Tauroursodeoxycholic acid (TUDCA) in the prevention of total parenteral nutrition-associated liver disease.
OBJECTIVE
To determine whether tauroursodeoxycholic acid (TUDCA) would prevent or ameliorate the liver injury in neonates treated with total parenteral nutrition (TPN).


METHODS
Eligible infants were enrolled after surgery when serum direct bilirubin (DB) was <2 mg/dL. TUDCA (30 mg/kg/day) was given enterally to 22 subjects. A concurrent untreated/placebo group was evaluated for comparison (n = 30). Blood chemistries including alanine aminotransferase (ALT), alkaline phosphatase (AP), conjugated bilirubin (CB), and bile acids (BA) were obtained weekly.


RESULTS
There was no difference in peak serum CB, ALT, AP, or BA levels between the TUDCA-treated and control infants. When stratified for birth weight (<1500 g and >1500 g), no differences in peak CB, ALT, AP, or BA were noted. Serum CB levels were similar between TUDCA-treated and control infants after 14, 40, 60, 70, and 120 days of TPN.


CONCLUSIONS
TUDCA appears ineffective in preventing the development or treatment of TPN-associated cholestasis in neonates. Erratic biliary enrichment and prolonged inability to initiate treatment may compromise the utility of enterically administered TUDCA for TPN-treated infants.
Division of Pediatric Gastroenterology, Department of Hepatology and Nutrition, the General Clinical Research Center, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
James E
JE
Heubi
David A
DA
Wiechmann
Vivian
V
Creutzinger
Kenneth D R
KD
Setchell
Robert
R
Squires
Robert
R
Couser
Philip
P
Rhodes
D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001647:Bile Acids and Salts / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001724:Birth Weight / Q000502:physiology; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D004750:Enteral Nutrition; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008107:Liver Diseases / Q000209:etiology* / Q000517:prevention & control*; D008910:Minnesota; D008922:Mississippi; D009820:Ohio; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D013655:Taurochenodeoxycholic Acid / Q000627:therapeutic use*; D013781:Texas; D013997:Time Factors
D001647:Bile Acids and Salts; D015415:Biomarkers; D002756:Cholagogues and Choleretics; D013655:Taurochenodeoxycholic Acid; C031655:ursodoxicoltaurine; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin