroneous statistical methodology and trial set-up,<ref>{{Cite journal|author= McRee JT, Hanioka T, Shizukuishi S, Folkers K |title= Therapy with coenzyme Q<sub>10</sub> for patients with periodontal disease |journal= J Dent Health |volume=43 |pages=659–666 |year=1993|doi= 10.5834/jdh.43.659|issue= 5}}</ref><ref>{{cite journal |author=Hanioka T, Tanaka M, Ojima M, Shizukuishi S, Folkers K |title=Effect of topical application of coenzyme Q<sub>10</sub> on adult periodontitis |journal=Mol. Aspects Med. |volume=15 |issue=Suppl |pages=S241–8 |year=1994 |pmid=7752836 |doi=10.1016/0098-2997(94)90034-5}}</ref> or were sponsored by a manufacturer of the product.<ref>{{cite journal |last1=Wilkinson |first1=EG |last2=Arnold |first2=RM |last3=Folkers |first3=K |title=Bioenergetics in clinical medicine. VI. adjunctive treatment of periodontal disease with coenzyme Q<sub>10</sub> |journal=Research communications in chemical pathology and pharmacology |volume=14 |issue=4 |pages=715–9 |year=1976 |pmid=785563}}</ref>
CoQ<sub>10</sub> is not approved by the U.S. ] (FDA) for the treatment of any medical condition.<ref name="canter-patient">{{Include-USGov|agency=]|url=http://www.cancer.gov/cancertopics/pdq/cam/coenzymeQ10/patient|publisher=]|title=Coenzyme Q<sub>10</sub>|date=April 2022}}</ref><ref name="pmid26389329">{{cite book|pmid=26389329 |date=2002 |publisher=PDQ Integrative, Alternative, and Complementary Therapies Editorial Board |title=Coenzyme Q10: Health Professional Version |author=((PDQ Integrative, Alternative, and Complementary Therapies Editorial Board)) }}</ref><ref name="White-2014">{{Include-USGov|agency=]| vauthors = White J |date= 14 May 2014 |title=PDQ Coenzyme Q<sub>10</sub> |url=http://www.cancer.gov/cancertopics/pdq/cam/coenzymeQ10/HealthProfessional |publisher= ], ], ] |access-date= 29 June 2014}}</ref><ref name="nice.org.uk-2017">{{Cite web |url=https://www.nice.org.uk/advice/es11/resources/mitochondrial-disorders-in-children-coenzyme-q10-pdf-1158110303173 |title=Mitochondrial disorders in children: Co-enzyme Q10 |date=28 March 2017 |website=nice.org.uk |publisher=National Institute for Health and Care Excellence |location=UK |access-date=10 October 2019 |archive-date=10 October 2019 |archive-url=https://web.archive.org/web/20191010120754/https://www.nice.org.uk/advice/es11/resources/mitochondrial-disorders-in-children-coenzyme-q10-pdf-1158110303173 |url-status=live }}</ref> However, it is sold as a ] not subject to the same ], and is an ingredient in some cosmetics.<ref name="pmid10953455">{{cite journal | vauthors = Hojerová J | title = | journal = Ceska a Slovenska Farmacie | volume = 49 | issue = 3 | pages = 119–123 | date = May 2000 | pmid = 10953455 }}</ref> The manufacture of CoQ<sub>10</sub> is not regulated, and different batches and brands may vary significantly.<ref name="White-2014"/>


==Research==
===Parkinson's disease===
A 2014 ] found insufficient evidence to make a conclusion about its use for the prevention of heart disease.<ref name="pmid25474484">{{cite journal | vauthors = Flowers N, Hartley L, Todkill D, Stranges S, Rees K | title = Co-enzyme Q10 supplementation for the primary prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 12 | pages = CD010405 | date = 4 December 2014 | pmid = 25474484 | pmc = 9759150 | doi = 10.1002/14651858.CD010405.pub2 }}</ref> A 2016 Cochrane review concluded that CoQ<sub>10</sub> had no effect on ].<ref name="pmid26935713">{{cite journal | vauthors = Ho MJ, Li EC, Wright JM | title = Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 3 | pages = CD007435 | date = March 2016 | pmid = 26935713 | pmc = 6486033 | doi = 10.1002/14651858.CD007435.pub3 }}</ref> A 2021 Cochrane review found "no convincing evidence to support or refute" the use of CoQ<sub>10</sub> for the treatment of heart failure.<ref name="pmid35608922">{{cite journal | vauthors = Al Saadi T, Assaf Y, Farwati M, Turkmani K, Al-Mouakeh A, Shebli B, Khoja M, Essali A, Madmani ME | title = Coenzyme Q10 for heart failure | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 2 | pages = CD008684 | date = February 2021 | pmid = 35608922 | pmc = 8092430 | doi = 10.1002/14651858.CD008684.pub3 | collaboration = Cochrane Heart Group }}</ref>


A 2017 ] of people with heart failure taking 30–100&nbsp;mg/d of CoQ<sub>10</sub> found a 31% lower mortality and increased exercise capacity, with no significant difference in the endpoints of left heart ejection fraction.<ref name="pmid28738783">{{cite journal | vauthors = Lei L, Liu Y | title = Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials | journal = BMC Cardiovascular Disorders | volume = 17 | issue = 1 | pages = 196 | date = July 2017 | pmid = 28738783 | pmc = 5525208 | doi = 10.1186/s12872-017-0628-9 | doi-access = free }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref> A 2021 meta-analysis found that coenzyme Q10 was associated with a 31% lower all-cause mortality in HF patients.<ref>{{Cite journal |last1=Khan |first1=Muhammad Shahzeb |last2=Khan |first2=Fiza |last3=Fonarow |first3=Gregg C. |last4=Sreenivasan |first4=Jayakumar |last5=Greene |first5=Stephen J. |last6=Khan |first6=Safi U. |last7=Usman |first7=Muhammad Shariq |last8=Vaduganathan |first8=Muthiah |last9=Fudim |first9=Marat |last10=Anker |first10=Stefan D. |last11=Butler |first11=Javed |date=June 2021 |title=Dietary interventions and nutritional supplements for heart failure: a systematic appraisal and evidence map |url=https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2278 |journal=European Journal of Heart Failure |language=en |volume=23 |issue=9 |pages=1468–1476 |doi=10.1002/ejhf.2278 |pmid=34173307 |issn=1388-9842 |access-date=10 June 2024 |archive-date=2 January 2023 |archive-url=https://web.archive.org/web/20230102122936/https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2278 |url-status=live }}</ref> In a 2023 meta-analysis of older people, ubiquinone had evidence of a cardiovascular effect, but ubiquinol did not.<ref name="pmid37971634">{{cite journal | vauthors = Fladerer JP, Grollitsch S | title = Comparison of Coenzyme Q10 (Ubiquinone) and Reduced Coenzyme Q10 (Ubiquinol) as Supplement to Prevent Cardiovascular Disease and Reduce Cardiovascular Mortality | journal = Current Cardiology Reports | volume = 25 | issue = 12 | pages = 1759–1767 | date = December 2023 | pmid = 37971634 | pmc = 10811087 | doi = 10.1007/s11886-023-01992-6 | doi-access = free }}</ref>
A 2011 review by the ] suggesting CoQ<sub>10</sub> supplementation might benefit people with ] was subsequently withdrawn from publication following a review by independent editors.<ref name=pdno>{{cite journal |author=Liu J, Wang LN, Zhan SY, Xia Y |title=WITHDRAWN: Coenzyme Q10 for Parkinson's disease |journal=Cochrane Database Syst Rev |volume=5 |issue= |pages=CD008150 |year=2012 |pmid=22592726 |doi=10.1002/14651858.CD008150.pub3}}</ref>


Although CoQ<sub>10</sub> has been studied as a potential remedy to treat purported muscle-related ]s of ] medications, the results were mixed. Although a 2018 meta-analysis concluded that there was preliminary evidence for oral CoQ<sub>10</sub> reducing statin-associated muscle symptoms, including muscle pain, muscle weakness, muscle cramps and muscle tiredness,<ref name="pmid30371340">{{cite journal | vauthors = Qu H, Guo M, Chai H, Wang WT, Gao ZY, Shi DZ | title = Effects of Coenzyme Q10 on Statin-Induced Myopathy: An Updated Meta-Analysis of Randomized Controlled Trials | journal = Journal of the American Heart Association | volume = 7 | issue = 19 | pages = e009835 | date = October 2018 | pmid = 30371340 | pmc = 6404871 | doi = 10.1161/JAHA.118.009835 }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref> 2015<ref name="pmid25440725"/> and 2024<ref name="pmid36852817"/> meta-analysis found that CoQ<sub>10</sub> had no effect on statin myopathy.<ref name="pmid25440725">{{cite journal | vauthors = Banach M, Serban C, Sahebkar A, Ursoniu S, Rysz J, Muntner P, Toth PP, Jones SR, Rizzo M, Glasser SP, Lip GY, Dragan S, Mikhailidis DP | title = Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials | journal = Mayo Clinic Proceedings | volume = 90 | issue = 1 | pages = 24–34 | date = January 2015 | pmid = 25440725 | doi = 10.1016/j.mayocp.2014.08.021 | type = Systematic Review and Meta-Analysis }}</ref><ref name="pmid36852817"/>
==Drug interactions==
Coenzyme Q10 has potential to inhibit the effects of ] (Coumadin), a potent anticoagulant, by reducing the ]. The structure of coenzyme Q10 is very much similar to the structure of ], 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.<ref name=wyman/>


CoQ<sub>10</sub> is studied as an adjunctive therapy to reduce inflammation in ].<ref name="pmid37592831">{{cite journal |vauthors=Fawzy El-Sayed KM, Cosgarea R, Sculean A, Doerfer C |title=Can vitamins improve periodontal wound healing/regeneration? |journal=Periodontol 2000 |volume=94 |issue=1 |pages=539–602 |date=February 2024 |pmid=37592831 |doi=10.1111/prd.12513 |url=}}</ref>
==Chemical properties==
The oxidized structure of CoQ<sub>10</sub> is shown on the top-right. The various kinds of Coenzyme Q may be distinguished by the number of isoprenoid subunits in their ]. The most common Coenzyme Q in human mitochondria is CoQ<sub>10</sub>. Q refers to the quinone head and 10 refers to the number of isoprene repeats in the tail. The image below has three isoprenoid units and would be called Q<sub>3</sub>.
]

==Biochemical role==
CoQ<sub>10</sub> is found in the ] of many ]. Since its primary function in cells is in generating energy, the highest concentration is found on the inner membrane of the ]. Some other organelles that contain CoQ<sub>10</sub> include ], ]s, ]s, and ]s.

=== CoQ<sub>10</sub> and electron transport chain ===
CoQ<sub>10</sub> is fat-soluble and is therefore mobile in cellular membranes; it plays a unique role in the ] (ETC). In the inner mitochondrial membrane, electrons from NADH and succinate pass through the ETC to oxygen, which is reduced to water. The transfer of electrons through ETC results in the pumping of H+ across the membrane creating a proton gradient across the membrane, which is used by ATP synthase (located on the membrane) to generate ATP. CoQ<sub>10</sub> functions as an electron carrier from enzyme complex I and enzyme complex II to complex III in this process. This is crucial in the process, since no other molecule can perform this function (Note: recent research now establishes that ] co-performs this role with CoQ<sub>10</sub><ref name="sciencemag.org">http://www.sciencemag.org/content/336/6086/1241</ref>). Thus, CoQ<sub>10</sub> functions in every cell of the body to synthesize energy.

=== Antioxidant (reductant) function of CoQ<sub>10</sub> ===
The ] nature of CoQ<sub>10</sub> derives from its energy carrier function. As an energy carrier, the CoQ<sub>10</sub> molecule continuously goes through an oxidation–reduction cycle. As it accepts electrons, it becomes reduced. As it gives up electrons, it becomes oxidized. In its reduced form, the CoQ<sub>10</sub> molecule holds electrons rather loosely, so this CoQ molecule will give up one or both electrons quite easily and, thus, act as an antioxidant.<ref name="mbschachter.com">http://www.mbschachter.com/coenzyme_q10.htm</ref> CoQ<sub>10</sub> inhibits lipid peroxidation by preventing the production of lipid peroxyl radicals (LOO). Moreover, CoQH<sub>2</sub> reduces the initial perferryl radical and singlet oxygen, with concomitant formation of ubisemiquinone and H<sub>2</sub>O<sub>2</sub>. This quenching of the initiating perferryl radicals, which prevent propagation of lipid peroxidation, protects not only lipids, but also proteins from oxidation. In addition, the reduced form of CoQ effectively regenerates vitamin E from the a-tocopheroxyl radical, thereby interfering with the propagation step. Furthermore, during oxidative stress, interaction of H<sub>2</sub>O<sub>2</sub> with metal ions bound to DNA generates hydroxyl radicals, and CoQ efficiently prevents the oxidation of bases, in particular, in mitochondrial DNA.<ref name="mbschachter.com"/> In contrast to other antioxidants, this compound inhibits both the initiation and the propagation of lipid and protein oxidation. It also regenerates other antioxidants such as vitamin E. The circulating CoQ<sub>10</sub> in LDL prevents oxidation of LDL, which may provide benefit in cardiovascular diseases.

==Biosynthesis==

Biosynthesis occurs in most human tissue. There are three major steps:
# Creation of the benzoquinone structure (using phenylalanine or tyrosine)
# Creation of the isoprene side chain (using acetyl-CoA)
# The joining or condensation of the above two structures

The initial two reactions occur in mitochondria, endoplasmic reticulum, and peroxisomes, indicating multiple sites of synthesis in animal cells.<ref>{{cite journal |author=Bentinger M, Tekle M, Dallner G |title=Coenzyme Q—biosynthesis and functions |journal=Biochem. Biophys. Res. Commun. |volume=396 |issue=1 |pages=74–9 |date=May 2010 |pmid=20494114 |doi=10.1016/j.bbrc.2010.02.147 |url=http://linkinghub.elsevier.com/retrieve/pii/S0006-291X(10)00381-5}}</ref>

An important enzyme in this pathway is ], usually a target for intervention in cardiovascular complications. The "statin" family of cholesterol-reducing medications inhibits HMG-CoA reductase. One side effect of statins is decreased production of CoQ-10, which leads to myopathy and rhabdomyolysis.{{citation needed|date=May 2016}}

Genes involved include '']'', '']'', '']'', and '']''(''COQ8'',''CABC1'').<ref name="EspinósFelipo2009">{{cite book|author1=Carmen Espinós|author2=Vicente Felipo|author3=Francesc Palau|title=Inherited Neuromuscular Diseases: Translation from Pathomechanisms to Therapies|url=http://books.google.com/books?id=uxQ_pjKNhE8C&pg=PA122|accessdate=4 January 2011|date=1 August 2009|publisher=Springer|isbn=978-90-481-2812-9|pages=122–}}</ref>

Increasing the endogenous biosynthesis of CoQ<sub>10</sub> has gained attention in recent years as a strategy to fight CoQ<sub>10</sub> deficiency.{{citation needed|date=January 2016}}

==Absorption and metabolism==


==Pharmacology==
===Absorption=== ===Absorption===
CoQ<sub>10</sub> is a crystalline powder insoluble in water. Absorption follows the same process as that of lipids; the uptake mechanism appears to be similar to that of ], another lipid-soluble nutrient. This process in the human body involves secretion into the small intestines of pancreatic enzymes and bile, which facilitates emulsification and ] formation required for absorption of lipophilic substances.<ref name="Bhagavan">{{cite journal |last1=Bhagavan |first1=Hemmi N. |last2=Chopra |first2=Raj K. |title=Coenzyme Q<sub>10</sub>: Absorption, tissue uptake, metabolism and pharmacokinetics |journal=Free Radical Research |volume=40 |issue=5 |pages=445–53 |year=2006 |pmid=16551570 |doi=10.1080/10715760600617843}}</ref> Food intake (and the presence of lipids) stimulates bodily biliary excretion of bile acids and greatly enhances absorption of CoQ<sub>10</sub>. Exogenous CoQ<sub>10</sub> is absorbed from the small intestine and is best absorbed if taken with a meal. Serum concentration of CoQ<sub>10</sub> in fed condition is higher than in fasting conditions.<ref>Bogentoft 1991{{Verify source|date=November 2010}}</ref><ref>{{cite journal |author=Ochiai A, Itagaki S, Kurokawa T, Kobayashi M, Hirano T, Iseki K |title=Improvement in intestinal coenzyme Q<sub>10</sub> absorption by food intake |journal=Yakugaku Zasshi |volume=127 |issue=8 |pages=1251–4 |date=August 2007 |pmid=17666877 |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/yakushi/127.1251?from=PubMed&lang=en |doi=10.1248/yakushi.127.1251}}{{Verify source|date=November 2010}}</ref> CoQ<sub>10</sub> in the pure form is a ]line powder insoluble in water. Absorption as a pharmacological substance follows the same process as that of lipids; the uptake mechanism appears to be similar to that of ], another lipid-soluble nutrient.<ref name="Žmitek-2008"/> This process in the human body involves ] into the ] of ]s and ], which facilitates ] and ] formation required for absorption of ] substances.<ref name="pmid16551570">{{cite journal | vauthors = Bhagavan HN, Chopra RK | title = Coenzyme Q10: absorption, tissue uptake, metabolism and pharmacokinetics | journal = Free Radical Research | volume = 40 | issue = 5 | pages = 445–453 | date = May 2006 | pmid = 16551570 | doi = 10.1080/10715760600617843 | s2cid = 39001523 }}</ref> Food intake (and the presence of lipids) stimulates bodily biliary excretion of bile acids and greatly enhances absorption of CoQ<sub>10</sub>. Exogenous CoQ<sub>10</sub> is absorbed from the small intestine and is best absorbed if taken with a meal. ] concentration of CoQ<sub>10</sub> in fed condition is higher than in fasting conditions.<ref name="Bogentoft-1991">{{cite book | vauthors = Bogentoft C, Edlund PO, Olsson B, Widlund L, Westensen K | chapter = Biopharmaceutical aspects of intravenous and oral administration of coenzyme Q10. | title = Biomedical and clinical aspects of coenzyme Q | date = 1991 | volume = 6 | pages = 215–224 }}</ref><ref name="pmid17666877">{{cite journal | vauthors = Ochiai A, Itagaki S, Kurokawa T, Kobayashi M, Hirano T, Iseki K | title = Improvement in intestinal coenzyme q10 absorption by food intake | journal = Yakugaku Zasshi | volume = 127 | issue = 8 | pages = 1251–1254 | date = August 2007 | pmid = 17666877 | doi = 10.1248/yakushi.127.1251 | hdl-access = free | doi-access = free | hdl = 2115/30144 }}{{Verify source|date=November 2010}}</ref>


===Metabolism=== ===Metabolism===
CoQ<sub>10</sub> is metabolized in all tissues, with the metabolites being phosphorylated in cells.<ref name=sood/> CoQ10 is reduced to ubiquinol during or after absorption in the ].<ref name=sood/> It is absorbed by ]s, and redistributed in the blood within ]s.<ref name=sood/> Its elimination occurs via ] and ] ].<ref name=sood/>
Data on the metabolism of CoQ<sub>10</sub> in animals and humans are limited.<ref name="Zmitek" /> A study with ] CoQ<sub>10</sub> in ]s showed most of the radioactivity in the liver 2 hours after oral administration when the peak plasma radioactivity was observed, but it should be noted that CoQ<sub>9</sub> (with only 9 isoprenyl units) is the predominant form of coenzyme Q in rats.<ref>{{cite book |first1=H. |last1=Kishi |first2=N. |last2=Kanamori |first3=S. |last3=Nisii |first4=E. |last4=Hiraoka |first5=T. |last5=Okamoto |first6=T. |last6=Kishi |chapter=Metabolism and Exogenous Coenzyme Q<sub>10</sub> in vivo and Bioavailability of Coenzyme Q<sub>10</sub> Preparations in Japan |title=Biomedical and Clinical Aspects of Coenzyme Q |pages=131–42 |publisher=Elsevier |location=Amsterdam |year=1964}}</ref> It appears that CoQ<sub>10</sub> is metabolised in all tissues, while a major route for its elimination is biliary and fecal excretion. After the withdrawal of CoQ<sub>10</sub> supplementation, the levels return to normal within a few days, irrespective of the type of formulation used.<ref name="Ozawa"/>


==Pharmacokinetics== ===Pharmacokinetics===
Some reports have been published on the pharmacokinetics of CoQ<sub>10</sub>. The plasma peak can be observed 2–6 hours after oral administration, depending mainly on the design of the study. In some studies, a second plasma peak also was observed at approximately 24 hours after administration, probably due to both enterohepatic recycling and redistribution from the liver to circulation.<ref name="Bhagavan"/> Tomono et al. used deuterium-labelled crystalline CoQ<sub>10</sub> to investigate pharmacokinetics in humans and determined an elimination half-time of 33 hours.<ref>{{cite journal |last1=Tomono |first1=Y |last2=Hasegawa |first2=J |last3=Seki |first3=T |last4=Motegi |first4=K |last5=Morishita |first5=N |title=Pharmacokinetic study of deuterium-labelled coenzyme Q<sub>10</sub> in man |journal=International journal of clinical pharmacology, therapy, and toxicology |volume=24 |issue=10 |pages=536–41 |year=1986 |pmid=3781673}}</ref> Some reports have been published on the ] of CoQ<sub>10</sub>. The plasma peak can be observed 6–8 hours after oral administration when taken as a pharmacological substance.<ref name=sood/> In some studies, a second plasma peak also was observed at approximately 24 hours after administration, probably due to both enterohepatic recycling and redistribution from the liver to circulation.<ref name="pmid16551570" />


Deuterium-labeled crystalline CoQ<sub>10</sub> was used to investigate pharmacokinetics in humans to determine an elimination half-time of 33 hours.''<ref name="pmid3781673">{{cite journal | vauthors = Tomono Y, Hasegawa J, Seki T, Motegi K, Morishita N | title = Pharmacokinetic study of deuterium-labeled coenzyme Q10 in man | journal = International Journal of Clinical Pharmacology, Therapy, and Toxicology | volume = 24 | issue = 10 | pages = 536–541 | date = October 1986 | pmid = 3781673 }}</ref>''
===Improving the bioavailability of CoQ<sub>10</sub>===

The importance of how drugs are formulated for bioavailability is well known. In order to find a principle to boost the bioavailability of CoQ<sub>10</sub> after oral administration, several new approaches have been taken; different formulations and forms have been developed and tested on animals and humans.<ref name="Zmitek">Zmitek et al. (2008) Agro Food Ind. Hi Tec. 19, 4, 9. – </ref>
===Bioavailability===
In contrast to intake of CoQ<sub>10</sub> as a constituent of food, such as nuts or meat, from which CoQ<sub>10</sub> is normally absorbed, there is a concern about CoQ<sub>10</sub> bioavailability when it is taken as a dietary supplement.<ref name="mantle">{{cite journal|doi=10.3390/antiox9050386|doi-access=free |title=Bioavailability of Coenzyme Q10: An Overview of the Absorption Process and Subsequent Metabolism |date=2020 |journal=Antioxidants |volume=9 |issue=5 |page=386 |pmid=32380795 | vauthors = Mantle D, Dybring A |pmc=7278738 }}</ref><ref>{{cite journal|doi=10.3390/nu11030527|doi-access=free |title=Bioavailability and Sustained Plasma Concentrations of CoQ10 in Healthy Volunteers by a Novel Oral Timed-Release Preparation |date=2019 |journal=Nutrients |volume=11 |issue=3 |page=527 |pmid=30823449 |pmc=6471387 | vauthors = Martucci A, Reurean-Pintilei D, Manole A }}</ref> Bioavailability of CoQ<sub>10</sub> supplements may be reduced due to the lipophilic nature of its molecule and large molecular weight.<ref name=mantle/>


====Reduction of particle size==== ====Reduction of particle size====
An obvious strategy is reduction of particle size to as low as the micro- and nano-scale. Nanoparticles have been explored as a delivery system for various drugs; an improvement of the oral bioavailability of drugs with poor absorption characteristics has been reported;<ref>{{cite journal |last1=Mathiowitz |first1=Edith |last2=Jacob |first2=Jules S. |last3=Jong |first3=Yong S. |last4=Carino |first4=Gerardo P. |last5=Chickering |first5=Donald E. |last6=Chaturvedi |first6=Pravin |last7=Santos |first7=Camilla A. |last8=Vijayaraghavan |first8=Kavita |last9=Montgomery |first9=Sean |title=Biologically erodible microspheres as potential oral drug delivery systems |journal=Nature |volume=386 |issue=6623 |pages=410–4 |year=1997 |pmid=9121559 |doi=10.1038/386410a0 |last10=Bassett |first10=Michael |last11=Morrell |first11=Craig}}</ref> pathways of absorption and efficiency were affected by reduction of particle size. So far, this protocol has not proved to be very successful with CoQ<sub>10</sub>, although reports have differed widely.<ref>{{cite journal |author=Hsu CH, Cui Z, Mumper RJ, Jay M |title=Preparation and characterization of novel coenzyme Q<sub>10</sub> nanoparticles engineered from microemulsion precursors |journal=AAPS PharmSciTech |volume=4 |issue=3 |pages=24–35 |year=2003 |pmid=14621964 |pmc=2750625 |doi=10.1208/pt040332 }}{{Verify source|date=November 2010}}</ref><ref>{{cite journal |author=Joshi SS, Sawant SV, Shedge A, Halpner AD |title=Comparative bioavailability of two novel coenzyme Q<sub>10</sub> preparations in humans |journal=Int J Clin Pharmacol Ther |volume=41 |issue=1 |pages=42–8 |date=January 2003 |pmid=12564745 |doi=10.5414/CPP41042 }}{{Verify source|date=November 2010}}</ref> The use of aqueous suspension of finely powdered CoQ<sub>10</sub> in pure water also reveals only a minor effect.<ref name="Ozawa">{{cite journal |last1=Ozawa |first1=Y |last2=Mizushima |first2=Y |last3=Koyama |first3=I |last4=Akimoto |first4=M |last5=Yamagata |first5=Y |last6=Hayashi |first6=H |last7=Murayama |first7=H |title=Intestinal absorption enhancement of coenzyme Q<sub>10</sub> with a lipid microsphere |journal=Arzneimittel-Forschung |volume=36 |issue=4 |pages=689–90 |year=1986 |pmid=3718593}}</ref> ]s have been explored as a delivery system for various drugs, such as improving the oral bioavailability of drugs with poor absorption characteristics.<ref name="pmid9121559">{{cite journal | vauthors = Mathiowitz E, Jacob JS, Jong YS, Carino GP, Chickering DE, Chaturvedi P, Santos CA, Vijayaraghavan K, Montgomery S, Bassett M, Morrell C | title = Biologically erodable microspheres as potential oral drug delivery systems | journal = Nature | volume = 386 | issue = 6623 | pages = 410–414 | date = March 1997 | pmid = 9121559 | doi = 10.1038/386410a0 | s2cid = 4324209 | bibcode = 1997Natur.386..410M }}</ref> However, this has not proved successful with CoQ<sub>10</sub>, although reports have differed widely.<ref name="pmid14621964">{{cite journal | vauthors = Hsu CH, Cui Z, Mumper RJ, Jay M | title = Preparation and characterization of novel coenzyme Q10 nanoparticles engineered from microemulsion precursors | journal = AAPS PharmSciTech | volume = 4 | issue = 3 | pages = E32 | year = 2003 | pmid = 14621964 | pmc = 2750625 | doi = 10.1208/pt040332 }}{{Verify source|date=November 2010}}</ref><ref name="pmid12564745">{{cite journal | vauthors = Joshi SS, Sawant SV, Shedge A, Halpner AD | title = Comparative bioavailability of two novel coenzyme Q10 preparations in humans | journal = International Journal of Clinical Pharmacology and Therapeutics | volume = 41 | issue = 1 | pages = 42–48 | date = January 2003 | pmid = 12564745 | doi = 10.5414/CPP41042 }}{{Verify source|date=November 2010}}</ref> The use of aqueous ] of finely powdered CoQ<sub>10</sub> in pure water also reveals only a minor effect.<ref name="pmid3718593">{{cite journal | vauthors = Ozawa Y, Mizushima Y, Koyama I, Akimoto M, Yamagata Y, Hayashi H, Murayama H | title = Intestinal absorption enhancement of coenzyme Q10 with a lipid microsphere | journal = Arzneimittel-Forschung | volume = 36 | issue = 4 | pages = 689–690 | date = April 1986 | pmid = 3718593 }}</ref>


====Water-solubility====
====Soft-gel capsules with CoQ<sub>10</sub> in oil suspension====
Facilitating drug absorption by increasing its solubility in water is a common pharmaceutical strategy and also has been shown to be successful for CoQ<sub>10</sub>. Various approaches have been developed to achieve this goal, with many of them producing significantly better results over oil-based softgel capsules in spite of the many attempts to optimize their composition.<ref name="Žmitek-2008" /> Examples of such approaches are use of the aqueous dispersion of solid CoQ<sub>10</sub> with the ] ],<ref name="USP619">{{cite patent |inventor = Westesen K, Siekmann B |title=Particles with modified physicochemical properties, their preparation and uses |country=US |number=6197349 |publication-date=2001}}</ref> formulations based on various solubilising agents, such as hydrogenated lecithin,<ref name="US 4483873">{{cite patent| inventor = Ohashi H, Takami T, Koyama N, Kogure Y, Ida K |title=Aqueous solution containing ubidecarenone |country=US |number=4483873 |publication-date=1984}}</ref> and ] with ]; among the latter, the complex with ] has been found to have highly increased bioavailability<ref name="pmid18645245">{{cite journal | vauthors = Zmitek J, Smidovnik A, Fir M, Prosek M, Zmitek K, Walczak J, Pravst I | title = Relative bioavailability of two forms of a novel water-soluble coenzyme Q10 | journal = Annals of Nutrition & Metabolism | volume = 52 | issue = 4 | pages = 281–287 | year = 2008 | pmid = 18645245 | doi = 10.1159/000129661 | s2cid = 825159 }}</ref><ref name="Kagan-2010">{{cite journal |vauthors = Kagan D, Madhavi D |year=2010 |title=A Study on the Bioavailability of a Novel Sustained-Release Coenzyme Q<sub>10</sub>-β-Cyclodextrin Complex |journal=Integrative Medicine |volume=9 |issue=1}}</ref> and also is used in pharmaceutical and food industries for CoQ<sub>10</sub>-fortification.<ref name="Žmitek-2008" />
A successful approach was to use the emulsion system to facilitate absorption from the gastrointestinal tract and to improve bioavailability. Emulsions of soybean oil (lipid microspheres) could be stabilised very effectively by lecithin and were used in the preparation of soft gelatine capsules. In one of the first such attempts, Ozawa et al. performed a pharmacokinetic study on beagle dogs in which the emulsion of CoQ<sub>10</sub> in soybean oil was investigated; about two times higher plasma CoQ<sub>10</sub> level than that of the control tablet preparation was determined during administration of a lipid microsphere.<ref name="Ozawa" /> Although an almost negligible improvement of bioavailability was observed by Kommuru et al. with oil-based soft-gel capsules in a later study on dogs,<ref>{{cite journal |last1=Kommuru |first1=TR |last2=Ashraf |first2=M |last3=Khan |first3=MA |last4=Reddy |first4=IK |title=Stability and bioequivalence studies of two marketed formulations of coenzyme Q<sub>10</sub> in beagle dogs |journal=Chemical & pharmaceutical bulletin |volume=47 |issue=7 |pages=1024–8 |year=1999 |pmid=10434405 |doi=10.1248/cpb.47.1024}}</ref> the significantly increased bioavailability of CoQ<sub>10</sub> was confirmed for several oil-based formulations in most other studies.<ref>{{cite journal |author=Bhagavan HN, Chopra RK |title=Plasma coenzyme Q<sub>10</sub> response to oral ingestion of coenzyme Q<sub>10</sub> formulations |journal=Mitochondrion |volume=7 |issue=Suppl|pages=S78–88 |date=June 2007 |pmid=17482886 |doi=10.1016/j.mito.2007.03.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S1567-7249(07)00061-X}}{{Verify source|date=November 2010}}</ref>


==Adverse effects and precautions==
====Novel forms of CoQ<sub>10</sub> with increased water-solubility====
Generally, oral CoQ<sub>10</sub> supplementation is well tolerated.<ref name=lpi/> The most common side effects are gastrointestinal symptoms (], vomiting, ], and ]), ]es, and headaches.<ref name="pmid20601617">{{cite journal | vauthors = Wyman M, Leonard M, Morledge T | title = Coenzyme Q10: a therapy for hypertension and statin-induced myalgia? | journal = Cleveland Clinic Journal of Medicine | volume = 77 | issue = 7 | pages = 435–442 | date = July 2010 | pmid = 20601617 | doi = 10.3949/ccjm.77a.09078 | s2cid = 26572524 | doi-access = free }}</ref> Some adverse effects, largely gastrointestinal, are reported with intakes.<ref name=sood/> Doses of 100–300&nbsp;mg per day may induce ] or elevate ].<ref name=sood/> The observed safe level risk assessment method indicated that the evidence of safety is acceptable at intakes up to 1200&nbsp;mg per day.<ref name="pmid16814438">{{cite journal | vauthors = Hathcock JN, Shao A | title = Risk assessment for coenzyme Q10 (Ubiquinone) | journal = Regulatory Toxicology and Pharmacology | volume = 45 | issue = 3 | pages = 282–288 | date = August 2006 | pmid = 16814438 | doi = 10.1016/j.yrtph.2006.05.006 }}</ref>
Facilitating drug absorption by increasing its solubility in water is a common pharmaceutical strategy and also has been shown to be successful for CoQ<sub>10</sub>. Various approaches have been developed to achieve this goal, with many of them producing significantly better results over oil-based soft-gel capsules in spite of the many attempts to optimize their composition.<ref name="Zmitek" /> Examples of such approaches are use of the aqueous dispersion of solid CoQ<sub>10</sub> with ] ],<ref>K. Westesen and B. Siekmann. Particles with modified physicochemical properties, their preparation and uses. US6197349. 2001.</ref> formulations based on various solubilising agents, i.e., hydrogenated ],<ref>H. Ohashi, T. Takami, N. Koyama, Y. Kogure and K. Ida. Aqueous solution containing ubidecarenone. US4483873. 1984</ref> and complexation with ]; among the latter, complex with ] has been found to have highly-increased bioavailability.<ref>{{cite journal |last1=Žmitek |first1=Janko |last2=Smidovnik |first2=Andrej |last3=Fir |first3=Maja |last4=Prosek |first4=Mirko |last5=Zmitek |first5=Katja |last6=Walczak |first6=Jaroslaw |last7=Pravst |first7=Igor |title=Relative Bioavailability of Two Forms of a Novel Water-Soluble Coenzyme Q<sub>10</sub> |journal=Annals of Nutrition and Metabolism |volume=52 |issue=4 |pages=281–7 |year=2008 |pmid=18645245 |doi=10.1159/000129661}}</ref><ref>{{cite journal |first1=Daniel |last1=Kagan |first2=Doddabele |last2=Madhavi |year=2010 |title=A Study on the Bioavailability of a Novel Sustained-Release Coenzyme Q<sub>10</sub>-ß-Cyclodextrin Complex |journal=Integrative Medicine |volume=9 |issue=1}}</ref> and also is used in pharmaceutical and food industries for CoQ<sub>10</sub>-fortification.<ref name="Zmitek" /> Also some other novel carrier systems such as liposomes, nanoparticles, dendrimers, etc. may be used to increase the bioavailability of CoQ<sub>10</sub>.{{Citation needed|date=October 2010}}


Caution should be observed in the use of CoQ<sub>10</sub> supplementation in people with bile duct obstruction, and during pregnancy or breastfeeding.<ref name=sood/>
==History==

CoQ<sub>10</sub> was first discovered by Professor Fredrick L. Crane and colleagues at the ] Enzyme Institute in 1957.<ref>{{cite journal |last1=Crane |first1=F |last2=Hatefi |first2=Y |last3=Lester |first3=R |last4=Widmer |first4=C |title=Isolation of a quinone from beef heart mitochondria |journal=Biochimica et Biophysica Acta |volume=25 |issue=1 |pages=220–1 |year=1957 |pmid=13445756 |doi=10.1016/0006-3002(57)90457-2}}</ref><ref name="washington">Peter H. Langsjoen,""{{self-published inline|date=October 2010}}</ref> In 1958, its chemical structure was reported by Dr. ] and coworkers at ]. In 1961 ] proposed the electron transport chain (which includes the vital protonmotive role of CoQ<sub>10</sub>) for which he received the ] in 1978. In the early 1970's Gian Paolo Littarru and Karl Folkers observed that a deficiency of CoQ<sub>10</sub> was associated with human heart disease.<ref>{{cite journal|last1=Folkers|first1=K|last2=Littarru|first2=GP|last3=Ho|first3=L|last4=Runge|first4=TM|last5=Havanonda|first5=S|last6=Cooley|first6=D|title=Evidence for a deficiency of coenzyme Q10 in human heart disease.|journal=Internationale Zeitschrift fur Vitaminforschung. International journal of vitamin research. Journal international de vitaminologie|date=1970|volume=40|issue=3|pages=380-90|pmid=5450999}}</ref><ref>{{cite journal|last1=Littaru|first1=GP|last2=Ho|first2=L|last3=Folkers|first3=K|title=Deficiency of coenzyme Q 10 in human heart disease. I.|journal=International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition|date=1972|volume=42|issue=2|pages=291-305|pmid=5053855}}</ref><ref>{{cite journal|last1=Littarru|first1=GP|last2=Ho|first2=L|last3=Folkers|first3=K|title=Deficiency of coenzyme Q 10 in human heart disease. II.|journal=International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition|date=1972|volume=42|issue=3|pages=413-34|pmid=5086647}}</ref> The 1980s witnessed a steep rise in the number of clinical trials due to the availability of large quantities of pure CoQ<sub>10</sub> and methods to measure plasma and blood CoQ<sub>10</sub> concentrations. The redox functions of CoQ in ] and ] protection are based on the ability to exchange two ]s in a redox cycle between ubiquinol (reduced CoQ) and ubiquinone (oxidized CoQ).<ref>{{cite journal |author=Mellors A, Tappel A, |title=The Inhibition of Mitochondrial Peroxidation by Ubiquinone and Ubiquinol |journal=J. Biol. Chem. |volume=241 |issue=19 |pages=4353–4356 |year=1966 |pmid=5922959 }}</ref><ref>{{cite journal |author=Mellors A, Tappel A, |title=Quinones and Quinols as Inhibitors of Lipid Peroxidation |journal=Lipids |volume=1 |issue=4 |pages=282–284 |date=July 1966 |pmid=17805631 |doi=10.1007/BF02531617 }}</ref>
==Potential drug interactions ==
The antioxidant role of the molecule as a free radical scavenger was widely studied by ]. Numerous scientists around the globe started studies on this molecule since then in relation to various diseases including cardiovascular diseases and cancer.
CoQ<sub>10</sub> taken as a pharmacological substance has potential to inhibit the effects of ] as well as the ] ]; CoQ<sub>10</sub> may interfere with warfarin's actions by interacting with ] enzymes thereby reducing the ], a measure of blood clotting.<ref name="pmid27012265">{{cite journal | vauthors = Sharma A, Fonarow GC, Butler J, Ezekowitz JA, Felker GM | title = Coenzyme Q10 and Heart Failure: A State-of-the-Art Review | journal = Circulation: Heart Failure | volume = 9 | issue = 4 | pages = e002639 | date = April 2016 | pmid = 27012265 | doi = 10.1161/CIRCHEARTFAILURE.115.002639 | s2cid = 2034503 | doi-access = free }}</ref> The structure of CoQ<sub>10</sub> is similar to that of ], which competes with and counteracts warfarin's anticoagulation effects. CoQ<sub>10</sub> is not recommended in people taking warfarin due to the increased risk of clotting.<ref name="pmid20601617"/>


==Dietary concentrations== ==Dietary concentrations==
Detailed reviews on occurrence of CoQ<sub>10</sub> and dietary intake were published in 2010.<ref name="Pravst">{{cite journal |last1=Pravst |first1=Igor |last2=Zmitek |first2=Katja |last3=Zmitek |first3=Janko |title=Coenzyme Q<sub>10</sub> Contents in Foods and Fortification Strategies |journal=Critical Reviews in Food Science and Nutrition |volume=50 |issue=4 |pages=269–80 |year=2010 |pmid=20301015 |doi=10.1080/10408390902773037}}</ref> Besides the endogenous synthesis within organisms, CoQ<sub>10</sub> also is supplied to the organism by various foods. Despite the scientific community’s great interest in this compound, however, a very limited number of studies have been performed to determine the contents of CoQ<sub>10</sub> in dietary components. The first reports on this aspect were published in 1959, but the sensitivity and selectivity of the analytical methods at that time did not allow reliable analyses, especially for products with low concentrations.<ref name="Pravst" /> Since then, developments in analytical chemistry have enabled a more reliable determination of CoQ<sub>10</sub> concentrations in various foods (table below). Detailed reviews on occurrence of CoQ<sub>10</sub> and dietary intake were published in 2010.<ref name="pmid20301015">{{cite journal | vauthors = Pravst I, Zmitek K, Zmitek J | title = Coenzyme Q10 contents in foods and fortification strategies | journal = Critical Reviews in Food Science and Nutrition | volume = 50 | issue = 4 | pages = 269–280 | date = April 2010 | pmid = 20301015 | doi = 10.1080/10408390902773037 | s2cid = 38779392 }}</ref> Besides the endogenous synthesis within organisms, CoQ<sub>10</sub> also is supplied by various foods.<ref name=lpi/> CoQ<sub>10</sub> concentrations in various foods are:<ref name=lpi/>


{| class="wikitable" {| class="wikitable"
|+ CoQ<sub>10</sub> levels in selected foods<ref name="Pravst" /> |+ CoQ<sub>10</sub> levels in selected foods<ref name="pmid20301015" />
! Food !! CoQ<sub>10</sub> concentration ! colspan="2"| Food !! CoQ<sub>10</sub> concentration (mg/kg)
|- |-
| rowspan="5" | ]s
!Beef
| ] || 54–280
|- |-
| ] || 40–160
| heart|| 113
|- |-
| ] || 64–73
| liver||39–50
|- |-
| ] || 4–15
| muscle||26–40
|- |-
|] || 64–73
!Pork
|- |-
|rowspan="3"|Beef
| heart ||11.8–128.2
| heart || 113
|- |-
| liver ||22.7–54.0 | liver || 39–50
|- |-
| muscle ||13.8–45.0 | muscle || 26–40
|- |-
|rowspan="3" | Pork
!Chicken
| heart || 12–128
|- |-
| heart ||116.2–132.2 | liver || 23–54
|- |-
| muscle || 14–45
!Fish
|- |-
| rowspan="3" | Chicken
| sardine ||5–64
| breast || 8–17
|- |-
|thigh
| mackerel
|24–25
|- |-
|wing
| red flesh ||43–67
|11
|- |-
|rowspan="5" | ]
| white flesh ||11–16
| ] || 5–64
|- |-
| ] – red flesh|| 43–67
| salmon ||4–8
|- |-
| ] – white flesh || 11–16
| tuna ||5
|- |-
| ] || 4–8
!Oils
|- |-
| ] || 5
| soybean ||54–280
|- |-
|rowspan="6" | ]s
| olive ||4–160
| ] || 27
|- |-
| ] || 19
| grapeseed ||64–73
|- |-
| ] || 18–23
| sunflower ||4–15
|- |-
| ] || 20
| rice bran ||/
|- |-
| ] || 17
| coconut ||
|- |-
| ] || 5–14
|canola
|64-73
|- |-
|rowspan="5" | Vegetables
!Nuts
| ] || 8–26
|- |-
| ] || 6–9
|peanuts (legume)||27
|- |-
| ] || 2–7
| walnuts ||19
|- |-
| ] || up to 10
| sesame seeds ||18–23
|- |-
| ] || 2–5
| pistachio nuts ||20
|- |-
|rowspan="8" | ]
| hazelnuts ||17
| ] || 10
|- |-
| ] || 3
| almond ||5–14
|- |-
| ] || 6–7
!Vegetables
|- |-
| ] || 1
| parsley ||8–26
|- |-
| ] || 1–2
| broccoli ||6–9
|- |-
| ] || 1
| cauliflower ||2–7
|- |-
| spinach ||up to 10 | ] || 1
|- |-
| ] || 1
| grape ||6–7
|-
| Chinese cabbage ||2–5
|-
!Fruit
|-
| avocado ||10
|-
| blackcurrant ||3
|-
| strawberry ||1
|-
| orange ||1–2
|-
| grapefruit ||1
|-
| apple ||1
|-
|banana
|1
|} |}


Meat and fish are the richest sources of dietary CoQ<sub>10</sub>; levels over 50&nbsp;mg/kg may be found in beef, pork, chicken heart, and chicken liver. Dairy products are much poorer sources of CoQ<sub>10</sub> compared to animal tissues. Vegetable oils also are quite rich in CoQ<sub>10</sub>. Within vegetables, parsley and ] are the richest CoQ<sub>10</sub> sources, but significant differences in their CoQ<sub>10</sub> levels may be found in the literature. ], grape, and ] are modest sources of CoQ<sub>10</sub>. Most fruit and berries represent a poor-to-very-poor source of CoQ<sub>10</sub>, with the exception of ], which has a relatively high CoQ<sub>10</sub> content.<ref name="Pravst" /> Vegetable oils, meat and fish are quite rich in CoQ<sub>10</sub> levels.<ref name=lpi/> ]s are much poorer sources of CoQ<sub>10</sub> than animal tissues. Among vegetables, ] and ] are good sources of CoQ<sub>10</sub>.<ref name=lpi/> Most fruit and berries are poor sources of CoQ<sub>10</sub>, with the exception of ]s, which have a relatively high oil and CoQ<sub>10</sub> content.<ref name="pmid20301015" />


===Intake=== ===Intake===
In the developed world, the estimated daily intake of CoQ<sub>10</sub> has been determined at 3–6&nbsp;mg per day, derived primarily from meat.<ref name="Pravst" /> In the developed world, the estimated daily intake of CoQ<sub>10</sub> has been determined at 3–6&nbsp;mg per day, derived primarily from meat.<ref name="pmid20301015" />

South Koreans have an estimated average daily CoQ (Q<sub>9</sub> + Q<sub>10</sub>) intake of 11.6&nbsp;mg/d, derived primarily from ].<ref name="doijfca">{{cite journal|doi=10.1016/j.jfca.2011.03.018 |title=Ubiquinone contents in Korean fermented foods and average daily intakes |date=2011 |journal=Journal of Food Composition and Analysis |volume=24 |issue=8 |pages=1123–1129 | vauthors = Pyo Y, Oh H }}</ref>


===Effect of heat and processing=== ===Effect of heat and processing===
Cooking by frying reduces CoQ<sub>10</sub> content by 14–32%.<ref>{{cite journal |last1=Weber |first1=C |last2=Bysted |first2=A |last3=Hłlmer |first3=G |title=The coenzyme Q<sub>10</sub> content of the average Danish diet |journal=Int J Vitam Nutr Res |volume=67 |issue=2 |pages=123–9 |year=1997 |pmid=9129255}}</ref> Cooking by frying reduces CoQ<sub>10</sub> content by 14–32%.<ref name="pmid9129255">{{cite journal | vauthors = Weber C, Bysted A, Hłlmer G | title = The coenzyme Q10 content of the average Danish diet | journal = International Journal for Vitamin and Nutrition Research. Internationale Zeitschrift Fur Vitamin- und Ernahrungsforschung. Journal International de Vitaminologie et de Nutrition | volume = 67 | issue = 2 | pages = 123–129 | year = 1997 | pmid = 9129255 }}</ref>


==See also== ==History==
In 1950, a small amount of CoQ<sub>10</sub> was isolated from the lining of a horse's gut, a compound initially called ''substance SA'', but later deemed to be quinone found in many animal tissues.<ref name="pmid13622652">{{cite journal | vauthors = Morton RA | title = Ubiquinone | journal = Nature | volume = 182 | issue = 4652 | pages = 1764–1767 | date = December 1958 | pmid = 13622652 | doi = 10.1038/1821764a0 | bibcode = 1958Natur.182.1764M }}</ref> In 1957, the same compound was isolated from ]l membranes of beef heart, with research showing that it transported electrons within mitochondria. It was called ''Q-275'' as a quinone.<ref name="pmid13622652"/><ref name="pmid13445756">{{cite journal | vauthors = Crane FL, Hatefi Y, Lester RL, Widmer C | title = Isolation of a quinone from beef heart mitochondria | journal = Biochimica et Biophysica Acta | volume = 25 | issue = 1 | pages = 220–221 | date = July 1957 | pmid = 13445756 | doi = 10.1016/0006-3002(57)90457-2 }}</ref> The Q-275/substance SA was later renamed ''ubiquinone'' as it was a ''ubiquitous'' quinone found in all animal tissues.<ref name="pmid13622652"/> In 1958, its full chemical structure was reported.<ref name="pmid13622652"/><ref name="Wolf-1958">{{Cite journal|vauthors=Wolf DE|date=1958|title=Coenzyme Q. I. structure studies on the coenzyme Q group|journal=Journal of the American Chemical Society|volume= 80|issue=17|page=4752|doi=10.1021/ja01550a096|issn=0002-7863}}</ref> Ubiquinone was later called either ''mitoquinone'' or ''coenzyme Q'' due to its participation to the mitochondrial electron transport chain.<ref name="pmid13622652"/> In 1966, a study reported that reduced CoQ<sub>6</sub> was an effective ] in cells.<ref name="pmid17805631">{{cite journal | vauthors = Mellors A, Tappel AL | title = Quinones and quinols as inhibitors of lipid peroxidation | journal = Lipids | volume = 1 | issue = 4 | pages = 282–284 | date = July 1966 | pmid = 17805631 | doi = 10.1007/BF02531617 | s2cid = 2129339 }}</ref>
*] – synthetic analog with reduced oxidant generating properties


==References== == See also ==
* ] – synthetic analog with reduced oxidant generating properties
{{reflist|colwidth=30em}}
* ] – synthetic analog with improved mitochondrial permeability


==External links== == References ==
{{reflist}}
*
*
* Robert Alan Bonakdar and Erminia Guarneri,


{{Electron transport chain}} {{Electron transport chain}}
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{{Antioxidants}} {{Antioxidants}}


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{{Use dmy dates|date=July 2013}}

{{DISPLAYTITLE:Coenzyme Q<sub>10</sub>}}


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Latest revision as of 14:44, 7 January 2025

Biochemical cofactor and antioxidant

Coenzyme Q10
Names
Preferred IUPAC name 2--5,6-dimethoxy-3-methylcyclohexa-2,5-diene-1,4-dione
Other names
  • In general: Ubiquinone, coenzyme Q, CoQ, vitamin Q
  • This form: ubidecarenone,

Q10, CoQ10 /ˌkoʊˌkjuːˈtɛn/

Identifiers
CAS Number
3D model (JSmol)
ChEBI
ChEMBL
ChemSpider
ECHA InfoCard 100.005.590 Edit this at Wikidata
KEGG
PubChem CID
UNII
CompTox Dashboard (EPA)
InChI
  • InChI=1S/C59H90O4/c1-44(2)24-15-25-45(3)26-16-27-46(4)28-17-29-47(5)30-18-31-48(6)32-19-33-49(7)34-20-35-50(8)36-21-37-51(9)38-22-39-52(10)40-23-41-53(11)42-43-55-54(12)56(60)58(62-13)59(63-14)57(55)61/h24,26,28,30,32,34,36,38,40,42H,15-23,25,27,29,31,33,35,37,39,41,43H2,1-14H3/b45-26+,46-28+,47-30+,48-32+,49-34+,50-36+,51-38+,52-40+,53-42+Key: ACTIUHUUMQJHFO-UPTCCGCDSA-N
  • InChI=1/C59H90O4/c1-44(2)24-15-25-45(3)26-16-27-46(4)28-17-29-47(5)30-18-31-48(6)32-19-33-49(7)34-20-35-50(8)36-21-37-51(9)38-22-39-52(10)40-23-41-53(11)42-43-55-54(12)56(60)58(62-13)59(63-14)57(55)61/h24,26,28,30,32,34,36,38,40,42H,15-23,25,27,29,31,33,35,37,39,41,43H2,1-14H3/b45-26+,46-28+,47-30+,48-32+,49-34+,50-36+,51-38+,52-40+,53-42+Key: ACTIUHUUMQJHFO-UPTCCGCDBK
SMILES
  • O=C1/C(=C(\C(=O)C(\OC)=C1\OC)C)C\C=C(/C)CC\C=C(/C)CC\C=C(/C)CC\C=C(/C)CC\C=C(/C)CC\C=C(/C)CC\C=C(/C)CC\C=C(/C)CC\C=C(/C)CC\C=C(/C)C
Properties
Chemical formula C59H90O4
Molar mass 863.365 g·mol
Appearance yellow or orange solid
Melting point 48–52 °C (118–126 °F; 321–325 K)
Solubility in water insoluble
Pharmacology
ATC code C01EB09 (WHO)
Related compounds
Related quinones 1,4-Benzoquinone
Plastoquinone
Ubiquinol
Except where otherwise noted, data are given for materials in their standard state (at 25 °C , 100 kPa). checkverify (what is  ?) Infobox references
Chemical compound

Coenzyme Q10 (CoQ10 /ˌkoʊkjuːˈtɛn/), also known as ubiquinone, is a naturally occurring biochemical cofactor (coenzyme) and an antioxidant produced by the human body. It can also be obtained from dietary sources, such as meat, fish, seed oils, vegetables, and dietary supplements. CoQ10 is found in many organisms, including animals and bacteria.

CoQ10 plays a role in mitochondrial oxidative phosphorylation, aiding in the production of adenosine triphosphate (ATP), which is involved in energy transfer within cells. The structure of CoQ10 consists of a benzoquinone moiety and an isoprenoid side chain, with the "10" referring to the number of isoprenyl chemical subunits in its tail.

Although a ubiquitous molecule in human tissues, CoQ10 is not a dietary nutrient and does not have a recommended intake level, and its use as a supplement is not approved in the United States for any health or anti-disease effect.

Biological functions

See also: Q cycle

CoQ10 is a component of the mitochondrial electron transport chain (ETC), where it plays a role in oxidative phosphorylation, a process required for the biosynthesis of adenosine triphosphate, the primary energy source of cells.

CoQ10 is a lipophilic molecule that is located in all biological membranes of human body and serves as a component for the synthesis of ATP and is a life-sustaining cofactor for the three complexes (complex I, complex II, and complex III) of the ETC in the mitochondria. CoQ10 has a role in the transport of protons across lysosomal membranes to regulate pH in lysosome functions.

The mitochondrial oxidative phosphorylation process takes place in the inner mitochondrial membrane of eukaryotic cells. This membrane is highly folded into structures called cristae, which increase the surface area available for oxidative phosphorylation. CoQ10 plays a role in this process as an essential cofactor of the ETC located in the inner mitochondrial membrane and serves the following functions:

  • electron transport in the mitochondrial ETC, by shuttling electrons from mitochondrial complexes like nicotinamide adenine dinucleotide (NADH), ubiquinone reductase (complex I), and succinate ubiquinone reductase (complex II), the fatty acids and branched-chain amino acids oxidation (through flavin-linked dehydrogenases) to ubiquinol–cytochrome-c reductase (complex III) of the ETC: CoQ10 participates in fatty acid and glucose metabolism by transferring electrons generated from the reduction of fatty acids and glucose to electron acceptors;
  • antioxidant activity as a lipid-soluble antioxidant together with vitamin E, scavenging reactive oxygen species and protecting cells against oxidative stress, inhibiting the oxidation of proteins, DNA, and use of vitamin E.

Biochemistry

This article needs attention from an expert in biochemistry. See the talk page for details. WikiProject Biochemistry may be able to help recruit an expert. (April 2024)

Coenzymes Q is a coenzyme family that is ubiquitous in animals and many Pseudomonadota, a group of gram-negative bacteria. The fact that the coenzyme is ubiquitous gives the origin of its other name, ubiquinone. In humans, the most common form of coenzymes Q is coenzyme Q10, also called CoQ10 (/ˌkoʊkjuːˈtɛn/) or ubiquinone-10.

Coenzyme Q10 is a 1,4-benzoquinone, in which "Q" refers to the quinone chemical group and "10" refers to the number of isoprenyl chemical subunits (shown enclosed in brackets in the diagram) in its tail. In natural ubiquinones, there are from six to ten subunits in the tail, with humans having a tail of 10 isoprene units (50 carbon atoms) connected to its benzoquinone "head".

This family of fat-soluble substances is present in all respiring eukaryotic cells, primarily in the mitochondria. Ninety-five percent of the human body's energy is generated this way. Organs with the highest energy requirements—such as the heart, liver, and kidney—have the highest CoQ10 concentrations.

There are three redox states of CoQ: fully oxidized (ubiquinone), semiquinone (ubisemiquinone), and fully reduced (ubiquinol). The capacity of this molecule to act as a two-electron carrier (moving between the quinone and quinol form) and a one-electron carrier (moving between the semiquinone and one of these other forms) is central to its role in the electron transport chain due to the iron–sulfur clusters that can only accept one electron at a time, and as a free radical–scavenging antioxidant.

Deficiency

There are two major pathways of deficiency of CoQ10 in humans: reduced biosynthesis, and increased use by the body. Biosynthesis is the major source of CoQ10. Biosynthesis requires at least 15 genes, and mutations in any of them can cause CoQ deficiency. CoQ10 levels also may be affected by other genetic defects (such as mutations of mitochondrial DNA, ETFDH, APTX, FXN, and BRAF, genes that are not directly related to the CoQ10 biosynthetic process). Some of these, such as mutations in COQ6, can lead to serious diseases such as steroid-resistant nephrotic syndrome with sensorineural deafness.

Assessment

Although CoQ10 may be measured in blood plasma, these measurements reflect dietary intake rather than tissue status. Currently, most clinical centers measure CoQ10 levels in cultured skin fibroblasts, muscle biopsies, and blood mononuclear cells. Culture fibroblasts can be used also to evaluate the rate of endogenous CoQ10 biosynthesis, by measuring the uptake of C-labeled p-hydroxybenzoate.


CoQ10 is studied as an adjunctive therapy to reduce inflammation in periodontitis.

Statins

Although statins may reduce CoQ10 in the blood it is unclear if they reduce CoQ10 in muscle. Evidence does not support that supplementation improves side effects from statins.

Chemical properties

The oxidized structure of CoQ10 is shown below. The various kinds of coenzyme Q may be distinguished by the number of isoprenoid subunits in their side-chains. The most common coenzyme Q in human mitochondria is CoQ10. Q refers to the quinone head and "10" refers to the number of isoprene repeats in the tail. The molecule below has three isoprenoid units and would be called Q3.

Coenzyme Q3

In its pure state, it is an orange-colored lipophile powder, and has no taste nor odor.

Biosynthesis

Biosynthesis occurs in most human tissue. There are three major steps:

  1. Creation of the benzoquinone structure (using phenylalanine or tyrosine, via 4-hydroxybenzoate)
  2. Creation of the isoprene side chain (using acetyl-CoA)
  3. The joining or condensation of the above two structures

The initial two reactions occur in mitochondria, the endoplasmic reticulum, and peroxisomes, indicating multiple sites of synthesis in animal cells.

An important enzyme in this pathway is HMG-CoA reductase, usually a target for intervention in cardiovascular complications. The "statin" family of cholesterol-reducing medications inhibits HMG-CoA reductase. One possible side effect of statins is decreased production of CoQ10, which may be connected to the development of myopathy and rhabdomyolysis. However, the role statins play in CoQ deficiency is controversial. Although statins reduce blood levels of CoQ, studies on the effects of muscle levels of CoQ are yet to come. CoQ supplementation also does not reduce side effects of statin medications.

Genes involved include PDSS1, PDSS2, COQ2, and ADCK3 (COQ8, CABC1).

Organisms other than humans produce the benzoquinone and isoprene structures from somewhat different source chemicals. For example, the bacteria E. coli produces the former from chorismate and the latter from a non-mevalonate source. The common yeast S. cerevisiae, however, derives the former from either chorismate or tyrosine and the latter from mevalonate. Most organisms share the common 4-hydroxybenzoate intermediate, yet again uses different steps to arrive at the "Q" structure.

Dietary supplement

Although neither a prescription drug nor an essential nutrient, CoQ10 is commonly used as a dietary supplement with the intent to prevent or improve disease conditions, such as cardiovascular disorders. CoQ10 is naturally produced by the body and plays a crucial role in cell growth and protection. Despite its significant role in the body, it is not used as a drug for the treatment of any specific disease.

Nevertheless, CoQ10 is widely available as an over-the-counter dietary supplement and is recommended by some healthcare professionals, despite a lack of definitive scientific evidence supporting these recommendations, especially when it comes to cardiovascular diseases.

Regulation and composition

CoQ10 is not approved by the U.S. Food and Drug Administration (FDA) for the treatment of any medical condition. However, it is sold as a dietary supplement not subject to the same regulations as medicinal drugs, and is an ingredient in some cosmetics. The manufacture of CoQ10 is not regulated, and different batches and brands may vary significantly.

Research

A 2014 Cochrane review found insufficient evidence to make a conclusion about its use for the prevention of heart disease. A 2016 Cochrane review concluded that CoQ10 had no effect on blood pressure. A 2021 Cochrane review found "no convincing evidence to support or refute" the use of CoQ10 for the treatment of heart failure.

A 2017 meta-analysis of people with heart failure taking 30–100 mg/d of CoQ10 found a 31% lower mortality and increased exercise capacity, with no significant difference in the endpoints of left heart ejection fraction. A 2021 meta-analysis found that coenzyme Q10 was associated with a 31% lower all-cause mortality in HF patients. In a 2023 meta-analysis of older people, ubiquinone had evidence of a cardiovascular effect, but ubiquinol did not.

Although CoQ10 has been studied as a potential remedy to treat purported muscle-related side effects of statin medications, the results were mixed. Although a 2018 meta-analysis concluded that there was preliminary evidence for oral CoQ10 reducing statin-associated muscle symptoms, including muscle pain, muscle weakness, muscle cramps and muscle tiredness, 2015 and 2024 meta-analysis found that CoQ10 had no effect on statin myopathy.

CoQ10 is studied as an adjunctive therapy to reduce inflammation in periodontitis.

Pharmacology

Absorption

CoQ10 in the pure form is a crystalline powder insoluble in water. Absorption as a pharmacological substance follows the same process as that of lipids; the uptake mechanism appears to be similar to that of vitamin E, another lipid-soluble nutrient. This process in the human body involves secretion into the small intestine of pancreatic enzymes and bile, which facilitates emulsification and micelle formation required for absorption of lipophilic substances. Food intake (and the presence of lipids) stimulates bodily biliary excretion of bile acids and greatly enhances absorption of CoQ10. Exogenous CoQ10 is absorbed from the small intestine and is best absorbed if taken with a meal. Serum concentration of CoQ10 in fed condition is higher than in fasting conditions.

Metabolism

CoQ10 is metabolized in all tissues, with the metabolites being phosphorylated in cells. CoQ10 is reduced to ubiquinol during or after absorption in the small intestine. It is absorbed by chylomicrons, and redistributed in the blood within lipoproteins. Its elimination occurs via biliary and fecal excretion.

Pharmacokinetics

Some reports have been published on the pharmacokinetics of CoQ10. The plasma peak can be observed 6–8 hours after oral administration when taken as a pharmacological substance. In some studies, a second plasma peak also was observed at approximately 24 hours after administration, probably due to both enterohepatic recycling and redistribution from the liver to circulation.

Deuterium-labeled crystalline CoQ10 was used to investigate pharmacokinetics in humans to determine an elimination half-time of 33 hours.

Bioavailability

In contrast to intake of CoQ10 as a constituent of food, such as nuts or meat, from which CoQ10 is normally absorbed, there is a concern about CoQ10 bioavailability when it is taken as a dietary supplement. Bioavailability of CoQ10 supplements may be reduced due to the lipophilic nature of its molecule and large molecular weight.

Reduction of particle size

Nanoparticles have been explored as a delivery system for various drugs, such as improving the oral bioavailability of drugs with poor absorption characteristics. However, this has not proved successful with CoQ10, although reports have differed widely. The use of aqueous suspension of finely powdered CoQ10 in pure water also reveals only a minor effect.

Water-solubility

Facilitating drug absorption by increasing its solubility in water is a common pharmaceutical strategy and also has been shown to be successful for CoQ10. Various approaches have been developed to achieve this goal, with many of them producing significantly better results over oil-based softgel capsules in spite of the many attempts to optimize their composition. Examples of such approaches are use of the aqueous dispersion of solid CoQ10 with the polymer tyloxapol, formulations based on various solubilising agents, such as hydrogenated lecithin, and complexation with cyclodextrins; among the latter, the complex with β-cyclodextrin has been found to have highly increased bioavailability and also is used in pharmaceutical and food industries for CoQ10-fortification.

Adverse effects and precautions

Generally, oral CoQ10 supplementation is well tolerated. The most common side effects are gastrointestinal symptoms (nausea, vomiting, appetite suppression, and abdominal pain), rashes, and headaches. Some adverse effects, largely gastrointestinal, are reported with intakes. Doses of 100–300 mg per day may induce insomnia or elevate liver enzymes. The observed safe level risk assessment method indicated that the evidence of safety is acceptable at intakes up to 1200 mg per day.

Caution should be observed in the use of CoQ10 supplementation in people with bile duct obstruction, and during pregnancy or breastfeeding.

Potential drug interactions

CoQ10 taken as a pharmacological substance has potential to inhibit the effects of theophylline as well as the anticoagulant warfarin; CoQ10 may interfere with warfarin's actions by interacting with cytochrome p450 enzymes thereby reducing the INR, a measure of blood clotting. The structure of CoQ10 is similar to that of vitamin K, which competes with and counteracts warfarin's anticoagulation effects. CoQ10 is not recommended in people taking warfarin due to the increased risk of clotting.

Dietary concentrations

Detailed reviews on occurrence of CoQ10 and dietary intake were published in 2010. Besides the endogenous synthesis within organisms, CoQ10 also is supplied by various foods. CoQ10 concentrations in various foods are:

CoQ10 levels in selected foods
Food CoQ10 concentration (mg/kg)
Vegetable oils soybean oil 54–280
olive oil 40–160
grapeseed oil 64–73
sunflower oil 4–15
canola oil 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
tuna 5
Nuts peanut 27
walnut 19
sesame seed 18–23
pistachio 20
hazelnut 17
almond 5–14
Vegetables parsley 8–26
broccoli 6–9
cauliflower 2–7
spinach up to 10
Chinese cabbage 2–5
Fruit avocado 10
blackcurrant 3
grape 6–7
strawberry 1
orange 1–2
grapefruit 1
apple 1
banana 1

Vegetable oils, meat and fish are quite rich in CoQ10 levels. Dairy products are much poorer sources of CoQ10 than animal tissues. Among vegetables, broccoli and cauliflower are good sources of CoQ10. Most fruit and berries are poor sources of CoQ10, with the exception of avocados, which have a relatively high oil and CoQ10 content.

Intake

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

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

Effect of heat and processing

Cooking by frying reduces CoQ10 content by 14–32%.

History

In 1950, a small amount of CoQ10 was isolated from the lining of a horse's gut, a compound initially called substance SA, but later deemed to be quinone found in many animal tissues. In 1957, the same compound was isolated from mitochondrial membranes of beef heart, with research showing that it transported electrons within mitochondria. It was called Q-275 as a quinone. The Q-275/substance SA was later renamed ubiquinone as it was a ubiquitous quinone found in all animal tissues. In 1958, its full chemical structure was reported. Ubiquinone was later called either mitoquinone or coenzyme Q due to its participation to the mitochondrial electron transport chain. In 1966, a study reported that reduced CoQ6 was an effective antioxidant in cells.

See also

  • Idebenone – synthetic analog with reduced oxidant generating properties
  • Mitoquinone mesylate – synthetic analog with improved mitochondrial permeability

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