S-adenosylmethionine in treatment of cholestasis after total parenteral nutrition: laboratory investigation and clinical application

Abstract

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.

Conclusion: SAMe could prevent and treat cholestasis without discontinuation of TPN.