Branched Chain Amino Acids in the Treatment of Hepatic Encephalopathy

  • Filippo Rossi-Fanelli
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 272)


To understand the role that branched chain amino acids (BCAA) may play in the pathogenesis and treatment of hepatic encephalopathy (HE) and the consequent relevance they may assume in the nutritional approach to a patient with chronic liver failure (CLF) we must carefully consider three main aspects:
  1. 1.

    The mechanisms leading to the characteristic alteration of the plasma amino acids (AA) pattern observed in CLF.

  2. 2.

    The role that changes in plasma AA play in the pathogenesis of HE.

  3. 3.

    The peculiar metabolic activities of BCAA.



Hepatic Encephalopathy Branch Chain Amino Acid Hepatic Coma Chronic Liver Failure Amino Acid Infusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Collins R L, Lacy W W, Steil J N. Glucose intolerance and insulin resistance in patients with liver disease. Arch Intern Med 1970; 126: 608–614.PubMedCrossRefGoogle Scholar
  2. 2.
    Riggio O, Merli M, Cangiano C, Cascino A, Rossi Fanelli F, Capocaccia L. Glucose intolerance in liver cirrhosis. Metabolism 1982; 31: 627–634.PubMedCrossRefGoogle Scholar
  3. 3.
    Greco A V, Bertoli A, Ghirlanda G “et al”. Insulin resistance in liver cirrhosis: decreased insulin binding to circulating monocytes. Horm Metab Res 1980; 12: 577–583.PubMedCrossRefGoogle Scholar
  4. 4.
    Blei A, Robbins D C, Drobny J “et al”. Insulin resistance and insulin receptors in hepatic cirrhosis. Gastroenterology 1982; 83: 1191–1195.PubMedGoogle Scholar
  5. 5.
    Conn H O, Schreiber W, Elkington S G. Cirrhosis and diabetes. II. Association of impaired glucose tolerance with portal-systemic shunting in Laennec’s cirrhosis. Am J Dig Dis 1971; 16: 227–234.PubMedCrossRefGoogle Scholar
  6. 6.
    Gavin III J R, Roth J, Neville Jr. D M “et al”. Insulin dependent regulation of insulin receptor concentration: a direct demonstration in cell culture. Proc Natl Acad Sci USA 1974; 71: 84–88.PubMedCrossRefGoogle Scholar
  7. 7.
    Berkowitz D. Glucose tolerance, free fatty acid, and serum insulin responses in patients with cirrhosis. Am J Dig Dis 1969; 14: 691–695.PubMedCrossRefGoogle Scholar
  8. 8.
    Riggio O, Merli M, Cantafora A. “et al”. Total and individual free fatty acid concentrations in liver cirrhosis. Metabolism 1984; 33: 646–651.PubMedCrossRefGoogle Scholar
  9. 9.
    Muscaritoli M, Cangiano C, Cascino A, Ceci F, Serra P, Rossi-Fanelli F. Exogenous lipid clearance in patients with liver cirrhosis. JPEN 1986; 10 (6): 599–603.CrossRefGoogle Scholar
  10. 10.
    Muscaritoli M, Cangiano C, Cascino A “et al”. Exogenous triglyceride clearance and apoprotein in C-II levels in patients with decompensated liver cirrhosis. Clin. Invest, (in press).Google Scholar
  11. 11.
    Marchesini G, Zoli M, Angiolini A, Dondi C, Bianchi F B, Pisi E. Muscle breakdown in liver cirrhosis and the role of altered carbohydrate metabolism. Hepatology 1981; 1: 294–342.PubMedCrossRefGoogle Scholar
  12. 12.
    Owen O E, Trapp V E, Reichard G A Jr. “et al”. Nature and quantity of fuels consumed in patients with alcoholic cirrhosis. J Clin Invest 1983; 72: 1821–1827.PubMedCrossRefGoogle Scholar
  13. 13.
    Cascino A, Cangiano C, Calcaterra V, Rossi Fanelli F, Capocaccia L. Plasma amino acid imbalance in patients with liver disease. Am J Dig Dis 1978; 23: 591–598.PubMedCrossRefGoogle Scholar
  14. 14.
    Rossi Fanelli F, Cascino A, Strom R “et al”. Amino acids and hepatic encephalopathy. Prog Neurobiol 1987; 28: 277–301.PubMedCrossRefGoogle Scholar
  15. 15.
    Fischer J E, Baldessarini R J. False neurotransmitters and hepatic failure. Lancet 1971; 2: 75–79.PubMedCrossRefGoogle Scholar
  16. 16.
    Pardridge W M. The regulation of amino acid availability in the brain. In: Nutrition in the Brain. Raven Press New York 1977; 141–204.Google Scholar
  17. 17.
    Cascino A, Cangiano C, Fiaccadori F, Ghinelli F “et al”. Plasma and cerebrospinal fluid aminoacid patterns in hepatic encephalopathy. Dig Dis Sci 1982; 27: 828–832.PubMedCrossRefGoogle Scholar
  18. 18.
    Rossi Fanelli F, Freund H, Krause R “et al”. Induction of coma in normal dogs by the infusion of aromatic amino acids and its prevention by the addition of branchedchain amino acids. Gastroenterology 1982; 83; 664–671.PubMedGoogle Scholar
  19. 19.
    Sherwin R S. Effect of starvation on the turnover and metabolic response to leucine. J Clin Invest 1978; 21: 1471–1481.CrossRefGoogle Scholar
  20. 20.
    Freund H R, James J H, Fischer J E. Nitrogen sparing mechanisms of singly administered branched chain amino acids in the injured rat. Surgery 1981; 90 (2): 237–243.PubMedGoogle Scholar
  21. 21.
    Rossi Fanelli F, Angelico M, Cangiano C “et al”. Effect of glucose and/or branched amino acid infusion on plasma amino acid imbalance in chronic liver failure. J Parent Ent Nutr 1981; 5: 414–419.CrossRefGoogle Scholar
  22. 22.
    Capocaccia L, Calcaterra V, Cangiano C “et al”. Therapeutic effect of branched-chain amino acids in hepatic encephalopathy. A preliminary study. In: Orloff A, Stipa S, Ziparo V, eds. Medical and surgical problems of portal hypertension. London-New York: Academic Press, 1979; 239–249.Google Scholar
  23. 23.
    Rossi Fanelli F, Riggio O, Cangiano C “et al”. Branched chain amino acids vs. lactulose in the treatment of hepatic coma: a controlled study. Dig Dis Sci 1982; 27: 929–935.PubMedCrossRefGoogle Scholar
  24. 24.
    Cangiano C, Cascino A, Capocaccia L, Ceci F, Fiaccadori F, Ghinelli F, Muscaritoli M, Pelosi G, Sacchini D, Rossi Fanelli F. Modifications of plasma and CSF amino acid pattern in patients with severe hepatic encephalopathy receiving i.v. branched-chain amino acids. J Clin Nutr Gastroenterol, 1986; 1 (3): 133–138.Google Scholar
  25. 25.
    Watanabe A, Takesue A, Higashi T “et al”. Serum amino acids in hepatic encephalopathy. Effects of branched chain amino acid infusion on serum aminogram. Acta Hepato-gastroenterol 1979; 26: 346–357.Google Scholar
  26. 26.
    Caparros T, Lopez J, Pérez F “et al”. Nutrición parenteral en 29 enfermos afectos de encefalopatia hepatica tratados con FO80. Rev Clin Esp 1979; 155: 355–361.Google Scholar
  27. 27.
    Okada A, Kamata S, Kim C W “et al”. Treatment of hepatic encephalopathy with BCAA-rich amino acid mixtures. In: Walser S and Williamson R J, eds. Metabolism and clinical implications of branched-chain amino and ketoacids. New York: Elsevier North Holland. 1981; 447–452.Google Scholar
  28. 28.
    Freund H, Diestang J, Leriche F “et al”. Infusion of branched chain amino acid solution in patients with hepatic encephalopathy. Ann Surg 1982; 196: 209–220.PubMedCrossRefGoogle Scholar
  29. 29.
    Cerra F B, Cheung N K, Fischer J E “et al”. A multicenter trial of branched chain enriched amino acid infusion (FO80) in hepatic encephalopathy (HE). Hepatology 1982; 2: 699–702.Google Scholar
  30. 30.
    Fiaccadori F, Ghinelli F, Pedretti G “et al”. Branched chain amino acid enriched solutions in the treatment of encephalopathy: A controlled trial. In: Capocaccia, Fischer, Rossi Fanelli, eds. Hepatic Encephalopathy in Chronic Liver Failure. New York, London: Plenum Press 1984; 323–334.Google Scholar
  31. 31.
    Strauss E, Santos W R, Da Silva E C. A randomized controlled clinical trial for the evaluation of the efficacy of an enriched branched chain amino acid solution compared to neomycin in hepatic encephalopathy. Hepatology 1983; 3: 862 (abstract).Google Scholar
  32. 32.
    Gluud C, Dejgaard A, Hardt F “et al”, and the Copenhagen Coma group: Preliminary treatment results with balanced amino acid infusion to patients with hepatic encephalopathy. Scand J Gastroent 1983; 18 (suppl. 86): 19–21.Google Scholar
  33. 33.
    Wahren J J, Denis J, Desurmont P, Ericson S “et al”. Is intravenous administration of branched chain amino acids effective in the treatment of hepatic encephalopathy? A multicenter study. Hepatology 1983; 3: 475–480.PubMedCrossRefGoogle Scholar
  34. 34.
    Michel H, Pomier-Layrargues G, Duhamel O “et al”. Intravenous infusion of ordinary and modified amino acid solutions in the management of hepatic encephalopathy. Liver 1985; 5: 282–289.PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1990

Authors and Affiliations

  • Filippo Rossi-Fanelli
    • 1
  1. 1.Laboratory of Clinical Nutrition 3rd Department of Internal MedicineUniversity of Rome “La Sapienza”Italy

Personalised recommendations