Affiliations: Istituto di Medicina Interna e Geriatria, Università degli Studi di Siena, Italy
Note: [] Corresponding author: Dr Vera Turchetti, Istituto di Medicina Interna e Geriatria, Università degli Studi di Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy. Tel.: +39 0577 585355/233319; Fax: +39 0577 233318; E‐mail: images@unisi.it.
Abstract: Alterations of fluidity of the hepatocytic membrane and of the transport related systems are the basis of the cholesteatic syndrome and favour the tissue accumulation of cytotoxic metabolites. S‐Adenosyl‐L‐Methionine (SAM) is a natural molecule which acts as a giver of methylic groups and as an enzymatic activator in several enzymatic actions of transmethylase and of transulphuration and plays a key role in biochemical processes of hepatic cell. The aim of our study was to evaluate the effects of SAM on the restoration of the membrane fluidity and on the hepatic function in general. In studying the fluidity of the cell membrane we evaluated some hemorheological parameters (total blood viscosity and red cell morphology). Fluidity of the red cell membrane is one of the most important elements of red cell rheology. We studied 15 patients (Group A) suffering from micro‐ and macro‐nodular cirrhosis verified through hepatic biopsy, with alcoholic or post‐viral causes. We evaluated the values of: blood viscosity (with a cone‐plate rheometer by Carri‐med), haematocrit, plasma fibrinogen and the erythrocytic morphology at the optical microscope with the Zipursky–Forconi method before and after 7 days of therapy with SAM iv. Data were compared with those of a similar group (Group B) treated with traditional therapy only (hyposodic and hypoprotein diet supplemented with multivitamin preparations, vitamin K in particular, if necessary, and potassium sparing diuretics). We also measured biliary salts, alkaline phosphatase, transaminase and gamma‐GT. In the first group we observed a statistically significant reduction of blood viscosity, haematocrit didn’t change significantly; biliary salts reduced in a statistically significant way. Evaluation of red cell morphology showed in all cases a pathological percentage (>15%) of echinocytes and knizocytes which reduced to a mean of 5% after SAM therapy. We observed no further modifications of the other hemorheological parameters. Results demonstrate that SAM has a positive action on the fluidity of the membrane, as indicated by the improvement of haemorheological parameters and by the significant decrease of biliary salts, indicating the presence of cholesteasis.
