Journal of Energy Bioscience 2025, Vol.16, No.1, 42-52 http://bioscipublisher.com/index.php/jeb 48 6 Creatine Supplementation: Applications and Mechanisms 6.1 Effects of creatine supplementation on muscle performance and recovery There have been many studies looking at the effects of creatine supplementation on exercise performance and recovery. Creatine supplementation can significantly increase muscle strength, power, and lean body mass, especially during short, high-intensity training (Balestrino and Adriano, 2019; Kazak and Cohen, 2020). This is because creatine can quickly help cells regenerate ATP, which is the main energy source for cells. This ability to quickly replenish energy is critical during intense exercise (Kazak and Cohen, 2020). Creatine supplementation can also reduce muscle damage and inflammation and speed up recovery after exercise, a process related to the activity of satellite cells. Creatine can stimulate the activation and proliferation of these cells, which play an important role in repairing and growing muscles (Vulturar et al., 2021). 6.2 Mechanistic insights into how supplementation impacts cellular energy levels From a cellular perspective, creatine supplementation can enhance the capacity of the PCr system, allowing cells to replenish ATP more quickly when they need a lot of energy (Bonilla et al., 2021a; 2021b). When creatine enters the cell through the Na+/Cl−-dependent creatine transporter (CRT), it is converted into phosphocreatine (PCr) by creatine kinase (CK) (Bonilla et al., 2021a). PCr transfers a phosphate group to ADP and then regenerates ATP, a mechanism that helps cells maintain energy stability during exercise (Bonilla et al., 2021a; 2021b). Creatine also affects some intracellular pathways (such as those related to oxidative stress and inflammation), which can further improve the overall metabolic function and energy level of the cell (Clarke et al., 2020; Bonilla et al., 2021b). 6.3 Potential therapeutic roles in neurodegenerative and muscle diseases Creatine not only helps with athletic performance, but can also help treat related diseases. In muscular dystrophy and inflammatory myopathy, creatine supplementation can improve patients' muscle strength and health (Balestrino and Adriano, 2019; Vulturar et al., 2021). Balestrino and Adriano (2019) also found that creatine is also very useful in preventing and treating statin-related myopathy, and it also has a certain effect on refractory depression in some female patients (Balestrino and Adriano, 2019). In neurodegenerative diseases, creatine works in two ways: one is to help cells increase energy, and the other is to reduce oxidative stress (Clarke et al., 2020; Kreider and Stout, 2021). Creatine can increase the creatine content in the brain and improve cognitive ability and memory in the elderly (Prokopidis et al., 2022). Creatine also affects the immune system and has anti-inflammatory effects (Clarke et al., 2020; Kazak and Cohen, 2020). 7 Advances in Research Techniques for Studying Creatine Phosphate Metabolism 7.1 Imaging and molecular methods for tracking creatine phosphate levels In recent years, there have been many advances in imaging technology, especially magnetic resonance spectroscopy (MRS). This technology makes it easier for us to track phosphocreatine (PCr) levels in the body. The advantage of MRS is that it can detect creatine (Cr) and PCr in living tissue without surgery. This allows us to see how the creatine kinase (CK) system changes in the body. Specifically, 1H MRS can measure the concentration of Cr and PCr, while 31P MRS can also estimate the reaction rate of CK, so that we can see if there is any problem with the entire Cr/PCr/CK system (Račkayová et al., 2017). These technologies are very helpful in our understanding of the role of creatine in the brain, especially when studying creatine deficiency, they can provide important information. 7.2 Emerging genetic and biochemical tools in creatine-related research Now, people who study creatine metabolism have more tools in their hands. For example, genetic engineering and new biochemical methods have made the research more detailed. These tools allow scientists to study how creatine works not only in muscle and brain, but also in other tissues, such as adipose tissue, the immune system, and cancer cells (Kazak and Cohen, 2020). Some genetic tools have found that creatine is also involved in regulating thermogenesis and even affects the survival of cancer cells. Researchers are also using bioinformatics methods to combine various data from public databases. These reviews can help everyone understand the overall situation of creatine metabolism, especially in the study of cellular energy metabolism and the distribution of the CK/PCr system (Bonilla et al., 2021a).
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