EPL helps patients with liver damage
Evidence on use of essential phospholipids to treat liver disease
Patients with liver disease from various causes, such as alcoholism, obesity, exposure to toxic chemicals, and viral hepatitis, may benefit from the administration of polyenylphos-phatidylcholine (PPC) or essential phospholipids (EPL) in addition to usual therapy.
Speaking in a symposium organized by the Philippine Society of Gastroenterology and the Philippine Society of Digestive Endoscopy, Dr. Karl-Josef Gundermann of Poland's Pomeranian Medical Academy presented evidence supporting the use of EPL in patients with liver disease from various causes.
In particular, he talked about Essentiale or PPC, a phospholipid that is 40- to 52-percent dilinoleoyl (18:2-18:2) phosphatidylcholine (DLPC). DLPC is the molecule that differentiates the phosphatidylcholine in Essentiale from other phospholipids.
"When you look into the detailed composition of polyenylphos-phatidtylcholine in Essentiale, you will see that there is one single ingredient predominating quantitavely," said Gundermann. "This is called 1-2 dilinoleoyl PC or DLPC. In fact, that's not only quantitavely but qualitatively the main ingredient in Essentiale."
What EPL does
Phospholipids, the primary component of biological membranes, play an integral role in both structure and function. EPL is vital in the following functions:
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Cellular differentiation, proliferation, and regeneration
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Activity and activation of membrane-bound proteins such as enzymes (e.g. Na+-K+-ATPase, lipoprotein lipase) and receptors (e.g. insulin)
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Transport of molecules through membranes
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Membrane-dependent metabolic processes between the intracellular and intercellular space
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Erythrocyte and platelet aggregation
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Immunological reactions on the cellular level
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As donor of polyunsaturated fatty acids (precursors of eicosanoids) and phosphate (for ATP formation)
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As a source of second messengers in cell signaling (e.g. of diacylglycerol)
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As fat emulsifier in the gastrointestinal tract and the bile
Gunderman said evidence on the use of EPL comes from 209 clinical trials that have been conducted on the effects of PPC in various liver diseases.
Gundermann presented studies in which EPL:
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reduced fatty infiltration in fatty liver arising from obesity after three months;
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improved liverblood flow in workers exposed to xylene-toluene-benzene;
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reduced liver size and fatty infiltration, improved steatosis classification, and reduced caffeine clearance in patients exposed to potentially toxic chemicals such as phenols and cresols; and
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improved transaminase levels in patients with nonalcoholic steatohepatitis (NASH) that did not improve with administration of neominophagen C and UDCA4.
A systematic review by Hu G et al. of six randomized, double-blind trials involving EPL in the treatment of alcoholic liver disease and fatty-liver disease concluded that:
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One showed a trend in favor of EPL in decreasing mortality.
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Four showed a significant difference between EPL and placebo in terms of symptoms and biochemical variables.
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Three showed significant favorable effects on histology.
Gundermann said EPL acts in the fatty liver by decreasing cholesterol absorption and ACAT activity and increasing cholesterol excretion, HTGL and LPL activity, mitochondrial function, and lipid metabolism.
In patients with chronic viral hepatitis, studies showed EPL improved ALT, AP, procollagen-III-peptide and cholinesterase levels in patients with corresponding improvement in histology. There was also a highly favorable response to EPL versus control groups as revealed in a metaanalysis of nine double-blind trials.
Lower relapse rates were noted with EPL compared with placebo and there was clear synergism between antivirals and EPL, with coadministration resulting in significant decrease in AST and ALT levels and improvement of fibrosis not seen with antiviral treatment alone. When coadministered with a-interferon and continued for up to 24 weeks after a-interferon is stopped, EPL improved the rate and maintenance of the decrease in ALT levels.
There is also evidence that EPL is beneficial even for CVH patients for whom interferon therapy is contraindicated. Gundermann said EPL normalized levels of albumin bound hydroxyproline, indicating normal collagen synthesis, produced favorable histologic and electron microscopic features, increased the number of unchanged cells and the nuclear-cytoplasmic ratio, decreased the number of changed cells, and slowed down fatty degeneration in cells.
Said Gundermann: "We can definitely have some immunostimulator effect with EPL. But it is not an antiviral agent."
The lack of serious side effects allows patients to take Essentiale at recommended doses for prolonged periods of time, said Gundermann.
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