S-adenosyl-L-methionine Treatment for Alcoholic Liver Disease: A Double-Blinded, Randomized, Placebo-Controlled Trial

Background:  S‐adenosyl‐L‐methionine (SAM) is the methyl donor for all methylation reactions and regulates the synthesis of glutathione, the main cellular antioxidant. Previous experimental studies suggested that SAM may benefit patients with established alcoholic liver diseases (ALDs). The aim of t...

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Published in:Alcoholism, clinical and experimental research clinical and experimental research, 2011-11, Vol.35 (11), p.1960-1965
Main Authors: Medici, Valentina, Virata, Maria C., Peerson, Janet M., Stabler, Sally P., French, Samuel W., Gregory III, Jesse F., Albanese, Anthony, Bowlus, Christopher L., Devaraj, Sridevi, Panacek, Edward A., Richards, John R., Halsted, Charles H.
Format: Article
Language:English
Subjects:
Adult
Aged
Alanine Transaminase - blood
Alcoholic Liver Disease
Alcoholism and acute alcohol poisoning
Aspartate Aminotransferases - blood
Biological and medical sciences
Biopsy
Double-Blind Method
Female
Gastroenterology. Liver. Pancreas. Abdomen
Histopathology
Humans
Liver - metabolism
Liver - pathology
Liver cirrhosis
Liver Diseases, Alcoholic - drug therapy
Liver Diseases, Alcoholic - metabolism
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Methionine - metabolism
Middle Aged
Other diseases. Semiology
Retrospective Studies
S-Adenosyl-L-Methionine
S-Adenosylmethionine
S-Adenosylmethionine - therapeutic use
Toxicology
Treatment Outcome
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Summary:Background:  S‐adenosyl‐L‐methionine (SAM) is the methyl donor for all methylation reactions and regulates the synthesis of glutathione, the main cellular antioxidant. Previous experimental studies suggested that SAM may benefit patients with established alcoholic liver diseases (ALDs). The aim of this study was to determine the efficacy of SAM in treatment for ALD in a 24‐week trial. The primary endpoints were changes in serum aminotransferase levels and liver histopathology scores, and the secondary endpoints were changes in serum levels of methionine metabolites. Methods:  We randomized 37 patients with ALD to receive 1.2 g of SAM by mouth or placebo daily. Subjects were required to remain abstinent from alcohol drinking. A baseline liver biopsy was performed in 24 subjects, and a posttreatment liver biopsy was performed in 14 subjects. Results:  Fasting serum SAM levels were increased over timed intervals in the SAM treatment group. The entire cohort showed an overall improvement of AST, ALT, and bilirubin levels after 24 weeks of treatment, but there were no differences between the treatment groups in any clinical or biochemical parameters nor any intra‐ or intergroup differences or changes in liver histopathology scores for steatosis, inflammation, fibrosis, and Mallory‐Denk hyaline bodies. Conclusions:  Whereas abstinence improved liver function, 24 weeks of therapy with SAM was no more effective than placebo in the treatment for ALD.
ISSN:0145-6008
1530-0277
DOI:10.1111/j.1530-0277.2011.01547.x