1. Introduction
In recent decades, there has been growing interest in complementary therapeutic strategies targeting the multifactorial pathophysiology of chronic diseases. Among the compounds with promising therapeutic potential, alpha-lipoic acid (ALA) has emerged as a notable agent due to its potent antioxidant and anti-inflammatory properties, along with favorable effects on metabolic and cardiovascular parameters [1,2]. Endogenously synthesized within the mitochondria, ALA acts as a crucial cofactor in mitochondrial multienzyme complexes, playing a key role in cellular energy metabolism and redox homeostasis [3]. While the oral form of ALA is the most extensively studied, increasing evidence supports the superior bioavailability and efficacy of parenteral administration, particularly intravenous routes. This is especially relevant in clinical conditions characterized by heightened oxidative stress, systemic inflammation, and insulin resistance [1,3]. Patients with type 2 diabetes mellitus, cardiovascular diseases, and diabetic neuropathy appear to benefit significantly from ALA supplementation [2,4]. Several systematic reviews and meta-analyses have demonstrated that ALA supplementation can improve glycemic control (insulin, HOMA-IR), lipid profiles (total cholesterol, low density lipoprotein- LDL, triglycerides), inflammatory biomarkers (C Reactive Protein- CRP, Interleukin-6- IL-6, Tumor Necrosis Factor Alpha- TNF-α) and endothelial function [4–7]. However, the heterogeneity in dosing regimens, treatment duration and routes of administration limits the interpretability of these findings. In this context, a critical appraisal of the literature is warranted to better elucidate the clinical efficacy and safety of injectable ALA formulations.
