Brief Article
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World J Gastroenterol. Mar 14, 2014; 20(10): 2673-2680
Published online Mar 14, 2014. doi: 10.3748/wjg.v20.i10.2673
Effect of branched-chain amino acids in patients receiving intervention for hepatocellular carcinoma
Tomoaki Ishihara, Motoh Iwasa, Hideaki Tanaka, Masahiko Kaito, Jiro Ikoma, Toshiya Shibata, Yoshiyuki Takei
Tomoaki Ishihara, Department of Gastroenterology and Hepatology, Yokkaichi Digestive Disease Center, Komono, Mie 510-1232, Japan
Motoh Iwasa, Hideaki Tanaka, Yoshiyuki Takei, Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
Masahiko Kaito, Jiro Ikoma, Department of Gastroenterology and Hepatology, Mie Shokakinaika, Tsu, Mie 514-0062, Japan
Toshiya Shibata, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
Author contributions: Ishihara T contributed to the study conception and design, analysis and interpretation of data, acquisition of data, drafting the article; Iwasa M contributed to the interpretation of data, drafting the article and revising it; Tanaka H contributed to the acquisition of data; Kaito M contributed to the acquisition of data; Ikoma J contributed to the the acquisition of data; Shibata T contributed to the acquisition of data; Takei Y contributed to the final approval of the article.
Correspondence to: Motoh Iwasa, MD, PhD, Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie 514-8507, Japan. motoh@clin.medic.mie-u.ac.jp
Telephone: +81-59-2315017 Fax: +81-59-2315223
Received: July 2, 2013
Revised: August 9, 2013
Accepted: December 12, 2013
Published online: March 14, 2014
Abstract

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 pre-intervention 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, the ΔAlb peaked on day 2, remained constantly lower in BCAA-treated patients, compared to the control group, and was -0.13 ± 0.42 g/dL in BCAA-treated patients and -0.33 ± 0.51 g/dL in untreated patients on day 10. The ΔCRP was also significantly lower in BCAA-treated patients on days 2, 5 and 10 after TACE. Like the trends noted after TACE, a similar tendency was noted as to the ΔAlb and ΔCRP 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 post-operative complications in patients undergoing TACE or RFA.

Keywords: Branched-chain amino acids, Cirrhosis, Hepatocellular carcinoma, Transarterial chemoembolization, Radiofrequency ablation, Hypoalbuminemia

Core tip: This study investigated whether the short-term effect of branched-chain amino acid (BCAA) for transarterial chemoembolization (TACE) or radiofrequency ablation (RFA), focusing on BCAA treatment prior to therapeutic intervention, suppresses the decrease in serum albumin (Alb) level associated with TACE or RFA and reduces postoperative complications. We thought that C-reactive protein (CRP) elevation was suppressed in BCAA-treated patients, that the severity of fever was milder as a result of BCAA treatment, and that the serum Alb level decreased to a lesser extent in patients with milder changes in CRP level.