L-isoleucine in the therapeutic drugs for hepatic encephalopathy

The application of L-isoleucine in drugs for the treatment of hepatic encephalopathy is mainly based on its physiological role as a branched-chain amino acid, and it exerts therapeutic effects through mechanisms such as regulating the amino acid balance and improving brain function. The following is a specific introduction to the progress of its application:

I. Mechanism of Action

Regulating Amino Acid Balance: Patients with hepatic encephalopathy often have an imbalance of plasma amino acids, manifested by a decrease in the level of branched-chain amino acids (BCAAs) and an increase in the level of aromatic amino acids (AAAs). As one of the BCAAs, L-isoleucine can competitively inhibit the entry of AAAs into the brain, reduce the production of false neurotransmitters, and thus improve neuropsychiatric symptoms.

Promoting Protein Synthesis: L-isoleucine participates in the anabolic metabolism of proteins in the body, which helps maintain the normal functions of tissues such as the liver and muscles. In patients with hepatic encephalopathy, supplementing it can promote the synthesis of liver proteins, improve liver function, and is also beneficial to the synthesis of muscle proteins, reduce muscle breakdown, and improve the nutritional status of the body.

Regulating Neurotransmitters: L-isoleucine can improve brain function by affecting the metabolism of neurotransmitters. It can promote the synthesis of inhibitory neurotransmitters such as γ-aminobutyric acid (GABA), and at the same time reduce the excessive release of excitatory neurotransmitters such as glutamate, thereby regulating the neurotransmitter balance in the brain and alleviating the neuropsychiatric symptoms of patients with hepatic encephalopathy.

II. Clinical Application

Single Use: Some studies have shown that supplementing L-isoleucine alone has a certain therapeutic effect on patients with hepatic encephalopathy. In some small-scale clinical trials, after giving an appropriate amount of L-isoleucine to patients with hepatic encephalopathy, the mental state and cognitive function of the patients have been improved to a certain extent, and the blood ammonia level has also decreased.

Combined Use with Other Drugs: L-isoleucine is more often used in combination with other drugs for the treatment of hepatic encephalopathy. For example, when used in combination with lactulose, lactulose can reduce the production and absorption of ammonia by regulating the intestinal flora and reducing the intestinal pH value. L-isoleucine exerts its effects in aspects such as regulating the amino acid balance and improving brain function. The two work synergistically to better improve the symptoms and prognosis of patients with hepatic encephalopathy. In addition, it can also be used in combination with drugs such as ornithine aspartate. Ornithine aspartate can promote the synthesis of urea and reduce the blood ammonia level. The combined application with L-isoleucine can comprehensively treat hepatic encephalopathy from different aspects.

III. Application Advantages

High Safety: L-isoleucine is an essential amino acid for the human body, and it cannot be synthesized by the human body under normal physiological conditions and needs to be obtained from food. When used as a therapeutic drug, as long as the dosage and usage method are well controlled, it generally has high safety and fewer adverse reactions. The common adverse reactions mainly include gastrointestinal discomfort, such as nausea, vomiting, diarrhea, etc., but the symptoms are usually mild and most patients can tolerate them.

Improving Nutritional Status: Patients with hepatic encephalopathy often have varying degrees of malnutrition. Supplementing L-isoleucine not only helps treat hepatic encephalopathy but also improves the nutritional status of the patients, and enhances the body's resistance and recovery ability.

IV. Application Limitations

Individual Differences: Different patients have different therapeutic responses to L-isoleucine. Due to differences in the severity of the disease, underlying diseases, genetic factors, etc., the absorption, metabolism, and curative effects of the drug vary. Some patients may respond well to its treatment, while others may not have obvious effects.

Optimization of the Treatment Plan: Currently, the optimal dosage, timing of use, and course of treatment of L-isoleucine in the treatment of hepatic encephalopathy have not been fully determined, and further research is needed to optimize the treatment plan. In addition, for hepatic encephalopathy caused by different etiologies, the therapeutic effect of L-isoleucine may also be different, and individualized treatment is required according to the specific situation.

L-isoleucine has a certain application value in the treatment of hepatic encephalopathy, but its application still requires further research and exploration to better exert its therapeutic effect and improve the treatment effect and quality of life of patients with hepatic encephalopathy.