Effect of branched-chain amino acids in patients receiving intervention for hepatocellular carcinoma

AIM:To investigate the usefulness of branched-chain amino acids(BCAA)before transarterial chemoembolization(TACE)or radiofrequency ablation(RFA).METHODS:We investigated the usefulness of preintervention with BCAAs by comparing patients treated with BCAAs at 12.45 g/d orally for at least 2 wk before TACE or RFA and those not receiving such pretreatment.A total of 270 patients with hepatocellular carcinoma complicated by cirrhosis were included in the study.Mean changes from baseline(Δ)in serum albumin(Alb),C-reactive protein(CRP),and transaminase levels,as well as peak body temperature were also determined and compared at days 2,5,and 10 after the start of TACE or RFA.RESULTS:In patients who underwent TACE or RFA,BCAA pre-intervention significantly suppressed the development of post-intervention hypoalbuminemia and reduced inflammatory reactions during the subsequent clinical course.After TACE,theΔAlb peaked on day 2,remained constantly lower in BCAA-treated patients,compared to the control group,and was-0.13±0.42g/dL in BCAA-treated patients and-0.33±0.51 g/dL in untreated patients on day 10.TheΔCRP was also significantly lower in BCAA-treated patients on days2,5 and 10 after TACE.Like the trends noted after TACE,a similar tendency was noted as to theΔAlb andΔCRP after RFA.The changes in serum Alb level were inversely correlated with CRP changes;therefore,a possible involvement of the anti-inflammatory effect of BCAAs was inferred as a factor contributory to the suppression of decrease in serum Alb level.CONCLUSION:Pre-intervention with BCAAs may hasten the recovery of serum Alb level and mitigate postoperative complications in patients undergoing TACE or RFA.

Improvement of regional cerebral blood flow after oral intake of ranched-chain amino acids in patients with cirrhosis

AIM: To evaluate the effect of oral intake of branchedchain amino acids (BCAA) on brain perfusion in patients with liver cirrhosis.METHODS: Single photon emission computed tomography scans were performed in 43 patients with cirrhosis and in 15 age-matched healthy subjects.Twenty-nine out of forty-three patients were randomly treated with either BCAA granules or placebo, and single photon emission computed tomography was performed before and after the treatment. We measured the regional cerebral blood flow values using a threedimensional stereotaxic region of interest template.RESULTS: Cirrhotic patients had regions of significant hypoperfusion in the bilateral central (right P=0.039,P＜0.05; left P = 0.006 P＜0.01), parietal (right P=0.018, P＜0.05;left P=0.009, P＜0.01), angular (right P=0.039, P＜0.05;left P = 0.008, P＜0.01), and left pericallosal segments (P= 0.038 P＜0.05) as compared with healthy subjects. A significant increase in cerebral perfusion was observed 70 min after the oral intake of BCAA in the angular (right P=0.012,P＜0.05;left P=0.049, P＜0.05), temporal (right P=0.012, P＜0.05; left P=0.038, P＜0.05), pericallosal segments (right P = 0.025,P＜0.05; left P = 0.049, P＜0.05) and left precentral (P=0.044, P＜0.05), parietal (P=0.040, P＜0.05) and thalamus (P=0.033, P＜0.05). No significant change in perfusion was observed in the placebo group.CONCLUSION: Administration of BCAA rapidly improves cerebral perfusion.