Essential phospholipids in fatty liver: a scientific update

Karl-Josef Gundermann, Simon Gundermann, Marek Drozdzik, V G Mohan Prasad, Karl-Josef Gundermann, Simon Gundermann, Marek Drozdzik, V G Mohan Prasad

Abstract

Aim: Although essential phospholipids (EPL) from soybean are often used in membrane-associated disorders and diseases, their high quality of purification and effects on prevalent liver diseases, especially on fatty liver diseases (FLDs) of different origin, are still widely unknown and a matter of continuous active research. The aim of this article is to review, discuss, and summarize the available results of EPL in the treatment of FLD.

Methods: Database research was carried out on Medline, Embase, Cochrane Library, country-specific journals, and follow-up literature citations for relevant hepatogastroenterological articles published between 1988 and 2014. We searched for and reviewed only those papers that indicated minimum extraction amount of 72% (3-sn-phosphatidyl)choline from soybean as being necessary to treat patients with a considerable amount of 1,2-dilinoleoylphosphatidylcholine as a key component in EPL.

Results: EPL has a well-established mode of action, therapeutic effectiveness, and lack of toxicity, which ensures clinically relevant efficacy-to-safety ratio. It influences membrane- dependent cellular functions and shows anti-inflammatory, antioxidant, antifibrogenic, anti apoptotic, membrane-protective, and lipid-regulating effects. Due to its positive effects on membrane composition and functions, it accelerates the improvement or normalization of subjective symptoms; pathological, clinical, and biochemical findings; hepatic imaging; and liver histology. It is justified to administer EPL together with other therapeutic measurements in the liver.

Conclusion: Pharmacological and clinical results confirm the efficacy of EPL in the treatment of FLD.

Keywords: dilinoleoylphosphatidylcholine; essential phospholipids; fatty liver disease; membrane.

Figures

Figure 1
Figure 1
1,2-Dilinoleoylphosphatidylcholine (DLPC), the main active ingredient in EPL. Abbreviation: EPL, essential phospholipids.

References

    1. Völzke H. Multicausality in fatty liver disease: is there a rationale to distinguish between alcoholic and non-alcoholic origin? World J Gastroenterol. 2012;18(27):3492–3501.
    1. Michelotti GA, Machado MV, Diehl AM. NAFLD, NASH and liver cancer. Nat Rev Gastroenterol Hepatol. 2013;10(11):656–665.
    1. Orman ES, Odena G, Bataller R. Alcoholic liver disease: patho genesis, management, and novel targets for liver therapy. J Gastroenterol Hepatol. 2013;28(Suppl 1):77–84.
    1. Verbeek J, Cassiman D, Lannoo M, et al. Treatment of non-alcoholic fatty liver disease: can we already face the epidemic? Acta Gastroenterol Belg. 2013;76(2):200–209.
    1. Kuntz E, Kuntz HD, editors. Hepatology. 3rd ed. Heidelberg: Springer; 2008. pp. 894–896.
    1. Gundermann KJ, Kuenker A, Kuntz E, Drozdzik M. Activity of essential phospholipids (EPL) from soybean in liver diseases. Pharmacol Rep. 2011;63(3):643–659.
    1. Oette K, Kühn G, Römer A, Niemann R, Gundermann KJ, Schumacher R. The absorption of dilinoleoyl-phosphatidylcholine after oral administration [Resorption von Dilinoleoyl-Phosphatidylcholin nach oraler Gabe] Drug Res. 1995;45(11):875–879. German.
    1. Lieber CS, Robins SJ, Li J, et al. Phosphatidylcholine protects against fibrosis and cirrhosis in the baboon. Gastroenterolgy. 1994;106(1):152–159.
    1. Watanabe A, Kobayashi M, Morishita N, Nagashima H. Multimodal treatment resulting in rapid improvement of fatty liver in obese patients. Curr Ther Res. 1988;43(2):239–246.
    1. Cairella M, Callisto F, Godi R, Marchini G. Polyunsaturated phosphatidylcholine combined with vitamin B complex in the treatment of patients with disorders of the hepatobiliary function caused by unbalanced nutrition [La fosfatidilcolina polinsatura associata a complesso vitaminico B nel trattamento del danni della funzione epato biliare da alimentazione squilibrata] Clin Ter. 1989;131(4):237–246. Italian.
    1. Koga S, Irisa T, Miyata Y, et al. Clinical progress of 51 fatty liver cases analyzed by liver function tests and ultrasonic screening and results of EPL administered cases. Prog Med. 1991;11(7):1891–1899. Japanese.
    1. Li JH, Chen XY, Zhong CF, Min J. A randomized controlled study of essential phospholipids (Essentiale capsules) in the treatment of fatty liver. Infect Dis Info. 2000;13(4):180–181. Chinese.
    1. Gonciarz Z, Besser P, Lelek E, Gundermann KJ, Johannes KJ. Randomised placebo-controlled double blind trial on “essential” phospholipids in the treatment of fatty liver associated with diabetes. Méd Chir Dig. 1988;17(1):61–65.
    1. Yin D, Kong L. Observation for curative effect of Essentiale in treatment of fatty liver caused by diabetes mellitus. Med J Q Ilu. 2000;15:277–278.
    1. Poongothai S, Karkuzhali K, Siva Prakash G, et al. Effect of essentiale in diabetic subjects with non-alcoholic fatty liver. Int J Diab Dev Ctries. 2005;25(1):12–19.
    1. Ohbayashi H, Fujimoto M, Yamase H, Ito M. Improvement of NASH with two-year treatment with oral polyenephosphatidylcholine. J Rural Med. 2007;1:67–73.
    1. Buyeverov AO, Yeshanu VS, Mayevskaya MV, Ivashkin VT. Application of essential phospholipids in complex therapy of steatohepatitis of the mixed origin. Klin Persp Gastroenterol Hepatol. 2008;1:17–22. Russian.
    1. Sun C, Zheng X, Tan Z, Cui F, Zhang R, Zhang H. Clinical observation on polyene phosphatidyl choline and metformin in the treatment of type 2 diabetes and non-alcoholic fatty liver disease. Clin Focus. 2008;23(17):1272–1273. Chinese.
    1. Sas E, Grinevich V, Efimov O, Shcherbina N. Beneficial influence of polyunsaturated phosphatidylcholine enhances functional liver condition and liver structure in patients with nonalcoholic steatohepatitis accompanied by diabetes type 2. Results of prolonged randomized blinded prospective clinical study [abstract] J Hepatol. 2013;58:S549.
    1. Ohbayashi H. Twelve-month chronic administration of polyenephos-phatidylcholine (EPL®) for improving hepatic function of fatty liver patients. Prog Med. 2004;24(7):1751–1756. Japanese.
    1. Ohbayashi H, Fujimoto M, Yoshida M, Ito M, Yamase H. The therapeutic effect of polyenephosphatidylcholine (EPL) on NASH. Liver Bile Pancreas. 2006;52(4):637–642. Japanese.
    1. Liang H. Treatment of fatty liver applying polyene phosphatidyl choline. Chin Med Factory Mine. 2006;19(3):207–208. Chinese.
    1. Fan X, Deng Y, Ye L, et al. Effect of Xuezhikang capsule on serum tumor necrosis factor- α and interleukin-6 in patients with nonalcoholic fatty liver disease and hyperlipidemia. Chin J Integr Med. 2010;16(2):119–123.
    1. Guo XL, Liang PX, Xu YQ. Comparison of efficacies of diammonium glycyrrhizinate and polyene phosphatidylcholine on nonalcoholic steatohepatitis. Chin J New Drugs. 2012;21(3):289–293. Chinese.
    1. Shen Z. Observation of efficacy in 100 patients with non-alcoholic fatty liver disease treated with Essentiale. Chin J Curr Clin Med. 2007;5(8):693–694. Chinese.
    1. Arvind N, Savaikar P, Rajkumar JS. Therapy for NAFLD – comparative study of essential phospholipids vs ursodeoxycholic acid. Ind J Clin Pract. 2006;16(10):21–24.
    1. Zhuang XS, Zhang ZJ. Study of ursodeoxycholic acid (UDCA) combined with polyene phosphatidylcholine in the treatment of non- alcoholic steatohepatitis. China Pract Med. 2009;4(10):11–12. Chinese.
    1. Zhou SY, Sun ZY. Therapeutic efficacy of polyunsaturated phosphatidylcholine on fatty liver disease. J Clin Hepatol. 2010;26(3):286–287. Chinese.
    1. Hu G, Liu K, Zhao L. Polyunsaturated phosphatidylcholine (Essentiale) for alcoholic/fatty liver: a systematic review. Liver. 2005;10(1):5–7. Chinese.
    1. Panos MZ, Polson R, Johnson R, Portmann B, Williams R. Polyunsaturated phosphatidyl choline for acute alcoholic hepatitis: a double-blind, randomized, placebo-controlled trial. Eur J Gastroenterol Hepatol. 1990;2(5):351–355.
    1. Lieber CS, Weiss DG, Grozmann R, Paronetto F, Schenker S, Veterans Affairs Cooperative Study 391 Group II. Veterans affairs cooperative study of polyenylphosphatidylcholine in alcoholic liver disease. Alcohol Clin Exp Res. 2003;27(11):1765–1772.
    1. Knüchel F. Double-blind study in patients with alcoholic fatty liver. The influence of “essential” phospholipids on enzyme behaviour and lipid composition of the serum [Doppelblindstudie bei Patienten mit alkoholtoxischer Fettleber. Der Einfluß von “essentiellen” Phospholipiden auf Enzymverhalten und Lipidzusammensetzung des Serums bei Patienten mit alkoholtoxischer Fettleber] Med Welt. 1979;30(11):411–416. German.
    1. Schüller Pérez A, Gonzáles San Martin F. Placebo-controlled study with polyunsaturated phosphatidylcholine in alcoholic steatosis of the liver. Med Welt. 1985;36(16):517–521.
    1. Lieber CS. New concepts of the pathogenesis of alcoholic liver disease lead to novel treatments. Curr Gastroenterol Rep. 2004;6(1):60–65.
    1. Sas E, Grinevich V, Kravchuk U, Efimov O. Polyunsaturated phosphatidylcholine reduces insulin resistance and hepatic fibrosis in patients with alcoholic liver disease: results of randomized blinded prospective clinical study [abstract] J Hepatol. 2011;54:S207.
    1. Gundermann KJ, Lehmacher W. The essential phospholipids as liver therapeutic – a meta-analysis of double-blind trials in chronic liver disease [Niezb dne fosfolipidy w leczeniu choró w troby – meta-analiza podwójnie lepych prób klinicznych w przewlekłych chorobach w troby] Gastroenterol Polska. 1998;5(6):553–559. Polish.
    1. Adams LA, Angulo P. Treatment of non-alcoholic fatty liver disease. Postgrad Med J. 2006;82(967):315–322.
    1. Ling J, Chaba T, Zhu LF, Jacobs RL, Vance DE. Hepatic ratio of phosphatidylcholine to phosphatidylethanolamine predicts survival after partial hepatectomy in mice. Hepatology. 2012;55(4):1094–1102.
    1. International Diabetes Federation [homepage on the Internet] The IDF Consensus Worldwide Definition of the Metabolic Syndrome. 2006. [Accessed March 15, 2016]. Available from:
    1. Klinger W, Gundermann KJ. (3-sn-phosphatidyl)choline in hyperlipoproteinemia [3-sn-Phosphatidyl)cholin bei Hyperlipoproteinämien] Dtsch Ärztebl. 1992;26(Suppl):24–25. German.
    1. Kirsten R, Heintz B, Nelson K, et al. Polyenylphosphatidylcholine improves the lipoprotein profile in diabetic patients. Int J Clin Pharmacol Ther. 1994;32(2):53–56.
    1. Okiyama W, Tanaka N, Nakajima T, et al. Polyenephosphatidylcholine prevents alcoholic liver disease in PPARα-null mice through attenuation of increases in oxidative stress. J Hepatol. 2009;50(6):1236–1246.
    1. Lieber CS, Weiss DG, Groszmann R, Paronetto F, Schenker S, Veterans Affairs Cooperative Study 391 Group I. Veterans Affairs Cooperative Study of polyenylphosphatidylcholine in alcoholic liver disease: effects on drinking behavior by nurse/physician teams. Alcohol Clin Exp Res. 2003;27(11):1757–1764.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit