Trillos-Almanza Maria Camila, Martinez-Aguilar Magnolia, Arroyave-Ospina Johanna C, van Vilsteren Frederike, Blokzijl Hans, Moshage Han
Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
Gastroenterology and Hepatology Research Group, Faculty of Medicine, University of Antioquia, Street 70 No. 52-21, Medellin 0500120, Colombia.
Muscles. 2024 Mar 4;3(1):71-87. doi: 10.3390/muscles3010008.
This comprehensive review focuses on the dynamics of branched-chain amino acids (BCAAs) metabolism and its clinical implications in chronic liver disease, with emphasis on the emerging concept of muscle-liver crosstalk. BCAAs, indispensable for protein synthesis and metabolic pathways, undergo unique tissue-specific processing in skeletal muscle and liver. The liver, responsible for amino acid metabolism, plays a distinctive role in sensing BCAAs catabolism, influencing glucose regulation and contributing to the systemic metabolism of BCAAs. Within the context of chronic liver disease, compromised liver metabolism becomes evident through amino acid abnormalities, particularly in the decrease of the Fischer ratio (BCAAs/aromatic amino acids concentrations in plasma). This reduction becomes important in assessing the severity of liver dysfunction due to its associations with adverse outcomes, including increased mortality and complications related to the liver disease. BCAAs supplementation, as explored in this review, emerges as a promising avenue, displaying positive effects on skeletal muscle mass, strength, and overall nutritional status in cirrhosis management. Understanding this interplay offers insights into therapeutic strategies for chronic liver diseases, exploring the way for precision interventions in clinical practice.
这篇综述聚焦于支链氨基酸（BCAAs）代谢的动态变化及其在慢性肝病中的临床意义，重点关注肌肉-肝脏相互作用这一新兴概念。BCAAs对蛋白质合成和代谢途径不可或缺，在骨骼肌和肝脏中经历独特的组织特异性加工过程。负责氨基酸代谢的肝脏在感知BCAAs分解代谢、影响葡萄糖调节以及参与BCAAs的全身代谢方面发挥着独特作用。在慢性肝病的背景下，肝脏代谢受损通过氨基酸异常表现出来，尤其是费舍尔比值（血浆中BCAAs/芳香族氨基酸浓度）降低。由于其与不良预后相关，包括死亡率增加和肝病相关并发症，这种降低在评估肝功能障碍的严重程度方面具有重要意义。如本综述所探讨的，补充BCAAs成为一条有前景的途径，在肝硬化管理中对骨骼肌质量、力量和整体营养状况显示出积极作用。理解这种相互作用为慢性肝病的治疗策略提供了见解，为临床实践中的精准干预探索了道路。
