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Espina S, Gonzalez-Irazabal Y, Sanz-Paris A, Lopez-Yus M, Garcia-Sobreviela MP, del Moral-Bergos R, Garcia-Rodriguez B, Fuentes-Olmo J, Bernal-Monterde V, Arbones-Mainar JM. Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy. Nutrients 2021; 13:nu13113764. [PMID: 34836020 PMCID: PMC8617874 DOI: 10.3390/nu13113764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023] Open
Abstract
Low plasma levels of branched chain amino acids (BCAA) in liver cirrhosis are associated with hepatic encephalopathy (HE). We aimed to identify a metabolic signature of minimal hepatic encephalopathy (MHE) in malnourished cirrhotic patients and evaluate its modification with oral nutritional supplements (ONS) enriched with ß-Hydroxy-ß-methylbutyrate (HMB), a derivative of the BCAA leucine. Post hoc analysis was conducted on a double-blind placebo-controlled trial of 43 individuals with cirrhosis and malnutrition, who were randomized to receive, for 12 weeks, oral supplementation twice a day with either 220 mL of Ensure® Plus Advance (HMB group, n = 22) or with 220 mL of Ensure® Plus High Protein (HP group, n = 21). MHE evaluation was by psychometric hepatic encephalopathy score (PHES). Compared to the HP group, an HMB-specific treatment effect led to a larger increase in Val, Leu, Phe, Trp and BCAA fasting plasma levels. Both treatments increased Fischer’s ratio and urea without an increase in Gln or ammonia fasting plasma levels. MHE was associated with a reduced total plasma amino acid concentration, a reduced BCAA and Fischer´s ratio, and an increased Gln/Glu ratio. HMB-enriched ONS increased Fischer´s ratio without varying Gln or ammonia plasma levels in liver cirrhosis and malnutrition, a protective amino acid profile that can help prevent MHE.
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Affiliation(s)
- Silvia Espina
- Gastroenterology Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain; (S.E.); (J.F.-O.); (V.B.-M.)
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
| | - Yolanda Gonzalez-Irazabal
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
- Clinical Biochemistry Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain
| | - Alejandro Sanz-Paris
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
- Nutrition Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain
| | - Marta Lopez-Yus
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
- Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, Instituto Aragones de Ciencias de la Salud (IACS), University Hospital Miguel Servet, 50009 Zaragoza, Spain
| | - Maria Pilar Garcia-Sobreviela
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
- Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, Instituto Aragones de Ciencias de la Salud (IACS), University Hospital Miguel Servet, 50009 Zaragoza, Spain
| | - Raquel del Moral-Bergos
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
- Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, Instituto Aragones de Ciencias de la Salud (IACS), University Hospital Miguel Servet, 50009 Zaragoza, Spain
| | - Beatriz Garcia-Rodriguez
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
- Clinical Biochemistry Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain
| | - Javier Fuentes-Olmo
- Gastroenterology Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain; (S.E.); (J.F.-O.); (V.B.-M.)
| | - Vanesa Bernal-Monterde
- Gastroenterology Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain; (S.E.); (J.F.-O.); (V.B.-M.)
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
| | - Jose M. Arbones-Mainar
- Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain; (Y.G.-I.); (A.S.-P.); (M.L.-Y.); (M.P.G.-S.); (R.d.M.-B.); (B.G.-R.)
- Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, Instituto Aragones de Ciencias de la Salud (IACS), University Hospital Miguel Servet, 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición (CIBERObn), 28029 Madrid, Spain
- Correspondence:
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Akbulut S, Dogan Z, Baskiran A, Elbe H, Turkoz Y. Effect of a honey and arginine-glutamine- hydroxymethylbutyrate mixture on the healing of colon anastomosis in rats immunosuppressed with tacrolimus. Biotech Histochem 2019; 94:514-521. [PMID: 30983411 DOI: 10.1080/10520295.2019.1601257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We compared the effect of honey and a mixture of arginine-glutamine-hydroxymethylbutyrate (AGHMB) on healing of a descending colon anastomosis in rats that were immunosuppressed with tacrolimus (Tac). Sprague-Dawley rats were divided into four groups: untreated control, Tac, Tac + honey and Tac + AGHMB. Colon resection and anastomosis were performed on day 14 and re-laparotomy was performed on the day 21 of the study. Anastomotic bursting pressure, macroscopic adhesion score, weekly body weight changes, histopathological features and immunohistochemical staining of TGF-β1 were determined for all groups. We found no significant difference in anastomotic bursting pressure among the experimental groups. We found significant weekly increases in body weight for the Tac + honey group. We found no significant difference in the weekly body weight measurements for the Tac + AGHMB group. We found significant increases in TGF-β1 expression in the Tac + honey group compared to the control and Tac groups. No significant differences in inflammatory cell infiltration, fibroblast proliferation or collagen deposition were found between the Tac + honey and Tac + AGHMB groups; however, a significant difference in neovascularization between these groups was found. Neovascularization in the Tac + honey group was significantly greater than for the Tac + AGHMB group. We found that both honey and the AGHMB mixture were beneficial for anastomotic wound healing in rats that were immunosuppressed using Tac.
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Affiliation(s)
- S Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine , Malatya , Turkey
| | - Z Dogan
- Department of Anatomy, Adiyaman University Faculty of Medicine , Adiyaman , Turkey
| | - A Baskiran
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine , Malatya , Turkey
| | - H Elbe
- Department of Histology and Embryology, Sıtkı Kocman University Faculty of Medicine , Mugla , Turkey
| | - Y Turkoz
- Department of Medical Biochemistry, Inonu University Faculty of Medicine , Malatya , Turkey
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