Efficacy of Branched-Chain Amino Acids in the Treatment of Hepatic Encephalopathy

  • J. E. Fischer


All therapy in patients with liver disease is a play for time, until the well-known regenerative capacity of the liver can occur. The regenerative capacity of the liver is an extremely complicated process, involving a series of permissive and stimulatory factors, such as steroids, triiodothyronine, insulin and glucagon and other factors, such as the ileal factor, which remain unknown. Of all the factors that are currently known which influence liver regeneration, nutrition is the easiest one for the physician to manipulate. Nutrition in the therapy of patients with liver disease has long been important in hepatology.


Hepatic Encephalopathy Amino Acid Solution Hepatic Coma Free Tryptophan Caloric Source 
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  1. 1.
    J. E. Fischer, J. M. Funovics, A. Aguirre, J. H. James, J. M. Keane, R. I. C. Wesdorp, N. Yoshimura,and T. Westman, The role of plasma amino acids in hepatic encephalopathy, Surgery 78: 276 (1975).Google Scholar
  2. 2.
    J. Wahren, P. Felig, and L. Hagenfeldt, Effect of protein ingestion on splanchnic and leg metabolism in normal man and in patients with diabetes mellitus, J. Clin. Invest. 57: 987 (1976).Google Scholar
  3. 3.
    A. L. Goldberg, Mechanism of growth and atrophy of skeletal muscle in “Muscle Biology”, New York, Dekker, vol. I, pp. 89–118 (1972).Google Scholar
  4. 4.
    T. Pozedsky, P. Felip, J. S. Soeldner, and G. F. Cahill, Jr., Insulin blockage of amino acid release by human forearm tissues, Trans. Assoc. Am. Physicians 81: 258 (1968).Google Scholar
  5. 5.
    H. N. Munro, J.G. Black,and W. S. T. Thomson, The mode of action of dietary carbohydrate on protein metabolism, Brit. J. Nutr. 13: 475 (1959).Google Scholar
  6. 6.
    R. Oddessey and A. L. Goldberg, Oxidation of leucine by rat skeletal muscle, Amer. J. Phys. 223: 1376 (1972).Google Scholar
  7. 7.
    R. S. Sherwin, Effect of starvation on the turnover and metabolic response to leucine, J. Clin. Invest. 21: 1471 (1978).Google Scholar
  8. 8.
    H. R. Freund, H. J. James, and J. E. Fischer, Nitrogen sparing mechanisms of singly administered branched-chain amino acids in the injured rat, Surgery 90: 237 (1981).PubMedGoogle Scholar
  9. 9.
    A. Sakamoto, L. L. Moldawer, A. Bothe, B. R. Bistrian, and G. L. Blackburn, Are the nitrogen sparing mechanisms of branched-chain amino acid administration really unique? Surg. Forum 31: 99 (1980).Google Scholar
  10. 10.
    R. A. Gelfaud, R. G. Hendler, and R. S. Sherwin, Dietary carbohydrate and metabolism of ingested protein, Lancet i: 65 (1979).CrossRefGoogle Scholar
  11. 11.
    J. H. James, P. M. Herlin, L. Edwards, C. A. Nachbauer, and J. E. Fischer, Effect of infusion of branched-chain amino acids on concentrations of amino acids in plasma and brain and on brain catecholamines after total hepatectomy in the rat, Life Sciences 30: 1361 (1982).PubMedCrossRefGoogle Scholar
  12. 12.
    J. E. Fischer and R. J. Baldessarini, Pathogenesis and therapy of hepatic coma, in: “Progress in Liver Disease” H. Popper and F. Schaffner, eds., Grune and Stratton, New York, pp. 363–397 (1976).Google Scholar
  13. 13.
    A. Okada, S. Kamata, C. W. Kim, and Y. Kawashima, Treatment of hepatic encephalopathy with BCAA-rich amino acid mixture, in: “Metabolism and Clinical Implications of Branched-Chain Amino and Ketoacids,” M. Walser, R. Williamson, eds., Elsevier North Holland, New York, pp. 447–452 (1981).Google Scholar
  14. 14.
    L. Capocaccia, V. Calcaterra, C. Cangiano, A. Cascino, F. Fiaccadori, S. Gentile, F. Ghinelli, G. Pelosi, O. Riggio, F. Rossi-Fanelli, D. Sacchini, and G. Giunchi, Therapeutic effect of branched-chain amino acids in hepatic encephalopathy: A preliminary study, in: “Medical and Surgical Problems of Portal Hypertension,” Orloff, M. J., Stipa, S., Ziparo, V. eds., Academic Press, London, New York, pp. 239–249 (1979).Google Scholar
  15. 15.
    H. Freund, J. Dienstag, F. Lehrich, N. Yoshimura, R. R. Bradford, H. Rosen, S. Atamian, E. Slemmer, J. Holroyde, and J. E. Fischer, Infusion of BCAA solution in patients with hepatic encephalopathy, Ann. Surg. 196: 209 (1982).PubMedCrossRefGoogle Scholar
  16. 16.
    D. B. Silk, M. A. Hanid, and P. N. Trewby, Treatment of fulminant hepatic failure by polyacrylonitrile membrane haemodialysis, Lancet ii: 1 (1977).CrossRefGoogle Scholar
  17. 17.
    B. G. Gazzard, M. J. Weston, J. M. Murray-Lyon, H. Flax, C. O. Record, R. Williams, B. Portmann, P. G. Langley, E. H. Dunlop, P. J. Mellon, and M. B. Ward, Charcoal hemoperfusion in the treatment of fulminant hepatic failure, Lancet i: 1301 (1974).CrossRefGoogle Scholar
  18. 18.
    S. Rakette, M. Fischer, H. J. Reimann, and S. V. Sommoggy, Effects of a special amino acid solution in patients with liver cirrhosis and hepatic encephalopathy, in: “Metabolism and Clinical Implications of Branched-Chain Amino and Ketoacids” M. Walser, R. Williamson eds., Elsevier, North-Holland, New York, pp. 419–427 (1981).Google Scholar
  19. 19.
    T. Higashi, A. Watanabe, S. Hayashi, T. Obata, N. Tanei, and H. Nagashima, Effect of branched-chain amino acid infusion on alterations in CSF neutral amino acids and their transport across the blood brain barrier in hepatic encephalopathy, in: “Metabolism and Clinical Implications of Branched-Chain Amino and Ketoacids,” M. Walser, R. Williamson eds., Elsevier, North-Holland, New York, pp. 465–470 (1981).Google Scholar
  20. 20.
    E. Holm, J. P. Streibel, P. Moller, and M. Hartman, Amino acid solutions for parenteral nutrition and for adjuvant treatment of encephalopathy in liver cirrhosis, studies concerning 120 patients, in: “Metabolism and Clinical Implications of Branched-Chain Amino and Ketoacids,” M. Walser, R. Williamson eds., Elsevier, North-Holland, New York, pp. 513–518 (1981).Google Scholar
  21. 21.
    F. Rossi Fanelli, O. Riggio, C. Cangiano, A. Cascino, D. De Conciliis, M. Merli, M. Stortoni, and G. Giunchi, Branched-chain amino acids vs lactulose in the treatment of hepatic coma: a controlled study, Dig. Dis. Sci. 27: 929 (1982).PubMedCrossRefGoogle Scholar
  22. 22.
    F. Fiaccadori, F. Ghinelli, G. Pedretti, G. Pelosi, D. Sacchini, M. L. Zeneroli, E. Rossi, P. Gibertini, and E. Ventura, Branched-chain amino acid enriched solutions in hepatic encephalopathy, a controlled trial (submitted for publication).CrossRefGoogle Scholar
  23. 23.
    F. B. Cerra, N. K. Cheung, J. E. Fischer, N. Kaplowitz, E. R. Schiff, J. L. Deinstag, C. D. Mabry, C. M. Leevy, and T. Kiernan, A multicenter trial of branched-chain enriched amino acid infusion (F080) in hepatic encephalopathy (HE), Hepatology 2: (5) 699 (1982).Google Scholar
  24. R. M. Abel, C. H. Beck, Jr., W. M. Abbott, J. A. Ryan, G. O. Barnett, and J. E. Fischer, Improved survival from acute renal failure after treatment with intravenous essential L-amino acids and glucose, N. Engl. J. Med. 288: 695 (1973).PubMedCrossRefGoogle Scholar
  25. 25.
    J. W. Alexander, B. G. McMillan, J. D. Stinnett, C. K. Ogle, R. C. Bozían, J. E. Fischer, J. B. Oakes, M. J. Morris, and R. Krummel, Beneficial effects of aggressive protein feeding in severely burned children, Ann. Surg. 192: 505 (1980).Google Scholar
  26. 26.
    E. Strauss, W. R. Santos, and E. C. DaSilva, A randomized controlled clinical trial for the evaluation of the efficacy of balanced amino acid solution compared to neomycin in hepatic encephalopathy (submitted for publication).Google Scholar
  27. 27.
    G. Polier-Layrargues, O. Duhamel, G. Cuilleret, P. Bovics, H. Bellet-Hermann, and H. Michel, Treatment of hepatic encephalopathy by infusions of a modified amino acid solution. Results of a controlled study in 33 cirrhotic patients (submitted for publication).Google Scholar
  28. 28.
    J. J. Wahren, J. Denis, P. Desurmont, L. S. Erikson, J. M. Escoffier, A. P. Gauthier, L. Hagenfeldt, H. Michel, P. Opolon, J. Paris, and M. Veyrac, Is i.v. administration of branched-chain amino acids effective in the treatment of hepatic encephalopathy? A multicenter study, Europ. Soc. Parent. Enter. Nutr. FC47: 61 (1981).Google Scholar
  29. 29.
    A. Cascino, C. Cangiano, V. Calcaterra, F. Rossi-Fanelli, and L. Capocaccia, Plasma amino acid imbalance in patients with liver disease, Am. J. Dig. Dis. 23: 591 (1978).Google Scholar
  30. 30.
    F. Rossi-Fanelli, F. H. Freund, R. Krause, A. R. Smith, J. H. James, S. Castorina-Ziparo, and J. E. Fischer, Induction of coma in normal dogs by infusion of aromatic amino acids and prevention by addition of branched chain amino acids, Gastroenterology 83: 664 (1982).PubMedGoogle Scholar
  31. 31.
    C. Cangiano, F. Rossi-Fanelli, and L. Capocaccia, Personal communication.Google Scholar
  32. 32.
    H. Freund, N. Yoshimura, and J. E. Fischer, Chronic hepatic encephalopathy. Long-term therapy with a branched-chainamino-acid-enriched elemental diet, JAMA 242: 347 (1979).PubMedCrossRefGoogle Scholar
  33. 33.
    D. Horst, N. Grace, H. O. Conn, E. Schiff, S. Schenker, A. Viteri, D. Law, and C. E. Atterbury, A double-blind randomized comparison of dietary protein and an oral branched chain amino acid (BCAA) supplement in cirrhotic patients with chronic portal-systemic encephalopathy (PSE) (ABS), Hepatology 5: 518 (1981).Google Scholar
  34. 34.
    E. M. Egberts, W. Hampter, and P. Jurgens, Effective treatment of latent portosystemic encephalopathy (PSE) with oral branched chain amino acids (BCAA). Presented at AISF Conference on Hepatic Coma, Rome, November 19–20, 1982 (this volume).Google Scholar
  35. 35.
    L. S. Eriksson, A. Persson, and J. Wahren, Branched chain amino acids in the treatment of chronic hepatic encephalopathy, Gut 23: 801 (1982).PubMedCrossRefGoogle Scholar
  36. 36.
    H. Schomerus, In discussion of paper 39, AISF Conference on Hepatic Coma, Rome, November 19–20, 1982 (this volume).Google Scholar

Copyright information

© Plenum Press, New York 1984

Authors and Affiliations

  • J. E. Fischer
    • 1
  1. 1.Department of SurgeryUniversity of Cincinnati Medical CenterCincinnatiUSA

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