S-adenosylmethionine in treatment of cholestasis after total parenteral nutrition: laboratory investigation and clinical application.
OBJECTIVE
To observe the effects of S-adenosylmethionine (SAMe) in the treatment of cholestasis after total parenteral nutrition (TPN).


METHODS
Thirty SD rats were randomly divided into control group, hypercalorie group, hypercalorie+SAMe group, sepsis group and sepsis+SAMe group to compare their states of cholestasis. Sixteen patients received SAMe because of cholestasis after prolonged TPN, and the therapeutic efficacy was observed.


RESULTS
Bile flow was obviously decreased and the serum levels of total bile acid and gamma-glutamyl transpeptidase (gamma-G T) were markedly increased in the hypercalorie and sepsis groups. Meanwhile, hepatocyte fatty degeneration, dilatation of cholangioles, and bile sludge could be seen microscopically. SAMe administration in the hypercalorie+SAMe and sepsis+ SAMe groups could increase the bile flow, decrease the serum levels of total bile acid and gamma-G T, reduce the pathological damage to the liver, and clear the bile sludge in the cholangioles. Cholestasis and abnormal liver function were the main manifestations of the 16 patients before SAMe administration. After SAMe treatment for 3 weeks, serum levels of total bilirubin, alkaline phosphatase (AKP), gamma-G T, alanine amino transferase (ALT), and aspartate amino transferase (AST) were obviously decreased, and normalized in the 4th week.


CONCLUSIONS
SAMe could prevent and treat cholestasis without discontinuation of TPN.
Li
Ning
N
Institute of General Surgery, Nanjing General Hospital of Nanjing PLA Command, Nanjing 210002, China.
Zhang
Hong-Hai
HH
Wang
Shao-Hua
SH
Zhu
Wei-Ming
WM
Ren
Jian-An
JA
Li
Jie-Shou
JS
D000818:Animals; D001647:Bile Acids and Salts / Q000378:metabolism; D002779:Cholestasis / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism; D004195:Disease Models, Animal; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012436:S-Adenosylmethionine / Q000494:pharmacology*; D018805:Sepsis / Q000188:drug therapy / Q000378:metabolism
D001647:Bile Acids and Salts; D012436:S-Adenosylmethionine