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Branched chain amino acids activate messenger ribonucleic acid translation regulatory proteins in human skeletal muscle, and glucocorticoids blunt this action.

Branched chain amino acids (BCAA) are particularly effective anabolic agents. Recent in vitro studies suggest that amino acids, particularly leucine, activate a signaling pathway that enhances messenger ribonucleic acid translation and protein synthesis. The physiological relevance of these findings to normal human physiology is uncertain. We examined the effects of BCAA on the phosphorylation of eukaryotic initiation factor 4E-binding protein 1 (eIF4E-BP1) and ribosomal protein S6 kinase (p70(S6K)) in skeletal muscle of seven healthy volunteers. We simultaneously examined whether BCAA affect urinary nitrogen excretion and forearm skeletal muscle protein turnover and whether the catabolic action of glucocorticoids could be mediated in part by inhibition of the action of BCAA on the protein synthetic apparatus. BCAA infusion decreased urinary nitrogen excretion (P < 0.02), whole body phenylalanine flux (P < 0.02), plasma phenylalanine concentration (P < 0.001), and improved forearm phenylalanine balance (P = 0.03). BCAA also increased the phosphorylation of both eIF4E-BP1 (P < 0.02) and p70(S6K) (P < 0.03), consistent with an action to activate the protein synthetic apparatus. Dexamethasone increased plasma phenylalanine concentration (P < 0.001), prevented the BCAA-induced anabolic shift in forearm protein balance, and inhibited their action on the phosphorylation of p70(S6K). We conclude that in human skeletal muscle BCAA act directly as nutrient signals to activate messenger ribonucleic acid translation and potentiate protein synthesis. Glucocorticoids interfere with this action, and that may be part of the mechanism by which they promote net protein catabolism in muscle.

Adaptor Proteins, Signal Transducing↗

Effect of enrichment of infusion solutions with branched chain amino acids in parenteral nutrition of rats.

The effect of enrichment of the branched chain amino acids (BCAAs) leucine, isoleucine and valine on total parenteral nutrition was studied in rats. Experimental infusion solutions with a sufficient, marginal or deficient level of glucose contained either the conventional amino acid composition (22.6% BCAAs) or a BCAA-enriched amino acid composition (36% BCAAs). Rats were infused with experimental solutions for 4 days and several parameters of protein metabolism were evaluated in various tissues. Under conditions of sufficient energy supply, BCAA-enriched and conventional groups showed similar body weight gains and muscle protein degradations as measured by urinary 3-methylhistidine excretion. Polysome profiles in the liver and gastrocnemius muscle of the BCAA-enriched group were more heavily aggregated than those of the conventional group. Under the conditions of marginal or deficient energy supply, beneficial effects of BCAA enrichment over the conventional amino acid composition became more evident in terms of better body weight retention, higher RNA/DNA ratio and heavier polysome profile in both liver and muscle, and reduced protein catabolism in muscle. The present study suggests that enrichment of BCAAs, particularly valine and isoleucine, may be useful for nutritional support under hypercatabolic or stressed conditions.

Amino Acids, Branched-Chain↗

Effects of branched-chain amino acid supplementation on serum creatine kinase and lactate dehydrogenase after prolonged exercise.

BACKGROUND: The aim of this study was to examine the effects of branched-chain amino acid (BCAA) supplementation on serum indicators of muscle damage after prolonged exercise. We hypothesized that BCAA supplementation would reduce the serum activities of intramuscular enzymes associated with muscle damage. METHODS: To test this hypothesis, sixteen male subjects were assigned to one of two groups: the supplemental group (consuming 12 g x d(-1) BCAA for 14 d in addition to their normal diet) or the control group (normal diet only). Baseline serum creatine kinase (CK) and lactate dehydrogenase (LDH), shown to be accurate indicators of muscle damage, were determined during the week before the exercise test. The exercise test was administered on day seven and required the subjects to cycle for 120 min on an ergometer at approximately 70% VO2max. Blood samples were taken prior to and immediately following exercise and at 1 hr, 2 hrs, 3 hrs, 4 hrs, 1 d, 3 d, 5 d and 7 d postexercise. All subjects were required have their diets analyzed daily during the 14 d. RESULTS: Dietary analyses indicated that all subjects consumed the recommended daily intake of BCAA (0.64 g x kg(-1)) in their normal diets. Baseline serum values for CK and LDH were not different between groups in the 7 d prior to the test (p>0.05). However there were significant increases (p<0.05) between the pre-exercise and postexercise values for LDH and CK until 5 d postexercise test. Importantly, the BCAA supplementation significantly reduced this change in LDH from 2hrs to 5 d posttest, and CK from 4 hrs to 5 d post-test (p<0.05). CONCLUSIONS: These results indicate that supplementary BCAA decreased serum concentrations of the intramuscular enzymes CK and LDH following prolonged exercise, even when the recommended intake of BCAA was being consumed. This observation suggests that BCAA supplementation may reduce the muscle damage associated with endurance exercise.

Adult↗

Metabolism of branched-chain amino acids in starved rats: the role of hepatic tissue.

Parameters of branched-chain amino acids (BCAA; leucine, isoleucine and valine) and protein metabolism were evaluated using L-[1-(14)C]leucine and alpha-keto[1-(14)C]isocaproate (KIC) in the whole body and in isolated perfused liver (IPL) of rats fed ad libitum or starved for 3 days. Starvation caused a significant increase in plasma BCAA levels and a decrease in leucine appearance from proteolysis, leucine incorporation into body proteins, leucine oxidation, leucine-oxidized fraction, and leucine clearance. Protein synthesis decreased significantly in skeletal muscle and the liver. There were no significant differences in leucine and KIC oxidation by IPL. In starved animals, a significant increase in net release of BCAA and tyrosine by IPL was observed, while the effect on other amino acids was non-significant. We conclude that the protein-sparing phase of uncomplicated starvation is associated with decreased whole-body proteolysis, protein synthesis, branched-chain amino acid (BCAA) oxidation, and BCAA clearance. The increase in plasma BCAA levels in starved animals results in part from decreased BCAA catabolism, particularly in heart and skeletal muscles, and from a net release of BCAA by the hepatic tissue.

Alanine Transaminase↗

Variations in plasma amino acids in septic patients subjected to parenteral nutrition with a high proportion of branched-chain amino acids.

Sepsis is characterized by an increase in the plasma concentration of aromatic amino acids (AAAs) and those containing sulfur and a decrease in the branched-chain amino acids (BCAAs). We studied changes in the plasma aminogram of septic patients given different types of total parenteral nutrition (TPN), analyzing variations in accordance with the type of TPN used and the importance that the use of BCAA may have in these patients. We studied 80 patients with peritonitis divided into two groups of 40 patients each: group 1 was given a solution with 22.5% BCAA and group 2 a solution with 45% BCAA. High BCAA content caused an increase in the plasma concentrations of these amino acids and in the BCAA/AAA quotient and a decrease in AAAs. Plasma concentrations of leucine and valine reached high, potentially toxic levels at 15 days when solutions with high BCAA content were used. Glycine increased in group 1, which may be important because of its tendency to produce hyperammonemia. BCAAs are of unquestioned nutritional importance in view of the evidence of changes that take place in muscle protein catabolism and in plasma amino acids. In the phase of increased protein catabolism, we saw a plasma amino acid pattern in keeping with the existing metabolic situation. The need for BCAA diminishes when the hypercatabolic state disappears.

Adult↗

Insulin action on glucose and branched-chain amino acid metabolism in cancer cachexia: differential effects of insulin.

In addition to the maintenance of glucose homeostasis, insulin plays a major role in the regulation of branched-chain amino acid (BCAA) metabolism. We investigated insulin action on glucose turnover rates, arterial BCAA concentrations, and forearm BCAA flux in cancer cachexia. Six weight-losing patients with localized gastrointestinal malignancy and five age-matched control subjects underwent sequential 120-minute euglycemic insulin infusions. Steady-state insulin concentrations were 50 +/- 5, 97 +/- 14, and 435 +/- 14 microU/ml in patients and 44 +/- 4, 95 +/- 6, and 495 +/- 42 microU/ml in control subjects at the insulin infusion rates of 0.5, 1.0, and 4.0 mU/kg.min, respectively. During the 0.5 and 1.0 mU/kg.min insulin infusions, a primed, continuous infusion of D-[3-3H] glucose was used to quantify endogenous glucose production. Total body glucose uptake was decreased in patients with cancer compared with control subjects at the 0.5 mU/kg.min (2.9 +/- 0.4 vs 3.6 +/- 1.2 mg/kg.min), 1.0 mU/kg.min (5.3 +/- 0.3 vs 8.7 +/- 0.8 mg/kg.min; p less than 0.05), and 4.0 mU/kg.min (10.9 +/- 0.9 vs 13.7 +/- 1.1 mg/kg.min) insulin infusion rates, consistent with a state of insulin resistance. Progressive euglycemic insulin infusion induced a marked, comparable insulin-dependent decrease in arterial plasma BCAA concentrations in both patients with cancer and control subjects. There was no change in postabsorptive forearm BCAA flux with progressive hyperinsulinemia. Insulin-induced branched-chain hypoaminoacidemia is unimpaired in this group of patients manifesting resistance to insulin action on glucose metabolism, thereby providing evidence of a differential resistance to insulin action on glucose metabolism versus insulin action on BCAA concentrations in cancer cachexia. Peripheral BCAA flux is not affected by systemic insulin infusion, suggesting that skeletal muscle is not a major site of BCAA disposal during insulin-mediated hypoaminoacidemia.

Amino Acids↗

Improvement in amino acid use in the critically ill patient with parenteral formulas enriched with branched chain amino acids.

To assess the value of BCAA enriched solutions in patients under stress, we studied five critically ill, intensive care unit patients requiring total parenteral nutrition. Two complete feeding solutions were compared: one containing 15.6 per cent of the amino acids as BCAA and the other enriched to contain 50 per cent as BCAA. These solutions were prepared to be isocaloric and isonitrogenous and were administered in consecutive 24 hour periods. The order of administration was determined randomly. In the last ten hours of each infusion day, 50 microcuries of L-[1-14C]leucine were added to the solution to estimate leucine kinetics. Increased plasma leucine appearance (from 3.92 +/- 0.48 to 6.26 +/- 0.51 millimoles per hour, p less than 0.05), oxidation (from 0.83 +/- 0.23 to + 1.41 +/- 0.33 millimoles per hour, p less than 0.05) and net leucine balance (from + 0.48 +/- 0.23 to + 1.41 +/- 0.33 millimoles per hour, p less than 0.05) were found in patients while receiving the solution enriched to contain 50 per cent of the amino acids as BCAA. Plasma leucine, isoleucine and valine concentrations were also significantly increased with administration of the BCAA enriched solution, whereas plasma levels of glycine, tyrosine and phenylalanine were significantly reduced. These changes represent a normalization of plasma amino acid levels with administration of BCAA enriched solution. In addition, the improved net leucine balance observed during administration of BCAA suggests patients have an improved protein balance while receiving BCAA enriched solutions.

Aged↗

Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial.

BACKGROUND & AIMS: The role of oral supplementation with branched-chain amino acids (BCAA) in advanced cirrhosis is far from settled. A nutritional approach might prevent progressive liver failure and improve nutritional parameters and quality of life. METHODS: A multicenter, randomized study comparing 1-year nutritional supplementation with BCAA against lactoalbumin or maltodextrins was performed in 174 patients with advanced cirrhosis. Primary outcomes were the prevention of a combined end point (death and deterioration to exclusion criteria), the need for hospital admission, and the duration of hospital stay. Secondary outcomes were nutritional parameters, laboratory data and Child-Pugh score, anorexia, health-related quality of life, and need for therapy. RESULTS: Treatment with BCAA significantly reduced the combined event rates compared with lactoalbumin (odds ratio, 0.43; 95% confidence interval, 0.19-0.96; P = 0.039) and nonsignificantly compared with maltodextrins (odds ratio, 0.51; 95% confidence interval, 0.23-1.17; P = 0.108). The average hospital admission rate was lower in the BCAA arm compared with control treatments (P = 0.006 and P = 0.003, respectively). In patients who remained in the study, nutritional parameters and liver function tests were, on average, stable or improved during treatment with BCAA and the Child-Pugh score decreased (P = 0.013). Also, anorexia and health-related quality of life (SF-36 questionnaire) improved. Long-term compliance with BCAA was poor. CONCLUSIONS: In advanced cirrhosis, long-term nutritional supplementation with oral BCAA is useful to prevent progressive hepatic failure and to improve surrogate markers and perceived health status. New formulas are needed to increase compliance.

Amino Acids, Branched-Chain↗

Branched-chain amino acid administration in surgical patients. Effects on amino acid and fuel substrate profiles.

During the first five days following gastric bypass surgery, 15 patients received near isotonic amino acid solutions that varied in their branched-chain amino acid (BCAA) content and amino acid profiles (15.6%, 50%, or 100% BCAA solutions). Plasma valine concentrations were elevated in patients receiving 50% and 100% BCAA solutions. Plasma alanine concentrations were highest in patients receiving 50% BCAA. Plasma free fatty acids and blood lactate concentrations were unchanged by either the operation or BCAA administration. Serum glucose concentration was unaffected by the different amino acid administrations and followed the pattern induced by stress initially and later by starvation. beta-Hydroxybutyrate concentrations increased as starvation proceeded and were highest in patients receiving the 15.6% BCAA solution. Branched-chain amino acid-enriched solutions without additional energy may be administered safely to patients recovering from operative trauma. Plasma amino acid concentrations and fuel substrate profiles appear to follow metabolic patterns determined by the physiologic response to stress and starvation and can be affected by large quantities of BCAAs.

3-Hydroxybutyric Acid↗

Negative nitrogen balance in cirrhotics. (A correct therapeutic approach).

The aims of this study were: 1. the assessment of the nitrogen balance (NB) in both compensated and encephalopathic cirrhotics, 2. the evaluation of the efficacy of a new therapeutic approach: amino acid solutions enriched with branched chain (BCAA) but poor in aromatic (AAA) amino acids. Solutions containing only BCAA were also employed: 42 cirrhotics were divided into the following groups: 1st group (26 cases), cirrhosis without hepatic encephalopathy (HE); 2nd group (16 cases), cirrhosis with HE. Six patients (23%) in the 1st group showed a positive NB at the beginning; 20 (77%) were negative; 18 of them were fed an oral diet (0.8 g protein/kg/day; 35 cal/kg/day) as a result of which they were brought into a positive NB within 5 days (from - 7.38 +/- 0.95 to + 3.67 +/- 0.46 g N/24 h). In two cases the diet failed to give a positive NB, so it was replaced by a BCAA enriched solution infusion (NB raised from - 1.0 +/- 5.4 g N/24 h). Patients in the 2nd group were put on total parenteral nutrition (TPN); two cases receiving glucose alone achieved a positive NB only when BCAA enriched solutions were added (from - 4.0 to + 3.0 g N/24 h). Four patients treated for 3 days with BCAA alone did not achieve a positive NB; in these cases likewise, BCAA enriched solutions were added in order to achieve a positive NB (from - 0.8 to + 4.2 g N/24 h); all 14 cases treated from the beginning with glucose + BCAA enriched solutions became positive, on average, within 5 days (from - 4.82 +/- 0.89 to + 3.15 +/- 0.61 g N/24 h). In addition to the NB, other parameters (blood ammonia, BCAA/AAA ratio, blood urea, electroencephalograms) and clinical symptoms were beneficially influenced by these solutions.

Aged↗

Morphological alterations and cell death provoked by the branched-chain alpha-amino acids accumulating in maple syrup urine disease in astrocytes from rat cerebral cortex.

1. Maple syrup urine disease (MSUD) is an inherited metabolic disorder predominantly characterized by neurological dysfunction and cerebral atrophy whose patophysiology is poorly known. 2. We investigated here whether the branched-chain amino acids (BCAA) leucine (Leu), isoleucine (Ile) and valine (Val), which are the biochemical hallmark of this disorder, could alter astrocyte morphology and cytoskeleton reorganization by exposing cultured astrocytes from cerebral cortex of neonatal rats to various concentrations of the amino acids. A change of cell morphology from the usual polygonal to the appearance of fusiform or process-bearing cells was caused by the BCAA. Cell death was also observed when astrocytes were incubated in the presence of BCAA for longer periods. 3. Val-treated astrocytes presented the most dramatic morphological alterations. Immunocytochemistry with anti-actin and anti-GFAP antibodies revealed that all BCAA induced reorganization of actin and GFAP cytoskeleton. In addition, lysophosphatidic acid, an activator of RhoA GTPase pathway, was able to totally prevent the morphological alterations and cytoskeletal reorganization induced by Val, indicating that the RhoA signaling pathway was involved in these effects. 4. Furthermore, creatine attenuated the morphological alterations provoked by the BCAA, the protection being more pronounced for Val, suggesting that impairment of energy homeostasis is partially involved in BCAA cytotoxic action. The data indicate that the BCAA accumulating in MSUD are toxic to astrocyte cells, a fact that may be related to the pathogenesis of the neurological dysfunction of MSUD patients.

Amino Acids, Branched-Chain↗

Leucine metabolism during chronic ethanol consumption.

Chronic ethanol consumption is known to increase plasma concentrations of branched-chain amino acids (BCAA) in rats and man, but the mechanisms of this effect are not known. Chronic ethanol consumption may increase levels of BCAA by altering protein turnover and/or by affecting the oxidation of BCAA. These possibilities were investigated in rats pair-fed liquid diets containing either 0% or 36% of total calories as ethanol for 21 days. In the fed state, ethanol-treated rats had a plasma ethanol level of 20 +/- 5 mmol/L and twofold increases in BCAA concentrations in plasma. There were also significant increases (37% to 63%) in muscle, liver, and jejunal mucosa BCAA concentrations. Chronic ethanol consumption significantly increased whole-body rates (mumol/100 g/h) of leucine turnover (73.8 +/- 7.5 v 104 +/- 5.6, P < .01) and oxidation (12.0 +/- 1.7 v 17.7 +/- 1.1, P < .05). In contrast, it significantly decreased leucine incorporation (nmol/mg protein/240 min) into both muscle (0.61 +/- 0.07 v 0.35 +/- 0.05, P < .01) and liver (13.25 +/- 1.40 v 6.78 +/- 0.98, P < .01) proteins. Incorporation of leucine into the mucosal proteins of jejunum (17.42 +/- 1.42 v 15.85 +/- 1.90, P = NS) was not significantly altered by ethanol. These results suggest that reduced protein synthesis and/or increased protein breakdown may account for the elevated tissue BCAA concentrations in chronic ethanol consumption. The consequences of these increased tissue concentrations are increases in tissue oxidation and plasma concentrations of BCAA.

Alcohol Drinking↗

Effects of branched chain enriched amino acid solutions on septic rats.

An experimental study was performed to determine the effects of a BCAA enriched amino acid solution on sepsis in rats. After sepsis had been induced in male Wistar rats by caecal ligation and puncture the animals were divided into four groups according to the amino acid solutions infused: Group B-I, a solution containing no amino acid; Group B-II, a commercially available solution containing 21.1% branched chain amino acids (BCAA); Group B-III, a solution containing 38.7% BCAA and Group B-IV, that containing BCAA only. The control group of the animals received simple laparotomy and infusion without amino acids. Infusion was continued for 96 hours after the operation and all the solutions had the same caloric and nitrogen value. Group B-I had a plasma aminogram peculiar to sepsis; a significant rise in the concentration of the total 17 amino acids (TAA), BCAA and aromatic amino acid (AAA) together with a decrease in the BCAA/AAA ratio. Furthermore, the arterio-venous difference (AV-D) of AAA and BCAA showed a large negative value. In the three groups infused with amino acids, only Group B-III showed a significant improvement in the survival rate and nitrogen balance compared with Group B-I. Moreover, not only did the concentration of TAA and AAA significantly decline, but also the BCAA/AAA ratio increased. Therefore, the abnormal aminogram in sepsis tended to return to the control level. In Group B-IV despite the significant decrease of the peripheral TAA, no improvement in plasma aminogram, nitrogen balance or survival rate were shown. In Group B-II, in addition to the persisting plasma aminogram changes and peripheral efflux of amino acids, no improvement of survival rate were noted. Therefore, it was concluded that an amino acid composition richer in BCAA and lower in both AAA and SCAA is beneficial in the treatment of sepsis.

Journal Article↗

Metabolic effects of branched chain amino acids in patients with severe pancreatitis.

Twenty-four patients with acute severe pancreatitis were randomised to receive total parenteral nutrition for 7 days with one of two isocaloric (35 kcal/kg/day) and isonitrogenous (0.16 g/kg/day) programmes containing either a low (15.5% w/w (control group)) or a high (57%) content of branched chain amino acids (BCAA (BCAA group)). During treatment, the nitrogen balance was similar in both groups. The concentrations of serum protein, albumin, prealbumin and retinol-binding protein did not differ between the groups. The plasma concentrations of BCAA measured 2 h after discontinuation of amino acid infusions rose in the BCAA group. In urine, only the concentrations of valine increased as compared with those of control patients. Serum glucose levels were higher in the BCAA group than in the control group, although the BCAA group received slightly more insulin than the control group in order to keep the blood glucose concentration below 10 mmol/l. The results suggest that BCAA-enriched solutions may stimulate gluconeogenesis without affecting catabolism.

Journal Article↗

Effects of infusion of branched chain amino-acids enriched TPN solutions on plasma amino-acid profiles in sepsis and trauma patients.

Total parenteral nutrition with branched chain amino-acids enriched solutions has been advocated in patients with sepsis and stress because of favourable effects on nitrogen balance, protein synthesis and immune competence. The rationale for the use of BCAA-enriched solutions is based on their potential to correct the plasma amino-acid imbalances seen in these patients. In a 7-day prospective randomised study we investigated the effects on plasma amino-acid concentrations of a standard amino-acid solution (15.6% BCAA) and a branched chain amino-acid enriched solution (50.2% BCAA) in 101 parenterally fed patients with carefully assessed sepsis and/or stress scores. The infusion of the BCAA-enriched solution led to an imbalance of the essential plasma amino-acids. The branched chain amino-acids valine, leucine and isoleucine increased significantly while the non-BCAA essential amino-acids decreased significantly. In the standard solution the non-BCAA-essential amino-acids increased significantly with a slow and insignificant rise in the levels of the branched chain amino-acids. We conclude that infusion of a BCAA enriched TPN formulation induced amino-acid profile derangements that can be considered ill-suited to the achievement of anti-catabolic effects.

Journal Article↗

Tumor and host tissue responses to branched-chain amino acid supplementation of patients with cancer M A McNurlan, S D Heys, K G M Park et al Clinical Science 1994; 86: 339-345.

The metabolic effects of intravenous nutrition (IVN) with branched chain amino acid (BCAA) enriched solutions on skeletal muscle and tumor were investigated in patients with colorectal cancer. Patients (n = 26) undergoing surgical removal of clinically localized tumors were allocated to 3 treatment groups: fasted, conventional IVN or BCAA supplemented (30% of nitrogen as BCAA). Nutritional treatments started 20 h before surgery and protein synthesis was assessed in vivo using a flooding dose technique with L-[1-13C]leucine. The plasma level of most amino acids was higher in the fed groups than in the fasted group; the level of BCAA was increased in the BCAA fed group. Conventional IVN stimulated protein synthesis in tumor (+94%) and in skeletal muscle (+48%) compared to the fasted group; this effect was less pronounced in the BCAA group (+49% and +19% respectively). Anti-proliferative cell nuclear antigen (PCNA) expression in the tumors was increased in both fed groups compared to the fasted state, and correlated with the rate of protein synthesis. It is concluded that the rate of tumor growth can be influenced by the composition of nutrient infused. However, BCAA seems to provide no clear advantage over a conventional IVN, since lower stimulation of tumor protein synthesis was associated with a lower stimulation of muscle protein synthesis.

Journal Article↗

Branched-chain amino acids enhance the cognitive recovery of patients with severe traumatic brain injury.

OBJECTIVE: To investigate whether supplementation with branched-chain amino acids (BCAAs) in patients with severe traumatic brain injury (TBI) improves recovery of cognition and influences plasma concentrations of tyrosine and tryptophan, which are precursors of, respectively, catecholamine and serotonin neurotransmitters in the brain. DESIGN: Forty patients with TBI were randomly assigned to 15 days of intravenous BCAA supplementation (19.6g/d) (n=20) or an isonitrogenous placebo (n=20). SETTING: Tertiary care rehabilitation setting in Italy. PARTICIPANTS: Forty men (mean age, 32+/-15 y) with TBI and 20 healthy subjects (controls) matched for age, sex, and sedentary lifestyle. INTERVENTION: Supplementation with BCAAs. MAIN OUTCOME MEASURES: Disability Rating Scale (DRS) and plasma concentrations of BCAAs, tyrosine, and tryptophan. RESULTS: Fifteen days after admission to the rehabilitation department, the DRS score had improved significantly in both the placebo group (P<.05 vs baseline) and in the BCAA-supplemented group (P<.01 vs baseline). The difference between the 2 groups was significant (P<.004). Plasma tyrosine concentration improved in the group given BCAA supplementation, and tryptophan concentration increased in patients receiving placebo. CONCLUSIONS: Supplemental BCAAs enhance the retrieval of DRS without causing negative effects on tyrosine and tryptophan concentration.

Adolescent↗

Phagocytic function of neutrophils of patients with decompensated liver cirrhosis is restored by oral supplementation of branched-chain amino acids.

It has been reported that phagocytic function of neutrophils is impaired in cirrhotic patients. We examined the effects of oral supplementation of branched-chain amino acids (BCAA) on phagocytic function of neutrophils in peripheral blood of patients with decompensated cirrhosis. Five patients with decompensated cirrhosis received 12g of BCAA daily for 3 months. Phagocytic function of neutrophils and NK activities of lymphocytes in peripheral blood as well as serum albumin levels and Fisher's ratios were determined before and at 1 and 3 months of BCAA supplementation. Phagocytic function of neutrophils was significantly improved by 3-month BCAA oral supplementation. NK activity of lymphocytes was improved in four of five patients at 3 months of BCAA supplementation, although the changes were not statistically different. In conclusion, BCAA supplementation improved phagocytic function of neutrophils in cirrhotic patients. BCAA supplementation may reduce the risk of bacterial infection in patients with decompensated liver cirrhosis.

Journal Article↗