Amino Acid Profile in 18 Patients with Rheumatic Diseases Treated with Glucocorticoids and BCAAs

Abstract

The administration of glucocorticoids to patients with rheumatic diseases often results in glucocorticoid-induced myopathy. We previously found that administration of branched-chain amino acids (BCAA) to such patients improves the loss of skeletal muscle, however, their individual differences were often observed. The present study, therefore, aims to identify specific parameters associated with BCAA-induced increases in skeletal muscle mass. Eighteen patients with rheumatic diseases treated with prednisolone were randomly assigned to receive additional BCAAs for 12 wk. Serum biochemistry, plasma fibroblast growth factor (FGF) 19 and 21, and plasma and urinary amino acid concentrations were assessed. The relationship between these parameters and the cross-sectional area (CSA) of the biceps femoris (slow-twitch muscle) and rectus femoris (fast-twitch muscle) was assessed using computed tomography. BCAA supplementation increased serum levels of creatinine and albumin and decreased ammonia and urinary 3-methylhistidine levels. With or without BCAA supplementation, each plasma amino acid concentration decreased during the study period, but the decrease was lower in patients receiving BCAA. Interestingly, a positive correlation was observed between plasma isoleucine, aspartate, and glutamate concentrations and improvement in the biceps femoris muscle atrophy. Plasma amino acid concentrations in patients with rheumatic diseases treated with glucocorticoids decreased despite tapering the dose of glucocorticoids, with a smaller decrease in the BCAAtreated group. Plasma BCAA, aspartic acid, and glutamate concentrations correlated positively with the rate of improvement in biceps femoris muscle atrophy, suggesting that these amino acids are associated with the BCAA-induced increase in muscle mass.

A Review from a Clinical Perspective: Recent Advances in Biosensors for the Detection of L-Amino Acids

“…It was reported that the supplementation of BCAAs may reduce the muscle damage for patients with rheumatic diseases. It was demonstrated that plasma BCAAs, aspartic acid, and glutamate concentrations correlate positively with the rate of improvement in biceps femoris muscle atrophy, suggesting that these amino acids are associated with the BCAA-induced increase in muscle mass [24]. It was also demonstrated that, for patients treated in intensive care units, the supplementation of L-amino acids can protect skeletal muscle mass and function; for severely ill patients, a higher provision of protein and L-amino acids has been associated with a lower mortality [25].…”