title: Usefulness of Levocarnitine and/or Branched-Chain Amino Acids during Invasive Treatment for Hepatocellular Carcinoma.
abstract: Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are effective treatments for hepatocellular carcinoma (HCC). However, the extent of treatment depends on hepatic functional reserve. L-Carnitine is a vitamin-like substance and several reports have described the usefulness of L-carnitine supplementation in cases of cirrhosis, with confirmed effectiveness against refractory hepatic encephalopathy. On the other hand, we have previously reported that in patients who underwent TACE or RFA, administration of branched-chain amino acids (BCAAs) pre-intervention significantly reduced inflammatory reactions. We first determined serum levels of total, free, and acyl-carnitine before and at 7 d after performing TACE in 10 HCC patients. We administered levocarnitine (L-carnitine chloride, a biologically active form of carnitine) at 900 mg/d to 69 consecutive HCC patients hospitalized to undergo TACE and/or RFA, and compared changes in blood test values with those in 119 consecutive patients not administered this drug. Sixty-seven patients had a history of using BCAAs at the time of admission. We found that after 7 d of TACE, serum levels of total and acyl-carnitine are significantly decreased. On comparing the four groups, the carnitine+BCAA, carnitine-alone, and BCAA-alone groups showed significantly higher values for changes in NH3 when compared with the non-dosed group. The decrease in albumin (Alb) was significantly suppressed in the carnitine+BCAA and BCAA-alone groups. We also conducted the same examinations in a subset of patients classified as Child-Pugh class A, and noted the same trends. Administration of levocarnitine and/or BCAAs during invasive treatments reduced blood NH3 concentrations and suppressed decreases in Alb.
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine.
authors.forename: Motoh
authors.initials: M
authors.lastname: Iwasa
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Sugimoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ishihara
authors.forename: Noriko
authors.initials: N
authors.lastname: Sekoguchi-Fujikawa
authors.forename: Kyoko
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Rumi
authors.initials: R
authors.lastname: Mifuji-Moroka
authors.forename: Hideaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takei
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000378:metabolism; D000597:Amino Acids, Branched-Chain / Q000494:pharmacology / Q000627:therapeutic use*; D000641:Ammonia / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000628:therapy*; D002331:Carnitine / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D019587:Dietary Supplements; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000517:prevention & control; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology / Q000517:prevention & control; D008099:Liver / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications; D008113:Liver Neoplasms / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged
chemical_list: D000418:Albumins; D000597:Amino Acids, Branched-Chain; D000641:Ammonia; D002331:Carnitine