Which of the branched-chain amino acids increases cerebral blood flow in hepatic encephalopathy? A double-blind randomized trial

Romeiro, Fernando Gomes; Ietsugu, Marjorie do Val; Franzoni, L.; Augusti, Laís; Alvarez, Matheus; Santos, L.; Lima, Tiago Barbalho; Koga, Kátia Hiromoto; Moriguchi, Sônia Marta; Caramori, Carlos Antonio; Silva, Giovanni Faria; Betting, Luiz Eduardo

doi:10.1016/j.nicl.2018.03.028

Cited by 11 publications

(11 citation statements)

References 49 publications

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“…Perfusion SPECT reveals diffuse hypoperfusion in metal toxicity ( 281 ), mold toxicity ( 282 ), and other toxin exposure ( 109 , 283 , 284 ), including recreational toxins ( 284 – 290 ). SPECT is also beneficial in the identification and grading of severity of hepatic encephalopathy due to ammonia toxicity ( 291 – 295 ), even in mild cases ( 296 ), as well as for tracking progress ( 295 ). Carbon monoxide poisoning is characterized by decreased perfusion of the bilateral frontal cortex, bilateral temporal cortex, and the globus pallidus ( 297 – 301 ) and perfusion SPECT has been used to document these findings.…”

Section: Assessment Of the State Of The Art—spect In Brain Disordersmentioning

confidence: 99%

The Legacy of the TTASAAN Report—Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I

2022

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Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease—comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.

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Section: Assessment Of the State Of The Art—spect In Brain Disordersmentioning

confidence: 99%

The Legacy of the TTASAAN Report—Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I

2022

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“…Branched-chain amino acids (e.g., isoleucine) may be such supplements, which are often recommended for patients with HE [43].…”

Section: Discussionmentioning

confidence: 99%

Energy Metabolites and Indicative Significance of α-Ketoglutarate and α-Ketoglutaramate in Assessing the Progression of Chronic Hepatoencephalopathy

Shurubor,

Krasnikov,

Isakova

et al. 2024

Biomolecules

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In the example of a rat model with chronic hepatoencephalopathy (HE), changes in the organ morphology of rats affect the balance of metabolites of the tricarboxylic acid (TCA) cycle and metabolites of the glutamine–glutamate (Gln-Glu) cycle, namely α-ketoglutarate (αKG) and α-ketoglutaramate (αKGM), as well as the enzymes associated with them, ω-amidase (ωA) and glutamine transaminase (GTK). This model of rats was obtained as a result of 2–22 weeks of consumption by animals of hepatotoxin thioacetamide (TAA) added to drinking water at a concentration of 0.4 g/L. The control (n = 26) and TAA-induced (n = 55) groups of rats consisted of 11 cohorts each. The control cohorts consisted of 2–4 rats, and the TAA-induced cohorts consisted of 4–7 individuals. Every two weeks, samples of blood plasma, liver, kidney, and brain tissues were taken from the next cohort of rats (a total of 320 samples). By the end of the experiment, irreversible morphological changes were observed in the organs of rats: the weight of the animals was reduced up to ~45%, the weight of the kidneys up to 5%, the brain up to ~20%, and the weight of the liver increased up to ~20%. The analysis revealed: (i) a decrease in the activity of ωA and GTK in the tissues of the brain, kidneys, and liver of rats with chronic HE (by ~3, 40, and 65% and ~10, 60, and 70%, respectively); and (ii) the appearance of a significant imbalance in the content of metabolites of the Gln-Glu cycle, αKG, and αKGM. It is indicative that a ~1.5–12-fold increase in the level of αKG in the blood plasma and tissues of the organs of rats with chronic HE was accompanied by a synchronous, ~1.2–2.5-fold decrease in the level of αKGM. The data obtained indicate an essential involvement of the Gln-Glu cycle in the regulation of energy metabolism in rats under conditions of chronic HE. Attention is focused on the significance of the αKG/αKGM ratio, which can act as a potential marker for diagnosing the degree of HE development.

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“…An increase in serum albumin in patients with a low albumin levels during BCAA supplementation was also observed. Furthermore, isoleucine long-term supplementation has been associated with increased brain perfusion and clinical improvement of overt HE compared to leucine [ 52 ]. BCAAs can be considered as a way to guarantee adequate protein intake in patients with recurrent/persistent HE on vegetable/diary diets [ 16 ].…”

Section: Therapies Other Than Non-absorbable Disaccharides and Non-absorbable Antibioticsmentioning

confidence: 99%

New Therapies of Liver Diseases: Hepatic Encephalopathy

Mangini

Montagnese

2021

JCM

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Hepatic encephalopathy (HE) is a common complication of advanced liver disease which has profound implications in terms of the patients’ ability to fulfil their family and social roles, to drive and to provide for themselves. Recurrent and persistent HE is still a serious management challenge, translating into a significant burden for patients and their families, health services and society at large. The past few years have been characterized by significantly more attention towards HE and its implications; its definition has been refined and a small number of new drugs/alternative management strategies have become available, while others are underway. In this narrative review we summarize them in a pragmatic and hopefully useful fashion.

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Which of the branched-chain amino acids increases cerebral blood flow in hepatic encephalopathy? A double-blind randomized trial

Cited by 11 publications

References 49 publications

The Legacy of the TTASAAN Report—Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I

The Legacy of the TTASAAN Report—Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I

Energy Metabolites and Indicative Significance of α-Ketoglutarate and α-Ketoglutaramate in Assessing the Progression of Chronic Hepatoencephalopathy

New Therapies of Liver Diseases: Hepatic Encephalopathy

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